Clinical analysis of vascular anomalies: a hospital-based retrospective study of 592 patients in southeast China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.</p><p><b>METHODS</b>A total of 592 vascular anomalies patients (patients with intracranial tissues or viscera involved were excluded), admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.</p><p><b>RESULTS</b>Of the 592 patients, the male:female ratios in the vascular tumor group (n = 187) and the vascular malformation group (n = 405) were 1:1.49 and 1:1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group (p < 0.001). The head and neck were the most commonly (31.4%) involved areas in vascular anomalies. A total of 23.8% of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1% of them were infantile hemangiomas. Venous malformation was the most common (41.0%) subtype of vascular malformations. Surgical therapy was undertaken in 94.2% of the patients with vascular anomalies. Of the 519 patients available for the 16 - 58 month follow-up, 322 patients (62.0%) were cured, 108 patients (20.8%) were markedly improved, 57 patients (11.0%) were partially improved, and 32 patients (6.2%) were uncured.</p><p><b>CONCLUSIONS</b>Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.</p>

Endovascular repair of abdominal aortic aneurysm: a clinical report of 81 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages.</p><p><b>METHODS</b>The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups.</p><p><b>RESULTS</b>All covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups.</p><p><b>CONCLUSIONS</b>EVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.</p>

Effect of external vavuloplasty of deep vein in the treatment of chronic venous insufficiency of lower extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To verify the role and effect of external vavuloplasty in the treatment of chronic venous insufficiency (CVI) of lower extremity.</p><p><b>METHODS</b>Thirty patients with CVI of bilateral lower extremities were enrolled to accept surgical management of vein systems. Both limbs of each patient were randomized into two groups respectively according to the operating style. One limb was given external vavuloplasty of the superficial femoral vein and surgery of superficial venous system (group A), the another limb was only given the surgery of superficial venous system (group B). The effect comparison between both limbs of each patient and two groups by color duplex scanning, color doppler velocity profile (CDVP), air plethysmography and CEAP score system one month and 3 years after operation.</p><p><b>RESULTS</b>All 60 limbs of 30 cases were CEAP C(2)-C(4) with degree III reflux (Kistner's method) in the deep veins confirmed by color duplex scanning and venography. In 1 month and 3 years after surgery, all the indexes of the limb in the group A were dramatically improved compared with those of the limbs in the group B. The average value of venous reflux degree, reflux volume, and venous filling index (VFI) had significant difference between the two groups (P < 0.001). In 3 years after surgery, there was significant difference between the two groups on ejective fraction (EF)and residual volume fraction (RVF) (P < 0.05) and CEAP clinical score (P < 0.001).</p><p><b>CONCLUSION</b>External vavuloplasty of deep vein may reduce the reflux volume of the affected deep vein and improve the valve function, and can result in better outcomes when combined with surgery of the superficial venous system.</p>

Clinical analysis of medullary carcinoma of the breast / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical manifestation, management and outcome in patients with medullary carcinoma of the breast (MBC).</p><p><b>METHODS</b>Retrospective analysis was carried out on patients with MBC who were admitted from January 1995 to December 1999.</p><p><b>RESULTS</b>A total of 616 female patients treated for breast carcinoma, 26 cases (4.2%) were histopathologically confirmed MBC. The mean age was (45.8 +/- 10.6) years. The tumor size was among 1-5 cm and axillary lymph node involvement was 23.1%; there was no statistically significant correlation between tumor size and metastatic axillary lymph node. Estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu assay were performed immunohistochemically, and the overexpression was 26.3%, 21.1% and 5.3% respectively. All patients underwent operation and polychemotherapy (5-fluorouracil, methotrexate, cyclophosphamide), hormone therapy with Tamoxifen was applied in five patients, and three cases received postoperative irradiation. The follow-up period ranged from 5 to 9 years. Overall five-year survival was 88.4%.</p><p><b>CONCLUSIONS</b>MBC is a favorable histological type of breast carcinoma with good prognosis. Operation and chemotherapy are main procedures for MBC. The significance of molecular biologic parameters in the prognosis of MBC should not be overlooked.</p>

Endovascular stent-graft exclusion on aortic dissection and dissecting aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To study the techniques and therapeutic effects of endovascular stent-graft exclusion in aortic dissection and dissecting aneurysm.</p><p><b>METHODS</b>The clinical data of 20 cases with aortic dissection and(or) dissecting aneurysm were analysed. Stanford A dissection was found in 2 cases, in which one had a tear entry on ascending aorta. Stanford B dissection was found in 18 cases. Five patients had two or more tear entries in different sites. Endovascular polyester-covered stent-graft exclusion was performed in all cases, of which, one case was also given fenestration and graft replacement and one subjected to Y graft bypass from ascending aorta to the left common carotid artery and left subclavian artery before endovascular stent-graft exclusion.</p><p><b>RESULTS</b>No one died in operation. One patient died of heart infarction on the third day after operation. During the followup of 1 - 20 months, 19 patients were alive well (95%). The aortic dissections and(or) dissecting aneurysms of all the patients disappeared without endoleaks and organ or limb ischemia.</p><p><b>CONCLUSION</b>Endovascular stent-graft exclusion with high successful rate, low mortality and high survival rate, is simple, safe and effective in treating aortic dissection and dissecting aneurysm.</p>