Findings of non-pathologic perfusion defects by CT arterial portography and non-pathologic enhancement of CT hepatic arteriography

ＩＮＴＲＯＤＵＣＴＩＯＮＣＴａｒｔｅｒｉａｌｐｏｒｔｏｇｒａｐｈｙ（ＣＴＡＰ）ａｎｄＣＴｈｅｐａｔｉｃａｒｔｅｒｉｏｇｒａｐｈｙ（ＣＴＨＡ）ａｒｅｔｈｅｍｏｓｔｓｅｎｓｉｔｉｖｅｍｅｔｈｏｄｓｏｆｄｅｔｅｃｔｉｎｇｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉ...

CT arterial portography and CT hepatic arteriography in detection of micro liver cancer

AIM To recognize the characteristic findings of micrQliver cancer (MLC) and to evaluate the effect of CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in diagnosis of MLC. METHODS Between April 1996 to December 1998, CTAP and CTHA were performed in 12patients with MLC, which were not detect ed byconventional CT examinations. After CTHA, 3 mL-- 5 mL mixture of lipiodol, doxorubic in andmitomycin C were injected into hepatic arterythrough the catheter, and then followed up by CTthree or four weeks later (Lipiodol CT LP-CT).RESULTS A total of 22 micro--tumors (0 .2 cm 0.6 cm in diameter ) were detected in 12patients, which manifested as small perfusiondefects in CTAP and small round enhancement inCTHA. The rate of detectability of CTAP andCTHA was 68.2% (15/ 22) and 77.3% (17/ 22)respectively, and the rate of the simultaneoususe of both procedures reached 86. 4% (19/ 22 ).All micro--tumors were demonstrated as punctatelipiodol deposit fool in LP--CT. After LP--CT, theelevated serum level of Q-fetoprotein (AFP)dropped to the normal level in all patients.CONCLUSION The CTAP and CTHA are the mostsensitive imaging methods for detecting microIiver cancer. Confirmed by the change of theelevated serum AFP level and lipiodol depositfool in LP-CT, small perfusion defects in CTAPand punctate enhancement in CTHA may suggestmicro--liver cancer.

The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pectoris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 cases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided into three groups in light of the results of the hemodynamic examination: ① diastolic dysfunction group ② systolic dysfunction group ③ normal heart function group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary arteriography and heart function. Results ① Under basic conditions, patients with angina decubitus suffered from the systolic (36%) or diastolic dysfunction (48%). 43 percent of the patients with mixed angina had systolic dysfunction and other 43 percent of them had normal cardiac function. However, patients with accelerated effort angina (AEA) were characterized by diastolic dysfunction (31%) or normal heart function (60%). ② In hemodynamic examination, the pulmonary capillary wedge pressure of positive patients rose, at the same time cardiac index fell to the extreme instantaneously after loading in volume-loading test and then they restored to the basic level until 60 minutes. However, both PCWP and CI of the negative patients reach the peak momentarily after loading. They returned to the basic level within 30 minutes. ③ coronary arteriography show: there are 41% of patient with three-vessel disease, 50% with two-vessel disease, 9% single vessel disease and left main narrowing 22. 7% in AEA. There are separately 76%, 24%, 0% and 36% in AD; and 26.1% , 43.4% , 21.7% , 43.4% in MA. ④ Constituent ratio of the AEA and MA were separately compared with AD, AEA/AD: P < 0.05(P = 0.031); MA/AD: P < 0.01 (P = 0.000313). Conclusions Most of patients with the above three types of unstable angina pectoris suffered from the basic heart dysfunction and cardiac reserve dysfunction which might participate in the occurrence and development of unstable angina pectoris. In angiography, there are the most three-vessel diseases in AD that are, therefore, the most severe UAP.

Value of CT pulmonary arteriography and venography in the evaluation of venous thromboembolism in a multiracial Asian population

Background There is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis （DVT） in suspected acute pulmonary embolism （PE）. The aim was to investigate the value for using such an approach in a multiracial Asian population. Methods A total of 135 consecutive subjects with clinically suspected PE in various clinical settings （postoperative in 23 subjects） were referred and evaluated for venous thromboemboUsm using CT pulmonary arteriography and venography in a tertiary hospital, Malaysia. The distribution of DVT was assessed based on the frequency rate of thrombosis in a particular anatomical region （inferior vena cava, pelvic, femoral and popliteal）. Results In 130 subjects, excluding 5 subjects having poor images, both DVT and PE were detected in 11.5% （15/130） subjects and DVT alone was detected in 6.9% （9/130） subjects giving a combined rate of venous thromboembolism of 18.4%. A history of malignancy was significantly associated with positive scans, P=0.02. It was found that left pelvic veins （18.2%） and left femoral veins （19.5%） were more commonly thrombosed in this population. Conclusion CT pulmonary arteriography and venography is a useful technique in the evaluation of venous thromboembolism in a multi-racial Asian population.

Saddle pulmonary embolism is not a sign of high-risk deterioration in non-high-risk patients: A propensity score-matched study

BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address this issue by conducting a propensity score matching(PSM) study.METHODS: A total of 727 non-high-risk acute PE patients were retrospectively evaluated. We evaluated the Bova score and risk stratification to examine the risk of deterioration. Deterioration defined as any adverse event within 30 days after admission. Computed tomographic pulmonary angiography was used to identify the embolism type. All patients were matched into four subgroups by PSM according to age, sex, Bova score, and risk stratification:(1) MPA and non-MPA embolism;(2) non-saddle MPA and non-MPA embolism;(3) saddle MPA and non-saddle MPA embolism;(4) saddle MPA and non-MPA embolism. Correlations were analyzed using Cox regression analysis, and deterioration risk was compared between subgroups using Kaplan-Meier analysis.RESULTS: Cox regression analysis revealed that MPA embolism was correlated with deterioration, regardless of whether saddle MPA embolism was included or excluded. Saddle MPA embolism was not correlated with deterioration, regardless of comparison with non-saddle MPA embolism or non-MPA embolism. Patients with MPA and non-saddle MPA embolism presented a high risk for deterioration(logrank test=5.23 and 4.70, P=0.022 and 0.030, respetively), while patients with saddle MPA embolism were not at a high risk of deterioration(log-rank test=1.20 and 3.17, P=0.729 and 0.077, respetively).CONCLUSIONS: Saddle MPA embolism is not indicative of a high risk of deterioration in nonhigh-risk acute PE patients.

Familial left cervical neurofibromatosis 1 with scoliosis:A case report

BACKGROUND Neurofibromatosis type 1(NF1)is an inherited autosomal dominant disorder affecting many parts of the body with caféau lait spots,skeletal deformity,and scoliosis.A familial case of NF1 with scoliosis and a painless mass had not yet been reported.CASE SUMMARY We describe the case of a 15-year-old male patient with a painless lump on the left side of his neck for 10 years and scoliosis.His right shoulder was about 5 cm lower than the left,the left side of his face was deformed,and the left submandibular skin was relaxed.The folding and drooping were obvious and movement was poor.Computed tomography revealed the involvement of the neck,upper chest wall,and surrounding left shoulder,accompanied by bone changes and scoliosis.Histological evaluation showed subepidermal pale blue mucoid degeneration,fibrous fusiform cells in the dermis in a fascicular,woven arrangement.His mother had the same medical history.The diagnosis was neurofibromatosis of the left neck.Various parts of the tumor tissue were serially resected during several visits.Eight months after surgery,there was a slight tendency to regrow.CONCLUSION This case of slow-progressing NF1 highlights the importance of early diagnosis and treatment to reduce its impact on the patient’s growth and development.

ASSESSMENT OF CORONARY FLOW RESERVE IN PATIENTS WITH ANGINA PECTORIS

ＡＳＳＥＳＳＭＥＮＴＯＦＣＯＲＯＮＡＲＹＦＬＯＷＲＥＳＥＲＶＥＩＮＰＡＴＩＥＮＴＳＷＩＴＨＡＮＧＩＮＡＰＥＣＴＯＲＩＳＳｈｅｎｇＷｅｉｆｅｎｇ（沈卫峰）；ＣａｉＸｕ（蔡煦）；ＺｈａｎｇＤａｄｏｎｇ（张大东）；ＺｈａｎｇＸｉａｎ（张宪）；ＺｈｅｎｇＡｉ...

Hemobilia Due to an Iatrogenic Arteriobiliary Fistula Complicating Laparoscopic Cholecystectomy: A Case Report

Hemobilia is the result of a pathological communication between bile duct and intra or extrahepatic vessel. 40% to 60% of the haemobilia cases are Iatrogenic, and the other causes are either vascular malformations or hepatic blunt trauma. We describe the case history of a patient in which laparoscopic cholecystectomy was complicated 3 months later by massive hemobilia. The cause of haemorrhage was a fistula between the principal bil duct and the right hepatic artery. This complication was successfully managed by surgery and angiographic embolization with full recovery of the patient.

The Relatlonahlp Between Pleame Calcltonin Gane-Rslated Peptlds Leval and Early Cardlac Dyafunetion In Patianta with Coronary Artery Dlsease

To identify whether plasma Calcitonin gene-related peptide （CGRP） level isindexe for evaluating early cardiac dysfunction in patients with coronaryartery disease.Normal and coronary artery disease total sixty cases werechosen at random,which were diagnosed by coronary arteriography,foursubgroups （0,1,2,3 lesion branch group） were divided basing on coronaryartery lesion branch,each having fifteen cases.hemodynamic parameters weremeasured by left cardiac cather and left ventricular cineangiography,plasmaCGRP concentration was msaured by radioimmunoassay.results reveal:LVEFdecressed as coronary artery lesion branch increased,but there were nosignificantly difference between subgroups (only Psio【0.05);there weresignificantly difference of diastolic function parameters between subgroups,especially T,bad positive relativity to stenosis score （r=0.72,P【0.01）.Plasma CGRP level had positive relativity to stenosis score,time constant（r=0.37～0.38,P【0.05）;bad negative relativity to LVEF （r=-0,46,P【0.01）.in brief,Coronary artery disease imparies diastolic function prior tosystolic function;CGRP is a important index for evaluating early cardiacdysfunction in patients with coronary artery disease.

Endovascular embolization of pulmonary arteriovenous malformations

Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients （n=-23） with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases. Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from （78.04＋8.22）% to （95.13＋3.67）% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization （t=9.101, P 〈0.001）. Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood oxygen saturation between 85% and 90%. Symptoms of hypoxia never recurred in the other cases. Conclusions Endovascular embolization of pulmonary arteriovenous malformations can significantly improve blood oxygen saturation and reduce serious complications such as cerebral infaction. Therefore, this kind of interventional procedure is a safe and effective treatment method with a low complication rate.

Treated With Retrograde Guide Wire Technique:A Case Report

Chronic total occlusion （CTO） of coronary artery accounts for 10 % - 20 % in coronary intervention cases. It is the most challenging coronary artery disease at present and is regarded as the most difficult issue for intervention doctor. Herein, we report a case in a 55-year-old woman with right coronary artery opening total occlusion who was treated with retrograde guide wire technique.

Serum apelin predicts spontaneous reperfusion of infarct-related artery in patients with ST-segment elevation myocardial infarction

Objective To assess whether serum Apelin correlates with spontaneous reperfusion(SR)of the infarct-related artery(IRA)in STEMI patients.Methods Blood samples were obtained on admission and before p PCI in 280 consecutive STEMI patients,who were hospitalized in China-Japan Friendship Hospital between January 2016 and December 2016.Blood chemistry,Apelin level were examined.Coronary arteriography and echocardiography were performed after admission.Patients were divided into SR(TIMI 2-3,n=57)and non-SR(TIMI 0-1,n=223)groups according to TIMI results.Logistic regression analysis was performed to define the independent predictors of SR.Results Prevalence of smoking and pathoglycemia(including diabetes,impaired glucose tolerance and impaired fasting glucose)was significantly higher in the non-SR group than in the SR group(both P<0.05).Peak values of plasma troponin-I and percent of the patients with Killip 2 ~ 3 were significantly higher in non-SR group than in SR group(P<0.05).Left ventricular systolic and diastolic functions were remarkably improved in SR group compared with non-SR group.Gensini scores were lower in the SR-group than the non-SR group(P=0.02).Serum Apelin was significantly higher in patients with SR compared to patients with non-SR([0.82±0.34] ng/ml vs [0.35±0.22] ng/ml,P=0.04).A cut off Apelin value of 0.75 ng/ml had a predictive value of 77% to identify patients with SR(sensitivity=81%).Logistic regression analysis showed that serum Apelin level is an independent predictor of SR(OR=2.18,95% CI:1.10-4.33,P=0.01)for STEMI patients.Conclusion Patients with SR have better cardiac systolic function and diastolic func-tion.An increased serum Apelin level is an independent and novel predictor of SR for STEMI patients.Detection of serum Apelin level is helpful to predict SR in STEMI patients.