Objective To evaluate the long term efficacy of partial splenic embolization(PSE) for thalassanemia major. Methods 75 patients with thalassanemia major were treated with PSE and followed for 5 years,in which 30 patients with compelete data were studied.There were 8 patients with ? thalassanemia major,22 patients with ? thalassanemia major.The follow up indices included mean haemoglobin concertration,transfusion indices and blood transfusion consumption after embolization at 1,2,3,4,5 years. Results 26 of 30 patients showed a reduction in blood transfusion requirements and increase in haemoglobin level after embolization. The median blood transfusion requirements decreased from 1 200 ml/year before embolization to 200 ml/year; and the transfusion indices dropped from 6 times/year to 1 time/year. The mean of haemoglobin level increased from (60 9? 18 9)g/L to (82 3?17 4)g/L. The total effective rate was 86 7%,in which ? ,? thalassanemia major were 100 0%,81 8% respectively. Conclusion PSE is an effective therapeutic procedure for thalassanemia major, especially for ? thalassanemia major.

Objective To evaluate the effectiveness, safety and clinical feasibility of long-term drainage following percutaneous transhepatic cholangiography and drainage (PTCD) for the treatment of ischemic-type biliary lesion (ITBL) after liver transplantation. Methods There were 11 patients with ITBL after liver transplantation. Of the 11 patients with a mean age of 42. 3, 10 were male and 1 female. All 11 cases were diagnosed by PTC or ERC (endocopic retiogiade cholangiogiaphy) before PTCD, and they responded poorly to medication or draining and stenting with ERCP. Long-term drainage following PTCD was performed, whereas adjuvant percutaneous aspiration through double guidewire technique was used for the patients with large quantities of chole mud. Results There were three types of ITBL: type Ⅰ (extrahepatic lesions, n=7), type Ⅱ (intrahepatic lesions, n= 1), and type Ⅲ (intra- and extra-hepatic alterations, n=3). PTCD was performed in all 11 patients successfully. The values of total bilirubin (TBIL) and direct reacting bilirubin (DBIL) were 206.70±54.18μmol/L, 170. 65±53. 97μmol/L and 90. 63± 13.00μmol/L, 63. 83± 13.61μmol/L before and 1 week after PTCD, respectively. The follow-up period was from 3 through 71 months (mean 20 months). During the follow-up, TBIL values ranged between 23.70 μmol/L and 241.0 μmol/L (mean 55.3±15.6 μmol/L), and DBIL values were between 8. 1 and 162.0 μmol/L (mean 32. 53±10. 21 μmol/L). Hepatic functions were good in 9 cases including 5 cases in which the drainage tube was withdrawn after long-time drainage (6～ 12 months, mean= 8.2 months) and 4 cases in which drainage continued. The other 2 cases received liver retransplantation for the grafts dyssynthesis of albumen after drainage for 3 and 8 months. Conclusion Long-term drainage following PTCD is an effective and safe approach for ITBL following liver transplantation.

Objective To analyze the factors that might affect the therapeutic results of pingyangmycin-lipiodol emulsion intra-arterial sclerosing embolization (PLE-IASE) in treating symptomatic cavernous hemangioma of liver (SCHL). Methods PLE-IASE was performed in 89 patients with SCHL (32 males and 57 females). Before treatment the mean diameter of the hemangioma was (8.3±3.8) cm. Of 89 patients, 53 experienced anxiety, 35 suffered from right upper abdominal pain and the remaining one developed Kasabach-Merrit syndrome. Before PLE-IASE, the arteriographic classification was conducted based on hepatic arteriographic findings. Then pingyangmycin-lipiodol emulsion (PLE) was injected through the feeding artery. The dosage of pingyangmycin (PYM) was (9.8±4.4) mg and the dosage of lipiodol (LP) was (5.9±2.9) ml. The lipiodol deposition status was judged by the follow-up spot film taken immediately after PLE-IASE. The observations of the occurrence of complications, the relief of symptoms and the minification of SCHL were followed for 6-72 months after PLE-IASE. The linear regression analysis statistics was conducted by taking the minification as dependent variable and taking the arteriographic classification, lipiodol deposition status, the dosage of PYM, the dosage of lipiodol and the preoperative SCHL diameter as independent variable. Results Of all 89 cases of SCHL, hypervascular type was seen in 51, hypovascular type in 26 and arteriovenous shunt (AVS) type in 12. Good lipiodol deposition status was found in 64 patients and poor deposition in 25 patients after PLE-IASE. After PLE-IASE, the symptom of anxiety in 53 patients was relieved and the right upper abdominal pain was reduced in 33 cases although intermittent pain still remained in 2 patients. The blood platelet count of the patient with Kasabach-Merrit syndrome returned to normal after the treatment. The symptomatic relieve rate was 98.7%. No serious complications occurred in the follow-up period. The linear regression analysis showed that arteriographic classification, lipiodol deposition status and PYM dosage used in treatment had statistically significant impact on tumor minification, while the preoperative diameter of SCHL and lipiodol dosage used in treatment had no statistically significant impact on it. Conclusion PLE-IASE is an effective and safe interventional treatment for SCHL. Arteriographic classification, lipiodol deposition status and PYM dosage used in treatment have a significant correlation with the minification of SCHL, while the preoperative diameter of SCHL and lipiodol dosage used in treatment bear no relationship to the minification of SCHL.

BACKGROUND: Polyvinyl alcohol (PVA) displays limitation to cell adsorbability. Can collagen improve the adsorbability of PVA to cells?OBJECTIVE: To develop a novel type composite of PVA and collagen, and explore the feasibility to serve as soft tissue substitute.DESIGN: Single sample observation.SETTING: Guangzhou Red Cross Hospital, Jinan University Medical College, Guangzhou Institute of Traumatic Surgery.MATERIALS: Fifteen New Zealand rabbits of 2.0-3.0 kg, either male or female, were provided by Medical Experimental Animal Center of Guangdong Province. The experiment was carried out in the Laboratory of Guangzhou Institute of Traumatic Surgery, and the experimental procedure was accorded with the animal ethical standards. Bovine typeI collagen was purchased from Guangzhou Trauer Biotechnology Co., Ltd. and PVA-124 from Guangzhou Chemical Reagent and Instrumentation Co., Ltd.METHODS: The experiment was performed in Guangzhou Red Cross Hospital, Jinan University Medical College between July 2003 and December 2006. ①Preparation of PVA-collagen material: 5 g/L bovine type I collagen was mixed with 5% PVA-124 at a ratio of 1 : 1. The mixture was freeze-dried at vacuum until becoming gelatinous. The internal structure was observed under the use of scanning electron microscope. ②Cytotoxicity test: PVA-collagen composite was cut into pieces of 10 mm×5 mm× 1 mm, put into 48-well culture plate after sterilized by Y ray, cultured with 1×104 3T3 cells in each well. Cell growth was observed under scanning electron microscope and laser scanning confocal microscope. ③Embedding test in vivo: Two longitudinal incisions were cut at the two sides of spine. The subcutaneous tissue was separated bluntly to form subcutaneous lacuna. Four pieces of PVA-collagen material were implanted in the lacuna and fixed. Nine specimens and the surrounding tissues were harvested from three rabbits each at one, four, eight and sixteen weeks postoperatively for pathological observation.MAIN OUTCOME MEASURES: The internal structure of gel film under scanning electron microscope, cytotoxicity test and embedding test in vivo results.RESULTS: ①Internal structure of PVA-collagen material:PVA-collagen material showed white gel shape after freeze-drying at vacuum. Penetrating three-dimensional pores were observed in the surface and inner section under scanning electron microscope. ②Cytotoxicity test results showed that 3T3 cells grew normally on the PVA-collagen material. ? Embedding test in vivo results suggested that one week after PVA-collagen implantation, foreign body reaction occurred, and the interface between material and tissue was clear. Four weeks later, only rare lymphocyte infiltration was observed, and a great amount of fibroblast hyperplasia formed collagen fibrils and false simple cuboidal epithelium coating material. In 8 weeks, no lymphocyte infiltration, neutrophilic granulocyte infiltration or foreign body giant cell were found; dense capsule wall and capsule coating material generated from a great amount of fibroblasts were observed. In 16 weeks, extending collagen fibrils were found arranged regularly with shrank nucleus, showing long ovoid or long fusiform in shape; no new formation small vessels, lymphocyte, neutrophilic granulocyte infiltration or foreign body giant cell infiltration were observed. The capsule wall was stable and thinned. CONCLUSION: PVA-collagen composite has good cell compatibility and tissue compatibility but no toxic or adverse effect. It can serve as in vivo implant.

Objective To investigate the success rate of fluoroscopy-guided subclavian vein catheter implantation (SVCI) in children with hematologic diseases,to improve the visualization of the position of the catheter head,and to reduce the incidence of procedure-related complications.Methods Fluoroscopyguided SVCI was performed in 183 sick children (aged 1-16 years) with confirmed hematologic disease.The success rate of the catheter implantation,the number of needle puncturing,the operation time,the fluoroscopy time and the occurrence of procedure-related complications were recorded.Results Successful fluoroscopy-guided SVCI was accomplished in all 183 sick children,with a success rate being 100％.Successful SVCI was obtained with ＜3 times of puncturing in 151 sick children (82.5％),with 4-6 times of puncturing in 25 sick children,and with 7-10 times of puncturing in 7 sick children.The catheter tip was successfully positioned at the junction of the superior vena cava with the right atrium in all sick children.The operation time ranged from 5 min to 25 min with a mean of (10.38±4.04) min.The fluoroscopy time varied from 16 seconds to 607 seconds with a mean of (65.46±55.86) seconds.During the procedure,artery was wrongly punctured two times in two sick children.The mean follow-up time was 35 days.Cather-related infection occurred in 2 sick children.No local hematoma at puncture point,nor hemopneumothorax or catheter-related thrombosis occurred.Conclusion Fluoroscopy-guided SVCI has high technical success rate in children with hematologic diseases.For a successful procedure of SVCI,less number of needle puncturing is needed by using this technique.The satisfaction rate for the placement of catheter tip is high and the incidence of complications is low.Therefore,fluoroscopy-guided SVCI is a safe and effective method.

Objective The clinical effects of endoprotheses in the palliative treatment of malignant biliary obstruction were evaluated.Methods The palliative treatment of endoprothese in 74 cases(including 42 Wallstents and 32 plastic stents )were analyzed retrospectively.Results There were remarkable effects on reducing the level of serum bilirubin and improving the symptoms.The bilirubin was decreased more obviously in the first week,and tended to normal in 3 weeks.Stenting was performed on upper bileduct obstruction mostly(accounted for 52.7%).The early complications were less;late complications were blockage mainly.The half-year obstructive rate in metal stent group was 19%;plastic stent 25%.Average stent patency was 214 days in metal stent versus 122 days in plastic stent.Conclusion Endoprotheses are an efficient means of treating malignant biliary strictures and reducing the level of serum bilirubin,particularly of upper biliary obstructions.As its micro-invasion,it is fit for old age and asthenic (such as dyscrasia),whose survival time may be shorter(estimated less than 6 months),doctor may choose metal stent.If patient is impoverished,the doctor could use plastic stent.

OBJECTIVE: To analyze the relationship of the height difference and bone density (BD) of premenopausal and postmenopausal women. METHODS: The height values of 191 premenopausal and postmenopausal women were recorded, and the BD values of lumbar vertebrae and hip were detected by double energy X-ray BD detector. RESULTS: The lower the height of the postmenopausal women, the less the BD value. The BD of lumbar vertebrae dropped 0.025 5 g/cm(2) with each 2 cm of the shortened height, and the BD of hip joint dropped 0.029 2 g/cm(2). The shortened value in postmenopausal women with osteoporosis was statistically greater than that in postmenopausal women without osteoporosis. CONCLUSION: The BD of the postmenopausal women can be estimated by the calculation of their shortened height value.

Objective To evaluate the changes of immunologic function in children with thalassanemia major after partial splenic embolization(PSE).Methods Immunoglobulins,T cell subsets were detected by immunologic turbidimetry and APAAP with monoclonal antibody respectively in 40 children with thalassanemia major and also in 20 healthy persons before and after PSE.These immunologic indexes were compared before and after PSE.Results The levels of IgG in serum were significantly lower one week after PSE than that before PSE.It turned to normal three weeks after PSE.The IgM,IgA levels remained unchanged during PSE.The levels of CD_3、CD_4、CD_4/CD_8 ratio in children with thalassanemia major were decreased(P

Objective To evaluate the conditions and risk factors of esophageal stent dys-seal phenomenon (ESDP) .Methods Ninety-eight patients with malignant esophageal obstruction underwent metallic stent placement and 7 patients with ESDP were analyzed.The possible contributing factors,including age,gender,obstruction segment,esophagorespiratory fistula,surgical intervention,radiotherapy,the degree of upper obstruction segment expansion,stent with bellmouth,application of covered stent were investigated.All factors mentioned above were analyzed with Logistic regression analysis.Results ESDP was observed in 7 patients (7/98,7.14%) and defined as a space between the esophageal wall and the proximal part of stent without contrast agent obstruction within stent.The clinical situations of patients with ESDP included dysphagia,bucking and constantly chest pain,especially at foodintake.The results of Logistic regression analysis indicated radiotherapy (P=0.005) and the degree of upper obstruction segment expansion (P=0.017) were significantly correlated with ESDP.Conclusion ESDP is one of the complications after esophageal stent placement.It is prudent to implant esophageal stent for those patients with radiotherapy and significant upper obstruction segment expansion.

Objective To study the damage of liver function after transcatheter arterial chemoembolization (TACE) with low-dose versus conventional-dose anticancer drugs in patients with hepatocellular carcinoma (HCC). Methods One hundred and twelve patients with unresectable HCC were randomly divided into two groups (A and B) to receive superselective TACE. Low-dose anticancer drugs including mitomycin C (MMC) 2 ～ 8 mg, epirubicin (EPI) 5 ～ 10 mg and carboplatin (CBP) 100 mg were used in group A (n= 52), and conventional-dose of anticancer drugs (MMC 10 mg, EPI 40 mg and CBP 300 mg)for patients in group B(n= 60). Lipiodol-anticancer drugs emulsion was injected into the feeding arteries of tumor and then followed by embolization of gelatin sponge (GS) or polyvinyl alcohol (PVA) particles.Laboratory examination of the liver function including Child-Pugh scores, total bilirubin (TBIL), albumin (ALB) and alanine aminotransferase (ALT) were evaluated respectively before TACE and at third day, one week and four weeks after this procedure. Results In both groups, TBIL, ALT, and Child-Pugh scores increased (P ＜ 0.001 or P ＜ 0.05) and ALB decreased (P ＜ 0.001 or P ＜ 0.01) at three days and one week after TACE. Four weeks after-procedure, all the parameters described above showed no significant difference than those before the procedure in group A (P ＞ 0.05 ). On the contrary in group B, a significant difference (P ＜ 0.05) was found in the comparison of these parameters (except ALT). Conclusion Superselective TACE with low-dose anticancer drugs may induce transient impairment of liver function in the patients with HCC, but those patients used conventional-dose of anticancer drugs frequently cause lasting and more serious worsening of liver function.