Amygdala ; Animals ; Disease Models, Animal ; Electroencephalography ; Epilepsy ; etiology ; physiopathology ; Kindling, Neurologic ; Male ; Rats ; Rats, Wistar

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.

Objective To evaluate the indications and intraoperative management of nephron-spar- ing surgery (NSS) for renal cell carcinoma (RCC).Methods A total of 53 patients (32 men and 21 women;age range,21 -76 years) with unilateral RCC and a normal contralateral kidney underwent NSS.The disease course ranged from 1 week to 13 months.The unilateral RCCs were detected by B-uhrasonography. Partial nephrectomy was performed on 38 cases of polar RCC and wedge nephrectomy was performed on 15 cases of central RCC.Both renal vein and artery were blocked for 10 - 15 min,and unclamped for 1 -2 min if necessary.The resections were finished within 7 -21 min (mean,12 min).No inosine and regional hypo- thermia were used during operation.Absorbable hemostatic gauze and terylene flake were used to suture renal wound surface.After operation all patients were treated with interferon hypodermic injection of 5 000 000 U every other day for 3 months.Results The diagnosis of RCC with negative cutting margin was confirmed by pathological examination in all patients.The greatest dimension of the renal cancers were＜4 cm except for one of 6 cm.The clinical stage was T_1N_0M_0 in all patients.During the follow-up of 6 -48 months,all pa- tients were alive without recurrence and had normal renal function.Conclusions NSS can be rapidly per- formed for T_1 stage renal cancer＜4 cm or single clearly localized cancer＞4 cm in diameter.The follow-up results are satisfactory.

Objective To investigate neuroprotective effect of AM-36 on secondary brain injury following traumatic brain injury(TBI)in rats.Methods A total of 38 male Sprague-Dawley rats were divided into an experimental group,a control group and a sham operation group,then sustained to moder- ate TBI.AM-36(0.1 ml/100 g)was administered intraperitoneally in the experimental group and isoton- ic saline solution was administered intraperitoneally in the control and the sham operation groups at 30 mi- nutes,24 and 48 hours after TBI,respectively.The brain water content was determined at 24 hours after TBI.Rats were sacrificed by decapitation at 24 hours or one week after TBI for observing histological changes in peripheral cortex,thalamus and hippocampus by means of Hematoxylin and Eosin staining and Fluoro-Jade(F-J)staining.Results The brain water content of bilateral hemispheres 24 hours after TBI in the experimental group was significantly decreased,compared to that of the control group.Histo- logical examination revealed less degenerating neurons(F-J positive neurons)in the cortex,thalamus, CAI and CA3 of the hippocampus in AM-36 treated rats 24 hours and one week after injury(P＜0.05). Conclusion Systemic administration of AM-36 at the early stage after TBI can decrease brain water content and exert neuroprotective effect on TBI.F-J staining can be used for histopathologic quantitation of neuronal damage,for it can accurately exhibit pathologic changes following TBI induced by fluid per- cussion.

Background and purpose: With the development of the means of preoperative diagnosis and treatment of breast cancer, ifne needle puncture no longer seems to be popular with the clinical use. The safety and effectiveness of fine needle aspiration as preoperative diagnosis of breast cancer are controversial. This study was aimed to investigate the application of fine needle aspiration (FNA) of breast cancer and association between FNA and recurrence and metastasis for 30 years in our hospital. Methods:A total number of 1 260 patients with breast cancer treated in Peking Union Medical College Hospital from 1975 to 2006 were reviewed in two groups for clinical characters, recurrence, and survival rate. The two groups were FNA and non-FNA. Results:The positive rate of FNA was 61.4%and the highest rate was inⅣstage (100%). StageⅡandⅢwere the major ones in FNA group (45.2%). The local recurrence (7.0%vs 6.4%), recurrence and metastasis (13.2%vs 14.0%), 5-year (82.0%vs 81.0%) and 10-year disease free survival rates (51.0%vs 64.0%) have no signiifcant difference between FNA and non-FNA groups. Conclusion:FNA is still one of the most important methods for preoperative investigation of breast cancer. Background and purpose: With the development of the means of preoperative diagnosis and treatment of breast cancer, ifne needle puncture no longer seems to be popular with the clinical use. The safety and effectiveness of fine needle aspiration as preoperative diagnosis of breast cancer are controversial. This study was aimed to investigate the application of fine needle aspiration (FNA) of breast cancer and association between FNA and recurrence and metastasis for 30 years in our hospital. Methods:A total number of 1 260 patients with breast cancer treated in Peking Union Medical College Hospital from 1975 to 2006 were reviewed in two groups for clinical characters, recurrence, and survival rate. The two groups were FNA and non-FNA. Results:The positive rate of FNA was 61.4%and the highest rate was inⅣstage (100%). StageⅡandⅢwere the major ones in FNA group (45.2%). The local recurrence (7.0%vs 6.4%), recurrence and metastasis (13.2%vs 14.0%), 5-year (82.0%vs 81.0%) and 10-year disease free survival rates (51.0%vs 64.0%) have no signiifcant difference between FNA and non-FNA groups. Conclusion:FNA is still one of the most important methods for preoperative investigation of breast cancer.

Abstract: Objective　To investigate the clinical characteristics and diagnosis key points of brain abscess caused by Nocardia asiatica, and provide a clinical basis for diagnosing and treating intracranial infection caused by Nocardia. Methods　A case of pulmonary Nocardia asiatica complicated with brain abscess diagnosed at the Second Affiliated Hospital of Hainan Medical University was selected to analyze the clinical manifestations, cerebrospinal fluid characteristics, pulmonary and cranial imaging features, and treatment plan, and to summarize the diagnosis and treatment experience. Results　The patient was an elderly woman with a history of diabetes, dry cough was the first symptom without fever or headache. At the beginning of the course, it was diagnosed as pulmonary infection and tuberculosis in the local hospital, and received conventional antimicrobial and anti-tuberculosis therapies, but showed no improvement. The patient developed progressive limb weakness, followed by consciousness disorders, and coma. Cerebrospinal fluid (CSF) adenosine deaminase and lactate dehydrogenase were not abnormal, CSF pressure, protein and white blood cells were high, mainly with multiple nuclear cells. CSF glucose and chloride were normal in the early stage of the disease, but decreased significantly in the later stage. Metagenomic analysis of cerebrospinal fluid indicated Nocardia asiatica with a specific sequence number of 537. Lung CT showed exudation, abscess, and cavity in the right lung. Skull MRI scan + enhancement suggested multiple scattered abscesses in both cerebral hemispheres. The abscesses were of different sizes and showed ring enhancement, with extensive surrounding edema, and ventricular compression. After treatment with meropenem, linezolid, and compound sulfamethoxazole tablets, the cerebrospinal fluid recovered, and the lesions in the lungs and intracranial structures improved. Conclusions　Brain abscess caused by Nocardia asiatica is similar to the tuberculous brain in clinical symptoms, cerebrospinal fluid examination, craniocerebral imaging, so we should be alert to the possibility of Nocardia infection in patients with diabetes. At the same time, metagenomic testing of the cerebrospinal fluid can help confirm the diagnosis. The mortality and disability rates of brain abscess caused by Nocardia are high. Early diagnosis and treatment can improve the prognosis.

Altitude ; Heart Rate ; Humans ; Oxygen ; Oxygen Consumption

OBJECTIVETo evaluate the incidence of extrahepatic collateral arteries involved in the blood supply to hepatocellular carcinoma (HCC) and to assess the technical success rates and complications of transcatheter arterial chemoembolization (TACE) through the collaterals.

METHODS1356 TACE procedures were performed in 874 consecutive patients through extrahepatic collateral pathways to HCC between August 2006 and August 2010 in our department. The extrahepatic collateral pathways to HCC revealed on angiography were retrospectively evaluated. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the feeding branch to avoid nontarget embolization.

RESULTSIncidences of collateral source to HCC were 76.3% from the right inferior phrenic artery (RIPA), 2.4% from the left inferior phrenic artery (LIPA), 6.9% from the right and 0.4% from the left internal mammary arteries (RIMA, LIMA), 2.9% from the right intercostal artery (RICA), 2.0% from the omental artery, 0.8% from the right or middle colic artery, 2.3% from the cystic artery, 1.3% from the left and 1.1% from the right gastric arteries (LGA, RGA), 3.5% from the right renal capsular artery (RRCA), right middle adrenal artery (RMAA) and right inferior adrenal artery (IAA). Technical success rates of TACE were 95.9% in the RIPA, 93.8% in the LIPA, 100.0% in the RIMA and LIMA, 55.0% in the RICA, 77.8% in the omental artery, 63.6% in the colic artery, 67.7% in the cystic artery, 76.5% in the LGA, 73.3% in the RGA and 95.8% in the RRCA, RMAA, and RIAA. Complications included skin erythema and necrosis after TACE through the RIMA, skin erythema after TACE through the RICA, cholecystitis after TACE through the cystic artery (n = 1), and pleural effusion, basal atelectasis and hiccup after TACE through the IPA.

CONCLUSIONTACE through extrahepatic collaterals is safe and feasible, and with a high success rate in the treatment of hepatocellular carcinoma.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; administration & dosage ; Arteries ; Carcinoma, Hepatocellular ; blood supply ; diagnostic imaging ; pathology ; therapy ; Chemoembolization, Therapeutic ; adverse effects ; methods ; Collateral Circulation ; Erythema ; etiology ; Female ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; blood supply ; diagnostic imaging ; pathology ; therapy ; Male ; Middle Aged ; Pleural Effusion ; etiology ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo determine the concentrations of interleukin-18 (IL-18), IL-6, IL-8, and prostaglandin E2 (PGE2) in the synovial fluid in patients with osteoarthritis (OA), and explore the role of IL-18 in the pathogenesis of OA.

METHODSThe synovial fluid was collected from 30 patients with knee OA, and the concentrations of IL-18 and the other cytokines were measured using enzyme-linked immunosorbent assay (ELISA). A linear regression was performed between IL-18 and the other cytokines.

RESULTSThe average IL-18 and PGE2 concentrations were 220-/+304 pg/ml and 89-/+104 pg/ml in the synovial fluid, respectively, and the two cytokines showed a positive correlation in the synovial fluid (r=0.628, P=0.001). The IL-18 concentration was also correlated to the concentrations of IL-6 (1200-/+1587 pg/ml, n=22; r=0.590, P=0.008) and IL-8 (5190-/+6024 pg/ml, n=9; r=0.776, P=0.014).

CONCLUSIONIL-18 can promote PGE2 production, which causes cartilage degradation in OA, thus therapies targeting this cytokine may prove an effective approach to early OA treatment.

Aged ; Dinoprostone ; biosynthesis ; Female ; Humans ; Interleukin-18 ; metabolism ; Male ; Middle Aged ; Osteoarthritis ; metabolism ; Synovial Fluid ; metabolism