Adult ; Cardiovascular Diseases ; physiopathology ; Cardiovascular Physiological Phenomena ; Case-Control Studies ; Female ; Heart ; physiopathology ; Humans ; Pregnancy ; Sports ; Stress, Psychological ; physiopathology

OBJECTIVETo analyze the long-term results of TIPS, TIPS with coronary vein occlusion (CVO) and combined TIPS and portal azygous disconnection for the treatment of portal hypertension and variceal bleedings.

METHODSThree hundreds and fifty-eight patients with portal hypertension were admitted because of variceal bleeding from July 1993 to May 2008. All patients were divided into 3 groups: 227 cases in group TIPS, 36 cases in TIPS and CVO group, 95 cases in combined TIPS and portal azygous disconnection group. The rates of successful operation, shunt patency, rebleeding, encephalopathy and survival were observed and compared by statistics methods.

RESULTSThere were 349 cases (97.5%) underwent successful surgery and 9 cases with failure surgery. The rates of occluded shunts, encephalopathy, rebleeding, and death in early periods were 2.5%, 31.8%, 4.7% and 9.0% respectively. The rate of encephalopathy and death in group with TIPS were higher than in group with combined TIPS and portal azygous disconnection (P < 0.01). The rate of encephalopathy and death were 41.2% and 24.7% in 85 cases with emergency TIPS. During the follow-up 1 - 15 years, the rate of patency shunts in 12 and 24 months after operation was 74.0% and 48.1% respectively. The rate of 1-year patency shunts in group with combined TIPS and portal azygous disconnection was higher than in group with TIPS, TIPS and CVO (P < 0.01 and P < 0.05). The rebleeding in group with TIPS was higher than in group with combined TIPS and portal azygous disconnection (P < 0.01), and the survival rate in group with TIPS was lower than in group with TIPS and CVO, combined TIPS and portal azygous disconnection (P < 0.01 and P < 0.01).

CONCLUSIONSTIPS is an efficient therapy for portal hypertension with CVO, combined TIPS and portal azygous disconnection can improve the results of TIPS for portal hypertension.

Adult ; Aged ; Azygos Vein ; surgery ; Coronary Vessels ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Hypertension, Portal ; surgery ; Male ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo determine the outcome of hepatic venousaplasty and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of the Budd-Chiari syndrome with occlusion of the hepatic veins.

METHODSFifty patients of the Budd-Chiari syndrome with occlusion of the hepatic veins (23 males and 27 females, with a mean age of (39 ± 11) years) were elected for venousaplasty or TIPS. The average of Child-Pugh scores was 9.6 ± 2.6. Three patients had a acute course of the disease, while 47 patients had a subacute or a chronic course of the disease. The clinical presentation was ascites in all 50 cases, with concomitant upper gastrointestinal bleeding in 10 patients, hepatorenal syndrome in 4 patients and impaired liver function in all patients. Hepatic venousplasty was performed for 12 patients with occlusion of hepatic venous. Hepatic and inferior caval venousplasty were performed for 6 patients with occlusion of hepatic and inferior caval vein. TIPS was performed for 13 patients with occlusion of small hepatic vein. Modified TIPS was performed for 19 patients with extensive occlusion of hepatic vein.

RESULTSThe procedure of treatment was successfully performed in all patients. The shunt reduced the portosystemic pressure gradient from (41 ± 10) to (27 ± 6) cmH2O (1 cmH2O = 0.098 kPa, t = 20.20, P = 0.001) and improved the portal flow velocity from (14 ± 10) to (52 ± 14) cm/s (t = 15.02, P = 0.001) after TIPS or modified TIPS. Clinical symptoms and the biochemical test results improved significantly during 3 weeks after hepatic venousplasty and shunt treatment. During the hospitalization, the death occurred in 1 case due to hepatic failure and the acute occlusion of shunt was treated with secondary intervention in another case. The mean follow-up was (82 ± 46) months. The revisions of shunt with TIPS were needed in 2 patients and the inflation of stenosised hepatic vein in another 2 patients during the follow-up. All patients were still observed.

CONCLUSIONHepatic venousaplasty and TIPS provide an excellent outcome in patients of Budd-Chiari syndrome with occlusion of the hepatic veins.

Adult ; Angioplasty ; Budd-Chiari Syndrome ; surgery ; Female ; Hepatic Veins ; surgery ; Humans ; Male ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo retrospectively compare the clinical outcome in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt (TIPS) using Fluency stent-graft (PTFE-covered stents) or bare stents.

METHODSApproval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Sixty consecutive patients with portal hypertension treated with TIPS from April 2007 to April 2009 were included. TIPS creation was performed with Fluency stent-graft in 30 patients (group A) and with bare stents in 30 patients (group B). Liver function, TIPS patency and clinical outcome were evaluated every 3 months.

RESULTSDuring hospitalization, there was no hepatic encephalopathy and recurrency of variceal bleeding.Acute shunt occlusion was observed in one patient with group A and another patient with group B.Follow-up was performed with average time of (6.2 +/- 3.9) months in group A and (8.3 +/- 4.4) months in group B. The rates of recurrent bleeding, acute shunt occlusion, hepatic encephalopathy and death were 3.3% and 20.0%, 0 and 30.0%, 16.7% and 20.0%, 0 and 13.3% in group A and B. The rates of recurrent bleeding, acute shunt occlusion and death in group A was lower than those in group B. There was no difference of hepatic encephalopathy between group A and B. The decrease of portal pressure and portosystemic pressure gradient, and the increase of portal flow and shunt flow in group A were higher than those in group B. There were no difference of liver function, ammonia and MELD between group A and B.

CONCLUSIONSFluency stent-graft is safe and effective in TIPS creation, with high patency rate. Covered-stent can improve the clinical outcome of portal hypertension.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Hypertension, Portal ; surgery ; Male ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; instrumentation ; Retrospective Studies ; Stents ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the outcome of a transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of 11 patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins.

METHODSEleven patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins were elected for TIPS. Three patients had a acute; eight, a subacute or a chronic course of the disease. All patients were associated with variceal bleeding and massive ascites. The diagnosis of Budd-Chiari syndrome was established by duplex-sonography, CT, MRI, upper digestive barium meal, angiography of hepatic veins and IVC, and liver biopsy. The shunt with diameter of 10 cm was established between the inferior caval vein and the intrahepatic portal vein with self-expandable stents in all patients. The mean follow-up was 63 +/- 43 months.

RESULTSThe shunt reduced the portasystemic pressure gradient from 41.2 +/- 10.5 to 12.4 +/- 4.7 cm H2O and improved the portal flow velocity from 11.2 +/- 2.8 to 52.2 +/- 13.7 cm/s. Clinical symptoms and the biochemical test results improved significantly during 3 weeks after shunt treatment. Ten patients are alive without clinical symptoms except one death due to hepatic failure. Revision in 2 patients was needed during the follow-up. The inflation of stenosing shunt was performed in 1 patient, and the reimplantation of stent in another patient. Eight patients had no revisions.

CONCLUSIONSTIPS provided an excellent outcome in patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins. It might be regarded as a treatment for the acute and long-term management of these patients.

Acute Disease ; Adult ; Budd-Chiari Syndrome ; surgery ; Chronic Disease ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Portasystemic Shunt, Transjugular Intrahepatic ; Retrospective Studies ; Treatment Outcome

0.05);2)After 12,24,36 months' treatment,BP was decreased significantly in each group (P0.05).Conclusion Both combined spirono- lactone/HCTZ and captopril/HCTZ significantly reduced BP and LVMI or LVMI and the maguitude of reduction was further enhanced after prolonged treatment.

Objective To measure the upper airway of obstructive sleep apnea hypopnea syndrome by 256 slice spiril CT, and to access the airway obstruction plane with the airway plane data in OSAHS patients.Through these measurements, we can provide assistance for clinical diagnosis and treatment.Methods This study randomly selected 178 patients diagnosed with OSAHS and 110 cases non-snoring healthy people as the control group by the Philips 256 slice CT.Under the nasopharyngeal area, velopharyngeal area, glossopharyngeal area, epiglottis area, we measured the cross-sectional area and volume of the narrowest plane in the two groups of quiet respiration and Müller status.Results The OSAHS group underwent quiet respiration and Müller status during CT scanning, and the two states about epiglottis area in cross-sectional area and volume had no significant difference, Other groups had differences between the parameters.There was a significant difference in the volume about velopharyngeal area and glossopharyngeal area. In the control group undergoing quiet respiration and Müller status during CT scanning, there was difference in velopharyngeal cross-sectional area.Other parameters had no significant difference.Conclusions The obstruction plate of OSAHS patients with 256-slice spiril CT measurement is mostly in the velopharyngeal area and glossopharyngeal area. The volume measurement of upper airway by CT can predict airway obstruction plate in patients with OSAHS.

OBJECTIVETo determine whether the perioperative disease activity is associated with recurrence and complications after bowel resection for Crohn's disease (CD).

METHODSClinical data of patients underwent bowel resection for CD at the Nanjing General Hospital of Nanjing Military Command from January 2002 to January 2011 was retrospectively analyzed. Postoperative recurrence and complications in patients with active disease were compared with those in patients with remission.

RESULTSA total of 90 patients underwent bowel resection for CD, active disease were seen in 43 patients at the time of surgery, while the rest 47 patients were in remission. The postoperative cumulative endoscopic recurrence rate was 8.5% at 1 year, 27.7% at 2 years and 44.7% at 3 years in the patients with remission, and was 27.9% at 1 year, 37.2% at 2 years and 53.5% at 3 years in patients with active disease. Data indicated the endoscopic recurrence were statistically significant in the first year after surgery (χ² = 4.605, P = 0.032). Additional, the postoperative complication rates in patients with remission (14.9%) was significantly lower than that in patients with active disease (51.2%) (χ² = 6.979, P < 0.001).

CONCLUSIONPatients with active disease at the time of surgery were encountered with early postoperative recurrence and increased complications after intestinal resection for CD.

Adult ; Colon ; surgery ; Crohn Disease ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Young Adult

BACKGROUNDPre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced gastric cancer.

METHODSA total of 56 histologically proven gastric cancer patients, who were considered to be stage II or higher with metastatic lymph nodes and with or without distant metastasis (T2-4, N1-3, and M0-1), were treated with a neoadjuvant chemotherapy. Patients received a combination of intravenous 5-Fu (370 mg/m2) and leucovorin (200 mg/m2) on days 1-5, and intra-arterial etoposide (80 mg/m2) and cisplatin (80 mg/m2) on days 6 and 20. After two cycles of preoperative chemotherapy, patients with resectable tumors underwent laparotomy.

RESULTSAll patients finished two cycles of chemotherapy. The overall response rate was 78.57% (44 cases), of which 7.14% (four cases) clinical complete response. Forty-six patients underwent resection, including 21 initially unresectable diseases. R0 resection rate for prechemotherapy resectable and unresectable diseases was 96.15% (25/26 cases) and 66.67% (20/30 cases), respectively. Pathological complete response was observed in 8.70% of patients. Toxicity was moderate and there were no chemotherapy-related deaths. With a median follow-up of 31 months (range 6-76 months), the 5-year survival rate for the whole group and patients with initially resectable tumors were 21.8% and 42.3%, respectively. The median survival for initially resectable and unresectable patients were 41 months (95%CI, 31.006-50.994) and 18 months (95%CI, 13.399-22.601; P<0.01), respectively.

CONCLUSIONPreliminary results proved that the combined intensive chemotherapy was a safe and promising regimen for pre-operative treatment of advanced gastric cancer.

Adult ; Aged ; Cisplatin ; administration & dosage ; therapeutic use ; Etoposide ; administration & dosage ; therapeutic use ; Female ; Fluorouracil ; administration & dosage ; therapeutic use ; Humans ; Infusions, Intra-Arterial ; Infusions, Intravenous ; Leucovorin ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Neoadjuvant Therapy ; methods ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery

OBJECTIVETo compare the efficacy of preemptive epidural analgesia combined with postoperative epidural analgesia, postoperative epidural analgesia alone and intravenous analgesia for postoperative pain relief and their effects on plasma interleukin-6 (IL-6) concentration following radical surgery for gastric carcinoma.

METHODSSixty-six patients with gastric carcinoma scheduled for gastrectomy were randomly divided into 3 groups, namely group P (n=22), group E (n=22) and group V (n=22), to receive preemptive epidural analgesia combined with postoperative epidural analgesia, exclusive postoperative epidural analgesia, and exclusive postoperative intravenous analgesia, respectively. Hemodynamic data were recorded for all the patients during the operation, and visual analogue scale (VAS) was used to assess the pain intensity at 4, 8, 16, 24, 48 and 72 h after surgery. Plasma IL-6 concentration was determined before surgery and at 24, 48, 72 h after surgery.

RESULTSNo significant changes occurred in the hemodynamics during the preoperative periods. VAS and IL-6 were lower in group P than in group E and V, and group E had lower measurement than group V (P<0.05).

CONCLUSIONPreemptive epidural analgesia combined with postoperative epidural analgesia provides more satisfactory pain relief and more effectively prevents IL-6 increment than exclusive epidural analgesia or intravenous analgesia after gastrectomy for gastric carcinoma.

Adult ; Amides ; administration & dosage ; Analgesia, Epidural ; methods ; Analgesics ; administration & dosage ; Female ; Fentanyl ; administration & dosage ; Gastrectomy ; methods ; Humans ; Infusions, Intravenous ; Interleukin-6 ; blood ; Male ; Middle Aged ; Morphine ; administration & dosage ; Pain, Postoperative ; drug therapy ; Stomach Neoplasms ; blood ; surgery ; Treatment Outcome