PURPOSE: This study compared the clinical results of an ultrasound (US)-guided regional nerve block with those of general anesthesia in below-knee amputation (BKA) surgery. In addition, the 1-year mortality rate of BKA patients was evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level. MATERIALS AND METHODS: Among 47 patients who underwent BKA between January 2011 and August 2016, 18 patients in the US-guided regional nerve block group (group 1) and 29 patients in the general anesthesia group (group 2) were analyzed retrospectively and compared. For the clinical assessment, the 30-day mortality, 1-year mortality, postoperative hemoglobin level, and postoperative complications of both groups were investigated. The visual analogue scale (VAS) pain scores at postoperative 1, 6, and 12 hours for both groups were evaluated. The 1-year mortality of BKA patients was also evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level (hemoglobin < 7 g/dl). RESULTS: Significant differences in the 30-day mortality were observed between the two groups (p=0.023). Group 1 showed a higher 30-day mortality but the 1-year mortality was similar in both groups (p=0.051). The postoperative hemoglobin level was similar in the two groups (p=0.085). The VAS pain scores for the postoperative 1-hour and 6-hour differed significantly between the two groups (p < 0.001). The VAS pain scores for postoperative 12-hour showed no significant difference (p=0.10). The 1-year mortality rate of both groups was not affected by hypertension, diabetes mellitus, arteriosclerosis obliterans, and postoperative hemoglobin less than 7 g/dl, but was affected by chronic kidney disease (CKD) (Pearson's chi-square=14.39, p < 0.05). CONCLUSION: Although US-guided regional nerve block showed comparable 1-year mortality and postoperative hemoglobin levels compared to general anesthesia in BKA, it showed better results in postoperative 1, 6 hour pain control than general anesthesia. The 1-year mortality of BKA was affected by CKD. Therefore, careful consideration is needed for patients with CKD before undergoing BKA regardless of the anesthetic methods.
Amputation* ; Anesthesia, General ; Arteriosclerosis Obliterans ; Comorbidity ; Diabetes Mellitus ; Humans ; Hypertension ; Mortality ; Nerve Block* ; Postoperative Complications ; Renal Insufficiency, Chronic ; Retrospective Studies ; Ultrasonography

OBJECTIVETo explore the clinical screening and value of vertebral artery ultrasound, Transcranial doppler (TCD), Magnetic resonance angiography (MRA) and Computed tomography angiography (CTA) in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography (DSA).

METHODSFrom January 2006 to September 2010, 186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients, 133 cases were males and 53 cases were females,ranged from 30 to 84 years (with a mean of 63.8 years). All the patients were estimated by DSA; 172 cases were estimated vertebral artery ultrasound and TCD; 53 cases were estimated by MRA; 25 cases were estimated by CTA. The positive results by DSA were seen as case group, while the negative results were seen as control group. The sensitivity, specificity and concordance rate among four groups were calculated.

RESULTSThe abnormality rate of vertebral artery with DSA, vertebral artery ultrasound, TCD, MRA and CTA separately was 50.00% (93/186), 30.81% (53/172), 49.42% (85/172),15.10% (8/53) and 40.00% (10/25). According to DSA standard, the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%, the specificity was 89.41%, and concordance rate was 69.77%; while the sensitivity of TCD was 68.48%, the specificity was 72.50%, and concordance rate was 70.35%; the sensitivity of MRA was 21.43%, specificity was 92.00%, and concordance rate was 54.72%; the sensitivity of CTA was 63.64%,the specificity was 78.57%, and concordance rate was 72.00%.

CONCLUSIONThe reasonable and combined application of vertebral artery ultrasound, TCD, MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease, cervical massage technique should be paid highly attention, which may cause vertebral artery injury and other complications.

Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Arteriosclerosis ; diagnosis ; Cerebral Arteries ; diagnostic imaging ; Cerebrovascular Disorders ; diagnosis ; diagnostic imaging ; Female ; Humans ; Intracranial Arteriosclerosis ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Ultrasonography ; Vertebral Artery ; abnormalities ; diagnostic imaging

OBJECTIVE: To investigate the diagnostic value of transcranial Doppler ultrasound in early stage cerebral arteriosclerosis. METHODS: We selected 50 patients with early cerebral arteriosclerosis as the disease group. At the same time we selected another 50 patients as a control group with no significant symptoms in the nervous system. By 2 MHz pulse Doppler probe through double-temporal windows and pillow windows Basilar artery (BA), the bilateral middle cerebral artery (MCA) was detected. In the TCD spectrum, we selected the spectrum of a single-family cardiac cycle, identified the starting point (ts), pulse-incisure point (ti), end point (te), and the peak velocity (tp), measured the time of the spectrum starting point to the peak velocity (Tp) and calculated the time required for the peak velocity in the share of ventricular systolic (Tp/Ti), the time required for the peak velocity in the share of the whole cardiac cycle (Tp/T). Tp, Tp/Ti and Tp/T were respectively named as time to peak velocity (TPV), peak-time index-1 (PTI-1) and peak-time index-2 (PTI-2). All data were analyzed by SPSS13.0. RESULTS: There was no significant difference in blood vessel velocity, PI, RI and S/D of BA and RMCA (P>0.05) between the control group and the disease group. Compared with the control group, TPV of the BA, LMCA and RMCA significantly extended, PTI-1 and PTI-2 of BA, LMCA and RMCA increased significantly in the disease group (P<0.01). In the disease group, there was no significant correlation between peak time index and PI, S/D (P>0.05). CONCLUSION TPV, PTI-1 and PTI-2 are sensitive indicators of early stage cerebral arteriosclerosis.
Adult ; Basilar Artery ; diagnostic imaging ; Blood Flow Velocity ; physiology ; Case-Control Studies ; Female ; Humans ; Intracranial Arteriosclerosis ; diagnostic imaging ; Male ; Middle Aged ; Middle Cerebral Artery ; diagnostic imaging ; Ultrasonography, Doppler, Transcranial

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.
Arteries ; Arteriosclerosis ; Follow-Up Studies ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Transplants ; Tunica Intima ; Ultrasonography, Doppler

OBJECTIVETo observe the effect of Tongmai Recipe (TMR) on atherosclerosis (AS) in patients with early lower extremity arteriopathy disease (LEAD) caused by type 2 diabetes mellitus (T2DM).

METHODSPatients were randomly assigned to two groups. The 23 patients in the treatment group were treated by TMR and the 22 in the control group were given Cilostazo, all for 3 months. Before and after treatment, lower extremity vascular color Doppler image, blood levels of glucose, insulin, serum matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6) were measured.

RESULTSThe thickness of AS plaque and that of arterial intima-media obviously reduced (P < 0.01 and P < 0.05), insulin sensitivity improved noticeably (P < 0.01), and serum levels of MMP-9 and IL-6 lowered obviously (P < 0.05) in the treatment group after treatment, but these indexes were unchanged in the control group statistically.

CONCLUSIONTMR has remarkable action in reducing the thickness of AS plaque and intima-media of artery, its mechanism might be related with improving of insulin sensitivity and anti-inflammatory reaction, and reducing of serum MMP-9 level as well in patients.

Adult ; Aged ; Arteriosclerosis ; diagnostic imaging ; drug therapy ; etiology ; Diabetes Mellitus, Type 2 ; complications ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Insulin Resistance ; Interleukin-6 ; blood ; Lower Extremity ; blood supply ; Male ; Matrix Metalloproteinase 9 ; blood ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Tibial Arteries ; diagnostic imaging ; pathology ; Ultrasonography

OBJECTIVETo observe the effect and safety of Shuxuetong Injection (SXT) in treating patients with type 2 diabetes mellitus accompanying lower extremity atherosclerotic obliterans.

METHODSThe selected patients were assigned by randomized digital table to the treated group (180 cases treated with SXT) and the control group (80 cases treated with alprostadil). The clinical efficacy was assessed after 4 weeks of treatment, and the inner diameters and blood flow of the superficial femoral artery, the posterior tibial artery and the foot dorsal artery were measured and compared before and after treatment using Doppler's ultrasonography.

RESULTSThe total effective rate in the treated group was 94.4% (170/180), better than that in the control group, 85.0% (68/80, P < 0.01). Ultrasonic examination showed that the inner diameter and the blood flow of all the arteries measured in the treated groups increased after treatment (P < 0.01), with the increase superior to those in the control group (P < 0.05). No adverse reaction was found during the treatment.

CONCLUSIONSXT has the effect of activating blood circulation, dissolving stasis and dredging collaterals, it could reduce or eliminate the formation of thrombi, being effective and safe when applied in clinical practice for the treatment of lower extremity diabetic atherosclerotic obliterans.

Adult ; Aged ; Arteriosclerosis Obliterans ; drug therapy ; etiology ; Diabetes Mellitus, Type 2 ; complications ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Infusions, Intravenous ; Lower Extremity ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Phytotherapy ; Ultrasonography

We performed real-time 3D echocardiography in sixteen sheep to compare acute geometric changes in the mitral annulus after left anterior descending coronary artery (LAD, n=8) ligation and those after left circumflex coronary artery (LCX, n=8) ligation. The mitral regurgitation (MR) was quantified by regurgitant volume (RV) using the proximal isovelocity surface area method. The mitral annulus was reconstructed through the hinge points of the annulus traced on 9 rotational apical planes (angle increment=20 degrees). Mitral annular area (MAA) and the ratio of antero-posterior (AP) to commissure-commissure (CC) dimension of the annulus were calculated. Non-planar angle (NPA) representing non-planarity of the annulus was measured. After LCX occlusion, there were significant increases of the MAA during both early and late systole (p<0.01) with significant MR (RV: 30+/-14 mL), while there was neither a significant increase of MAA, nor a significant MR (RV: 4+/-5 mL) after LAD occlusion. AP/CC ratio (p<0.01) and NPA (p<0.01) also significantly increased after LCX occlusion during both early and late systole. The mitral annulus was significantly enlarged in the antero-posterior direction with significant decrease of non-planarity compared to LAD occlusion immediately after LCX occlusion.
Sheep ; Mitral Valve/*pathology/*ultrasonography ; Ligation ; Image Processing, Computer-Assisted ; Echocardiography, Three-Dimensional ; Coronary Vessels/*pathology/*ultrasonography ; Coronary Arteriosclerosis/pathology/ultrasonography ; Animals

BACKGROUND: Atherosclerosis of intracranial vessels may progress or regress, however, the natural course of middle cerebral artery (MCA) stenosis has not been known well. Using Transcranial Doppler ultrasonography, we attempt to reveal the frequency and the associated factors about progression or regression of MCA stenosis. METHODS: Among patients with MCA stenosis on MRA (>50% narrowing), objects with repeated TCD examinations (interval >6 months) were included. Mean flow velocity (MFV) changes over than 30 cm/sec were used as criteria for progression, stationary or regression of MCA stenosis. Demographic data, risk factors, and medications were assessed to identify predictors of progression or regression. RESULTS: Eighty-one MCA segments were analyzed (36 males, mean age 64 years). Mean follow-up period was 614 days (210~1457 days). Progression and regression were detected in 18.5% and 14.8%. With multivariate regression analysis, no clinical profiles, risk factors, medications were associated with progression or regression of MCA stenosis. CONCLUSIONS: With long term follow up, progression and regression of MCA stenosis is not uncommon, which means the intracranial atherosclerosis is a dynamic process. TCD seems to be useful in detecting progression or regression of MCA stenosis with optimal criteria. Predicting factors for progression and regression remain to be determined by further prospective, well-designed studies.
Atherosclerosis ; Constriction, Pathologic* ; Follow-Up Studies* ; Humans ; Intracranial Arteriosclerosis ; Male ; Middle Cerebral Artery* ; Risk Factors ; Ultrasonography, Doppler, Transcranial*

OBJECTIVE: To investigate the relationship between microalbuminuria and endothelial-dependent relaxing function and atherosclerosis of common carotid artery (CCA) in aged patients with essential hypertension (EH). METHODS: Sixty-four aged EH patients were recruited. According to the albumin excretion rate (AER) in the urine measured by immunoturbidimetry, patients were divided into 2 groups: normoalbuminuria group (NAU group) and microalbuminuria group (MAU group). Thirty aged persons without EH were served as the control group. The endothelium-dependent relaxing function of blood vessels, intima-media thickness (IMT) and the plaque of CCA were measured by color Doppler ultrasound. RESULTS: The flow-mediated dilation in the MAU group [(4.98+/-1.35)%] and that in the NAU group [(6.31+/-1.14)%] were significantly lower than that in the control group [(9.09+/-1.83)%, P<0.05, respectively], especially lower in the MAU group. The IMT of CCA in the MAU group [(0.97+/-0.19)mm] and that in the NAU group [(0.86+/-0.10)mm] were significantly thicker than that in the control group [(0.78+/-0.13)mm] (P<0.05, respectively), especially thicker in the MAU group. The analysis of multiple stepwise regression showed that the microalbuminuria was successively related to EDF, the IMT of CCA, the plaque index of CCA, systolic blood pressure, etc. CONCLUSION EDF is impaired, and there is the atherosclerosis of CCA in aged patients with EH. Microalbuminuria correlates with the decrease of endothelium-dependent relaxing function and the IMT of CCA in aged patients with EH.
Aged ; Aged, 80 and over ; Albuminuria ; etiology ; Arteriosclerosis ; complications ; diagnostic imaging ; Carotid Artery, Common ; diagnostic imaging ; Endothelial Cells ; physiology ; Female ; Humans ; Hypertension ; complications ; urine ; Male ; Middle Aged ; Ultrasonography

OBJECTIVETo explore the association of hypertension and carotid atherosclerosis in a general population in China.

METHODSA population-based epidemiological survey on cardiovascular diseases was performed in autumn, 2002. A total of 1198 rural residents with 426 men and 776 women aged 43 - 73 years, underwent carotid duplex examination. Hypertension was classified into 6 groups of optimal, normal, high-normal, stage 1, 2 and 3.

RESULTS(1) A significant positive dose-response relation was found between hypertension categories, duration of hypertension and intima-media thickness (IMT) in both genders (trend test P < 0.01). After adjustment of age, body mass index, total cholesterol, high density lipoprotein cholesterol, glucose and smoking, the relation did not change. The associations between duration of hypertension and IMT disappeared after further adjustment with blood pressure. (2) The occurrence of plaque was positively associated with blood pressure groups and duration of hypertension, as well as in the age-adjusted models. The associations between duration of hypertension and plaque weakened or disappeared after further adjustment with systolic blood pressure, diastolic blood pressure or hypertension categories.

CONCLUSIONHypertension was associated with subclinical carotid atherosclerosis. Prolonged course of disease might aggravate the carotid atherosclerosis.

Adult ; Aged ; Arteriosclerosis ; complications ; diagnostic imaging ; epidemiology ; Carotid Stenosis ; diagnostic imaging ; epidemiology ; etiology ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Humans ; Hypertension ; classification ; complications ; epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Rural Health ; Ultrasonography