Objective To compare the recent clinical efficacy between ileal neobladder and orthotopic ileal neobladder.Methods The clinical data of 62 patients with bladder cancer who were performed with cystectomy plus urinary diversion were retrospectively analyzed.Among them,32 patients were performed with orthotopic ileal neobladder(orthotopic ileal neobladder group)and 30 patients were performed with ileal neobladder(ileal neobladder group).The operation time,intraoperative bleeding,intestinal function recovery time,hospital stay,early postoperative complications were compared between two groups.Results All the patients were successful,and there was no operative deaths occurred.There was no significant difference in the postoperative intestinal function recovery time between two groups(P ＞ 0.05).The operation time,intraoperative bleeding,hospital stay in orthotopic ileal neobladder group was higher than that in ileal neobladder group [(463.59 ± 50.24)min vs.(436.07 ± 44.91)min,(1081.16 ± 320.49)ml vs.(867.53 ± 224.61)ml,(46.88 ± 4.67)d vs.(20.37 ± 5.24)d],but the incidence of early postoperative complications in orthotopic ileal neobladder group was lower than that in ileal neobladder group [25.0％(8/32)vs.53.3％(16/30)],and there were significant differences between two groups(P ＜0.05).Conclusions Two kinds of urinary diversion surgical urinary diversion are clinically more mature manner,in clinical practice.Clinicians should be based on the patient's comprehensive situation,combined with the clinical experience to select the most appropriate surgical procedures.

ObjectiveTo explore efficacy,durability and possible impacts on life quality of carotid occlusion treatment to carotid cavernous fistula (CCF) patients.MethodsCCF patients since 2001 were retrospectively analyzed,the clinical features,2 weeks post procedure mRS score and ratio of carotid occlusion were recorded.Headache impact test (HIT-6) and Short form health survey(SF-36) were used to assess impact of sequelae in patients' daily life,by phone call,questionnaire and clinic recheck.Results Total 96 cases were studied composed of 81 direct CCF and 15 dural AVF.Thirty-two direct CCF cases underwent carotid occlusion during procedure and many ophthalmologic signs but visual impairment got recovery after 2 weeks,the mRS score less than 2 were revealed.The one year post operation HIT-6 score more than 50 was more likely found in carotid occlusion cases comparing with those preserved carotid artery while the 3 year SF-36 scores of carotid occlusion cases revealed inferior to those with patent artery,especially in body pain,general health and vitality subscales.ConclusionCarotid occlusion seems to be a feasible,effective and durable alternative for CCF treatment,but which could play a negative role on quality of patients' life in the long run.

In recent years,endovascular treatment of intracranial aneurysms has been developed rapidly.Pipeline embolization device (PED),which is a novel blood flow guiding device,can creatively reconstruct the blood flow distribution of the aneurysm-bearing artery,and it has been widely employed in clinical practice.Satisfactory curative effect has been achieved by PED for intracranial aneurysms,especially for complex intracranial aneurysms.However,because of its high metal coverage rate,the complications such as aneurysm rupture,spontaneous cerebral parenchymal hemorrhage,branch artery occlusion,etc.are not uncommonly seen in patients after receiving flow divertion treatment,and the mortality rate is higher,to which sufficient attention should be paid by clinicians.This paper aims to make a review on the research progress concerning the postoperative complications of PED in the treatment of intracranial aneurysms.

Objective To evaluate the feasibility,efficacy and complication of early middle cerebral artery(MCA) mechanical recanalization(MER) for treatment of acute ischemic stroke.Methods Seven cases undergone MER of MCA for the treatment of acute cerebral infarct were retrospectively reviewed and analyzed,including the etiology,mechanism,Qureshi grading scale,location and size of infarcts,NIHSS score of pre and post procedure,endovascular technique and complications.Referring to the literature,the indications of MCA recanalization were further identified.Results A total of 7 cases with mean age of 48 yrs were reviewed,which included 3 cases of atherosclerotic thrombosis and 4 embolic cases with pre NIHSS score ranging from 3 to 22.Mechanical recanalization succeeded in 6 cases,but 2 cases of cardiogenic embolism died of intrac ranial hemorrhage postoperatively.Favorable clinical outcomes were achieved in 4 cases whereas 1 deteriorated.Overall complications seemed to be consistent with literatures reviewed.Conclusions Early MER of MCA may benefit to a certain subset of acute ischemia stroke patients,however,embolic cases,elder patients and those with severe neurologic deficits are often accompanied by higher complications and unfavorable outcome.

Objective To explore the technical skills and short-term efficacy of Pipeline Embolization Device (PED) deployment for endovascular treatment of complex intracranial carotid aneurysm. Methods The medical charts of 6 cases who underwent PED implant procedure in our institute from Jan. to Jun. 2015 were reviewed, including 4 female and 2 male; the mean age was (56 ± 13) years, ranging from 34—70 years. All the 6 cases suffered from intracranial carotid aneurysm and PED implant procedures were performed to cover the aneurismal neck under general anesthesia, while dual antiplatelet treatment (Bayaspirin+Plavix) was administered. The basic characteristics and peri-procedural adverse events were recorded, interview and mRS score were done by telephone 1 month after procedure, clinical examination and DSA angiographic re-check were made 3 months following procedure, respectively. Status of aneurysm occlusion was evaluated by Raymond grading scale. Results All 6 aneurysms involved were unruptured. Technical success was achieved in all procedures for 6 cases, of which 3 cases were single PED implantation and the other 3 PED adjuncted to coiling. No procedure related complication was detected during 30 days after operation. Follow up with 1.5—4.8 months (median 2.8 months) were conducted and last follow up revealed good outcome (mRS<2) in all cases. The control angiography showed contrast filling aneurismal sac even after PED implantation, DSA recheck performed in 2 cases at 3 months after operation and revealed good obstruction of aneurysm (Raymond grade≤2). Conclusion Domestic preliminary study shows PED implantation seems to be a safe and effective modality for treatment of complex intracranial carotid aneurysms.

Objective To evaluate the technical feasibility,safety and mid-term effect of endovascular revascularization of nonacute intracranial vertebrobasilar artery occlusion.Methods Consecutive data of patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization,were retrospectively collected and analyzed.Complications and recurrent events during the follow-up period were recorded.The modified Rankin scale (mRS) scores were used to compare the symptoms before and after the procedure.Results All 27 patients but 1 (96.3％) obtained successful recanalization.After the procedure,13 patients showed improvements,11 were stable,and 3 worse.The decline of median mRS scores,which was 4 [interquarter range(IR),2-5) preoperatively and 3 (IR,1-5) on discharge,showed significant statistical difference (Z =3.116,P =0.002).Five patients had procedural complications,namely 2 dissection,1 in-stent thrombosis during the operation,1 thrombus disruption and translocation during the operation and 1 acute reocclusion after operation.During the follow-up period with the median of 21 months,3 death,1 stroke and 2 transient ischemic attack occurred.The latest median mRS scores were 1 (IR,0-3).The ratio of patients with mRS ≤ 2 increased from 25.9％ (7/27) before operation to 63.0％ (17/27) at the follow up.Seventeen patients received imaging follow-up during the 9 months,with restenosis in 6 and symptom in 3 of them.Subgroup analyses revealed better functional recovery (lower mRS) both in patients with vertebral artery occlusion (Z =2.111,P =0.035) and those with basilar artery occlusion (Z =2.333,P =0.020).Conclusions Endovascular revascularization for the nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible,and improves disability recovery.However,the rates of procedural complication and restenosis are high.

Objective To evaluate the technical feasibility,safety and treatment effect of endovascular revascularization of symptomatic sub-acute and chronic intracranial vertebrobasilar artery occlusion.Methods Twenty-one consecutive patients with symptomatic sub-acute and chronic intracranial vertebrobasilar occlusion underwent endovascular revascularization.Perioperative complications and recurrent events during the follow-up period were recorded. The modified Rankin scale ( mRS ) scores and blood stream thrombolysis in myocardial infarction (TIMI) scores for all patients preoperatively,postoperatively and at follow-up were evaluated.The results were analyzed using Wilcoxon rank sum test and Fisher exact test.Results All 21 patients but 1 (95.2％,20/21 ) obtained successful recanalization. After the procedure,9 patients showed improvements,10 were stable,and 2 worse. The decline of median mRS scores,which was 4 preoperatively [ inter-quartile range ( IR ) 2.5-5.0 ] and 4 ( IR 1.0-5.0 ) on discharge from the hospital respectively,showed significant statistical difference (Z =2.810,P ＜ 0.01 ).Three ( 14.3％ ) patients suffered periprocedural complications,namely basal arterial dissection,intra-stent thrombosis and postoperatively acute occlusion in each one.There was no death,stoke or recurrent transient ischemic attack (TIA) occurring 30 days after the procedure. During the 7 months after operation,which was the mean clinical follow-up duration,TIA and recurrent stoke occurred in one patient respectively,and two patients died of systemic complications. The median mRS scores were 2.0 (IR 1.0-4.0 )in all 21 patients and 1 ( IR 1.0-4.0) in the surviving subjects.Conclusions Endovascular revascularization for the recanalization of symptomatic sub-acute and chronic vertebrobasilar artery occlusion is technically feasible,and helps to prevent ischemic events and improve disability recovery. However,its exact effect needs further verification by future random controlled studies.

Objective To assess the safety, feasibility, short-and mid-term efficacy of wingspan stent for treating patients with symptomatic intracranial artery stenosis. Methods A total of 113 patients with severe symptomatic intracranial stenosis were enrolled and Gateway-wingspan stenting were performed on all patients. The technical success, the pre- and post-stenting stenosis, perioperative complications, clinical outcome and restenosis rates were recorded, and chi-square test was used for analysis of complication rate by comparing our results with the results of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study and NIH multi-center Wingspan stenting trial. Results The technical success rate was 99. 1% ( 112/113). The mean pre and post-stent stenoses were (80.7 ± 9.3)% and (27.7 ± 9.7)% (χ2 =9.397,P < 0. 05 ). The total complication rate was 4.4% (5/113 ) during the follow-up ( mean 14. 5 months, range 1-28 months), and the frequency of restenosis was 12. 5% (5/40) at 6 months. The primary endpoint events, ischemic stroke, and lesion-related ischemic stroke were lower in our study (4.5%, 3.5%,3.5% ) compared with the results of WASID trial (21.1%, 20. 4%, 15.0% ,P<0. 05). For those with poor outcome in the three high-risk sub-groups which were with more than 70% stenosis, or last event from the treatment was less than 17 days, or NIHSS was above 1, a better outcome was observed in our group (4. 5% ,4. 7% and 2. 0% in our study, 19.0%, 17.0% and 19. 6% in previous study, P < 0. 05). The medium-term efficacy in this group (4. 5% ) significantly improved compared with NIH study ( 14. 0% ,P <0. 05 ). Conclusions Wingspan stenting for symptomatic intracranial arterial stenosis is with good safety,feasibility and low perioperative stroke rate and mortality. The incidence of primary endpoint events and the ischemic events are lower than those of medication group, and the efficacy of stenting is significantly better than medication even in high-risk population.

Objective To investigate the clinical efficacy of pedicled adrenal transposition for the treatment of adrenocortical and medullary hyperplasia, Methods Twenty cases of adrenal hyperpla-sia (6 men and 14 women; mean age,36 years ) had history of hypertension from 0.5 to 5 years. Of all cases, 15 had centripetal obesity and purple striae, 2 had weakness and polyuria, 3 had durative hypertension. Serum potassium and aldosterone were increased in 4 and 3 cases, respectively. Urinary 17-OH and 17-KS were increased in 15 cases. Epinepgrine, norepinephrine and dopamine increased in 3 cases, VMA increased in 4 cases. CT scan and MRI revealed adrenal diffuse enlargement with in-creased thickness or nodules in 18 and 3 cases, respectively, 131I-MIBG scan showed positive in 3 ca-ses. Preoperative diagnoses were Cushing's syndrome in 11 cases, hyperaldosteronism in 2 cases, pheochromocytoma in 1 case, adrenomedullary hyperplasia in 2 cases, Cushing's syndrome-cate-cholamine syndrome in 4 cases. All cases were treated with transposition of pedicled adrenal gland into the subcutaneous tissues. Results All operations were successful. The average operation time was 120 min, the average blood loss was 40 ml and the average hospital stay was 10 d. No obvious surgical complications occurred. Pathological studies of all the cases revealed the coexistence of adrenocortical and medullary hyperplasia. Seventeen cases were followed up for 0.5-8 years. Thirteen cases had no symptom and normal biochemical results. Four cases still had hypertension and abnormal biochemical results. They were recovered after adrenal operation of the ther side. Conclusion Transposition of pedicled adrenal gland could be an available option to treat patients with adrenocortical and medullary hyperplasia.