Objective To explore the effect of clinical pathway on the safety in patient with intracranial aneurysms during the perioperative period. Methods A total of 68 patients with intracranial aneurysms who had been hospitalized and treated from July to December 2012 were assigned to a study group and received clinical pathway. And then they were compared with 56 patients who had been treated from January to June (control group). The patients in control group received routine medical care. Then all the patients were evaluated in preoperative waiting duration, incidence of postoperative complications, health education compliance rate, and the Glasgow outcome scale (GOS) at discharge. Results Both the incidence rate of cerebral vasospasm and hydrocephalus and the health education compliance rate were improved in the study group (P<0.05), so was the GOS at discharge and 6 months after discharge (P<0.05). Conclusions The clinical pathway management plays a role in guarantee of the safety in patient during the perioperative phase and in the acceleration of postoperative rehabilitation.

Purpose: To evaluate the feasibility of interventional biopsy, the component of stenotic tissues of shunt tract and mechanism of shunt stenosis. Materials and Methods: The pathologic specimens of stenotis shunt tract were obtained in 10 patients with catherization endovascular biopsy clamp and atherectomy methods, then they were undergone routinely with HE stain and immunocytochemical stain, and observed procedures under microscope. Rusults: all of interventional biopsy were succeeded without complication. The microscopies, findcarge of stenotic tissue were primarily composed of fibrotic granulations and thrombi with inflammatory cells and exuberant foam cells derived from endothelial cells, smooth muscle cells and rhagiocrine cells. Conclusion: 1)The interventional biopsy is a safe and effective method. 2)The stenosis in parenchymal tract is related to thrombosis and tissue orangnization.

Objective To investigate the clinical features,diagnosis and treatment of spontaneous rupture of renal angiomyolipoma (RAML). Methods A total of 23 cases of spontaneous rupture of renal angiomyolipoma were studied retrospectively.The main clinical manifestations were summarized as follows.Sudden and unexpected lumbar and abdominal pain occurred in 21 cases and lumbar swollen pain in 2.Of them 3 cases concomitantly had hematuria.Nausea and vomiting occurred in 2 cases,shock in 3 and fever in 1.All cases underwent B-ultrasonic examination and 21 had CT examination. Results Diagnosis of RAML was established preoperatively in 16 cases,but 4 cases were misdiagnosed for carcinoma of kidney,1 case for renal infectious disease.Two cases were diagnosed by frozen-section sample during operation.Nephrectomy was performed in 10 cases and nephron sparing nephrectomy in 12,and digital subtraction angiography (DSA) embolization in 1. Conclusions Spontaneously ruptured RAML often changes its clinical symptoms and imaging features,which may result in a high misdiagnosis rate and subsequent nephrectomy.Comprehensive analysis of clinical manifestations and image findings can improve preopreative diagnosis rate,and frozen slice sample examination during operation can avoid unnecessary nephrectomy.

Purpose:To evaluate the effect of metallic stent in the treatment of malignant stricture in esophagus and cardia.Materials and Methods:Treated by metallic stent:14patients with malignant stricture in esophagus and cardia,13 males and 1 female aged ranged from 57 to 81,were discussed in this article.Among 12 patients,8 were proved as esophageal squamous carcinoma,4 as esophagus adenocarcinoma,and 1 was complicated with esophagotrachial fistula,l0 of the pa- tients could take fluid food and 4 only water.After catheterizing from mouth,the strictured portions dilated with hallon catheter,15 selfmade Z stents coveted with dacron and 1 strecker stent were in 13 and 1 patients respectively.Results:All stems were successfully placed.Patients could eat more easily after the operations.The esophogotrachial fistula was completely sealed.The average lifetime after the operation was 5.5 months.Conclusions:Metallic stent prosthesis is an effective method to treat malignant stricture in esophagus and cardia,and could elevate the life quality of patients sig- nifieantly.

Purpose:To study the angiographic characteristics and mechanism of shunt stenosis-occlusiion after TIPSS.Materials and methods:Eighty-nine portal venograms were obtained in 58 patients.Venograms analysis had been performed according to shape,position and degree of shunt stenosis.Results:Thirty-six shunt abnormaloties were found in the portal venograms of 58 patients,Shunt stenosis(diameter

Objective To explore the changes in fractional anisotropy (FA) among cerebral infarction pa-tients using MR diffusion tensor imaging (DTI), and to verify the relationship between any FA changes and functional recovery. Methods Thirty-eight cerebral infarction patients were divided into two groups according to their recovery level using Brunnstrom's criteria. All the patients accepted routine MR and DTI examination, and FA values were measured during the acute, subacute and chronic stages of their recovery. Results Average FA values in the lesion area were significantly lower than in the corresponding contralateral area, and were highest daring the acute stage.There was no significant difference between the subacute and chronic stages. Conclusions The FA values of cere-bral infarction patients change during the different stages of recovery with a certain regularity. This may be valuable for clinical treatment and prognosis.

Purpose To investigate the significance of arterial phase display of right ovarian vein (ROV) for patients with pelvic congestion syndrome (PCS) through multi-slice CT angiography (MSCTA) Materials and Methods Forty-three patients with PCS confirmed clinically who underwent MSCTA were involved in the study. Revascularization was realized via add vessel volume rendering technique and maximum intensity projection (MIP) and the relationships among ROV early development, location of converging vascular, development of LOV and pelvic draining veins were analyzed. Results Out of 43 cases of ROV early development during arterial phase, 21 cases (48.8%) took ROV as draining vein of PCS, among which 17 cases (81.0%) converged into the inferior cava vena. In 19 cases (44.2%), ROV took part in the formation of PCS, all originating from the main right renal vein. Three cases (7.0%) were renal vein-derived PCS, among which two ROV originated from the main right renal vein and one from the branch of the right renal vein. Conclusion According to the imaging features of bilateral ovarian veins and pelvic veins, ROV, as draining veins, is associated with the formation of PCS.

Objective To evaluate effectiveness and safety of the transobturator tension-free vaginal tape technique (TVT-O) for the treatment of female stress urinary incontinence(SUI). Methods Twenty-six cases of SUI patients with average (52.6±6.3) years old were included. Mean course of disease was (9.2± 2.3) years. Two cases were type Ⅱ ,23 cases were type Ⅱ/Ⅲ,and 1 case was type ID. One case had history of pelvic operation procedure,2 cases accompanied by urgent urinary incontinence. All cases were undergone TVT-0 procedure. The methods of this procedure and the outcomes and complications were closely analyzed. Results The average operating duration was (18.0 ±2.3) min (15-20 min) and average blood loss was (20.0±3.4)ml (10-40 ml). Twenty-four cases (92.3%) were cured, 2 cases (7.7%) were improved, 2 cases (7.7% ) had dysuria, 1 case improved after prolonged indwelling of catheter, 1 case was recovery with urethral dilations. Four cases (15.4% ) suffered pain of thigh skin around the wound, and relieved by analgesia. One case (3.8%) complained of frequency of micturition, and improved by medicine. Twenty-six cases were followed up of 8-16 months with no recurrence. Conclusion TVT-0 for the treatment of SUI is a simple optimal and reliable method with less complications and eusemia.

Objective To evaluate the reliability of the panoramic radiographs for diagnosing mandibular asymmetry.Methods A total of 25 cases with no asymmetry in chief complaint or in appearance were selected for symmetry group.Pa and PAC from 16 cases of facial asymmetry were selected for asymmetric group.Marker points were fixed,a reference line and the reference plane drawn,and then relevant measurement items determined.The repeatability of the fixed position was observed.The difference of all measurement items between the left and right on Pa in symmetry group and asymmetric group were compared respectively and the asymmetric rate of corresponding measuredvalues on two sides between two groups were observed too.Correlation test was used to evaluate the measured-values on Pa and PAC in asymmetric group.Results Dispersion became smaller with the help of reference line and reference plane.And the dispersion was larger when Me was used as a marker other than MF.Most measured-values in symmetry group on Pa and all measured-values in asymmetric group on Pa showed statistically significant difference (P＜ 0.05).The mean difference of CP-GoP distance representing the vertical measured-value was 4.73 mm (P＜0.01); and the mean difference of GoP-MF distance representing the horizontal measured-value was 5.77 mm (P＜0.01).The horizontal measurements on PA and PAC showed closer correlation (r=0.78～0.85,P＜0.01) while the vertical was poorer (r=0.64,P＜0.01).Conclusions This study suggests that marking assisted with reference line and reference plane could get a more repeatable fixed-point on Pa.MF point could be used as a fixed-point for measuring mandibular asymmetry on Pa and the Pa measurement can be used to evaluate mandibular asymmetry.

Objective To investigate the value of MSCTA in diagnosing the origin of abdominal ectopic ovarian tumor. Methods Twenty-eight patients with 30 ectopic ovarian tumors that mainly manifested as abdominal lumps were evaluated with MSCTA retrospectively. Vascular three-dimensional reconstruction by VR based on add vessel (AV) and MIP was performed for all these patients after MSCT scanning.The origin of these tumors was judged by the feeding artery and ovarian vascular pedicle (OVP) sign.The result was compared with surgical findings.Results The maximum diameter of the 30 ectopic ovarian tumors ranged from 5.2 to 19.5 cm with an average of 9.3 cm.Of the 30 ectopic ovarian tumors, the ramus ovaricus arteriae uterinae (ROAU) and ovarian artery (OA) were demonstrated in 96.7% (29/30) and 56.7% (17/30) respectively.The feeding artery of the tumor was ROAU (29 cases) or OA (1 case), and OA participated in feeding the tumor in 16 cases.The accuracy rate of diagnosis of ectopic ovarian tumors according to the feeding artery was 100% (30/30).According to OVP the accuracy rate was 85.2% (23/27) with an incidence of 76.7% (23/30).Conclusion By showing ROAU and OA as the feeding artery and ovarian vein (OV) as the draining vein, MSCTA can accurately diagnose ectopic ovary tumors in the abdomen.