This paper discussed on the importance of management system of paperless electronic medical record and pointed out that we would encountered lots of problems during the construction of paperless electronic medical record management system including authenticity,legal effect,similarity,safety,mistakes and missing of medical records.This paper analyzed these problems and proposed corresponding countermeasures including developing safety management system,whole-process monitoring of medical record quality,enhancing archive management,developing backup and recovery mechanisms,improving secrecy and authorization system,promoting borrowing management,performing copy system,strengthening electronic signature management,implementing unique number management and enhancing overall quality of personnel

Objective To retrospectively analysis our experience of embolization of ruptured intracranial aneurysms during the period of cerebral vasospasm (CVS). Methods Thirty-seven patients with ruptured intracranial aneurysms were embolized with electrolytic detachable coils during the period of CVS (days 4 to 14). Group A included the 14 patients with angiographic CVS and group B included 23 patients without angiographic CVS. All except 2 patients were transferred to our department during the CVS period. Results Twelve patients in group A were successfully received the aneurysms embolization and treatment of the CVS with intraarterial papaverine injection and balloon angioplasty. The Glasgow Outcome Scales (GOS) in 3 months were good recovery in 7 patients, moderate disability in 2, severe disability in 1 and dead in 2. Two patients failed the embolization because the microcatheters can't pass the spasmatic parent arteries. All the aneurysms in group B were successfully embolized. The GOS were good recovery in 18 patients, moderate disability in 2, severe disability in 2 and dead in 1. There was no intraprocedural aneurysmal rupture but with 2 thromboembolic events. No rebleeding occurred during the mean 11 months follow-up.Conclusions The so-called “the period of CVS” isn't always associated with CVS in angiograpy. Embolization of ruptured intracranial aneurysms during the period of pure CVS doesn't carry an increased risk. Both the aneurysms and CVS can be treated during the single procedure. It can reduce the rebleeding rate in hospital and improved the prognosis of the patients with CVS.

Objective To assess the initial clinical effect of combined endovascular and extravascular neurointerventional technique for treatment of acutely ruptured cerebral aneurysms.Methods Forty patients with acutely ruptured aneurysms were embolized with Guglielmi detachable coil (GDC) or Dendron electrically detachable coil (EDC) firstly. Immediately after the embolization, all patients were received lumbar puncture and over-the-wire microcatheters were catheterized into cisterna magna via the spinal subarachnoid space. Urokinase(100,000 IU in 2mL normal saline) was injected into cisterna magna via the microcatheter to dissolve clot 2 hours later. Urokinase injection was repeated according to the CT results. Results All the procedures of aneurysm embolization and catheterization of cisterna magna were successful, no technical complications were found. In all patients, CT scans of the day 3th to day 7th revealed complete disappearance of clot in basal cistern. One patient experienced transient sympotomatic cerebral vasospasm without permanent neurologic deficit. The other 39 patients didn't manifest symptomatic cerebral vasospasm. No aneurysmal rebleeding was detected. Conclusions Combined endovascular and extravascular neurointerventional technique can obliterate acutely ruptured cerebral aneurysms and remove the clot of basal cistern. It can prevent aneurysm rebleeding and cerebral vasospasm. Therefore it is a minimally invasive, safe and reasonable method for treatment of acutely ruptured cerebral aneurysms.

Objective The Neuroform stent is the first self-expandable intracranial stent designed for the treatment of wide-necked intracranial aneurysms. We report the results of our preliminary experience in combination of this stent and detachable coils to treat patients with wide-necked intracranial aneurysms. Methods From August 2003 to August 2004, 22 patients with 24 wide-necked intracranial aneurysms were treated with combination of Neuroform stents and detachable coils. There are 19 acutely ruptured aneurysms and 5 unruptured aneurysms. Results Twenty-three aneurysms were successfully treated by combination of stents and detachable coils. In one patients with multiple aneurysms, an unruptured small wide-necked aneurysm was successfully treated with the stent deployment but failed coiling. All stents were deployed successfully. Mild stent displacement was found in one patient. Intraaneurysmal contrast media stagnation was not seen immediately after the stents deployment. Total (100%) obliteration of the aneurysm was achieved in 18 aneurysms, and subtotal (more than 90%) obliteration was achieved in 5 aneurysms. All the parent arteries were patency after treatment. In 2 aneurysms, some small coil loops were herniated into the parent artery from the stent struts but did not affect the blood flow within parent artery. No symptomatic brain ischemia was found in perioperative period. Seventeen patients were received a mean of 3 months follow-up and control angiography. No recurrence was found in 16 patients. Recanalization was found in one patient, he received a second embolization and the aneurysm was totally oberliterazation.Conclusions The Neuroform stent is a very safe and effective intracranial stent for treatment of wide-necked intracranial aneurysm. It is very suitable for wide-necked intracranial aneurysm with severely tortuous parent artery. Due to lack of significant radial strength of the stent, the stent can be shifted by a microguidewire or microcatheter when performed superselective catheterization. Because the big struts of this stent, the change of intraaneurysmal hemodynamics after stent deployment was notevident as coronary stent. So dense packing the aneurysm is advocated. Care must be taken when packing the detachable coils after the stent deployment. The administration of dual anti-platelet drug to prevent stent-related thromboembolic complications in the perioperative period is important. Although a good angiographic result is achieved, long-term angiographic follow-up is still necessary.

Objective To investigate the therapeutic effects of endovascular management for oculomotor nerve palsy caused by unruptured aneurysm of posterior communicating artery.Methods Endovascular treatment was carried out in 11 patients with oculomotor nerve palsy due to unruptured aneurysm of posterior communicating artery.The choice of the therapeutic opportune moment and the treatment way were retrospectively evaluated.The relationship between the therapeutic results and the treatment time and way was analyzed.Results Of the 11 patients,complete recovery of oculomotor nerve palsy was obtained in 10(90.91%) and partial recovery in one(9.09%).Conclusion Oculomotor nerve palsy cause by unruptured aneurysm of posterior communicating artery can be effectively treated by endovascular management,and the recovery of oculomotor nerve function depends on the time to take treatment and the degree of nerve palsy.

Objective To evaluate the effect of transcatheter arterial chemoembolization using ethanol and iodized-oil emulsion(TACE-EIOE) on prognosis of patients with hepatocellular carcinoma(HCC). Methods Eighteen patients with histologically-proven HCC were underwent TACE-EIOE. The extent of apoptosis was analyzed by terminal deoxynucleotidy transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) staining. The expressions of Bcl-2, Bax, p53, Ki-67 and PCNA proteins were detected by immunohistochemical method. Changes of these markers, tumor necrosis, encapsulation, volume, cumulative survival were analyzed. Results Complete tumor necrosis was 33.33%(6/18), severe tumor necrosis was 44.44%(8/18), moderate tumor necrosis was 5.56%(1/18), lesser tumor necrosis was 16.67%(3/18). Apoptosis rate was (22.79?3.34)%. Complete encapsulation was 88.89%(16/18). Evident volume-lessening was 66.67% (12/18), partial volume-lessening was 22.22%(4/18),and stable volume was 11.11%(2/18). Ki-67,PCNA, p53, Bcl-2, and Bax were (30.93?18.10)%, (41.16?11.83)%, (53.41?18.13)%, (6.32?2.10)%, and(58.73?17.32)%, respectively. The cumulative 1-, 2-,and 3-year survival rates were 83.33%,72.22%,and 66.67% for patients, respectively. Conclusions The preoperative TACE-EIOE is safe, it might benefit patients with HCC.

Objective To evaluate the relationship between the tumor encapsulation,lymphocytic infiltration,fibroplasia and cirrhosis and transcatheter arterial chemoembolization(TACE)methods for hepatocellular carcinoma(HCC).Methods Histopathological changes were studied in 59 cases of HCCs treated with four kinds of TACE and 58 cases of HCCs treated with surgical resection alone.Results In TACE group the encapsulation,lymphocytic infiltration,fibroplasia was more severe and extensive than that in group of surgical resection alone(?0.05),had relation to TACE time(?

Objective　To evaluate the relationship between the tumor encapsulation,lymphocytic infiltration,fibroplasia and cirrhosis and transcatheter arterial chemoembolization(TACE)methods for hepatocellular carcinoma(HCC).Methods　Histopathological changes were studied in 59 cases of HCCs treated with four kinds of TACE and 58 cases of HCCs treated with surgical resection alone.Results　In TACE group the encapsulation,lymphocytic infiltration,fibroplasia was more severe and extensive than that in group of surgical resection alone(Ρ＜0.01）.The TACE method and treatment time had effect on encapsulation and fibroplasia of tumor,but treatment interval was no effect.The rate of cirrhosis among TACE method had no significantly difference（Ρ＞0.05）,had relation to TACE time（Ρ＜0.05）.Conclusion　The changes in the encapsulation,lymphocytic infiltration,fibroplasia are more easily find by polytimes,multimaterial chemoembolization than that by one time single material chemoembolization and chemotherapy alone.The superselective cathetering can avoid the damage of normal liver.

Objective To evaluate double microcatheter technique for detachable coil treatment of wide-necked intracranial aneurysms. Methods Routine endovascular coil occlusion was not achieved in 6 cases of wide-necked intracranial aneurysms. A second femoral arterial sheath was inserted on the opposite side . A second microcatheter was positioned within the aneurysm. The detachable coils were introduced via double microcatheter simultaneously or successively till the aneurysm were compactly embolized. The coils were detached after satisfactorily positioned. Results Total 6 cases of wide-necked aneurysms were successfully embolized with detachable coil. Aneurysmal sacs were 100% embolized in 2 cases, over 90% in 4 cases. 1 case suffered moderate disablement as a result of complication of. Angiographic follow-up in 5 cases revealed no recurrent or rerupture.Conclusions The double microcathter technique may be an optional method during embolization of some complicated wide-necked aneurysms.

Objective To retrospectively analyze our experience of embolization of ruptured intracranial aneurysms during the period of cerebral vasospasm (CVS). Methods Thirty-seven patients with ruptured intracranial aneurysms were embolized with electrolytic detachable coils during the period of CVS (days 4 to 14). Group A included the 14 patients with angiographic CVS and group B included 23 patients without angiographic CVS. All except 2 patients were transferred to our department during the CVS period. Glasgow outcome score (GOS) was evaluated 3 months after the treatment. Results Twelve patients in group A successfully received the aneurysm embolization and treatment of the CVS with intraarterial papaverine injection and balloon angioplasty. GOS in 3 months was good recovery in 7 patients, moderate disability in 2, severe disability in 1, and dead in 2, respectively. Embolization failed in 2 patients because the microcatheters could't pass the spasmodic parent arteries. All the aneurysms in group B were successfully embolized. GOS were good recovery in 18 patients, moderate disability in 2, severe disability in 2, and dead in 1, respectively. There was no intraprocedural aneurysmal rupture but with 2 thromboembolic events. No rebleeding occurred during the mean 11 months follow-up. Conclusions The so-called “period of CVS” isn′t always associated with CVS in angiograpy. Embolization of ruptured intracranial aneurysms during the period of pure CVS doesn′t carry an increased risk. Both the aneurysms and CVS can be treated during the single procedure. It can reduce the rebleeding rate in hospital and improve the prognosis of the patients with CVS.