Twin reversed arterial perfusion sequence-a rare and dangerous complication form of monochorionic twins:A case report

BACKGROUND Twin reversed arterial perfusion(TRAP) sequence is an extremely rare congenital anomaly in monochorionic(MC) twins.The condition is characterized by a malformed fetus(acardiac twin) without cardiac activities being perfused by a structurally normal one(pump twin) via an artery-to-artery anastomosis in a reverse direction.CASE SUMMARY We described the first case of TRAP to receive laser surgery in Vietnam.The 26-wk pregnancy was originally misdiagnosed in another hospital as MC twins with single intrauterine fetal death.Following admission to our center,the diagnosis was amended to a 26-wk TRAP sequence stage IIb.The acardiac twin was 7.5 cm at the longest length,the ratio of the weight of the acardiac twin to the weight of the pump twin was more than 90%,the pump twin showed fetal distress with absent diastolic flow in umbilical artery of pump twin,and the peak systolic velocity in the middle cerebral artery = 1.6 Mo M.We performed emergency laser photocoagulation of the acardiac twin’s umbilical cord.After surgery,we successfully maintained the pregnancy for 8 wk and ended it electively by cesarean section at 34 wk of gestation due to rupture of membranes.CONCLUSION TRAP should be appropriately diagnosed and treated early to avoid complications of the pump twin.Fetoscopic laser photocoagulation is a new and effective treatment for this condition.

Studies of Selective Arterial Perfusion plus Chemoembolization on Hepatic Metastasis from Rectal Cancer

OBJECTIVE To develop an effectual method for treating hepatic metas-tasis from rectal cancer. METHODS A randomized control study of celiac artery perfusion plus transcatheter hepatic arterial chemoembolization (TACE) (observation group) and intravenous chemotherapy (control group) for 99 cases with hepatic me-tastasis from rectal cancer was performed. The perfusion was repeated once at 4 weeks after the first treatment of 52 cases in the observation group, and it was subsequently repeated at an interval of 2 or 3 months. Using intrave-nous administration, the perfusion was repeated once every 3 weeks with 47 cases in the control group. RESULTS Three months after treatment, the patients in the observation group who showed a relief or elimination of a former superior abdominal pain amounted to 70.6%, and those with a diminution of their intrahepatic mass reached 55.8%. In the control group, the patients with a relief or disappear-ance of hepatalgia reached 20%, and those with a diminution of their intrahe-patic mass reached 10.6%. The 1, 2 and 3-year survival rates were 80.8%, 46.2% and 25.0% in the cases of the observation group and 61.7%, 19.1% and 4.3% in the control group, respectively. CONCLUSION For the patients who failed to receive a surgical opera-tion on their hepatic metastasis from rectal cancer, celiac artery perfusion plus TACE is a more effective regimen for improvement of the clinical symp-toms and extension of the survival time, compared to intravenous chemo-therapy, and is a better choice for palliative therapy.

Efficacy of continuous arterial perfusion chemotherapy combined with transarterial chemoembolization regional arterial thermal perfusion in the treatment of pancreatic cancer with liver metastases

Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.

Intrauterine Treatment of Monochorionic Triamniotic Triplet Pregnancy with Twin Reverse Arterial Perfusion Sequence

To editor:This study reports a pregnant woman who was naturally conceived with monochorionic triamniotic(MCTA)combined with twin reversed arterial perfusion(TRAP).An ultrasound revealed that one of the fetuses had a cardiac malformation,and a connection between the umbilical arteries was suspected.To reduce the acardiac fetus,radiofrequency ablation was performed at 17+3 weeks of pregnancy.At 36+4 weeks,two healthy infants were delivered via elective cesarean section.Postoperative examination revealed a direct connection between the umbilical arteries,with the placental perfusion acting as a direct pump.It is essential to identify the intrauterine status of the blood-supplying infant and vascular connections in order to achieve successful outcomes in pregnancies with complications,such as edema and heart failure.The studies involving human participants were reviewed and approved by Human Research Ethics Committee of Tianjin Central Hospital of Obstetrics and Gynecology.The patient provided her written informed consent to participate in this study.

Clinical Observation on Primary Hepatocarcinoma Treatedby Arterial Perfusion with Cinobufotalin and Chemicals

Objective: To find effective treatment with less side-effect for hepatocarcinoma.Methods: Seventy patients were divided into two groups, treated with cinobufotalin plus chemicals and chemicals alone by arterial perfusion respectively. The symptoms, hematological picture, tumor size and viral marker of patients were observed and compared.Results: The treatment with cinobufotalin plus chemicals was more effective than that of chemicals alone in body weight increasing, pain relieving, liver function recovering and virus marker negative inversing.Conclusion: Cinobufotalin could improve the effect of chemo-embolization therapy of hepatocarcinoma.

Study on Treatment of Primary Hepatic Carcinoma by Arterial Perfusion Embolization with Zedoary Turmeric Oil

To evaluate the effect, side-effect and prospect of hepatic arterial perfusion embolization (HAPE) with Zedoary turmeric oil (ZTO) in treating primary hepatic carcinoma (PHC).Methods: Clinical study was carried out by administration of 1-3 ml ZTO through arterial catheter to induce embolism in 32 patients of PHC, and compared with 32 patients treated by hepatic arterial perfusion embolization with chemical agents (HAPE-C) in the control group. The Chinese herbal medicine was given orally to both groups according to Syndrome Differentiation of TCM. In the experimental study, transplantation hepatic carcinoma model was established in 40 rats. They were randomly divided into the treated group and the control group, 20 in each group, and were perfused with 10 mg/kg ZTO and 0.2-0.3 ml normal saline respectively to observe the effect of treatment.Results: The effect of treatment in the ZTO group was CR in 1 case and PR in 13 cases, the total effective rate being 43.75%, with AFP negative reversed in 7 cases, titer decreased in 7; while in the control group it was PR in 10 cases, the total effective rate being 31.25%, AFP negative reversed in 5, titer decreased in 2, and the difference of therapeutic effect between the two groups was insignificant (P>0.05). The post-perfusion thrombotic syndrome occurrence, with the symptoms of fever, abdominal pain, vomiting, etc. in the two groups was similar, but no bone marrow inhibition occurred in the ZTO group, which was different from the control group (P<0.01, P<0.05). The mean survival time, median survival time, 1-, 2-, 3- and 4-year survival rate in the ZTO group was 13.84 months, 10 months, 37.5%, 18.87%, 9.70% and 6.4% respectively, and in the control group, 8.03 months, 6 months, 15.6%, 6.27%, 0% and 0% respectively, the mean survival time, median survival time and 1-year survival rate in the ZTO group were significantly superior to those in the control group (P<0.05). Experimental study showed that the effect in the treated group was better than that in the control group in tumor growth inhibition with the tumor growth rate as 10.8±4.5%% vs 20.6±12.7%, P<0.05, tumor necrosis degree (P<0.01) and survival time prolonged (14.8±3.4 days vs 11.7±1.9 days, P<0.05).Conclusion: HAPE-ZTO in treating PHC showed the therapeutic effect similar to that of HAPE-C, but superior to the latter in survival time prolongation and bone marrow inhibition.

A perfusion mode of pulmonary artery during cardiopulmonary bypass

Objective Lung injury occurred during cardiopulmonary bypass as a result of both ischemic reperfusion injury and systemic inflammatory response is critical for patients’recovery. This study was designed to establish a convenient and appropriate mode for pulmonary arteryperfusion and evaluate its effects on the

Sports compression garments improve resting markers of venous return and muscle blood flow in male basketball players

Background:The benefits associated with sports compression garments are thought to be closely related to enhanced blood flow.However,findings are equivocal,possibly due to heterogeneity in the techniques used for measuring blood flow,the garment types used,and the pressures applied.This study combined Doppler ultrasound and near-infrared spectroscopy technologies to provide the first comprehensive assessment of the effects of 3 sports compression garment types on markers of venous return and muscle blood flow at rest.Methods:Resting lower-limb blood flow measures(markers of venous return,muscle blood flow,and muscle oxygenation)of 22 elite,junior,male basketball players(age=17.2±0.9 years,mean±SD)were assessed in 4 separate conditions:no compression(CON),compression tights(TIGHTS),compression shorts(SHORTS),and compression socks(SOCKS).Markers of venous return(cross-sectional area,time-averaged mean and peak blood flow velocity,and venous blood flow)were measured via Doppler ultrasound at the popliteal and common femoral veins.Muscle blood flow and muscle oxygenation were measured in the gastrocnemius medialis and vastus lateralis using near-infrared spectroscopy.Results:Popliteal markers of venous return were higher in TIGHTS compared to CON(p<0.01)and SHORTS(p<0.01),with SOCKS values higher compared with CON(p<0.05).Common femoral vein markers of venous return were higher for all conditions compared to CON(p<0.05),with TIGHTS values also higher compared to SOCKS(p<0.05).Gastrocnemius medialis blood flow was higher for TIGHTS compared to CON(p=0.000),SOCKS(p=0.012),and SHORTS(p=0.000),with SOCKS higher compared to SHORTS(p=0.046).Vastus lateralis blood flow was higher for TIGHTS compared to CON(p=0.028)and SOCKS(p=0.019),with SHORTS also higher compared to CON(p=0.012)and SOCKS(p=0.005).Gastrocnemius medialis oxygenation was higher for TIGHTS compared to CON(p=0.003),SOCKS(p=0.033),and SHORTS(p=0.003),with SOCKS higher compared to CON(p=0.044)and SHORTS(p=0.032).Vastus lateralis oxygenation was higher for TIGHTS compared to CON(p=0.020)and SOCKS(p=0.006).Conclusion:Markers of venous return,muscle blood flow,and muscle oxygenation are increased with sports compression garments.TIGHTS are most effective,potentially because of the larger body area compressed.

The Umbilical Cord and Complications of Twin Gestations

The rate of twin pregnancies has increased over the last decades, largely because of the ongoing development of assisted reproductive technology and increased maternal age at childbearing. Twins have a higher risk of adverse outcomes during pregnancy and the perinatal period. The prevalence of umbilical cord abnormalities is higher for twin pregnancies compared with singleton pregnancies. Some of these abnormalities are nonspecific to twinning and can also be found in singleton gestations (such as velamentous cord insertion, vasa previa, and single umbilical artery). Other abnormalities are associated with monochorionic twins, such as umbilical cord entanglement, and umbilical proximate cord insertion. Most of these abnormalities can be detected by ultrasound evaluation. The early and accurate ultrasound diagnosis of chorionicity, amnionicity, and placental and umbilical cord characteristics is crucial if we are to predict the risk of complications and to determine the best management for twin pregnancies. Histopathological examination of the placenta and umbilical cord after delivery can help to confirm prenatal diagnosis and to provide a better understanding of the physiopathology of their abnormalities. The aim of this review was to emphasize the role that the umbilical cord plays in twin complications and to describe the management of these high-risk pregnancies.

Therapeutic Effects of Pefusing Compound Salvia Miltiorrhiza Injection Through the Hepatic Artery in the Late Stage of Hepatocarcinoma

In the treatment of 20 patients with advanced hepatocarcinoma, whose conditions wors-ened affer chemotherapy, with hepatic artery intubation, by injection of Compound Salvia Miltiorrhizathrough the hepatic artery, it can be seen that their signs were relaxed and tumor masses were diminishedand biochemical indices were improved. The test group had a 65% rate of general efficiency, while thecontrol group had only 25%. There is a significant difference (P<0. 01) between the two groups. There-fore the method of treatment for such patients is thought to be worthy of being further studied.