Purpose:To assess the security and efficacy of mechanical recanalization and stenting of lilac arteries with complete occlusions without preceding thrombolytic therapy. Materials and methods:During a 3-year period,Eighteen consecutive patients underwent mechanical reeanalization and stenting for complete occlusion of the iliac artery.The method involved recanalizition with a guide wire and a catheter advanced as a while unit through the occluded segment(snowplow technique).Results The occluded segments were successfully traversed and dilated and 32 stents were placed in 18 patients.The mean ankle-brachial index (BAI)increased from 0.39?0.33 before the procedure to 0.86?0.13 after the procedure(P

Objective To evaluate the application of rotational digital subtraction angiography(DSA) with three-dimensional(3D) reconstruction in the diagnosis and treatment of intracranial aneurysms.Methods Philips ALLUR12 system was employed to perform 2D and rotational DSA examination for 35 patients suspected of intracranial aneurysms with subarachnoid hemorrhage,and the 3D reconstruction of the arteries was then performed with computer to gain the stereopicture of localization and direction of the aneurysms,shape and size of aneurismal neck and vascular branch anatomy.The rotational DSA and 3D reconstructed images were compared with that of conventional 2D DSA.Results In the 35 patients,36 intracranial aneurysms out of 30 cases were found by conventional DSA,but there were 7 aneurysms with obscure direction and construction and 3 aneurysms with obscure aneurismal neck,and no sign of aneurysm was found in the other 5 patients by the conventional DSA.After rotational DSA and 3D reconstruction,additional 3 microaneurysms were found,with the result of final diagnosis of 39 aneurysms in total in 33 patients,though if still failed to find an aneurysm in two patients.The overall view of aneurysm,location and size of aneurysmal neck,anatomy of parent artery and vascular branches in the vicinity,and even the microaneurysms manifested themselves clearly by rotational DSA and 3D reconstruction examination,and the sheltering effects due to overlapping artery were avoided.Conclusion Rotational DSA can successfully display the aneurysm sac and anatomical structures of aneurysmal neck and surrounding vascular branches in a 270? rotational optic angle,and a stereopicture of aneurysmal size,direction,parent artery and surrounding vascular branches can be showed more clearly compared with conventional DSA.It can not only greatly improve the diagnostic sensitivity and reduce the rate of misdiagnosis,but also provides the doctors with overall and precise aneurysmal images for the operation and interventional treatment.

Objective To study the clinical significance of using MSCT(16 multi slice spiral CT,MSCT)to evaluate the patency of coronary arterial stent,and to explore the factors contributing to the image quality.Methods 32 patients with coronary arterial stent im- plantation received MSCT.The shape and position of the stent and the situation of restenosis were checked with several methods.Of the 32 patients,the results in 7 cases were further verified by X-ray coronary artery angiography.The image qualities were classified in three grades.The influence factors contributing to imaging quality were analyzed.Results The rate of good image quality for MSCT coronary artery angiography was 87.5%(28/32).The rate of good image quality for the patients with heart rate less than 60 was 94.7%,for those with heart rate of 61-70 was 88.9%,and for those with heart rate over 70 was 50.0%,there existed significant differences(X~2=16.354, P

Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Arteriosclerosis Obliterans ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Humans ; Male

OBJECTIVE: Computer has become an important tool in medical works. However, application ability of clinical physicians is imbalanced with the fast development of information technology (IT) system. Therefore, it is necessary to explore a bridge between researchers and integrate decentralized IT resources. Based on this survey, we provide some views concerning IT applying in medical procedures. METHODS: The correlated computer information was collected from a patient with coronary heart disease from early diagnosis, interventional therapy to coronary bypass surgery, until rehabilitation. The medical staffs were investigated from the general status, computer skills, knowledge structure, as well as the acceptance degree of computer application to measure computer skills. RESULTS: The correlated computer information was characterized by large soft variability, a large time span, and various date categories with more dynamic data or three-dimensional data. The investigation of computer knowledge demonstrated that the lack of IT knowledge resulted in poor outcome in their appointed tasks. From the view of self-assessment of IT knowledge, nursing staff and technician exhibited deficiency IT knowledge than doctors, who learned from department training, self-study or internet. Resident physicians and attending physicians were familiar with office system, so they were satisfied with IT skills. In contrary, nurses and majority of high-ranking professor or chief physicians were found difficult to study IT skills. However, most nurses were fond of their office system. The results also demonstrated that people aged 31 -40 years were easy to receive IT system. CONCLUSION: It is very important to enhance the cooperation between computer researchers and medical users for the treatment of coronary atherosclerotic heart disease.

OBJECTIVETo determine and analyze plasma ammonia concentration difference of the portal vein system and ramifications of rabbits and consequently guide selection of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) so that reduce shunt-induced hepatic encephalopathic incidence. To evaluate clinical significance of transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) and to analyse hemodynamics of both branches of the portal vein and to observe long-term results in the prevention of encephalopathy.

METHODSBlood samples in different portal vein branches of rabbits were collected and the plasma ammonia concentration was assayed and compared. The left branch of portal vein was used as the puncture site to perform TILPS and to keep away from the right branch of portal vein blood that contains nutrition and toxin.

RESULTSPlasma ammonia content was superior in the mesenteric vein and higher than the portal vein branch, the splenic vein, and the vena cava. The right portal vein was above the left. Encephalopathy did not occur in all patients within 3 months. Of the 341 patients undergoing TILPS, encephalopathy occurred in only 5 patients (1.47%) and shunt abnormalities in 19 patients (5.57%) verified by venography during overall follow-up period.

CONCLUSIONSSelective left branch of the portal vein portosystemic shunt can decrease encephalopathy obviously and protect liver function.

Adult ; Aged ; Ammonia ; blood ; Animals ; Female ; Follow-Up Studies ; Hepatic Encephalopathy ; blood ; etiology ; prevention & control ; Humans ; Male ; Middle Aged ; Portal Vein ; surgery ; Portasystemic Shunt, Transjugular Intrahepatic ; adverse effects ; Rabbits ; Treatment Outcome

Objective To analyze the effect of carotid artery stenting (CAS) on cerebralblood flow and cerebrovascular reactivity in patients with severe carotid stenosis.Methods Twenty patients with unilateral severe internal carotid artery stenosis,conformed by carotid color ultrasonography or MR angiography in our hospital from August 2014 to December 2015,were chosen in our study.CAS was performed;relative cerebral blood flow (rCBF) detection and relative cerebrovascular reactivity (rCVR) assessment were performed by single photon emission computed tomography (SPECT) combined with carbon dioxide (CO2) inhalation within one week before surgery and 3 months after surgery.Four regions of interest (ROIs) in the bilateral middle cerebral artery (MCA) territory of internal carotid stenosis were selected for data analysis.The changes of rCBF and rCVR before and after CAS between the ipsilateral and contralateral ROIs of these patients were compared.Results In these 20 patients,80 ROIs from each patient were obtained.Preoperative ipsilateral rCBF averaged 0.883±0.075,and contralateral rCBF averaged 0.929±0.033;preoperative ipsilateral rCVR averaged 0.010±0.055,and contralateral rCBF averaged 0.124±0.053;postoperative ipsilateral rCBF and rCVR averaged 0.927±0.040 and 0.092±0.058,and contralateral rCBF averaged 0.938±0.038 and 0.127±0.054.Postoperative ipsilateral rCBF and rCVR were significantly improved as compared with preoperative ones (P＜0.05).Postoperative contralateral rCBF and rCVR were improved as compared with preoperative ones,without significant differences (P＞.05).Conclusions CAS can not only improve rCBF and rCVR of the MCA in the carotid artery stenosis,but also improve the contralateral side.

Objective To investigate the significance of intravascular ultrasound (IVUS) in diagnosis and treatment of carotid stenosis.Methods IVUS was performed before and after carotid arterial stenting (CAS) in 12 patients with moderate or severe carotid stenosis,admitted to our hospital from July 2014 to April 2016 and diagnosed by digital subtraction angiography (DSA).The severity of carotid stenosis,expansion and adherence of the stent were observed,respectively.Results DSA indicated 17 vessels having pathological changes,including 4 (23.5％) eccentric lesions and 13 (76.5％) concentric lesions;IVUS indicated 23 vessels having pathological changes,including 13 (56.5％) eccentric lesions and 10 (43.5％) concentric lesions;the rate of eccentric plaque detected by IVUS was significantly higher than that by DSA (P＜0.05).The carotid diameter stenosis degree measured by DSA was smaller than the stenosis degree by IVUS (P＜0.05).In 4 patients underwent CAS,DSA showed that the residual stenosis was more than 30％,and IVUS showed stent underexpansion or poor adherence;in other 5 patients undewent CAS,IVUS showed poor stent symmetry,however,IVUS showed that the stent expansion,symmetry and adherence became better after the balloon expansion.Conclusion IVUS is useful for evaluation before and after stenting in patients with moderate or severe carotid stenosis.