Risk factors of neurologic complications after surgical resection of carotid body tumor / 中华普通外科杂志

Objective:To investigate risk factors of nerve injury after carotid body tumor resection.Methods:From 1991 to 2016, the clinical data of patients with neurologic complications after resection of carotid body tumor was retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors of nerve injury.Results:A total of 132 patients with 142 tumors underwent surgery. 45 patients (46 sides) suffered nerve injury, including 4 strokes and 44 nerve injuries. After active rehabilitation, 18 cases were left with permanent nerve injury, and the 4 patients with strokes regained self-care ability. By multivariate regression analysis, high-lying tumors ( OR=4.345, P=0.005), Shamblin Ⅲ tumor ( OR=4.382, P=0.047) increase the risks of postoperative nerve injury. Resection of high-lying tumors carried a higher risk of developing permanent nerve injury ( OR=7.290, P=0.001). Conclusions:Neurologic complication could be alleviated by rehabilitation. Intraoperative abrupt rupture of carotid artery is the leading cause of stroke. Shamblin Ⅲ and high-lying tumor are the predictors of postoperative nerve injury.

Interference of IP-10 expression inhibits vascular smooth muscle cell proliferation and intimal hyperplasia in carotid artery: a new insight in the prevention of restenosis.

After vascular angioplasty, vascular smooth muscle cell (VSMC) proliferation causes atherosclerosis and intimal hyperplasia leading to restenosis. Interferon-γ-inducible protein (IP)-10 plays a role in atherogenesis, but the mechanism remains unclear. We evaluated the role of IP-10 in intimal hyperplasia and restenosis. IP-10 expression was determined in arterial specimens from 20 arteriosclerotic obliteration patients and 6 healthy individuals. VSMCs were stimulated in vitro with IFN-γ and transfected with IP-10 siRNA. Silencing was verified with RT-PCR/Western blot; cell proliferation rate was detected by methyl-thiazol-tetrazolium. The carotid artery model of atherosclerosis injury was established with IP-10 siRNA. IP-10 expression was detected at 1 and 4 weeks using RT-PCR and immunohistochemistry. Artery morphology was assessed with hematoxylin-and-eosin staining, and intimal hyperplasia was evaluated by electron microscopy. IP-10 was overexpressed in arteriosclerotic obliteration group compared with control group (P < 0.05). IP-10 expression in transfected group was significantly lower than in untransfected group. The intima-to-media ratio of transfected group at 4 weeks was lower than that of untransfected group (P < 0.01). The transfected group exhibited more regular intimal structure and less hyperplasia under electron microscopy. We, therefore, concluded that IP-10 played an important role in intimal hyperplasia as siRNA-mediated IP-10 silencing inhibited aberrant VSMCs hyperplasia and reduced restenosis.

Screening and cloning of genes related to varicose great saphenous vein accompanying with primary deep vein valve insufficiency / 中华外科杂志

<p><b>OBJECTIVE</b>To screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency.</p><p><b>METHODS</b>Using mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins.</p><p><b>RESULTS</b>Altogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene).</p><p><b>CONCLUSION</b>C(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.</p>

Subfascial endoscopic perforator surgery for severe chronic venous insufficiency of the lower extremities / 中国普通外科杂志

Objective To sum up clinical experience on subfascial endoscopic perforator surgery (SEPS) for the treatment of severe chronic venous insufficiency (CVI) of the lower extremities. Methods Fifty-one patients (64 limbs) with severe CVI received SEPS from Nov. 1999 to Aug.2002. CEAP classification, scoring of venous dysfunction (SVD), Color Doppler, Color Doppler velocity profile (CDVP), venography and air plethysmography (APG) were applied to assess the status of the affected limbs before and after operation. Results The postoperative follow-up was made from 3 to 35 months with the follow-up rate of 90.6% (58/64 limbs). No limbs suffered from recurrent superficial varicose. Venous ulcer was healed in 40 limbs (97.6%) and the ulcer ameliorated significantly in one limb. Ulcer healing time ranged from 9 to 91 days with the average time of (32?5) days. The average SVD was (13.9?1.7) preoperatively , while (6.4?0.8)postoperatively ( P

Air plethysmography in diagnosing deep venous valvular insufficiency of lower limbs / 中国普通外科杂志

Objective To study the diagnostic value of air plethysmography (APG) in deep venous valvular incompetence of lower limbs and the relationship between deep venous reflux and calf muscular pump function. Methods Sixty-five varicose cases (89 limbs) were detected by APG in alterations of venous filling index (VFI), ejection fraction(EF), residual volume fraction(RVF) and outflow fraction(OF). Of 89 limbs, 18 limbs were in GradeⅠ of deep venous reflux, 24 in Grade Ⅱ, 18 in Grade Ⅲ and 12 in Grade Ⅳ. Integrated vectors analysis (Hotelling T 2test) was done with these index. Venography was performed in all patients. Results There were statistical differences in VFI between each two Grades of deep venous reflux except for between Grade Ⅰ and Ⅱ. There were also statistical differences in EF,RVF and OF between Grade Ⅳ and the other Grades. Hotelling T 2test showed significant testing efficiency of APG. ConclusionsDeep venous valvular insufficiency of lower limbs can be assessed by APG. VFI is a reliable quantitative index for evaluating the degree of deep venous reflux. There may be an exponent relation between deep venous reflux and calf muscular pump function.

Hemodynamic changes after external valvuloplasty of the superficial femoral vein / 中国普通外科杂志

ObjectiveTo analyze the effect of external valvuloplasty of the superficial femoral vein for primary deep venous valvular incompetence in the lower limbs (PDVI). Methods Consecutive seventy four cases(96 limbs) of PDVI were enrolled for prospective study, and color Doppler velocity profile technology and APG were performed preoperatively, the first month, the third month and the first year postoperatively. Results Postoperative venous reflux volume, VFI and score of venous dysfunction significantly decreased ( P

Diagnosis and treatment of acute occlusion of abdominal aorta / 中国普通外科杂志

Objective To study the etiology, diagnosis and treatment of acute occlusion of abdominal aorta(AOAA). Methods Clinical data of 35 patients with AOAA admitted to our hospital from January 1980 to August 2001 were analyzed retrospectively. Results There were 17 patients with acute aortic embolism(AAE) and 18 patients with acute aortic thrombosis(AAT) . All cases had total occlusion of abdominal aorta,and bilateral iliac arteries were involved. All the 35 cases underwent operations, including bilateral transfemoral thromboembolectomy by Fogarty balloon catheter in 18 cases, thromboembolectomy via laparotomy aortotomy in 11 cases, aortobiiliac reconstruction in 2 cases, aortobifemoral bypass in 2 ( 1 had profundaplasty) and axillobifemoral bypass in other 2 cases. Operative mortality was 25.7%(9/35). After the operations, artery embolism recurred in 3 cases; 3 patients required amputation; renal failure occurred in 3 cases and paraplegia in 4; ischemic colitis occurred in 5, impaired sexuality in 1 and incomplete intestinal obstruction in 1. Conclusions AOAA is an urgent disease with high mortality. Fast preoperative diagnosis and prompt operation are the keys to salvage the patient. Color Doppler is the first choice of diagnosis. Fogarty balloon catheter thromboembolectomy and vascular reconstruction are effective treatments for this disease.

Venohemodynamics after superficial vein and calf perforating vein surgery / 中国普通外科杂志

Objective To assess the role of superficial vein and calf perforating vein in chronic venous insufficiency of lower limbs. Methods Consecutive seventy-five cases (78 limbs) of slight PDVI ( I? -Ⅱ?) were evaluated. Venous hemodynamics were detected by color duplex, color Doppler velocity profile technology and APG preoperatively, in the first month, the third month and the first year postoperatively. Data were statistically analyzed. Results Symptoms and signs disappeared in 88. 5% (69/78) limbs. The ulcer-healing rate was 92. 8% ( 13/14). The postoperative VFI at each check-point significantly decreased than that before operation (P0.01). Conclusions Superficial venous reflux can be effectively broken up by the operations. Venous stasis on calf effectively decreased by subfascial endoscopic perforator surgery (SEPS). But neither of the two procedures greatly improve the hemodynamic status of deep vein.

Unconfirmed thyroid cancer of intraoperative frozen-section pathology:strategy and analysis of curative effect / 中国普通外科杂志

Objective To study the management and curative effect of the thyroid cancer suspected clinically but with inconclusive frozen-section intraoperatively. Methods The clinical data of 29 consecutive cases of thyroid cancer suspected clinically but with inconclusive frozen-section intraoperatively admitted to our hospital during Jan 1980 to Dec 1999 were analyzed retrospectively. Results Among these 31 suspected patients 29 were negative on frozen-section but confirmed thyroid cancer on postoperative paraffin-section. 20 underwent total involved lobe thyroidectomy in one-stage and other 11 as a second stage. No case recurred or metastased in the follow-up. Complication incidence was significantly different between one-stage and two-stage procedure (P

Diagnosis and treatment of occult thyroid cancer with metastasis / 中国普通外科杂志

Objective To study the diagnosis and treatment of occult thyroid cancer with metastasis. Methods The clinical data of 18 cases of occult thyroid cancer with metastasis were analyzed retrospectively . Results All cases underwent operations. No death occurred during the operation and hospitalization .Postoperative metastasis occurred in 5 cases(27.8%). There was significant difference between the patients with metastasis and the other 100 patients without metastasis(P

Effect of apoptosis in the pathogenesis of the great saphenous varicose result ing from primary deep venous insufficiency / 中国普通外科杂志

ObjectiveTo study the effect of apoptosis in the p athogenesis of great saphenous varicose(GSV) resulting from primary deep ven ous insufficiency (PDVI). Methods Apoptosis and Bcl-2 expres sion in the segment of first valve sinus of the GSV of PDVI of lower limbs w ere detected by transmission electron microscopy(TEM), agarose gel electrophore sis, TUNEL and immunohistochemistry. ResultsThere were 38 case s of PDVLs in experment group and 5 normal GSV in control group. In experiment group,the apoptosis cells(AC) (6.30? 2.70 )and apoptosis rate (AR)(0.42?2 .12) in the first valve sinus of GSV were significantly higher than those in control group(1.60?0.81,0.21?1.10,respectively)(all P