Portal Hypertensive Vascular Lesions

The aim of present study is to assess the pathological changes of gastric coronary vein in cirrhotic patients (n= 30) by immunohistochemical and morphological observation. The damage to endothelium, hypertrophy and hyperplasia of smooth muscle and increament of ECM were found in gastric coronary vein of cirrhotic patients. The vessel wall hardened and thickened with decrease of elasticity. The results showed that the portal hypertension could accompany with ' portal hypertensive vascular lesions'.

Artificial intelligence in detection of small bowel lesions and their bleeding risk:A new step forward

The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool to assess SB diseases but it is a time-consuming procedure with a significant error rate.The development of artificial intelligence(AI)in CE could simplify physicians’tasks.The novel deep learning model by Zhang et al seems to be able to identify various SB lesions and their bleeding risk,and it could pave the way to next perspective studies to better enhance the diagnostic support of AI in the detection of different types of SB lesions in clinical practice.

Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report

Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries. In such cases, a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient. We herein describe a case of blunt abdominal trauma in a 29-year- old man whose pancreatic rupture was associated with hepatic artery, splenic vein and extrahepatic bile duct damage. Immediate surgery was performed after computer tomograghy (CT), the haemorrhagic lesions dictat the emergency transfer to the operating room. Spleno-pancreatic resection was done with reconstruction of the hepatic artery, ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion. The early post-operative course was complicated by stenosis of the arterial reconstruction, which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst, rest and antibiotics. Finally, the patient was discharged and was alive without clinical problems at the time when we wrote this case report. The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma.

Bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma:A case report

BACKGROUND Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause.Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause.Therefore,we aimed to describe a case of an orbital hematoma after a severe cough the night before due to inhalation of cooking oil fumes.CASE SUMMARY A 46-year-old woman was referred to our hospital with a complaint of exophthalmos accompanied with blurred vision,pain,binocular diplopia,and dizziness lasting for 5 h noted on waking in the morning.She also experienced nausea and vomiting due to high pressure of orbit and dizziness.Based on the auxiliary examination and her medical history,the patient was finally diagnosed with bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma.The patient was administered tobramycin and dexamethasone eye ointment,and applied pressure dressing on the left eye to stop the bleeding.Simultaneously,we administered intravenous etamsylate,oral Yunnan Baiyao capsule,intravenous mannitol to reduce orbital pressure,and intravenous dexamethasone injection at 10 mg/dL combined with neurotrophic therapy to reduce tissue edema.Among them,the Yunnan Baiyao capsule is a traditional Chinese herbal medicine to remove stasis and stop bleeding;thus,it promotes blood circulation and relieves pain resulting in reduced edema of the lesion site.The symptoms did not improve significantly during the first 2 d of treatment.We speculate that high orbital pressure and binocular diplopia induced frequent nausea and vomiting in the patient,causing increased pressure on the superior vena cava and leading to repeated orbital bleeding.After the second day,the symptoms started gradually improving.CONCLUSION This case further emphasizes the importance of comprehensive,detailed medical history and careful ophthalmic examination of the patient.

Recurrent orbital space-occupying lesions:a clinicopathologic study of 253 cases

Objective：To analyze the clinical features,histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.Methods：A retrospective study was carried out in 253 consecutive patients with recurrent orbital spaceoccupying lesions treated by surgical excision in the Institute of Orbital Diseases,the General Hospital of the Armed Police Force from January 2009 to December 2010.Results：The patients included 123 males and 130 females aged 2 to 78 years（mean,36.2 years）,and the last recurrence interval after operation ranged from 1 month to 40 years（median,4.75 years）.Of all the cases,159（62.8%）,65（25.7%）,20（7.9%）,8（3.2%） and 1（0.4%） had previously experienced once,twice,three,four and six times of surgeries,respectively.Among them,29（11.5%） cases had recurred 3 times or over,and 37（14.6%） cases got recurrence in 10 or more years postoperatively.Most of the patients with local recurrence presented with various clinical manifestations,while 31（12.3%） cases were symptom-free.Two hundred and thirty-one（91.3%） cases underwent surgical removal of the recurrent orbital lesions,and another 22（8.7%） cases had to receive the exenteration of orbit.Categories of these recurrent orbital lesions after operation were as follows：lacrimal gland tumors,65（25.7%） cases;vasogenic diseases,54（21.3%） cases;neurogenic tumors,42（16.6%） cases;secondary tumors,24（9.5%） cases;orbital inflammation,21（8.3%） cases;myogenic tumors,14（5.5%） cases;fibrous and adipose tumors,12（4.7%） cases;lympho-hematopoietic tumors,7（2.8%） cases;bone or cartilage tumors,7（2.8%） cases;orbital cysts,6（2.4%） cases;and indefinitely differentiated tumor,1（0.4%） case.The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma,hemangiolymphangioma,lacrimal gland adenoid cystic carcinoma,meningioma,inflammatory pseudotumor,neurofibroma,sebaceous gland carcinoma,vascular malformation,rhabdomyosarcoma and hemangioma.Conclusions：The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions.The lacrimal gland epithelial tumor is most prone to relapse after resection,and early and longer-term postoperative follow-up is needed.

Intervention of Tongxinluo Capsule (通心络胶囊) against Vascular Lesion of Atherosclerosis and Its Effect on Lectin-like Oxidized Low Density Lipoprotein Receptor-1 Expression in Rabbits

Objective.- To investigate the prevention by Tongxinluo capsule （通心络胶囊, TXL） of vascular lesions and its effect on the levels of protein and gene expression of lectin-like oxidized low-density lipoprotein receptor-1 （LOX-1） of vascular wall in rabbits with atherosclerosis （AS）, and to explore its possible mechanism against AS. Methods： AS models were established by feeding New Zealand white rabbits with high-cholesterol diet, and 24 immature rabbits were randomly divided into the control group, model group and treated group （treated with TXL capsule）. The indexes of total cholesterol （TO） and low density lipoprotein （LDL） levels were measured at the 16th week. The intima thickness and the plaque area of abdominal aorta were quantitatively analyzed by pathological morphological analysis, the expression of macrophage and smooth muscle cell （SMC） in intima were detected by immunohistochemical method and histologic segments were stained by Hematoxilin-Eosin （HE） to identify the degree of atherosclerotic lesion in the model group and the prevention by TXL. The LOX-1 gene and protein expression in abdominal aorta was detected by semi-quantitative RT-PCR and immunohistochemistry, respectively. Results： In the model group, the levels of TC and LDL were significantly elevated, aortic intima thickened extensively, the intima area enhanced, and macrophages expression increased; the levels of LOX-1 gene and protein expression was up-regulated in endothelium and neo-intima of the abdominal aorta. The treatment with TXL reduced blood lipids, attenuated arterial intimal proliferation, markedly inhibited the expression of macrophage and excessively expressed the level of LOX-1. Conclusion：TXL has an inhibitory effect on blood lipids, and it can prevent the occurrence of vascular lesion and cure its development, and its protection against AS was possibly associated with a crucial endothelial protective action through lowering the expression of LOX-1 in vascular walls.

Retrospective Analysis of Outcomes with a Unique IPL System

Introduction: Intense Pulsed Light (IPL) technology is well accepted in the medical aesthetic field for the treatment of various skin lesions, including pigmented and vascular lesions. The light penetrates into the skin and is selectively absorbed by lesion chromophore. Absorbed energy is converted into heat, coagulating the lesion, which naturally fades following the treatment. The current article presents a retrospective efficacy evaluation of an IPL device with high peak power. Methods: Representative treatment results were collected from several clinics based on photographs taken at baseline and after treatments. Photos were evaluated and analyzed for aesthetic improvement of the various skin conditions in different facial and body areas. Results: Analysis included cases of pigmented and vascular lesions, textural lesions, and more specific conditions such as melasma and rosacea. The two evaluators’ scoring demonstrated improvement in all cases according to the Global Aesthetic Improvement Scale (GAIS) scale. Conclusion: The vast experience gathered from the market in treating various skin lesions supports the safety and efficacy of the investigated IPL device. The device’s particular specifications contribute to the successful results and ease of treatment for the practitioner and the patient.

Hepatic hemangioma:What internists need to know

Hepatic hemangioma(HH)is the most common benign liver tumor and it is usually found incidentally during radiological studies.This tumor arises from a vascular malformation;however,the pathophysiology has not been clearly elucidated.Symptoms usually correlate with the size and location of the tumor.Less commonly the presence of a large HH may cause life-threatening conditions.The diagnosis can be established by the identification of HH hallmarks in several imaging studies.In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause.In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm.Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation.Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques.Progression of the tumor is seen in less than 40%.Hormone stimulation may play a role in HH growth;however,there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence.When clinicians encounter this condition,they should discern between observation and surgical or non-surgical management based on the clinical presentation.

Management of extensive intraparotid vascular malformation: a case report

Treatment of large soft tissue vascular lesions remains one of the greatest challenges in modern plastic surgery.The extent of the disease and the involved structures,but also the expectations of the patients are important in determining the way of treatment.The effective management of hemangiomas and vascular malformations of the head and neck requires a team approach,in order to understand the biologic behavior of the lesion,complete the diagnostic studies necessary to define the area of involvement,and understand the benefits and limitations of interventional radiologic and surgical procedures.The synthesis of this knowledge can help determine the best treatment.The strategic plan and subsequent management of a 34-year-old Maori man with an extensive arteriovenous intraparotid malformation is presented.

Toxicity Features of High Glucose on Endothelial Cell Cycle and Protection by Dan Gua-Fang(丹瓜方) in ECV-304 in High Glucose Medium

Objective： To study the toxicity features of high glucose on the endothelial cell cycle and the influence of Dan Gua-Fang , a Chinese herbal compound prescription, on the reproductive cycle of vascular endothelial cells cultivated under a high glucose condition; to reveal the partial mechanisms of Dan Gua- Fang in the prevention and treatment of endothelial injury caused by hyperglycemia in diabetes mellitus （DM）; and offer a reference for dealing with the vascular complications of DM patients with long-term high blood glucose. Methods： Based on the previous 3-（4,5）-dimethylthiahiazo （z-yl）-3-5-diphenytetrazoliumromide （MI-I-） experiment, under different medium concentrations of glucose and Dangua liquor, the endothelial cells of vein-304 （ECV-304） were divided into 6 groups as follows： standard culture group （Group A, 5.56 mmol/L glucose）; 11300 herb-standard group （Group B）; high glucose culture group （Group C, 16.67 mmol/L glucose）; 1/150 herb-high glucose group （Group D）; 1/300 herb-high glucose group （Group E）; and 1/600 herb-high glucose group （Group F）. The cell cycle was assayed using flow cytometry after cells were cultivated for 36, 72 and 108 h, respectively. Results： （1） The percentage of cells in the Go/G1 phase was significantly increased in Group C compared with that in Group A （P〈0.05）, while the percentage of S-phase （S%） cells in Group C was significantly reduced compared with Group A （P〈0.05）; the latter difference was dynamically related to the length of growing time of the endothelial cells in a high glucose environment. （2） The S% cells in Group A was decreased by 30.25% （from 40.23% to 28.06%） from 36 h to 72 h, and 12.33% （from 28.06% to 24.60%） from 72 h to 108 h; while in Group C, the corresponding decreases were 23.05% and 21.87%, respectively. The difference of S% cells between the two groups reached statistical significance at 108 h （P〈0.05）, （3） The percentage difference of cells in the Gz/M phase between Group C and Group A was statistically significant at 72 h （P〈0.01）. （4） 1/300 Dan Gua-Fang completely reversed the harmful effect caused by 16.67 mmol/L high glucose on the cell cycle; moreover it did not disturb the cell cycle when the cell was cultivated in a glucose concentration of 5.56 mmol/L. Conclusions： High glucose produces an independent impact on the cell cycle. Persistent blocking of the cell cycle and its arrest at the Go/G1 phase are toxic effects of high glucose on the endothelial cell cycle. The corresponding variation of the arrest appears in the S phase. 1/300 Dan Gua-Fang completely eliminates the blockage of high glucose on the endothelial cell cycle.