Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization Therapy Versus Surgical Resection for Hepatocellular Carcinoma within the Milan Criteria: A Meta-Analysis

OBJECTIVE: To meta-analytically compare combined transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) and surgical resection (SR) for the treatment of hepatocellular carcinoma (HCC) within the Milan criteria. MATERIALS AND METHODS: PubMed, Medline, Embase, and Cochrane Library were searched for studies comparing these two therapies that were published between January 2006 and August 2017. Overall survival rate (OS), recurrence-free survival rate (RFS), major complications and the average length of hospital stay were compared between these two therapies. Meta-analytic pooled odds ratio (OR) was calculated using TACE plus RFA as the base category. RESULTS: Seven case-control studies and one randomized trial were identified. Meta-analytic results revealed that, compared with SR, TACE plus RFA had significantly higher 1-year OS (OR for survival = 0.50, p = 0.009) and lower major complications (OR = 1.88, p = 0.02) after therapy. Three studies reported on the length of hospital stay. The average length ± standard deviation reported in individual studies for SR and TACE plus RFA groups was 19.8 ± 8.4 days and 7.4 ± 2.2 days, respectively; 18.7 ± 4.9 days and 11.5 ± 6.9 days, respectively; and 16.6 ± 6.7 days and 8.5 ± 4.1 days, respectively (p < 0.0001 for all studies). Three or 5-year OS and 1-, 3-, or 5-year RFS did not significantly differ between the two therapies. CONCLUSION: Combined TACE plus RFA may be an alternative to SR for the treatment of patients with HCC within Milan the criteria. Non-randomized design in most of the original studies was a limitation.

Endovascular repair with covered stent for the treatment of ruptured carotid artery pseudoaneurysms / 介入放射学杂志

Objective To evaluate the efficacy and safety of endovascular repair with covered stent in treating ruptured carotid artery pseudoaneurysms.Methods The clinical data of 15 patients with ruptured carotid artery pseudoaneurysm,who were admitted to Sun Yat-Sen Memorial Hospital of Zhongshan University during the period from July 2009 to July 2015 to receive emergency rescue with endovascular covered stent implantation,were retrospectively analyzed.Of the 15 patients,the rupture of common carotid artery pseudoaneurysm caused by direct trauma was seen in one and caused by cervical operation was observed in one,the rupture of internal carotid artery pseudoaneurysm caused by cervical operation was found in 3,and the rupture of internal carotid artery pseudoaneurysm due to radiotherapy for nasopharyngeal carcinoma was seen in 10.Results Successful rescue with endovascular repair using covered stent implantation was obtained in all 15 patients.No immediate procedure-related complications or death occurred.The mean follow-up time was 11 months.During the follow-up period,no re-bleeding or cerebral ischemic complications occurred.Conclusion For the treatment of ruptured carotid artery pseudoaneurysms,endovascular repair with covered stent is minimally invasive,safe and effective with less complications;and along with the occlusion of carotid artery rupture,the blood supply of the head and neck returns to normal.However,further clinical researches with larger samples are needed before its long-term efficacy can be completely clarified.

[Preliminary clinical results of deep anterior lamellar keratoplasty in the treatment deep infectious purulent keratitis].

OBJECTIVE: To evaluate the clinical results of deep anterior lamellar keratoplasty (DALK) assisted by big bubble technique in the treatment of deep infectious purulent keratitis. METHODS: Seventeen patients (17 eyes) with deep infectious purulent keratitis received DALK surgery in Shandong Eye Hospital from January 2011 to March 2012. Case selection:Patients with purulent keratitis, the infection or infiltrate depth was more than four fifth corneal thickness; SURGICAL TECHNIQUE: Use DALK assisted by big bubble technique to cut off the lesions and expose the Descemet's membrane. The prepared donor which stored in D-X medium or in glycerine preoperatively was oversized by 0.25 mm, and after stripping of Descemet's membrane, the donor button was interrupted sutured with 10-0 nylon suture. The perioperative complications, recurrence, graft status and visual recovery were evaluated. RESULTS: The mean follow up time were 9 months.17 patients with average age of (46 ± 13) year old received DALK surgery, including 14 cases of fungal keratitis and 3 cases of bacteria keratitis. Perioperative complications:Two cases suffered micro perforation and were continuing performed DALK surgery after injecting air bubble in the anterior chamber. Three cases suffered double anterior chamber, one was resolved after graft resuture, and the other two were absorbed automatically.One patient suffered fungal recurrence and cured with secondary penetrating keratoplasty. Graft status:All grafts attached closely to the recipients, slit lamp and AS-OCT examinations were difficult to distinguish the interface. All of grafts were transparent. Visual acuity:before the operation best corrected visual acuity (BCVA) in patients with HM/20 cm to 3.7, after the surgery patients' BSCVA improved to 4.5-5.0. The mean astigmatism postoperatively of 16 cases received successful DALK finally was (4.53 ± 2.35) D . CONCLUSIONS: For patients with deep infectious purulent keratitis, big bubble technique assistants DALK surgery is still a safe and effective method.