Objective To discuss the clinical complications caused by inferior vena cava abnormality and their interventional management. Methods The clinical data and interventional therapeutic results of 4 patients with complications due to abnormalities of the inferior vena cava were retrospectively analyzed. Results Duplicate inferior vena cava deformity was confirmed in two cases; one of them was complicated by right inferior vena cava with deep venous thrombosis of right lower extremity;and the other case had bilateral inferior vena cava thrombosis secondary to tumor thrombus within the intrahepatic segment of inferior vena cava, for which interventional treatment was not employed. Left-sided inferior vena cava was observed in 2 cases; clinically, one showed microscopic haematuria and lower back pain, and interventional treatment was not adopted; the other case had abdominal pain, and the symptom showed no obvious improvement after receiving stent implantation in the crossing segment of the left-sided inferior vena cava. Conclusion Clinically, the complications caused by abnormalities of inferior vena cava are rare. The diagnosis and the treatment of its complications should be based on the imaging manifestations, the related clinical symptoms, blood flow dynamics, etc. and the misdiagnosis and mistreatment should be avoided.

Objective To discuss the safety and clinical effect of fine needle single-step centesis in percutaneous endoscopic nephrolithotomy for renal staghorn calculi. Methods Percutaneous endoscopic nephrolithotomy with fine needle single-step centesis was employed in 75 patients (single-step group) with renal staghorn calculi, and percutaneous endoscopic nephrolithotomy with two-step centesis was adopted in other 75 patients with renal staghorn calculi (two-step group). The clinical effect and the incidence of complications were compared between the two groups. Results The placement of drainage catheter was successfully accomplished in all 150 patients. In single-step group the operation time was 18-45 minutes with a mean of 36 minutes; the mean blood loss during the procedure was about 5 ml. After the treatment, massive bleeding occurred in 3 cases that needed blood transfusion, and residual stone was observed in 6 cases. In two-step group the operation time was 16-42 minutes with a mean of 34 minutes; the mean blood loss during the procedure was about 7 ml. After the treatment, massive bleeding occurred in 7 cases that needed blood transfusion; one of them had renal pseudoaneurysm and the bleeding was stopped after renal artery embolization treatment; and residual stone was observed in 7 cases. No procedure-related perirenal organ injury was seen in single-step group, while in two-step group pneumothorax (n=1) and injury of splenic flexure of colon (n=1)were found. Conclusion In performing percutaneous endoscopic nephrolithotomy, fine needle single-step centesis is more safe and effective than conventional two-step centesis.

Objective To discuss the safety of percutaneous puncture drainage for liver abscess in patients with blood coagulation dysfunction. Methods A total of 85 patients with liver abscess, who were admitted to authors’ hospital during the period from January 2013 to January 2014 to receive ultrasound-guided percutaneous puncture drainage, were included in this study. According to the international normalized ratio of prothrombin time≥1.5 and platelet count≤50 ×109/L, the patients were divided into group A (normal coagulation group,n=67) and group B (coagulation dysfunction group,n=18). The occurrence of postoperative complications was recorded and the results were compared between the two groups. Results In both groups, no statistically significant difference in hemoglobin level existed between preoperative level and postoperative one, and no bleeding complications occurred in all patients after the procedure. Conclusion For patients with liver abscess complicated by blood coagulation dysfunction, percutaneous puncture drainage treatment is safe and reliable.

Objective To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) combined with argon-helium cryoablation in treating small renal cancers. Methods During the period from February 2008 to July 2013, a total of 44 patients with small renal cancer were treated with TAE and argon-helium cryoablation at The Medical Imaging Department of Nanjing General Hospital of Nanjing Military Area Command. The renal function was reexamined one month after the treatment. Contrast-enhanced CT or MRI was performed in all patients within 1-3 months after the treatment. By using mRECIST, the therapeutic efficacy was evaluated. All patients were followed up for 12-46 months (mean 28 months). Results A total of 48 lesions in the 44 patients were treated with sequential therapy of TAE and argon-helium cryoablation. Of the 48 lesions, complete remission (CR) was achieved in 38, partial remission (PR) in 6 and stable disease (SD) in 4, the remission rate (CR+PR) was 91.7%. No severe complications occurred in all patients, except one who developed localized hemorrhage during the performance of argon-helium cryoablation, which was improved after symptomatic medication. The mean postoperative hospitalization time was 4 days. Three patients were lost to follow-up, one patient died of esophageal cancer-related complication. The remaining patients were survival during the follow-up period, among them recurrence occurred in five within 13-22 months after the treatment, and the sequential therapy of TAE and argon-helium cryoablation had to be carried out once more. Conclusion For the treatment of small renal cancers, the sequential therapy of TAE combined with argon-helium cryoablation is minimally-invasive, safe and effective, and TAE that is performed before argon-helium cryoablation can reduce the incidence of bleeding occurring in the freezing process. Therefore, this technique should be recommended in clinical practice.

Objective To investigate the clinical application of a new thermosensitive embolic agent in interventional arterial embolization treatment, and to evaluate its effectiveness and safety in treating inoperable advanced hepatocellular carcinoma (HCC). Methods Prospective, open and single center clinical study of a new thermosensitive embolic agent was conducted. A total of 10 patients with clinically confirmed inoperable advanced HCC were treated with percutaneous arterial embolization using thermosensitive embolic agent; a maximum of 4 therapeutic cycles were performed until the disease progressed. Objective effect was evaluated at (30 ±7) days after the treatment according to mRECIST standard; the progression free survival (PFS) time and the survival period (OS) were recorded. The adverse reactions and adverse events were determined by NCI-CTC 3.0 version standard. Results Ten patients (23 target lesions in total) were enrolled in this study. After the treatment, complete remission (CR) was obtained in one patient, partial remission (PR) in 3 patients, stable disease (SD) in 5 patients, and progress disease (PD) in one patient. The objective response rate (CR+PR) was 40%, and the disease control rate (CR+PR+SD) was 90%. The PFS of hepatic lesions was 18.4 weeks (95%CI:14.15-22.65), the cumulated median survival period was 46.2 weeks (95%CI:38.18-54.22). The most common adverse reactions included pain, fever, hepatic function damage, small amount of ascites, diarrhea, etc. Conclusion The new thermosensitive embolic agent is not sticky to vessel and is visible under X-ray; it has reliable embolization effect, and the therapeutic results can be easily evaluated. This embolic agent is not perfect, and it has some limitations in clinical use. The adverse reactions are mild, which can be easily tolerated by the patients. It is worth trying to carry out large sample and randomized controlled studies in order to open up more areas for arterial chemoembolization therapy of tumors.

Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P<0.000 1). In the retrograde group, the blood flow perfusion of the distal foot tissue was improved. The primary target vessel patency rate at 12 months and 24 months after the treatment in the retrograde group and the routine group were 63.6%(14/22), 45.5%(10/22) and 52.9%(45/85), 37.6%(32/85) respectively (P>0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.

Objective To investigate the effects of ischemic postconditioning (IPOC) on myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with emergency percutaneous coronary intervention (PCI). Methods A total of 203 patients with STEMI who received emergency PCI were randomly divided into IPOC group (n=103) and control group (n=100). For the patients of IPOC group the angioplasty balloon was re-inflated within one minute after the beginning of reperfusion, the procedure was repeated three times, each time the inflation of balloon lasted for 1 minute using low-pressure (4-6 atm), and the interval between the inflation procedures was one minute. For the patients of the control group , no additional intervention was employed during the first 6 minutes of reperfusion. Cardiac troponin I(cTnI) peaks, creatine kinase-MB (CK-MB) peaks, left ventricular ejection fraction (LVEF), wall motion score index (WMSI), corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC), and major adverse cardiac events (MACE) occurred during hospitalization time in both groups were recorded and the results were compared between the two groups. Results No significant differences in age, sex, risk factors, infarction-related artery, ischemia time, etc. existed between the two groups (P>0.05). The CTFC values of IPOC group were significantly faster than those of the control group, that was (25.3±7.9) vs.(29.4±8.4),(P<0.05). The CK-MB peak and cTnI peak values of IPOC group were remarkably lower than those of the control group, those were (157.3 ±83.6) U/L vs. (201.5 ±77.3) U/L and (2.5 ±1.3) ng/mL vs. (3.1 ±1.0) ng/mL respectively (P<0.05). At the time of admission, there were no significantly differences in the LVEF and WMSI values between the two groups, and three months after PCI the LVEF and WMSI values of IPOC group were significantly better than those of the control group, those were (57.4 ±8.7)% vs. (53.6 ±9.3)% and (1.19 ±0.4) vs. (1.27 ±0.3) respectively, the differences were statistically significant (P<0.05). Three months after PCI, the occurrence of MACE in IPOC group was obviously lower than that in the control group (P<0.05). Conclusion Ischemic postconditioning can improve the infarction-related artery blood flow in patients with STEMI who receive emergency PCI treatment, it can also reduce ischemia-reperfusion injury and improve the cardiac function as well as patient’s prognosis after AMI.

Objective To investigate the efficacy and safety of different acoustic power of high-intensity focused ultrasound (HIFU) in treating human pancreatic xenograft models. Methods Human pancreatic cancer cells (YY-1) were implanted subcutaneously in nude mice to establish animal models. The tumor bearing mice were divided into low-power HIFU treatment group (200 W,n=10), high-power HIFU treatment group (300 W,n=10) and blank control group (n=10). The change of tumor volume, the tumor growth rate and side effects were recorded. The apoptosis rate of tumor cells of each group was determined by TUNEL method. Results The tumor volume and the tumor growth rate of the low-power group and the high-power group were significantly lower than those of the control group (P<0.05), while no statistically significant differences in the tumor volume and the tumor growth rate existed between the low-power group and the high-power group (P>0.05). Compared with the low-power group, the incidence of side effects in the high-power group was significantly higher (P<0.05), including mainly skin burn (60%) and acoustic channel injury (20%). At the 7th and 14th day after the treatment, the apoptosis rates of tumor cells in both the low-power group and the high-power group were significantly higher than that of the control group (P<0.05), but the difference in the apoptosis rates of tumor cells was not statistically significant between the low-power group and the high-power group (P>0.05). Conclusion For the treatment of human pancreatic xenograft tumor in nude mice models, HIFU with low power is effective and safer.

Objective To discuss the clinical application of ultrasound-CT double-guided radiofre-quency ablation(RFA) in treating hepatic tumors. Methods Fifteen patients with 20 liver tumor lesions were included in this study. Ultrasound-CT double-guided radiofrequency ablation was employed in all patients. First, under ultrasound guidance the electrode of RFA was inserted to the site close to the lesion, then, guided by CT scanning the accurate positioning of the electrode was accomplished and RFA procedure was completed. Results The accurate puncturing of the electrode was achieved in all 20 hepatic lesions, and the RFA procedure was successfully performed in a short time. Follow-up examination showed that there was no obvious residual tumor tissue, and no RFA-related complications occurred in all the 15 patients. Conclusion Under ultrasound-CT double-guidance, the percutaneous transhepatic puncturing can be more accurately accomplished, which can ensure a successful RFA procedure. This technique is especially useful when the hepatic tumor is incomplete or unclear on ultrasonograph, and it can improve the puncturing accuracy and reduce the complications as well.

Objective To evaluate the clinical efficacy of uterine artery chemoembolization (UACE) and uterine artery embolization (UAE) with subsequent curettage in treating cesarean scar pregnancy (CSP). Methods A total of 79 patients with clinically-confirmed CSP were randomly divided into two groups:group A (UACE group,n=43) and group B (UAE group,n=36). Patients in each group were subdivided into two subgroups: endogenous type subgroup and exogenous type subgroup. Interventional management (UACE for group A and UAE for group B) with subsequent curettage was carried out in all patients of both groups. The amount of blood loss during curettage, the recovered time of human chorionic gonadotropin (HCG) level, the twice treatment rate and the success rate of treatment were measured and were used as the therapeutic evaluation parameters. The results were compared between group A and group B as well as between the subgroups. Results After UACE or UAE, the uterine dilation and curettage was successfully accomplished in all patients of both groups. Hysterectomy was not needed in all patients. Statistically significant differences in the recovered time of HCG level, occurrence of complications and the twice treatment rate existed between the two groups (P<0.05). The endogenous type of cesarean scar pregnancy in group A and group B was confirmed in 28 cases and 25 cases respectively, and the success rate of treatment for them was 100% (28/28) and 96.0% (24/25) respectively (P>0.05). The exogenous type of cesarean scar pregnancy in group A and group B was proved in 15 cases and 11 cases respectively, and the success rate of treatment for them was 86.7%(13/15) and 45.5%(5/11) respectively (P<0.05). The differences in postoperative vaginal bleeding time, the menstrual recovery time, the recovered time of HCG level, the twice treatment rate and the success rate of treatment between the two exogenous type subgroups were statistically significant (P<0.05 in all). Conclusion For the treatment of cesarean scar pregnancy, both UAE and UACE with subsequent curettage are safe and effective. For the treatment of endogenous type of CSP, it is better to use UAE, while for the treatment of exogenous type of CSP, it is better to use UACE.