Objective To study blood supply by the internal mammary artery(IMA)for hepatic carcinoma and evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)via IMA. Methods 86 cases of hepatic cancer(HCC)fed by the IMA underwent TACE of the IMA.All of the patients had previously undergone several TACE for HCC.16 patients had undertaken percutaneous microwave coagulation therapy in addition to TAE.4 patients had a history of surgery for upper abdomen.Plain and enhanced CT and MRI scannings were performed before operation.Internal mammary arteriography was carried out during the interventional procedure to clarify the feeding range and then the superselected catheterization of the feeding branch was done with TACE.The IMA angiographic features,tumor location,clinical observation, laboratory tests,imageology were evaluated,and finally were correlated with the angiographic findings of the IMA.Results All lesions were massive type and located at the ventral aspect and subcapsular region of the liver:57 cases in segment 4,5,8,and 29 cases in segment 5,7,8.Recurrent HCCs were supplied by the right IMA in 80 cases,from the left IMA in 5 cases and with the bilateral IMA in 1 case.Lipiodol-TACE of the IMA for HCC can be performed without skin complications in cases of subselective catheterization.Conclusion Tumors located ventrally and superficially in the liver may recruit blood supply through IMA collaterals,often occurring in massive type of HCC after several times of TACE.TACE of IMA is safe and has become technically feasible in almost all patients,although cutaneous damage should be cautious during the interventional procedure.(J Intervent Radiol,2007,16:816-819)

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

According to the super-position principle of the reinforcement of biological activities, a series of novel E-substituted 2, 3-diaryl propenoic acyloxy phosphonate derivatives were designed and synthesized. And the structures of the target compounds were confirmed by IR, 1H NMR, 13C NMR and elemental analysis. Furthermore, the cytotoxicities of all compounds on A-549, SGC-7901 and EC-109 in vitro were evaluated by MTT assay, and some of them showed good antitumor activity. Among the active compounds, especially, the IC50 value of compound 3e was (12.7 ± 1.9) μmol x L(-1) against A-549 cells, similar to cisplatin [IC50 = (8.0 ± 1.5) μmol x L(-1)], compounds 3g and 3k had better inhibition effect on EC-109 cells growth, with the IC50 values of (9.5 ± 1.8) μmol x L(-1) and (11.5 ± 0.9) μmol x L(-1) respectively, and compounds 3i and 3k exhibited good cytotoxic property on A-549, SGC-7901 and EC-109, which were worth further investigation.
Antineoplastic Agents ; chemical synthesis ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; Drug Design ; Humans ; Organophosphonates ; chemical synthesis ; pharmacology

Objective To observe the influence of dexmedetomidine applied in combined acupuncture-medication anesthesia on vomiting after thyroidectomy. Method Seventy patients who were going to receive thyroidectomy were randomized into group A and B, with 35 cases in each group. Combined acupuncture-medication anesthesia [electroacupuncture at Hegu (LI4), Neiguan (PC6) and Futu (ST32) plus intravenous infusions of sufentanil citrate injection (0.3 mg/kg) 20 minutes before operation]was adopted in both groups. Group A was additionally intervened by constantvelocity micropump infusion of dexmedetomidine hydrochloride injection (0.5 mg/kg) within 10 minutes before operation and remaining 0.4 mg/kg/min during operation, while group B was intervened by infusion of normal saline 10 minutes before operation. The observer's assessment of awareness/sedation (OAA/S) scores at different time points[lying in bed for 5 minutes before operation (T0), before the beginning of the operation (T1), 30 minutes after operation (T2), 60 minutes after operation (T3) and at the end of operation (T4)] in the two groups were observed. The additional times and total dose of sufentanil during operation, the number of cases using esmolol and urapidil, and the number of vomiting cases occurred within 2 hours after operation and 2～24 hours after operation in the two groups were recorded.Result The additional times and total dose of sufentanil during operation in group A were significantly different from those in group B (P<0.01). The utilization rate of esmolol and urapidil were respectively 31.4％ and 14.3％ in group A versus 77.1％ and 65.7％ in group B, and the between-group differences were statistically significant (P<0.01). The incidence of vomiting within 2 hours after operation and 2～24 hours after operation were respectively 20.0％ and 17.1％in group A versus 54.3％ and 42.9％ in group B, and the between-group differences were statistically significant (P<0.01). The OAA/S scores at different time points (T1, T2, T3 and T4) in group A were significantly different from those in group B (P<0.01). Conclusion Dexmedetomidine applied in combined acupuncture-medication anesthesia can reduce the additional times and total dose of sufentanil during thyroidectomy, and it can reduce the incidence of postoperative vomiting as well.

OBJECTIVETo evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.

METHODSA total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles (PVA) in 9, and gelfoam particles in 6 cases.

RESULTSRenal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months (mean, 48 months). Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor). Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range.

CONCLUSIONTranscatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.

Adult ; Aged ; Arteriovenous Fistula ; therapy ; Embolization, Therapeutic ; Emergency Medical Services ; Female ; Humans ; Iatrogenic Disease ; epidemiology ; Low Back Pain ; etiology ; Male ; Middle Aged ; Radiography ; Renal Artery ; diagnostic imaging ; injuries ; Renal Veins ; diagnostic imaging ; injuries

BACKGROUNDDelayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a serious complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.

METHODSDuring a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.

RESULTSThe immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examination verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).

CONCLUSIONSInterventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technically possible, is a valuable alternative to TAE and surgical intervention for management of DMH.

Adult ; Aged ; Embolization, Therapeutic ; adverse effects ; methods ; Endovascular Procedures ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; adverse effects ; methods ; Postoperative Hemorrhage ; prevention & control ; Treatment Outcome ; Young Adult

The treatment of fracture has been greatly improved, but the incidence of nonunion is still high and which is a challenge that orthopedic clinicians. The treatment of nonunion has been the concern to the scholars. New technologys of surgical and non-surgical therapies continue to emerge, and achieve good clinical efficacy. In particular the development of non-surgical therapy has brought hope for non-invasive treatment of nonunion. This paper attempts to make a review of the status and progress of non-surgical treatment of bone nonunion which are more commonly used in clinical.
Bone Marrow Transplantation ; Bone Morphogenetic Proteins ; therapeutic use ; Fractures, Ununited ; therapy ; Genetic Therapy ; High-Energy Shock Waves ; therapeutic use ; Humans ; Transplantation, Autologous ; Ultrasonic Therapy

OBJECTIVETo evaluate the clinical value of the three-dimensional (3D) CT module of the flat-panel digital subtraction angiography (DSA) system.

METHODSA retrospective analysis was conducted among 278 patients receiving examination with rotational 3D-CT of INNOVA 3100 flat-panel DSA system. AW4.3-04 workstation was used to perform the 3D reconstruction and INNOVA CT reconstruction, and the imaging data were analyzed in comparison with the clinical results.

RESULTSThe 3D-CT of the flat panel DSA system displayed the conditions of cerebral aneurysms in 54 cases, cerebral arteriovenous malformation in 25 cases, and the intracranial conditions in 24 cases. The blood supply and tumor vessels were clearly displayed in 57 cases, and the effects of embolization and endovascular stenting were evaluated in 27 and 21 cases, respectively. The rotational 3D-CT was used to evaluate complete embolization in 24 cases, and failed to display the feeding arteries of small tumors in 11 cases. The vascular lesions, biliary tract lesions, and the occurrence of hemorrhage during interventional therapy were observed in 58, 5 and 25 cases, respectively.

CONCLUSIONThe 3D-CT module of the flat-panel DSA system can easily display abnormal vascular lesions and provide comprehensive anatomical information to facilitate interventional therapies and complication monitoring.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; instrumentation ; methods ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; Cerebral Angiography ; methods ; Cerebral Arterial Diseases ; diagnostic imaging ; pathology ; Female ; Hepatic Artery ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Intracranial Aneurysm ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Young Adult

Cysts ; therapy ; Embolization, Therapeutic ; methods ; Female ; Hepatic Artery ; Humans ; Liver Diseases ; therapy ; Male ; Middle Aged