Objective To evaluate the effect and safety of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization femoral arterial pseudoaneurysm.Methods Seventy-eight patients with femoral anterial pseudoaneurysm were included in this study.Pseudoaneurysms were treated by bedside compression in 50 of these 78 patients(group A),and by thrombin injection in 28 patients(group B).All patients were diagnosed by GE LOGIQ 9 Color Doppler Ultrasound.Ultrasound guided thrombin injection for femoral arterial pseudoaneurysme were carried out in patients in group B.Results Closure of the pseudoaneurysm was successfully in 82 percent(41/50) of the patients in group A.Six patients had vagus reflex,4 patients could not tolerate repeating compression and 5 patients were not effectively cured by compression and needed to receive remedial ultrasound-guided percutaneous thrombin injection.Closure of the pssudoareurysm by percutaneous thrombin injection was successful in all patients in group B.Successful immediate closure were noted in 25 patients and 2 patients needed second thrombin injection.One patient had vasovagal syncope and 12 patients had mild fever.No distal embolization,infection,hemorrhage or allergic reaction occurred.Conclusion Compared to compression therapy for treatment of femoral arterial pseudoaneurysme,ultrasound-guided percutaneous thrombin injection is a simple,safe and effective treatment alternative.

Objective To analyze the clinical and pathological characteristics of 35 hepatocellular carcinoma (HCC) patients with bile duct tumor thrombi (BDTT),and to investigate the expressions of CD133,CD90,EpCAM,CK19,VEGF,and C-kit in the tumor tissues.Methods 35 HCC patients with BDTT out of 943 HCC patients who underwent surgical treatment were studied.The expressions of biomarkers in tissue specimens were determined by immunohistochemistry.35 HCC patients without BDTT were selected using the method of stratified sampling as a control group.Results In 19 of 35 patients,the diameters of the primary tumor were less than 5 cm (range 0 ～ 17 cm,average 6.9 ± 0.7 cm).When compared to the control group,most of the primary tumors were moderately to lowly differentiated (33/35,94％ vs 18/ 35,51％),had incomplete capsules (18/35,51％ vs 3/35,8％) and micro vascular invasion (29/35,83％ vs 7/35,20％).The positive expression rates of CD90,EpCAM,CK19,VEGF,CD133,and C-kit in the group of patients with HCC with BDTT and in the control group were 82.9％,77.1％,71.4％,85.7％,80.0％,80.0％ and 57.1％,54.3％,34.3％,65.7％,54.3％,51.4％,respectively.The 1-,2-,3-year postoperative survival rates of the HCC patients with BDTT were 69％,37％,20％ respectively which were worse than the HCC patients without BDTT (1-,2-,3-year postoperative survival rates were 88％,72％,62％ respectively,P ＜ 0.05).Conclusions The prognosis of HCC patients with BDTT was worse than HCC patients without BDTT.The expressions of liver stem cell biomarkers in the tumor specimens of the group of HCC patients with BDTT were higher than the control group.These findings prompt that this kind of HCC originate from liver stem ceils.

Objective To review the clinical features of fulminant myocartitis,in order to provide assistance to the clinical management.Methods The clinic data of 183 patients with viral myocarditis,including 153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed.The age of onset,interval after virus infect,initial symptoms,auxiliary examination,treatment,and turnover were compared in the study.Results The average onset age of fulminant myocartitis and acute myocarditis were similar [(22.3 ± 7.6) vs.(26.2 ± 12.6) years,P =0.105 5].There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection [30.0％ (9/30) vs.78.4％ (120/153),x2 =28.3,P ＜0.001],the average interval after virus infect [(3.1 ±2.2) vs.(7.0 ±3.80) d,P＜0.001] and the length of hospital stay [(12.1 ± 6.9) vs.(6.9 ± 4.50) d,P ＜ 0.001].Chest congestion (101/153,66.0％),feebleness (76/153,49.7％),fluster (74/153,48.4％) are the most onset symptoms of acute myocarditis,while chest congestion (24/30,80.0％),shortness of breath (14/30,46.7％),feebleness (13/30,43.3％) in flunimant myocarditis.Advanced A-V block (19/30,63.3％),cardiogenic shock (18/30,60.0％),ventricular arrhythmia(16/30,53.3％),Adams-Stokes syndrome(8/30,26.67％) and acute renal failure (8/30,26.7％) were the most complications of flunimant myocarditis.Temporary pacemaker (11 cases),extracorporeal memberane exygenator (7 cases) and intra-aortic balloon pump (7 cases) were applied in critical patients.In acute phase,21 cases were cured,9 cases was dead of cardiogenic shock and ventricular(27,30.0％).Two dead cases applied with ECMO because of delay.After leaving hospital,1 case was implanted permanent pacemaker,2 cases became chronic myocarditis and required hospitalization repeatedly.Conclusions The fulminant myocarditis has a rapid onset,most of which has no prodrome of virus infection or a shorter interval than acute myocarditis.Timely and effective mechanical circulatory support is critical for fulminant myocarditis.

Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.

Objective To evaluate the clinical efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome ( ACS) .Methods A total of 218 ACS patients admitted in Hangzhou First People′s Hospital from March 2013 to July 2013 were enrolled into this study .The patients were randomly assigned to receive atorvastatin 80 mg/d during hospitalization , and 40 mg/night after discharge for one month ( intensive group , n=107 );or receive atorvastin 20 mg during hospitalization and 20 mg/night after discharge for one month ( control group, n =111 ).The biochemical indexes were measured on the admission and after one-month treatment.Results After one-month treatment, the total cholesterol, triglycerides and LDL cholesterol of intensive group were significantly lower , and the high density lipoprotein cholesterol was higher than baseline values ( 0.75 ±0.14 ) mmol/L vs.( 1.52 ±0.88 ) mmol/L, P<0.05;(2.21 ±0.78)mmol/L vs.(4.55 ±1.12)mmol/L, P<0.05;(1.76 ±0.31)mmol/L vs.(2.23 ±0.77) mmol/L, P<0.05; (1.15 ±0.34) vs.(1.52 ±0.41) mmol/L, P<0.05.The liver enzymes creatine kinase in intensive group was not significantly changed , but the creatinine levels decreased (82.53 ±23.85)μmol/L vs.(57.81 ±15.27) μmol/L, P<0.05, and the blood homocysteine and ultra-sensitivity C-reactive protein levels also decreased compared with the baseline ( 10.52 ±4.66 ) mmol/L vs.(30.70 ±18.82 ) mmol/L, P <0.05;( 8.06 ±2.68 ) mg/L vs.( 19.75 ±11.91 ) mg/L, P <0.05. Conclusions Short-term intensive statin therapy can effectively reduce blood lipid , cholesterol and homocysteine levels and raise HDL cholesterol levels; also with its anti-inflammatory and renal protective effect the therapy can provide more clinical benefit for patients with ACS .