Management of peripheral artery rupture: clinical analysis of 4 cases / 中华全科医师杂志

The clinical data of 4 patients with peripheral vascular rupture admitted in the Hetian Regional People′s Hospital from March 2012 to October 2017 were retrospectively analyzed. The 4 patients were all males, aged 17-59 years. Among them, 2 cases caused by firearm injury, 1 case was caused by a car accident and 1 case was caused by a sharp injury; 2 cases were incompletely ruptured in femoral artery, 1 case was completely ruptured in popliteal artery, and 1 case was completely ruptured in axillary artery. All patients underwent successful reconstructive surgical procedures, and the skin temperature, skin color, and arterial pulse of the affected limb returned to normal after operation. The followed-up time was 28-95 months, with an average of 47.8 months. Blood flow in the reconstructed vessel was unobstructed. There were no complications. It is indicates that for peripheral vascular rupture if the diagnose and treatment are timely, the satisfactory results can be achieved.

Endovascular treatment of innominate artery stenosis or occlusion / 中国医师杂志

Objective:To explore the method and effect of endovascular treatment to innominate artery stenosis or occlusion.Methods:The data of 11 patients with stenosis or occlusion of innominate artery from January 2014 to November 2019 at Xuanwu Hospital of Capital Medical University were collected. All patients received endovascular treatment. We summarized the changes of clinical symptoms, surgical methods, perioperative complications, stent patency, and analyzed the changes in systolic blood pressure and peak blood flow velocity on the involving side.Results:All 11 patients underwent endovascular treatment. The surgical technique success rate was 100%. All patients were followed up. The follow-up time was 4-69 months, with an average of (30.1±23.4)months. 2 patients used cerebral umbrella during the operation. 1 patient was performed ipsilateral carotid endarterectomy, 1 patient underwent contralateral carotid stent implantation, 1 patient was diagnosed as severe stenosis of the innominate artery and left common carotid artery, and an innominate artery stent implantation was performed at one stage, left common carotid artery stent implantation was performed after half a year. We done operation from the femoral artery puncture approach (6 patients), brachial artery puncture approach (2 patients), axillary artery and femoral artery puncture approach (1 patients), and right common carotid artery and the femoral artery puncture approach (2 patients). 3 patients had in-stent restenosis at 6, 7and 12 months after stenting, respectively. 1 patient underwent balloon dilatation, and 2 patients underwent re-stent implantation. We have not do further intervention to 1 case of in-stent occlusion occurred 14 months after the stenting, for the clinical symptoms did not improve significantly. The clinical re-intervention rate in this group was 3/11, and the primary patency rate was 7/11. The secondary patency rate was 10/11. The symptoms of 10 patients were relieved and the weakness of right upper extremity was not significantly changed in 1 patient. No puncture point complications occurred in all patients, and no cerebral infarction occurred during the perioperative period. There were statistically significant differences in systolic blood pressure, blood pressure difference and peak blood flow velocity before and after the operation ( P<0.05). Conclusions:Endovascular treatment of innominate arterial stenosis or occlusion was safe and effective, and the appropriate surgical approach and plan should be selected according to the lesion characteristics and the whole body conditions.

Endovascular treatment to cerebral infarction combined with right aortic arch and Kommerell 's diverticulum: case report / 中国医师杂志

Objective@#To investigate the effect of endovascular treatment of cerebral infarction with right aortic arch and Kommerell's diverticulum.@*Methods@#Retrospective analysis was done to assess the treatment effect of a case from vascular surgery, Xuanwu Hospital of Capital Medical University. This case was diagnosed as cerebral infarction with right aortic arch and Kommerell's diverticulum.@*Results@#One month after the treatment of cerebral infarction, we successfully used the thoracic aortic stent to isolate the Kommerell's diverticulum. There were no operative complications occurred. The stent had good shape and smooth blood flow was seen in the stent.@*Conclusions@#Endovascular treatment to cerebral infarction with right aortic arch and Kommerell's diverticulum is safe and feasible, and the clinical outcome requires further long-term follow-up.

Warfarin individualized medication in the treatment of first acute deep venous thrombosis of lower extremity / 中国医师杂志

Objective@#To study the effect of warfarin individualized drug regimen based on gene detection on anticoagulation in patients with acute deep vein thrombosis (DVT).@*Methods@#From January 2016 to June 2017, 62 patients with DVT diagnosed for the first time in vascular surgery of the Affiliated Hospital of Jining Medical College were analyzed retrospectively, including 33 in the individualized group and 29 in the experience group. All patients were diagnosed by Color Doppler Ultrasound (CDUS). Gender, age, the results of the initial international standardized ratio (INR) measurement, the time from the first dose to the INR standard, and whether the INR exceeds the standard in the process of increasing the dose were collected.@*Results@#There was no significant difference in sex, age and initial INR between the two groups (P>0.05). The time of reaching the standard in the individualized group was significantly lower than that in the experience group [(13.8±6.8)d vs (17.6±7.5)d, P<0.05]; There was no significant difference in INR between the two groups (P=0.377).@*Conclusions@#For the patients with DVT for the first time, the individualized drug regimen of warfarin based on the guidance of gene detection can shorten the time of reaching the standard without increasing the risk of bleeding.

Endovascular treatment to cerebral infarction combined with right aortic arch and Kommerell's diverticulum: case report / 中国医师杂志

Objective To investigate the effect of endovascular treatment of cerebral infarction with right aortic arch and Kommerell's diverticulum.Methods Retrospective analysis was done to assess the treatment effect of a case from vascular surgery,Xuanwu Hospital of Capital Medical University.This case was diagnosed as cerebral infarction with right aortic arch and Kommerell's diverticulum.Results One month after the treatment of cerebral infarction,we successfully used the thoracic aortic stent to isolate the Kommerell's diverticulum.There were no operative complications occurred.The stent had good shape and smooth blood flow was seen in the stent.Conclusions Endovascular treatment to cerebral infarction with right aortic arch and Kommerell's diverticulum is safe and feasible,and the clinical outcome requires further long-term follow-up.

Warfarin individualized medication in the treatment of first acute deep venous thrombosis of lower extremity / 中国医师杂志

Objective To study the effect of warfarin individualized drug regimen based on gene detection on anticoagulation in patients with acute deep vein thrombosis (DVT).Methods From January 2016 to June 2017,62 patients with DVT diagnosed for the first time in vascular surgery of the Affiliated Hospital of Jining Medical College were analyzed retrospectively,including 33 in the individualized group and 29 in the experience group.All patients were diagnosed by Color Doppler Ultrasound (CDUS).Gender,age,the results of the initial international standardized ratio (INR) measurement,the time from the first dose to the INR standard,and whether the INR exceeds the standard in the process of increasing the dose were collected.Results There was no significant difference in sex,age and initial INR between the two groups (P ＞ 0.05).The time of reaching the standard in the individualized group was significantly lower than that in the experience group [(13.8 ± 6.8) d vs (17.6 ± 7.5) d,P ＜ 0.05];There was no significant difference in INR between the two groups (P ± 0.377).Conclusions For the patients with DVT for the first time,the individualized drug regimen of warfarin based on the guidance of gene detection can shorten the time of reaching the standard without increasing the risk of bleeding.

Percutaneous endovascular aorta repair under local anesthesia with no use of any contrast agent for abdominal aortic aneurysm: initial experience in one patient / 介入放射学杂志

Objective To evaluate the feasibility of endovascular aortic repair (EVAR) under local anesthesia without using any contrast agent for abdominal aortic aneurysm in patients with high allergic risk to contrast agent.Methods Under local anesthesia and with no use of any contrast,percutaneous EVAR was performed in a patient with abdominal aortic aneurysm who carried high allergic risk to contrast agent.Results Percutaneous EVAR was successfully accomplished.Postoperative follow-up MRI examination showed that the abdominal aortic aneurysm was completely isolated with no endoleak.The blood flow was unobstructed in the covered stent,and bilateral renal arteries were well visualized.Conclusion For the treatment of abdominal aortic aneurysm in patients who are highly allergic to contrast agent and who have contraindications to general anesthesia,percutaneous EVAR performed under local anesthesia and using no contrast agent is safe and effective.Strict observation of indications and sufficient preoperative evaluation of clinical conditions is the key to ensure a successful operation.

Values of high resolution manometry in the diagnosis of hiatal hernia / 中华普通外科杂志

Objective To evaluate high resolution manometry in the diagnosis of hiatal hernia.Methods Clinical data were reviewed on 20 patients suffering from gastroesophageal reflux who had laparoscopic Toupet fundoplication for preoperative tentative diagnosis of hiatal hernia.Preoperative diagnosis of hiatal hernia was made collectively by endoscopy,X-ray examination,24 hour esophageal pH monitoring and high resolution manometry before surgery.Results Preoperative diagnosis of hiatal hernia was made in 3 patients by X-ray examination,in 9 patients by high resolution manometry.11 patients were finally diagnosed with hiatat hernia intraoperatively.X ray was consistent with intraoperative diagnosis in 27％ cases.Intraoperative and endoscopic diagnoses were 55％.High resolution manometry and intraoperative diagnoses were consistent in 82％.Lower esophageal sphincter length was (1.92 ± 0.38) cm in hiatal hernia group and (2.10 ± 0.92) cm in non-hiatal hernia group (t =0.60,P ＞ 0.05),lower esophageal sphincter pressure (respiratory min) was (0.64 ±0.55) kPa in hiatal hernia group and (1.31 ± 1.07) kPa in nonhiatal hernia group(t =1.80,P ＞ 0.05),and lower esophageal sphincter pressure (respiratory mean) was (1.43 ±0.92) kPa in hiatal hernia group and (2.57 ± 1.33) kPa in non-hiatal hernia group(t =2.26,P ＜0.05).The reflux parameters,including the percent total time pH ＜ 4,and DeMeester score,were significantly greater in hiatal hernia group than in non-hiatal hernia group (all P ＜ 0.05).Conclusions Hiatal hernia patients are with poor esophageal antireflux competency and severe reflux.High resolution manometry is more valuable in the diagnosis of hiatal hernia than endoscopy or X-ray examination.

Analysis on the award-winning of scientific and technological achievements of Nanjing Military Command health system for 20 years / 中华医学科研管理杂志

Use of the existing data to analyse the situation for Military progress prizes in science and technology,medical achievement prizes,Army logistics major science and technology achievement award of Nanjing Military Commands health system from the eighth five-year plan period to the eleventh five-year plan.It shows that the medical research is overall increase during the ninth five-year plan period and downturn during the tenth five-year plan period,then the lever picks up again during the eleventh five-year plan period.This suggests that the improve the quality and quantity of the achievement in science and technology is effected by subject scale and scientific research innovation factors.Then put forward some countermeasures and suggestions for guiding the project direction of subject research,expanding the scale of subject,introducing high quality talents actively,using the incentive mechanism to strengthen the innovation of science and technology and expressing the special advantage to speed up the transformation of scientific and technological achievements.