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 evaluate the significance of clinical grading methods in acute pulmonary embolism (APE). Methods Clinical data of 259 patients suspected APE were retrospectively analyzed. The clinical probability was classified into low, intermediate and high grade by the Geneva score, the Wells score and the SYSU score. The result was contrasted with gold standard. Results Through the three, methods, pa-tients were classified into low pmbability (43.9%-52.5%), intermediate probability (38.0%-42.1%) and high probability (9.5%-14.0%), and the actual frequencies of APE in each category were 6.2%-14.4% in low probability, 65.9%-76.2% in intermediate probability, 88.5%-90.5% in high probability. The SYSU score had the lowest rate of missed diagnosis in low probability (P<0.05 ).The Geneva score was the most accurate in predicting the intermediate probability (P<0.05). But in high probahility, three prediction rules had no significant difference (P>0.05). Combined with D--dimer test, the rote of missed diagnosis in low probability can be lowered. Conclusions The clinical grading methods can predict the clinical probability of APE. It exists similar accuracy, but has different scope of application. Clinical doctor should choose the ap-propriate grading methods in different patients.

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.

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.