Objective To explore the approach and early effects of endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus.Methods Six cases with portal vein stenosis of cancerous thrombus,which caused by primary hepatic carcinoma(5 cases)and eholangiocarcinoma(1 case)and the severity of stenosis showed on contrast enhanced CT were more than 75% or occluded,were performed percutaneous transhepatie or transsplenic portography.FLUENCY~(TM) endovascular stent-graft(10 mm diameter)was placed at the position of stenosis after gastroesophageal varices embolization.Portal pressure was measured pre-and post-deployment.Results Stents were successfully placed in all patients.The average portal pressure decreased from 50.7 cm H_2O(1 cm H_2O = 0.098 kPa)to 41.3 cm H_2O after endovascular stent-graft deployment.The restenosis were found in 2 cases after one month.Haematemesis and refractory aseites appeared in one case respectively,the other 4 cases showed no significant symptoms above caused by portal hypertension.Conclusion It is safe and feasible for endovaseular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus.Selecting the suitable indications,the symptoms of portal hypertension can be controlled effectively.

OBJECTIVETo evaluate the efficacy and complications of radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) for management of hepatocellular carcinoma (HCC).

METHODSA retrospective analysis was conducted for 62 small HCC cases undergoing RFA with or without TACE, and in each case, the tumors were not more than 3 with a diameter below 5 cm. Nineteen cases were managed with RFA alone (RFA group) while the other 27 underwent RFA combined with TACE (TACE+RFA group). Percutaneous RFA (RITA 1500) procedure was performed under CT guidance 1-3 weeks after TACE in TACE+RFA group.

RESULTSThe complete tumor necrosis rate was 77.8% (21/27) in TACE+RFA group, significantly higher than that in RFA group [57.9% (11/19), P<0.01], and the former group had a significantly lower local recurrence rate than the latter [22.2% (6/27) vs 42.1% (8/19), P<0.01]. Postoperative fever, local pain and temporary hepatic function abnormality were the common complications that were relieved after proper interventions, and mortality did not occur in these cases.

CONCLUSIONThe combination of TACE and RFA significantly increases the complete tumor necrosis rate and decreases the recurrence rate of small HCC. CT-guided percutaneous RFA can be a safe and effective therapy for small HCC.

Adult ; Aged ; Carcinoma, Hepatocellular ; therapy ; Catheter Ablation ; methods ; Chemoembolization, Therapeutic ; methods ; Female ; Humans ; Liver Neoplasms ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVE: To observe effects of restraint position on the changes of diaphragmatic mechanical characteristic in rats, and try to explore the role of nitric oxide (NO). METHODS: Rat model of restraint position was established. Rats were divided into control group, restraint position 12h and 24h groups. The markers of respiratory functions in vivo and the biomechanical markers of diaphragmatic characteristic ex vivo were evaluated. Serum NO levels were measured with spectrophotometry. The expressions of nNOS and iNOS mRNA in diaphragm were detected using RT-PCR. RESULTS: Compared with control group, respiratory rate, tidal volume and minute ventilation were significantly decreased in the restraint position 12h and 24h groups. Pt of diaphragm significantly decreased and force-generating capacity reduced at low frequency stimulation in 12h group. Force-generating capacity over the full range reduced at low and high frequency stimulation in 24h group. Pt of diaphragm in control and restraint position groups increased after L-NNA pre-incubation. Force-frequency relationship after L-NNA pre-incubation reduced in 24h group. NO level in serum increased significantly in the restraint position groups. Diaphragmatic nNOS mRNA expression was upregulated significantly in the restraint position groups. CONCLUSION Restraint position induces the decreasement of diaphragmatic contractility and the decreasement is mediated by NO from diaphragm or circulation blood.
Animals ; Biomechanical Phenomena ; Diaphragm/physiopathology* ; Male ; Muscle Contraction/physiology* ; Muscle Tonus/physiology* ; Nitric Oxide/metabolism* ; Nitric Oxide Synthase/metabolism* ; Posture ; RNA, Messenger/metabolism* ; Rats ; Rats, Sprague-Dawley ; Respiration Disorders/physiopathology* ; Restraint, Physical ; Reverse Transcriptase Polymerase Chain Reaction

Objective To evaluate the clinical outcome of transvenous embolization withdetachable coils and N-butyl cyanoacrylate (n-BCA) for management of dural carotid-cavernous sinusfistulas (dCCFs). Methods Six patients with angiographically confirmed spontaneous dCCF wereinvolved in this study, including two with concurrent ipsilateral internal jugular vein occlusion. All thepatients received surgeries for transvenous embolization through the superior ophthalmic vein (2 cases) orthe inferior petrosal sinus (4 cases), using detachable coils (2 cases) or detachable coils combined withn-BCA (4 cases). Results The vascular murmur, exophthalmos and conjunctival congestiondisappeared in 4 patients shortly after the total embolization of the fistulas, while eyeball movementdisorder, diplopia and visual deterioration persisted for at least 1 month and gradually recovered 3 monthsafter the surgery. The fistulas failed to be completely embolized in two patients, and in one of the patients,the symptoms resolved after intermittent carotid artery compression for one week; in the other patient,exophthalmos recurred and worsened 1 month after embolization, and was successfully managed withtransarteriai embolization of the fistula. No symptomatic complications were found in these 6 patientsafter transvenous embolization in spite of the presence of a few small n-BCA granules in the lungs of twopatients. Conclusion Transvenous embolization is safe and effective for management of dCCF, andcombined use of detachable coils and n-BCA may enhance the success rate of total fistula embolization.

OBJECTIVESTo evaluate the feasibility and effectiveness of stent placement in treating hepatic artery stenosis after orthotopic liver transplantation (OLT).

METHODSFrom November 2003 to September 2005, 14 patients who had hepatic artery stenosis after OLT underwent stent placement in their narrowed hepatic arteries. This included early interventional treatment in 10 patients and delayed interventional treatment in 4 patients. The technical results, clinical outcomes, and the hepatic artery patencies were reviewed.

RESULTSTechnical and immediate success was 100%. After a mean follow-up of 146 days (range, 9-345 days), all patients' hepatic arteries were patent, except that hepatic arterious restenosis occurred in 2 patients at 26 and 45 days after the stent placement. Of the 10 patients who received early treatment, 8 survived with normal results of liver function test and 2 patients died of septic multiple-organ failure at 9 and 30 days after the stent procedure. One patient received a retransplantation because of refractory biliary infection. Of the 4 patients who received a delayed interventional treatment, 1 patient survived for 345 days but with abnormal liver functional test results, the other 3 patients died of septic multiple-organ failure resulting from liver abscesses biliary infection.

CONCLUSIONHepatic artery stenosis after OLT can successfully be treated with stent placement and an early interventional treatment is the key for a good clinical outcome.

Adult ; Constriction, Pathologic ; therapy ; Female ; Graft Occlusion, Vascular ; etiology ; therapy ; Hepatic Artery ; surgery ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Stents ; Vascular Diseases ; etiology ; therapy

BACKGROUNDUterine arterial embolization (UAE) is a safe and effective therapy for symptomatic uterine leiomyoma. This study was to assess the effectiveness and the feasibility of pingyangmycin-lipiodol emulsion (PLE) for the management of symptomatic uterine leiomyoma.

METHODSOne hundred consecutive patients (aged 21 - 53 years, with 38 in average) with symptomatic uterine leiomyoma underwent superselective UAE with PLE. Clinical symptoms of the patients (including menorrhagia, bulk-related symptoms, and postprocedure-related abdominal pain) and the changes in uterine volume and tumor size after the embolization were analyzed. The patients were followed up for 8 - 21 months (mean, 15 months).

RESULTSNinety-nine patients (99%, 99/100) were interviewed in their first menses circle after embolization, showing improvements in their abnormal bleeding and bulk-related symptoms to some extent. Imagiological results during follow-up showed a mean of 48% reduction in uterine volume at 6 months and a mean of 75% reduction in tumor size at 9 months. Eighty-three percent of the patients reported complete resolution of postprocedure pain within 7 days.

CONCLUSIONSPLE is effective in the management of uterine leiomyoma, having superiority in alleviating postprocedure-related pain.

Adult ; Antibiotics, Antineoplastic ; administration & dosage ; Bleomycin ; administration & dosage ; analogs & derivatives ; Contrast Media ; administration & dosage ; Embolization, Therapeutic ; methods ; Emulsions ; Female ; Follow-Up Studies ; Humans ; Iodized Oil ; administration & dosage ; Leiomyoma ; therapy ; Middle Aged ; Uterine Neoplasms ; therapy ; Uterus ; blood supply

OBJECTIVETo explore the relationship of plasminogen activator inhibitor-1 (PAI-1) gene-675 4G/5G and methylenetetrahydrofolate reductase(MTHFR) gene C677T polymorphisms to recurrent early spontaneous abortion(RESA).

METHODSOne hundred and twenty-seven currently non-pregnant women with at least 3 unexplained spontaneous abortions during the first trimester of pregnancy (patient group). Normal control group consisted of 117 currently non-pregnant women with at least 1 pregnancy and without a history of prematurity, miscarriage, stillbirth, eclampsia and other pregnancy complications. The genotypes of PAI-1 gene and MTHFR gene were assessed by polymerase chain reaction-restrictive fragment length polymorphism.

RESULTSThe frequencies of 4G/4G genotype and 4G allele of PAI-1 were higher in patient group (45.7% and 66.1%) than in normal controls (17.1% and 46.6%) (P < 0.01). The PAI-1 4G/4G genotype was significantly associated with RESA (OR = 4.8, 95% CI: 2.23 - 10.35). Besides, MTHFR gene T/T genotype and T allele frequencies were increased in RESA patients (43.3% and 66.5%) versus normal controls (21.4% and 52.6%) (P < 0.01). The patients carrying T/T genotype had a high risk of early spontaneous abortion (OR = 3.2, 95% CI: 1.40 - 7.30). In additionìthe presence of the PAI-1 gene 4G/4G genotype together with the T/T genotype of the MTHFR gene was found to be a risk factor (OR = 6.20, 95% CI: 2.62 - 14.67) for RESA greater than the 4G/4G genotype or the T/T genotype alone.

CONCLUSIONThe above findings suggest that genetic polymorphisms of PAI-1 4G/5G and MTHFR C677T were associated with RESA. They may have synergetic impact and present gene dosage effect on the susceptibility to the development of early spontaneous abortion.

Abortion, Habitual ; genetics ; Adult ; Alleles ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; genetics ; Genotype ; Humans ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Plasminogen Activator Inhibitor 1 ; genetics ; Polymerase Chain Reaction ; Polymorphism, Genetic ; genetics ; Polymorphism, Restriction Fragment Length ; Pregnancy ; Young Adult

BACKGROUNDConsiderable evidence suggests that phosphatase of regenerating liver-3 (PRL-3) plays multiple roles in cancer metastasis; however, the molecular mechanisms remain largely unknown. The aim of this study was to identify proteins associated with PRL-3-promoted colon cancer metastasis, by comparative proteomic analysis.

METHODSProteomes of human colon cancer LoVo cells transfected with PRL-3 gene (LoVo-PRL-3) or empty vector PAcGFP-C3 (LoVo-control) were compared using 2D gel electrophoresis. Proteins that varied significantly in concentration were selected and identified using mass spectrometry. Expression of translationally controlled tumor protein (TCTP) mRNA and protein in LoVo-PRL-3 and LoVo-control cells was detected by real-time PCR and Western blotting. Small interfering RNA (siRNA) targeting TCTP was used for silencing TCTP expression in LoVo-PRL-3 cells. Functional significance of TCTP in PRL-3-promoted colon cancer cell proliferation, migration and invasion was investigated by Cell Counting Kit-8 assay and transwell chamber.

RESULTSSeventeen proteins displaying significant and reproducible differences between LoVo-PRL-3 and LoVo-control cells were identified. Ten proteins were upregulated and seven were downregulated in LoVo-PRL-3 cells when compared with LoVo-control cells. Eight identified proteins are associated with distinct steps of tumor metastasis: ubiquitin-like protein ISG15, interleukin-18, TCTP, serpin B5, annexin A3, macrophage-capping protein, ATP-dependent RNA helicase DDX3X, and cathepsin D. Real-time PCR and Western blotting results showed that both TCTP mRNA and protein were significantly increased in LoVo-PRL-3 cells compared to LoVo-control cells. Transfection with TCTP siRNA significantly reduced the expression of both mRNA and protein levels of TCTP in LoVo-PRL-3 cells. Knockdown of TCTP by siRNA inhibited PRL-3-promoted proliferation, migration and invasion of LoVo-PRL-3 cells.

CONCLUSIONOur results imply that TCTP might be a mediator of PRL-3-promoted proliferation, migration and invasion of human colon cancer cells.

Biomarkers, Tumor ; genetics ; metabolism ; Blotting, Western ; Cell Line, Tumor ; Cell Movement ; physiology ; Cell Proliferation ; Colonic Neoplasms ; metabolism ; Humans ; Neoplasm Proteins ; genetics ; metabolism ; Protein Tyrosine Phosphatases ; genetics ; metabolism ; Proteomics ; methods ; Real-Time Polymerase Chain Reaction

OBJECTIVETo evaluate the technique, safety and clinical efficacy of transportal variceal sclerotherapy with n-butyl-2-cyanoacrylate (NBCA) for gastric fundal varices.

METHODSTwenty-one patients with gastric fundal varices confirmed by endoscopy were enrolled in this study. The causes of the gastric varices were cirrhosis caused by hepatitis virus B or C (n = 16) and hepatocellular carcinoma with portal venous obstruction (n = 5). Percutaneous transhepatic or transplenic portography were performed on all 21 patients. The gastric varices were treated with NBCA-lipiodol mixture injected via a microcatheter introduced into the varices. For 8 patients who had large gastrorenal shunts (GRS), a balloon-occluded catheter was introduced into the GRS via the right femoral and left renal veins before injecting the NBCA-lipiodol. During the NBCA-lipiodol injection, the balloon was inflated to block the flow of GRS. Follow-up evaluations included findings of the laboratory liver function tests, upper intestinal endoscopies, and the occurrences of rebleeding.

RESULTSIn 20 patients (95.2%), the gastric varices were successfully obliterated with 2-8 ml of NBCA-lipiodol. In one patient with a large GRS, sclerotherapy was not successfully performed because a balloon-occluded catheter was not available during the procedure. In five patients, small amounts of NBCA-lipiodol entered into the distal pulmonary artery branches. Two of them suffered from transient irritable coughs; no patient developed severe pulmonary embolism. Embolization of portal venous branches occurred in two patients, which were not treated specifically. In comparison with the findings before the treatments, the serum alanine aminotransferase levels decreased at both 3 and 6 months after treatments (P less than 0.05); serum albumin levels increased at 6 months (P less than 0.05); the prothrombin times decreased at 6 months (P less than 0.05); but no significant changes were seen in the serum bilirubin levels. Fifteen patients were followed-up endoscopically for 3 months after the treatment. Gastric varices were completely resolved in 10 patients (66.7%) and were markedly smaller in 4 patients (26.6%). Worsening of the esophageal varices occurred in 3 patients (20%). All the patients were followed-up from 1 to 30 months [(16.7+/-8.8) months]. Rebleeding was observed in 4 patients, and the cumulative rebleeding rate at 1 year was 9.52%.

CONCLUSIONTransportal variceal sclerotherapy with NBCA is a safe and effective method for treating gastric varices. Microcatheter technique and occlusion of the large gastrorenal shunt with a balloon-occluded catheter are necessary to ensure obliteration of gastric varices and prevent pulmonary embolism.

Adult ; Aged ; Catheterization ; Enbucrilate ; therapeutic use ; Esophageal and Gastric Varices ; therapy ; Female ; Gastric Fundus ; pathology ; Gastrointestinal Hemorrhage ; therapy ; Humans ; Male ; Middle Aged ; Portal Vein ; Sclerotherapy ; methods