Objective To evaluate the safety and feasibility of portal CO 2-DSA with fine needle splenic puncture. Methods The splenic tails of seven adult white rabbits were exteriorized by laparotomy, and followed by a 25 gauge fine needle inserting about 1.0 cm into the splenic parenchyma. Portal CO 2-DSA was performed (2.0 ml/s, 10ml) and the images were evaluated. After removal of the needle, the puncture site was observed for bleeding till coagulation occurred. The spleen were taken for gross and histological examination. Results All the CO 2-DSA clearly showed the portal trunk with intrahepatic branches above 3～4 orders, the main splenic vein, and the main mesenteric veins with parts of its branches. CO 2 disappeared from the intrahepatic portal vein over 2～3 minutes. In one animal, the left renal vein and the inferior vena cava were also displayed by CO 2 through communication between splenic vein and renal vein. After removal of the needle, there was small amount of bleeding at the puncture site which ceased spontaneously over 3～5 minutes. In all animals, no extravasation of CO 2 at the puncture site, no subcapsular dissection or intrasplenic hematoma was observed. Microscopically, the splenic capsule appeared intact and there was no evidence of subcapsular hematoma formation.Conclusions Portal CO 2-DSA with fine needle splenic puncture is feasible, safe and efficient. In normal adult rabbit, CO 2 may help to visualize the left renal vein and inferior vena cava through communication between splenic and renal vein.

Objective To analyze the treatment of transplant renal artery stenosis (TRAS) by percutaneous transluminal angioplasty (PTA) and stenting. Methods The average time duration from transplantation to the on set symptom of TRAS was 6.9 months (3 - 18 months) in 35 TRAS patients. BP and creatinine level were recorded before and after the procedure. PTA was performed through contralateral femoral or left brachial approach with ordinary balloon (5 F, length 20 ～ 30 mm) and / or small balloon catheters (2. 6 F, length 36 mm) in all patients, and stents were embedded in 11 of them. Results A total of 46 PTA were successfully performed (1 time, 20 cases; 2 times, 12 cases, and 3 times, 3 cases) via contralateral femoral approach (26) and left brachial approach (15). Stenosis were significantly decreased from 75% ～ 98% pre-PTA to 10% ～ 30% post-PTA.Systolic pressure decreased from 170 mmHg (150 ～ 210 mmHg) pre-PTA to 135 mmHg (100 - 190 mmHg) post-PTA and diastolic pressure decreased from 120 mmHg (90 - 145 mmHg) to 85 mmHg (80 - 125 mmHg) respectively. Restenosis rates were 39% after first PTA and 15% after the second time. All 46 times of PTA used 26 ordinary balloon catheters and 20 microballoon catheters. 8 self-expandable stents (Wallstent) and 3 balloon-dilatation stents (Palmaz) were released in 11 cases. There were healed case (n = 11) , melioration (n = 15), improvement (n = 7), and inefficiency (n = 2) after follow - up of 23 months (3 - 60 month). No complication occured except puncture site hematoma via the brachial artery approach in 1 case. Conclusions PTA is safe and effective in the treatment of TRAS and high rate of procedure success may be achieved with the help of brachial approach and micro-balloon catheter.Reasonable use of stents is beneficial in decreasing the restenosis.

Objective To evaluate the clinical efficiency of partial splenic embolization on portal hypertension patients of hepatocellulocarcinoma(HCC).Methods 110 patients of hepatocellulocarcinoma with portohypertension were treated with 1-3 times of TACE, and partial splenic embolization, with PVA of 355～500 ?m injecting into the arteries of inferior splenic pole. In order to control the area of splenic embolization, multi-embolizations were done according to the various conditions. Results 172 times of embolization were performed in 110 patients involving 134 times of fever lasting for 3-30 days and 126 times of bellyache with 27 times appealing for morphine. Treatable hydrothorax appeared in six, and no serious complications occurred. The area of embolization covered 30%～60%. WBC and BPC counts were increased after the 24 hour (P

Objective To discuss the clinical value of preoperative embolization of vertebral tumors. Methods Data of 54 patients were retrospectively studied. Thirteen lesions were in the cervical, 17 in the thoracic, 15 in the lumber and 9 in the sacral regions. The vertebral tumors were embolized prior to operation with gelatin sponge particles, polyvinyl alcohol (PVA) particles or coils. Surgical operations were performed within 1-7 days after the embolization. Results Totally 79 vessels of 43 patients were embolized, which included ascending cervical artery,1;vertebral artery,1;intercostal artery,39; lumber artery,19;internal iliac artery,15 and median sacral artery,4. Intraoperative hemorrhage showed a mean value of 1312 ml with range of 300-3000 ml in patients after embolization, and a mean value of 2375 ml with range of 1500-5000ml in patients without embolization at the same period(P

Objective To investigate the hemodynamic and rheological effects of acute hypovolemic hemodilution with 6% hydroxyethyl starch (HES) at different infusion rates. Methods 20 ASA Ⅰ adult patients undergoing elective surgery were randomized to one of two groups with 10 patients each. The patients were premedicated with intramuscular midazolam 0.06 mg/kg and atropine 0.01 mg/kg 30 min before anesthesia. Before anesthesia an intravenous line was established and lacted ringer solution was infused at a rate of 5 ml. kg-1. h-1 . Anesthesia was induced with midazolam 0.2mg/kg , fentanyl 5μg/kg and vecuronium 0. lmg/kg and maintained with inhalation of 50 % N2O and 1% isoflurane. After tracheal intubation the patients were mechanically ventilated and PET CO2 was maintainted between 4.6-6.0 kPa.Swan-Ganz catheter was inserted via right internal jugular vein. The dorsalis pedis artery was cannulated for direct measurement of arterial pressure. 6% HES infusion rates were 10 ml.kg-1.h-1 in group Ⅰ and 20ml.kg-1 .h-1 in group Ⅱ respectively. ECG, heart rate (HR), arterial blood pressure (SBP, DBP and MAP), CO, CL, CVP, PAP, PCWP, SpO2, PET CO2 and inhalation concentrations of N2O and isoflurane were monitored before and 30, and 60 min after infusion was started. Arterial and venous blood samples were taken for blood gas analysis and rheological studies. Results The two groups were comparable with respect to demographic data. During HES infusion HR decreased and CL increased in both groups and there was no significant difference between the two groups. BP increased slightly at 60 min in group Ⅰ , whereas in group Ⅱ it tended to decrease. CVP, PAP and PCWP increased significantly in both groups especially at 60 min. Hct decreased from 36.2% ±4.5% to 30.4% ±4.1% in group Ⅰ and from 39.6%±8.0 % to 30.8% ± 5.9 % in group Ⅱ at 60 min. Hb and K value of erythrocyte sedimentation rate (ESR) equation decreased significantly in both groups especially at 60 min. Conclusions Intravascular volume expansion ismore efficient with increased infusion rate of HES but the influences on hemodynamics would be more significant. HES infused at 20 ml. kg-1 . h -1 is safe in healthy patient during operation with blood loss.[Key Words] Hemodilution; Hydroxyethyl starch; Hemodynamics; Hemorheology

Objective To analyze the curative effects of total knee arthroplasty(TKA)for severe genu varus combined with flexion deformity.Methods The clinical data of 25 patients(36 knees),who had undergone TKA for severe genu varus combined with flexion deformity from January 2005 to October 2010,were retrospectively analyzed.There were 7 males and 18 females,aged from 55 to 80 years(average 70.5 years).The primary diseases were osteoarthritis in 22 cases and rheumatoid arthritis in 3 cases.HSS knee score was used before and after the operation to assess the efficacy of the TKA.Results All of the patients were followed up for 4 to 9 years(average 6 years).The degree of flexion deformity was reduced from (21 ±63)°to(1.1 ±2.3)°;the degree of the varus decreased from(210 ±4.8)°to(175.6 ±2.1)°;range of motion of the knee joint increased from(70.5 ±20.5)°to(115.1 ±5.3)°;knee score augmen-ted from(33.2 ±10.5)to(90.7 ±8.5);function score added from(35.5 ±14.2)to(85.6 ±10.5);there were 21 cases(8 knees)rated as excellent,2(3 knees)as good and 2(3 knees)as fair,and the excel-lent and good rate was 86%.Most of the patients had normal force line of the knee joint,but 2 patients re-mained varus deformity of 5°~10°.Conclusion Satisfying outcome can be achieved by TKA in treating severe genu varus combined with flexion deformity of the knee.

This study was concerned about comparing the degree and process of cardiopulmonary effect of propofol and midazolam. Forty-five adult patients,ASA grade Ⅱ, scheduled for elective operation, were randomly allocated to intravenously receiving midazolam 0.28mg?kg~(-1)(group Ⅰ,n=16), 0.40mg?kg~(-1) (group Ⅱ,n=16) ,or propofol 2.5mg?kg~(-1) (group Ⅲ,n=13) ,respectively. MAP ,HR, SpO_2 ,TV ,MV ,RR and P_(ET)CO_2 were monitored continuously before and in 30 minutes following the administration ,and the arterial blood gas analysises were performed before and 1,2,3,4,5,10,15,20 and 30 minutes after the administration. The results showed that in group Ⅰ, Ⅱ and Ⅲ after the administration separately,the maximal decrease of MAP were 20.0% ,22.8% and 22.20%, and occured in 10.8, 9.3 and 3.5 minutes;HR decreased maximally by 6.3% ,8.7% and 15.5%,TV by 76.6% ,81.3% and 91.3%/00 ,MV by 87.2%,91.6% and 93.6%,RR by 60.3%,67.5% and 83.6%; the incidences and durations of apnea were 37.5%vs 57.5 seconds,31.3%vs 68. O seconds and 76.9%vs 73.0 seconds. The MV recovered to the baseline 5 minutes in group Ⅲ and more than 10 minutes in group Ⅰ and Ⅱ following the administration. The arterial blood pH reduced and PaCO_2 increased significantly in three groups (P

Objective: To study clinical pharmacodynamics and efficacy for endotracheal intubation of rocuronium and succinylcholine at different dosage. Method: Sixty adult patients under general anesthesia according to the different drugs and dosage, were randomly divided into four groups. In groupⅠorⅡ,2 or 3?ED_(95) rocuronium were administrated,and in group Ⅲ and Ⅳ, 2 or 3?ED_(95) succinylcholine were given respectively. The course of depression and recovery of twitch response of the adductor pollicis muscle were recorded, and intubating condition were assessed. Result:The intubation condition was excellent in all patients of group Ⅱ,but only in 20％ of group Ⅲ.The degree of twitch at maximal depression was similar between all groups. The lag time and the time of twitch reaching maximal depression were not significantly different between group Ⅱ,Ⅲ and Ⅳ, which were shorter than those of groupⅠ.The times of twitch recovery to 25％ and 95％ of baseline in groupⅠor Ⅳ were significantly longer than in groupⅠor Ⅲ, respectively. Conclusion: 3?ED_(95) rocuronium has similar onset time to 2 or 3?ED_(95) succinylcholine with the excellent intubation condition,but the clinical effective duration is more longer than that of 2?ED_(95) rocuronium.

Objectvive To evaluate the blood supply of pulmonary metastases using small volume of lipiodol through pulmonary arterial infusion. Methods 10 cases of lung metastasis were enroled including the primary tumors of liver cancer(n = 5), renal carcinoma(n = 3), chordoma(n = 1) and malignant neurofibroma (n = 1). Plain CT scan was performed to exclude calcification or ossification within metastasis and then pulmonary arterial DSA was undertaken to evaluate tumor vessels or staining. After pulmonary arteriovenous fistula or other anomalous circulation was excluded by lobar arterial DSA, small volume of lipiodol was infused under fluoroscopy (0.5 -1.5 ml for each lobar artery, total volume less than 3.0 ml). CT scan was immediately performed. Blood supply of the pulmonary metastases was assessed according to the accumulation of lipiodol on CT scans. Results No cases but one experienced cough, expectoration, suffocating or dyspnea. No complication of cerebral or visceral embolism occurred. Totally 27 nodules were studied including 6 nodules with cloudy lipiodol accumulation and 6 nodules with tiny granules of lipiodol accumulation. No enlarged tumor vessel or tumor stain was observed within all 27 nodules on pulmonary arterial DSA. Conclusions Pulmonary artery supplys only parts of pulmonary metastases, especially those sited at the peripheral region of the lung. Infusion of small volume of lipiodol through pulmonary artery is safe, and the increased density of lung field could return normal after several days.

Objective To evaluate the efficacy and safety of azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC).Methods Retrospective analysis of the clinical improvement,endoscopic improvement and mucosal healing rate,inflammation marker improvement after AZA administration and its safety in 24 refractory UC patients were performed,who were recruited between January 2007 and December 2011 in West China Hospital,Sichuan University,China.Results Twenty-four patients were enrolled,with a median age of 36 years old and a median course of 4 years.Among them,14 cases were moderate UC and 10 cases were severe UC.The patients were treated with AZA in a dose of (1.23 ±0.34) mg· kg-1 · d-1 from 7 weeks to 42 months.Efficacy was judged by Mayo disease activity index.At 3 months,6 months and 1 year after treatment,the effective rates were 73.9％ ( 17/23),81.8％(18/22) and 14/16 respectively,and the remission rates were 17.4％ (4/23),54.5％ (12/22) and 12/16respectively.Both ESR and C reactive protein level after treatment for 6 months and 1 year were significantly lower than those before treatment [ (9.3 ±8.9) mrn/1h,(10.9 ±7.3) mm/1h vs (22.3 ± 10.7) mm/1h;2.5(1.0-22.3) mg/L,2.3(1.0-28.0) mg/L vs 18.4(3.6-137.0) mg/L; all P ＜0.05].Corticosteroid withdrawal rates at 3 months and 1 year after AZA treatment were 16/18 and 15/16,respectively.At 6 months and 1 year after AZA treatment,the endoscopic improvement rates were 85.7％ ( 18/21 ) and 13/15 respectively; the cndoscopic remission rates were 61.9％ ( 13/21 ) and 11/15 respectively; and the mucosal healing rates were 61.9％ ( 13/21 ) and 11/15 respectively.Adverse effects were occurred in 8 patients.Leukopenia was the most common adverse effect,followed by liver function injury,alopecia and epigastric discomfort.Conclusions AZA is effective in the treatment of refractory UC patients with a low dose of ( 1.23 ± 0.34) mg· kg - 1 · d - 1,especially in the steroid withdrawing,maintaining remission and mucosal healing without severe adverse effects.