Objective To evaluate the efficacy of transcatheter lipiodol chemoembolization therapy (TOCE) for HCC via inferior phrenic artery (IPA) and to analyse the location of the tumor feeding inferior phrenic artey. Methods Twenty five cases of HCC underwent the procedure of TOCE via the IPA, as well as the hepatic artery using Seldinger's method. The patterns of tumor growth included huge type in 12 cases, solitary nodular type in 8 cases and multiple nodular type in 5 cases. Hepatic artery and inferior phrenic artery chemoembolizations were performed in all cases. Results Inferior phrenic artery originated from celiac trunk in 16 cases (64%); abdomen aorta around celiac trunck in 8(32%). The sitesot tumors supplied by IPA in right lobe (Ⅶ,Ⅷ segment) were 23 cases and left lobe (Ⅳ segment) 2 cases. The cumulative survival rates of IPA chemoembolization for hepatocellular carcinoma were 84%(1 year) and 68%(2 years). No severe complications occurred. Conclusions TOCE of the IPA is a safe and effective method in the management of HCC supplied by IPA. When the tumor site is adjacent to diaphragm, hepatic ligaments or bare area, may arouse the blood supply by IPA, especially in no tumor staining or staining defect in hepatic artery angiography but tumor enhancement on CT, and increase of the level of serum ? fetoprotein.

Objective To determine the clinical efficacy and safety of domestic biliary metallic stents in the management of biliary obstruction. Methods 75 domestic biliary metallic stents were implanted in 66 of 72 patients with obstructive jaundice due to malignant (n=70) and benign stenoses (n=2). Results The technical successful rate was 92.7% (64/66). Palliation with rid of jaundice was achieved in 96.9% (64/66) within 1 month. The 30-day mortality rate was 3% (2/66). Early complications occurred in 7.6% (5/66). 44 patients were followed from 2 to 24 months after treatment. 33 (33/42) of 42 patients with malignancy died after a median survival of 5.3 months (range 2-23 months). The remaining 9 patients (9/42) remained alive with a mean follow-up of 11.6 months. The stent patency rates were 92.8%,89.9% and 79.4% at 3,6,12 months respectively. 6 patients (6/42) presented stent occlusion within a median period of 3 months. One of two patients with benign stenoses sustained a patency duration time of 24 months. One patient died 3 months after treatment. Conclusions The domestic biliary metallic stent implantation is efficacy and safety in the management of biliary obstruction.

Objective The detection results of intestinal virus nucleic acid related to HFMD( hand,foot and mouth disease)from the anal swabs and throat swabs were compared so as to explore more effective methods for laboratory diagnostic of the disease. Methods Real-time fluorescence quantitative polymerase chain reaction (PCR)was used to detect RNA of enterovirus 71(EV71),coxsackievirus A16(CA16),and other enterovirus (EV)in the paired samples. The virus detection results from the two sample types were compared to find out the miss rate in a single sample. Results The detection rates of EV71,CA16 and Non-EV71/Non-CV16 enterovirus (Non-EV71/Non-CV16 EV)in the anus swabs/ throat swabs were 17.25%/12.18%,4.03%/3.54% and 40.28%/45.32%,respectively. Obviously ,the detection rates of EV71 and CA16 in anal swabs were higher than those in throat swabs ,while the detection rates of Non-EV71Non-CV16 EV was lower than that in throat swabs. The differences were statistically significant(P<0.05). Compared with the detection results of the paired samples ,the miss rate of a virus in a single sample type ranged from 10.33%to 36.27%. Conclusion The detection miss rates of HFMD related intestinal virus nucleic acid in one sample type(anal swabs or throat swabs)are high,while tak-ing the detection in the paired samples can significantly improve the detection rate.

Objective To discuss the clinical value of interventional management before surgical therapy for massive gastrointestinal hemorrhage, and to compare the clinical efficacy and re-bleeding rate between hypophysin infusion group and embolization group. Methods During the period of June 1998-Apr.2009, 31 patients with massive gastrointestinal hemorrhage in our institution underwent preoperative interventional managements before they received surgical treatment. According to DSA manifestations, the patients underwent trunsarterial hypophysin infusion or transcatheter embolization as interventional management. The clinical efficacy of interventional procedures and its influence on the surgery were evaluated, and the hemostasis rate and re-bleeding rate were compared the two kind of intervention managements. The numeration data were analyzed with Fisher's exact test, and the SPSS 11.0 was used as statistical software. Results The interventional managements were successfully performed in all the 31patients, with a total hemostasis rate of 83.9% (26/31) and a total re-bleeding rate 30.7% (8/26). The hemostasis rate and re-bleeding rate of hypephysin infusion group and embolization group were 69.2% (9/13), 94.4% (17/18) and 44.4% (4/9), 23.7% (4/17), respectively. All the 31 patients received surgery after interventional therapy, of which selective operation was carried out in 20. Neither surgery-related or intervention-related serious complications nor death occurred. Conclusion Preoperative interventional managements can provide patients with massive gastrointestinal hemorrhage with valuable chance of a successful surgery, enable the physician to take a selective operation to replace an emergency one, as a result, the surgical risk will be greatly reduced. Therefore, it is worth popularizing the preoperative interventional managements in clinical practice.

Objective To investigate anticoagulation and security of heparin and low molecular weight heparin applied to the carotid artery after CASA, to provide a reference for clinical anticoagulation. Methods From January 2010 to December 2013,120 cases of implementation of CASA surgical patients with carotid artery were selected,according to anticoagulation method they were divided into control group and observation group, control group had 54 patients, the implementation was continuous intravenous infusion of heparin for 3 days; observation group had 66 patients with sub-cutaneous low molecular weight heparin anticoagulation, one injection for 12 h, lasted for three days, before surgery,24 h,72 h after surgery,anti-Xa activity were detected in patients,activated partial thromboplastin time(APTT),pro-thrombin time (PT), complications were compared between the two groups. Results Anti-Xa activity of observation group and control group after 24 h were (1.204±0.413) IU/mL, (1.428±0.512) IU/mL, the difference was statistically significant(t=3.189,P=0.037), anti-Xa activity levels after 72 h of observation group and control group were (1.314±0.533)IU/mL,(1.684±0.687) IU/mL, the difference was statistically significant (t=4.218, P=0.030); in observation group,before surgery,24 h, 72 h after surgery APTT were(27.93±3.86)s,(37.97±5.14)s,(37.73±4.28)s, differences were statistically significant before and after surgery (t=6.453, P=0.009; t=6.449,P=0.010); in the control group,be-fore surgery,24 h,72 h after surgery APTT were(27.64±3.24)s,(38.34±4.55)s,(38.21±4.41)s,differences were statisti-cally significant before and after surgery(t=6.534,P=0.007;t=6.530,P=0.007);preoperative and 24 h,72 h postoper-ative at the same period for observation group and control group there were no significant difference(t=0.927,P=0.197;t=1.023, P=0.143; t=0.993, P=0.176); in observation group before surgery,24 h,72 h after surgery for PT compared with the control group the difference was not statistically significant (P>0.05); in observation group complication rate was 9.09%(6/66)and the control group was 7.41%(4/54)the difference was no statistically significant(χ2=1.034,P=0.114).Conclusion Low molecular weight heparin and unfractionated heparin used in carotid surgery CASA have similar anti-coagulant effect,low molecular weight heparin is slightly lower in anti-Xa activity,but it's easy to monitor and control to ensure the safety of the treatment.