Abstract:To study methods of salvage therapy for acute lower extremity(ALEI) ischemia. Methods:A restrospectively analyzsis was made on the clinical data of 96 patients with consecutive 106 ALEI limbs. In which Fogarty catheter embolectomy was used as the initial treatment for ALEI in a regular operating room or in an intervention therapy room under DSA monitoring,and graft bypass after embolectomy was performed on 8 cases(12 limbs). Results:In 70 cases(75 limbs) successful embolectomy of the iliac，femoral，popliteal and tibial artery was achieved. In 11 cases(12 limbs) embolectomy at distal to the popliteal artery was unsuccessful. Eight cases(12 limbs) with obstruction proximal to the femoral artery were treated by axillofemoral bypass in 4 cases, and femorofemoral bypass in 4 cases. One case of thoracoabdominal aortic dissection aneurysm and lower extremity ischemia had fenestration of the abdominal aoric dissection. Proximal embolectomy and distal amputation was performed in 6 cases. Fimally, 76(79.2%) cases had salvaged limbs,11(11.4%) patients had amputated limbs, and 9(9.4%) patients died. Seventy-six patients(85 limbs) were followed up for 1 to 38 months, 7 cases(7 limbs) were reoperated on because of recurrent embolism. Conclusions:Embolectomy is the effective treatment method for ALEI. Embolectomy under DSA monitoring can improve therapeutic results. The prognosis lies on the duration and extent of ischemia, and management of complications.

Abstract:Abstract:Objective:To study the treatment of multilevel atherosclerotic occlusive disease of the lower extremity. Methods:From March 2004 to January 2006，intraoperative iliac balloon angioplasty and stenting combined with simultaneous vascular bypass and profundoplasty were performed on 24 limbs in 21 patients suffering from lower extremity multilevel atherosclerotic occlusive disease. In 24 limbs iliac balloon angioplasty and stent placement were performed with simultaneous profundoplasty in 12 limbs and femoro-popliteal bypass in 14 limbs. Results:Surgical procedures were technically successful in all patients. There were no severe postoperative morbidity or mortality. Before-operative vs postoperative ABI was 0.24±0.13 vs 0.63±0.18(P<0.05) . The mean following-up period was 13 months (range of 1 to 23 months). Follow-up observations found that none of the patients had rest pain, but four patients had intermittent claudication, 3 of them received autologous bone stem cell transplantation 3 months after the operation and the claudication markedly improved. Conclusions:Simultaneous intravascular interventional therapy combined with vascular bypass and profundoplasty are effective in the treatment of patients with severe and multilevel atherosclerotic occlusive diseasis of the lower extremity. The operation is less traumatic and the procedures are easy to do. The operative method is flexible and is especially suitable for high risk patients.

Abstract:Abstract:Objective:To discuss the manifestations,diagnosis and management of acute superior mesenteric artery embolism. Methods:The clinical data of 22 cases of acute superior mesenteric artery embolism admitted in our hospital in recent 10 years were analyzed retrospectively. Results:The preoperative diagnostic rate was 77.3%. Among them, 2 cases who refused operation died（100%）; 20 cases were subjected to operation, in whom 5 cases underwent simple resection of necrotic bowel and 3 of them died（60%）,while 15 cases were subjected to resection of necrotic bowel after removal of the embolus and 5 of them died（33.3%）.The overall mortality was rate 45.5%. Conclusions:Acute superior mesenteric artery embolism should be suspected in every patient with sudden abdominal pain,especially in those who have organic cardiac disease. CTA is an effective method for diagnosis of acute superior mesenteric embolism. Early diagnosis and prompt embolectomy are the key points to improve the therapeutic effects.

Abstract:Abstract:Objective:To study the management of vascular injury. Methods:Retrospective analysis was made on the clinical data of 59 cases of vascular injury, including 55 cases of vascular injury in neck and extremity and 4 cases of portal vein and vena cava injury. Among them, 21 cases had femoral artery injury with infection and 4 cases had vascular injury due to intervention therapy. All patients with vascular wound of extremity or neck had undergone hemostasis by compression and antishock treament before hospital admission. All cases of femoral artery injury with infection underwent hemostasis by arterial ligation and incision and drainage of abscess. Vascular anastomosis was performed in 11 cases, vascular grafting in 12 cases, and vascular repair in 14 cases. Results:There were 2 deaths. 5 cases had amputation(including a case of femoral embolism due to intervention trerapy). Postoperative intermittent claudication, decreased skin temperature and other signs of ischemia occurred in 21 cases of femoral artery injury with infection, but none developed limb gangrene. The other cases were discharged in good health. Conclusions:In the treatment of vascular injury, wound hemostasis and antishock treatment should be done first to save the patient′s life and the management of the vascular injury depends on the situation, with the aim to try by all means to save the extremity.Vascular reconstruction is the main method for treatment of vassular injury. Vascular ligation can be done in cases of femoral artery injury with infection.

Abstract:Abstract:Objective:To evaluate the compositive methods of endovenous treatment with laser in the treatment of superficial varicosities in lower extremities individually. Methods:Two hundred ninty-five limbs in 285 patients with chronic venons insufficiency were studied. According to the clinical manifestations, ultrasound and venography and using the clinical-etiology-anatomy-pathophysiology(CEAP) classification of chronic venous insufficiency, the patients were grouped A,B and C. Three surgical strategies were used. Group A:Simple endovenous laser therapy(129 limbs, 43.72%). Group B: Endovenous laser therapy combined with punctate ligation(143 limbs, 48.47%). Group C: Endovenous laser therapy combined with external banding valvuloplasty of superficial femoral vein and punctate ligation(23 limbs, 7.8%). Results:The cirsoid superficial vein disappeared in all the groups. The color of the skin became lighter, and swelling was reduced. The ulcers healed or shrunk in size. Conclusions:Endovenous laser treatment(EVLT) is an effective minitraumatic operation for treatment of varicosities of lower extremities. The use of EVLT combined with other surgical procedures is effective treatment for primary deep venous valvalar insufficiency.

Abstract:Abstract:Objective:To assess the effect of anticoagulant drugs,elastic compression stockings(ECS)and Daflon on the prevetion of the post-thrombotic syndrome (PTS). Methods:Fifty-eight deep venous thrombosis(DVT) patients were divided into control group and treatment group I and II. The control group (n=15) did not take anticoagulant drugs or the time of anticoagulant drug administration was less than 1 month, and the use of (ECS) was less than 3 months. The treatment group I(n=24) took warfarin for 6 months and the ECS were used in the follow-up time; the treatment group II(n=19), besides warfarin therapy and ECS, took Daflon for 12 months. All the patients were followed up, the general conditions were assessed with clinical score, and the therapeatic results of the 3 groups were assessed. Results:The rate of PTS occurrence in control group was significantly higher than that in treatment group 1 and treatment group 2. At 6 months, the clinical score of treatment groups 1 and 2 was significantly lower than that of control group. At 1 and 1.5 years after discharge, the clinical score of treatment group 2 was significantly lower than that of treatment group 1.Conclusions:The long-term comprehensive and systemic therapy (including warfarin, ECS and daflon) for DVT could prevent PTS.

Abstract:Abstract:Objective:To evaluate the effect of subfascial endoscopic perforator surgery (SEPS) for the treatment of recurrent venous ulcer. Methods:SEPS Was preformed on 56 limbs with recurrent venous ulcer, and ulcer healing was assessed at follow up. Results:Fifty-five limb ulcers healed in 10～49 days,one limb ulcer was not healed after 90 days, but healed after ligation of lesser saphenous vein. The patients were followed up for 1 to 3 years, 1 case recurred after 6 months and it healed with antibiotic treatment; 2 cases recurred after 18 months, and both healed after high ligation of lesser saphenous vein. Conclusions:SEPS is effective and safe in the treatment of recurrent venous ulcer. SEPS is minitraumatic with few complications.

Abstract:Abstract:Objective:To study the depressant effect of atorvastatin on arteriosclerosis of aortic allograft in rats. Methods:The models of abdominal aorta transplantation were established in rats with the use of micro-surgery. The recipients were divided into three groups:allograft control group, allograft experimental group and isograft control group. After 60 days of transplant, vascular intimal thickness(VIT) in all of the groups was observed by histological examination. The expression of PCNA and α-SMA was determined by immunohistochemistry. Results:The degree of VIT in rats of the allograft experimental group was lower than that in the allograft control group; the VIT area ratio in the allograft control group, allograft experimental group and isograft control group was （12.40±2.65）%, （5.20±6.35）%, and （1.2±1.10）%, respectively, A statistical difference between these groups was observed (P<0.05). The expression level of PCNA was lower in allograft experimental group (5.40±0.80)% than that in allograft control group (17.20±1.65)%(P<0.05). Conclusions:The expression of PCNA in the transplant aorta and the arteriosclerosis of aortic allograft could be suppressed by atorvastatin.

Abstract:Abstract:Objective:To investigate the effect of early inflamation on the efficacy of gene(LacZ gene) transfer to vein graft by adenovirus vector.Methods:The liquid containing adenovirus vector was infused through external carotid vein and the segment of carotid vein was resected. The veins were inflated naturally. After 30min incubation, the veins were transplanted into carotid artery in experimental group, and the circulation was restored in control group. The veins with transferred gene were collected on day 3,day 14 and day 21. The mark gene expression in the veins was studied with X-Gal stain and activities of β-galactase were measured. ICAM-1 and VCAM-1 expressions were observed by immunohistochemistry stain in transgenic veins.Results:The activities of β-galactase in mark gene expressed for 14 days was decreased and in 21 day nearly disappearred. VCAM-1 and ICAM-1 expression upregulated after day 3 in transplanted veins and there was leucocyte infiltration and shedding of endothelial cells with endothelial disruption. On the other hand, there was no expression of VCAM-1 and ICAM-1 in control group veins and integrity of endothelium was intact. The positive ECs expressed mark gene was obviously reduced in transplanted veins compared to control group. But the number of positive SMCs were not significently different between to two groups.Conclusions:The inflammation of vein grafts in early stage of transplantation may be the cause of endotheliocyte damage and is related to rapid depression of gene expression.

Abstract:Abstract:Objective:To study the effect of imbalance of proliferation and apoptosis in the development of colorectal carcinoma(CRC)，and the molecular mechanism of the dynamic change.Methods:ORC was induced with dimethylhydrazine(DMH) in male mice of Kimming strain. The mice were killed in batches in the 12th，18th and 24th weeks of carcinoma induction. The distribution and extent of proliferation and apoptosis of the colorectal mucosa, at various intervals, were dynamically observed. Three genes,p21waf1,Bax and Gadd45 were analyzed by RT-PCR, immunohistochemistry and Western blot. Results:During the course of carcinoma induction,the mucosas of the model mice showed sequential changes of atypital hyperplasia，adenoma，and carcinoma. Compared with control group, the PCNA expression of the model group mice was significantly higher（P<0.01）; and the expression was also progressively increased from normal mucosaatypital hyperplasiaadenomacarcinoma（P<0.01）.The highest PCNA expression was observed in cancer.Meanwhile, the ratio of proliferation to apoptosis also progressively increased(P<0.01). The three genes , p21waf1，GADD45 and Bax were increased during the mucosa development from normal mucosa to adenoma,whereas their expression was very weak in cancer.Conclusions:During the mice colon carcinogenesis induced by DMH, the colorectal mucosa appears to be in a disequilibrium of proliferation and apoptosis; colon carcinogenesis is related to the 3 suppressor genes, p21waf1, GADD45 and Bax.

Abstract:Abstract:Objective:To prepare the carboplatin-Fe@C nanocage-loaded chitosan nanoparticles (C-Fe@CN-CN), and observe the inhibitive effect on the proliferation of human hepatoma cell line HepG2 in vitro. Methods:The C-Fe@CN-CN were prepared by the reverse microemulsion method and the character and drug release in vitro were observed. The inhibitive effect on the proliferation of the HepG2 cell was measured by MTT colorimetry, IC50 was calculated and the growth curve of HepG2 cell was drawn. Results:C-Fe@CN-CN were in good spherical shape. The average size was 207nm±21nm with narrow distribution. The drug content was 11.40±1.31%. After a fast release during the first day, a more gradual drug release was sustained for another 4 days. C-Fe@CN-CN could apparently inhibit the proliferation of HepG2 cell in the dose-dependent and time-dependent manner. The inhibitive effect of C-Fe@CN-CN at 24 hours was lower than that of original carboplatin, and was equal to original carboplatin at 48 hours and 72 hours. IC50 of C-Fe@CN-CN at 24h, 48h and 72h was 135μg/ml, 18.84μg/ml and 6.09μg/ml respectively. Bland nanoparticles had no cytotoxicity on HepG2 cell. Conclusions:C-Fe@CN-CN possess strong magnetic responsivity, drug controlled releasing performance and the potential abilities of long circulation and permeation in tumor tissue. C-Fe@CN-CN can effectively inhibit the proliferation of HepG2 cell, and the blank nanoparticles express favourable biocompatibility in vitro.

Abstract:Abstract:Objective:To investigate the effect of cyclooxygenase-2 inhibitor Celebrex on the growth of gallbladder carcinoma GBC-SD cell line. Methods:Cell growth suppression was counted by MTT method. Apoptotic index(AI) was evaluated by TUNEL staining. The apoptotic rate was counted by flow cytometry(FCM), fluorescence microscopy(FM) and transmission electron microscopy(TEM). Results:Celebrex inhibiting the growth of GBC-SD cell line was dose-depend. The growth inhibition rate with 40μmol/L,80μmol/L,120μmol/L and 160μmol/L was 18.77%,25.32%,46.58% and 52.19% respectively,（P<0.01）.Apoptotic rate of GBC-SD cell with 40μmol/L,80μmol/L,120μmol/L and 160μmol/L Celebrex was (8.51±1.44)%,(12.40±0.87)%,(26.37±1.72)% and (43.21±0.39)% respectively, and was significant difference in relation to the control group (4.87±0.55)%. Apoptotic bodies and cell shrinkage and fragmentation was observed by FM and TEM. Conclusions:Celebrex can effectively inhibit the growth of gallbladder carcinoma GBC-SD cell line, and induce the apoptosis.

Abstract:Abstract:Objective:To evaluate the diagnosis and management of acute mesenteric venous thrombosis (AMVT). Methods:A retrospective analysis was made on the clinical data of 22 patients with AMVT treated from October 1990 to September 2004. Among them, 16 cases were diagnosed before operation by CT and ultrasounography, and 6 cases during laparotomy. Sixteen patients underwent surgical operation and 6 patients received interventional thromblytic therapy (4 cases were treated by superior mesenteric artery thrombolysis with urokinase and the other 2 patients underwent percutaneous transhepatic removal of supeior mesenteric vein thrombus). Results:The 6 patients who received interventional therapy were all cured successfully. After operation, 3 patients died from toxic shock and 1 patient died from multiple organ failure in the 16 operated patients. Conclusions:The most important of all to the prognosis of AMVT is diagnosis and management in its early stage. The best management for the necrotic bowel type of AMVT is operative resection. During the operation injection of methylene blue is of some value to determine the extent of bowel necrosis. For patients with non-necrotic AMVT interventional therapy is of value.

Abstract:Abstract:Objective:To discuss the clinical value of D-dimer(DD) testing in diagnosis of patients with deep vein thrombosis(DVT) of the lower extremity. Methods:An analysis retrospectively was made on the changes of DD testing in 106 cases of DVT at different periods after onset and different clinical stages of DVT, and DD testing in 99 patients with primary deep venous insufficiency(PDVI) as control group. Results:DD was higher in the acute stage of DVT, and gradually decreased with time in chronic DVT, and was negative in the patients with PDVI; the positive rate was up to 85.7% in the distal DVT. Conclusions:The DD testing can be used as one of the methods for diagnosis, prediction and prognosis of acute DVT，especially for diagnosis of distal DVT.

Abstract:Abstract:Objective:To study the surgical managements for obstructive coleratal carcinoma(OCRC). Methods:Clinical data of 126 patients with OCRC who underwent surgical treatment between January 1995 and December 2004 were reviewed. Results:Thirty-five patients received one-stage right hemicolectomy, ten patients received one-stage resection of transverse colon. forty-eight patients received one-stage left hemicolectomy, eighteen patients received one-stage resection of left colon or proximal rectum with colostomy followed by two-staged anastomosis. For 15 patients with unresectable lesions, colostomy of transverse colon or sigmoid colon was performed. Seventeen patients (13.5%) experienced postoperative complications. The operative mortality was 4.8%(6/126). The 1-year, 3-year and 5-year overall survival rate was 95.1%, 52.7% and 38.1%, respectively. Conclusions:Proper perioperative period managements and selection of surgical techniques are important for better results and lower complications in the treatment OCRC.