Risk factors of neurologic complications after surgical resection of carotid body tumor / 中华普通外科杂志

Objective:To investigate risk factors of nerve injury after carotid body tumor resection.Methods:From 1991 to 2016, the clinical data of patients with neurologic complications after resection of carotid body tumor was retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors of nerve injury.Results:A total of 132 patients with 142 tumors underwent surgery. 45 patients (46 sides) suffered nerve injury, including 4 strokes and 44 nerve injuries. After active rehabilitation, 18 cases were left with permanent nerve injury, and the 4 patients with strokes regained self-care ability. By multivariate regression analysis, high-lying tumors ( OR=4.345, P=0.005), Shamblin Ⅲ tumor ( OR=4.382, P=0.047) increase the risks of postoperative nerve injury. Resection of high-lying tumors carried a higher risk of developing permanent nerve injury ( OR=7.290, P=0.001). Conclusions:Neurologic complication could be alleviated by rehabilitation. Intraoperative abrupt rupture of carotid artery is the leading cause of stroke. Shamblin Ⅲ and high-lying tumor are the predictors of postoperative nerve injury.

Progress in endovascular treatment for juxtarenal abdominal aortic aneurysm / 国际外科学杂志

Endovascular aortic aneurysm repair has become the preferred treatment for most patients with infrarenal abdominal aortic aneurysm. However, for juxtarenal abdominal aortic aneurysm with a short-neck, visceral branch reconstruction is required, and the conventional endovascular aortic aneurysm repair effect is not satisfactory. In recent years, the application of innovative techniques such as chimney technique, fenestration technique, branch technique and octopus technique have provided a variety of solutions for the endovascular treatment of patients with juxtarenal abdominal aortic aneurysms. This article reviews and summarizes the current progress of endovascular treatment in order to analyze and reflect on the application difficulties of various techniques.

Strategy of surgical management on abdominal aortic aneurysm combined with gastrointestinal malignancy / 中华消化外科杂志

The incidence of concomitant abdominal aortic aneurysm (AAA) combined with gastrointestinal malignancy is rare,but it still represents an issue of controversy regarding the optimal treatment.It is unclear whether to treat the AAA and gastrointestinal malignancy simultaneously or in a staged manner as both options offer advantages but also carry some substantial risks.This study attempts a historical review of the surgical practice during the past decades by reviewing the existing literatures on this topic.In general,the most symptomatic lesion or the most life threatening condition should be treated firstly.Large aneurysm should usually be resected in preference to gastrointestinal malignancy unless the tumor is locally advanced,perforated or likely to result in intestinal obstruction.If both lesions are complicated there may be a case for simultaneous treatment.The evolution of vascular stents and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating high risk patients.If the anatomical criteria are satisfied,EVAR combined with laparoscopic operation could become the optimal solution for the concomitant AAA and gastrointestinal malignancy patients,especially those who require minimally invasive treatment.

Hybrid treatment of aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair.</p><p><b>METHODS</b>From January 2002 to June 2013, 10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital, Sun Yat-sen University. There were 9 male and 1 female patients with a mean age of (54 ± 14) years (ranging from 34 to 71 years). Of the 10 patients, 8 were aortic dissection and 2 were thoracic aortic aneurysm. All aortic arch debranching was performed with mid-sternotomy, including 7 ascending aorta to innominate artery and left common carotid artery bypass, and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently, simultaneous (n = 5) and staged (n = 5, mean interval (7 ± 4) days) endovascular repair were performed via femoral artery.</p><p><b>RESULTS</b>Technical success rate was 10/10. The 30 day-mortality was 3/10, including 1 brain stem infarction, 1 circulatory failure and 1 aorto-tracheal fistula. Complication included 1 type II endoleak. The median time of follow-up was 24 (14) months. CT scanning was performed at 1, 3 months and annually thereafter. There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type II endoleak.</p><p><b>CONCLUSION</b>Ascending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement.</p>

Outcomes of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.</p><p><b>METHODS</b>It was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.</p><p><b>RESULTS</b>Technical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.</p><p><b>CONCLUSIONS</b>Endovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.</p>

Preliminary fabrication of tissue engineered veins containing valves using bone marrow mesenchymal stem cells and biodegradable scaffolds in vitro / 中国组织工程研究

BACKGROUND:Chronic venous insufficiency is a major health problem worldwide. Clinical treatments include venous valve repair and venous segment containing valve transplantation. However, these are invasive procedures, and the supply of vein containing valves is limited. Significant progress in the fields of tissue engineering and regenerative medicine has been made towards the creation of tissue engineered vascular grafts for the repair of damaged or malformed vessels. It has been reported that using tissue engineering, a tissue engineered vein containing valves constructed with self-derived endothelial cells and al ogeneic acellular matrices can provide the complex physiological valve structure and mechanical stability, but this elicited an immunogenic response. OBJECTIVE:To create a viable and functional vein containing valves, which has the ability to grow, repair, and imitate natural tissues. METHODS:Bone marrow mesenchymal stem cells were obtained from Beagle dogs by density gradient centrifugation and adherence methods. Bone marrow mesenchymal stem cells were cultured in vitro. Fol owing isolation and culture the cells were examined using flow cytometry and identified by direct induction towards the osteogenic and adipogenic lineages. We fabricated biodegradable venous scaffold containing valves using the method of injection molding combined with thermal y induced phase separation. Based on the self-made cast, a three-dimensional biodegradable vein scaffold containing valves was constructed from poly(lactic-co-glycolic acid). Morphological structure was tested. Bone marrow mesenchymal stem cells were used as seed cells to be seeded onto the lumen of the tissue engineered vein scaffold containing valves in vitro and then incubated for 2 weeks. RESULTS AND CONCLUSION:Scanning electron microscopy images showed that the scaffold demonstrated sufficient porosity. Cultured cells expressed mesenchymal cellmarkers, CD44 and CD29, but did not express hematopoietic cellmarkers, CD34 and CD45 at the same time point. Scaffolds were nontoxic to cells and were favorable for the growth and migration of bone marrow mesenchymal stem cells. cells attached on the surface of poly(lactic-co-glycolic acid) scaffolds formed a confluent layer after incubation. The cellular constructs were tested in vitro, and the valve leaflets were functional y capable of opening and closing when stimulated. These results suggested that the tissue engineered vein containing valves have been successful y constructed by using a three-dimensional poly(lactic-co-glycolic acid) scaffold and bone marrow mesenchymal stem cells as seed cells. Tissue engineered vein containing valves is potential y useful for the substitution and regeneration of vein valves.

Concomitant Graves' disease and primary hyperparathyroidism: the first case report in mainland of China and literature review / 中华医学杂志(英文版)

Concurrent Graves' disease and primary hyperparathyroidism in the same patient is rare, probably accounts for hypercalcemia in no more than 1 percent of thyrotoxic patients. Hypercalcemia may be noted during the course of hyperthyroidism in as many as 22 percent of cases. The cause of hypercalcemia in a thyrotoxic patient might be due to the activation of osteoclastic bone resorption by the excess thyroid hormone, as the severity of hyperthyroidism correlates positively with osteoclastic activity in trabecular and cortical bone. In 1936, Noble JF et al reported the first case in the world. To our knowledge, only 49 such cases have been described in the literature until the year of 1989. No case has been reported again afterward. The occurrence of hypercalcemia in a patient with hyperthyroidism may present a challenging diagnostic problem. In this communication, we described the first case in mainland of China with hypercalcemia caused by concurrent hyperthyroidism and primary hyperparathyroidism, and the clinical and laboratory characteristics were studied before and after therapy with anti-thyroid medication.

Clinical analysis of colon ischemia complicating with operated abdominal aortic aneurysm / 中华外科杂志

OBJECTIVE To investigate the etiology, prevention and treatment of colon ischemia after operation for abdominal aortic aneurysm (AAA). METHOD Seven of 140 cases complicated with colon ischemia who had received AAA operation were analyzed retrospectively. RESULTS Three cases underwent emergency operation. The seven cases were subjected to removal of AAA, implantation of prosthesis, and ligation of the inferior mesenteric artery. Two cases had the ligation of the bilateral internal iliac artery (IIA). Epilateral IIA was ligated in 2 cases. Bowel resection was carried out in 3 cases, 1 of which received reconstruction of the inferior mesenteric artery (IMA). Three cases received conservative therapy, but died from multiply organ failure. CONCLUSION Correct prevention and management of colon ischemia can effectively reduce the operative morbidity of AAA patients.

Screening and cloning of genes related to varicose great saphenous vein accompanying with primary deep vein valve insufficiency / 中华外科杂志

<p><b>OBJECTIVE</b>To screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency.</p><p><b>METHODS</b>Using mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins.</p><p><b>RESULTS</b>Altogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene).</p><p><b>CONCLUSION</b>C(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.</p>

Hemodynamic changes after external valvuloplasty of the superficial femoral vein / 中国普通外科杂志

ObjectiveTo analyze the effect of external valvuloplasty of the superficial femoral vein for primary deep venous valvular incompetence in the lower limbs (PDVI). Methods Consecutive seventy four cases(96 limbs) of PDVI were enrolled for prospective study, and color Doppler velocity profile technology and APG were performed preoperatively, the first month, the third month and the first year postoperatively. Results Postoperative venous reflux volume, VFI and score of venous dysfunction significantly decreased ( P

Diagnosis and treatment of acute occlusion of abdominal aorta / 中国普通外科杂志

Objective To study the etiology, diagnosis and treatment of acute occlusion of abdominal aorta(AOAA). Methods Clinical data of 35 patients with AOAA admitted to our hospital from January 1980 to August 2001 were analyzed retrospectively. Results There were 17 patients with acute aortic embolism(AAE) and 18 patients with acute aortic thrombosis(AAT) . All cases had total occlusion of abdominal aorta,and bilateral iliac arteries were involved. All the 35 cases underwent operations, including bilateral transfemoral thromboembolectomy by Fogarty balloon catheter in 18 cases, thromboembolectomy via laparotomy aortotomy in 11 cases, aortobiiliac reconstruction in 2 cases, aortobifemoral bypass in 2 ( 1 had profundaplasty) and axillobifemoral bypass in other 2 cases. Operative mortality was 25.7%(9/35). After the operations, artery embolism recurred in 3 cases; 3 patients required amputation; renal failure occurred in 3 cases and paraplegia in 4; ischemic colitis occurred in 5, impaired sexuality in 1 and incomplete intestinal obstruction in 1. Conclusions AOAA is an urgent disease with high mortality. Fast preoperative diagnosis and prompt operation are the keys to salvage the patient. Color Doppler is the first choice of diagnosis. Fogarty balloon catheter thromboembolectomy and vascular reconstruction are effective treatments for this disease.

Subfascial endoscopic perforator surgery for severe chronic venous insufficiency of the lower extremities / 中国普通外科杂志

Objective To sum up clinical experience on subfascial endoscopic perforator surgery (SEPS) for the treatment of severe chronic venous insufficiency (CVI) of the lower extremities. Methods Fifty-one patients (64 limbs) with severe CVI received SEPS from Nov. 1999 to Aug.2002. CEAP classification, scoring of venous dysfunction (SVD), Color Doppler, Color Doppler velocity profile (CDVP), venography and air plethysmography (APG) were applied to assess the status of the affected limbs before and after operation. Results The postoperative follow-up was made from 3 to 35 months with the follow-up rate of 90.6% (58/64 limbs). No limbs suffered from recurrent superficial varicose. Venous ulcer was healed in 40 limbs (97.6%) and the ulcer ameliorated significantly in one limb. Ulcer healing time ranged from 9 to 91 days with the average time of (32?5) days. The average SVD was (13.9?1.7) preoperatively , while (6.4?0.8)postoperatively ( P

Air plethysmography in diagnosing deep venous valvular insufficiency of lower limbs / 中国普通外科杂志

Objective To study the diagnostic value of air plethysmography (APG) in deep venous valvular incompetence of lower limbs and the relationship between deep venous reflux and calf muscular pump function. Methods Sixty-five varicose cases (89 limbs) were detected by APG in alterations of venous filling index (VFI), ejection fraction(EF), residual volume fraction(RVF) and outflow fraction(OF). Of 89 limbs, 18 limbs were in GradeⅠ of deep venous reflux, 24 in Grade Ⅱ, 18 in Grade Ⅲ and 12 in Grade Ⅳ. Integrated vectors analysis (Hotelling T 2test) was done with these index. Venography was performed in all patients. Results There were statistical differences in VFI between each two Grades of deep venous reflux except for between Grade Ⅰ and Ⅱ. There were also statistical differences in EF,RVF and OF between Grade Ⅳ and the other Grades. Hotelling T 2test showed significant testing efficiency of APG. ConclusionsDeep venous valvular insufficiency of lower limbs can be assessed by APG. VFI is a reliable quantitative index for evaluating the degree of deep venous reflux. There may be an exponent relation between deep venous reflux and calf muscular pump function.

Microvessel density of follicular thyroid tumors and its clinical implications / 中国普通外科杂志

Objective To investigate the relationship between microvessel density (MVD) and the clinical features of thyroid follicular tumors. MethodsThe immunohistochemical staining was used to determine MVD in 40 cases of follicular thyroid carcinoma (FTC) and 20 cases of follicular adenoma (FA). Results MVD of FTC(228?91)was significantly higher than that of FA (156?73, t =2 763, P

Microcarcinoma of the thyroid: clinically missed diagnosis and management / 中国普通外科杂志

ObjectiveTo investigate the cause of clinically missed diagnosis of thyroid microcarcinoma(TMC) and the management. Methods Clinical diagnostic and therapeutic data of 110 cases with TMC operated and confirmed by pathology from Jan. 1985 to Dec. 2000 were analysed. Results Diagnostic positive rates by ultrasonography and freezing section were respectively 58%(15/26) and 66 7%(14/21) in 26 cases diagnosed preoperatively. Diagnostic positive rate of freezing section was 80%(24/30) in 30 cases discovered intraoperatively. Through postoperative pathologic exam,54 cases were confirmed as TMC that was not discovered in 19 cases by intraoperative freezing section.Total or near total thyroidectomy was only performed on 35 cases,lobectomy of one or both lobes on other cases. Follow up rate was 80 1% with time ranging from 6 months to 15 years. One case recurred without mortality.Conclusion The clinical diagnosis of TMC is often difficult to establish. Careful palpation, ultrasonography with fine needle aspiratiou cytology before operation, and thorough exploration of the suspected nodules in operation will help to heighten the diagnostic rate. Total or near total lobectomy fulfils the eradication of TMC.

Comprehensive surgical management in primary venous reflux disease of lower extremity / 中国实用外科杂志

ObjectiveTo evaluate the effect of the comprehensive surgical management of primary venous reflux disease in lower extremity. MethodsComprehensive surgical management was performed on 108 patients( 126 limbs) with primary venous reflux disease between February, 1996 and Sept, 2000. All limbs were performed with superficial venous operation. External valvuloplasty of femoral vein valve was given to 83 cases(97 limbs) simultaneously, and to 22 cases (26 limbs) with concomitant subfascial endoscopic perforator surgery(SEPS). 3 cases (3 limbs) were operated with concomitant SEPS only. ResultsVenous claudication,swelling, and aching disappeared in 80.2% of limbs( 101/126) and apparent improvement in 19.8 % of limbs(25/126). All varicose veins were gone. Ulcer healing pre sented in 80 % of the limbs(8/10) with ulcers and ulcer decreasing in 20% of the limbs(2/10) in 3～6 months after superficial and deep venous operations. Ulcer healing presented in 23 cases(26 limbs) with ulcers and ulcer decreasing in remaining 2 limbs in 14 to 32 days after additional SEPS besides superficial and or deep venous operations. Deep venous valve sufficiency was demonstrated in 89.7% (113/126) of the limbs by Color Duplex. ConclusionIn the patients with severe primary venous reflux disease,comprehensive surgical management with concomitant superficial, deep and perforating veins might greatly improve the clinical effect.

The clinical study of prevalence,prevention and treatment of hypophosphatemia in postoperative patients of general surgery / 中国实用外科杂志

Objective　In order to explore the prevalence of hypophosphatemia in postoperative patients of general surgery,as well as the time and dosage of phosphate replacement and its effects.Methods　To serum phosphate levels of 45 patients with phosphate replacement begun on the second postoperative day and 45 without replacement were monitored at the preoperative day,and the first,third,fifth and seventh postoperative day.Results　The incidence of hypophosphatemia was 91.1%(41/45) in cases without phosphate replacement.While it was 57.8%(26/45) in those with replacement.The serum phosphate concentrations in cases with phosphate replacement were higher than those without replacement on the third(P<0.001),fifth(P<0.05) and seventh(P<0.01) postoperative day.The Apache Ⅱ scores in cases with phosphate replacement decreased on the third postoperative days compared with those on the first day(P<0.001).Conclusion　The postoperative replacement of phosplates can avert the occurrence of hypophosphatemia and improve the Apache Ⅱ score.

Down-regulation of desmuslin in primary vein incompetence / 中国病理生理杂志

AIM: Utilizing mRNA fluorescent differential display RT-PCR in our previous study,we found that the mRNA expression level of an intermediate protein(IF)-desmuslin was dramatically down-regulated in the abnormal veins of patients with primary vein incompetence.In this study,we testified the alteration of desmuslin expressing style at gene transcription and translation levels.METHODS: Specific PCR primers were designed according to the sequence of desmuslin mRNA.The cDNA fragments of desmuslin obtained from differential display were labeled by DIG as specific probes.Then semi-quantitative RT-PCR and Northern blotting techniques were applied to investigate the expression level of desmuslin mRNA in normal and abnormal veins.Simultaneously,the specific single-cloned antibody bestowed by Yuji Mizuno was used to evaluate the amount of DMN protein in the two groups by Western blotting and immunohistochemical techniques.RESULTS: In the abnormal veins isolated from the patients with primary vein incompetence,the expression of desmuslin mRNA was significantly down-regulated,compared with that in control group(semi-quantitative RT-PCR: 0.19?0.05 vs 0.83?0.08,P

Venohemodynamics after superficial vein and calf perforating vein surgery / 中国普通外科杂志

Objective To assess the role of superficial vein and calf perforating vein in chronic venous insufficiency of lower limbs. Methods Consecutive seventy-five cases (78 limbs) of slight PDVI ( I? -Ⅱ?) were evaluated. Venous hemodynamics were detected by color duplex, color Doppler velocity profile technology and APG preoperatively, in the first month, the third month and the first year postoperatively. Data were statistically analyzed. Results Symptoms and signs disappeared in 88. 5% (69/78) limbs. The ulcer-healing rate was 92. 8% ( 13/14). The postoperative VFI at each check-point significantly decreased than that before operation (P0.01). Conclusions Superficial venous reflux can be effectively broken up by the operations. Venous stasis on calf effectively decreased by subfascial endoscopic perforator surgery (SEPS). But neither of the two procedures greatly improve the hemodynamic status of deep vein.

The relevant factors of hypophosphatemia in postoperative patients of general surgery / 中国现代普通外科进展

Objective:To study the correlative clinical factors that causing hypophosphatemia in postoperative patients of general surgery.Methods:Serum phosphate levels of 101 patients of general surgery were monitored at the preoperative day,and the first,forth and seventh postoperative day.Influence factors of the serum phosphate levels were analysed.Results:The serum phosphate levels in patients elder than 55 years were lower than those younger than 55 years on the first and forth postoperative day(P