ABSTRACT
Objective To investigate the efficacy and influence factors of uterine artery embolization (UAE)in treatment of intractable postpartum hemorrhage (PPH).Methods 126 patients with intractable PPH were treated by UAE in our hospital.We analyzed the influence factors of failed UAE treatments according to the amount of bleeding,the stability of hemodynamics,with disseminated intravascular coagulation(DIC)or not and active extravasation detected in angiography.Results In 126 intractable PPH patients,13 cases (10.3%) failed to stop bleeding after UAE and the other 113 cases (89.7%)successfully got hemostasis.Logistic regression analysis showed that DIC was a significant factor in failed UAE group (P=0.033,OR 0.107,95%CI 0.014-0.835).Conclusion UAE is an effective method of treating intractable PPH.DIC may be the main cause of the failure of UAE in treatment of intractable PPH.
ABSTRACT
BACKGROUND:It is difficult to perform superselective catheterization of the internal carotid artery in dogs because of the large bending and spiral shape of the interal carotid artery before entering into the skul. At present, the dog models of cerebral infarction established by injecting autologous blood clots and gelatin spongevia the internal carotid artery are far from the perspective of pathological mechanism of human patients with cerebral infarction. Aortography can visualize the structure of cerebral vessels and is likely to provide a new condition for the establishment of dog models of acute cerebral infarction. OBJECTIVE:To explore the feasibility of establishing cerebral infarction models in beagle dogs by superselective catheterizationvia the vertebral basilar artery. METHODS: Five beagle dogs were divided into thrombus group (n=3) and control group (n=2). The beagle dogs in the thrombus group were subjected to digital subtraction angiography of the aortic arch, bilateral common carotid arteries and vertebral arteries in addition to femoral arterial catheterization. The 2.7F micro-catheter was inserted into the convergence zone of the left posterior communicating artery and the internal carotid artery through the vertebrobasilar artery. An autologous blood clot was injected into the convergence zone. The dogs in the control group were injected with appropriate amount of contrast medium. RESULTS AND CONCLUSIONS:Through angiography of the left and right common carotid artery of five dogs, thick external carotid arteries (10/10) and their branches were clearly displayed, however, only five (5/10) internal carotid arteries were dimly present. A spiral vascular loop formed in the internal carotid artery with a smal-sized diameter. Through antiography of the left and right vertebral arteries (10/10) angiography, vertebral basilar artery, the circle of “Wilis”, bilateral posterior cerebral arteries, bilateral middle cerebral arteries and bilateral anterior cerebral arteries were clearly displayed, al these contribute to insertion of microcatheter into the convergence zone of the left posterior communicating artery and the internal carotid artery through the vertebrobasilar artery. High signal intensity of the left temporal lobe was shown on 3-hour and 6-hour diffusion weighted images.The results demonstrate that the beagle dog models of acute cerebral infarction can be successfuly established by injecting autologous blood clots into the left middle cerebral artery through a microcathter insertedvia the vertebrobasilar artery, which provides a new method of precisely occluding the middle cerebral artery of beagle dogs by catheterization.
ABSTRACT
BACKGROUND:In order to avoid distal arterial embolism fol owing mechanical thrombectomy, micro-bal oon catheter temporary isolation is applied to prevent thrombus shedding. OBJECTIVE:To investigate the safety and feasibility of adopting the micro-bal oon catheter technique in treatment of the hyperacute cerebral infarction. The micro-bal oon catheter technique can temporarily block the artery blood flow and isolate the embolism location fol owing mechanical thrombectomy and aspiration combined with thrombolysis. METHODS:Ten beagle dogs were included in this study. Under general anesthesia, the micro-bal oon catheter was delivered to the dominant vertebral artery through the femoral artery in al the dogs and it was fil ed and temporarily blocked the blood flow. Then the autologous thrombus was injected through the micro-catheter into proximal vertebral artery to make a thrombosis model. Al the dogs were equal y divided into two groups according to the embolectomy method:control group (receiving pure stent embolectomy, n=5) and experimental group (n=5). The experiment group was disrupted and aspirated thrombus combined with the drug thrombolysis after temporarily blocking out the blood flow and isolating the target artery by micro-bal oon catheter technique. After treatment, two groups underwent digital subtraction angiography to review the vertebral artery recanalization after different embolectomy methods. The hemodynamic status was evaluated through the thrombolysis in cerebral ischemia grade. Al the dogs were scanned with magnetic resonance diffusion weighted imaging before modeling and at 12 hours after the thrombectomy. The animals were kil ed to perform pathological examination after magnetic resonance diffusion weighted imaging (12 hours after the thrombectomy). The vessel recanalization rates and complications were calculated in the two groups. RESULTS AND CONCLUSION:The thromboembolism model was successful y established in the dominant vertebral artery of al the 10 beagle dogs. In the control group, the vertebral arteries were completely successful recanalized in two dogs and were partly recanalized in three dogs, while the vertebral-basilar and intracranial arteries in one dog showed multiple smal punctate fil ing defects with poor intracranial arterial development and contrast agent reflux. At 12 hours after embolectomy, the magnetic resonance diffusion weighted imaging showed slightly high signal intensity at the left temporoparietal lobe and the pathologic examination suggested thrombosis in the cerebral artery lumen of the left temporal lobe. In the experimental group, the vertebral arteries in five dogs were completely recanalized without infarction. The revascularization rate in the experimental group was significantly higher than that in the control group (P<0.05). Experimental findings indicate that, the application of disruption and aspiration thrombus combined with the drug thrombolysis after temporarily blocking the blood flow and isolating the target artery by micro-bal oon catheter technique in treatment of hyperacute cerebral infarction, can effectively prevent the smal embolus exfoliating, which can cause distal embolization. Thus, the micro-bal oon catheter technique is a safe, effective and relatively inexpensive interventional embolectomy.
ABSTRACT
Objective To investigate the value of multislice spiral CT(MSCT,)in interventional therapy of the hepatocellular carcinoma(HCC)emphasising on transcatheter hepanc arterial chemoembolization(TACE).Methods MSCT were performed in 60 cases of HCC before interventional procedure,CT findings of hepatic artery phase,portal venous phase and hepatic venous phase were observed respectively,among which CTA were done in 15 cases,and the anatomy of celiacartery and its branches were observed in 45 cases.The schemes of interventional therapy were worked out according to the findings of MSCT.Results MSCT showed 250 lesions,10 cases of tumor thrombosis in portal vein and 19 cases of hepatic arterioportal shunt.There was no significant difference between MSCT and digital subtraction angiography(DSA)in positive rate of in showing number of tumor or tumor thrombosis in portal vein(P＞0.05),but the 3D construction of celiac artery branches in CTA was better than that in DSA,while angles between celiac artery and abdominal aorta in MSCT were more convenient than that in DSA.MSCT showed 5 eases of hepatic artery original abnormality,according to that in DSA.Conclusion MSCT is of importance for guidance of interventional therapy of hepatocellular carcinoma.
ABSTRACT
Objective To evaluate the curative effect and optimal indications of reformed percutaneous lumbar diskectomy (RPLD) for the treatment of lumbar disc herniation.Methods One handred and thirty-three patients with lumbar disc herniation were treated by RPLD, of them, 20 cases were lumbar disc extrusion and 113 cases were lumbar disc protrusion. After the procedure, 85 patients underwent flush of intervertebral space with antibiotic saline and 48 patients underwent 10 ml(40?g/ml) medical ozone-injection inside the disc to prevent infection. All patients were followed up over the course of 3 months. The therapeutic effect was evaluated according to the MacNab criteria. Results All 133 cases underwent RPLD were successful. The total efficacy was 81.9%, There were no serious complications after operations. Conclusion RPLD is an effective method in the treatment of lumbar disc herniation. Both intradiscal ozone-injection or intradiscal antibiotic saline flush after RPLD can reduce the opportunity of infection.
ABSTRACT
Objective To ameliorate the percutaneous lumbar discectomy(APLD)for improving the effectiveness and amplifying the indicative range of PLD.Methods To ameliorate percutaneous punctured route based on classic PLD and discectomy of extracting pulp out of the herniated disc with special pulpforceps. The statistical analysis of the therapeutic results on 750 disc protrusions of 655 cases undergone APLD following up from 6 to 54 months retrospectively. Results The effective ratios were excellent in 40.2%, good for 46.6% and bad of 13.3%. No occurrance of intervertebral inflammation and paradiscal hematoma, there were only 1 case complicated with injuried cauda equina, and 4 cases with broken appliance within disc.Conclusions APLD is effective and safe, not only indicative for inclusion disc herniation,but also for noninclusion herniation.
ABSTRACT
Objective To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpforcep, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation.
ABSTRACT
Objective To investigate the feasibility and efficacy of treating C 7～T 1 intervertebral disc herniation by puncture cervical discotomy(PCD).Methods Three cases of C 7～T 1 intervertebral disc herniation were undergone PCD. Results All the procedures were succeeded with the main symptoms and signs of the 3 patients disappeared during 2 months after PCD. No recurrence occurred during the follow up of 7,11,16 months, respectively.Conclusion The treatment of C 7～T 1 intervertebral disc herniation by PCD is safe and effective.