Anticoagulants ; therapeutic use ; Humans ; Venous Thrombosis ; drug therapy

Objective To probe into the reasons for and results of remedial surgical therapy in thoracic aortic dissection patients after first endovascalar repair.Methods From July 2000 to December 2012,12 cases received second interventional surgery.The average time from second therapy to first surgery was ( 14 ± 11 ) months.Main reasons for second endovascular therapy were sustained type Ⅰ endoleak at proximal landing zone and type A dissection caused by retrograde tear.Therapies included hybrid operations in 8 cases and absnlute endovascular therapy in 4 cases.Results The 30 day mortality after the second intervention was 5.6％ ( 1/12),total mortality rate was 16.7％ (2/12).In 7 cases with endoleak,small endoleak remained after remedial therapy (57.1％ ) in 4 cases.Among 4 cases with secondary type A aortic dissection,successful staged hybrid operation with mid-sternal thoracotomy was adopted in 3 cases,one died of pulmonary emtbolism during follow-up period,1 case with Bebcet disease still had proximal type Ⅰ endoleak after second hybrid operation,and died from tear of aorta.Conclusions Endoleak and secondary type A aortic dissection are the main cause necessitating second intervention after primary endovascular therapy for thoracic aortic dissection.Hybrid operation remains the best choice to treat postoperative complications after endovascular therapy for thoracic aortic dissection.

Objective To evaluate early results of Endurant stent-graft in the treatment of abdominal aortic aneurysms (AAAs).Methods From July 2010 to June 2011,68 patients (57 men,11 women; mean age 74.3 years) were treated with Endurant stent-graft at our center.26 cases had hostile proximal neck in the anatomy.According to ASA classification,15 cases were class Ⅱ ; 32 cases were class Ⅲ and 21 cases were class Ⅳ.Results Intraoperative immediate technical success was achieved in all cases.At completion angiography,a type Ⅱ endoleak was detected in 18 (26％) of the 68 patients.The mean operation time was (96 ± 29) min,the mean blood loss was (99 ± 68 ) ml,and the mean contrast usage was (122 ± 65) ml.No intraoperative conversion to open surgery,stent migration,types Ⅰ/Ⅲ endoleak,other major complications,or death was encountered.49 patients (72％) had a postimplantation syndrome with fever,leukocytosis,and increase of C-reactive protein levels,which completely resolved within two weeks.The mean follow-up time was (8 ± 5) months.Conclusions Endurant stent-graft seems to be safe and effective in endovascular aneurysm repair,even in patients with hostile aortoiliac anatomy.

Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.

Objective To evaluate aneurysm sac pressure monitoring during endovascular repair (EVAR)of abdominal aortic aneurysm. Methods From April 2006 to May 2007,12 patients with abdominal aorta aneurysm underwent endovascular aneurysm repair.The average max-diameter of the aneurysm WR8(5.83±0.95)cm.The sac pressure was monitored during the whole process of the operation.The correlation between the pressure and endoleaks and long-term outcomes was observed during follow-up.Results Before the stentgraft was delivered.sac pressure was equal to the systemic blood pressure in all the 12 cases.After the EVAR wag finished,the sac systolic pressure dropped by＞40% in 11 cases,among which sac blood pressure bropped by ≥50% in 7 cases.sac pressure did not change in 1 case.In all the 12 cases,pulse pressure diminished by＞30%,and＞75%in 6 cages.During the follow-up,there were no endoleaks and death.In 5 Cases.with sac systolic pressure drop＞50%,the max-diameter of the aneurysm decreased by 1.6～3.1 mm,while in one c88e,in which sac pressure had no change the postoperative maxdiameter of the aneurysm has increased by 3.2 nma. Conclusion Abdominal aorta aneurysm sac pressure monitoring during EVAR helps to predict the change of the sac pressure after EVAR,and to detect the endoleaks.

Objective To study the anatomical characteristics of ascending aortic and aortic arch in adult Chinese. Methods From Sep 2006 to Sep 2007, we retrospectivly reviewed 388 volunteers undergoing thoracic aorta CTA in our institution. We measured the diameter of ascending aorta, aortic arch, and branch vessels of aortic arch respectively in AW4.2 work station. CHESS statistical software was used to analyze data. Results The aortic diameter above coronary artery (CA) (D1), the level at origin of brachiocephalie trunk (BCT) ( D3 ), the halfway of the AA( D2 ), the level at origin of LCCA( D4 ) , the level at origin of LSA ( D5 ) and the level at distal origin of LSA ( D6 ) respectively are: ( 34 ± 5 ) mm; ( 33 ± 4) mm; ( 34 ± 5 ) mm; ( 30 ± 4) mm; ( 28 ± 3 ) mm; ( 26 ± 3 ) mm. The diameters of two level between the origin of BCT and RSA are ( 13. 1 ± 1.9) mm, ( 12. 8±2. 3) mm, respectively. The diameter of two level at LCCA is ( 8. 7 ± 1.5 )mm and ( 7. 9 ± 1. 0) mm respectively. The diameter of two level between the origin of LSA and L-vertebral arteryis (10.7±1.7) mm,(9.3±1.3) mm, respectively. Conclusion The data of the diameter and length of ascending aort and vasculature arising from the arch abtained by CT topography in Chinese volunteers are very useful for clinical practice.

The adverse reaction monitoring is important in warning the risks of traditional Chinese medicines at an early stage, finding potential quality problems and ensuring the safe clinical medication. In the study, efforts were made to investigate the risk signal mining techniques in line with the characteristics of traditional Chinese medicines, particularly the complexity in component, processing, compatibility, preparation and clinical medication, find early risk signals of traditional Chinese medicines and establish a traditional Chinese medicine safety evaluation system based on adverse reaction risk signals, in order to improve the target studies on traditional Chinese medicine safety, effective and timely control risks and solve the existing frequent safety issue in traditional Chinese medicines.
China ; epidemiology ; Drug Evaluation ; Drug-Related Side Effects and Adverse Reactions ; epidemiology ; etiology ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Humans ; Product Surveillance, Postmarketing

Traditional Chinese medicine Polygoni Multiflori Radix is dried roots of Polygonaceae Polygortum multiflorum Thunb. Its clinical application records were first discovered in literatures of the Tang dynasty. The origins, efficacy, toxicity, processing and taboos of Polygoni Multiflori Radix have been discussed in many ancient herb literatures. In recent years, with the increase in the public awareness in health, Polygoni Multiflori Radix admits preparations have been more widely applied in the treatment and prevention of diseases. However, there have been more and more reports about Polygoni Multiflori Radix induced liver injury, the safety of Polygoni Multiflori Radix has increasingly attracted attention of the society. In this paper, the authors summarized and analyzed the toxicity and medication risk factors of Polygoni Multiflori Radix recorded in ancient herb literatures, and proposed that more attention shall be given to the effect of the planting and processing methods on the components and toxicity of Polygoni Multiflori Radix in safety studies, which provides clues for the further studies.
China ; Drugs, Chinese Herbal ; adverse effects ; history ; History, Ancient ; Humans ; Medicine in Literature ; Medicine, Chinese Traditional ; history ; Polygonum ; adverse effects ; Risk Assessment

The renal toxicity and mutagenicity of aristolochic acid (AA) as well as its carcinogenicity on upper urinary tract transitional epithelial cells have been widely known. Since 2003, drug regulatory departments have successively cancelled the quality standards for AA-containing medicines such as Aristolochiae Radix, Aristolochiae Manshuriensis Caulis and Aristolchiae Fangchi Radix, and adopted measures for strengthening regulation and revising package insert or quality standards for other AA-containing medicines, including Aristolochia Cinnabarina Radix, Aristolochiae Fructus, Aristolochiae Mollissimae Herba, in order to control its safety risk. In recent years, domestic and foreign studies on AA have mainly involved action mechanism and clinical performance of AA toxicity, early-stage diagnosis and treatment method. In this paper, authors gave a brief summary and evaluation on risk factors for using AA-containing medicines, and offered measures and suggestions for preventing and controlling AA toxicity.
Animals ; Aristolochia ; adverse effects ; chemistry ; Aristolochic Acids ; analysis ; therapeutic use ; toxicity ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; epidemiology ; etiology ; Drugs, Chinese Herbal ; analysis ; therapeutic use ; toxicity ; Humans

Post-marketing evaluation is a process which evaluate the risks and benefits of drug clinical application comprehensively and systematically, scientific and systematic results of post-marketing evaluation not only can provide data support for clinical application of traditional Chinese medicine, but also can be a reliable basis for the supervision department to develop risk control measures. With the increasing demands for treatment and prevention of disease, traditional Chinese medicine has been widely used, and security issues are also exposed. How to find risk signal of traditional Chinese medicine in the early stages, carry out targeted evaluation work and control risk timely have become challenges in the development of traditional Chinese medicine industry.
Drug Evaluation ; methods ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional