Isolated superior mesenteric artery dissection (ISMAD) is a clinically common disease,of which multi-slice spiral computed tomography (MSCT) is effective method for screening and follow-up.The diagnosis and treatment should be made based on pathological changes of true or and false lumen.Most patients can relieve by medical treatment,and those with treatment failure can adapt endovascular treatment.Patients with aneurysm rupture or intestinal necrosis should undergo emergent surgical treatment.

Neuroendocrine tumor liver metastases (NETLM) is a uncommon advanced tumor disease.Patients with unresectable NETLM have a poor outcome.The management of unresectable NETLM is a clinical dilemma.However,Yttrium-90 radioembolization is a safe and effective treatment for NETLM patients.The median disease control rate is 87.1％ (64.7％ ～ 100％);the median overall survival time is 34.4 months;and the median overall survival rate of 1,2,and 3 years are 79.8％ (63％～100％),62％ (57％ ～62.5％),45.5％ (45％ ～ 46％),respectively.Although there is good result of Yttrium-90 radioembolization in treatment of unresectable NETLM,the safety and effectiveness should be further verified.

Colorectal liver metastasis (CRLM) is a common liver metastatic tumor with poor prognosis.It was very difficult to treat patients with unresectable and chemotherapytolerant CRLM.With the tumor control rate ranging from 63％ to 78％,Yttrium-90 is both safe and effective in treating unresectable and chemotherapy-tolerant CRLM.The median survival time is 10.5 months,and the 1-,2-,3-year overall survival rates of patients are 44％,20％ and 14％ respectively.For a certain portion of patients,Yttrium-90 has distinct advantages over mo lecular targeted drugs and other local minimally invasive treatment.Though Yttrium-90 treatment has showed certain curative effect,its safety and effectiveness require further confirmation through multi-center randomized controlled trial.

Hepatocellular carcinoma with portal vein tumor thrombus (PVTT),an advanced stage of disease,is common.Patients who have hepatocellular carcinoma (HCC) with PVTT have a poor outcome.The management of HCC with PVTT is a clinical challenge.Although many treatment options are available,there are currently no consensus or guideline on optimal management of HCC with PVTT.To improve understanding of the two guidelines published recently,we compared the similarities and differences between them.

Tumor lysis syndrome (TLS) results from a sudden and rapid release of nuclear and cytoplasmic degradation products from malignant cells. It is a rare complication in adult patients with solid tumors who are undergoing treatment. Herein, the authors present a case with advanced hepatocellular carcinoma (HCC) who developed TLS after transarterial chemoembolization (TACE), which was successfully treated with aggressive fluid administration, oral allopurinol and urine alkalization, hemodialysis and other supportive therapies. TLS following TACE should be suspected in HCC patients who has large and rapidly-growing lesion.

Objective To investigate the expression and correlation of serum hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) level pre-and post-transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer (PLC) .Methods Expression of serum HIF-1α and VEGF were studied in 40 patients of PLC pre-and 1 day,1 week,1 month post-TACE and 20 healthy volunteers (as control group) .Results The expression of HIF-1α and VEGF was (154.94±83.29) pg/ml and (264.00±148.10) pg/ml before TACE,higher than those in control group (P＜0.01) .The expression of HIF-1α and VEGF was (570.64±230.87) pg/ml and (362.07±102.25) pg/ml in PLC patients 1 day post-TACE,higher than those before TACE (P＜0.01) ; (198.62±92.11) pg/ml,and (283.52±145.46) pg/ml 1 week post-TACE; (133.96±57.02) pg/ml and (150.96±84.89) pg/ml in the complete response (CR) group 1 month after TACE, (255.74±123.44) pg/ml and (368.95±161.90) pg/ml in partial response (PR) and stable disease (SD) group (P＜0.05) .The expression of serum HIF-1α was positively correlated with VEGF before TACE,and the serum HIF-1α also correlated with portal vein tumor thrombosis and metastasis.Serum VEGF was also correlated with clinical stage,portal vein tumor thrombosis and capsule.Conclusion The expression of serum HIF-1α and VEGF plays an important role in relapse of tumor,and contributes to the evaluation of the efficacy of TACE and metastasis of PLC.

Malignant biliary tract obstruction is a common disease.Nowadays,endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) have been used to treat such disease.EBD is a first-line intervention for lower segment of biliary duct obstruction caused by pancreatic cancer or other tumors.PTBD is a first-line treatment for gallbladder cancer or other tumors which lead to the hilar and intrahepatic bile duct obstruction and abnormal digestive anatomy.In a word,the proper selection of the drainage should be based on the patients' condition with minimal trauma and maximum therapeutic effect.

Objective To investigate the therapeutic efficacy of transcatheter arterial embolization (TAE) in treating advanced bladder cancer. Methods A total of 22 patients with advanced bladder cancer were included in this study. The clinical data and the imaging materials were retrospectively analyzed. The clinical efficacy of TAE in treating advanced bladder cancer was evaluated. Results TAE was successfully accomplished in all the 22 patients. The preoperative and the postoperative abdominal pain scores were 4.73± 1.91 and 2.45±1.29 respectively, the difference was statistically significant (P<0.01); the preoperative and the postoperative ECOG scores were 3.14±0.47 and 2.68±0.56 respectively (P<0.05); the preoperative and the postoperative hemoglobin levels were (61.4±11.8) g/L and (79.3±14.5) g/L respectively (P<0.01). Of 7 patients with urinary tract obstruction, after the treatment the obstruction disappeared in 5 and was improved in 2, although the urination was still not smooth. All patients were followed up for (7.1±3.0) months. The 6-month survival rate was 54.5% (12/22). No serious complications occurred in all patients. Conclusion TAE can not only effectively improve the hematuria and urinary tract obstruction symptoms caused by bladder cancer, but also effectively control the tumor growth, improve the quality of life and prolong the survival time as well.

Usually the survival period of patients with duodenal obstruction caused by inoperable advanced pancreatic cancer is rather short. For such patients, minimally invasive treatment should be employed as the first choice. This paper reported a case with advanced pancreatic cancer complicated by biliary and duodenal obstruction. After implantation of biliary stent, the obstructive jaundice was relieved. Because of the insufficient cardiac function, the patient was not able to tolerate gastrojejuostomy; besides, as both DSA-guided stent implantation and endoscopic nutrition tube placement failed to success, implantation of nutrition tube via the trans-hepatic and biliary route, as a novel tube placement technique, had to be carried out, and the result in this case was satisfactory.