Objective To improve the knowledge for flow direction of renal spleen circulation in Budd Chiari syndrome and effects in treatment. Methods Two Budd Chiari syndrome patients with reno splenic venous shunt were treated by PTA, and the circulation directions were investigated. Results One case with hepatic vein occlusion showed the circulation from left renal spleen vein to IVC; another case with IVC stenosis proximal to heart showed the flow direction from spleen left renal vein to varices and finally to SVC. The circulation disappeared after treatment with PTA.Conclusions The direction of circulation in different types of Budd Chiari with portal hypertension may be different and should be identified clearly for a suitable management.

Background and purpose:Since the number and tumor size of localized liver metastases can be controlled, local minimally invasive treatment can improve the survival of patients. Hence, microwave ablation has become an important treatment method for liver metastases. This study was to investigate the value of percutaneous microwave ablation in the treatment of tumor metastases. Methods: From Sep. 2011 to Oct. 2014, 26 advanced nasopharyngeal carcinoma patients with post-chemotherapy consolidation, liver metastases were collected. All the patients with the number of tumor lesions less than 3, diameter less than 5 cm, no other distant metastases was excluded. The ultrasound-guided percutaneous microwave ablation was used for 26 patients. Finally, 43 ablations were completed followed by liver function test, enhanced CT and MRI diagnosis 1 month later. mRECIST criteria was used to evaluate the effcacy of cancer treatment. Progression-free survival (PFS) and overall survival (OS) were calculated. Results:Twenty-six cases of a total of 53 lesions, including complete ablation (CA) 20 patients (20/26, 77.0%), partial ablation (PA) 3 patients (3/26,11.5%). The overall effciency was 88.5%(CA+PA) with no serious complications. 6 months, 1-, 2-year survival rates of 26 patients were 96.1%, 65.3%and 23.0%. PFS was 11.4 months. The median survival time (MST) was 11.9 months, while OS was 23.7 months. Conclusion:Percutaneous microwave ablation for limited liver metastases of nasopharyngeal carcinoma is a minimally invasive, safe and effective treatment method.

Objective To discuss the clinical application of preoperative tumor-feeding artery emboli -zation in treating hypervascular giant meningiomas.Methods A total of 71 patients with giant meningioma (maximum diameter ＞5 cm),who were admitted to authors' hospital during the period from April 2013 to August 2014,were selected for this study.Preoperative MRI demonstrated that the lesions showed obvious enhancement with rich blood supply.The patients were divided into the study group (using preoperative embolization,n =38) and the control group (not using preoperative embolization,n =33).Based on preoperative DSA findings,the lesions were classified into type Ⅰ and type Ⅱ.Tumor-feeding artery embolization with PAV particles (200-300 μm) was employed in the patients of the study group,while only cerebral angiography was adopted in the patients of the control group.The amount of intraoperative blood loss,tumor resection time and embolization complications in both groups were recorded.Postoperative MRI scan was performed to observe the degree of tumor resection.Results The amount of intraoperative blood loss and the tumor resection time in the study group were (562±178) ml and (5.45±2.13) h respectively,which in the control group were (833±234) ml and (7.23±2.45) h respectively;the differences between the two groups were statistically significant (both P＜0.05).The tumor resection degree of Simpson classification Ⅲ and ＜ Ⅲ was obtained in 27 patients of the study group (27/38,71.0％) and in 19 patients of the control group (19/33,57.6％),the difference between the two groups was statistically significant (P＜0.05).After embolization,cerebral edema became aggravated in 7 patients,ischemic necrosis of the scalp was observed in 2 patients,and one patient developed epileptic seizure during the operation.After symptomatic treatment,all the above complications were relieved.Conclusion For the treatment of hypervascular giant meningiomas,preoperative tumor-feeding artery embolization can strikingly reduce the amount of intraoperative blood loss,shorten the operation time,and improve the tumor resection degree,therefore,this therapy is worthy of clinical promotion and application.