Objective To study the clinical and image features of the aortic dissecting aneurysm(AD) combined with aberrant right subclavian arteries(ARSA),and to discuss the feasibility of endovascular repair for such disorder.Methods The clinical and image data of 4 patients,who suffered from AD combined with ARSA and admitted in the authors' service during 2004 to 2007,were retrospectively reviewed.All the 4 cases complained severe aches in their back,and one of them was companied with aches in upper abdomen.CT-exam showed that the first tear(gap) of AD located near or inside ARSA,the truncus aortae narrowed obviously.Four operational prescriptions were performed respectively for the 4 patients depending on the location of gaps and on the distance between the gap and ARSA.Results All the 4 cases received satisfy operation.A slight early leakage occurred in the first case without steal syndrome,and the lower blood pressure was 80 mmHg on right arm;for the second case,no leakage occurred with normal blood presser on both arms;for the third one a slight early leakage was companied with normal blood presser on both arms and for the fourth one a slight early leakage occurred without steal syndrome,and the lower blood presser was 60mmHg on right arm.Conclusion AD combined with ARSA is a rare case in clinic.The modus operandi of endovascular repair should be designed based on the situation of individual case considering the location of the first tear.Once the target area exposed is not wide enough for operation,subclavian artery bypass would be a right way in reduction of leakage complications and in increasing the opportunity for a successful operation.

Objective To describe the method and clinical result of super sural neuromusculocutaneous flap grafting plus catheter irrigation in the treatment for chronic lateral malleolus osteomyelitis. Methods From March 2000 to March 2008, 17 cases, male 14, femal 3, 21 to 75 years old (average 43-year-old),were underwent reversed saphenous musculocutaneous island flap after wide excision of lateralmalleolus lesion. The cause of lateral-malleolus lesions was trauma. The smallest flap was 5 cm× 6 cm and the largest was 7 cm × 11 cm. Catheter irrigation was used in all cases. Results Follow-up ranged from 12 to 96 months, average 49 months. After operation, the wounds were irrigated with sensitive antibiotics 1 to 2.5 months(average 49 days), and all flaps were survived. Except 2 cases, the other 15 were healed in 1 month.The 2 cases were not healed at first stage. According to the lab result,we changed the antibiotic, and in 2.5 months, we took off the catheter. Conclusion To deal with the chronic traumatic lateral-malleolus osteomyelitis, super sural neuromusculocutaneous flap grafting plus catheter irrigation is approprite and effective.

Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.

Objective To study the anatomical characteristics of ascending aortic and aortic arch in adult Chinese. Methods From Sep 2006 to Sep 2007, we retrospectivly reviewed 388 volunteers undergoing thoracic aorta CTA in our institution. We measured the diameter of ascending aorta, aortic arch, and branch vessels of aortic arch respectively in AW4.2 work station. CHESS statistical software was used to analyze data. Results The aortic diameter above coronary artery (CA) (D1), the level at origin of brachiocephalie trunk (BCT) ( D3 ), the halfway of the AA( D2 ), the level at origin of LCCA( D4 ) , the level at origin of LSA ( D5 ) and the level at distal origin of LSA ( D6 ) respectively are: ( 34 ± 5 ) mm; ( 33 ± 4) mm; ( 34 ± 5 ) mm; ( 30 ± 4) mm; ( 28 ± 3 ) mm; ( 26 ± 3 ) mm. The diameters of two level between the origin of BCT and RSA are ( 13. 1 ± 1.9) mm, ( 12. 8±2. 3) mm, respectively. The diameter of two level at LCCA is ( 8. 7 ± 1.5 )mm and ( 7. 9 ± 1. 0) mm respectively. The diameter of two level between the origin of LSA and L-vertebral arteryis (10.7±1.7) mm,(9.3±1.3) mm, respectively. Conclusion The data of the diameter and length of ascending aort and vasculature arising from the arch abtained by CT topography in Chinese volunteers are very useful for clinical practice.

Objective To evaluate aneurysm sac pressure monitoring during endovascular repair (EVAR)of abdominal aortic aneurysm. Methods From April 2006 to May 2007,12 patients with abdominal aorta aneurysm underwent endovascular aneurysm repair.The average max-diameter of the aneurysm WR8(5.83±0.95)cm.The sac pressure was monitored during the whole process of the operation.The correlation between the pressure and endoleaks and long-term outcomes was observed during follow-up.Results Before the stentgraft was delivered.sac pressure was equal to the systemic blood pressure in all the 12 cases.After the EVAR wag finished,the sac systolic pressure dropped by＞40% in 11 cases,among which sac blood pressure bropped by ≥50% in 7 cases.sac pressure did not change in 1 case.In all the 12 cases,pulse pressure diminished by＞30%,and＞75%in 6 cages.During the follow-up,there were no endoleaks and death.In 5 Cases.with sac systolic pressure drop＞50%,the max-diameter of the aneurysm decreased by 1.6～3.1 mm,while in one c88e,in which sac pressure had no change the postoperative maxdiameter of the aneurysm has increased by 3.2 nma. Conclusion Abdominal aorta aneurysm sac pressure monitoring during EVAR helps to predict the change of the sac pressure after EVAR,and to detect the endoleaks.

Objective To evaluate endovascular management for isolated iliac artery aneurysm (IIAA). Methods From May 1997 to Jan 2006, 15 IIAA cases underwent endovascular treatment, including 12 true aneurysms and 3 psudoaneurysms. There were 9 common iliac artery aneurysms (CIAA), 3 internal iliac artery aneurysms (IIAA) , and 3 external iliac artery aneurysms (EIAA). The average diameter was (5. 97?1. 49) cm (3. 5-9. 0 cm). IIAA was treated with metallic coils and CIAA/EIAA by stent-grafts. Results Unilateral internal iliac artery was preserved in 14 cases, and bilateral internal arteries were preserved in one case. Postoperative endoleak was found in 2 cases. There was no other major complications nor mortality. One case suffered buttock claudication because of internal iliac artery exclusion. The operation time was 1. 9?1. 1 h, blood loss was 126. 7?70. 1 ml. Patients were up and about after 2. 1?1. 1 d, hospital stay was 5.5?4.7 d. Conclusions Endovascular treatment is safe and effective for isolated iliac artery aneurysm. Internal iliac artery preservation and prevention of endoleak is of great importance.

Objective To study effect of parecoxib on sufentanil dosage and its analgesic effect in patients with laparoscopic radical resection of rectal carcinoma under combined anesthesia.Methods 120 cases patients diagnosed with rectal cancer and prepared to laparoscopic radical resection of rectal cancer were selected in Kailuan General Hospital, and randomly divided into experimental group and control group, 60 cases in each group, experimental group induced anesthesia with 40mg parecoxib sodium intravenous injection, while the control group were treated with normal saline, the postoperative dosage of sufentanil, analgesia pump using frequency and other indicators were detected at 6,12,24 and 48 h, and analgesic effect were observed.Results Compared with control group, in experimental group, postoperative dosage of sufentanil was less ( P <0.05 ) , analgesia pump pressing times and effective pressing numbers were fewer (P<0.05), VAS pain score was lower (P<0.05) and Ramsay score was lower (P<0.05) at each time point.Conclusion Parecoxib could reduce the dosage of sufentanil after laparoscopic radical resection of rectal cancer, and enhance the analgesic effect.

Objective To compare the relationship between the enzyme‐linked immunosorbent assay(ELISA) reagent and West‐ern blot(WB) confirmation reagent for analyzing the quality lever of human T‐cell lymphotropic virus(HTLV) detection reagent . Methods The WB confirmation reagent was used to detect anti‐HTLV antibody in 156 human serum samples of ELISA prelimina‐ry screening positive .The ELISA cut‐off value(optimal value) was selected by using the two‐graph receiver operating characteristics (TG‐ROC) analytical method .The two‐by‐two table analysis was constructed to analyze the consistency of results detected by the two methods ,moreover the McNemar test was used to evaluate the consistency of detection results .The quality level of HTLV de‐tection reagent was comprehensively evaluated .Results Among 156 serum samples of ELISA preliminary screening positive ,only 40 samples were positive by the WB confirmation ,and other 116 samples were negative .The sensitivity and specificity of ELISA de‐tection reagent obtained by TG‐ROC analysis were 97 .5% and 45 .7% respectively ,the TG‐ROC test also indicated that the detec‐tion results had significant difference between ELISA and WB(P<0 .05) .By adjusting the cut‐off value ,the sensitivity and specific‐ity of ELISA were increased to 88 .8% (parametric method) .In the comparison of the parametric method and the non‐parametric method ,the obtained areas under the curve(AUC) was 0 .923 5(parametric method) ,their results were basically consistent .Conclu‐sion Although above results indicate that the detection results of ELISA reagent are different from those of WB ,but adjusting the cut off value can increase its sensitivity and specificity ,thus increases the reliability of diagnosis result .

Aged ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Biopsy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gastroscopy ; Humans ; Stomach Neoplasms ; drug therapy ; pathology ; Time Factors

Objective To evaluate the feasibility of chimney technique during thoracic endovascular aneurysm repair(TEVAR) in aortic arch lesions. Methods The stent-graft was deployed covering super arch branch artery in arch lesions in case there was not enough landing zone. A chimney stent was put in the super arch branch artery. We retrospectively analyzed the data of this group, aiming at summarizing the indications, methods, results and complications of chimney technique. Results From August 2004 to August 2009, 27 aortic arch lesions were treated by TEVAR with chimney stent, male/female ratio was 25/2, average age was 67. 2 ±3. 8 years, including3 chimney stents for innominate artery, 11 chimney stents for left common carotid artery and 13 chimney stent for left subclavian artery. Type I endoleaks were encountered in 18. 5% (5/27) of this group by final angiogram. Left common carotid artery dissection was caused by puncture in one case. One patient died of respiratory failure. There was no postoperative stroke nor bleeding. Discharged patients were followed up from 3 to 60 months, averaging at 16. 8 months. There was one death from MI 4 years later. There was minor stroke and left subclavian artery chimney stent occlusion in one each cases during the follow-up. All endoleaks were sealed without stent migration. Conclusion Chimney technique improves the length of landing zone and decreases effectively the endoleak rate.