Surgical treatment of carotid artery stenosis (for 120 cases)

To evaluate the surgical treatment of carotid artery stenosis.Methods According to the level and degree of the stenosis,different operations were performed on 120 patients who suffered from the extracranial carotid stenosis.Treatment result was retrospectively reviewed.Results Surgery was successful in all the patients.We performed carotid endarterectomy on 111 cases and other operations on 9 cases.The incidence of postoperative complications was low,especially for carotid endarterectomy.Conclusion Carotid endarterectomy is still the main therapy for the treatment of carotid artery stenosis with a satisfactory result.4 refs,2 figs.

Surgical treatment of acute embolism of the upper extremity

Objective To study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity. Methods Balloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity. Results Both the pulse of the radial and ulnar artery could be aplpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6 th day after onset of the illness. Three patients died postoperatively. Conclusion Embolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary disease are the high risk factors for postoperative death. 4 refs,2 tabs.

Endovascular repair of aneurysms or dissection aneurysms of the aortic arch—preliminary experiences in 14 cases

To evaluate the efficacy of endovascular repair (EVR) for aneurysms or dissection aneurysms of the aortic arch.Methods Twelve aortic dissection aneurysm (ADA) patients with the primary entry located within 15 mm beyond the origin of the left subclavian artery (LSA) and two aortic arch aneurysm patients underwent EVR from June 2003 to August 2004.EVR with intentional coverage of the LSA without any supportive bypass was employed in 8 ADA patients,and the preliminary cervical reconstruction combined with EVR in the remaining 6 cases.Results Technical success was achieved in all cases.One case died of postoperative cerebral infarction.No neurological deficits or limb ischemia developed perioperatively or during the follow-up period ranging from 1 to 14 months and complete thrombosis of the thoracic aortic false lumen and remarkable aneurysmal thrombosis were revealed by CT in all 12 ADA cases and the remaining aneurysm case respectively.Conclusion EVR is effective in the management of aneurysms or dissection aneurysms of the aortic arch.6 refs,3 figs.

Endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome

To evaluate the effect of endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome.Methods Forty-two cases of Cockett syndrome with femoral veins reflux were treated with iliac vein stent implantation or venoplasy,and superficial femoral veins were constricted with ePTFE graft patch at the level of the first valves.Results All the iliac veins were patent after stent implantation.A follow-up of 8 to 45 months revealed that limb swelling disappeared in 38 cases with no varicose.Slight limb swelling was left over in 3 cases.Stent thrombosis,developed in one case two months later,subsided by a successful thrombolysis.Conclusion The procedure is mini-invasive,safe and effective for the treatment of Cockett syndrome.6 refs,1 fig.

Predominant expression of Th1-type cytokines in primary hepatic cancer and adjacent liver tissues

BACKGROUND: Research has revealed a shift towards Th2 in many types of malignant tumor, but the state of Th1/Th2 is not clear in patients with primary hepatic cancer (PHC). This study was designed to determine the expression of Th1- versus Th2-type cytokines in primary hepatic cancer and the adjacent liver tissue in order to provide evidence for treatment of the Th1/Th2 shift. METHODS: Samples were collected from 11 patients with PHC. The gene expression of Th1/Th2 cytokines was detected by reverse transcriptase polymerase chain reaction (RT-PCR) using IFN-gamma and IL-2 as Th1-type cytokine genes, and IL-4 and IL-10 as Th2-type cytokine genes. RESULTS: Th1-type cytokines were expressed in 7/11 PHCs and 9/11 adjacent liver tissues, while Th0 type cytokines occurred in 4/11 PHCs and 2/11 adjacent liver tissues. CONCLUSION: Th1-type cytokines are expressed predominantly in primary hepatic cancer and the adjacent liver tissue.

Reoperation for postoperative recurrence in Budd-Chiari syndrome patients undergoing radical resection

To explore the cases of recurrence of Budd-Chiari syndrome after radical resection and the key points of second surgery.Methods Venography was performed in 11 relapsing cases.The diseased IVC segment was resected and replaced with artificial vascular graft in 4 cases,membranectomy and thrombectomy were performed in 2 cases.Thrombectomy with artificial vascular patch cavoplasty in 4 cases,incision of the stenotic IVC and right hepatic venoplasty and IVC venoplasty with artificial vascular patch repairing was performed in 1 case.Results The mortality rate was zero.Acute heart failure occurred in 2 cases and thoracic hemorrhea in 2 cases.Symptoms disappeared or improved in all cases.Patients were followed up from 6 to 68 months,with excellent results in 9 cases and fair in 2 cases.Conclusion There were some factors influencing the long-term results of the surgery including distal free length from diseased IVC,thrombus clearance,material and size of the patch used for venoplasty.7 refs,2 figs.

Arterial bypass for subclavian arterial occlusion:results in 30 patients

To investigate the effect of arterial bypass for subclavian artery occlusive disease.Methods In this study,30 patients with subclavian artery occlusive disease received arterial bypass from Jan 1994 to Jan 2004.Occlousive lesions were documented preoperatively by arteriography.Patency was determined during follow-up by Duplex ultrasound.Results All 30 patients undergoing bypass procedure were measured with blood pressure differences of less than 10 mmHg between the treated and the healthy arms.The ratio of healthy/diseased side of the mean blood presure index increased from 0.66±0.11 preoperatively to 0.99±0.09 postoperatively (P<0.01).Twenty-two cases (73.3%) were followed up from 18 months to 9 years with patency rate of 83.3% (25/30).Conclusion Arterial bypass remains the choice of treatment for subclavian arterial occlusion.5 refs,3 figs.

Expression of transforming growth factor-β1 and its type Ⅰ receptor in autogenous vein grafts in rats

atday3,7,14,sedtomeasurethttimepoints.

Aortoduodenal fistula after endovascular aortic repair of an infected abdominal aortic aneurysm

To the editor： We report a case of aortoduodenal fistula presenting as right lower limb ischemia and infection after endovascular aortic repair （EVAR） of an infected abdominal aortic aneurysm （AAA）. A right above knee amputation was performed for the septic embolism of the ilio-femoral arteries before the stem-graft infection was finally diagnosed. Then an extra-anatomic revascularization of the left lower limb, following by explantation of the infected stent-graft and rebuilding of the gastro-intestinal continuity were done.

Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis

Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.

Rapamycin and 3-methyladenine regulate apoptosis and autophagy in bone-derived endothelial progenitor cells

Background Mammalian target of rapamycin （mTOR） is involved in a caspase independent form of programmed cell death called autophagy. The aim of this research was to investigate the effects of rapamycin and 3-methyladenine （3-MA） on autophagy, proliferation, apoptosis, and cell-cycle parameters of rat bone marrow-derived endothelial progenitor cells （EPCs）. Methods Mononuclear cells isolated from rat bone marrow were treated with rapamycin （0.01, 0.1, 1, or 10 pg/L） or 3-MA （1.25, 2.5, 5, or 10 mmol/L） for 24 hours. Expression of the autophagy marker protein LC3-11 was analyzed by Western blotting. Apoptosis and cell-cycle progression were analyzed by flow cytometry. Cell proliferation was measured using the MTT assay. Results Rapamycin treatment of EPCs induced apoptosis and autophagy and inhibited proliferation and cell-cycle progression in a dose-dependent manner. Treatment with 5 mmol/L 3-MA promoted cell proliferation; in contrast, treatment with 10 mmol/L 3-MA promoted apoptosis and induced S-phase arrest. Conclusions Rapamycin treatment of EPCs induced apoptosis and autophagy. Low concentrations of 3-MA had no significant effect on the proliferation and apoptosis of EPCs; The 5 mmol/L group promoted cell proliferation, but had no effect on the apoptosis; the 10 mmol/L group inhibited the proliferation and promoted apoptosis through the cell cycle.

Pulse-spray catheter directed thrombolysis in patients with recent onset or deterioration of lower extremity ischemia

Background The recent onset or deterioration of lower extremity ischemia is highly associated with intravascular thrombus.Treatment of these thrombotic occlusions is challenging.Pulse-spray catheter directed thrombolysis （PS-CDT） refers to the technique of intermittent forcefully injecting the thrombolytic agent into the thrombus to fragment it and increase the surface area available for enzymatic action.This study was designed to evaluate the efficacy and safety of PS-CDT in patients with recent onset or deterioration of lower extremity ischemia.Methods From August 2008 to March 2009,44 patients with acute or chronic lower extremity ischemia were recruited in this prospective study,which included 37 men and 7 women ranging from 15 to 83 years old （mean age （51.1±17.4） years）.PS-CDT through a multi-side-hole thrombolytic catheter by using urokinase was conducted in all patients.The progression of thrombolysis was assessed and graded by angiography.Adjunctive therapies were used to correct underlying lesions.The follow-up period was 12 months.Results In the 44 patients,the average total dose of urokinase for each patient was （2120000±1100000） IU （median 2000000 IU）,with a median duration of lysis of 48 hours.The rate of initial technical success was 97.7%.The rate of clinically successful lysis was 81.8%.Early （〈30 days） and late （from 30 days to 12 months） amputation rates were both 4.5% （2/44）.The overall amputation rate was 9.1% （4/44）.No mortality was recorded during thrombolysis and follow-up period （12 months）.No major bleeding or allergic reaction was seen during thrombolytic therapy.11.4% had symptoms of distal embolization.The primary patency rate for the arteries that were clinically successfully thrombolyzed as compared with those that failed to lysis was 83.3% vs.57.1%,respectively,at 1 year.Conclusions PS-CDT,combined with adjunctive therapies,is associated with good safety and efficacy in recent-onset or deterioration of lower extremity ischemia.Successful thrombolysis may be accompanied by better outcomes.

Progress of research on the biomechanics of aorta and stent graft

With improvements in the technology of clinical diagnosis of aortic diseases, more and more cases have been found on such vascular lesions as aortic dissection and abdominal aortic aneurysm, which lead to aortic biomechanical changes. Aortic biomechanics research will become a hot spot in the near future. At the same time, stent grafts （SGs） are widely used in the endovascular treatment of vascular diseases. The biomechanical properties of SGs will also become a focus of research. Understanding the relation between the aorta and SGs will better cater to clinical services by improving the success rate of surgery for aortic diseases and reducing intraoperative and postoperative complications. This article reviews researches on the biomechanics of the aorta and SGs.