Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for c...Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for complete resection of pancreatic tumors. However, the optimum surgical method for venous management is controversial. Resection of the SMV without reconstruction during surgery for pancreatic tumors is rarely reported. Here we present the case of a 58-year-old woman with a giant pancreatic mucinous cystadenoma adhering to the SMV, who underwent an en bloc tumor resection, including the main trunk of the SMV and the spleen. No venous reconstruction was performed during surgery. No ischemic changes occurred in the bowel. The presence of several welldeveloped collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged. This case indicated that the main trunk of the SMV can be resected without venous reconstruction if adequate collateralization has formed.展开更多
Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are es...Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.展开更多
This study aimed to explore the disinfection of drinking water in trunk water mains, based on published conditions denoted within the Irish Republic. The variables within the study were consumer draw-off rates, trunk ...This study aimed to explore the disinfection of drinking water in trunk water mains, based on published conditions denoted within the Irish Republic. The variables within the study were consumer draw-off rates, trunk main length, pipe diameter, and water temperature. All these factors are known to impact the free chlorine residual in operational supply networks. Based on published conditions obtained within the literature review, 60 hypothetical trunk mains were generated for this study. Of primary concern were the variables that affect the chlorine decay rate;total amount of chlorine decay;available amount of chlorine in the periphery of the trunk main;and the costs associated with effective chlorine disinfection of trunk mains. Based on the analysis performed, the following were the salient observations: 1) Low consumer draw-off rates and increased trunk main length and diameter increased the risk of the free chlorine residual in the periphery of the trunk mains not complying with the Environmental Protection Agency’s (EPA) minimum recommended residual value of 0.1 mg/l (EPA Drinking Water Audit Report, 2014). 2) Increasing the diameter of the trunk main from 125 mm to 180 mm had a negligible effect on the chlorine decay rate. However, increasing the trunk main diameter from 125 mm to 180 mm was shown to have a major impact on the total amount of chlorine decay and free chlorine residual available in the periphery of the main. The key parameters that affected disinfection costs associated with trunk mains include length, diameter and the need for chlorine boosting.展开更多
Objective To study the clinical value of coronary stenting in treatment of severe complex coronary artery lesions, to evaluate the short and long term outcome of the patients imployed coronary stents, and to well reco...Objective To study the clinical value of coronary stenting in treatment of severe complex coronary artery lesions, to evaluate the short and long term outcome of the patients imployed coronary stents, and to well recognize the role of stenting in dealing with the complications of PTCA.Methods In this study, two hundrad sixty four patients with coronary artery disease were included, who were classified as PTCA group (138 cases)and coronary stented group(126 cases).They all received Exercise Test(ET)、Ultrasound Cardiogram(UCG)and Ambulatory Electrocardiography (AECG)at admission and before discharge, respectively. The coronary artery lesions were categorized into type A.B.C according to the methods reported by ACC/AHA . It was that the data between two groups including clinical information, cronary artery lesion characteristicis, procedural success rate, major complications, Minimum Lumen Diameter (MLD),residual stenosis, collateral circulation scores both before and after procedure had been compared. Following up were performed 6 months to 3 years after procedure. Results The study showed that there were no significant different in two groups including the clinical information, positive rate of ET, EF, results of AECG. But the rate of type B2/C lesions were higher in CS group than that in PTCA group( P <0.05). Both PTCA Group and CS Group had extremely success rate in type A and type B1, but CS had a higher success rate than that in PTCA in type B2 and type C (94.28%VS 89.2%, P <0.05). CS group had a lower rate of complication in procedure than that of PTCA group. There are no signifiance in MLD between the two groups (0.53± 0.22)mm vs (0.42±0.26)mm,( P >0.05) before procedure. But MLD was signifantly higher in CS group than that in PTCA group (2.51±0.66)mm vs (3.08±0.66)mm,( P <0.001) after procedure.The collateral circulation scrores were signifantly decreased after procedure (1.7±0.6) vs (0.8±0.4); (2.1±0.3) vs (0.3±0.4) in both PTCA Group and PTCA Group respectivesly,( P <0.001). Residual stenosis were higher in PTCA group(15±6%)than that in CS group (6±3%, P <0.001). The positive rate of ET, exercise capacity, ST depressions, EF and wall motion were all improved significantly both in PTCA group and CS group, CS group has a higher effect in exercise capacity, MLD, EF and ischemia duration.Seventy nine patients were followed up and the rate of cardiac events in the CS group were lower than in PTCA group.Conclusions 1.Coronary stenting had a high success rate and low complication in treatment of severe and complex coronary artery lesions.2.Coronary stentig reduced residual stenosis, improved blood supply, salvaged the hibernating and /or stunned myocardium, improved the left ventricular function. CS have offered a new, safe and effective metbods for treatment of left main trunk lesions; 3.Coronary stenting has broden the indication for invasive treatment of coronary artery diseases.展开更多
文摘Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for complete resection of pancreatic tumors. However, the optimum surgical method for venous management is controversial. Resection of the SMV without reconstruction during surgery for pancreatic tumors is rarely reported. Here we present the case of a 58-year-old woman with a giant pancreatic mucinous cystadenoma adhering to the SMV, who underwent an en bloc tumor resection, including the main trunk of the SMV and the spleen. No venous reconstruction was performed during surgery. No ischemic changes occurred in the bowel. The presence of several welldeveloped collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged. This case indicated that the main trunk of the SMV can be resected without venous reconstruction if adequate collateralization has formed.
文摘Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.
文摘This study aimed to explore the disinfection of drinking water in trunk water mains, based on published conditions denoted within the Irish Republic. The variables within the study were consumer draw-off rates, trunk main length, pipe diameter, and water temperature. All these factors are known to impact the free chlorine residual in operational supply networks. Based on published conditions obtained within the literature review, 60 hypothetical trunk mains were generated for this study. Of primary concern were the variables that affect the chlorine decay rate;total amount of chlorine decay;available amount of chlorine in the periphery of the trunk main;and the costs associated with effective chlorine disinfection of trunk mains. Based on the analysis performed, the following were the salient observations: 1) Low consumer draw-off rates and increased trunk main length and diameter increased the risk of the free chlorine residual in the periphery of the trunk mains not complying with the Environmental Protection Agency’s (EPA) minimum recommended residual value of 0.1 mg/l (EPA Drinking Water Audit Report, 2014). 2) Increasing the diameter of the trunk main from 125 mm to 180 mm had a negligible effect on the chlorine decay rate. However, increasing the trunk main diameter from 125 mm to 180 mm was shown to have a major impact on the total amount of chlorine decay and free chlorine residual available in the periphery of the main. The key parameters that affected disinfection costs associated with trunk mains include length, diameter and the need for chlorine boosting.
文摘Objective To study the clinical value of coronary stenting in treatment of severe complex coronary artery lesions, to evaluate the short and long term outcome of the patients imployed coronary stents, and to well recognize the role of stenting in dealing with the complications of PTCA.Methods In this study, two hundrad sixty four patients with coronary artery disease were included, who were classified as PTCA group (138 cases)and coronary stented group(126 cases).They all received Exercise Test(ET)、Ultrasound Cardiogram(UCG)and Ambulatory Electrocardiography (AECG)at admission and before discharge, respectively. The coronary artery lesions were categorized into type A.B.C according to the methods reported by ACC/AHA . It was that the data between two groups including clinical information, cronary artery lesion characteristicis, procedural success rate, major complications, Minimum Lumen Diameter (MLD),residual stenosis, collateral circulation scores both before and after procedure had been compared. Following up were performed 6 months to 3 years after procedure. Results The study showed that there were no significant different in two groups including the clinical information, positive rate of ET, EF, results of AECG. But the rate of type B2/C lesions were higher in CS group than that in PTCA group( P <0.05). Both PTCA Group and CS Group had extremely success rate in type A and type B1, but CS had a higher success rate than that in PTCA in type B2 and type C (94.28%VS 89.2%, P <0.05). CS group had a lower rate of complication in procedure than that of PTCA group. There are no signifiance in MLD between the two groups (0.53± 0.22)mm vs (0.42±0.26)mm,( P >0.05) before procedure. But MLD was signifantly higher in CS group than that in PTCA group (2.51±0.66)mm vs (3.08±0.66)mm,( P <0.001) after procedure.The collateral circulation scrores were signifantly decreased after procedure (1.7±0.6) vs (0.8±0.4); (2.1±0.3) vs (0.3±0.4) in both PTCA Group and PTCA Group respectivesly,( P <0.001). Residual stenosis were higher in PTCA group(15±6%)than that in CS group (6±3%, P <0.001). The positive rate of ET, exercise capacity, ST depressions, EF and wall motion were all improved significantly both in PTCA group and CS group, CS group has a higher effect in exercise capacity, MLD, EF and ischemia duration.Seventy nine patients were followed up and the rate of cardiac events in the CS group were lower than in PTCA group.Conclusions 1.Coronary stenting had a high success rate and low complication in treatment of severe and complex coronary artery lesions.2.Coronary stentig reduced residual stenosis, improved blood supply, salvaged the hibernating and /or stunned myocardium, improved the left ventricular function. CS have offered a new, safe and effective metbods for treatment of left main trunk lesions; 3.Coronary stenting has broden the indication for invasive treatment of coronary artery diseases.
