Management of vena cava tumor thrombus dislodgement in robot-assisted laparoscopic surgery / 现代泌尿外科杂志

Renal cancer complicated with inferior vena cava tumor thrombus has been difficult to manage in urological surgery, because it has a complex anatomical relationship and involves vascular blockage of vital organs such as kidney, liver and heart, as well as the blockage and reconstruction of inferior vena cava. In addition, tumor thrombus dislodgement may occur intraoperatively, leading to acute pulmonary embolism, which makes the surgery extremely difficult and risky. In this paper, we report the successful treatment of thrombus dislodgement in a case of right kidney tumor with inferior vena cava thrombus during robot-assisted laparoscopic surgery and explore the treatment methods, aiming to avoid lethal pulmonary embolism caused by tumor thrombus dislodgement.

Surgical mobilization of an arterial embolus in cilioretinal artery occlusion

We describe an effective surgical approach for the management of cilioretinal artery occlusion. A 23?G pars plana vitrectomy assisted with two soft tip cannulas was performed. One cannula pressed the cilioretinal artery branch directed toward the macula, distal to the location of the embolus, whereas the other cannula was used to gently swipe over the cilioretinal artery proximal to the occlusion. Anatomical and functional outcomes were evaluated by fundus examination, fluorescein angiography, Goldmann visual field, and best?corrected visual acuity (BCVA). It was possible to mobilize the embolus by mechanical displacement with 23?G soft?tip cannulas and disintegrate it, preventing the passage toward the branch directed to the macula. Restoration of retinal circulation was confirmed by fluorescein angiogram. The patient recovered his previous documented BCVA and visual field. The described technique can be considered as a new possibility for achieving a solution to cilioretinal artery occlusion or any other retinal artery occlusion

Research progress on silent cerebral infarction after cardiac surgery through cardiopulmonary bypass / 中国胸心血管外科临床杂志

@#In the absence of symptoms, silent cerebral infarction can be discovered incidentally during an imaging or neuropathological examination. After cardiovascular surgery with cardiopulmonary bypass, the morbidity is high, and it may contribute to neurocognitive dysfunction, symptomatic cerebral infarction and increased risk of death. The embolus caused by various operations intraoperatively are closely associated with this progress. However, controversies over the prevention still persist. As a result, an overall summary of silent cerebral infarction after cardiovascular surgery with cardiopulmonary bypass will be presented in this review.

Comparison of Computed Tomography Pulmonary Angiograms at the University Hospital of the West Indies, Jamaica with Reported Cases in Literature / Comparación de las Angiografías Pulmonares por Tomografía Computarizada en el Hospital Universitario de West Indies, Jamaica, con los Casos Reportados en la Literatura

ABSTRACT Objective: This study was undertaken to determine the positive rate for computed tomography pulmonary angiograms (CTPAs) at the University Hospital of the West Indies (UHWI), to compare the positive rate at the UHWI to that reported in the literature and to compare the rates of positive CTPAs between the genders. Method: Data were obtained from the databases of the Radiology Department of the UHWI. All CTPAs performed to confirm a clinical diagnosis of pulmonary embolism and the results issued during the period January 1st 2013 and December 31st 2013 inclusive were reviewed. Only initial examinations of adequate diagnostic quality were included in the study. Results: Three hundred and thirteenth CTPAs were performed for initial diagnosis of pulmonary embolism. Sixteen examinations were excluded for inadequate diagnostic quality. Two hundred and ninety-seven examinations on 223 females and 74 males were included in the study. The means for age were 49.7 years and 55.1 years, respectively; the difference in the means was significant (p < 0.05). Ninety-four examinations (31.6%) on 22 males (7.4%, mean age 58.4 years) and 72 females (24.2%, mean age 57.5 years) were positive for pulmonary embolism. The difference in the means was not significant (p = 0.8). On Chi-squared test there was no significant difference in the percentage of positive CTPAs between males and females (p = 0.7). Conclusions: The percentage of positive CTPAs at the UHWI is high. There was no significant difference between the genders in the percentage of positive CTPAs or the mean age at which pulmonary emboli were detected.

ABSTRACT Objetivo: Este estudio se llevó a cabo con el propósito de determinar la tasa positiva de las angiografías pulmonares por tomografía computarizada (APTC) en el Hospital Universitario de West Indies (UHWI), comparar la tasa positiva en el UHWI con la que se reporta en la literatura, y comparar las tasas de APTC positivas entre géneros. Método: Se obtuvieron datos de las bases del Departamento de Radiología de UHWI. Se examinaron todas las APTC realizadas para confirmar un diagnóstico clínico de embolia pulmonar y los resultados emitidos durante el período del 1ero de enero de 2013 y 31 de diciembre de 2013 inclusive. En el estudio se incluyeron únicamente exámenes iniciales de calidad diagnóstica adecuada. Resultados: Trecientos trece APTC fueron realizadas para el diagnóstico inicial de embolia pulmonar. Se excluyeron 16 exámenes por poseer una calidad diagnóstica inadecuada. Doscientos noventa y siete exámenes de 223 hembras y 74 varones fueron incluidos en el estudio. Los promedios de edad fueron 49.7 años y 55.1 años respectivamente. La diferencia de los promedios fue significativa (p < 0.05). Noventa y cuatro exámenes (31.6%) de 22 varones (7.4%, edad promedio 58.4 años) y 72 hembras (24.2%, edad promedio 57.5 años) fueron positivos a la embolia pulmonar. La diferencia de los promedios no fue significativa (p = 0.8). En la prueba de Chi-cuadrado no hubo diferencias significativas en el porcentaje de APTC positivas entre varones y hembras (p = 0.7). Conclusiones: El porcentaje de APTC positivas en el UHWI es alto. No hubo diferencias significativas de género en el porcentaje de APTC positivas o la edad promedio a la que se detectaron los émbolos pulmonares.

Podoplanin expression and clinical prognosis of patients with esophageal squamous cell carcinoma: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To analyze the Podoplanin expression in patients with esophageal squamous cell carcinoma and to find out the relationship between Podoplanin expression and tumor embolus, lymph node metastasis, tumor differentiation as well as prognosis, and to provide clinical evidence for reducing the recurrence of esophageal squamous cell carcinoma and prolonging the disease-free survival and overall survival. Methods    A retrospective analysis of 70 patients with esophageal squamous cell carcinoma in our hospital from June 2010 to June 2012 was conducted, including 39 males and 31 females, with a mean age of 63.6 years. Positive diagnosis of tumor thrombus was achieved in 35 patients and negative in 35 patients. Postoperative pathological specimens were examined and normal esophageal tissues (esophageal tissue more than 5 cm from the edge of the tumor) of patients were excised as a control group. Results    The positive rate of Podoplanin was 34.2% in normal esophageal tissues and 62.8% in tumor tissues. The positive rate of Podoplanin expression was 77.1% and 48.6% in esophageal squamous cell carcinoma patients with or without tumor embolus, respectively. The positive rate of Podoplanin expression in tumor cells of patients with positive and negative lymph node metastasis was 71.9% and 23.1%, respectively (P<0.05). The mean disease-free survival of patients with Podoplanin expression-negative esophageal squamous cell carcinoma was 15.2 months, which was significantly longer than that of patients with Podoplanin expression-positive esophageal squamous cell carcinoma (P<0.05).  Conclusion    Podoplanin expression in the tumor cells and vessels can be an important reference index to the prognosis of patients with esophageal squamous cell carcinoma.

The causes and management of carbon dioxide embolism in laparoscopic hepatectomy / 中华肝胆外科杂志

Objective To investigate the strategies in dealing with intraoperative CO2 embolizm during Laparoscopic hepatectomy (LH).Methods We collected and analyzed data from patients who underwent laparoscopic hepatectomy (LH) in our hospital from Jan.2013 to Aug.2017.There were 321 patients.The criteria for the diagnosis of CO2 embolism were rapid intraoperative decrease in petCO2 and SPO2 accompanied with tachyarrhythmia.Results 12 patients were diagnosed to have CO2 embolism.The rate was 3.7％.For these 12 patients,10 patients were dealt with laparoscopically and 2 patients were converted to open surgery.Conclusion CO2 embolism did not rarely occur in LH patients.Sophisticated operations and careful manipulation in LH are the only ways to prevent CO2 embolism.

Clinical effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate feasibility and curative effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture.</p><p><b>METHODS</b>From March 2008 to February 2016, clinical data of 65 patients with massive haemorrhage from pelvic fracture were collected and analyzed, and patients were divided into non-embolic and embolic group according to whether perform vascular thrombosis. Thirty-three patients were in non-embolic group including 26 males and 7 females aged from 21 to 64 years old with an average of(39.2±5.7) years old, the time from injury to operation ranged from 1.1 to 4.8 h with an average of (2.2±0.4) h; 12 cases were type B and 21 cases were type C according to AO/Tile classification; injury severity score (ISS) ranged from 25 to 42 with an average of (37.7±7.5); shock index score ranged from 1.7 to 2.4 with an average of 2.1±0.3; treated with blood transfusion and fluid infusion. Thirty-two patients in embolic group, including 25 males and 7 females aged from 22 to 65 years old with an average of(38.1±4.5) years old; the time from injury to operation ranged from 1.2 to 4.8 h with an average of (2.1± 0.5) h; 14 cases were type B and 18 cases were type C according to AO/Tile classification; ISS ranged from 26 to 43 with an average of 38.9±4.5; shock index score ranged from 1.6 to 2.4 with an average of 2.2±0.2; treated by blood transfusion and fluid infusion with superselective arterial embolization. Blood transfusion volume, fluid infusion volume, shock correction time and survival rate were observed and compared, effective rate of hemostasis and postoperative complications were compared.</p><p><b>RESULTS</b>Thirty-seven artery were injured in embolic group, hemostasis were controlled at 3 h after operation, and hemodynamics turned to stable. There were significant difference in blood transfusion volume, fluid infusion volume, shock correction time between non-embolic and embolic group, and embolic group performed better. Survival rate in embolic group was also better than that of non-embolic group, and had significant difference. While there was obvious differences in complications(χ²=4.03,=0.045).</p><p><b>CONCLUSIONS</b>Superselective arterial embolization for massive haemorrhage from pelvic fracture could effective hemostasis, reduce blood transfusion and fluid infusion volume and occurrence rate of shock, moreover improve survival rate and deserves promotion.</p>

Analysis on correlation between vessel cancer embolus with prognosis in patients with colorectal cancer / 重庆医学

Objective To investigate the relationship between vessel cancer embolus with other clinicopathological features and tumor tissue KRAS gene mutation in the patients with colorectal cancer and its significance to colorectal cancer prognosis.Methods The postoperative clinicopathological data in 182 patients with colorectal cancer during 2011-2014 were retrospectively analyzed and the patients were followed up.Results Forty-five cases showed vessel cancer embolus positive of colorectal cancer,which had the rrelationship with the lymph node metastasis,pathological differentiation degree,liver metastasis,nerve infiltration and increase of CEA and CA199 levels,while had no relationship with the age,sex,tumor size,infiltration depth and pathological type.The 3-year survival rate was 51.1% in the vessel cancer embolus positive group,which was significantly lower than 61.3% in the negative group (P0.05).Conclusion Vessel cancer embolus decreases the 3-year survival rate and affects the prognosis in the patients with colorectal cancer.The survival rate in complicating KRAS gene mutation is similar.

Clinics in diagnostic imaging (176). Acute embolic occlusion of the coeliac artery

A 52-year-old man, who had a background of chronic heart disease and atrial fibrillation, as well as non-compliance with warfarin therapy, presented with a two-week history of worsening upper abdominal pain. Computed tomography mesenteric angiography showed complete embolic occlusion of the coeliac artery with resultant segmental splenic infarction, and thrombus within the left ventricle. A decision was made to proceed with catheter-directed thrombolysis. Subsequent follow-up angiogram at 12 hours showed successful treatment with complete dissolution of the coeliac embolus. The patient's symptoms resolved during his hospitalisation and he was subsequently discharged well on long-term oral anticoagulation therapy. Isolated acute embolic occlusion of the coeliac axis is a rare occurrence that may result in end-organ infarction. Treatment options include systemic anti-coagulation, mechanical thrombectomy, catheter thrombolysis or open surgery. Catheter-directed thrombolysis therapy is a feasible and effective option for treating acute thromboembolic occlusion of the coeliac artery.

Tromboembolismo pulmonar bilateral masivo puerperal, secundario a trombosis venosa profunda intraparto. A propósito de un caso / Postpartum massive bilateral pulmonary thromboembolism secondary to deep intrapartum venous thrombosis. A case report

Resumen ANTECEDENTES: la enfermedad tromboembólica es un cuadro clínico que puede manifestarse durante el embarazo, como un episodio aislado de trombosis venosa profunda en los miembros inferiores, o como tromboembolismo pulmonar. La prevalencia se considera baja: 1 caso por cada 1600 embarazos. El solapamiento de los síntomas de la enfermedad tromboembólica con el embarazo puede retrasar la sospecha clínica y complicar el establecimiento del diagnóstico. CASO CLÍNICO: paciente primigesta, de 37 años de edad, con un episodio de tromboembolismo pulmonar con inicio en el puerperio, asociado con trombosis venosa profunda intraparto como factor desencadenante que evolucionó favorablemente gracias al diagnóstico y tratamiento oportunos. CONCLUSIÓN: la importancia de este caso radica en la necesidad de actuar con rapidez para establecer el diagnóstico e indicar inmediatamente el tratamiento.

Abstract BACKGROUND: Venous thromboembolism (VTE) is a combination of pathologies, which can manifest during pregnancy as an isolated lower extremity deep vein thrombosis (DVT) or as a pulmonary embolus (PE). The global prevalence is low, which occurs in 1 to 1600 pregnancies. CLINICAL CASE: A 37-year-old primigravid patient with an episode of pulmonary thromboembolism with onset in the puerperium associated with intrapartum deep venous thrombosis as a triggering factor that evolved favorably due to timely diagnosis and treatment. CONCLUSION: The importance of this case lies in the need to act quickly to establish the diagnosis and immediately indicate the treatment.

Trombosis venosa profunda causando embolia pulmonar aguda e infarto cerebral isquémico / Deep vein thrombosis causing pulmonary embolism and ischemic cerebral infarct

En este artículo presentamos el caso de un paciente femenino de 59 años de edad que ingreso al hospital por insuficiencia respiratoria aguda; diagnosticada con trombosis venosa profunda (TVP) y tromboembolia pulmonar (TEP) masiva. Al cuarto día de admisión desarrolló afasia global y hemiplejia derecha. Imagen de resonancia magnética (IRM) del cerebro demuestra un infarto cerebral agudo en el territorio de la arteria cerebral media izquierda. La Ecografía trans-esofágica evidencia un foramen ovale permeable de 1.8 cm de diámetro con una derivación de flujo arterio-venosa de derecha a izquierda significativo. La paciente fue sometida al cierre del defecto cardiaco por cateterismo con resultados favorables sin recurrencia de infartos cerebrales posteriores. También revisamos la literatura sobre embolia paradójica como causa de infartos cerebrales y brindamos algunas recomendaciones para el manejo y prevención de infartos cerebrales criptogénicos.

Herein, we present a case of a 59 years old woman who was admitted to the hospital due to respiratory failure. She was diagnosed with deep vein thrombosis and massive pulmonary embolism. At the fourth day of admission she developed acute onset of global aphasia and dense acute right hemiplegia. Magnetic resonance imaging demonstrates an acute infarct in the left medial cerebral artery territory. Transesophageal echocardiogram found a large patent foramen ovale of 1.8 cm of diameter with a large right to left shunting. Patient underwent to successful closure of the defect via cardiac catheterization with no recurrence of embolic events. We also review the literature of paradoxical embolus as a cause of cerebral infarcts and provide some recommendations for treatment and prevention of cryptogenic infarcts.

Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective

OBJECTIVE: Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. METHODS: We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006–2010 including all adult patients with a primary diagnosis of DVT or PE. Simplified pulmonary embolus scoring index (sPESI) scores were determined in patients with PE to identify low risk patients. RESULTS: There were an estimated 652,000 and 394,000 ED visits for DVT and PE over the 5-year period (0.17%). Mean (SE) age was 59 (1.3), 50% were female, and 40% were > 65 years. Admission rates for DVT and PE were 52% and 90% respectively with no significant changes over time. In patients with DVT, predictors for admission were age (odds ratio, 1.03 per year of age [95% confidence interval, 1.01 to 1.05]) and race (odds ratio, 4.1 [95% confidence interval, 0.9 to 19.8] for Hispanics and 2.9 [1.2 to 7.4] for Blacks). Of all ED patients with PE, 51% were low risk based on sPESI scores. CONCLUSION: Admission rates for DVT and PE have remained high and unchanged, especially with PE, minorities, and in older patients. Based on sPESI scores, up to half of PE patients might be eligible for early discharge or outpatient therapy.

Research progress on the role of platelet in mediating tumor metastasis by hematogenous spread and its mechanisms / 中国药理学通报

Tumor metastasis is one of the most important biologi-cal characteristics of malignant tumor, and it is also the main factors that cause treatment failure and poor prognosis. Clinical studies have shown that the number of platelets in patients with malignant tumor increased more significantly than that in benign tumor patients and healthy people, which indicate that platelet might be involved in the development process of tumor. Further study found that in the process of cancer spreading to blood, platelet could interact with tumor cells to form tumor emboli, helped tumor cells escape from immune surveillance, thus pro-moted the tumor metastasis. In recent years, related mechanisms on platelets in promoting tumor metastasis were revealed gradual-ly, and several targeted therapies based on platelets were also carried out. This paper reviews the role of platelet in mediating tumor metastasis by hematogenous spread and its mechanisms and discusses the therapy strategies that target platelet, which may provide references for follow-up research and clinical treat-ment.

Surgical treatment for tumor involved inferior vena cava at the upper segment of kidney / 中华消化外科杂志

Objective To investigate surgical treatment for tumor involved inferior vena cava at the upper segment of kidney.Methods The clinical data of 35 patients with tumor involved inferior vena cava at the upper segment of kidney who were admitted to Changhai Hospital affiliated to the Second Military Medical University from January 2007 to May 2015 were retrospectively analyzed.All the patients received preoperative imaging examinations to insure the site and range of inferior vena cava involvement at the upper segment of kidney.Renal cell carcinomas with inferior vena cava involvement were found in 19 cases,leiomyosarcomas of inferior vena cava in 5 cases,leiomyomatosis involving inferior vena cava in 3 cases,adrenocortical carcinoma involving inferior vena cava in 3 cases,liver cancer involving inferior vena cava in 2 cases,right adrenal pheochromocytomas in 2 cases,retroperitoneal fibrosarcoma involving inferior vena cava in 1 case.According to tumor involvement types,the different surgical approaches,planes and method of inferior vena cava exclusion,reconstruction method and prevention of tumor embolus detachment were selected.Patients were followed up by outpatient examination and telephone interview till May 2015.Results Among 19 patients with renal cell carcinomas with inferior vena cava involvement,10 patients were placed inferior vena cava filters through internal jugular vein before surgery,10 patients underwent total hepatic vascular exclusion and 9 patients underwent intrahepatic inferior vena cava exclusion.All the 19 patients received tumor resection and inferior vena cava embolectomy.Of the 5 patients with leiomyosar-comas of inferior vena cava,3 patients underwent total hepatic vascular exclusion and 2 patients underwent intrahepatic inferior vena cava exclusion.The diseased segments of 5 patients were resected,including 4 patients of artificial vascular graft and 1 patient complicated with resection of right kidney receiving simple ligation of inferior vena cava and left renal vein at proximal and distal tumors.Of the 3 patients with leiomyomatosis involving inferior vena cava,2 patients received total hepatic vascular exclusion and 1 was treated surgically under cardiopulmonary bypass.All the 3 patients underwent inferior vena cava embolectomy and hysterectomy.Three patients with adrenocortical carcinoma involving inferior vena cava and 2 patients with liver cancer involving inferior vena cava underwent total hepatic vascular exclusion.Among the 5 patients,4 had direct suture after tumor removal combined with partial inferior vena cava resection,and 1 had patch repair after partial inferior vena cava resection.Two patients with right adrenal pheochromocytomas were exposed proximal and distal lifting devices of inferior vena cava without clamp,and the tumors were peeled off completely.Intraoperative death happened in the patient with retroperitoneal fibrosarcoma involving inferior vena cava who was prepared to undergo intrahepatic inferior vena cava exclusion but encountered intraoperative pulmonary embolism due to tumor thrombus shedding.Thirty-four patients of 35 patients underwent operation successfully without serious perioperative complications and a patient died in the perioperative period.The mean operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were 2.8 hours (range,1.5-5.0 hours),2 000 mL (range,400-5 000 mL) and 9.2 days (range,6.0-16.0 days).Thirty-four patients were followed up for a median time of 12 months (range,1-60 months).During the follow-up period,a patient with leiomyosarcomas of inferior vena cava and 2 patients with adrenocortical carcinoma involving inferior vena cava died of tumor recurrence,a patient with liver cancer had tumor recurrence,other patients were tumor-free survival.Conclusions Inferior vena cava at the upper segment of kidney is not contraindication for tumor resection.The appropriate way to expose,clamp and reconstruct are selected to safely remove the tumor based on extension and method of tumor involving inferior vena cava.

Prognosis and therapy of patient with renal cell carcinoma accompanied with venous tumor thrombus / 中国综合临床

Objective To investigate the clinical features and prognosis of the patients with renal cell carcinoma and venous tumor thrombus.Methods Fifty-six patients with renal cell carcinoma and venous tumor thrombus were selected as our subjects,who underwent radical nephrectomy and thrombectomy in the Second Hospital of Tianjin Medical University from June 2002 to May 2014.There were 28 patients with stage Ⅰ tumor thrombus,l5with stage Ⅱtumor thrombus,9 with stage Ⅲ tumor thrombus and 4 with stage Ⅳtumor thrombus.All patients underwent renal tumor resection and embolectomy,and were follow-up.Results Of all the patients,46 were male and 10 were female with a mean age of 61.7(age ranging from 42 to 83).Twenty-four were presented on the left kidney and 32 were right.The clinical features were as follows:The tumor size was 2.5 to 14 cm in diameter(mean:6.2 cm),there were 21 cases with low back pain,18 cases with hematuria,lcases with abdominal.Pathological results showed that 39 with clear cell carcinoma,9 with papillary cell carcinoma,3 with chromophobe cell carcinoma,1 with low-differentiated cell carcinoma and 1 with undifferentiated cell carcinoma,3 with sarcomatoid differentiation.Forty-three patients were followed up,and the median follow up period was 20.4 months (2-90 months).The median survival time for the patients was 47 months and the 5 year overall survival was 45.2％.The survival time of the patients with early tumor thrombus(below hepaticvein) was (55.3 ± 4.9) month,significantly longer than that of the patients with advanced tumor thrombus (above hepaticvein) ((24.8 ± 5.3) months,P =0.047).Conclusion Patients with renal cell carcinoma and venous tumor thrombus are characterized with high malignancy and poor prognosis.Surgical operations are effective therapies for the patients.Long term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor.

Ultrasound Study of Atherosclerotic Changes in Carotid Vessels and Role of Certain Factors which Increase the Incidence of Atherosclerosis

Atherosclerosis is supposed to be causing number of deaths due to coronary artery stenosis and major inability in the shape of hemipleagias involving carotid arteries, which is called stroke or vascular accident. In this study, evaluation of the factors causing increased incidence of carotid artery atherosclerosis is done. Ultrasound has unique capability to visualise vessel wall in vivo. This important arterial pathophysiolgy detected with B-mode sonography is arthrosclerosis and plaque formation. Atherosclerotic plaque is represented sonographically by echogenic material that thickens the intimal reflection and encroaches onto the arterial lumen and produces flow void. The study was carried out with 375 patients who were attending the medical, surgical and diabetic departments of Santhiram Medical College, Nandyal for attributable neurological signs. All the cases were examined with SIEMENS SONOLINE G-50 ultrasound machine using the 7.5–10 MHz linear array transducer. All examinations are done with the Doppler angle of 60 degree and sample volume of 1–5 mm[2,5]. All four vessels, i.e., common carotid, internal carotid, external carotid and vertebral arteries of both sides are evaluated both longitudinally and transversely. Following parameters are observed on both real time and frozen images. Intima-media thickness, patent lumen diameter, residual lumen diameter, dimensions of the plaque, peak systolic velocity, systolic velocity ratio (carotid index), diastolic velocity ratio and percentage of diameter stenosis.

Asymptomatic Pulmonary Embolus Following Percutaneous Kyphoplasty: A Case Report / 대한골다공증학회지

Percutaneous vertebroplasty is a relatively recent procedure in the treatment of osteoporotic vertebral compression fractures. Bone cement embolism is a severe and potentially life-threatening complication of percutaneous vertebroplasty with cement. The risk for cement pulmonary embolism ranges between 3.5 and 23% for osteoporotic fractures. Bone cement leakage may be usually more frequent with vertebroplasty than with kyphoplasty. We experienced a 69-year-old female patient of an asymptomatic pulmonary embolus (length 8 cm) after kyphoplasty for an osteoporotic vertebral compression fracture

Captured Macro-embolus of Fractured Atheromatous Plaque by the Embolic Protection Device during Carotid Stent Assisted Angioplasty / 신경중재치료의학

The authors present a case in which macro-embolus from the ruptured atheromatous plaque developed during carotid artery stenting (CAS). A 63-year-old man who had suffered a left middle cerebral artery territory infarction had significant proximal left internal carotid artery stenosis required CAS procedure. Immediate after stent deployment, the patient showed abrupt neurological deterioration with 12 x 3 mm sized macro-embolus which was caught by the embolus protection device (EPD). Retrieval of the macro-embolus was performed safely and the patient recovered to pre-procedure status. Macro-embolus can be resulted during the CAS. The EPD can capture the macro-embolus and safe removal is technically feasible.

Hemi-central retinal artery occlusion in young adults.

Amongst the clinical presentations of retinal artery occlusion, hemi-central retinal artery occlusion (Hemi-CRAO) is rarely described. This case series of four adults aged between 22 and 36 years attempts to describe the clinical profile, etiology and management of Hemi-CRAO. Case 1 had an artificial mitral valve implant. Polycythemia and malignant hypertension were noted in Case 2. The third patient had Leiden mutation while the fourth patient had Eisenmenger’s syndrome. Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases. Color Doppler examination of the central retinal artery confirmed branching of the artery behind the lamina cribrosa. It is hypothesized that bifurcation of central retinal artery behind the lamina cribrosa may predispose these hemi-trunks to develop an acute occlusion if associated with underlying risk factors. The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.