Objective To summarize our experiences in the diagnosis and treatment of traumatic splenic rupture (TSR), in order to improve the diagnosis and treatment effect of TSR. Methods Retrospective (analysis) of the diagnosis and treatment of 184 patients with traumatic splenic rupture in recent 9 years was made. Results The preoperative correct diagnosis rate was 96.7% and was established on the history of (injury), clinical presentation, abdominal paracentesis, abdominal ultrasonography and CT. All the 34 of (patients) treated nonoperatively were cured. Of the 150 patients treated by operation, two died during operation and 148 patients were cured. Conclusions Combination of obtaining a detailed history of injury, physical examination, abdominal paracentesis, abdominal ultrasonography and CT can improve the accuracy rate of (preoperative) diagnosis.Under the ensurrance of the safety of the patients' life, preservation of the spleen should be performed if possible, especially for children. Both splenorrhaphy with or without ligation of splenic artery are simple, safe and effective methods to salvage the spleen.

Objective To explore the biomechanical mechanism of long-term complication of cervical spinal operations by measuring pressure changes of zygapophysial joints using pressure sensitive film (PSF) after cervical spine anterior operations. Methods C4,5 anterior discectomy and C4,5 anterior plate fixation were done on 10 fresh adult cervical spine specimens (C2～T1). PSF was put into zygapophysial joints and pressure changes were measured in positions of extension, left/right lateral bending and axial rotation on a universal testing machine. Results After cervical spine anterior operations, pressure of the adjacent facet joints increased. The differences were significant in extension and axial rotation (P

Objective To study the characteristics of hepatic artery anatomy and master the method of arterial repair,especially the method and technology of repair of anomalous donor arteries.Methods Sixty-four(human) liver arteries were dissected and repaired,and 31 of these were used in liver transplantation.Results Twelve of 64 cases had anatomical anomaly of hepatic artery(12/64,18.75%).Five of 24 fetal(liver) donors(20.83%) had anatomical anomaly of hepatic artery,one arose from the superior mesentery(artery) as a replaced right hepatic artery,3 from accessory right hepatic artery,and in 1 case the hepatic(artery) arose from superior mesentery artery directly.Seven adults had hepatic artery anomalies:2 cases of right hepatic artery being replaced by artery derived from SMA,2 cases of left hepatic artery deriving from left gastric artery and 3 cases of accessory right hepatic artery derived from SMA.In 31 hepatic(transplantations),4 grafts with anatomical anomaly of right hepatic artery were used.Conclusions (Reconstruction) of hepatic artery plays an important role in hepatic transplantation.Avoidance of injury to(aberrant) hepatic avteries during removal of donor liver is a key to ensure successful arterial repair.During(repair) of very small accessory hepatic arteries,ligation or repair of the artery may be determined after(observation) of backflow from collateral vessels.

Objective To investigate the clinical effect of endovascular embolization in treating spinal dural arteriovenous fistulae, and to discuss its imaging manifestations. Methods A total of 7 patients with spinal dural arteriovenous fistulae were included in this study. Endovascular embolization was carried out in all the 7 patients. The clinical data, including epidemiology, spinal MRI and DSA manifestations, therapeutic method and follow-up findings, were retrospectively analyzed. Results Abnormal MRI manifestations of spinal cord were demonstrated in all 7 patients. After the diagnosis was confirmed by DSA, endovascular embolization was carried out. All patients were followed up for 6 months, and their clinical symptoms were improved in different degrees. N-butyl cyanoacrylate (NBCA) glue was used as embolization agent in 4 cases, and no recurrence was observed in them. Onyx liquid glue was used in 3 patients, and in one of them the arteriovenous fistula recurred. Conclusion For the treatment of spinal dural arteriovenous fistulae, endovascular embolization is effective and safe although further investigation is still needed.

Objective To evaluate the safety and tolerance of the first-line hiighly active antiretroviral therapy(HAART)regimen in Chinese HIV/AIDS patients.Methods The clinical data and laboratory results were retrospectively reviewed in 95 HIV/AIDS outpatients receiving first-line HAART regimen of zidovudine,lamivudine and efavirenz(or nevirapine)in Public Heahh Clinical Center Affiliated to Fudan University during January 2005 and August 2008.Mixed effects model and X2 test or Fisher test were used to analyze panel data and ratio data respectively.Results Totally 81%(77/95)patients had adverse events in the course of treatment,11.6%(11/95)developed grade 3 or higher adverse effects.Hematological adverse events and hepatotoxity were the most common in term of laboratory events with the total incidence of 46.3%(44/95)and 27.4%(26/95)respectively;8.4%(8/95)and 6.3%(6/95)were grade 3 or higher.In clinical events,30.5%(29/95),37.8%(36/95)and 27.4%(26/95)patients had dermatological,gastrointestinal and neurological adverse events respectively,however,only 1.1%(1/95)experienced grade 3 or higher dermatological adverse events.Conclusion The first line HAART regimen is safe and well tolerated in Chinese HIV/AIDS patients.

OBJECTIVETo investigate the efficacy of detachable balloon for splenic artery trunk embolization in patients with cirrhotic portal hypertension and hypersplenism.

METHODSEight patients with cirrhotic portal hypertension received splenic artery trunk disconnection using detachable balloons under the guidance of digital subtraction angiography. The diameter and blood flow of the portal vein, the superior mesenteric vein, the splenic vein and the hepatic artery were measured by color Doppler ultrasound. Markers of liver function and blood coagulation, and routine blood parameters were assessed. Gastroscopy was used to evaluate to the degree of gastroesophageal varices. All complications experienced during the perioperative period were recorded.

RESULTSThe portal vein diameter decreased from 1.55±0.38 cm to 1.55±0.38 cm, and the splenic artery diameter decreased from 1.45±0.10 cm to 1.41±0.09 cm (P < 0.05). The portal vein blood flow was reduced from 971.52±174.77 ml/min to 785.86±100.17 ml/min, and the splenic vein blood flow decreased from 938.01±208.86 ml/min to 644.02±188.15 ml/min, while the hepatic artery blood flow increased from 261.25±65.47 ml/min to 449.32±84.05 ml/min (P < 0.05). The symptoms of splenism were improved effectively, with platelet counts rising from 37.75±10.61*109/L to 138.63±28.22*109/L after the procedure (P < 0.05). There were no episodes of severe complications or death in the perioperative period, and all patients showed remarkable improvement in markers of liver function and coagulation function, and improvement of esophagogastric varices.

CONCLUSIONSThe interventional disconnection technique of the splenic artery trunk using detachable balloon for the treatment of portal hypertension and hypersplenism is safe and effective.

Angiography, Digital Subtraction ; Embolization, Therapeutic ; Esophageal and Gastric Varices ; Hemodynamics ; Hepatic Artery ; Humans ; Hypersplenism ; Hypertension, Portal ; Mesenteric Veins ; Platelet Count ; Portal Vein ; Splenic Artery