Objective To assess long-term outcomes of electrocoagulation for treating varicose veins of the lower extremities. Methods A retrospective review was made on clinical data of 426 cases of varicose veins of the lower extremities treatd by electrocoagulation from October 1996 to October 2001.Postoperative follow-ups were carried out with clinic checkups or questionnaires.Results Of the 426 cases,follow-ups for 4~9 years(mean,5.8 years) were completed in 364 cases(500 limbs) and a loss to follow-up was encountered in 62 cases,the follow-up rate being 85.4%.The cumulative rate of recurrent varicose veins was 10.4%(52/500),in which the recurrent varicose veins were cured with sclerosing agents in 50 limbs and with re-operations in 2 limbs.The relief rate of sensation of heaviness and tension was 95.1%(309/325).Accompanying venous ulcers in 20 limbs healed up within 2~8 weeks.The incidences of subcutaneous hematoma and saphenous nerve injury were 0.8%(5/594) and 1.2%((7/594),) respectively.Skin burns happened in 5 limbs(0.8%,5/594). Conclusions Electrocoagulation for varicose veins of the lower extremities is proved to be a novel minimally invasive method,with advantages of safety,effectiveness,low costs,and short hospital stay.

Objective To compare electrocoagulation effects of three types of electrodes for varicose veins.Methods Twelve dogs(24 veins in hind limbs)were randomly divided into 3 groups with 4 dogs in each group:columnar electrode group,circular electrode group,and radial electrode group.Each dog's long saphenous veins were high ligated and electrocoagulated.The activated partial thromboplastin time(APTT)was measured and pathological examinations(HE and Weigert)were performed immediately following operation and on the 7th and the 14th postoperative day,respectively.The destruction depth and extent,residual vessels,and skin burn after electrocoagulation were compared among the three groups.Results One case of skin burn on the left hind limb occurred in the columnar electrode group.Immediately following the operation,the number of vessels that were destroyed beyond 50% of perimeter in the radial electrode group was 8,which was significantly higher than that in the columnar electrode group(3 vessels)and the circular electrode group(4 vessels)(Fisher's exact test,P=0.013 and 0.038),and the number of vessels that were destroyed deep to the meddle membrane in the radial electrode group was 1,which was significantly lower than that in the columnar electrode group(7 vessels)and the circular electrode group(6 vessels)(Fisher's exact test,P=0.005 and 0.020).On the 7th day after operation,there was no statistical difference among the 3 groups in the number of vessels with remnant area above 50% of the perimeter(?2=5.371,P=0.068).On the 14th day after operation,the number of vessels with remnant area above 50% of the perimeter in the radial electrode group(1 vessel)was significantly lower than that in the columnar electrode group(7 vessels)and the circular electrode group(6 vessels)(Fisher's exact test,P=0.005 and 0.020).There was no statistical difference among 3 groups in APTT immediately following operation and on the 7th and the 14th postoperative day(P=0.905,0.871,and 0.865).Conclusions Compared with the other two catheters,radial electrode has the largest destroyed area,the smallest remnant area of the vessel,and the lowest risk of skin burn.

Objective:To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis.Methods:In the study,42 cases of renal artery stenosis were treated with 52 renal artery stent implantation.Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney,ipsilateral kidney (renal) glomerular filtration rate (GFR),renal effective renal plasma flow effective renal plasma flow (ERPF),kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed.Results:The 52 cases of renal artery stent implantation were all successful.Preoperative ipsilateral GFR was significantly lower than that of normal side (t =-3.989,P =0.000);preoperative ipsilateral ERPF was significantly lower than the contralateral side (t =-4.926,P =0.000).On both sides,the overall FF values were equal (t =1.273,P =O.207).Postoperative ipsilateral renal GFR was increased,but there was no statistical difference (t =-1.411,P =0.164).Postoperative ipsilateral renal ERPF was increased significantly (t =-4.954,P =0.000),and FF lower (closer to the normal value (t =3.274,P =0.002).Postoperative side GFR was significantly reduced (t =2.569,P =0.000),the contralateral ERPF was significantly reduced (t =3.889,P =0.001),and FF had no significant change (t =-0.758,P =0.454).Postoperative side GFR was lower than that of the contralateral (t =-3.283,P =0.002) and postoperative side ERPF was still lower than that of the contralateral (t =-3.351,P =0.001),but on both sides,the FF values were equal (t =-0.361,P =0.719).Preoperative FF was relatively normal in the patients with kidney,and the postoperative FF value change was small (t =O.799,P =O.430);preoperative FF was significantly higher in the patients with kidney,and the postoperative FF value was lower than the preoperative (normal value,t =5.299,P =0.000).Postoperative overall serum creatinine was significantly decreased (t =2.505,P =0.016);but for the patients with unilateral renal artery stenosis,the changes in serum creatinine had no statistical difference (t =1.228,P =0.299);and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative,the changes were decreased significantly (t =2.518,P =0.030);postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t =8.945,P =0.000);antihypertensive drugs taken were decreased significantly compared with the preoperative (t =5.280,P =0.000).Conclusion:For the patients with renal artery stenosis,FF is a useful index to understand the pathophysiological process of renal ischemia.Whether preoperative FF is significantly increased or FF is relatively normal,should be regarded as the indications of renal artery stent implantation.

BACKGROUND: Nerve growth factor (NGF) is characterized by poor stability both in vitro and in vivo, and liable to lose its bioactivity.OBJECTIVE: To study the stability of liposome-encapsulated NGF injection preserved under various conditions.DESIGN: A controlled study of liposome-encapsulated NGF.SETTING: Department of Surgery of the First Affiliated Hospital of Nanjing Medical University.MATERIALS: This study was carried out at the Central Laboratory of the First Affiliated Hospital of Nanjing Medical University between July 2002and March 2004. NGF from rat submaxillary gland was purified, encapsulated by liposome, and prepared into lyophilized dosage form before preserved under different conditions (at 4 ℃, room temperature, 40 ℃ or 40 ℃ with saturated humidity, respectively).METHODS: Chicken embryo dorsal root ganglion cultured in serum-free medium was used to evaluation the bioactivity of NGF in vitro. The dorsal root ganglion from 8-day-old chicken embryo was inoculated in a polylysine-coated 24-well culture plate and cultured in Dulbecco modified Ea-gle medium (DMEM) containing different testing samples. Only DMEM was used for culture in the negative control group, while DMEM containing NGF at different concentrations used in the positive control group. The ganglion was cultured at 37 ℃ with 50 mL/L CO2 and saturated humidity for 24 hours, and the growth of the nerve fibers was observed under an inverted microscope. The bioactivity of NGF was also evaluated in simulated condition in vivo by adding lyophilized liposome-encapsulated NGF and positive control NGF specimen into 0.5 mL rat serum, which, along with the blank control serum, was added into 2.5 mL DMEM at 0.5, 1, 2, 3, 4,6 hours and thoroughly mixed. The bioactivity of NGF was assessed accord-ing to the length and density of the dorsal root ganglion and graded the prominences (recorded as "++" or "+++ "), and very long and dense growth of the prominences (++++).MAIN OUTCOME MEASURES: In vitro bioactivity of NGF preserved for 10, 30, 60, and 90 days by testing the growth of cultured chick embryo dorsal root ganglion in serum-free DMEM and in test of rats serum containing NGF added at 0, 0.5, 1, 2, 3, 4, and 6 hours into DMEM.RESULTS: Lyophilized liposome-encapsulated NGF exhibited stable bioactivity (+++) after preservation at 4℃ and room temperature for 10-90days; at 40 ℃ for 10-60 days, the it retained its the bioactivity (+++),which, however, slightly decreased by 90 days (++); its bioactivity was preserved (+++) at 40 ℃ with saturated humidity for 10 days (+++), slightly decreased at 30-60 days (++) and noticeably lowered (+) at 90 days. When preserved for 0, 0.5, 1, 2, and 3 hours in rat seum, the NGF preparation retained stable bioactivity (++++ or +++), which slightly decreased at 4 hours and 6 hours (++).CONCLUSION: Liposome-encapsulated NGF has stable bioactivity but its preservation at relatively high temperature with high humidity is difficult.Lyophilized liposome-encapsulated NGF exhibits better bioactivity than NGF-liposome suspension after preservation under various conditions.

Objective To evaluate the outcomes of open reduction and internal fixation of complex tibial plateau fractures with improved three combined approaches.Methods In the period from July 2014 to February 2016,7 complex tibial plateau fractures underwent surgical treatment.These patients included 5 male and 2 female,aged from 24 to 68 years old (average,39.7± 15.3 years).According to Schatzker classification,they were all of type V.And all of type 41B-3.1 by AO/OTA classification.All these fractures were exposed and reduction via three combined approaches.First let the patients lied in lateral prone position,expose the anterolateral and the posterolateral of the tibia1 plateau,and fix the fractures of the posterior in the posterolateral approach,then fix the fractures of the lateral in the anterolateral approach.Then turn the patients to supine position,fix the fractures of the medial in the anteromedial incision.All patients received regular reexamination.The knee function was evaluated at the final follow-up using The Hospital for Special Surgery (HSS) score,the activity of the knee was evaluated by Lysholm score,and the stability of the knee was checked by Lachmantest and Pivot-shift test.The tibial plateau angle,the posterior slope angle and Rasmussen X-ray score were assessed on the X-ray films.Results The average time of operation is (3.3±0.9) h,and the hemorrhage volume in operation was (341± 106) ml for the 7 patients.The wounds of 6 patients healed by (11.8± 1.3) days,while the wound of the rest one of them occurred fat liquefaction after operation who is very fat (BMI ＞ 30) and suffered from diabetes.His wound healed by 21 days.These patients obtained follow-ups of 8 to 14 months (average,11.4±2.8 months).The average full weight-bearing time was 2-3 months (average,2.5±0.4 months).The fractures healed after 8 to 16 weeks (average,11.1 ±2.8 weeks).No displacement of the fractures or breakage of the implants occurred in our series.Nobody has activity limitation of the knee or pain because of the implant,and no never symptoms were noted postoperatively,so we would not take out the implant for these patients.The mean HSS score was 93.1±4.8 (range,from 85 to 100) at the final follow-up,and the excellent rate is 100％.The Lysholm score was 97.1±3.6 (range,from 90 to 100) at the final follow-up.The Lachman test and the Pivot-shift test were negative in our patients,and the mean knee flexion was 128.6±12.8°(range,from 105°to 140°).The fractures were all anatomical reduction by the X-ray after operation,and there had being no displacement of the fractures or breakage of the implants occurred during the follow-up period.The mean posterior slope angle was 8.29±2.87° (range,from 4 °to 12°),which was 8.71±2.63° (range,from 5 °to 14°) 6months after operation.The mean tibial plateau angle was 86.00± 1.41° (range,from 84 °to 88°),which was 86.43± 1.62° (range,from 84 °to 89°) 6 months after operation.The mean Rasmussen X-ray score was 16.86±1.57 (range,from 14 to 18),which was 16.57±1.51 (range,from 14 to 18) 6 months after operation,and the excellent rate are 100％.Conclusion For the complex tibial plateau fractures which simultaneous involved the medial,the lateral and the posterior,the improved three combined approaches showed the advantages of the convenient operation,the satisfactory results of reduction and fixation,and the less trauma and secondary damage,and could be worth for clinic.

Objective To analyze retrospectively the effect on patency of arterial bypasses combined with arteriovenous fistulae in patients with poor run-off. MethodsA retrospective analysis was made based on twenty-six patients with severe lower extremity arteries ischemia and poor run-off, undergoing arterial bypasses combined with arteriovenous fustulae. ResultsAmong the 28 diseased extremities in 26 patients,14 cases received bypass combined with deep arteriovenous fistulae(saphenous vein),and twelve underwent operations combined with superficial arteriovenous fistulae(popliteal vein,tibialis posterior vein).The short term patency rates in these two groups were both 78.6%.The two year′s patency of the bypasses combined with deep fistulae was 78.6%,that of combined with superficial fistula was 57.1%.ConclusionsArtery bypasses combined with arterovenous fistulae could improve the patency rates of the synthetic grafts in patients with severe lower extremity arteries ischemia and poor run-off.

ObjectiveTo compare two treatment methods for acute iliofemoral vein thrombosis:c atheter-directed pharmacomechanical thrombolysis (CDPT,47 cases) and intervention combined surgicaltherapy( IST,14 cases).MethodsThis study includes 61 patients of acute iliofemoral vein thrombosis treated by CDPT or IST.All discharged cases were followed up by telephone for a period of 14 -37 months.ResultsAmong the 61 patients (64 extremities),47 (forty-seven extremities) treated by CDPT,and 14 cases (seventeen extremities) treated by IST.The IST group included three patients of bilateral iliofemoral vein thrombosis,five patients on postoperative status within one month,and three patients in which the iliofemoral vein was not accessible.When discharged from hospital,the effective rate of edema relief is 93.6％ in CDPT group while that is 94.1％ in IST group; Melena occurred in one patient of CDPT group and incision hematoma occurred in one patient of IST group.According to the results of 14 -37 months follow-up,the effective rate of edema relief is 85.0％ in CDPT group while that is 85.7％ in IST group ( x2 =0.004 and the P =0.948).Calf pigmentation occurred in only one patient of CDPT group.The patency rate of vein by BUS examination is 52.6％ in CDPT group while that is 84.6％ in IST group x2 =4.157,P =0.041 ).ConclusionsComparing with CDPT group,IST group has the similar effective rate of edema relief,but has higher patency rate of iliofemoral vein.In case of bilateral acute iliofemoral vein thrombosis,in patients in whom thrombolysis is contraindicated,or when the iliofemoral vein is not accessible,IST is the treatment of choice for acute iliofemoral vein thrombosis.

Objective To study the clinical characteristics and treatment strategy for isolated dissection of the superior mesenteric artery (SMA).Methods Clinical data of 19 consecutive patients with IDSMA were retrospectively analyzed.There were 15 men and 4 women.The mean age was 56 ± 12 (41-84) years old.Fifteen patients presented with abdominal pain and 4 patients had no symptom.The dissections were diagnosed by contrast-enhanced computed tomography in 18 patients and ultrasonography in 1 patient.Results The dissections were located at the anterior wall of the curvature part of the SMA in all 19 patients.Asymptomatic patients underwent conservative management.One asymptomatic patient with aneurysmal dilation was managed by stent and the 15 symptomatic patients underwent endovascular management.During the mean 7-46 (21 ± 10) months follow-up period,all patients were asymptomatic with patency of SMA.Conclusions The dissection was located at the anterior wall of the curvature part of the SMA.Conservative management can be applied to the asymptomatic patients.For symptomatic patients without intestinal necrosis or artery rupture,stent implantation is recommended,and the curvature of SMA should be covered completely.Endovascular spasmolysis is helpful in relieving pain.

Objective To evaluate the technique of selective portal vein embolization before hepatectomy and its value in the preparation of major hepatic resection for those with insufficient future remnant liver.Methods From Jan 2008 to July 2012,6 patients who suffered from hepatic tumors underwent selective ipsilateral portal vein embolization (PVE) due to insufficient future remnant liver volume (FRLV) before second-stage major hepatic resection.Results Technically,all six PVE were completed successfully with only minor liver function damages.The average FRLV increased from (474.33 ± 89.19)cm3 to (722.67 ± 151.51) cm3 (t =-5.587,P =0.003).The average tumor burden (total tumor volume)increased from (134 ± 181) cm3 to (270 ± 346) cm3 (t =-1.64,P =0.16).Five cases underwent secondstage major hepatectomy 6 weeks after PVE,while in 1 case a resection attempt was abandoned because of uncontrolled tumor growth during the period.During the follow-up period (median 37 months),1 died,4 survived,2 were tumor-free.Conclusions Selective portal vein embolization is a safe and effective method to induce hepatic hypertrophy in the appropriate clinical setting.Before PVE,hepatic tumor should be controlled beforehand with chemotherapy or TACE to ensure the scheduled second-stage hepatectomy.

Objective:To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC Ⅱ( trans-atlantic inter-society consensus Ⅱ) C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans. Methods:One hundred and three patients(119 limbs) accepted bypass surgery or endovascular therapy for TASCⅡC/D femoropopliteal artery lesion between January 2002 and Decem-ber 2012 at our institution were retrospectively assessed. All the patients were diagnosed with arterioscle-rosis obliterins, and all their Rutherford classifications were from 2 to 5 degrees. Among them there were 71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery. We evaluated the short term clinical effect according to the condition when patients left the hospital, and evaluated the long term clinical effect according to the results of the patients' latest follow-up in 2014. Their clinical data before treatment, complication rates, death rates, hospital stays, short term and long term effects, reoperation rates, 1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared. Results:There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment [(67. 1 ± 7. 1) years (51 to 80 years) vs. (68. 0 ± 9. 4) years (49 to 91 years),P=0. 561;(0. 41 ± 0. 23) vs. (0. 40 ± 0 . 26 ) , P=0 . 928 ] . There were more TASCⅡD patients in the bypass group than those in the endovas-cular group ( P<0 . 001 ) , and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant[(41. 7 ± 23. 6) months vs. (59. 5 ± 41. 6) months,P =0. 065]. Five peri-operative complication cases occurred in the bypass group, including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure, and only 1 complication case occurred in the endovascular group that was heart failure. The complication rate was higher in the bypass group than that in the endovascular group [10. 4% vs. 1. 4%, P=0. 039]. And there was no death in both the groups. Compared with the endovascular group, the bypass group had a longer hospital stays [(13. 2 ± 4. 7) d vs. (6. 5 ± 3. 1) d, P<0. 001],a higher reoperation rate (58. 3% vs. 31. 0%,P =0. 003), a better short term, obvious, and effective rate (25. 0% vs. 9. 9%, P =0. 027),a worse long term deterioration rate (37. 5% vs. 18. 3%,P=0. 019) and higher 1 to 10 years primary and secondary accumulative patency rates( P =0 . 001 , P=0 . 001 ) . There was no significant difference between the two groups on the increase of ankle brachial index[(0. 34 ± 0. 28) vs. (0. 31 ± 0. 23), P=0. 371], and short term and long term total ef-fective rates (89. 6% vs. 84. 5%, P=0. 426;45. 8% vs. 56. 3%, P=0. 260), and limb salvage rate (83. 3% vs. 94. 4%,P =0. 051). Conclusion:Endovascular therapy is a safe, effective and minimally invasive therapy for TASCⅡ C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.