Objective To evaluate the safety and efficacy of the interventional techniques for the management of hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT).Methods Seven patients diagnosed with HAS after OLT were treated with interventional procedures. Three (patients) presented with biliary ischemic complications, 1 with hepatic abscess, and 3 with elevation of liver enzymes and bilirubin levels. Interventional techniques included transcatheter hepatic arterial thrombolysis with a low dose of urokinase (UK), and stent placement in the stenotic segment of the hepatic artery. All patients were followed up regularly by duplex ultrasound scan after discharge.(Results) HAS with over 70 % degree at the anastomosis was found in 3 patients. Complete occlusion of the proper hepatic artery was found in 4 patients, and the hepatic artery flow was re-established in these patients at 3 to 7 days after transcatheter hepatic arterial thrombolysis. However, an over 90 % degree of stenosis at the anastomosis was seen in 4 cases. Stent placement in the stenotic segment of the hepatic artery was performed successfully in 7 patients, and significant improvement of liver (function) was seen in these patients at 2 weeks after the procedures. No complications related to the procedure occurred. The 7 patients had a good clinical course with normal graft function during a mean follow-up of 9 months (4 to 18 months), and patent hepatic artery flow was identified by follow-up Doppler ultrasonography.Conclusion Transcatheter endovascular interventional techniques are safe and effective methods for treatment of HAS after OLT.

Objective To study the safety and efficacy of laparoscopic splenectomy and portoazygous devascularization for portal hyperteation.Methods The data of 58 patients who underwent laparoscopic splenectomy and portoazygous devascularization were retrospectively collected and analyzed.Results The operative time for laparoscopic splenectomy and portoazygous devascularization was (2.6 ±0.6) hours.The intraoperative bleeding was (149.5 ± 32.7) ml.The time taken for the bowel to return function was 3.5 ±1.3 days.The hospitalization time was (5.1 ± 1.2) days.When the splenic volume was greater than or equal to 1.5 liters, the conversion to open surgery rate significantly increased [36.0％ (5/14);P ＜ 0.05].The 1, 2, 3, and 4 years cumulative recurrent gastrointestinal bleeding rates were 0, 5.2％, 10.0％, and 15.8％, respectively.Conclusions Laparoscopic splenectomy and pericardial devascularization was safe, efficacious and feasible.When the splenic volume was greater than 1.5 L, whether laparoscopic surgery should be attempted requires further research.

Transcatheter internal iliac arterial embolization has become a first-choice treatment for control of life-threatened bleeding associated with pelvic tumors or obstetric disorders.Recently,uterine arterial embolization(UAE)has offered a successful alternative to surgery in the treatment of uterine fibroid.Clinical failure rates for this procedure was reported from 4% to 19% in literature,probably due to the existence of collateral flow to the pelvic lesions,especially the ovarian arteries(OA)being the most important source.Furthermore,the anastomosis between the ovarian and uterine arteries has been suggested as the pathway for nontarget embolization of the ovaries causing premature menopause.The OA are simple paired vessels and they usually arise from the anterolateral part of the abdominal aorta at the level of the second lumbar vertebra.Variations in origin of OA occur in 2%-10% with diameter smaller than 1.1 mm and routinely not identified on conventional aortography.However,in the presence of a uterine or other pelvic diseases,the OA become dilated as the result of pathologic blood supply demand.OA supply to the pelvic lesions are more frequently found in patients with large fundal fibroids,history of the pelvic surgery,post embolization of the uterine arteries,and dysplasia of uterine artery.In patient with one or more of these predisposing factors,the extent of OA supply to the pelvic lesions should be assessed using pigtail catheter pelvic aortography with the tip at the level of the renal arteries,followed by selective OA catheterization.In case of identified OA supply to the pelvic lesions,superselective embolization of the OA should be considered,using particles with diameters larger than 500 ?m.Proximal OA embolization,in combination with bilateral UAE,may significantly increase the risk of iatrogenic ovarian dysfunction.When necessary in a premenopausal patient,OA embolization should be performed unilaterally and as near as possible to the lesions,and the procedure is performed only with specific informed consent.

Objective To investigate the frequency, patterns of the angiographic findings and risk factors for development of complications after transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery (IPA).Methods One hundred and sixty eight patients with hepatic tumor fed by the IPA underwent a total of 226 procedures of TACE of the IPA, with combined routine TACEO(88.7%) or without (11.3%) the combination of routine TACE of the hepatic artery. TACE of the malignancy was performed with an emulsion of iodized oil and anti-cancer agents and then followed by gelatin sponge particle injection. The complications were assessed on clinical observation, laboratory tests, and computed tomographic (CT) images after TACE of the IPA; and finally were correlated with the angiographic findings of the IPA. Results The tumor supplied by IPA was noted at initial TACE in 25 (14.9%), at successive TACE in 97 (57.8%), after percutaneous tumor ablation guided by ultrasound in 28 (16.7%), and after hepatic surgery in 18 (10.7%) cases. The abnormal findings on arteriography showed enlargement of the IPA with tumor staining in all cases, dense non-tumor staining in 61(36.3%), artery-to-artery anastomosis in 62(36.9%),arteriovenous shunts in 12(7.1%) cases. 96.4% of these patients complained of shoulder pain during TACE of the IPA. The cumulative complication rate after the procedure was 8.9%,including hiccup in 13 cases (5.8%), chest pain with cough and mild hemoptysis in 9 (4.0%), phrenoparalysis in 8 (3.5%), angina with abnormal ECG in 4 (1.8%), increasing of CPK, AST, and ALT significantly in 6 (2.7%), transient myeloparalysis in 2 (0.9%), and subphrenic abscess in 2 cases (0.9%). Two patients with the subphrenic abscess were successfully treated with percutaneous catheter drainage and antibiotics. The symptoms of these mild complications subsided with symptomatic treatment.Conclusions Complications of TACE via the IPA occur in about 9% of the patients and these complications do not worsen the patients survival. IAP angiographic abnormalities such as arteriovenous shunts, artery-to-artery anastomoses, dense non-tumor contrast staining,are important risk factors for complications of TACE of the IPA.

90%) of CA. The stenotic segments were dilated and stented during the same session. One patient with balloon expandable Palmaz stent placed in the proximal celiac artery, the another with 2 wallstents deployed in the CA trunk. The postprocedural arteriograms showed good dilation of the lesions with immediate improvement of CA blood flow. Follow-up Doppler ultrasound scans showed normal flow patterns in the CA. Three months after the procedures, their upper gastrointestinal symptoms had resolved and regained body weights. They remained well and free of symptoms, at 16 months and 26 months follow-up, respectively, after the procedure.Conclusions CA stenosis can successfully be treated with angioplasty and stenting.

Objective To analyze the causes of recurrent hemoptysis after interventional treatment and to provide the reference to improve the interventional radiology technique in dealing with the hemoptysis.Methods From Oct.2000 to Oct.2008,repeated interventional procedure was carried out in 22 patients with recurrent hemoptysis after initial interventional treatment.After the bronchial arterial angiography and collateral branch arterial angiography were performed,embolization of diseased arteries with gelatin sponge particle,PVA particle or microcoil was conducted.Results Of 22 patients,re-canalization of the bronchial arteries was seen in 4,blood supply from additional bronchial artery other than from the already embolized bronchial artery in 3,and blood supply from the collaterals in 15.Technical success of the second interventional treatment was achieved in all the 22 cases.Bleeding ceased immediately after the second interventional treatment and no recurrent hemoptysis occurred during the follow-up period of 3 months to 4 years.Conclusion Complete embolization of all arteries related to the hemoptysis together with actively dealing with the primary disease can effectively improve the successful rate of interventional treatment for the massive hemoptysis.

mbus in IVC. Interventional treatment can prolong the survival time and promote the quality of life.

Objective To investigate the effects of high concentrations of iodide exposure on mitochondrial superoxide production,cell viability and cell damage in the thyroid of metallothionein Ⅰ/Ⅱ knockout (MT-Ⅰ/Ⅱ KO) mice and corresponding wild type (WT) mice.Methods Thyroid cell suspension of six to eight weeks old healthy male MT-Ⅰ/Ⅱ KO mice and WT mice were prepared.The thyroid cells were treated with high concentrations (10-4,10-3,10-2 mol/L) of potassium iodide(KI),or 10-3 mol/L hydrogen peroxide(H2O2) for 2 hours,respectively.Cell viability was evaluated with methyl thiazolyl tetrazolium(MTT) assay.Lactate dehydrogenase (LDH) level in cell culture medium was detected by enzyme-linked immunosorbent assay(ELISA).Mitochondrial superoxide production in the thyroid cells was measured by flow cytometry using a fluorescent probe,mitochondrial superoxide(MitoSOX).Results Compared to the control group[(100.00 ± 0.00)％,(100.00 ± 0.00)％],the cell viability of 10-4,10-3,10-2 mol/L KI and 10-3 mol/L H2O2 exposure groups were significantly decreased in the thyroid cells of both WT [(73.63 ± 2.05)％,(72.41 ± 2.26)％,(69.63 ± 2.29)％,(44.90 ± 2.93)％] and MT-Ⅰ/Ⅱ KO mice[(65.40 ± 2.39)％,(64.51 ± 2.27)％,(61.48 ± 2.33)％,(40.80 ± 2.76)％,all P＜ 0.05].Compared to the control group [(1 995.28 ± 30.52),(2 004.96 ± 19.71)U/L],significantly increased LDH activities were detected in the thyroid cells of WT [(2 809.22 ± 156.53),(2 850.80 ± 137.83),(2 920.45 ± 152.92),(4 487.49 ± 130.67)U/L] and MT-Ⅰ / Ⅱ KO mice [(3 261.06 ± 120.44),(3 474.19 ± 142.15),(3 597.08 ± 150.86),(4 706.64 ± 148.57)U/L,all P ＜ 0.05].Compared to the control group (26.49 ± 7.66,37.11 ± 8.48),the MitoSOX red fluorescence intensities of 10-2 mol/L KI and 10-3 mol/L H2O2 groups were significantly increased in WT mice(58.96 ± 5.11,87.95 ± 4.25) and MT-Ⅰ/ⅡKO mice(71.21 ± 5.55,99.76 ± 4.42) by flow cytometry (all P ＜ 0.05).Compared to the thyroid cells in WT mice,significantly decreased cell viability (all P ＜ 0.05),significantly increased LDH activity(all P ＜ 0.05) and significantly increased MitoSOX red fluorescence intensity by flow cytometry (all P ＜ 0.05) were detected in the thyroid cells of MT-Ⅰ/Ⅱ KO mice following treatment with KI or H2O2.Conclusions High concentrations of iodide (10-2 mol/L) and 10-3 mol/L H2O2 may lead to significant increase of mitochondrial superoxide production and LDH activity,decrease of cell viability in both WT and MT-Ⅰ / Ⅱ KO mice.More significant increase of superoxide production is detected in MT-Ⅰ / Ⅱ KO mice,indicating the potential protective role of metallothionein in the thyroid cells of WT mice.

Objective To investigate the prognostic significance of proteolysis-inducing factor (PIF) in gastric cancer patients.Methods Biopsies of the rectus abdominis muscle were obtained intra operatively from 53 gastric cancer patients and 53 subjects undergoing surgery for benign abdominal diseases,muscle and serum PIF,ubiquitin expression,and proteasome proteolytic activities were assessed through reverse-transcription polymerase chain reaction (RT-PCR),Western blot,and enzyme-linked immunosorbent assay (ELISA).Results PIF was significantly upregulated in muscle of gastric cancer compared to control muscles.PIF was upregulated in 60％ (32/53) muscle of gastric cancer.Over expression of PIF in muscles of gastric cancer were associated with level of serum albumin,tumor node metastasis (TNM) stage,and percent of weight loss.The survival rate of patients with a high expression of PIF was significantly lower than those in patients with low expression (P ＜ 0.05).Conclusions PIF was significantly upregulated in muscle of gastric cancer,over expression of PIF in muscles of gastric cancer was associated with level of serum albumin,TNM stage,percent of weight loss,and prognosis.PIF might play an important role in progression and prognosis of gastric cancer.

Objective To evaluate the efficacy and the safety of retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization to treat the gastric varices with spontaneous gastrorenal shunt. Methods From Nov. 2006 to Jun. 2010, retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization was performed on 8 patients who had gastric varices with spontaneous gastrorenal shunt. All the patients were men and the age ranged from 40 to 61 years. The balloon catheter was inserted into the spontaneous gastrorenal shunt through the right femoral vein, then percutaneous transhepatic splenic vein venograghy was performed to identify the number and morphology of gastric varices. After that gastric varices embolization was performed while the balloon catheter was dilated, which was withdrawn one day after the procedure. Results Technical success of interventional treatment was achieved in all 8 cases with no significant complications. The increase of average portal venous pressure was 5.5 cm H2O (1 cm H2O = 0. 098 kPa,preoperative 35.0 to 41.0 cm H2O,postoperative 39.0 to 45.5 cm H2O). After follow up of 1 to 46 months, no recurrence haemorrhage occurred. Conclusion Retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatie gastric variees embolization can be safely performed and could be one of the effective choices for patients who had gastric varices with spontaneous gastrorenal shunt, which is not suitable to treat by the endoscopic sclerotherapy.