[Effect of covered stent length in portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt].

OBJECTIVE: To evaluate the effect of the length of covered stents in the portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS). METHODS: We retrospectively reviewed 53 cases receiving TIPSs between January, 2008 and December, 2011. All the shunts were created with Fluency stents (8 mm in diameter). Bare metal grafts of the same diameter were implanted to extend the length in the portal and hepatic veins as deemed necessary according to angiographic images. The primary patency, hepatic encephalopathy and patient survival were evaluated during the follow up. The length of the covered stents within the hepatic vein (X1) and in the portal vein (X2), and the total length of stents placed in the hepatic vein (X3) and the portal vein (X4) were measured and their effects on primary patency and the patients'outcomes were evaluated. RESULTS: The procedures were completed successfully in all the patients and the mean portosystemic pressure decreased from 29.80∓4.83 mmHg to 19.00∓3.92 mmHg (t=13.44, P<0.01) after the procedure. The patients were followed up for a median of 64 months (3 to 89 months, 39 months on average). Hepatic encephalopathy occurred in 23% (12/53) of the patients after TIPS. Shunt dysfunction occurred in 16 cases, and the cumulative primary patency rates at 1 to 5 years were 83%, 75%, 63%, 62%, and 54%, respectively. The cumulative survival rates of the patients at 1 to 5 years were 79%, 72%, 72%, 69%, and 69%, respectively. Cox proportional regression analysis showed a significant association between the length of covered-stent in the hepatic vein and the primary patency (OR=0.42, P<0.01), and there was a significant association between the length of stent in the portal vein and the patient survival. No significant correlation was found between these parameters and hepatic encephalopathy. CONCLUSION: Increasing the length of the covered stent in the hepatic vein and decreasing the stent length in the portal vein can improve the primary patency and the patient survival receiving TIPS.

[Transjugular intrahepatic portosystemic shunt with Viatorr stent grafting: report of 3 cases].

We here report 3 cases successfully treated with transjugular intrahepatic portosystemic shunt using Viatorr stent. The 3 patients were had a diagnosis of liver cirrhosis with portal vein hypertension, and presented with black stool and hematemesis. After the treatment, the patients' portal vein pressures were decreased without black stool or hematemesis. Our success demonstrate the feasibility of using Viatorr stent in transjugular intrahepatic portosystemic shunt.

Effects of the intermittent injection with super-low pressure on the postoperative pain control during the uterine artery embolization for uterine myoma.

OBJECTIVE: Uterine artery embolization (UAE) has been commonly used for uterine myoma with satisfactory effects, but the pain during and following the procedure with an occurrence rate in 100%. The aim of this study was to observe the effects of intermittent injection with super-low pressure on pain control during the UAE for uterine myoma. METHODS: 67 subjects were divided into 2 groups with 47 in-group A and 20 in group B. A underwent UAE with the intermittent injection at super-low pressure, while B underwent routine UAE. Pain was assessed according to WHO analgesic ladder. Meanwhile, all were scored with the visual analogue scale (VAS). RESULTS: The numbers of first, second and third step analgesic user in Group A were 21, 18 and 6, respectively, with 2 non-analgesic users, while in Group B were 4, 6 and 10, respectively without non-analgesic user (chi-square = 7.043, P = 0.008). VAS showed good pain control in 23 cases, satisfactory in 18 and poor in 6 in Group A, while in Group B, were 4, 8 and 8, respectively (chi-square = 7.329, P = 0.007). Mean follow-up was 16.5 months (range, 6-32 months). The abnormal menstruation was improved and the ultrasound examination 6 months later demonstrated a significant decrease in the diameter of myoma (from 6.65 ± 2.40 cm to 5.22 ± 1.86 cm, t = 3.186, P = 0.002). CONCLUSION: The application of intermittent injection with super-low pressure during UAE can decrease and possibly eliminate post-operative pain. But the procedure time was increased.

T-Stenting-and-Small-Protrusion Technique for Bifurcation Stenoses After End-to-Side Anastomosis of Transplant Renal Artery and External Iliac Artery: Report of Two Cases.

Bifurcation stenoses after end-to-side anastomosis of transplant renal artery (TRA) and external iliac artery (EIA), including stenoses at the anastomosis and the iliac artery proximal to the TRA, are rare. In the present article, we report two successfully managed cases of bifurcation stenoses after end-to-side anastomosis of the TRA and EIA using the technique of T-stenting and small protrusion (TAP stenting).

Percutaneous intratumoral injection with pingyangmycin lipiodol emulsion for the treatment of recurrent sacrococcygeal chordomas.

This study describes fluoroscopy-guided percutaneous intratumoral injection therapy (PIIT) with a pingyangmycin lipiodol emulsion in the management of recurrent sacrococcygeal chordomas after surgical excision. Seven patients underwent a total of 22 treatment sessions (3-4 sessions per patient); treatment responses were evaluated clinically, and lesion size was determined using computed tomography (CT). Over 10-26 months of follow-up, tumor sizes and visual analogue scale (VAS) scores of all patients were decreased. No patients had complications during the follow-up period. Preliminary results showed that PIIT with pingyangmycin lipiodol emulsion under fluoroscopic guidance is effective and safe and may be considered as a treatment option.

[Removal of metallic foreign body in the soft tissue under fluoroscopy: 10 years of experiences].

OBJECTIVE: To summarize our 10-year experience with percutaneous fluoroscopically guided removal (PFGR) of metallic foreign body (MFB) in the soft tissue. METHODS: PFGR was performed in 65 patients for removing a total of 368 MFBs from the soft tissues. The MFBs ranged from 0.2 to 0.3 cm in length embedded in the soft tissue for 7 days to 8 years. For superficial MFBs, the MFBs were removed directly with curved forceps under real time fluoroscopy. For deep MFBs, trocar technique was applied using the instruments for percutaneous diskectomy, with the outer cannula inserted toward the foreign body under real-time fluoroscopy followed by MFB removal by grasping forceps. RESULTS: A total of 346 MFBs were successfully removed without any serious complications (success rate 94.0%), including 154 removed directly and 192 MFBs with trocal technique. The time of the procedures and radiation exposure for MFB removal was 30 s to 20 min and 1-6 min, respectively. CONCLUSION: PGFR of MFBs in the soft tissue under fluoroscope is safe and effective. Direct removal using curved forceps is suitable for MFBs in superficial soft tissues, while trocal techniques needs to be utilized for deep MFBs.

[Endovascular graft exclusion with digital subtraction angiography for treatment of Stanford type B aortic dissection].

OBJECTIVE: To assess value of endovascular graft exclusion (EVGE) with digital subtraction angiography (DSA) in the treatment of Stanford type B aortic dissection (AD). METHODS: On the basis of diagnosis with multi-slice spiral CT (MSCT), DSA was performed in 20 Stanford B AD cases for further diagnostic confirmation and EVGE was conducted for treatment. The DSA findings of the cases and the therapeutic effect of EVGE were evaluated. RESULTS: In the 20 cases of Stanford type B AD, altogether 22 stents were implanted during EVGF with a stent release success rate of 100%. Postoperative examination revealed no obvious leakage or false lumen in 15 cases, and death occurred in 1 case 6 days after the operation due to right renal hemorrhage and infection, and the rest 19 patients were cured and discharged. Follow-up of the patients demonstrated improvement in the clinical symptoms, and MSCT showed that all the dissections were sealed successfully. No severe complications were observed 3 months after the treatment in these patients. CONCLUSION: DSA can identify the fine anatomy of AD and allowed intraoperative monitoring in EVGE, which is an effective and safe means for treatment of Stanford type B AD.

[Percutaneous intradiscal oxygen-ozone injection for lumbar disc herniation: no need of perioperative antibiotic prophylaxis].

OBJECTIVE: To evaluate the feasibility of no antibiotic administration to prevent infection during the perioperative period of percutaneous intradiscal ozone-injection for treatment of lumbar disc herniation. METHODS: Seventy-two patients with lumbar disc herniation but normal body temperature as well as normal results of three routine tests (blood, urine, stool) and C-reactive protein (CRP) level were randomly divided into two groups. The patients in prophylaxis group were given cephalothin V(2.0 g) intravenous 30 min before the operation, and the control group did not use any antibiotics. All the patients were injected with 6-10 ml ozone (40 microg/ml) for medical use into the discs with 21G needles under fluoroscopic guidance, followed by 10 ml ozone into the paravertebral space. Three days later the general examinations and CRP measurement were repeated. RESULTS: No infection was found in these patients, nor were any significant differences noted in the results of the examinations between the two groups after controlling in patients with above-normal white blood cell count, neutrophil percentage and CRP level. CONCLUSION: Prophylaxis antibiotics is not necessary during the perioperative period of percutaneous intradiscal ozone injection for lumbar disc herniation.

[Synthesis of phenyloxyisobutyric acid derivatives and their antidiabetic activity in vitro].

AIM: To design and synthesize new phenyloxyisobutyric acid analogues as antidiabetic compounds. METHODS: Eight new target compounds were synthesized by combination of lipophilic moieties and acidic moiety with nucleophilic replacement or Mitsunobu condensation. The eight compounds were confirmed by 1H NMR, 13C NMR, IR and MS. RESULTS: In vitro insulin-sensitizing activity (3T3-L1 adipocyte) demonstrated, that the cultured glucose concentration of up-clear solution detected with GOD-POD assay were 5.942, 6.339, 6.226 and 6.512 mmol x L(-1), respectively, when rosiglitazone, pioglitazone, compounds A and B were added to the insulin-resistant system. CONCLUSION: In vitro insulin-sensitizing activity of target compound A is in between that of rosiglitazone and pioglitazone, and activity of target compound B is slightly less than that of pioglitazone.

Enantioseparation of amino acid derivatives on an immobilized network polymer derived from L-tartaric acid.

Seven structurally related amino acid derivatives were successfully enantioseparated by HPLC with a commercially available column containing a chiral immobilized network polymer derived from L-tartaric acid. The experiments were carried out under normal-phase conditions. All the solutes could be baseline separated using n-hexane/2-propanol (95/5) as eluent at a flow rate of 1 ml/min at 25 degrees C, with reasonable retention time (<12 min). The effects of the polar alcohol modifier (type and content) in the mobile phase and the column temperature on the enantioseparation were studied. Apparent thermodynamic parameters were also calculated from the plots of ln alpha or ln k' versus 1/T. Some mechanistic aspects of chiral recognition were discussed with respect to the structures of the solutes. It was found that the enantioseparations are all enthalpy driven, and the N-acyl groups of the solutes have significant influence on the chiral recognition.

[18F-Fluorodeoxyglucose uptake in hepatocellular carcinoma on positron emission tomography correlates with alpha-fetoprotein].

OBJECTIVE: To investigate whether (18)F-fluorodexyglucose (FDG) uptake in the primary hepatocellular carcinoma (HCC) correlates with serum alpha-fetoprotein (AFP). METHODS: Forty-five patients with histologically confirmed HCC underwent whole-body (18)F-FDG PET examination. Standardized uptake value (SUV) and tumor-to-nontumor ratio of the SUV (SUVratio) were calculated, and the relationship between serum AFP and glucose metabolism in HCC was analyzed. RESULTS: Of the 45 cases, the primary tumor and metastatic lymph nodes were clearly displayed on PET images in 43 cases and the well-differentiated tumors were shown negative in the other 2 cases. A linear correlation of the AFP with SUV (r=0.426, P<0.05) and SUVratio (r=0.532, P<0.001) was noted. CONCLUSION: Serum AFP correlates significantly with both SUV and SUN ratio, indicating that AFP is involved in glucose metabolism and cell proliferation in HCC.

Clinical application of transarterial embolization for massive hemorrhage in the nasopharyngeal and maxillofacial regions.

OBJECTIVE: To study the effect and safety of transarterial embolization (TAE) in the management of massive hemorrhage in the nasopharyngeal and maxillofacial regions. METHODS: Forty-two cases of massive hemorrhage in the nasopharyngeal and maxillofacial regions were treated by TAE. Gelfoam particles, polyvinyl acohol particles, and metallic coil were used to for embolism of the external carotid artery, maxillary artery, facial artery, occipital artery, sphenopalatine artery and ascending pharyngeal artery respectively according to the angiographic findings and the region of hemorrhage sites. RESULTS: TAE was successfully performed in all the cases, and no recurrence or serious complications were observed in the 3 to 12-month follow-up. CONCLUSION: TAE is safe and effective in the treatment of massive hemorrhage in the nasopharyngeal and maxillofacial regions.

Value of angiography in the diagnosis of patients with small kidney.

OBJECTIVE: To explore the diagnostic value of angiography in small kidney patients. METHODS: Angiographies were performed in 32 patients with small kidney of unknown etiology or with suspected renal arterial stenosis (RAS). RESULTS: Twelve cases of renal atrophy due to RAS were diagnosed by angiography, which demonstrated renal artery stenoses or occlusions. Angiography of 17 patients with nephrogenic renal atrophy displayed homogeneous shrinkage of the renal arteries except in the ostium. In 3 patients with renal hypoplasia, angiography showed narrowed renal arteries and tiny renal arterial branches. CONCLUSION: Renal artery angiography is of important values in the differential diagnosis between renal atrophy due to RAS, nephrogenic renal atrophy and non-renovascular renal atrophy, and renal hypoplasia.

[Intravascular administration of pingyangmycin lipiodol emulsion for Klippel-Trenaunay syndrome: clinical analysis of 7 cases].

OBJECTIVE: To define the arteriographic features of Klippel-Trenaunay sydrome (KTS) and explore the feasibility of the treatment with intravascular administration of pingyangmycin lipiodol emulsion (PLE). METHODS: Seven patients with KTS underwent arteriography followed by therapy with PLE administration (containing pingyangmycin 8-16 mg and lipiodol 4-6 ml) into the trunk of the arteries of all impaired extremities. The therapeutic effect and postoperative complications were observed. RESULTS: Arteriography revealed abundant small branches of the runoff arteries, showing sinusoid changes of varied sizes in 5 cases by staining of the soft tissue. During the 3 to 30-month follow-up, swelling of the extremities was obviously improved in 5 cases after PLE therapy, which failed to produce obvious effect in 1 case and recurrence was detected in another. The major complications included paresthesia of the limbs, serum transaminase disorder and local skin necrosis. CONCLUSION: Arteriography can detect the lesions of the arteries and soft tissues in the affected extremity of patients with KTS, intravascular administration of PLE was effective to alleviate the hypertrophy of the limbs.

[Effect of pingyangmycin on the growth and cell cycle of human vascular endothelial cells].

OBJECTIVE: To study the effect of pingyangmycin (PYM, bleomycin A5) on the proliferation and cell cycle of the cultured ECV304 cells, a human umbilical vein endothelial cell (HUVEC) line. METHODS: The growth inhibition of PYM on ECV304 cells was measured by MTT assay and the changes in the cell cycle by flow cytometry. RESULTS: After 10 microg/ml PYM treatment of the cells for 24, 48, and 72 h, the inhibition rates were 44.7%, 59.7%, and 74.4% respectively, showing a dose- and time-dependent inhibitory effect, with the 50% inhibitory concentration (IC50) of PYM corresponding to treatment durations of 24, 48 and 72 h being 32.94, 2.56 and 0.75 microg/ml respectively. Flow cytometry showed that ECV304 cell cycle was arrested at G2-M phase after 24-hour treatment with 1 microg/ml PYM, with significant reduction in the cell ratio of S phase and increase of G2-M phase (P<0.01) CONCLUSION: PYM can effectively inhibit the proliferation of ECV304 cells, the mechanism of which might involve the blocking of cell cycle.

[DSA manifestation of primary hepatocellular carcinoma complicated by tumor thrombus in the inferior vena cava].

OBJECTIVE: To study the manifestations of the primary hepatocellular carcinoma (PHC) complicated by tumor thrombus (TT) in the inferior vena cava (IVC) in digital subtraction angiography (DSA) and to understand their clinical implications. METHODS: A retrospective study of the hepatic arterial angiography, the inferior vena cavography and the interventional treatment in 8 cases of PHC patients was conducted. RESULTS: Hepatic arterial-venous shunt, tumor thrombus in the hepatic veins and filling defect in the IVC were identified in 6 patients. The IVC TT presented obvious "strip signs" in DSA images. In 4 patients TT in the right atrium (RA) was found in connection with the IVC TT. Scattered lipiodol deposits were observed in the IVC TT, which decreased in volume in 4 patients after hepatic arterial chemoembolization. Five patients with TT in the IVC and blood backflow blockage received IVC stent implantation for alleviation of the symptoms. CONCLUSIONS: The blood supply of TT in IVC is derived from the hepatic artery, and computed tomography, magnetic resonance imaging and DSA all have superior diagnostic value for such TT. Transcatheter hepatic arterial chemoembolization and IVC stent implantation may constitute effective treatment modalities for PHC complicated by TT in the IVC.

[Diagnosis of lesions in the major abdominal blood vessels by three-dimensional dynamic contrast-enhanced magnetic resonance angiography].

OBJECTIVE: To elucidate the working principles of three-dimensional dynamic contrast-enhanced magnetic resonance angiography(3D DCE-MRA)and assess its value in the diagnosis of lesions in the major abdominal blood vessels. METHODS: The imaging data of 3D DCE-MRA and conventional MR examination in 32 cases of suspected major abdominal blood vessel diseases were obtained and analyzed retrospectively. RESULTS: The peak flow of contrast agents through the abdominal aorta at the level of renal artery occurred 17 to 23 s after the injections. Normal presentation was found in 3 cases, with clear images of the abdominal aorta and its branches. Abdominal aortic aneurysm was identified in 7 cases, where the involved segment of the aorta was irregularly broadened and the actual lumen of the abdominal aorta was displayed. Aortic dissection was found in 18 cases, and the intima, the double-lumen, and the position where the abdominal aortic branches originated could be seen with 12 entry sites and 16 re-entry sites. Atherosclerosis was found in 3 cases, with tortuous abdominal aorta whose lumen was morphologically irregular. One case was found with thrombosis in the left iliac vein which was not visualized. CONCLUSIONS: 3D DCE-MRA is a non-invasive alternative for conventional angiography and has significant importance in the diagnosis of lesions in major abdominal blood vessels.

Effect of dosage of anticancer agents during transcatheter arterial chemoembolization on T cell subsets in patients with hepatocellular carcinoma.

OBJECTIVE: To investigate the effects of the dosage of anticancer agents during transcatheter arterial chemoembolization (TACE) on the T cell subsets in patients with hepatocellular carcinoma (HCC). METHODS: Thirty-six patients with unresectable HCC were randomly divided into 2 groups to receive superselective TACE. Patients in group A (n=18) received low-dose (2-4 mg) mitomycin C (MMC) as the anticancer drug when the tumor was less than 5 cm in diameter; when the tumor ranged from 5 and 8 cm in diameter, 4-6 mg MMC along with 10 mg epirubicin (EPI) was given, and in cases of even larger tumors, 6-8 mg MMC, 10 mg EPI and 100 mg CBP were prescribed. Conventional chemotherapy regimen constituted by 10 mg MMC, 40 mg PI and 300 mg CBP was adopted in group B (n=18). The peripheral blood T cell subsets including CD3(+), CD4(+), CD8(+), NK, CD4(+)/CD8(+) ratio, CD4(+)CD45(+), CD4(+)CD29(+), CD8(+)CD28(+) and CD8(+)CD28- were measured by flow cytometry in both groups before and one week after treatment. RESULTS: The T cell subsets were comparable in the 2 groups before the treatment. After TACE, no significant changes occurred in CD3(+), CD4(+), CD8(+), NK, CD4(+)/CD8(+), CD4(+)CD29(+) or CD8(+)CD28- cells in group A, while significant decrease in CD4(+)CD45(+) and increase in CD8(+)CD28(+) cells were observed (P<0.05 and P<0.001, respectively). In group B, CD4(+) and CD4(+)CD29(+) levels, together with CD4(+)/CD8(+) ratio, were significantly lower than those before treatment (P<0.05), but CD8(+) and CD8(+)CD28- subsets were significantly higher (P<0.05). CONCLUSIONS: The cellular immune function of HCC patients is significantly impaired by anticancer drugs for TACE at conventional dose, while low-dose of the drugs may enhance the cellular immune function.