Objective To investigate the diagnosis and treatment of gastric stromal tumor(GST). Methods Retrospective analysis was made on the clinical data of 18 cases of GST. The diagnosis of 18 cases was confirmed by pathology. Local resection of the tumor was performed in 2 cases,partial gastrectomy in 5 cases, subtotal gastrectomy in 9 cases, and total gastrectomy with lymph node clearance in 2 cases. Results Most of the patients were over forty years old.In 55.5% of cases,the location of tumor was at the middle of the stomach,and 61.0% of cases were intragastric growth type.The preoperative diagnostic rate was 27.8%,misdiagnostic rate was 72.2%.The resectability rate was 100%. No postoperative complications and operative death occurred in this series. Fifteen cases were followed up for 1 to 10 years. During follow up,2 cases died of recurrence of the tumor, and the other patients were still alive. Conclusion The GST patients lack typical clinical manifestations, and the preoperative diagnosis is difficult.Barium meal examination and gastroscopy are the main supplementary examinations.A combination of histological and immunohistochemical examinations is helpful to confirm the diagnosis.Surgical resection is the only effective therapeutic method.

Objective To enhance the yield and product quality of diosgenin extract,the method of stepwise biocatalysis was used.Methods The optimum conditions of slepwise biocatalysis were obtained through orthogonal tests.In qualitative and quantitative analysis of diosgenin extracted through stepwise biocatalysis,IR spectrum and HPLC chromatogram were used.The yield and melting point of diosgenin were taken as investigated standard index to compare this method with others,such as acid hydrolysis,spontaneous fermentation,and enzymatic hydrolysis.Results When cellulase and pectinase compound,amlyse and diastatic enzyme were added in order in the method of stepwise biocatalysis,98% diosgenin from plants was extracted.IR spectrum of the product was in accordance with that of reference substance and the purity of it is more than 95% according to its HPLC chromatogram.Conclusion Compared with other three methods,it can improve the yield and quality with less energy consumption by stepwise biocatalysis.

Objective To compare of the effect of portaazygous devascularization(PADV) and combination operation(splenorenal shunt plus portaazygous devascularization)on the treatment of esophageal variceal bleeding(EVB).Methods 28 cases of EVB admitted from October 1995 to October 2000 were divided randomly into two groups:(1)PADV group (14 cases);(2) combination operation(14 patients).The free portal pressure(FPP) and portal veinous flow(PVF)were measured intraoperatively; and pre and post-operative barium meal and therapeutic effect between 2 groups were compared.Results The average value of FPP of PADV group and combination operation group reduced (4.81?7.26)cmH 2O and (10.03?2.66)cmH 2O respectively after operation, there were significant difference (both P

Objective To evaluate the efficacy and mid-term follow-up results of endovascular treatment with Willis covered stent for traumatic pseudoaneurysms located in the internal carotid artery (ICA).Methods ICA angiogmphy was performed in 38 patients with traumatic brain and neck injury.Of the 38 patients.13 delayed traumatic pseudoaneurysms were found.All the pseudoaneurysms were treated with Willis covered stents.Follow-up angiography was performed at 1,3,6 and 12 months after the procedure,and the results were categorized as complete or incomplete occlusion.Clinical manifestations were graded as full recovery,improvement,unchanged and aggravation.Results Willis covered stent placement was technically successful in all traumatic pseudoaneurysms.No procedure-related complications occurred.The initial angiographic results showed a complete occlusion in 9 patients,and an incomplete occlusion in 4.The angiographic follow-up within 3-12 months exhibited a complete occlusion in 12 patients and the parent arteries remained patency in all patients.The clinical follow-up observation demonstrated that full recovery wag obtained in 11 patients,clinical improvement in one,and unchanged condition in one.No morbidity or mortality occurred.Conclusion Willis covered stent implantation iS a feasible and practical treatment for traumatic pseudoaneurysms located in the ICA.This technique can well preserve the parent artery with excellent therapeutic results.

Objective To investigate the diagnostic accuracy of contrast-free three dimensional time-of-flight (3D-TOF-MRA) with VR at 3.0 T in the detection of intracranial aneurysms in a large cohort of patients prospectively.Methods Four hundred and eleven patients with suspected aneurysms and other cerebral vascular diseases received contrast-free 3D-TOF-MRA examinations at 3.0 T MRA 2 weeks prior to DSA examination.2D-DSA and VR-DSA were regarded as the gold standard.Six patients were excluded because of motion artifacts,and 36 patients were excluded due to lack of VR-DSA data.Accuracy,sensitivity an specificity in detecting intracranial aneurysms were determined by patient-,aneurysm-,and aneurysm sizebased (＜ 3 mm,3-5 mm,＞ 5-10 mm,＞ 10 mm) evaluations.Results In 369 enrolled patients,VR-DSA revealed 306 aneurysms in 246 patients (66.7％) and no aneurysm in 123 patients; VR 3D-TOF-MRA revealed 311 aneurysms in 249 patients and no aneurysm in 120 patients.The patient-based evaluation of VR 3 D-TOF-MRA at 3.0T yielded accuracy of 97.6％ (360/369),sensitivity of 99.2％ (242/244),and specificity of 94.4％ (118/125) in the detection of intracranial aneurysms.The aneurysm-based evaluation yielded accuracy of 98.3％ (524/533),sensitivity of 99.3％ (304/306),and specificity of 96.1％(220/229).The evaluation based on aneurysm sizes (＜ 3 mm) yielded accuracy of 96.4％ (214/222),sensitivity of 98.2％ (112/114),and specificity of 94.4％ (102/108).Conclusion VR 3D-TOF-MRA at 3.0 T MR can detect intracranial aneurysms accurately and may replace DSA as a contrast-free,noninvasive and non-radiation-based modality for the diagnosis and screening of intracranial aneurysms.

Objective To evaluate the mid- and long-term radiological outcomes of cerebral aneurysms with GDCs embolization.Methods One hundred and sixty-two patients with 173 aneurysms embolized with GDCs underwent angiographic follow-up from 1 to 54 months post-operatively and were retrospectively reviewed. Three neuro-radiologists reviewed each angiogram and made a comparison between initial and follow-up angiograms. Morphological outcomes were evaluated as follows: unchanged; progressive thrombosis; and re-opening or re-growth. Results Of 173 aneurysms with GDC embolization, 142 aneutysms had total or nearly total occlusion, 23 subtotal occlusion and 8 partial occlusion shown on initial angiograms. The incidence of re-opening was 17.1% (13/76) in less than 3 months, and 6.2% (6/97) between 3 and 6 months postoperatively. Four aneurysms showed recurrency(2.3%) on second follow-up angiography in one year after procedure and one-year cumulative recurrent rate was 13.3% of 56 aneurysms with the third follow-up angiography in the post-operation period of 12 to 54 months, four showed a little enlargement and the cmnulative recurrent rate so far was 20.2% (35/173). Conclusions The direct and main causes for aneurysmal recurrence are incomplete and loosening packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier after the procedure, especially in aneurysms with initial incomplete occlusion. Re-treatment with balloon- or stent-assisted coil embolization is recommended in re-opening aneurysms. (J Intervent Radiol,2005,14:472-479)

Objective To present our single-center experience in treating traumatic direct carotidcavemous fistulas (TDCCFs)by using detachable balloon,coil and Willis covered stent via arterial route.Methods During the last five years,transarterial endovascular treatment by using detachable balloon,coil and Willis covered stent was performed in fifty-one consecutive patients of traumatic direct carotid-cavernous fistulas.with a total of 54 TDCCFs.The detachable balloon was the material of first choice,while Willis covered stents and coils were regarded as the back-up materials.A clinical and angiographic follow-up for 348 months (mean 20.8 months) was conducted to evaluate the arterial patency and the stability of embolization.The clinical data were retrospectively analyzed.Results By using the detachable balloon alone via transarterial route.85%TDCCFs were successfully treated with good preservation of ICA.A total of 98% TDCCFs in this study were successfully treated by using detachable balloon,coil and/or Willis coveted stent,the fistulas became occluded,and ICAs were preserved except one patient.Forty TDCCFs were treated with detachable balloons alone,two TDCCFs with the Willis covered stent alone,and one DCCF with coils alone.Eight TDCCFs were treated with detachable balloons together with Willis covered stent.Of these eight TDCCFs,two were treated with a single session,three were treated with detachable halloons in combination with coils,and one had to receive Willis covered stent.Second and third times of endovascular treatment were needed in 12 TDCCFs.The TDCCF-rel(at)ed symptoms were gradually relived or improved within 1 day to 6 months after treatment,except for five patients who suffered from ipsilateral moderate visual loss or cranial nerve deficit.No perioperative complications.such as vessel rupture,distal embolization or new neurologic deficits,occurred.During the follow-up period lasting for six months,neither delayed neurologic or vascular complications nor recurrence of the lesions developed.Conclusion Via the transarterial route,using detachable balloon to occlude the fistula and at the same time to preserve ICA remains the optimal treatment for TDCCFs.When the standard treatment fails.various coils and the Willis covered stents can be used as an effective alternative or remedial tool in the treatment of TDCCFs,which can preserve ICA.Willis covered stent deployment seems to be an effective,safe,feasible and economical endovasculal treatment for TDCCF,but more clinical studies are needed before we can further clarify its specifications and indications.

Objective To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery (CICA) aneurysm. Methods Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents (n = 43, group A) or coil embolization (n =46, group B) according to the patients'will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results Endovascular covered stent placement and coil embolization were technically successful in all patients,except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A (81%, 95% CI: 69%, 93% ) and 24 patients of group B (52%, 95% CI: 37%, 67% ) ( P ＜0. 05). The final angiographic results indicated complete occlusion in 39 patients of group A (39/41,95%,95% CI: 88%, 102% ) and 22 patients of group B (22/45,49%, 95% CI: 34%, 64% ,P ＜0. 01 ). The average procedure time was(103 ± 13)min in group A and (143 + 39) min in group B (P＜0. 01). No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographic results that were superior to those of coil embolization.