Objective To discuss the characteristics of multiple blood supplies and the significance of multiple intra-arterial embolization in massive hemoptysis. Methods Forty-four patients with massive hemoptysis underwent digital subtraction angiography (DSA) and intra-arterial embolization after ineffective medical treatment. The characteristics of blood supply of lesions,the methods of intra-arterial embolization and the clinic efficacy were retrospectively analyzed. Results All the patients, one artery was embolized in 9 patients,2 arteries were embolized in 18,3 in 14 and 4 in 3. The hemoptysis decreased or ceased immediately after intra-arterial embolization in 43 patients and recurrence within lweek in 2,which were controlled with additional emblization. 1 patient died in surgery. Conclusion The lesions of massive hemoptysis had complicated blood supplies,and multiple intra-arterial embolization was very important.

Objective To investigate the feasibility and the clinical effect of bronchial arterial chemoembolization with ADM-Lipiodol mixture in the treatment of brochogenic carcinoma. Methods Thirty-three cases of bronchogenic carcinoma undertaken bronchial arterial chemoembolization, including 20 cases of adenocarcinoma, 8 of squamous cell carcinoma, 1 of small cell carcinoma and 4 of undifferentiated carcinoma. The clinical staging consisted of 5 cases in II, 13 in III A, 11 in IIIB and 4 in IV. Using Seldinger's technique and selective bronchial arterial catheterization (5 cases of super-selective catheterization). After perfusion of 80 - 100 mg CDDP and 10 mg MMC, embolization with a mixture of 30 mg ADM and 2 - 10 mg Lipidol was performed. Another 3 cases were undergone surgery within 1 week after bronchial arterial chemoembolization. Results The 33 cases of bronchial arterial chemoembolization, showed 2 cases of complete response(CR), 21 of partial response (PR), 9 of stable (S) and 1 of processes (P). The pathology revealed massive necrosis of tumor cells after bronchial arterial chemoembolization. No severe complications such as spinal injury occurred. Conclusions Bronchial arterial chemoembolization with ADM-Lipiodol mixture for the treatment of brochogenic carcinoma is good short-term effectiveness. The procedure should be carried out carefully on the basis of fine digital subtraction angiography.

Objective To evaluate the effectiveness of transcatheter arterial embolization for congenital renal arteriovenous malformation.Methods Seven cases of congenital renal arteriovenous malformation causing gross hematuria were retrospectively studied.All of 7 cases were demonstrated by means of angiography and then the catheter was placed superselectively into the involved arterial end of the malformation undertaking embolization with gelfoam,dehydrated ethanol,coils,etc.Results All the malformations of the 7 cases were successfully embolized with stoppage of gross hematuria within 24 hours.No serious complications occurred except lumbago,fever,gastrointestinal reaction for one week.There was no recurrence of haematuria and the renal function was also normal in all cases during the follow-up for 36 to 98 months.Conclusions Transcatheter renal arterial angiography and embolization are the important and effective management for the diagnosis and treatment of congenital renal arteriovenous malformation.

Objective To analyse the normal helical CT appearances of the bronchial stump or anastomosis after pulmonectomy for central bronchial carcinoma.Methods The available 110 contrast-enhanced spiral CT images in 55 patients undergone different surgical procedures for central bronchial carcinoma were evaluated retrospectively.Results The CT findings of bronchial anastomosis in shape appeared as smooth,concave and convex,sharp angle,obtuse angle,spininess,irregulated or short tube.The thickness of anastomosis was (3.26?1.46) mm.Conclusion Spiral CT can display the bronchial anastomosis clearly after pulmonectomy for central bronchial carcinoma.

Objective To summarize the experience of diagnosis and treatment for peripancreatic pseudoanemysms.Methods The clinical data of 12 patients with peripancreatic pseudoaneurysm were analyzed retrospectively.Out of 12 patients,6 presented with abdominal or alimentary tract bleeding because of pseudoaneurysm rupture.Possible etiology included chronic pancreatitis (6 cases),severe acute pancreatitis (3 cases),postpancreatoduedenectomy (3 cases),developed after transarterial chemoembolisition for hepatic carcinoma (1 case) and 1 without any definitive cause.Results Interventional radiology as first therapeutic procedure was carried out in 10 patients including 9 endovascular coil embolizations and 1 stent graft placement for pseudoaneurysm from branch of SMA,and bleeding was controlled successfully in 5 patients with pseudoaneurysm rupture.2 patients underwent laparotomy as initial therapy.Three patients underwent surgeries after a failed embolisation,another underwent laparotomy and peritoneal lavage and drainage for pancreaticoenteric anastomotic leak complicated with abdominal infection.2 SAP patients underwent ultrasound guided drainage for peripancreatic abscess.2 after PD patients died,with mortality of 16.7％ (2/12).Conclusions Peripancreatic pseudoaneurysm carried a high and an unpredictable risk of rupture that warranted prompt interventional treatment or surgery.

Objective To investigate anticoagulation and security of heparin and low molecular weight heparin applied to the carotid artery after CASA, to provide a reference for clinical anticoagulation. Methods From January 2010 to December 2013,120 cases of implementation of CASA surgical patients with carotid artery were selected,according to anticoagulation method they were divided into control group and observation group, control group had 54 patients, the implementation was continuous intravenous infusion of heparin for 3 days; observation group had 66 patients with sub-cutaneous low molecular weight heparin anticoagulation, one injection for 12 h, lasted for three days, before surgery,24 h,72 h after surgery,anti-Xa activity were detected in patients,activated partial thromboplastin time(APTT),pro-thrombin time (PT), complications were compared between the two groups. Results Anti-Xa activity of observation group and control group after 24 h were (1.204±0.413) IU/mL, (1.428±0.512) IU/mL, the difference was statistically significant(t=3.189,P=0.037), anti-Xa activity levels after 72 h of observation group and control group were (1.314±0.533)IU/mL,(1.684±0.687) IU/mL, the difference was statistically significant (t=4.218, P=0.030); in observation group,before surgery,24 h, 72 h after surgery APTT were(27.93±3.86)s,(37.97±5.14)s,(37.73±4.28)s, differences were statistically significant before and after surgery (t=6.453, P=0.009; t=6.449,P=0.010); in the control group,be-fore surgery,24 h,72 h after surgery APTT were(27.64±3.24)s,(38.34±4.55)s,(38.21±4.41)s,differences were statisti-cally significant before and after surgery(t=6.534,P=0.007;t=6.530,P=0.007);preoperative and 24 h,72 h postoper-ative at the same period for observation group and control group there were no significant difference(t=0.927,P=0.197;t=1.023, P=0.143; t=0.993, P=0.176); in observation group before surgery,24 h,72 h after surgery for PT compared with the control group the difference was not statistically significant (P>0.05); in observation group complication rate was 9.09%(6/66)and the control group was 7.41%(4/54)the difference was no statistically significant(χ2=1.034,P=0.114).Conclusion Low molecular weight heparin and unfractionated heparin used in carotid surgery CASA have similar anti-coagulant effect,low molecular weight heparin is slightly lower in anti-Xa activity,but it's easy to monitor and control to ensure the safety of the treatment.

Objective To discuss the clinical value of interventional management before surgical therapy for massive gastrointestinal hemorrhage, and to compare the clinical efficacy and re-bleeding rate between hypophysin infusion group and embolization group. Methods During the period of June 1998-Apr.2009, 31 patients with massive gastrointestinal hemorrhage in our institution underwent preoperative interventional managements before they received surgical treatment. According to DSA manifestations, the patients underwent trunsarterial hypophysin infusion or transcatheter embolization as interventional management. The clinical efficacy of interventional procedures and its influence on the surgery were evaluated, and the hemostasis rate and re-bleeding rate were compared the two kind of intervention managements. The numeration data were analyzed with Fisher's exact test, and the SPSS 11.0 was used as statistical software. Results The interventional managements were successfully performed in all the 31patients, with a total hemostasis rate of 83.9% (26/31) and a total re-bleeding rate 30.7% (8/26). The hemostasis rate and re-bleeding rate of hypephysin infusion group and embolization group were 69.2% (9/13), 94.4% (17/18) and 44.4% (4/9), 23.7% (4/17), respectively. All the 31 patients received surgery after interventional therapy, of which selective operation was carried out in 20. Neither surgery-related or intervention-related serious complications nor death occurred. Conclusion Preoperative interventional managements can provide patients with massive gastrointestinal hemorrhage with valuable chance of a successful surgery, enable the physician to take a selective operation to replace an emergency one, as a result, the surgical risk will be greatly reduced. Therefore, it is worth popularizing the preoperative interventional managements in clinical practice.

Primary hepatic carcinoma has ranked as the sixth most commonly diagnosed cancer and the third leading cause of cancer death. China shares about 50% of new liver cancer cases, including 80% of hepatic carcinoma. Non-surgical therapy continues to make breakthroughs. The authors report a case of hepatic carcinoma with intrahepatic metastasis and tumor thrombus in the left portal vein, which has achieved continious partial response after the treatment of atezoli-zumab combined with bevacizumab, without adverse reactions such as liver and kidney function damage. The life quality of the patient was improved, showing safety and efficacy of the treatment.