OBJECTIVETo observe the effect of carbon dioxide pneumoperitoneum and Trendelenburg position on cerebral blood backflow during robot-assisted radical prostatectomy in elderly patients.

METHODSFifty elderly patients (65-80 years) and 50 middle-aged patients (45-64 years) undergoing elective robot-assisted prostatectomy were enrolled in this study. For all the patients, jugular bulb and arterial blood gas was monitored and recorded before pneumoperitoneum (0), 10 min after pneumoperitoneum was achieved (T₁), 10 min (T₂) and 60 min (3) after Trendelenberg position, and 10 min in supine position after termination of pneumoperitoneum (4).

RESULTSCompared with those at 0, the mean arterial pressure, heart rate, and BIS value at 1, 2, 3 and 4 all showed no significant variations (P>0.05), but rSO2, SjvO2, and JBP increased significantly in both groups (P<0.01). Compared with those in the middle-aged group, rSO₂, SjvO₂, and JBP increased significantly and Da-jO₂decreased at 2, 3 in the elderly group (P<0.01), but jugular vein blood glucose or lactic acid content showed no significant difference between the two groups (P>0.05).

CONCLUSIONPneumoperitoneum and Trendelenburg position cause more obvious cerebral blood backflow in elderly patients than in middle-aged patients but do not affect cerebral metabolism of oxygen.

Aged ; Aged, 80 and over ; Brain ; blood supply ; Carbon Dioxide ; Head-Down Tilt ; Heart Rate ; Humans ; Jugular Veins ; Male ; Middle Aged ; Monitoring, Physiologic ; Oxygen ; Pneumoperitoneum, Artificial ; Prostate ; surgery ; Prostatectomy ; methods ; Robotic Surgical Procedures ; methods

OBJECTIVETo discuss the management of vascular crisis of free flaps after reconstruction of head and neck defects caused by tumor resection.

METHODSA total of 259 cases of free flap reconstruction performed in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010 to 2013 were retrospectively analyzed, including 89 cases of anterolateral thigh flaps, 48 cases of radial forearm flaps, 46 free fibula flaps, 5 cases of inferior epigastric artery perforator flaps, 5 cases of free latissimus dorsi flaps, one case of lateral arm flap, and one case of medial femoral flap. The surveillance frequency of free flaps was q1h on post-operative day (POD) 1, q2h on POD 2 and 3, and q4h after POD 3. Vascular crises were reviewed for analysis.

RESULTSThe incidence rate of vascular crisis was 8.1% (21/259), with 15 males and 6 females. The average age was 54.8 years old (17-68), and the average time of vascular crisis was 100.8 h post-operation (3-432). There were 7 cases of free jejunum flaps and 14 dermal free flaps. Seven of these 21 cases with vascular crisis were rescued by surgery. The success rate of salvage surgery within 72 hours from the primary operation was 54.5% (6/11), significantly higher than that of salvage surgery performed later than 72 hours from primary operation (10.0%, 1/10, P=0.043). There were 14 cases of flap necrosis, two of which died of local infection.

CONCLUSIONEarly detection of vascular crisis can effectively improve the success rate of salvage, so as to avoid the serious consequences caused by free flap necrosis.

Adolescent ; Adult ; Aged ; Female ; Femur ; Free Tissue Flaps ; blood supply ; pathology ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Jejunum ; Male ; Middle Aged ; Necrosis ; Postoperative Period ; Reconstructive Surgical Procedures ; Retrospective Studies ; Salvage Therapy ; Time Factors ; Treatment Outcome

OBJECTIVE: To investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion MRI for the evaluation of femoral head ischemia. MATERIALS AND METHODS: Unilateral femoral head ischemia was induced by selective embolization of the medial circumflex femoral artery in 10 piglets. All MRIs were performed immediately (1 hour) and after embolization (1, 2, and 4 weeks). Apparent diffusion coefficients (ADCs) were calculated for the femoral head. The estimated pharmacokinetic parameters (Kep and Ve from two-compartment model) and semi-quantitative parameters including peak enhancement, time-to-peak (TTP), and contrast washout were evaluated. RESULTS: The epiphyseal ADC values of the ischemic hip decreased immediately (1 hour) after embolization. However, they increased rapidly at 1 week after embolization and remained elevated until 4 weeks after embolization. Perfusion MRI of ischemic hips showed decreased epiphyseal perfusion with decreased Kep immediately after embolization. Signal intensity-time curves showed delayed TTP with limited contrast washout immediately post-embolization. At 1-2 weeks after embolization, spontaneous reperfusion was observed in ischemic epiphyses. The change of ADC (p = 0.043) and Kep (p = 0.043) were significantly different between immediate (1 hour) after embolization and 1 week post-embolization. CONCLUSION: Diffusion MRI and pharmacokinetic model obtained from the DCE-MRI are useful in depicting early changes of perfusion and tissue damage using the model of femoral head ischemia in skeletally immature piglets.
Animals ; Arteries/physiopathology ; Diffusion Magnetic Resonance Imaging/*methods ; Disease Models, Animal ; Embolism/complications ; Epiphyses/*blood supply/*pathology ; Femur Head/*blood supply/*pathology ; Male ; Osteonecrosis/pathology ; Pelvic Bones/blood supply/pathology ; Reperfusion Injury/complications/*diagnosis ; Swine

Balanced steady-state free precession (bSSFP) is a highly efficient pulse sequence that is known to provide the highest signal-to-noise ratio per unit time. Recently, bSSFP is getting increasingly popular in both the research and clinical communities. This review will be focusing on the application of the bSSFP technique in the context of probing the physiological and functional information. In the first part of this review, the basic principles of bSSFP are briefly covered. Afterwards, recent developments related to the application of bSSFP, in terms of physiological and functional imaging, are introduced and reviewed. Despite its long development history, bSSFP is still a promising technique that has many potential benefits for obtaining high-resolution physiological and functional images.
Cervical Vertebrae/*blood supply/radiography ; Head/*blood supply/radiography ; Humans ; Image Processing, Computer-Assisted/*methods ; Magnetic Resonance Imaging/*methods ; Signal-To-Noise Ratio

The present paper aims to investigate whether or not vasculogenic mimicry (VM) exists in laryngeal squamous cell carcinoma (LSCC), and to elucidate its relationship to microvessel density (MVD), galectin-3 (Gal-3) expression, and clinicopathological factors of patients with LSCC. VM, score of MVD and expression of Gal-3 protein were detected by immunohistochemistry and histochemistry in 83 specimens of LSCC tissue and 20 specimens of normal laryngeal tissue. The positive rate of VM in normal laryngeal tissues was 0%, and was 33.7% in LSCC tissues. There was a significant difference between the two groups (P<0. 01). VM or MVD was significantly related to differentiation, pTNM stages and lymph node metastasis of LSCC (P<0.05), but not to age, gender and tumor site (P>0. 05). And there was a positive correlation between every two of VM, score of MVD, and Gal-3 protein (P< 0. 05). The results suggest that expression of Gal-3 protein may be related to the initiation, angiogenesis and VM formation in LSCC; And VM, angiogenesis and Gal-3 protein may be involved in the development, invasion and metastasis of LSCC.
Carcinoma, Squamous Cell ; blood supply ; Galectin 3 ; metabolism ; Head and Neck Neoplasms ; blood supply ; Humans ; Immunohistochemistry ; Laryngeal Neoplasms ; blood supply ; Lymphatic Metastasis ; Neovascularization, Pathologic ; Prognosis

OBJCETIVETo investigate the method of separation of culture of bone microvascular endothelial cells (BMECs) of human femoral head in vitro.

METHODSFrom October 2013 to January 2014,15 femoral heads without pathologic change from patients resected during hip replacement were selected involving 2 males and 13 females with a mean age of 71.2 years old ranging from 38 to 92. Cancellous bone in femoral head was bited into broken bone grain and transfered into medium in aseptic contidion. Cells were isolated by the methods of enzymic digestion and density gradient centrifugation,purified by differiential attachment. The characteristics of cells was observed by inverted microscope. vWF and CD31 immunofluorescence analysis was applied for identification of cells.

RESULTSThe number of cells was positively correlated with patients' age after 24 hours in primary culture. The older patients had the less cells numbered. After 4 to 5 days' culture, primary cells appeared short spindle,polygon shaped and cobblestone-like morphology. After 7 to 10 days' culture, primary cells proliferated densely, became fusion, arranged in swirl, and contact inhibition appeared significantly. Immunofluorescence staining revealed the cells were 100% positive for vWF and CD31, and it showed that the cultured cells were BMECs.

CONCLUSIONIt was a simple, steady, effective method with good reproducibility, by which highly purified human BMECs can be obtained.

Adult ; Aged ; Aged, 80 and over ; Cell Culture Techniques ; Cell Proliferation ; Cell Separation ; methods ; Cells, Cultured ; Endothelial Cells ; cytology ; Female ; Femur Head ; blood supply ; Humans ; Male ; Microvessels ; cytology ; Middle Aged

Adult ; Aged ; Carcinoma, Squamous Cell ; rehabilitation ; surgery ; Carotid Arteries ; Female ; Head and Neck Neoplasms ; rehabilitation ; surgery ; Humans ; Male ; Middle Aged ; Neck ; blood supply ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply

OBJECTIVE: To explore the feasible monitoring techniques for the buried free flap. METHOD: Buried free flaps in reconstruction were monitored using combined monitoring techniques in five cases of advanced hypopharyngeal cancer The monitoring effects were analyzed retrospectively. RESULT: The operations were carried out successfully and all the five patients got primary healing of incision without vascular crisis. Four patients need combined monitoring techniques to confirm the microcirculatory results of the buried free flap. CONCLUSION Application of Doppler combined with flap island was feasible on monitoring the blood supply of post-operative buried free flap, it is a good monitoring technique.
Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Free Tissue Flaps ; blood supply ; Head and Neck Neoplasms ; diagnostic imaging ; pathology ; surgery ; Humans ; Hypopharyngeal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Hypopharynx ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Squamous Cell Carcinoma of Head and Neck ; Surgical Flaps ; blood supply ; Ultrasonography, Doppler

OBJECTIVE: To investigate the expression of Caspase-3 and bFGF in laryngeal squamous cell carcinoma and the affection angiogenesis. METHOD: Immunohistochemistry was used to detect the expression of Caspase-3. bFGF and MVD in 36 cases of para-carcinoma tissue and 67 cases of laryngeal squamous cell carcinoma. RESULT: The expression of bFGF in laryngeal squamous cell carcinoma was significantly higher than that in para-carcinoma tissue (P < 0.05), however the expression of Caspase-3 was significantly higher in para-carcinoma tissue than that in Laryngeal squamous cell carcinoma (P < 0.05). In laryngeal carcinoma, the expression of bFGF and Caspase-3 were associated with differentiation, lymph node metastasis and clinical stage (P < 0.05), but was independent of clinical classification,smoking history, sex and gender (P > 0.05). A significantly negative correlation was found between hFGF and Caspase-3 (P < 0.05). The value of MVD in laryngeal squamous cell carcinoma was significantly higher than that in para-carcinoma tissue (P < 0.05), and was significantly associated with lymph node metastasis (P < 0.05), but not associated with age, gender, differentiation, clinical stage, clinical classification or smoking history. The MVD of the tissue with positive expression of bFGF was significantly higher than that with negative expression of bFGF in laryngeal squamous cell carcinoma (P < 0.05). There was no significant difference between the MVI) of the tissue with positive expression of bFGF and that with negative expression of bFGF in laryngeal squamous cell carcinoma (P > 0.05). CONCLUSION bFGF was positively related to Caspase-3, which might play an important role in the carcinogenesis and development of laryngeal carcinoma by synergic effect.
Adult ; Aged ; Carcinoma, Squamous Cell ; blood supply ; metabolism ; pathology ; Caspase 3 ; metabolism ; Female ; Fibroblast Growth Factor 2 ; metabolism ; Head and Neck Neoplasms ; blood supply ; metabolism ; pathology ; Humans ; Laryngeal Neoplasms ; blood supply ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neovascularization, Pathologic ; Squamous Cell Carcinoma of Head and Neck

Superficial veins of the head and neck are utilised for central venous cannulation, oral reconstruction and parenteral nutrition in debilitated patients. Clinical and sonological examinations of these veins may provide clues toward underlying cardiac pathology. Hence, although variations in these vessels are common, a sound knowledge of such variations becomes clinically important to surgeons, radiologists and interventional anaesthetists. We report a rare case of a left-sided double external jugular vein where the common facial vein continued as the second external jugular vein, and where there was a communicating channel between the internal jugular vein on the same side and the anterior jugular vein.
Brachiocephalic Veins ; abnormalities ; Cadaver ; Head ; blood supply ; Humans ; Jugular Veins ; abnormalities ; Male ; Middle Aged ; Neck ; blood supply ; Subclavian Vein ; abnormalities ; Vascular Malformations ; diagnosis