OBJECTIVETo discuss the change of blood supply pattern in visceral arteries of Stanford B dissection. The visceral arteries include celiac trunk (CA), superior mesenteric artery (SMA) and renal artery (RA).

METHODSBy retrospectively analysing the clinical data of 52 cases with Stanford B dissection, the blood supply pattern of visceral arteries was confirmed by aortography and the changes before and after endovascular repair were compared.

RESULTSAfter repair: the stenosis lesions disappeared in 7 cases supported by true channel completely but one. Twenty-two visceral arteries supported by true and false channel simultaneously recovered true channel chiefly but one. One recovered true channel chiefly and one had no change in 2 visceral arteries supported by false channel completely. Four recovered true channel chiefly and one had no change in 5 visceral arteries without blood support. 88.9% blood support got better and 11.1% blood support had no change in 36 damaged visceral arteries after endovascular repair.

CONCLUSIONBlood support from true and false channel simultaneously is the chief pattern in the injured visceral arteries before repair; Endovascular repair technique is benefit to recovering the blood support of true channel.

Adult ; Aged ; Aneurysm, Dissecting ; physiopathology ; surgery ; Aortic Aneurysm ; physiopathology ; surgery ; Celiac Artery ; physiopathology ; Female ; Humans ; Male ; Mesenteric Artery, Superior ; physiopathology ; Middle Aged ; Regional Blood Flow ; Renal Artery ; physiopathology ; Retrospective Studies

OBJECTIVETo explore the therapeutic effect of interleukin-11 (IL-11) on high-dose methotrexate (HDMTX) induced mucositis in Wistar's rats, the proliferative effect on CEM leukemia cell line and the antitumor effect on HDMTX.

METHODSNinety-five 5-week old, 120 - 150 grams weight Wistar rats were randomly divided into five groups. Group A is normal control (n = 15), group B MTX control (n = 20), group C IL-11 pretreatment group before MTX injection (n = 20), group D (n = 20) the high dose IL-11 group (475 microg.kg(-1).d(-1)) after MTX injection, group E (n = 20) the low dose IL-11 group (150 microg.kg(-1).d(-1)) after MTX injection. All rats in group B approximately E were given 1 ml MTX intraperitoneally (100 mg/kg). Rats were killed at day 1, 3, 5, 7 after MTX injection. The mortality rates, changes of small intestine tissue morphology and ultra structure were observed. The proliferation of small intestine crypt cell was assayed by proliferating cell nuclear antigen (PCNA) immunohistochemical staining. MTT method was used to detect the proliferation of CEM cell line.

RESULTIL-11 treatment resulted in a significant increase of survival of HDMTX treated rats, increased of small intestinal villus length and villus/crypt ratio. IL-11 administration was associated with enhancement of small intestine mucosa recovery after HDMTX therapy. Group C showed a greater effect than group B (P < 0.01). IL-11 had no effect on CEM cell proliferation.

CONCLUSIONIL-11 has a significant mitigating effect on high-dose MTX induced intestinal mucositis in rat, and significantly increase the survival of the rats. IL-11 could be safely used in the HDMTX treatment of childhood acute lymphocyte leukemia.

Animals ; Antimetabolites, Antineoplastic ; toxicity ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cell Survival ; drug effects ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Female ; Humans ; Immunohistochemistry ; Interleukin-11 ; pharmacology ; therapeutic use ; Intestinal Mucosa ; drug effects ; pathology ; ultrastructure ; Intestine, Small ; drug effects ; metabolism ; pathology ; Male ; Methotrexate ; toxicity ; Microscopy, Electron ; Mucositis ; chemically induced ; mortality ; prevention & control ; Proliferating Cell Nuclear Antigen ; analysis ; Random Allocation ; Rats ; Rats, Wistar ; Survival Rate

Objective To present the experience and advantage of cooperation management by head and neck surgery and neurosurgery for communicating skull base tumors. Methods A review of 54 communicating skull base tumors (benign tumor 21, malignant tumor 33) cooperation resection by head and neck surgery and neurosurgery from July 2005 to July 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences was presented. The tumor originated in the anterior skull base in 19 cases, originated in the lateral skull base in 12, in the central skull base in 17, and in the posterior skull base in 6. Results All procedures were conducted in a single stage by a muhidisciplinary team. Total resection of tumor was achieved in 45 cases, and subtotal resection was achieved in 9. There was no operative death. There were 2 cases postoperative hemorrhage. All cases except 3 were followed up with a period of 8 to 43 months (median, 19. 1 months for benign tumor and 21.0 months for malignant tumor). Three patients with malignant tumor were lost. Twelve cases of malignant tumor and one case of benign tumor recurred postoperatively. Nine patients with malignant tumor had died( one of these died from heart trouble). Three-year disease-free survival rates and overall survival rates of malignant tumor were 52. 7% and 53.0%, respectively. Conclusions It suggested that a special operative team constituted of head and neck surgeon and neurosurgeon may improve the outcome of the difficult skull base tumors.

OBJECTIVETo discuss the safety, feasibility, efficacy and problem of endovascular repair (EVR) for ruptured aortic aneurysm (RAA).

METHODSFourteen patients with RAA were obtained diagnosis and anatomic data of proximal and distal neck through magnetic resonance imaging and CT. The patients with hypotension were accepted anti-shock treatment. Stent-grafts were deployed in proper position of RAA under X-ray fluoroscopic.

RESULTSThe time from rupture to operation was 50 min to 21 d. Three cases had plenty of blood in left pleural cavity and 2 cases were done under bleeding shock condition. Five cases with RAA were fixed by bifurcated stent-grafts and others by straight stent-grafts. Follow-up term was 1 month to 38 months. One with ruptured thoracic aortic aneurysm died 4 h later after operation, another one died of left thoracic cavity infection 9 months later, and others lived well without complication.

CONCLUSIONThe EVR is a safe, efficient and feasible method. It will be a potential alternative to treat RAA in future, but more suitable for RAA with better proximal and distal landing zones.

Adult ; Aged ; Aortic Rupture ; diagnosis ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection.

METHODSFrom June, 1998 to Dec, 2004, 178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases, 19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen, visceral and limbs blood supply were investigated after operation.

RESULTS10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass. 36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6 +/- 23.7) mm Hg. The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication. The average operation time 1.5 h (0.5-4.3 h), blood loss 140 ml (30-500 ml), movement recover time 1.8 d (0.5-21.0 d), food recover time 1.5 d (0.5-9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months, the endoleak rate was 6.4% one month later.

CONCLUSIONThe endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; methods ; Catheterization, Peripheral ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the treatments of left subclavian artery (LSA) in endovascular repair (EVR) of thoracic aortic aneurysm (TAA) and thoracic aortic dissection (TAD).

METHODSIn 54 TAD or TAA cases, all of the proximal landing zone (PLZ) were less than 15 mm and only the LSA was needed to be treated in EVR, the following methods and techniques were used in the treatments of LSA: complete cover, partial cover, endovascular reconstruction following complete cover, surgical reconstruction before complete cover.

RESULTSDSA was used to evaluate the condition of cerebral circulation in all cases. Forty left subclavian arteries were covered completely. Ten were covered completely after right subclavian artery (RSA)-LSA or left common carotid artery (LCCA)-LSA bypass. PTA and stent in LSA was done in 3 cases. In 1 case, LSA was covered completely first, and then the graft was punctured and bare stent was fixed after inflation by cutting balloon. All of the ancillary techniques were enforced successfully. No severe complications were found in brain and upper extremity. The proximal endoleak rate was 17% (9/54). In the 40 cases whose LSA were not reconstructed, the primary left subclavian steal syndrome (LSSS) happened in 8 cases (20%) and the primary average systolic pressure of left brachial artery was 63 +/- 24 mm Hg.

CONCLUSIONSEVR can be enforced safely and efficiently in TAA and TAD with short PLZ by some ancillary endovascular or surgical techniques. The methods to treat the LSA depend on the condition of the cerebral circulation.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Subclavian Artery ; surgery

Adolescent ; Adult ; Angiography ; methods ; Constriction, Pathologic ; Hematuria ; diagnostic imaging ; Humans ; Male ; Mesenteric Artery, Superior ; diagnostic imaging ; Renal Veins ; diagnostic imaging ; Syndrome ; Tomography, Spiral Computed ; methods

OBJECTIVETo clarify the anatomical relationship of the structures in the first toe webbing space for better dissection of toes in thumb reconstruction.

METHODSThe first dorsal metatarsal artery, the first deep transverse metatarsal ligament and the extensor expansion were observed on 42 adult cadaveric lower extremities. Clinically the method of tracing the first dorsal metatarsal artery around the space of the extensor expansion was used in 36 cases of thumb reconstruction.

RESULTSThe distal segments of the first dorsal metatarsal artery of Gilbert types I and II were located superficially to the extensor expansion. The harvesting time of a toe was shortened from 90 minutes to 50 minutes with 100% survival of reconstructed fingers.

CONCLUSIONSThe distal segment of the first dorsal metatarsal artery lies constantly at the superficial layer of the extensor expansion. Most of the first metatarsal arteries of Gilbert types I and II can be easily located via the combined sequential and reverse dissection around the space of the extensor expansion.

Adolescent ; Adult ; Child ; Dissection ; Finger Injuries ; surgery ; Humans ; Metatarsus ; anatomy & histology ; blood supply ; Reconstructive Surgical Procedures ; Thumb ; injuries ; surgery

OBJECTIVETo investigate tracheal mucociliary transport change after reconstructed with free jejunum.

METHODSTwelve canine models of extensive circumferential tracheal defects reconstructed with revascularized jejuno combined with Ni-Ti alloy mesh tube were established. Every canine model was marked in cervical skin projecting the lower resected margin of trachea lumen and was injected 50% barium sulfate mucilage as a tracer into the trachea lumen under bronchoscopy. Record the time from tracer injected into trachea lumen to its arriving glottis (mucociliary transit time, MTT) and the length from tracer injected into trachea lumen to glottis (mucociliary transport length, MTL). Mucociliary transit rate (MTR), as MTL/ MTT, was calculated. The same procedure was performed at preoperative and postoperative 7th day, 1 month, 3 months and 6 months.

RESULTSThere were statistical significance between preoperative MTR and 1 month postoperative MTR (P < 0.05). There were no differences between preoperative MTR and postoperative MTR at the 7th day, 1 month, 3 months and 6 months. There were also no differences between postoperative MTR at the 7th day and 1 month, 3 months and 6 months.

CONCLUSIONIn new tracheal tract reconstructed with free jejunum, MTR becomes normal at 3 months postoperatively.

Animals ; Dogs ; Female ; Jejunum ; transplantation ; Male ; Mucociliary Clearance ; Reconstructive Surgical Procedures ; methods ; Trachea ; physiopathology ; surgery ; Transplantation, Autologous

Objective To investigate the effects of DL-3-n-Butylphthalide(NBP)on proliferation and apoptosis of 1-methyl-4-phenyl-pyridinium (MPP +)-induced SH-SY5Y cells, and mechanisms via mixed lineage kinase 3 (MLK3) signaling pathway. Methods The SH-SY5Y cells were divided into control group,MPP+group,NBP group and URMC-099 group,that cultured normally,with 1 mmol/L MPP+for 24 hours,with 10μmol/L NBP for 3 hours and then with MPP+for 24 hours,and with 200 nmol/L MLK3 inhibitor URMC-099 for 3 hours and then with MPP+for 24 hours,respectively.The morphology of SH-SY5Y cells was observed under inverted phase contrast mi-croscope and the survival rate was measured with 3-(4,5-Cimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assays.The apoptosis was quantified under flow cytometry with Annexin V/PI fluorescence staining,and the nuclear morphology was observed with Hoechst 33342 staining.The expression of phosphorylated protein of MLK3(p-MLK3),c-Jun N-terminal kinase(p-JNK),extra cellular regulated protein ki-nases(p-ERK1/2)were detected with Western blotting.Results Compared with the control group,the survival rate reduced and apoptosis in-creased in MPP+group(P<0.05),with the increase of p-MLK3 and p-JNK and decrease of p-ERK1/2 d(P<0.05).Compared with MPP+group,the survival rate increased and apoptosis reduced in both NBP and URMC-099 groups(P<0.05),with the decrease of p-MLK3 and p-JNK and increase of p-ERK1/2(P<0.05).Conclusion NBP can decrease the apoptosis and promote the proliferation of SH-SY5Y cells in-duced by MPP+,which may be associated with inhibiting MLK3 signaling pathway,and regulating the downstream p-JNK and p-ERK1/2.