Spontaneous renal hemorrhage: a clinical analysis of 50 patients / 中华肾脏病杂志

Objective:To provide clinical experience for the diagnosis and treatment of spontaneous renal hemorrhage through retrospective analysis of clinical features, imaging manifestations, underlying causes, treatment , and prognosis of spontaneous renal hemorrhage. Methods:By searching hospital information system, medical records scanning system, department of the interventional vascular surgery registry system, and picture archiving and communication systems, the patients with spontaneous renal hemorrhage admitted to Peking University First Hospital between January 1, 2000 to April 10, 2020 were enrolled. The clinical manifestations, investigations, imaging features, treatment, and prognosis of patients were retrospectively reviewed. The diagnostic efficiency and the accuracy of etiological diagnosis of renal hemorrhage by imaging examinations such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and angiography were compared and evaluated.Results:A total of 50 patients with 51 events of spontaneous renal hemorrhage were enrolled in the study. Laboratory tests showed hemoglobin was (103.3±29.4) g/L. The most common clinical features were flank or abdominal pain (48 cases, 96.0%), fever (17 cases, 34.0%), nausea (10 cases, 20.0%), vomiting (9 cases, 18.0%), and gross hematuria (4 cases, 8.0%). Nine patients (18.0%) experienced hypovolemic shock (systolic pressure<90 mmHg). With an initial assessment of the imaging method, the diagnostic accuracy of bleeding was 98.0%(49/50), yet the accuracy of underlying causes was 56.0%(28/50). The diagnostic accuracy of bleeding was 100.0%(25/25) by non-contrast abdominopelvic CT. The most common cause of spontaneous renal hemorrhage syndrome was renal tumors (27 cases, 54.0%), among which angiomyolipoma occurred most frequently (20 cases, 40.0%). Other causes included renal cyst (10 cases, 20.0%), autoimmune diseases (4 cases, 8.0%), bleeding diathesis (3 cases, 6.0%), and idiopathic renal hemorrhage (6 cases, 12.0%). Twelve patients (24.0%) received conservative management, 29 patients (58.0%) underwent interventional embolization therapy, and 11 patients (22.0%) received nephrectomy. The success rate on first embolization therapy was 86.2%(25/29), and approximately 13.8%(4/29) required second embolization therapy or nephrectomy.Conclusions:Spontaneous renal hemorrhage has no specific clinical features and is easy to be underdiagnosed or misdiagnosed. Non-contrast CT scan has a high diagnostic value for renal bleeding. Comprehensive judgement consisting of clinical features, laboratory tests, imaging manifestations and pathological examinations should be relied on for finding the underlying causes. Prompt diagnosis and management can guarantee a better prognosis.

Super-selective renal arterial embolization in treating huge renal angiomyolipoma / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of super-selective renal arterial embolization (SRAE) for treatment of huge renal angiomyolipoma (RAML).Methods Data of 16 patients with huge RAML treated with SRAE were retrospectively analyzed.The clinical symptoms,tumor size,serum creatinine and complications were compared before and after SRAE.Results A total of 26 SRAE treatments were performed on 16 patients with huge RAML.The technical success rate of SRAE was 100％ (26/26).Seven cases (7/16,43.75 ％) received one SRAE treatment,whereas 8 (8/16,50.00％) required two SRAE treatments.Only one case (1/16,6.25％) received three SRAE treatments.The mean follow-up period was (16.60± 15.60) months.The maximum diameter of the tumor reduced significantly after SRAE at final follow-up than before embolization ([9.00±2.80]cm vs [12.60±2.40]cm,t=12.41,P＜0.01).The symptoms of flank pain and hematuria gradually relieved after SRAE.And there was no statistical difference of mean serum creatinine before and after SRAE ([76.00±14.90]μmol/L] vs [79.10±12.80]μmol/L,t=0.89,P=0.39).Fourteen cases (14/ 16,87.50％) experienced post-embolization syndrome including varying degrees of fever,local pain or nausea on 1-3 days after embolization.No serious complications occurred.Conclusion SRAE is an effective method for stopping bleeding of ruptured huge RAML,as well as relieving symptoms and reserving nephron.

Impact of local lipiodol deposition in liver on necrotic area after microwave ablation in miniature pigs / 中国介入影像与治疗学

Objective To explore the impact of local lipiodol deposition in liver of miniature pigs on the shape and size of the necrotic area after microwave ablation (MWA).Methods Ten healthy miniature pigs were selected and equally divided into experimental group and control group (each n=5).In experimental group,transcatheter hepatic arterial embolization with lipiodol was done before microwave ablation,while only standard microwave ablation was performed in control group.Immediate post-ablation CT images were obtained.Long-axis diameter (LAD),short-axis diameter (SAD),sphericity index (SI=SAD/LAD) and volume of ablation zone were calculated.The size and shape of the ablated areas were compared between two groups.Results The mean LAD,SAD,SI and volume of ablation zone in experimental group ([4.21 ± 0.52]cm,[2.87±0.38]cm,0.69±0.10,[18.72±6.08]cm3) were larger than those in control group ([3.71±0.42]cm,[2.19±0.42]cm,0.60±0.09,[9.44±2.29] cm3;all P＜0.05).Conclusion Local deposition of lipiodol in liver parenchyma of miniature pigs can help to produce larger and rounder necrosis in the ablation zone.

Brief introduction and compliance research of 2017 Fleischner society lung nodules guidelines / 中国介入影像与治疗学

In this article,2017 Fleischner society lung nodules guidelines for management of lung nodules accidentally discovered and lung nodule measurement were briefly introduced.Electronic questionnaires were sent to doctors nationwide,and their familiarity and consistency with these recommendations were assessed.The results showed relatively high familiarity with the guideline,but the consistency in clinical practice was still unsatisfactory,suggesting that further promotion of these guidelines is necessary in the future.

Efficacy and safety of radiofrequency ablation combined with or without TACE for hepatocellular carcinomas: Meta-analysis / 中国介入影像与治疗学

Objective To investigate the effectiveness and safety of TACE combined with radiofrequency ablation (RFA) and simple RFA in the treatment of hepatocellular carcinoma (HCC) with Meta-analysis.Methods The randomized controlled trials comparing of TACE combined with RFA and simple RFA in the treatment of HCC from January 2000 to November 2016 in Chinese and English literatures were included.Results A total of 12 articles were enrolled in this study.Meta-analyses showed that the 1-year,3-year overall survival rate and 1-year,3-year recurrence-free survival rate of TACE combined with RFA group were better than those of simple RFA group (all P＜0.05).And there was no significant difference between TACE combined with RFA group and simple RFA group in 5-year overall survival rate (P =0.07).There was no significant difference of the 1-year,3-year overall survival and 1-year and 3-year recurrence-free survival rate between TACE combined with RFA group and simple RFA group for tumor with maximum diameter ＜3 cm in HCC (all P＞ 0.05).There was no significant difference in the incidence of serious complication in both two groups (P=0.82).Conclusion The short-term and mid-term efficacy in the treatment of HCC using TACE combined with RFA is better than those using simple RFA,while the long-term efficacy of two kinds of therapy have no significant differences.

Efficacy and safety of radiofrequency ablation combined with or without TACE for hepatocellular carcinomas: Meta-analysis / 中国介入影像与治疗学

Objective To investigate the effectiveness and safety of TACE combined with radiofrequency ablation (RFA) and simple RFA in the treatment of hepatocellular carcinoma (HCC) with Meta-analysis.Methods The randomized controlled trials comparing of TACE combined with RFA and simple RFA in the treatment of HCC from January 2000 to November 2016 in Chinese and English literatures were included.Results A total of 12 articles were enrolled in this study.Meta-analyses showed that the 1-year,3-year overall survival rate and 1-year,3-year recurrence-free survival rate of TACE combined with RFA group were better than those of simple RFA group (all P＜0.05).And there was no significant difference between TACE combined with RFA group and simple RFA group in 5-year overall survival rate (P =0.07).There was no significant difference of the 1-year,3-year overall survival and 1-year and 3-year recurrence-free survival rate between TACE combined with RFA group and simple RFA group for tumor with maximum diameter ＜3 cm in HCC (all P＞ 0.05).There was no significant difference in the incidence of serious complication in both two groups (P=0.82).Conclusion The short-term and mid-term efficacy in the treatment of HCC using TACE combined with RFA is better than those using simple RFA,while the long-term efficacy of two kinds of therapy have no significant differences.

Transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of renal cell carcinoma / 中国介入影像与治疗学

Objective To evaluate the safety and effectiveness of TACE with radiofrequency ablation (RFA) in treatment of renal cell carcinoma.Methods Data of 23 cases of renal cell carcinoma were retrospectively analyzed.Firstly all patients were treated with renal TACE,and then RFA under the guidance of ultrasound and CT was performed 3 to 4 weeks later.The therapeutic effects were evaluated by enhanced CT or MR scans during the follow-up period.Meanwhile,the changes of Karnofsky Performance Status (KPS) scores and renal functions between preoperative and postoperative periods were also evaluated.Results To the end of the follow-up,in all 23 patients 21 cases (21/23,91.30％) survived and 2 cases died (2/23,8.70 ％).KPS scores and serum creatinine levels were observed in all 23 patients at the initial stage and the end of the follow-up period,there were no significant differences (all P＞0.05).At the end of follow-up,16 cases were complete remission,5 were partial remission and 2 were progressive disease.Conclusion TACE combined with RFA is a safe and effective method in treatment of renal cell carcinoma with less trauma,less complication and more effective.

Extended hepatectomy using preoperatively PTCD and PVE to treat patients with locally advanced hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To assess the safety and efficacy of extended liver resection using preoperative PTCD (percutaneous transhepatic cholangial drainage) and PVE (portal vein embolization) to treat patients with locally advanced hilar cholangiocarcinoma.Methods We collected and analyzed the clinical data of 27 patients with Bismuth types Ⅲ and Ⅳ hilar cholangiocarcinoma who underwent extended hepatecomy using preoperative PTCD and PVE in our hospital.Results There were 21 patients with R0 resection and 6 patients with R1 resection.The mortality rate was 0％.Eight patients died of cancer recurrence.Conclusion Preoperative PTCD and PVE combined with extended hepatectomy were safe and efficacious in treating patients with locally advanced hilar cholangiocarcinoma,which resulted in potential cure.

Role of endovascular technique in acute arterial hemorrhage of abdominal organs / 中国介入影像与治疗学

Objective To investigate the effectiveness of endovascular technique in treatment of acute arterial hemorrhage of abdominal organs.Methods Totally 159 cases (145 patients) acute arterial hemorrhage of abdominal organs were enrolled.All patients underwent emergency transarterial angiography.Endovascular treatment by spring coil,gelatin sponge,or covered stent were in 40 cases.The success rate of immediate and long-term hemostasis was judged by the postoperative radiography,symptoms and the changes of vital signs and laboratory results.Results The positive signs in angiography were observed in 47 among the total 159 cases (47/159,29.56％).Seventy-seven postoperative hemorrhage cases underwent angiography and 29 cases (29/77,37.66 ％) were positive,82 non-operative hemorrhage cases underwent angiography and 18 cases (18/82,21.95％) were positive.The difference was statistical significant (P＜0.05).Endovascular treat ment were performed in 40 cases (33 by spring coils,4 by gelatin sponge and 3 by covered stent).Hemorrhages were con trolled immediately in all the 40 cases after embolization and the success rate were 100％.Conclusion Endovascular tech nique is minimal invasive,and it is an effective method for treatment of acute arterial hemorrhage in abdominal organs.

Super-selective renal artery embolization in treatment of iatrogenic renal pseudoaneurysm and arteriovenous fistula / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of super-selective renal artery embolization in treatment of iatrogenie renal pseudoaneurysm and arteriovenous fistula.Methods Twenty-nine patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula underwent renal angiography after ineffective conservative treatment.After identifying the location and characteristic of lesions by DSA,super-selective renal artery embolization was performed.Symptoms and signs,renal function changes before and after embolization and complications were recorded to evaluate the therapeutic effect.Results The technical success rate of super-selective renal artery embolization was 100％ (29/29),and clinical success rate was 96.55 ％ (28/29).The serum creatinine level before and after embolotherapy was (93.26 ± 28.79) mmol/L and (91.51 ± 27.68) mmol/L respectively,and there were no significant differences (t=1.28,P=0.22).No serious complications such as nephrapostasis or renal failure occurred in the study.Conclusion Super-selective renal artery embolization has technically and clinically high success rate with limited effect on renal function.It is a safe and effective therapy method in patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula.

Clinical value of lidocaine combined with remifentanil intravenous anesthesia in radiofrequency ablation of liver tumors / 中国介入影像与治疗学

Objective To explore the clinical value of lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors.Methods Totally 1 252 patients with hepatic tumors treated by radiofrequency ablation were analyzed.RITA cluster multipole radio needles were used in all cases.Local anesthesia with lidocaine was used before percutaneous puncture,and the dosage was 2 mg/kg of body mass.The initial dose of remifentanil was injected with pump at 0.05 μg/(kg · min) during operation.Mean arterial pressure (MAP),heart rate (HR) and saturation of peripheral oxygen (SPO2) were recorded 24 h before radiofrequency ablation (T0),at the beginning of operation (T1),30 min after operation (T2) and at the end of surgery (T3).Visual analogue scale (VAS) was used to assess the analgesic effect during the whole ablation procedure.Results Radiofrequency ablation were successfully performed in 1 250 patients (1 250/1 252,99.84％).The average time was (59.02 ±14.63) min.The average dosage of remifentanil was (242.22± 22.73)μg.The average VAS score was (2.42± 1.13) points.Compared with the preoperative T0 time point,SPO2 did not change significantly at each time of T1,T2 nor T3,but MAP and HR were significantly higher than those before operation (both P＜0.05).VAS scores were significantly higher in patients with tumors size ＞5 em than those in patients with tumors size ≤5 cm (P＜0.05).VAS scores were significantly higher in patients with lesions under hepatic capsule and in diaphragm dome than in patients with lesions in other parts (both P＜0.05).Severe anesthesia related complications occured in 2 patients,related to the respiratory inhibitory effect of remifentanil,and the patients were completely recovered after corresponding treatment.Conclusion Lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors can effectively relieve the pain in patients.Tumor size and tumor location are the main impact factors on analgesic effect.

Endovascular treatment of subclavian artery stenosis / 中国医师杂志

Objective To evaluate the safety and efficacy of the endovascular treatment of subclavian artery stenosis.Methods From January 2010 to December 2015,the clinical data of 93 patients with subclavian artery stenosis were analyzed retrospectively.All the patients were received angiography and endovascular treatment.Results The technical success rate was 97.9％.Clinical symptom remission rate was 97.8％ after the treatment.There was no procedure related death.During the procedure,limited arterial dissection was encountered in two cases.One patient had minor cerebellar hemorrhage.The follow-up time was 12 to 60 months.Median follow-up time was 36 months.Restenosis was occurred in nine cases.The patency rate of 5 years was 81.0％.Conclusions Endovascular treatment was a safe and effective treatment as the result of our data.It should be used as the preferred treatment of choice for subclavian artery stenosis.

Radiofrequency ablation combined with transarterial chemoembolization for treating of hepatic metastases / 中华放射学杂志

Objective To investigate the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for treating of hepatic metastasis. Methods From Mar. 2005 to Oct. 2010, 22 males and 14 females with hepatic metastasis were enrolled in this study. Mean age of the patients was 63±12 (42-82) years. Tumor size was (4.5±2.4) cm (min.1.5 cm, max. 12.0 cm). Totally 47 lesions were treated with single metastasis in 29 cases and multiple ones in 7 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. Contrast enhanced CT scan was given to all patients before RFA+TACE. For lesions with rich blood supply, TACE was given and then RFA. For those with poor blood supply, RFA was given first and then TACE. For multiple lesions, RFA+TACE was given one by one for each lesion. As for follow up, ultrasound and blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA+TACE were given repeatedly. The whole patients was divided into two groups according to the image follow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, repeated TACE was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia and local anesthesia, no severe complication was noted. Lesions in 16 patients were completely ablated after single or multiple sections of RFA+TACE. Twenty patients were in the partially ablated group. Follow up time was 25±10 (10-40) months. Twenty-three patients died and 13 kept alive during the follow up time. The estimated median survival time was 27 month (95%CI: 24-32 months). Survival ration at 1, 2, 3 years for the whole group was 91.7%(33/36),55.5%(20/36),36.1%(13/36) for the whole group. The 3 years survival for complete and partial ablation group was 75.0%(12/16),5.0%(1/20),there was a significant difference between the two groups(P<0.01). Conclusion For patients with hepatic metastasis, RFA+TACE can effectively control the local lesion. Complete ablation is the key point for a better survival.

Application of Interventional Treatment in Acute Massive Gastrointestinal Hemorrhage / 中国医学影像学杂志

Purpose To investigate the diagnostic and therapeutic value of vascular interventional technology dealing with acute massive gastrointestinal hemorrhage. Materials and methods 59 patients with acute massive gastrointestinal hemorrhage underwent the arteriography of mesenteric arteries and abdominal arteries. When positive signs of bleeding appeared, super-selective catheterization and embolization with micro-coil and gelfoam was applied immediately. Results Positive signs of bleeding were detected in 28 of 59 patients, among which 25 patients underwent embolization, and successful hemostasis was achieved in 21 cases with an achievement ratio of 84%. And there were 10 cases eventually turning to surgery.Conclusion Vascular interventional technology such as arteriography and embolization played an important role in diagnosis and treatment of acute massive gastrointestinal hemorrhage.

Influence of hepatic artery embolization with lipiodol on perfused radiofrequency ablation: An experimental study / 中国介入影像与治疗学

Objective To evaluate the effect of transcatheter hepatic artery embolization with lipiodol on perfused radiofrequency ablation (PRFA) on mini-porcine.Methods Ten Chinese mini-porcine were randomly divided into embolization group and control group (each n=5) .A standard PRFA with infusing cooling procedure was done in control group,while transcatheter hepatic artery embolization with lipiodol was done before PRFA in embolization group.CT and MR scan were performed after PRFA.Then a comparative analysis of the shape and volume of the lesions in the liver were performed.Resuits In both two groups,distinct spherical margin of the PRFA lesions was obtained.The minimal diameter was (31.76±3.43) mm in embolization group and (27.23±3.49) mm in control group (t=2.675,P＜0.05) .The average volume of the embolization group was (54.47±9.98) cm~3,while in the control group was (20.90±5.68) cm~3 (t=10.424,P＜0.05) .Conclusion Transcatheter hepatic artery embolization with lipiodol before PRFA can enlarge the ablation size of mini-porcine's liver.

Evaluation of a newly designed retrievable inferior vena cava filter in vitro flow model / 中国介入影像与治疗学

Objective To evaluate the efficacy and stability of a newly designed retrievable inferior vena cava (IVC) filter in vitro experiment.Methods In the flow model,thrombus capture rate and stability of the new IVC filter,and the Recovery retrievable filter were tested in varied thrombus size,tube diameters and positions.The process was repeated with a piece of cow aorta to observe the capture rate and stability.Results The emboli capture rate of different embolism diameter (2,3,5 mm) was 91.50%,96.50%and 99.50%,respectively.For two tube diameter (21,28 mm) was 98.00%and 93.67%,respectively.For the two directions (horizontal,vertical) was 94.33%,97.33%,and the total capture rate was 95.83%.Under those different conditions,the capture rates of Recovery filter was 81.00%,91.00%,95.00%;92.33%,85.67% and 87.67%,90.33%,respectively.while the total capture rate was 89.00%.Using the cow vessel,the capture rate was 88.50%,94.00%,98.00%;94.67%,92.33%;91.33%,95.67%,respectively;and the total rate was 93.50%.During experiment,two types of filter did not move or deflect.Conclusion The newly designed retrievable IVC filter is effective and stable in vitro study,and the capability of trapping emboli is better than that of Recovery filter.

Usefulness of Balloon-Occluded Retrograde Transvenous Obliteration in the Treatment of Gastric Varices / 实用放射学杂志

Objective To evaluate the usefulness of balloon-occluded retrograde transvenous obliteration(B-RTO)in treating varices of gastric fundus.Methods Total 11 patients with liver cirrhosis-combined gastric varices were treated by B-RTO.Transfemoral approach was used in all cases.A balloon catheter was inserted into left adrenal vein,then sclerosing material(5% ethanolamine oleate)was injected into the gastric varices via a gastrorenal shunt with the balloon inflated,the balloon was kept in place for 60 minutes.Follow-up was made by enhanced CT and endoscopy.Results 9 varices of the 11 were disappeared or remarkably decreased in size,and no recurrence or rupture was found during the follow-up period(2-12 months).1 of the remaining two varices decreased after second B-RTO procedure.No definitive change of liver or renal function was noted.Conclusion B-RTO is effective,reliable and less invasive for the treatment of gastric varices.

Relationship Between the Volume of Spleen and Zebra Enhancement Pattern on CTAP / 实用放射学杂志

Objective To evaluate the relationship between the volume of spleen and zebra enhancement pattern on CTAP(CT arterial portography).Methods Total 219 cases of hepatocellular carcinoma underwent CTAP were retrospectively analyzed.The patients were divided into three groups according to the CTAP enhancement patterns:group l,patchy heterogeneous enhancement(zebra pattern);group 2,homogeneous enhancement with remarkable hypodensity of the liver parenchyma(hypodensity pattern);group 3,homogeneous enhancement with definitive contrast(normal pattern).The volume of spleen was measured based on CT findings and compared among the groups.Results In the total 219 cases,there were 10 cases showing zebra enhancement pattern(4.6%),16 cases of homogeneous hypodensity(7.3%)and 193 of normal enhancement pattern(88.1%).The average volumes of the spleen of the three groups were (588.3?331.5) cm 3,(883.2?296.5) cm 3 and (474.4?275.0) cm 3,respectively.There was no significant difference of the splenic volume between groups 1 and 3,and the difference between groups 2 and 3 was significant.Conclusion There is no definitive relationship between the zebra enhancement pattern on CTAP and the volume of spleen,while the homogeneous hypodense enhancement is positively and significantly correlated with the volume of spleen.