To investigate the contents and distribution of matrix metallproteinases(MMP) in abdominal aortic aneurysm(AAA) on protein level, forty male Wistar rats were randomly divided into two groups, the rats of experimental group were perfused with pancreatic elastase in the isolated abdominal aorta to construct the model of AAA. Laparotomy was preformed on the 14th day after operation, the aortas were measured and harvested. The rats of control group were operated with the aortas harvested immediately. Immunohistochemical staining and computer image analysis were performed to analyze the contents and distribution of MMP 2 and MMP 9. The aortic diameter progressed to aneurysmal dimension in the experimental group. Immunohistochemistry study revealed that the MMP contents in AAA exceeded that in normal aorta obviously. The MMP 2 cotents in AAA tunica media were higher than MMP 9. It is suggested that MMP 2 plays the main role in extracellular matrix degradation of AAA tunica media.

To investigate the prevention and management of postoperative complications of lower extremity amputation for arterial occlusive diseases, a retrospective analysis was made in 18 lower extremity amputations which were performed on 14 patients from Jan 1996 to Dec 1999. The mean age of the patients was 72. Before opeoation,78 6% of the patients were complicated with coronary artery disease, 69.9% with high blood pressure and 78.6% with diabetes mellitus, 43.4% with vascular reconstruction history. 6 above the knee amputations, 7 below the knee amputations, 1 hemiterpene amputation and 4 amputations of the toes were performed. Postoperative myocardial infarction occarred in 2 cases, gangrene of the stump in 3 cases and infection in 1 case, the total incidence rate of complication was 33%. The results showed that lower extremity amputation is not a complex operation, but preoperative estimation of the level of amputation and postoperative intensive care can reduce the postoperative rate of complication.

Colonic ischemia is a well documented complication of abdominal aortic reconstruction. In this retrospective study of abdominal aortic aneurysm patients undergone endovascular graft exclusion, the incidence and management of this complication were investigated. From Mar 1997 to Apr 2000,among the 40 patients who received elective endovascular graft exclusion for,infrarenal abdominal aortic aneurysm the bilateral hypogastric artery was retained in 30 patients, the unilateral hyogastric artery was retained in 10 patients. One patient had lower abdominal pain on the 28th day after operation, CTA showed the bilateral hypogastric artery occlusion, the symptoms were relieved after drug treatment. Retaining unilateral hypogastric artery can prevent the colonic ischemia after endovascular graft exclusion for abdominal aortic aneurysm, the chronic colonic ischemia secondary to bilateral hypogastric artery occlusion can be relieved by effective drug treatment.

To investigate the diagnosis and treatment of Stanford B thoracic aortic dissection eomplicated with renal ischemia, 29 cases of Stanford B thoracic aortic dissection admitted from January 1996 to April 2000 were retrospectively studied. Three of them had renal ischemia secondary to aortic dissection (2 acute,1 chronic). One patient in acute stage died 3 days after onset, the other patient in acute stage complicated with bilateral lower extremity ischemia was treated with fenestration of intimal flap, and the symptom was relieved. The patient in chronic stage was treated with endovascular graft exclusion for aortic dissection and the renal ischemia was relieved because of the restored true lumen blood. The results showed that palliative bypass helps relieve symptoms and improve survival rate. For the chronic aortic dissection complicated with renal ischemia, endovascular graft exclusion can restore the true lumen blood and relieve renal ischemia.

This paper reviewed the development of vascular surgery in diagnosis and treatment in recent years,the concepts and specialty of Duplex scan,MRA, CTA were discussed,the progress and problems of traditional revascularization and endovascualr technique were analyzed.

To investigate the relationship between the diameter of abdominal aortic aneurysm(AAA) and the concentration of elastin, forty five healthy male Wistar rats were selected,5 rats of them were used as normal control, the other 40 rats were randomly divided into 2 groups. A 1 cm segment of the abdominal aorta of the rat was isolated and perfused with pancreatic elastase in the experimental group, and the control group was given normal saline solution. Laparotomy was performed immediately after operation and on the 2, 7, 14 day, the aortas were measured and harvested. Histological studies were carried out to analyze the changes in elastin. The aortic diameter progressed to aneurysmal dimension in the experimental group. Histological study revealed loss of elastin in tunica media of the aorta in the experimental group. Neither macroscopic nor microscopic lesions were found in control group. It is suggested that there is a significant correlation between the aortic diameter and the decreased elastin content.

Objective To evaluate the surgical approach of endovascuar exclusion for thoracic dissection.Methods Thirty-seven cases of Stanford B type thoracic aortic dissection were undergone endovascular exclusion (EVE) and had been studied retrospectively. Preoperative evaluations for delivery arteries, including common femoral artery, iliac artery, and abdominal aorta, were earried out by using duplex ultrasonography (US), computed tomographic angiography (CTA) and magnetic resonance angiography(MRA). Factors such as arterial calibers, stenosis, tortuosity, sclerotic plaque and media dissection were taken into account. Choices of surgical approach were decided after comprehensive consideration of these factors. If the common femoral artery inner diameter was wider than 8 mm, without severe iliac artery stenosis or tortuosity; the common femoral artery should be selected as the delivery artery. In case of severe arterial stenosis and tortuosities, then the common iliac arteries were exposed by retroperitonial approach and graft was delivered through this artery. Results Mural sclerotic plaques were more sensitive to be revealed by US, conversely with CTA and MRA in showing stenosis and tortuosity directly and clearly. Utilizing this preoperative evaluating system, all the grafts passed successfully and favourably through the arteries, without any delivery artery associated complications.Conclusions Using US, CTA and MRA in combination was necessary for preoperative evaluation of the delivery artery. In those with poor femoral artery condition, exposing common iliac artery decidedly is necessary to ensure the procedure favorably and to avoid delivery artery associated complications.

Problem-based learning is a student-centered teaching mode,which is based on creating question circumstances.In our clinical teaching,we put up questions based on real cases and inspire students'enthusiasm,activity and creativity.The results show the PBL can elevate students' clinical ability and also can promote teachers'capability.

OBJECTIVETo investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.

METHODSFrom March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.

RESULTSThe average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.

CONCLUSIONWhen treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

Adult ; Chronic Disease ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Reconstructive Surgical Procedures ; methods

Objective To evaluate the clinical results of femoral-deep femoral crossover bypass in the treatment of long-segment unilateral iliac artery occlusive disease.Methods From July 1995 to December 2010,40 patients (28 males,12 females,aged from 66 to 90,with mean age of 73) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were enrolled in this procedure.All patients suffered from unilateral common iliac,external iliac,common femoral,and superficial femoral arteriosclerosis obliterans.These patients were treated with femoral-deep femoral crossover bypass.Postoperative ankle-brachial index,blood flow velocity and patency rates in 5,7 and 10 years and limb salvage rates in 5,7 and 10 years were evaluated.Results There was no perioperative mortality nor extremity amputation.35 (87.5％ ) patients were followed-up from 1 to 13 years (mean 5.7 y).Anklebrachial index rose from preoperative 0.23 ± 0.10 to postoperative 0.55 ± 0.11 (t =15.91,P =0.000 ).Popliteal arterial velocity rose from preoperative ( 14 ±6) cm/s to postoperative (34 ± 10) cm/s (t =15.63,P =0.000) ; Tibial arterial velocity rose from ( 10 ±4) cm/s to (22 ±7) cm/s (t =15.71,P =0.000).The primary and secondary patency rates were 60.1％,44.3％,25.3％,and 93.5％,86.8％,57.9％ at 5,7 and 10 years,respectively.Limb salvage rates were 97.5％,95％,and 90％,at 5,7 and 10 years,respectively.Conclusions Femoral-deep femoral crossover bypass is safe and reliable in treating certain unilateral iliofemoral occlusive disease,especially for high-risk old patients or those who are not indicated for endovascular therapies or direct aortic approaches.