Purpose: To study the incidence of new or worsened hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic stent shunts (TIPSS) and to identify periprocedural factors influeneing patients at risk. Materials and methods: Between March 1993 and March 1997, 264 patients were treated with TIPSS. 212 patients were possible to assess the development of encephalopathy comprising the wholersome study data, 148 men and 64 women with age ranging from 18 to 74 years old. All patients underwent more than 3 months of clinical follow-up (3~45 months). 118 patients (55.66%) were categorized as Child's class A, 69 patients (52.55%) as Child's class B, 25 patients (11.75%) as Child's C. The diametes of the stent were 8mm im 41(18.87%) patients and 10 mm in 171(81.13%). We analyzed the following factors: age, sex, Child's classification the degree of liver atrophy, TIPSS in emergency or not, and size, the curvature of the shunt tract, portacaval gradient (PCG) before and after TIPSS, embolization of the gactric varices, blood ammonia level, derection of portal vein flow detected with color Doppler imageng after shunt. Statistical methods were used with Student's test, X~2 test, rand sum tets, linear regression and correlation, and multeple limear regressin. Results: The overall incidence of nwe and worsened HE was 16.03% (33/212). Of these, 27 patients were claigced as minimal (grade Ⅰ) and 6 advanced (grade Ⅱ). By Child's classification, new or worsening HE was seen in 8.47% of class A, 11.59% of class B, 60.0% of class C. TIPSS- related HE was correlated to Child's classification (r=0.86). As regard to shunt siza, the HE rate of 8mm stent was 7.31% (3/41), 10mm stent was 17.54%(30/171), and the difference between the two groups wss statistically significance (P

Objective To investigate the feasibility of gadopentetate dimeglumine as contrast agent for arteriography and interventional procedures.Methods Nine patients received gadopentetate dimeglumine as contrast agent during interventional procedures. Gadopentetate dimeglumine was used in 2 patients with contraindications to iodinated contrast media. In addition to the standard injection sequences with iodinated contrast media, arteriograms were obtained after administration of gadopentate dimeglumine in seven patients. Diagnostic arteriographies were performed in thoracic aorta, common carotid artery, bronchial artery, intercostal artery, hepatic artery, iliac artery and uterine artery. The doses of gadopentetate dimeglumine used in this series were≤0.3 mmol/kg. Vital signs and arterial oxygen saturation were monitored during the procedures. The blood and urine routine examinations, the hepatic and renal functions tests were done after the procedure. Results There were no significant differences between the gadopentetate dimeglumine and the iodinated contrast media examinations for illustrating the main trunk of these arteries. Angiograms obtained with the iodinated contrast media appeared to be better than that of with gadopentetate dimeglumine for visualizing the distal branches of these arteries and the tumor stain. The interventional procedure was completed successfully in the two patients using gadopentetate dimeglumine alone. No patient suffered from complication related to the use of gadopentetate dimeglumine, and also no worsened renal function was shown after the procedure. Conclusions Diagnostic arteriograms can be achieved safely and successfully by using gadopentetate dimeglumine, especially in patients with allergy to iodinated contrast media and chronic renal insufficiency.

Objective To evaluate the safety and efficacy of the interventional techniques for the management of hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT).Methods Seven patients diagnosed with HAS after OLT were treated with interventional procedures. Three (patients) presented with biliary ischemic complications, 1 with hepatic abscess, and 3 with elevation of liver enzymes and bilirubin levels. Interventional techniques included transcatheter hepatic arterial thrombolysis with a low dose of urokinase (UK), and stent placement in the stenotic segment of the hepatic artery. All patients were followed up regularly by duplex ultrasound scan after discharge.(Results) HAS with over 70 % degree at the anastomosis was found in 3 patients. Complete occlusion of the proper hepatic artery was found in 4 patients, and the hepatic artery flow was re-established in these patients at 3 to 7 days after transcatheter hepatic arterial thrombolysis. However, an over 90 % degree of stenosis at the anastomosis was seen in 4 cases. Stent placement in the stenotic segment of the hepatic artery was performed successfully in 7 patients, and significant improvement of liver (function) was seen in these patients at 2 weeks after the procedures. No complications related to the procedure occurred. The 7 patients had a good clinical course with normal graft function during a mean follow-up of 9 months (4 to 18 months), and patent hepatic artery flow was identified by follow-up Doppler ultrasonography.Conclusion Transcatheter endovascular interventional techniques are safe and effective methods for treatment of HAS after OLT.

90%) of CA. The stenotic segments were dilated and stented during the same session. One patient with balloon expandable Palmaz stent placed in the proximal celiac artery, the another with 2 wallstents deployed in the CA trunk. The postprocedural arteriograms showed good dilation of the lesions with immediate improvement of CA blood flow. Follow-up Doppler ultrasound scans showed normal flow patterns in the CA. Three months after the procedures, their upper gastrointestinal symptoms had resolved and regained body weights. They remained well and free of symptoms, at 16 months and 26 months follow-up, respectively, after the procedure.Conclusions CA stenosis can successfully be treated with angioplasty and stenting.

Intracerebral hemorrhage is a disease with high mortality and morbidity. This article discussed the application of magnetic resonance diffusion tensor imaging for intracerebral hemorrhage clinical research, and its limitations and prospect.

OBJECTIVE: To evaluate the effect of aural/oral rehabilitation in the prelingual deaf children with cochlear implants, analyze the relationship between the age at the time of surgery and the rehabilitation effect, and explore the law of aural/oral rehabilitation in the prelingual deaf children after cochlear implantation. METHOD: Prelingual deaf children with cochlear implants were divided by age into 1.3-2.9 group (17 cases), 3.0-4.9 group(14 cases)and 5.0-7.9 group (26 cases). All the children were evaluated by CAP and SIR questionnaires 3 months, 6 months, 9 months and 12 months after the surgery. RESULT: The scores of CAP and SIR in different age groups were all increased with time after cochlear implantation. The score of CAP in 1.3-2.9 group rose the fastest, which was lowest at the end of the 3rd month and was highest at the end of the 12th month. There were no differences between the CAP scores of 1.3-2.9 group and 5.0-7.9 group in the later test. The score of SIR rose the fastest in 1.3-2.9 group, which was lowest at the end of the 3rd month and highest at the end of the 12th month and rose the slowest in 5.0-7.9 group, which was lower than the other groups at the end of the 12th month. CONCLUSION Within one year after cochlear implantation, the younger the age, the better the effect of aural/oral rehabilitation.
Child ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Deafness ; rehabilitation ; Humans ; Infant ; Postoperative Period ; Surveys and Questionnaires

Objective To assess the efficacy and safety of interventional techniques for the management of symptomatic portal vein (PV) and superior mesenteric vein (SMV) thrombosis. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic (TIPS) approach. Contrast PV SMV venography was carried out to verify the access to the PV branch. Then a 8F large bore catheter was used to aspirate thrombus. A J shaped guide wire and pig tail catheter were used to fragment the thrombus. Local thrombolysis with urokinase (UK) was delivered through a catheter in the SMV. An 4 French multiple side hole catheter was put into the SMV and UK was continuously infused for 3 to 13 days.Results The procedure was successful in all cases. One patient died of intra abdominal sepsis 12 days after. Five patients were followed up by color Doppler ultrasonography for 4～36 months with confirmed patency of the PV and SMV in all these patients. Conclusions This procedure is both safe and effective in the treatment of symptomatic PV and SMV thrombosis.

Objective To evaluate interventional techniques for the management of splanchnic artery areurysms. MethodsThere were 11 cases including splenic artery aneurysm in 5 cases, gastroduodenal in 5, and superior mesenteric artery (SMA) aneurysm in 1. Five patients presented with ruptured pseudoaneurysms and bleeding. Three patients presented with abdominal pain and epigastric pulsatile mass. Three patients were asymptomatic. Transcatheter endovascular coil embolization was used in 10 patients. Combination of the endovascular embolization and stent-graft placement in the SMA was performed in 1 patient with SMA areurysm. ResultsTechnical success was achieved in all cases with no significant complications. Hemostasis was achieved in all 5 patients. One patient was cured by combination of stenting and endovascular coil embolization. An average follow-up of 25.5 months in 11 cases revealed no complications. Doppler ultrasound scan showed complete thrombosis and occlusion of these aneurysms. ConclusionsTranscatheter endovascular interventional techniques are safe and effective methods for the treatment of splanchnic artery areurysms.

Objective To analyze the effect of interventional treatment in patients with swelling hand syndrome.Methods 100 patients with maintained hemodialysis were enrolled in this study (49 male,51 female).Upper limb swelling involved the dialysis was examined with a course of 1 week to 36 months.Before intervention treatment,stenosis or occlusion of the brachiocephalic vein or subclavian vein were found in 95 patients diagnosed by CTA.Angiography was performed through the affected side of the upper limb.Then a balloon pre-dilatation of the stenosis or occlusion was performed,followed by balloon dilatation or stent molding treatment through the femoral vein.Results Percutaneous transluminal angioplasty or stent angioplasty was performed in 87 patients without severe complications,while treatment was failed in 13 cases.Swelling was gone in 85 patients 2-5 days after surgery,and persistent symptom was observed in 2 cases.All the 87 patients were followed up from 2 to 46 months after interventional treatment,one patient died of cancer after 14 months.Relapsed symptom of swelling hands was found in 20 patients and interventional therapy was performed again.Conclusion Swelling hand syndrome is common in maintained hemodialysis patients due to the stenosis or occlusion of central vein involved the dialysis side.Interventional treatment is a safe and effective procedure.

Objective:To investigate the effect of serum cystatin C level on the occurrence and its long-term prognosis of contrast agent-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in elderly patients.Methods:A total of 848 elderly patients(≥60 years)undergoing PCI in our department between Mar 2015 and Dec 2017 were enrolled in a prospective cohort.The CI-AKI was defined as the increase of serum creatinine ≥44.2 μmol/L within 48-72 h after using iodine contrast agent or more than 25 % higher than base level within 48-72 h after PCI.A receiver operating characteristic curve was used to analyze the optimal cut-off value of Cystatin C for predicting CI-AKI after PCI.Patients were divided into 2 groups based on the optimal cut-off value of Cystatin C: the high Cystatin C group(Cystatin C ≥1.3 mg/L, n=178)and the control group(Cystatin C<1.3 mg/L, n=670). The differences in the incidence of CI-AKI after PCI and major adverse cardiac events(MACE)at 1 year follow-up were compared between the two groups.The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.Results:Of 848 patients receiving PCI, the incidence of CI-AKI was 9.4%.The incidence of MACE at 1 year after PCI was higher in the high Cystatin C group than in the control group(15.7% vs.9.3%, χ2=6.524, P=0.011). Cox regression analysis confirmed that the high baseline level of Cystatin C was the most independent predictive factor for MACE at 1 year of follow-up( HR=16.244, P<0.001). Conclusions:The high baseline level of Cystatin C(≥1.3 mg/L)is an independent risk factor for CI-AKI and is also the most important predictor for the occurrence of long-term MACE in elderly patients undergoing PCI.