[Efficacy of early consecutive lumbar puncture treatment in aneurysmal subarachnoid hemorrhage after embolization].

OBJECTIVE: To summarize the significance of lumbar punctures in remedy for aneurysmal subarachnoid hemorrhage (aSAH) after embolization. METHODS: From December 2002 to September 2011, 43 cases of aSAH underwent aneurysm embolization at department of interventional radiology and vascular surgery, Peking University Third Hospital. After the embolization,consecutive lumbar punctures were undertaken everyday, by which we measured proper cerebrospinal fluid pressure and slow drainage of cerebrospinal fluid. In accordance with the lumbar puncture results we determined the control of blood pressure, dehydration and rehydration therapy procedures. RESULTS: Two patients died. Only one patient in the 41 cases of the survived patients developed cerebral vasospasm, cerebral infarction and obstructive hydrocephalus, but by ventriculo-peritoneal shunt, obstructive hydrocephalus was relieved. The remaining 39 patients recovered well. After the mean follow-up of (26.0±5.8) months, no new neurological symptoms were found. CONCLUSION: Early consecutive lumbar puncture treatment in ASH after embolization is significant.

Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection.

OBJECTIVE: We report our experience in the treatment of isolated superior mesenteric artery dissection and review the clinical and imaging features reported in the literature. METHODS: A retrospective study was conducted of 18 consecutive patients with isolated superior mesenteric artery dissection who presented at the Peking University Third Hospital between September 2008 and May 2012. Their clinical characteristics, including age, sex, medical history, risk factors, symptoms, diagnostic imaging modality, and treatment, were analyzed. Also reviewed were 278 patients with isolated superior mesenteric artery dissection reported in the English language literature. The epidemiology, mechanism, clinical presentation, imaging features, and treatment were discussed. RESULTS: There were 14 men and four women with a mean age of 55.6 years (range, 41-84 years). Four patients were asymptomatic, and 14 presented with acute-onset abdominal pain. The diagnosis was established by contrast-enhanced computed tomography in 17 patients and ultrasound imaging in one patient. All dissections were located at the anterior wall and around the convex curvature of the superior mesenteric artery. The decision to intervene was based on symptoms. Three asymptomatic patients underwent successful conservative management, and one asymptomatic patient with an aneurysmal dilated false lumen underwent endovascular stent placement. For the 14 symptomatic patients, definitive treatment included catheter-directed infusion of a vasodilator in four and stent placement combined with catheter-directed infusion of a vasodilator in 10, of whom one patient underwent hybrid stent placement. No complications or deaths occurred. During the mean 14.9-month (range, 1-40 month) follow-up period, all patients were asymptomatic, and patency of the superior mesenteric artery was demonstrated by contrast-enhanced computed tomography scan. CONCLUSIONS: Conservative management can be applied to asymptomatic patients with isolated superior mesenteric artery dissection. For symptomatic patients, stent placement is the definitive treatment if there is no arterial rupture or intestinal necrosis. Self-expanding bare stents that completely cover the curvature of the superior mesenteric artery are recommended. Catheter-directed infusion of a vasodilator can be an effective accessional process after stent placement.

[Histological character of intimal hyperplasia post jugular vein grafts and the protective effect of lovastatin].

OBJECTIVE: To investigate the characteristics of intimal hyperplasia and lovastatin's effects on canine jugular venous prosthesis bypass grafting. METHODS: In the study, 12 adult mistus dogs were randomly divided into 2 groups: lovastatin group and control group. All the dogs were performed with jugular venous prosthesis bypass grafting (ePTFE, 6 mm in diameter, and 5 cm in length). Four weeks later, all the 12 specimens were harvested. The patency and mural thrombus of grafts were evaluated. The characteristics of intimal hyperplasia were described and measured by HE staining and endothelial nitric oxide synthase (eNOs) immunohistochemical method. The differences between the two groups were compared. RESULTS: Four weeks later, 3 grafts with complete occlusion were found in the two groups separately. Apparent intimal hyperplasia was observed in all the grafts. The neointima of proximal and distal part in lovastatin group were thinner than in control group respectively (proximal P=0.045, distal P=0.040). The endothelial cells were found in the surface of neointima. Newly born vessels could be found in the neointima and the new vessels were more in lovastatin group than in control group (proximal P=0.041, distal P=0.031). CONCLUSION: At the end of 4 weeks, the intimal hyperplasia with neovascularization was obviously near the anastomosis. Lovastatin showed the ability to inhibit the intimal hyperplasia and promote the neovascularization.