Percutaneous vertebroplasty (PVP) is a relative new interventional technique, which is widely used in treatment of vertebral collapse caused by vertebral neoplasms and osteoporotic compression fractures. The general technical considerations of PVP techniques are discussed based on authors' experience obtained over 400 patients in the past years in this article, including preparation of PMMA, instrument of PVP, guidance and puncture approaches, and technique of the procedure, etc. The conclusion is that PVP is a safe procedure if the physicians handle it properly.

Objective To evaluate the efficacy of percutaneous vertebroplasty(PVP) and endovascular chemotherapy and embolization for the treatment of vertebrae malignant tumors. Methods Twenty nine patients (male 16, female 13) had 40 vertebrae malignant tumors, including 28 patients with 37 vertebrae metastases and 1 patient with multiple myeloma involving 3 vertebrae. The primary foci were esophageal cancer, lung cancer, colon carcinoma, hepatic cancer, stomach cancer, breast cancer, kidney cancer and 2 of unknown. All the patients showed moderate or severe thoracic and lumbar pain with 2 patients of spinal cord dysfunction. Eighteen cases with 26 vertebrae were performed PVP only, 11 cases with 16 vertebrae were undergone endovascular chemotherapy and/or embolization. Results After treatment among 29 patients, 16 had CR(55.1%), 12 had PR(41.4%), 1 was unsuccessful with PVP but pain was relieved by endovascular therapy. No complication occurred.Conclusions PVP and PVP combined with endovascular therapy may have an excellent efficacy for vertebral malignant tumors, with relief of pain obviously and prolong the patient's life.

Objective To explore the feasibility of using rotating pliers system for treating lumbar disc herniation with concomitant prolapse.Methods Ex vivo incision experiment was performed on 8 lumbar discs of 2 pigs using rotating pliers. Clinical application included 12 patients of lumbar disc herniation shown by CT or MRI. 40% herniations excerted enough pressure on dural sac with concomitant prolapse of different degrees. The symptoms and image findings were concordant. The herniated nucleus pulposus were resected using rotaing pliers system, MacNab standard was applied for the clinical evaluation. Results The ex vivo experiments and clinical application were successful. Clinical application showed CR in 4 patients (33.3%), PR in 5 patients (41.7%) and NR in 3 patients (25.0%). CT demonstrated the herniated disk tissue retraction of different degrees in CR and PR patients, together with decrease in CT attenuation number, ranging from 8 30 HU, 18?5HU in average but no changes in NR patients.Conclusions Percutaneous lumbar diskectomy is safe and effective to treat lumbar disc herniation with concomitant prolapse by using rotating pliers systems and thus extending the PLD application.

Objective To assess the long-term outcomes as well as the living quality of the patients with lumbar disc herniation (LDH) after the treatment of percutaneous lumbar discectomy (PLD), and to discuss the influential factors related to the long-term effectiveness. Methods During the period of January 2000 to March 2002, PLD was performed in 129 patients with LDH. By using self-evaluation questionnaires of Oswestry disability index (ODI), Short Form-36 (SF-36) and Japanese Orthopaedic Association (JOA) through letter or telephone interviews as well as the patients' initial medical records, the related clinical data were collected. Statistical analysis was conducted by using Wilcoxon's rank sum test, Chi-square test. Results One hundred and eight patients (83.7%) were able to be followed up and 104 effective ques-tionnaires were collected. The mean follow-up time was (6.64 ± 0.67) years, the excellent rate (ODI score, 0 ～ 20%) was 71.15%. The average scores of the JOA and SF-36 was 23.66 ± 5.72 and 75.88 ± 25.57, respectively. The scores of quality of life were obviously improved in all follow-up subscales. Conventional operations were carried out subsequently in 9 patients as they failed to respond to PLD. No complications related to PLD occurred in this study. The age, course of the disease and the patient's condition at the time of discharge might bear a relationship to long-term effectiveness. Conclusion PLD is a safe and minimally-invasive technique for the treatment of LDH with quick and reliable effect, PLD can dramatically improve the quality of life. Many factors, such as the age, course of the disease and the patient's condition at the time of discharge, can affect the long-term outcomes.

Objective To assess the long-term outcomes as well as the living quality of the patients with lumbar disc herniation(LDH) after the treatment of percutaneous lumbar discectomy(PLD),and to discuss the influential factors related to the long-term effectiveness.Methods During the period of January 2000 to March 2002,PLD was performed in 129 patients with LDH.By using self-evaluation questionnaires of Oswestry disability index(ODI),Short Form-36(SF-36) and Japanese Orthopaedic Association(JOA) through letter or telephone interviews as well as the patients’ initial medical records,the related clinical data were collected.Statistical analysis was conducted by using Wilcoxon’s rank sum test,Chi-square test.Results One hundred and eight patients(83.7%) were able to be followed up and 104 effective ques-tionnaires were collected.The mean follow-up time was(6.64 ? 0.67) years,the excellent rate(ODI score,0 ～ 20%) was 71.15%.The average scores of the JOA and SF-36 was 23.66 ? 5.72 and 75.88 ? 25.57,respectively.The scores of quality of life were obviously improved in all follow-up subscales.Conventional operations were carried out subsequently in 9 patients as they failed to respond to PLD.No complications related to PLD occurred in this study.The age,course of the disease and the patient’s condition at the time of discharge might bear a relationship to long-term effectiveness.Conclusion PLD is a safe and minimally-invasive technique for the treatment of LDH with quick and reliable effect.PLD can dramatically improve the quality of life.Many factors,such as the age,course of the disease and the patient’s condition at the time of discharge,can affect the long-term outcomes.

Objective To explore the feasibility and value of treating esophageal thoracic fistula with covered esophageal stent through nasal esophagus drainage tube. Methods Seven patients with esophageal thoracic cavity fistula were enrolled and treated by 5F pigtail side-holes catheter inserting into thoracic cavity for drainage and then again through nasal esophagus and fistula, placing a covered stent in the esophagus to occlude the orifice of the fistula. The abscess cavities were washed and radiographied periodically through drainage tubes. Results The insertion of the drainage tube and the placement of covered stent were all successful. The drainage tubes were placed in abscess cavities for 12-22 days, average 15 days. The radiography through drainage tubes showed that the abscess cavities disappeared or shrank obviously with control of hydropneumothorax before the drainage tubes being pulled out. The esophagogram after withdrawal of the drainage tubes notified that the fistulae were occluded satisfactorily with stents expanded fully without displacement and stenosis. Conclusions Treating esophageal thoracic cavity fistula with covered esophageal stent through nasal esophagus drainage tube is feasible and safe with clinical efficiency.

A study of 10 cadavers and 100 CT scans of lumbar spine was performed to investigate the topographical anatomy of the posterolateral disc puncture in percutaneous lumbar discectomy.A way of the puncture at L_5-S_1 disc,with comparative plain films of lumbar spine in different positions were taken in 50 cases.The results showed that the pos- terolateral approach for percutaneous discectony was a safe way.However,it is important to have full knowledge of the regional topographical anatomy associated with the puncture tech- nique to avoid the potential neurovascular complications.The special position designed by authors for the puncture at L_5-S_1 disc is useful by lowering the position of iliac crest which hinders the entrance of needle,thus can raise the successful rate of the percutaneous discec- tomy 100% successful rate of the disc puncture at L_5-S_1 disc was obtained in 130 cases.The two puncture parameters of Chinese associated with percutaneous lumbar discectomy were first measured;and also the route including nearby structures,the complications were dis- cussed.

Objective To investigate the possible correlation between the monocyte chemoattractant protein-1 ( MCP-1 ) gene A-2518G single nucleotide polymorphism (SNPs) in the promoter region and acute coronary syndrome (ACS) in Chinese Han ethnic population of Sunan region,Methods This study was conducted with a case-control design in 484 ACS patients including 290 acute myocardial infarction (AMI)patients and 194 patients with unstable angina pectoris (UAP) and 346 control subjects ruled out coronary disease by coronary angiography (control group),including 166 patients with coronary atherosclerosis and 180 subjects without coronary stenosis.Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used for the detection of the A-2518G polymorphism in MCP-1 gene,and then thefrequency of genetype was statistically analyzed.Results There were AA,AG and GG genotypes of MCP-1 gene A-2518G polymorphism in the ACS group and control group.The two groups could be considered as a genetic equilibrium representative by Hardy-Weinberg equilibrium ( P ＞ 0.05 ).Compared with the control group,the frequencies of AA genotype ( 15.32％ vs.16.12％ ),AG genotype (53.47％ vs.51.86％ ),GG genotype (31.21％ vs.32.02％ ) and G allele genotype (57.95％ vs.57.95％ ) in ACS group were not significantly different ( P was 0.083,0.673,0.821 and 1.00,respectively).Multivariate logistic regression analysis indicated that there was no significant correlation between MCP-1 gene A-2518G polymorphism and ACS regardless of differences in gender,age,smoking,diabetes,TG and LDL-C ( P ＞0.05 ).There was no significant difference in gender and age of ACS onset between two groups ( P ＞ 0.05).There were no significant differences in the frequencies of AA,AG and GG genotypes and G allele genotype among AMI group,UAP group and normal coronary group ( P ＞ 0.05).Conclusions The data shows that MCP-1 gene A-2518G polymorphism is not associated with the risk of ACS in the Chinese Han ethnic population living in Sunan region.

Objective To investigate the trans-arterial delivery of p53 gene transfection efficiency and therapy effect on hepatic carcinoma in combination with transferrin mediated by liposome. Methods Twenty-five VX2 experimental rabbits were randomly divided into five groups, and the different doses of transferrin combined with p53-LipofectAMINE complex were delivered into the hepatic arteries of the VX2 hepatic carcinoma models. The tissue protein of the carcinoma was extracted after 48 h and the transfection efficiency and expression rate of p53 gene were analyzed by western blot and immune histochemical techniques, to inspect the expression proportion of p53 with different doses transferring. Another ten VX2 were divided into two groups, recombinant plasmid p53-LipofectAMINE complex and transferrin-p53-LipofectAMINE complex were delivered into the hepatic arteries in two groups respectively. The liver function, size of the tumor and survival time of the animals was compared between the two groups, and results were analyzed statistically. Results Semiquantitative analysis by Western Blot showed that the transfection and expression efficiency of p53 gene combined with transferrin were higher than those without it. By immune histochemieal techniques, the p53 gene's positive rate of highly expression with various doses of transferrin were found to be different, and there was remarkable difference between the groups with and without transferring. They were 58. 33%, 69. 44%, 80. 00%, 83.33%, 81.67% respectively, there was remarkable difference between the groups with and without transferring ( Totality: x2 = 42. 37, P < 0. 01 ). The p53 gene's positive rate of expression increased gradually as the doses of transferrin increasing from 0 up to 200 μg, but the differences of positive rate had no statistical significance as the doses of transferrin increasing from 200 up to 400 μg ( x2 section : 3 groups as former x2 = 4. 82, P < 0. 05,3 groups as latter x2 =0. 67 ,P <0. 05). There was no statistical difference in the liver function at points of time between VX2 rabbits with and without transferring. But the tumors' sizes had significant difference at various points of time. Conclusion Liposome-mediated p53 gene on treating hepatic carcinoma by trans-arterial gene delivery combined with transferrin is safe, and it can markedly enhance transfection efficiency and improve the therapy effect of p53 gene.

Objective To investigate the value of positron emisson tomography-computed tomography ( PET-CT) in monitoring the residual lesions in lipiodol sedimentary region and extrahepatic metastastic lesions of hepatocellular carcinoma ( HCC) with alpha fetoproteins ( AFP) positive after interventional therapy. Methods The data of 20 cases with primary HCC confirmed by histopathology were retrospectively analyzed. Their AFP levels decreased to normal range after interventional treatments, but rose to abnormal high level during following-up. After the abdominal routine imaging examinations, the definite diagnosis of the residual lesions in lipiodol sedimentary region or extrahepatic lesions can't be made confidently. All cases were scanned by PET-CT, and according to their PET-CT results, the further treatments were given and the therapeutic results were monitored with radiology and AFP tests. Results In all 20 cases, 10 of them were detected to have the extrahepatic metastastic lesions by PET-CT, including 4 with abdominal wall metastasis upon the liver, 3 with solitary pulmonary metastasis with diameter less than 1 cm, 2 with mesenteric mestastasis, 1 with mestastasis of operative incisions, but these lesions were neglected by abdominal routine imaging examinations. Eight cases showed the uneven lipiodol sedimentary region in the primary lesion by CT or MRI examination, but can't be diagnosed whether it was residual lesion with other examinations including DSA. A definite diagnosis was obtained by PET-CT. In 2 cases, lymph nodes less than 1. 5 cm were found in the hepatic portal area(PHA) and retroperitoneum on CT images,which was determined to be metastatic by PET-CT. All the detected lesions were given further treatments of surgery or interventional therapy. Most patients showed decreased AFP levels except the 2 patients with lymph node metastasis. The imaging examinations also indicated that the treatments had a good effect on lesions. Conclusion In the patients with HCC and abnormal high levels of AFP, in addition to abdominal routine imaging examinations, PET-CT is beneficial for those who is suspected of residual lesions in lipiodol sedimentary region or extrahepatic metastasis.