Objective To explore CTA characteristics of diabetic lower extremities arterial disease (LEAD) with different Fontaine stage.Methods Data of 100 patients clinically diagnosed as diabetic LEAD and underwent lower limbs arterial CTA were analyzed retrospectively.The patients were classified into grade Ⅰ-Ⅳ according to Fontaine classifications.Lower extremities arteries were graded according to CTA.Stenosis degree of lower extremity arteries in different Fontaine stages were analyzed.Results The grades of lower extremity arteries stenosis in different Fontaine stages had statistically significant difference (x2 =186.24,P＜0.001).There had statistically significant difference of stenosis degree in different lower extremity arterial levels among different Fontaine stages (superior genicular artery:x2 =69.24,P＜0.001;inferior genicular artery:x2 =111.59,P＜0.001;dorsalis pedis and arteriae plantaris:x2 =94.15,P＜0.001).Grades of stenosis between superior genicular arteries and inferior genicular arteries,superior genicular arteries and dorsalis pedis and arteriae plantaris had statistically significant differences (Z=12.59,P＜0.001;Z=10.47,P＜0.001).There was statistically significant difference of stenosis grades between inferior genicular artery and dorsalis pedis and arteriae plantaris (Z=12.66,P＜0.001).Occluded inferior genicular arteries usually associated with collateral vessels.Conclusion CTA can reflect the clinical stages of LEAD,which is the ideal method in diagnosing of diabetic LEAD.

Objective To study the value of MSCT angiography(MSCTA)in diagnosing lower extremities arterial disease (LEAD) of diabetic foot ulcers and analyze the possible influential factors on the onset of diabetic foot ulcers.Methods 80 diabetic patients for MSCTA examination were divided into two groups by whether combined with foot ulcers.The tibial artery calcification score (TACS) and peripheral arterial occlusion index (PAOI) were calculated and the possible risk factors of diabetic foot ulcer were analyzed.Results There were 30 cases suffered with foot ulcer and 18 cases occurred lower extremity arterial occlusion (LEAO), the average PAOI was 4.40(3.60, 5.75).Non-foot ulcer cases were 50, and there were 8 cases suffered with LEAO, the average PAOI was 2.05(1.43, 3.10).Compared to patients without foot ulcer, patients with foot ulcer were older, had a lower BMI, and were more likely to have a history of tobacco use.They usually had higher TACS and severer peripheral arterial occlusive disease (PAOD).Stepwise regression model showed that foot ulcers had significant correlation with TACS and PAOI.Partial correlation analysis showed TACS was independent from PAOI in impacting diabetic foot ulcer.Conclusion MSCTA has important clinical value in diagnosing and valuing diabetic foot ulcer LEAD.Age, smoking history,BMI,TACS and PAOI affect the incidence of diabetic foot ulcers, and TACS and PAOI are the independent risk factors for diabetic foot ulcers.

OBJECTIVE: To explore the diagnostic role of computed tomographic dacryocystography (CTDCG) in lacrimal path damage and provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy (DCR). METHOD: Twenty-eight cases with lacrimal path damage underwent CTDCG. The following reconstruction techniques including volume rendering (VR), multiple planar reconstruction (MPR), maximum intensity projection (MIP) and three-dimensional reconstruction (3-d R) were done on the real-time workstation. The morphology of dacryocyst, displacement fracture of the lacrimal fossa (FS) and the relationship between the uncinate process (UP) and the FS were observed. The thickness of inner walls of anterosuperior and posteroinferior aspects of lacrimal fossa was measured. RESULT: The morphology of dacryocyst, the displacement fracture of the lacrimal fossa and the block site of the lacrimal passage could be displayed clearly by CTDCG with the following reconstruction techniques including VR, MPR, MIP and 3-d R, 6 cases of canaliculus obstruction, 14 cases of lacrimal sac obstruction, 8 cases of lacrimonasal duct obstruction were showed. Meanwhile the relationship between the UP and the FS could also be showed clear. The average bony thickness of the anterosuperior part of FS was (2.96 +/- 0.30) mm, while the bony thickness of the posteroinferior half was (0.02 +/- 0.005) mm, and the distance between the top and bottom of dacryocyst to the operculum of the middle turbinated (OMT) are (6.80 +/- 1.50) mm, (4.00 +/- 1.80) mm respectively (P < 0.05). CONCLUSION The morphology of dacryocyst, the displacement fracture of the lacrimal fossa, block site of the lacrimal passage and the relationship between the UP and FS can be clearly displayed by CTDCG, which provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy.
Adolescent ; Adult ; Dacryocystorhinostomy ; Endoscopy ; Female ; Humans ; Lacrimal Apparatus ; diagnostic imaging ; injuries ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods ; Young Adult

Objective To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy (EST) combined with large balloon dilation for bile duct stones.Methods A total of 83 patients with common bile duct stones were randomly divided into 2 groups to receive standard EST (n =41,EST group) or EST plus large balloon dilation (n =42,EPLBD group),respectively.The number of endoscopic session,operation time,rates of successful complete stone retrieval,mechanical lithotripsy,and procedure related complication were compared between the two groups.Results The rate of early procedure-related complications was similar in 2 groups (9/41 vs.7/42,P ＞0.05),including perforation ( 1/41 vs.0/42,P ＞0.05),bleeding (5/41 vs.2/42,P＞0.05) and pancreatitis (3/41 vs.5/42,P＞0.05).The rate of successful complete stone removal was also similar in 2 groups (39/41 vs.41/42,P ＞ 0.05 ).However,EST group needed more procedure time (38.8 ±4.3 min vs.29.2 ±5.3 min,P ＜0.01 ) and use of mechanical lithotripsy to achieve complete stone removal (9/41 vs.2/42,P ＜ 0.05 ).Only one patient in EPLBD group ( 1/42,2.4％ ) needed a second ERCP to clear bile duct stone,while in EST group,8 patients underwent a second procedure ( 19.5％,P ＜ 0.05 ).Conclusion For endoscopic removal of common bile duct stones,EST combined with larg4e balloon dilation is as safe and effective as EST,while easier in manipulation.

Background and purpose: Carcinosarcoma of the lung is a rare malignant pulmonary neoplasm,which including epithelial and parenchymal malignant structure with a poor prognosis. The purpose of this study was to describe the clinicopathologic characteristics and the survival of pulmonary carcinosarcoma. Methods: From Jan.1980 to Dec. 2006, 64 patients with pulmonary carcinosarcoma who underwent surgical treatment were retrospectively analyzed. Results: The overall 5-year survival rate of the patients was 14.1%. There was significant difference between stage Ⅰ/Ⅱ and stage Ⅲ/Ⅳ disease (28.6% vs 2.8%, P=0.003), respectively. The 5-year survival rates of lobectomy, pneumonectomy and palliative resection were 3 3.3 %, 2.8% and 0% ( P=0.003 ), respectively. Conclusion:p-TNM and operative pattern were correlated with survival. Early diagnosis and radical operation are important to the survival of the patients with pulmonary carcinosarcoma.

Objective To investigate the correlation between lower extremity CTA and ankle brachial index (ABI) of the diabetic lower extremity arterial disease (LEAD),and to study the difference of the examination methods.Methods 80 patients of clinical diagnosed with diabetic LEAD that underwent CTA check were enrolled.The indexes of ABImax,ABImin,ABIave and lower limb atherosclerosis integral (LEAI) of the 80 patients were calculated respectively,and the relationship and correlation were analyzed between ABI and LEAI in different degree of lower extremity arterial calcification.Results ABI index of 58 (58/80) cases could be determined,with an average of 0.87.CTA results displayed that below-the-knee artery had a high incidence of atherosclerosis.According to the degree of arterial calcification,non-calcified in 4(4/58) cases,mild in 20(20/58),moderate in 10(10/58),and severe in 24(24/58).The patients with moderate and severe calcification,means the arterial calcification,had lower ABI (P =0.001),higher LEAI (P ＜ 0.001),and higher pressure of brachial artery(P =0.03).There was weak correlation between ABImax and LEAI(r =-0.48) and the best correlation between ABIave and LEAI(r=-0.59).The correlations between ABI and LEAI of non calcified cases were better than that of calcified ones.Conclusion ABI monitoring of diabetic LEAD has some limitations.Diabetic lower extremity artery CTA has important clinical value that can accurately assess the degree of arterial calcification and occlusion.