Objective To explore the application efficacy of scalp nerve block combined with sevoflurane in craniotomy.Methods Fifty-five patients undergoing craniotomy in pingdingshan second people's hospital of henan province from Mar 2013 to Mar 2015 were randomly divided into observation group (n =28) and control group (n =27).The scalp nerve block combined with sevoflurane was performed in observation group and the sevoflurane intravenous inhalational combined with sufentanil was performed in control group.The changes of MAP and HR were observed before induction,5min after induction,skin incision,break the meninges,operation end and 5rmin after catheter removal.The agitation scale after operation,anesthesia duration,awaking time and dosage of sufentanil were compared.Restults MAP and HR at skin incision,break the meninges,operation end and 5min after catheter removal in control group were significantly increased than those before operation,and significantly higher than those in observation group at same stage of operation,with statistically significance differences (P ＜0.05).The agitation scale of observation group was lower than that of control group,with statistically significance difference (P ＜0.05).There was no significance difference between two groups in anesthesia duration (P＞0.05),the awaking time in observation group was significantly shorter than that in control group and the dosage of sufentanil was significantly reduced in observation group (P＜0.05).Corclusion Scalp nerve block combined with sevoflurane used in craniotomy has advantages in stable vital signs,rapid awaking,less dosage of sufentanil and lower score of agitation,which is suitable for clinical application.

Bleeding is a rare but fatal complication after radiotherapy for nasoparyngeal carcinoma(NPC).In this article,we report an NPC case treated with radiotherapy complicated with bleeding of the common carotid artery(CCA).A 44-year-old man with NPC was treated with external radiotherapy 19 years ago,and a second course of treatment to the same field was administrated because of local nasoparyngeal recurrence 4 years ago.The patient was admitted to our hospital for massive bleeding.Conservative therapy including routine medication,blood transfusion and local compression showed almost no effect.Emergency carotid angiography revealed bleeding from the left CCA,and a self-expanding covered stent was deployed through percutaneous transluminal femoral approach.After the placement of the co-vered stent,angiography showed the bleeding was successfully controlled.So self-expanding covered stenting may be a safe,effective and minimal-invasive option for bleeding of the carotid artery.Long-term follow-up is required for further evaluation.Abstract:SUMM ARY B leed ing is a rare but fatal complication after rad iotherapy for nasoparyngeal carcinoma(NPC).In this article,we report an NPC case treated with rad iotherapy complicated with bleed ing of the common carotid artery(CCA).A 44-year-old man with NPC was treated with external rad iotherapy 19 years ago,and a second course of treatment to the same field was adm inistrated because of local nasopa-ryngeal recurrence 4 years ago.The patientwas adm itted to our hospital formassive bleed ing.Conserva-tive therapy includ ing routine med ication,blood transfusion and local compression showed almost no effect.Emergency carotid angiography revealed bleed ing from the leftCCA,and a self-expand ing covered stentwas deployed through percutaneous translum inal femoral approach.After the placement of the co-vered stent,angiography showed the bleed ing was successfully controlled.So self-expand ing covered stenting may be a safe,effective and m inimal-invasive option for bleed ing of the carotid artery.Long-term follow-up is required for further evaluation.

Objective To evaluate the effectiveness and side effects of uterine arterial embolization with Pingyangmycin(a homogenous bleomycin) lipiodol emulsion(PLE) for symptomatic uterine fibroids. Methods Uterine arterial embolization with PLE was performed in 25 patients.The improvement of symptoms and uterine size changes were followed up in 3-18 months(mean 6 months) after the procedure. Results All but 2 cases were successfully treated bilaterally.Superselective angiography showed enlargement of uterine artery,accompanied by tortuous branches.The uterine size was increased.The uterus itself was significantly stained and emptied slowly. Coagulation necrosis was found in resected fibroids after embolization in 3 patients. One month after the procedure, a mean 40% reduction of uterine volume was obtained in 18 followed up cases.The clinical symptoms were relieved significantly. The main side effects were hypogastic pain(13/25),which was intense in 6 cases. Conclusion Uterine arterial embolization with PLE is a good non surgical therapy in symptomatic uterine fibroids with mild side effects.

Objective To evaluate the cause and management of intraoperative stent-graft migration during endovascular repaire of aortic dissection (AD). Method During the period between May 2001 and Dec 2007 intraoperative stent-graft migration occurred in 17 cases ( 14 males and 3 females) including 15 acute AD cases and 2 chronic AD cases. Backward migration was noticed in 11 cases including the 2 cases found during balloon extention, in 1 case the migration found during the removal of the releasing sheath which scratched the stent-graft, in 2 cases the migration occurred when the grafts were half released. Forward migration occurred in 6 cases resulting in left subclavian artery (LSA) occlusion in 3 cases and left common carotid artery (LCCA) occlusion in the other 3 cases. For the 3 cases of LCCA occlusion, the backward migrated stent-graft was pushed forward by the cuff releasing system and consequently occluded the LCCA in 1 case, and the cuff jumped forward during release and occluded the LCCA in 1 case. Result Backward migration of stent-grafts can be treated by pushing forward the graft with the sheath or additional placement of a cuff. Intraoperative complication may be less life threatening and no perioperative death occurred in this group. Occlusion of LSA in 3 cases by forward migration of stent-grafts were left untreated and 1 case died of leter cerebellar infarction. For the LCCA occlusion in 3 cases, 2 were treated by drawing back the graft with a balloon, and in the remaining 1 case the migrated graft was pushed back with the catheter in the LSA captured by a snare. Conclusion Stent-graft migration during endovascular repair may be related with poor experience of the operator, specific anatomical condition of the patient and the design drawback of the stent-graft. Forward migration of stent-graft is less common but may be more harmful for the patient. Beside back drawing with a balloon, the captured catheter with a snare may be helpful in the management of forward migration of the released stent graft.

SUMMARY Bleeding is a rare but fatal complication after radiotherapy for nasoparyngeal carcinoma ( NPC ) . In this article , we report an NPC case treated with radiotherapy complicated with bleeding of the common carotid artery (CCA) . A 44-year-old man with NPC was treated with external radiotherapy 19 years ago, and a second course of treatment to the same field was administrated because of local nasoparyngeal recurrence 4 years ago. The patient was admitted to our hospital for massive bleeding. Conservative therapy including routine medication, blood transfusion and local compression showed almost no effect. Emergency carotid angiography revealed bleeding from the left CCA, and a self-expanding covered stent was deployed through percutaneous transluminal femoral approach. After the placement of the covered stent , angiography showed the bleeding was successfully controlled. So self-expanding covered stenting may be a safe, effective and minimal-invasive option for bleeding of the carotid artery . Longterm follow-up is required for further evaluation.

Objective To evaluate venous substitutes and investigate the effect of bone marrow seeded vascular graft in venous system. Method Knitted double velour Dacron grafts were implanted in the infrarenal vena cava in 8 mongrel dogs. Four grafts were seeded by autogenous bone marrow, and four were treated by autogenous plasma. The grafts were harvested at postop day 10.Light and electron microscopy were used to measure the thickness and endothelialization of neointima. The level of 6-keto-PGF1-alpha and TXB2 were also measured. Results All bone marrow seeded grafts and 2 of 4 controls were patent. The thickness of neointima in the seeded grafts was significantly thinner than that in the control(P

Objective To establish technique skills and evaluate complications of carotid artery stenting with the use of Filter. Methods In this study, 38 carotid lesions in 35 patients (with an asymptomatic stenosis exceeding 70% or a symptomatic stenosis exceeding 50% ) received stenting with the use of protective filter. The skills, complication and outcomes were evaluated. Follow-up surveillance included ultrasound examination, CTA, or MRA. Results The technique was successful in all 38 lesions. Angiography after stenting showed that the treated vessels were all patent (remained stenosis was less than 20% ). Sclerotic debris was found in 21 (55.3%) filters, 3 of which were full filled with debris. Complications included 1 (2.6%) stroke and hemiplegia, and I (2.6%) cerebral bleeding, 2 (5.3%) TIA after stenting and recovered after withdrawing the filter, 10 (26.3% ) suffered from perioperative transient decrease of heart rate and blood pressure. In a follow-up of 6 to 54 months (mean 32 months), all treated vessels were patent except 1 with stent-graft for carotid ulcer, no new TIA and stroke was found. Conclusion Meticulous technique and the use of carotid fiter permits carotid stenting in a safe and effective manner and prevents complications.

Objective To summarize the experience and efficiency of coils in endovascular aortic repair.Methods From September 2008 to December 2013,48 patients received endovascular aortic repair in combination of coil embolization including abdominal aortic aneurysm in 32 patients, and aortic dissection in 16.Results Coils were successfully implanted in all cases.One patient with ruptured abdominal aortic aneurism (AAA) underwent emergency endovascular aortic repair and died of multiple organ failure the day after surgery.One patient died of pulmonary artery embolization 3 hours after TEVAR.44 patients were followed up ranging from 7 to 60 months.In AAA group, 25 patients received endovascular exclusion in combination with internal iliac artery embolization, four of them had claudication due to gluteal ischemia but without other severe complications.Post-operative CTA found endovascular thrombosis in aneurysm.In the aortic dissection group, one patient died of pulmonary infection.During the follow up, there was no AAA dissection, and AAA rupture.Post-operative CT confirmed thrombus in cavity.There were no scaffold and coil translocation and surrounding tissue injury.Conclusions Endovascular aortic repair in combination with coil embolization is a complementary treatment to aortic diseases.

Intravenous leiomyomatosis is characterized by a proliferation of benign smooth muscular tissue growing into uterine with malignant appearance.On extremely rare occasions,the tumor may grow out of the pelvis and extend into the inferior vena cava and the right atrium.We report a case of intravenous leiomyomatosis extending into the right atrium.A 41-year-old woman complained of 20 days of intermittent abdominal pain and lower limbs swell.Medical history of the patient revealed a previous hysterctomy operation 3 years ago due to uterine leomyoma.Echocardiography showed a homogenous mass extending from the inferior vena cava to the right atrium,without evidence of adherence to the right atrial wall,the left ventricular ejection fraction was only 60%.Computer tomography showed that a large mass arising from the left internal iliac vein and extending into the right chambers.Pelvic vascular ultrasound revealed the thrombotic material in the inferior vena cava and the left common iliac vein,and confirmed the presence of a complex mass in the left annex region.Based on the findings,the initial diagnosis was intracardiac and intravenous tumor.An operation was performed through a sternotomy and laparotomy to remove the whole tumor from the left common iliac vein to the right atrium,ligate left internal iliac vein meanwile.No hormonal therapy was administrated after the operation.Immunohistochemical studies revealed that the tumor cells were fusiform shape,there was no karyokinesis and necrosis,and the tumor cells were positive for smooth muscle antigen and desmin,as well as estrogen receptor and progesterone receptor.Six months postoperation follow-up revealed no signs of recurrence.The differential diagnosis of the disease compared with primary cardiovascular sarcomas and thrombus was difficult.The final diagnosis relied on immunohistochemical analysis,however,the short-term result of operation was acceptable.

Objective To analyse the recurrence rate of patients with Budd-Chiari syndrome (BCS) after radical correction.Method We retrospectively analyzed the clinical characters and follow-up of patients who underwent radical correction and suffered recurrence.Patency rate of inferior vena cava (IVC) and hepatic veins (HVs) were examined.We present the causes of recurrence and clarify risk factors for recurrence by survival analysis.Result Among the 102 patients undergoing radical correction,34 patients suffered from postoperative recurrence,including 32 cases of IVC lesions,21 cases of HVs lesions (19 patients suffered concurrently from IVC and HVs lesions).One patient received reoperation,16 patients received balloon angioplasty of IVC or HVs,3 patients received stent implantation,and 14 patients received conservative treatment.Conclusions The recurrence rate is high after radical correction for BCS.Once the abnormal syndrome recurs,the patients can be managed by radical correction,balloon or stent angioplasty.The main causes of recurrence are thrombosis of IVC,compression of caudate lobe,scar contracture,and the risk factors for recurrence are concurrent hypercoagulation status,too short period of postoperative anticoagulation (less than 6 months).