Objective To summarize the experience of 40 patients with carotid artery stenosis treated by carotid artery stenting (CAS). Methods Endovascular plasty and stent placement were performed in 40 patients with carotid artery stenosis from October 2000 to July 2002. A total of 43 stents were placed into, comprising 39 WALLSTENT stents and 4 SMART stents. Out of the 40 cases, cerebral protection devices were used in 5 cases. Results The stent placement was completed successively in all the patients.Diameters of carotid artery all returned to 4mm or above.Mild intraoperative ischemic stroke occurred in 2 cases, and severe intraoperative ischemic stroke was found in other 2 cases: visual field loss of the left eye in 1 case, with after-effects even 3 months after surgery; loss of consciousness and right hemiplegia in 1 case, whom was cured to full consciousness subsequently. The complication rate was 10% (4 of 40) and the rate of severe ischemic stroke was 5% (2 of 40). No complications were seen in patients with cerebral protection devices. Conclusions CAS is effective in the treatment of carotid artery stenosis. Carotid stenting with cerebral protection devices may further ensure the patients' safety.

Objective To evaluate hybrid therapy in patients with complex arteriosclerosis obliterans.Methods From Sep 2006 to Oct 2011,66 patients with complex arteriosclerosis obliterans were treated by hybrid therapy.A retrospective review was performed in all cases.Primary patency rate analyses were performed using Kaplan-Meier life tables.Results The technical success rate was 100％,and no patients died in perioperative period.12.1％ patients improved 3 levels,22.7％ patients improved 2 levels,and 65.2％ patients improved 1 level in Fontaine grade after procedures.The average ABI before and after procedures were 0.38 and 0.67 (P ＜ 0.05).2 patients died and other 64 patients completed 24 months follow-up.The primary patency rates and second patency rates were 75.0％ and 92.2％ at 24 months respectively.Primary patency rates of Fontaine Ⅱ patients were better than Fontaine Ⅲ and Ⅳ patients (P ＜ 0.05),and primary patency rates of Fontaine Ⅲ patients were better than Fontaine Ⅳ patients (P ＜ 0.05).Conclusions Hybrid therapy procedures provide an effective treatment in complex arteriosclerosis obliterans patients.

Objectives To evaluate the safety and efficacy of endovascular angioplasty for extracranial vertebral artery ( VA ) stenosis caused by atherosclerosis. Methods We analyzed retrospectively data of the 24 patients with extracranial vertebral artery stenosis who had been placed endovascular angioplasty from April 2006 to March 2010. According to Mori classification, there were 21 type A and 3 type B among all cases.The artery stenosis rate was 60％ -95％ , the average was 79％ ± 10％. Results Twenty-four balloon mounted stents were placed, the successful rate was 100％. Postoperatively the stenosis rate decreased to 4％ ± 6％. Patients were followed up from 3 to 36 months, the average was 22 months. Symptomes disappeared in 15 out of 17 patients. Postoperative restenosis on the treatment site with transient brain ischemia occurred in one patient. The symptoms in another patient of multiple cerebral infarction with ataxia and episodic vertigo were not relieved, although the patient didn't suffer from apoplectic seizure after the intervention. Postoperative color Doppler ultrasound revealed an over 50％ residual stenosis in 5 patients. The postoperative restenosis rate was 20. 8％. According to Malek scoring, 22 patients were scored 1 point, 1 patient scored 2 and one scored 4. Conclusions Endovascular angioplasty with stent placement is a safe and effective treatment. The restenosis rate could be futher reduced by technology improvement.

Objectives To compare Doppler noninvasive vascular testing and computed tomographic angiography(CTA) with vascular angiography in the assessment of arteriosclerotic occlusion of the lower limbs. Methods In this study 97 lower extremities in 64 patients suffering from arteriosclerotic occlusion underwent both Doppler and CTA plus angiography. Angiogram results were taken as golden standard.The sensitivity and specificity of Doppler was calculated,the diagnostic accuracy of Doppler scanning and CTA plus angiography was calculated and compared.The statistic analysis was performed using x2 test in SPSS 16.0 format. Results Compared with CTA,Doppler scanning is equally accurate at the segments of iliac artery,common femoral artery,superficial femoral artery,dorsal pedis artery and posterior tibial artery (P ＞ 0.05).At segment of popliteal artery,Doppler scanning yields more accurate results (P ＜0.05 ). Conclusions Being noninvasive convenient and of good accuracy,Doppler examination has a role for the diagnosis of arteriosclerotic occlusion of the lower limbs.

OBJECTIVETo evaluate clinical outcomes of fixation for the treatment of radial head fracture with collapse of anterior articular surface.

METHODSFrom March 2006 to January 2013,17 patients with radial head fractures with collapse of anterior articular surface were analysed. According to the Mason classification, there were 12 cases with Mason type II fractures and 5 cases with Mason type III fractures. All the patients were treated with open reduction through posterolateral entrance of elbow joint and Herbert or titanium cannulated screw internal fixation.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 18 months, with a mean of 11.3 months. According to the Broberg and Morrey score system, 2 patients got an excellent result, 12 good and 3 fair. There were no complications such as infection of elbow joint, nerve injury, non-union, traumatic osteoarthritis, heterotopic ossification and elbow instability. However, the postoperative activity range of elbow in the injuried side was less than that in the normal side.

CONCLUSIONRadial head fracture with collapse of anterior articular surface is easily misdiagnosed, and it can be treated with open reduction and internal fixation through posterolateral entrance.

Adult ; Aged ; Elbow Joint ; physiopathology ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radius Fractures ; physiopathology ; surgery ; Range of Motion, Articular

Objective To investigate influence of dexmedetomidine on postoperative cognitive function in elder patients after hip re-placement surgery under spinal anesthesia. Methods Forty elderly patients with ASAⅠ~Ⅲ,undergoing hip replacement with spinal anesth-sia,were randomly divided into dexmedetomidine group( group A) and normal saline group( group B) ,with 20 patients in each group. Dexme-detomidine was given with 1 μg/kg after anesthesia and followed with 0. 5 μg·kg-1 ·h-1 in group A. The equal volume of normal saline was infused in group B. Cognitive function was evaluated before anesthesia,3 and 7 days after surgery by mini-mental state examination( MMSE) . The intraoperative concentration of TNF-α,IL-6,MDA were detected at the time of before surgery(T0),end of surgery(T1),3 days after sur-gery(T2),7 days after suegery. Results There was no significant difference in MMSE score before anesthesia between the two groups (P>0. 05). The difference of MMSE score at postoperative 3 days between two groups was statistical significance (P<0. 05). The MMSE score recovered normal in both groups 7 days later. There was no significant difference of TNF-α,IL-6,MDA concentration at T0 between two groups(P>0. 05). Compared with T0,the concentration of TNF-α,IL-6,MDA at T1,T2 in group B increased,the difference was significant. And the concentration of IL-6 at T1 in group A decreased,compared with that at T0,the difference was significant(P<0. 05). The concentra-tion of TNF-α,IL-6 at T1,T2 and MDA at T2 in group A were lower than those in group B,the difference was significant. (P<0. 05). Con-clusion Dexmedetomidine can decreased the concentration of TNF-α,IL-6,MDA,and improve the postoperative cognitive dysfunction of eld-erly patients who finished the hip replacement surgery under spinal anesthesia.

Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy for huge left hepatoma.Methods Nine patients with huge left hepatoma underwent hand- assisted laparoscopic hepatectomy including hepatocellular carcinoma(4 cases),intrahepatic cholangioearcinoma(1 case),hepatic metastatic squamous carcinoma(1 case),hepatic cavernous hemangioma(2 cases),and hepatic spindle cell tumor(1 case).The mean age was 45.3 years.AFP was positive in 3 cases and CEA was positive in 1 case.The preoperative liver function was Child-Pugh A in all patients.The procedure included dissection of left hepatic ligaments and portal triad clamping with Pringle's maneuver and hepatectomy.Results The laparoscopic procedures were completed safely in all patients including 6 left lateral segmentectomies and 3 left hemihepatectomies.There was no conversion to laparotomy.Mean surgical time was 111.7 minutes.Mean blood loss was 97.8 ml.Portal triad clamping was used in 8 cases and mean clamping time was 13.4 minutes.Neither formidable bleeding nor gas embolism occurred.There were no serious postoperative complications such as postoperative bleeding or bile leak or liver failure.Liver function recovered within 7 to 10 days.Preoperatively positive AFP and CEA turned negative after operation.The mean postoperative hospital stay was 8.4 days.Four patients with HCC underwent postoperative prophylactic hepatic arterial chemoembolization within the first postoperative month. All patients were tumor-free as evaluated by postoperative follow-up of 4～11 months.Conclusions Hand-assisted laparoscopic hepatectomy for huge left hepatoma is feasible and safe in appropriately selected patients.

Objective To evaluate the safety and efficacy of endovascular intervention to revise peripheral bypass problems through prosthetic approach.Methods Among 17 cases undergoing graft bypass anastomotic stenosis and graft thrombosis was identifled in 16 cases(inflow or outflow obstructive lesions in 10),inflow obstructive lessions in 1(without anastomotic and graft thrombosis).All revision procedures were taken under local anesthesia,16 patients were treated by means of surgical thrombectomy followed by endovascular intervention through prosthesis itself in addition to one who had no thrombectomy.The graft patency and clinical outcome were observed.Resuits Thirteen stents were implanted in 13patients with distal anastomotic stenosis and 1 with proximal anastomotic stenosis including 10 stentings/PTAs in iliac popliteal,posterior tibial or anterior tibial arteries.One stent was implanted in 1 patient with common femoral stenosis.Stenting were not used(abandoned)in 2 patients,of which one underwent a foot amputation and calf gangrene occurred a week later,and the other had a redo of grafting.Follow-up time is 1-35 months.with an average of 12±4 months.One had a below-knee amputation two months after intervention,the other had symptoms recurred and treated with a redo 3 months afterwards.the third died of myocardial infarction six months later.Grafts remained patent in the rest 13 patients at follow-up.Conclusions Endovascular intervention through prosthesis is a safe and effective method,which offers an alternative means to treat anastomotic stenosis.inflow or outflow obstructive lesions.

OBJECTIVETo introduce the procedure of carotid stenting, and to summary experiences of 55 cases. To study the theory and clinical significance of carotid stenting for carotid artery stenosis.

METHODSFifty-five patients with severe carotid atheromatous stenoses were treated by stent implantation. Fifty-eight stents were implanted. Forty-one of these stents were Wallstent, 14 were Smart stents and 3 were OptiMed stents. Cerebral protection device was furnished for 18 patients.

RESULTSDuring operation, there were 2 cases of small stroke and 2 cases of major stroke. One patient suffered from left eye area deficit, who had a little signs after 3 months. Another patient had consciousness loss and right-side paralysis and had a recovery in consciousness after salvage. The incidence of nervous system complications was 6.9%. Serious stroke rate was 3.5%. The incidence of circulatory system complications was 10.3%. Those patients who received cerebral protection device did not have nervous complication.

CONCLUSIONCarotid stenting is effective for the treatment of carotid artery stenosis. The experienced surgeon can make this procedure safe. The procedure's safety is enhanced by using cerebral protection device.

Aged ; Angioplasty, Balloon ; adverse effects ; methods ; Carotid Stenosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; etiology ; prevention & control ; Stents ; Treatment Outcome

Adult ; Arnold-Chiari Malformation ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged