Intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage / 中华放射学杂志

Objective:To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods:The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 6 cases of chylothorax, 1 case of chylous ascites, and 3 cases of chylothorax combined with chylous ascites, respectively. Conservative treatment was invalid in all cases. The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography. Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted. The location of fistula was visualized by thoracic duct lymphangiography, and the embolization was performed by microcoils combined tissue adhesive agents. The post-operative curative effect and complications were recorded.Results:One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography; thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located. Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients. As for the other patient, after repeated failure of puncture, fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully. After the operation, the drain output was completely disappeared within 3 to 7 days in 8 patients, and decreased down to 120 ml/d in 1 patient. Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization, without any treatment. No serious complications was found in all cases.Conclusion:Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage, with a low complication rate.

A new integrated portable biliary internal-external drainage catheter loaded with 125I seeds: its design and clinical application / 介入放射学杂志

Objective To design a new integrated portable biliary internal-external drainage catheter carrying125 I seeds used for the treatment of malignant biliary obstruction lesions so as to achieve the dual curative effects of biliary drainage and brachytherapy. Methods A total of 15 patients with malignant obstructive jaundice, who were admitted to the First Affiliated Hospital of Zhengzhou University, China, during the period from September 2016 to January 2018, were enrolled in this study. Biliary stent implantation was performed in all patients, which was followed by insertion of a new integrated portable biliary internal-external drainage catheter carrying125 I seeds. The technical success rate, clinical success rate, complications, stent patency time and patient survival rate were evaluated. Results The placement of the drainage tube was simple and smooth, and the technical procedure was successful in all patients. One month after treatment, the bilirubin level was decreased significantly when compared with preoperative one (P<0.01), while the blood indexes and immunological indicators showed no obvious changes (P>0.05) . After treatment, 2 patients (13.3％) developed cholangitis and 2 patients (13.3％) had small amount of biliary bleeding, which returned to normal after symptomatic treatment. No severe complications such as perforation of bile duct, massive bleeding, radiation enteritis and radioactive source leakage, etc., occurred. The patients were followed up for 55-402 days, 6 patients (40.0％) developed biliary re-obstruction. The median patency time of stent was 255 days, and 6-month stent patency rate was 64.5％. Five patients died and 10 patients survived, the 9-month survival rate was 64.3％, the median survival time was 368 days. Conclusion By using the new integrated portable biliary internal-external drainage catheter carrying125 I seeds, the effects of bile drainage and brachytherapy can be simultaneously achieved. Preliminary clinical practice indicates that this new drainage catheter is feasible, safe and effective, although its long-term efficacy needs to be clarified with further follow-up observations and controlled studies.

Necessity of prophylactic uterine artery embolization before curettage in treatment of cesarean scar pregnancy / 中国介入影像与治疗学

Objective To evaluate the necessity of prophylactic uterine artery embolization (UAE) before curettage in treatment of cesarean scar pregnancy (CSP).Methods A total of 142 patients with CSP were enrolled and divided into 3 groups according to Adler grading standard,including little vascularity (grade 0-Ⅰ,n=40),moderate vascularity (grade Ⅱ,n=41) and rich vascularity groups (grade Ⅲ,n=61).All patients were treated with curettage or prophylactic UAE before curettage.The differences of age,times of cesarean section,time to last cesarean section,intraoperative blood loss and success rate of therapy were compared between different treatment methods in each group.Results There was no statistical difference of age,times of cesarean section,time to last cesarean section,intraoperative blood loss and success rate of therapy between curettage and prophylactic UAE before curettage in little vascularity group and moderate vascularity group (all P＞0.05).Compared with curettage,the success rate of prophylactic UAE before curettage was higher and the intraoperative blood loss was lower in rich vascularity group (both P＜0.05).There was no statistical difference of age,times of cesarean section nor time to last cesarean section in rich vascularity group (all P＞0.05).Conclusion It is necessary to perform prophylactic UAE before curettage for cesarean scar pregnancy patient with rich vascularity,which is helpful to reduction of intraoperative blood loss.

Clinical application of interventional therapy in the treatment of gestational trophoblastic neoplasia / 实用放射学杂志

Objective To investigate the effect and clinical value of interventional therapy in the treatment of gestational trophoblastic neoplasia(GTN).Methods 28 cases of GTN were selected,of which 18 cases were treated with fluorouracil +dactinomycin(5-Fu+KSM)for 2 courses,however,the level of β-HCG and uterine lesions did not significantly reduced.The remained 10 cases were treated with etoposide+actinomycin-D+ methotrexate+ tetrahydrofolate+ vincristine+ cyclophosphamide(EMA-CO)chemotherapy for 2 courses,Ⅳ degree of myelosuppression and severe gastrointestinal reactions appeared and had to cease the next cycle of treatment. All patients were treated with uterine artery and/or ovarian arterial infusion(cisplatin,etoposide,bleomycin)for 2 courses,meanwhile, the gelatin sponge particles were used for embolization of uterine arteries and/or ovarian arteries.The β-HCG level,tumor volume, and the changes of sex hormones were tested before and one year after interventional therapy.Results 28 patients underwent transcatheter uterine arterial and/or ovarian arterial chemoembolization and embolization,the internal iliac arteriography showed significant tumor staining.20 patients underwent double uterine arterial infusion and embolization,and 8 patients underwent bilateral uterine arterial and unilateral ovarian arterial infusion and embolization.β-HCG and lesion size were measured on the 18th day after intervention.The results showed that the β-HCG decreased significantly after 2 courses of treatment,and the uterine lesion was reduced or disappeared,with a significant statistical difference,however,sex hormone levels did not changed significantly before interventional therapy and during one year follow-up.Conclusion The interventional treatment of GTN is less invasive,effective,and worthy of clinical application.

Preliminary experience of 125I seed strands cavity brachytherapy for ureteral carcinoma / 中华放射医学与防护杂志

Objective To evaluate the safety and efficacy of 125I seed strands cavity brachytherapy for ureteral carcinoma.Methods To tally 10 patients with ureteral carcinoma underwent Carm CT and DSA guided percutaneous nephrostomy with 125I seed strands cavity brachytherapy.The technical success rate,complications,tumor local control rate,ureteral patency andsurvival time,and compared the Karnofsky scores,Girignon grade,pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment.Results 125I seed strands implantation was successfully completed in all patients with technical success rate of 100％.The mean procedure time was (12.3 ±3.8) min.No severe complications such as ureteral perforation,infection,severe bleeding occurred.Local tumor response was CR in 4 cases and PR in 6 cases,showing local control efficiency (CR + PR) 100％ after 2-3 months.Ureteral patency rate was 50％ (5/10).Postprocedure Karnofsky scores,Girignon grades,and pain scores were significantly improved (Z =-2.72,-2.88,-2.83,P＜0.01).The average follow-up time was (14.6 ±6.5) months (5-25 months),tumor progression was observed in 3 cases,stable disease in 7 cases.Nine cases were alive and one died due to multiple organ failure.The differences of D90％,mPD,V100％,V150％,V200％,CI,EI,HI between the preand post-treatment were not statistically significant (P ＞ 0.05).Conclusions 125I seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications,and an effective alternative treatment for patients who are unable to undergoor refuse surgery.

Nasal feeding nutritional tube capable of carrying 125I particles: its preparation and preliminary clinical application / 介入放射学杂志

Objective To design a kind of nasal feeding nutritional tube that can carry 125I particles,to use this tube for the treatment of upper digestive tract malignant occlusive disease in order to achieve double effect of nasal feeding nutrition and brachytherapy.Methods 125I particles were put into a 3F catheter,then both ends of the catheter were sealed off to make 125I particle chain.By using binding technology,the 125I particle chain was fixed on the nasal feeding tube.Under DSA guidance,the nasal feeding tube carrying 125I particle chain was inserted into the esophagus,with the 125I particle chain segment crossing over the section of esophageal stenosis or occlusion to conduct brachytherapy.This technique was employed in 6 patients with advanced esophageal carcinoma.The technical success rate,operation time and complications were recorded.Two months after the treatment,the Karnofsky score,visual analogue scale (VAS) pain score,Neuhaus dysphagia grading,esophagus patency on esophageal radiography,and local tumor control rate were determined.Results The preparation of nasal feeding nutritional tube carrying 125I particle chain was simple.The technical success rate was 100％,the mean operation time was 15.5 min,no serious complications such as bleeding or infection occurred.Two months after the treatment,the Karnofsky score,VAS pain score and Neuhaus dysphagia grading were significantly improved when compared with the preoperative data (P＜0.O1).On esophageal radiography,the contrast agent passed through the narrow area smoothly.Partial remission (PR) of local tumor was obtained in all patients,and the local tumor control rate was 100％.The patients were followed up for 2-6 months,one patient developed recurrent obstruction.Conclusion It is simple and easy to prepare a nasal feeding nutritional tube carrying 125I particle chain,the use of this kind of tube can achieve both parenteral nutrition and brachytherapy at the same time.Therefore,this technique opens a new way for the treatment of esophageal malignant tumor.

Efficacy of the double inverted Y-shaped airway covered stent therapy thoracostomach-right main bronchus fistula / 实用放射学杂志

Objective To study the efficacy of double inverted Y-shaped airway covered stent for patients with thoracostomach-right main bronchus fistula.Methods Fifteen cases with thoracostomach-right main bronchus fistula were investigated retrospectively.All patients had accepted esophageal resection and thoracostomach esophagus anastomosis,as well as radiation therapy after surgery due to esophageal cancer. All fistulas located close to the opening of right upper lobe bronchus.According to the normal tracheobronchial diameter and length of patients,two inverted Y-shaped airway covered stents were designed individually.Stenting was performed under X-ray,and the situation of fistula and clinical symptoms improvement were investigated.Results The double inverted Y-shaped airway covered stents were implanted and fistulas were closed successfully.All patients could take normal diet,and the supine cough symptoms disappeared, without complications such as airway bleeding and pneumothorax after stenting.Conclusion The stenting of double inverted Y-shaped airway covered stent may be an effective,feasible and safe treatment for thoracostomach-right main bronchus fistula.

Interventional Treatment of Renal Artery Pseudoaneurysms / 中国微创外科杂志

Objective To evaluate the clinical value of percutaneous renal artery angiography and embolization of the renal artery pseudoaneurysms. Methods A retrospective analysis was made on 15 cases of postoperative urethral bleeding following urinary calculi surgery from January 2012 to February 2014, which were diagnosed of renal artery pseudoaneurysms via the renal artery angiography.Superselective catheter placement was carried out into the proximal of parent artery and the pseudoaneurysm was embolized by using a coil and gelatin sponge. Results Renal artery angiography clearly displayed pseudoaneurysms in the 15 cases, which were located in interlobular artery in 11 cases, arcuate artery in 3 cases, and minor interlobular artery in 1 case.Urethral bleeding was stopped after using gelatin sponge and spring coil embolization.Among them urethral bleeding recurred in 1 case after two days, and a second embolization was conducted.After the embolization, transient renal colic happened in 2 cases and a fever of 37.8-39.3 ℃lasting for 3-8 d was seen in 7 cases.Follow-ups for 3-24 months ( mean, 15 months) showed no renal dysfunction and urinary tract bleeding. Conclusion The transcatheter embolization and angiography can diagnose and treat renal artery pseudoaneurysms, with safe and effective outcomes.

Selectiv renal arterial embolization for mononephrous renal angiomyolipoma (report of 1 6 cases) / 实用放射学杂志

Objective To assess the value of selective renal arterial embolization in treating mononephrous renal angiomyolipoma. Methods 1 6 patients with mononephrous renal angiomyolipoma were retrospectively analyzed.To observe and analyze the changes in renal function,lesions reduction and its complications.Results Symptoms have been improved significantly after treatment,no se-rious complications were observed during operation and postoperation.The creatinine level in postoperation was lower than the pre-operative level,followed-up after 1year.Conclusion Selective renal artery embolization is a safe and effective method for the treat-ment of mononephrous renal angiomyolipoma.

Biomechanical Analysis of Wrist under Axial Static Compressive Force on Metacarpals / 航天医学与医学工程

Objective To study the force and pressure transmission through normal wrist,and the effect of transverse carpal ligament release on the biomechanics of carpal tunnel.Methods A 3-D finite element model of the wrist based on CT scan images was established.The load transmission of carpus and the distribution of contact stress on radiocarpal joint under axial compressive force on metacarpals as well as the effect of transverse carpal ligament(TCL)release on the displacement of carpal bones were computed and analyzed.Results The computational results of force and pressure transmission through normal carpus matched well with previous studies.The release of TCL resulted in radial and palmar displacement of the scaphoid,flexion and radial rotation of radiocarpal joint as well as a further radial deviation of the whole carpal tunnel.Conclusion A 3-D finite element model of the wrist that includes the carpal tunnel,distal radius and ulna and proximal metacarpals is developed.This model may simulate the load transmission better and contact stress distribution of carpal tunnel and radiocarpal joint,as well as provide an operational plateform for further deeply studing on biomechanical behavior of carpal structure.The computed and analyzed results of the effect of TCL release on the displacements of carpal bones can be served as related theoratic base on carpal tunnel syndrome,carpal tunnel release surgery and recovery after operation.