Abstract:

Objective：To explore the methods for diagnosis and treatment of tumors at bifurcation of carotid artery. 
Methods：We retrospectively analyzed the clinical data of 11 cases of tumors at bifurcation of carotid artery who admitted in our hospital from February 2004 to November 2007. 
Results：Seven of the 11 cases were carotid body tumors of which six underwent operation and one case refused surgical treatment. The other 4 cases were neurinoma and underwent operation. All of the 10 operated patients had total tumor resection; 2 of them had reconstruction of carotid artery using great saphenous vein graft.  Six operated patients were followed up for 0.5-6 years, the results were good.
Conclusions：Exact diagnosis of tumors at bifurcation of carotid artery, especially the differential diagnosis of carotid body tumor and neurinoma, is diffecult. A clear understanding of the relationship between the tumor and the blood vessels and the condition of Willis circle is necessary before operation, and equally important is ensuring the blood supply from internal carotid artery and protecting nerves during the procedure of the operation.

Abstract:

Objective：To assess the use and outcomes of chimney grafts inserting into the left carotid artery in endovascular repair of aortic dissection.
Methods：The clinical data of 8 patients with aortic dissection ［7 male, 1 female with average age (47.25±15.35) (29-71) years］ hospitalised in our hospital from June 2009 to February 2010 were analysed retrospectively. They all suffered from aortic dissection that did not have adequate proximal zone for sealing the stent the stent. These patients were managed by endovascular repair combined with placement of chimney grafts to restore flow of the aortic branches which were intentionally covered. Follow-up examinations was made by spiral computer tomography.
Results：All the 8 operations were clinically successful after treatment, and no patient died in the perioperative period. Type II endoleaks occurred in 2 patients, but one disappeared in 2 weeks, while one persisted but decreased in size at 5 months postoperatively. During the follow-up of 2-10 months postoperatively, spiral CT showed patency of all stent-grafts, enlargement of true lumen and compression of false lumen. No other complications occurred.
Conclusions：Endovascular repair combined with protecting aortic branches by chimney grafts for aortic dissection with inadequate proximal sealing zones  seems promising at short-term follow-up. More cases and data are needed to evaluate the safety and efficiency of this technique.

Abstract:

Objective：To investigate the diagnosis and treatment methods of ruptured femoral artery psudoaneurysm caused by drug injection.
Methods：A retrospective analysis of the clinical data of 22 cases of ruptured femoral artery false psudoaneurysm caused by drug injection and treated from March 2003 to February 2009 was conducted. 
Results：All patients underwent operation. After excision of the aneurysm and debridement, 8 cases had repair of the femoral artery rupture, 4 cases were additionally treated by proximal and distal ligation of femoral artery, and 10 had proximal and distal ligation of the ruptured artary and prosthetic interposition graft between external iliac and femoral arteries. The  lower extremities of all the patients were successfully saved. During 6 months to 7 years follow up, 1 patient occurred graft infection, 1 had vassel anastomrostic bleeding, both were cured by reoperation; and 2 cases of argery ligation had mild intermittent claudication.
Conclusions：Excision of pseudoaneurysm, local debridement and repair of the rupture is the simplest and safest method to treat rupture of femoral artery pseudoaneurysm. Prosthetic graft is an effective operation to maximally save the blood supply for the affected extremity. Ligation of the femoral artery is also an effective and safe method to cure the disease in selected patients.

Abstract:

Objective：To study the outcome of endovascular therapy alone or combined prosthetic bypass surgery for  arteriosclerosis obliterans of lower limbs.
Methods：The clinical data of 48 patients with arteriosclerosis obliterans, multiple levels of stenosis and postoperative arterial reocclusion were retrospectively andayzed.
Results：Endovascular therapy  alone was performed in 24 cases, including balloon dialation in 4 patients and plus stent in 20 patients; and combined with prosthetic bypass graft  in 24 patients.  In 48 patients,rest pain disappeared and the ulcers healed after the operation, and  ABI increased gradually after treatment(P＜0.01). Forty-six patients had regular follow-up for 3 months to 82 months, of whom 43 cases had no recurrence.
Conclusions：Endovascular therapy alone or combined with surgical treatment is a feasible,safe and effective choice for arteriosclerosis obliterans of lower limbs, and with a low complication rate and quick recovery.

Abstract:

Objective：To investigate the clinical features, diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD).
Methods：The clinical data of 9 cases of SISMAD admitted in our hospital between January 2006 and March 2010 were retrospectively analyzed. Acute abdominal pain occurred in 8 cases and one case was symptomless. 
Results：Conservative treatments were performed in 2 cases and interventional self-expanding stents were implanted in 4 cases; and operation was performed on 3 cases, in one of them, an aortomesenteric bypass was done, and the other 2 cases underwent endarterectomy and patch plasty of superior mensenteric artery. Eight cases recovered satisfactorily from the procedure with resolution of the abdominal pain in 3 days postoperatively.  One month to 51 months of follow-up showed that no recurrence of abdominal discomfort in any of the cases. Contrast-enhanced CT examination showed superior mesenteric arteries were patent and with no marked aneurysmal dilatations. 
Conclusions：One should be vigilant of the potential patients with spontaneous isolated superior mesenteric artery dissection, and institute appropriate management based on the actual condition of the patient.

Abstract:

Objective：To evaluate the clinical application  of transcatheter thrombolytic therapy combined with percutaneous transluminal angioplasty in the treatment of Budd-Chiari Syndrome complicated with inferior vena cava thrombosis or lower extremity venous thrombosis.
Methods：Stenosis and occlusion of supra-hepatic inferior vena cava (IVC) accompanied by inferior vena cava thrombosis, or accompanied by unilateral or bilateral lower extremity deep venous thrombosis, were detected by angiography in 29 patients.  All patients received transcatheter thrombolytic therapy through popliteal vein, and 25 of them received secondary balloon angioplasty and stent implantation.
Results：After treatment, the thrombosis resolved or was markedly alleviated with patency of the vein in 18 cases, of which, 6 cases were simply treated with balloon angioplasty and 12 cases were treated with balloon angioplasty and stent implantation. However, after thrombolytic therapy,widespread old thrombosis was found in 9 cases, of which 7 cases were apparently alleviated after endovascular treatment. In 2 cases with significant bleeding tendency, the treatment was suspended, so the obstruction area was still extensive, but without pulmonary embolism. During an average follow-up of 31 months (range from 2 to 72 months), 21 cases had apparent amelioration of clinical symptoms and signs, 2 cases relapsed after earlier apparent relief and 2 cases were not relieved. The overall effective rate was 84.0%.
Conclusions：Transcatheter thrombolytic therapy via popliteal vein for Budd- Chiari Syndrome complicated with thrombosis of inferior vena cava or the lower limbs veins is more effective than systemic thrombolytic administration, and the subsequent interventional therapy is minimally invasive and effective. So this method can be considered as routine treatment for such disorders.

Abstract:

Objective：To evaluate the efficacy and safety of catheter-directed thrombolysis （CDT）compared with traditional treatment（Anticoagulant alone  AC）for early（pristine） iliofemoral venous thrombosis (IFVT).
Methods：We searched MEDLINE(OVID,1990 to June 2010), EMBASE(1990 to June 2010),Cochrane Central Register of Controlled Trials(1991 to June 2010), PubMed(1990 to June 2010), Chinese Biomedical Literature Database(CBM), Chinese Scientific Journal, Full-text Database(CSJD), and Chinese Journal Full-text Database(CJFD), added with handsearching and other retrievals. The Cochrane Collaboration′s RevMan 5.0.18 was used for meta-analyses.
Results：Only two randomized controlled trials were available and were included in the study. Meta-analysis showed that 6 months after treatment, iliofemoral vein patency rate of CDT group was higher than that of AC group［45/68 vs. 21/70，OR=4.47，95% CI（2.19,9.12），P<0.0001］, the iliofemoral vein occlusion and (or) venous reflux rate of CDT group was less than that of AC group ［12/68 vs. 33/70，OR=0.24，95% CI（0.11，0.53），P=0.004］. Major complications of CDT group compared to those of AC group were not statistically significant ［2/68 vs. 1/70，OR=1.53，95% CI（0.25，9.24），P=0.65］, but the minor complications and total complications of CDT group were higher than those of AC group, ［11/68 vs. 2/70，OR=5.48，95% CI（1.33，22.51），P=0.02］ and ［13/68 vs. 3/70，OR=3.55，95% CI（1.20,10.45），P=0.02］.
Conclusions：CDT is a positively effective way to treat early IFVT. Application of CDT in patients without contraindications to its use can have good therapeutic effect.

Abstract:

Objective：To study the method and effect of  thrombolytic therapy for deep venous thrombosis (DVT).
Methods：We performed a retrospective analysis of the clinical data of 146 DVT cases,which were grouped into acute (0-7 d, n=40), sub-acute  (8-30 d, n=70) and chronic  (>3 d, n=36) series according to their course of disease. Statistical analysis was used to analyze the data including femoral vein peek velocity/diameter changes, popliteal vein peek velocity/diameter changes and circumference changes in the thigh and calf before and after treatment.
Results：Femoral and popliteal vein peek velocity increased after thrombolytic therapy.  On the other hand, femoral and popliteal vein diameter, along with circumference in the thigh and calf, decreased after thrombolytic therapy, with the highest decrease in acute group and lowest decrease in chronic group.
Conclusions：As regards thrombolytic therapy, the earlier it is performed, the better will be the effects achieved. Aggressive thrombolytic therapy can improve venous obstruction and valve damage, and attenuate postthrombotic syndrome.

Abstract:

Objective：To study the clinical application of retrieval inferior vena cava filter (IVCF) for deep venous thrombosis (DVT) of lower extremities.
Methods： A retrospective analysis of clinical data of 28 patients with DVT undergoing  IVCF implantation was made. Appling Seldinger technique,28 filters were inserted in inferior vena cava below the renal veins.Anticoagulation therapy was given after operation. The IVCF was taken out  after 14-22 days except 1.
Results：Twenty-seven IVCFs were taken out via femoral venous access.Some blood clot was found in all the filters. One filter was fully blocked by blood clot following venous thrombolysis, but it resolved on thrombolytic therapy. so the filter was not removed. No pulmonary embolism(PE) occurred.
Conclusions：The use of temporary filter in cases of deep venous thrombosis can effectively prevent the development of pulmonary embolism.

Abstract:

Objective：To explore the relationship between genetic polymorphism of MTRR and lower extremity deep venous thrombosis (DVT).
Methods：Polymorphism of the 66th site A/G of MTRR gene in disease group (n=101) and normal controls(n=120) was detected by polymerase chain reaction-sequence specific primer (PCR-SSP). The patients in the disease group were from the clinical cases which were diagnosed as DVT, and health examination adults were used as the normal control group.
Results：The 66th site of MTRR gene frequencies of AA，AG and GG genotypes was 26.76%, 43.66% and 29.58% in disease group, and 43.57%, 4.28% and 12.14% in normal controls, respectively. No significant difference was seen in the distribution frequency in two groups (χ2=3.22, P>0.05).
Conclusions：The distribution frequency of MTRR gene does not seem to be an independent genetic risik factor for deep venous thrombosis in China.

Abstract:

Objective：To study the expression and effect of mammalian target of rapamycin (mTOR) on rat skeletal muscle ischemia-reperfusion(I/R) treated by ischemic postconditioning (I-postC). 
Methods：Forty-eight healthy male Wistar rats were randomly divided into three groups (n=16)：I/R group(4-hour ischemia/12-or 24-hour reperfusion)，ischemic preconditioning(IPC)group (3 cycles of 5-minute ischemia /5-minute reperfusion) and I-postC group(3 cycles of 1-minute reperfusion/l-minute ischemia). I/R of right hind limb was induced by clamping the right femoral artery,  in each group the left hind limb (the femoral artery was no clamping) as controll. The tissue morphology, wet-to-dry weight (W/D) ratio, malondialdehyde (MDA), myeloperoxidase (MPO) and expression of mTOR in skeletal muscle were and detected compared in the 3 groups.Results：In I-postC and IPC group, the edema, MDA and MPO of skeletal muscle decreased significantly compared with I/R group (P＜0.05). There was no significant difference between the I-postC and IPC group(P＜0.05).Compared with I/R group, expression of mTOR increased significantly in I-postC and IPC group(P＜0.05)
Conclusions：I-postC can attenuate I/R injury of the hind limbs in rats, which may be accomplished by activation of mTOR signal pathway. The mechanism of the effect of I-postC  my by as the same as IPC.

Abstract:

Objective：To study the changes of NF-κB expression in kidney tissues and the protective effect of xuebijing injection on ischemic-reperfusion (I/R) of hind leg of rats. 
Methods：The I/R models were prepared on thirty Wistar male rats, and were divided into  five groups: A,control group;B, ischemia only group; C, ischemia- reperfusion group; D, I/R with low dosage xuebijing injection group；E, I/R with high dosage xuebijing injection group. Serum level of CK and content of MDA in kidney tissues of each group were examined.At the same time,the expression of NF-κB in kidney tissue was detected with real-time polymerase chain reaction and immunohistochemical technique,respectively.
Results：Compared with control group, the expression level of NF-κB increased in ischemia group and significantly increased in I/R group（P<0.01）; in two xuebijing treated groups, the expression level of  NF-κB decreased，but there was no difference between groups D and E（P>0.05）. Compared with control group,  serum level of CK and kidney tissues content of MDA were increased in ischemia group and I/R group（P<0.01）. Compared with I/R group,serum level of CK and kidney tissues content of MDA were decreased in xuebijing treated group（P<0.01）.
Conclusions：The expression of NF-κB in kidney tissue is significantly upregulated in limbs of I/R model rats. The xuebijing injection has protective effect on kidney injury against skeletal musle ischemia-reperfusion injury and the protective effect is not dosage related.

Abstract:

Objective：To identify the effects of miRNA-214 on cell cycle and apoptosis of gastric cancer cells, and its influence on PTEN protein level.
Methods：miRNA-214 in poorly differentiated human gastric cancer cell line BGC823, MKN45 and normal gastric mucosal cell line GES-1 was detected by real-time PCR. Antisense-miRNA-214 oligonucleotides(miRNA-214 inhibitor) were  transfected transiently into gastric cancer cell lines to down-regulate the expression of miRNA-214. The cell cycle and apoptosis rate were studied by flow cytometry. PTEN, the target gene of miRNA-214, was detected by immunofluorescence.
Results：The miRNA-214 was upregulated in gastric cancer cell BGC823 and MKN45 （P＜0.05） compared with normal gastric mucosal cell line GES-1. The transfection of miRNA-214 inhibitor downregulated miRNA-214 expression in BGC823 （P＜0.05）. G1-phase cells were increased in BGC823 and MKN45, ［(60.20±3.38)% vs. (49.33±7.99)% (P＜0.05)；(69.90±0.28) vs. (54.85±0.64)% (P＜0.05) respectively］ compared with the control groups. But the alteration of apoptotic rate was not significant(P＞0.1). The immunofluorescence result showed that PTEN was upregulated after transfection in both cell lines.
Conclusions：(1)miRNA-214 is upregulated in human gastric cancer cell BGC823 and MKN45. (2)miRNA-214 could reduce the G1-phase cells and increase S-phase cells in BGC823 and MKN45, and the downregulation of PTEN may be one of the mechanisms. (3)miRNA-214 has no effect on apoptosis of BGC823 and MKN45.

Abstract:

Objective：To explore the value of multi-slice spiral computed-tomography angiography in the design of complicated abdoninal operation scheme for space-occupying lesions that involve major intraabdominal vessels.
Methods：Thirty-one patients underwent multi-slice spiral computed-tomography angiography before operation. Then, individualized operation scheme was made according to the result of multi-slice spiral computed-tomography angiography.
Results：Multi-slice spiral computed-tomography angiography accurately revealed the complicated relationship between a variety of severe intraabdoninal lesions and major intraabdoninal vessels. Individualized operation scheme for the 31 patients was made according to the result of multi-slice spiral computed-tomography angiography. Based on individualized operation schemes, all of the 31 patients successfully underwent operation without injury of major intraabdominal vessels, and were satisfactorily discharged.
Conclusions：Multi-slice spiral computed-tomography angiography is safe, convenient, authentic, accurate, high resolution, fast and non-invasive. It is very useful in planning rational individualized operation scheme for complicated intraabdominal operations that involve major intraabdominal vessels, and can help to direct and improve the effect of surgical treatment. 

Abstract:

Objective：To investigate the early diagnosis and treatment of acute mesenteric venous thrombosis (AMVT).
Methods：Retrospective analysis of the clinical data of 25 patients with AMVT admitted to the First Affiliated Hospital of Chongqing Medical University from August 2008 to May 2010 was carried out.
Results：All of the 25 patients had abdominal pain, and with signs of peritoneal irritation in 11. The 25 patients were diagnosised by CTA. Thirteen patients underwent laparotomy, 5 received regional  thrombolytic therapy via superior mesenteric artery, and 7 received anticoagulation and thrombolytic therapy by peripheral venous route. Twenty-one patients were cured, but four patients died including two who had surgical treatment and two who were treated conservatively. At follow-up of 2-24 months, there were two cases of recurrence.
Conclusions：After diagnosis of AMVT is determined by color doppler ultrasound and CTA, prompt treatment with anticoagulation and thrombolytic medication, and in cases of peritonitis, surgery with postoperative thrombolysis and anticoagulant therapy, can resut in good clinical outcome.

Abstract:

Objective：To study the etiological factors and the treatment methods of portal vein thrombosis (PVT) and mesenteric venous thrombosis (MVT) after splenectomy.
Methods：Clinical materials of 12 patients with PVT and MVT after splenectomy  were analyzed retrospectively.
Results：Venous thrombosis occurred in 12 of 280 post-splenectomy patients (4.3%) including nine patients with PVT（4.3%）and three patients  with MVT(1.1%). All of the PVT patients had leukocytosis, increase  platelet count,  positive  D-dimer and abnormal  thromboplastic function. PVT and MVT were discovered with color ultrasonography, CT, and MRI in nine patients, with superior mesenteric artery angiography in one case, and at exploratory laparotomy because of acute intestinal obstruction in two cases. Nine patients were cured by anti-coagulation and thrombolytic therapy. Two MVT cases had small intestinal necrosis underwent intestioal resection and anastomosis, postoperative systemic anticoagulation and thrombolytic therapy, and were cured. One case of acute PVT thrombosis with progression to intrahepatic portal vein, died of liver failure.
Conclusions：Post-splenectomy portal system thrombosis is related with many factors. Early diagnosis and prompt anticoagulant therapy has an important impact on prognosis. If results of non-operative therapy are not satisfactory, prompt surgical therapy is advocated.

Abstract:

Objective：To study the  clinical features and treatment of male breast cancer.
Methods：The clinical data of 14 cases of male breast cancer admitted in our hospital during past 14 years were analyzed retrospectively.
Results：Of the 14 patients, 7.1 percent （1/14）  was medullary carcinoma, the other 92.9% （13/14） were invasive ductal carcinoma. The tumor diameter was 1.5-5.2 cm.  Three patients underwent radical mastectomy and axillary lymphadenectomy, 10 patients had modified radical resection, and one patient had simple mastectomy. The lymph node metastasis rate was 71.4%. Twelve patients were followed up for 9 months to 12 years,  of them 3 cases died, 3 cases survived with tumor, 6 cases survived tumor-free, and 2 cases were lost to follow-up. The 5, 10-year survival rate was 58.3%, 16.7%, respectirely.
Conclusions：The majority of male breast cancer cases were invasive ductal carcinoma which could easily develop lymph node metastasis, and has a poor prognosis and low survival rate.