[Endovascular Treatment of Blood Blister-like Aneurysms in Internal Carotid Artery].

OBJECTIVES: To study the feasibility and effectiveness of endovascular treatment to blood blister-like aneurysms (BBA) in internal carotid artery. METHODS: Retrospective analyzed the clinical features, outcomes, and complications of 20 cases of BBA treated with endovascular intervention techniques from 2013-2015 in our center. RESULTS: The patients were treated with covered stent, internal carotid artery balloon occlusion, and stents assisted coiling, respectively. One death occurred after the patient accepted covered stent treatment, another 2 death was due to vasospasm after internal carotid artery balloon occlusion, and double stents assisted coiling, respectively. The modified Rankin Scale (mRS) score when patients being discharged were 0-2 in 15 cases, and 3-4 in 2 cases. There were 17 cases with clinical follow-up from 1 to 26 months (9.3 months on average), the mRS scores were all less than 2 points. 16 cases accepted angiographic review. 14 cases had BBA totally occluded, 1 case had stable neck residue, and 1 case had incompleted occlusion and the aneurysm dwindled at follow-up. CONCLUSIONS: Stent-assisted coiling is feasible and effective in the treatment of BBA in internal carotid artery.

[Application of endometrial sampling device during the follow-up visit for the conservative treatment of endometrial cancer].

OBJECTIVE: To study the feasibility of endometrial sampling device as a sampling tool during the follow-up visit for endometrial cancer patients undergone conservative treatment. METHODS: Before the hysteroscopy examination, endometrial sampling device was used to take the endometrium specimens 43 times in 19 patients who had been diagnosed as endometrial cancer or atypical hyperplasia, and were undergone conservative treatment during May 2012 to Mar. 2013. All cases accepted vaginal ultrasound screening before every sampling by endometrial sampling device. The histological results were compared with those done by hysteroscopy. RESULTS: The average age of those patients was (30 ± 6) years old. The mean thickness of the endometrium during the treatment was (0.81 ± 0.65) cm. The qualified rate for the sampling was 95% (41/43). Compared with the specimens undergone by hysteroscopy direct sampling, 32 samples got by the endometrial sampling device with thicker endometrium (0.93 ± 0.70) cm had the same histological results, while the other 9 patients with thinner endometrium (0.40 ± 0.14) cm were not (P = 0.031). CONCLUSION: The endometrial sampling device could be used during the follow-up visit for the conservative treatment patients with endometrial cancer or atypical hyperplasia, the vaginal ultrasound screening should be used together to figure out those with thinner endometrium.

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study.

Objective: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. Methods: The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. Results: A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin Scale, 0-2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. Conclusion: In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.

Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms technique of C1-C2 fixation.

Harms technique of C1-C2 fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury (VAI) rate. But considering the unique and variable anatomy of atlantoaxial complex, iatrogenic VAI will result in catastrophic consequences and provides particular surgical challenges for surgeons. To our knowledge, comparing with iatrogenic VAI in the screw hole, iatrogenic VAI in the "open space" is much rarer during the Harms technique of C1-C2 fixation. In this article, we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C1-C2 fixation. This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compression was initially misdiagnosed as VAI by pedicle screw perforation. It can be concluded that intraoperative or postoperative computed angiography is very helpful to diagnose the exact site of VAI and the combination of endovascular coil occlusion as well as external local compression can further prevent bleeding and abnormal vertebral artery flow in the pseudoaneurysm. However, patients treated require further follow-up to confirm that there is no recurrence of the pseudoaneurysm.

Transcatheter embolization of a ruptured internal pudendal artery pseudoaneurysm in a patient with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder. Pseudoaneurysms formation and rupture is an unusual complication of neurofibromatosis. To date, pseudoaneurysm of the internal pudendal artery associated with NF-1 has not been reported. In this article, we present a 62-yr-old man with NF-1 suffering from spontaneous hematoma of the perinea and scrotum. A digital substraction angiography disclosed a ruptured pseudoaneurysm of the right internal pudendal artery, which was successfully managed with transcatheter embolization.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience and Systematic Literature Review.

OBJECTIVE: The purpose of the present study was to introduce our initial experience with the use and feasibility of the Willis covered stent (WCS) in the treatment of blood blister-like aneurysms (BBAs) and to present a systematic review of the reported data on the treatment of BBAs with covered stents. METHODS: Fourteen consecutive patients with BBAs had been treated with WCSs at West China Hospital from January 2015 to August 2017. The patient medical records, angiographic findings, and endovascular treatment reports were reviewed by interventional neuroradiologists and neurosurgeons to obtain relevant clinical and angiographic information. We conducted a systematic review of all reports of BBAs treated with covered stents. We searched the reported data using PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases and commercial Internet search engines. We included BBAs located at nonbranching portions of the internal carotid artery (ICA). RESULTS: The present study included 9 men and 5 women, with a mean age of 54.5 years (range, 30-79). All patients had complete occlusion found on immediate postoperative angiography. The ophthalmic artery was occluded in 2 patients (14.3%). No mortality or morbidity had occurred during the procedure. Two patients (14.3%) experienced a mild recurrence. One patient (7.1%) had developed mild in-stent stenosis. The clinical follow-up period was 6-15 months for all the patients. Of the 14 patients, 11 (78.6%) had a modified Rankin scale score of 0, and 1 (7.1%) had a modified Rankin scale score of 1 during the follow-up period. One patient (7.1%) experienced subarachnoid hemorrhage at 7 days postoperatively and had died 10 days after surgery. None of the patients experienced visual defects. Of our 14 patients, 13 (92.9%) survived, as determined by outpatient department visits or telephone interviews. A total of 8 reports, including 38 patients, met our criteria. Of these 38 patients, 37 (97.3%) had successful delivery to the diseased ICA, and 34 (89.5%) had experienced complete occlusion during follow-up. The overall rate of complete occlusion was 83.0% (95% confidence interval, 68%-91%). CONCLUSIONS: Patients with ruptured BBAs treated with WCSs can achieve satisfactory clinical results. Therefore, for BBAs, the implementation of the WCS could be safe and feasible. This strategy could be a promising option for this type of high-risk aneurysm. However, patients with tortuous ICAs or aneurysms close to essential branch arteries should be carefully evaluated before the WCS is used.

Application of the Willis Covered Stent in the Treatment of Ophthalmic Artery Segment Aneurysms: A Single-Center Experience.

OBJECTIVE: The purpose of this study is to introduce our initial experience with the evaluation of the feasibility of using Willis covered stents (WCSs) in the treatment of complicated ophthalmic artery (OA) segment aneurysms. METHODS: Of the 162 patients with OA segment aneurysms treated by endovascular techniques in West China Hospital from January 2015 to August 2017, a total of 26 patients treated with WCSs were included in the study. RESULTS: Twenty-six patients with 26 aneurysms were included (mean age, 57.0 years; range, 22-76 years). The cohort had 20 patients with large or giant aneurysms, 3 patients with blood blister aneurysms, and 3 patients with pseudoaneurysms. Ten aneurysms were OA type, and 16 were internal carotid artery (ICA) type. Twenty-four patients were treated with 1 stent, and 2 patients were treated with 2 stents. Among the 26 patients, 2 patients had minimal endoleak, and 24 patients had complete occlusion after immediate postoperative angiography. One patient who had complete occlusion experienced contrast agent extravasation, and this phenomenon disappeared by balloon compression during the procedure. The 3- to 15-month angiographic follow-up showed that all patients experienced complete occlusion, including 2 patients with minimal endoleak during immediate postprocedural angiography. Two patient showed signs of in-stent stenosis. Clinical follow-up demonstrated that no delayed thromboembolic or ischemic events were recorded in the stent-grafted vascular region and no bleeding occurred in any of the patients (except 1 patient who experienced subarachnoid hemorrhage, left frontal lobe hemorrhage, and hydrocephalus 10 days after the procedure). CONCLUSIONS: WCSs may provide an alternative solution for treating complex OA segment aneurysms by reconstruction and preservation of the ICA. Our study also confirms the safety, efficacy, and midterm durability of WCSs for complex OA segment aneurysms.

Application of the Willis Covered Stent in the Treatment of Carotid-Cavernous Fistula: A Single-Center Experience.

BACKGROUND: The purpose of the present study was to describe our single-institutional experience of treating direct carotid-cavernous fistulas (DCCFs) with Willis covered stents (WCSs). METHODS: Of a total of 31 DCCFs, 10 were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to December 2016. The indications for treatment, perioperative findings, and postoperative and follow-up results were collected and analyzed. RESULTS: All 10 patients had successful deployment of WCSs. Complete exclusion of the fistula was achieved in 6 patients immediately after deployment of 1 stent. Endoleak was observed in 4 patients (patients 2, 4, 5, and 9). Thus, repeat dilation of the stent with greater pressure was performed, which resolved the endoleak in 2 patients (patients 2 and 9). The endoleak of the other 2 patients persisted after repeat dilation of the balloon. Hence, a second stent was deployed in these 2 patients (patients 4 and 5), which eliminated the endoleak in patient 4. However, patient 5 continued to have a minimal endoleak. Nine patients had fistulas successfully occluded by WCSs during the follow-up period. One patient experienced recurrence of a DCCF at the 10-day follow-up point. We chose coil embolization to address this DCCF. No stenosis of the internal carotid artery or DCCF recurrence, except that in the abovementioned patient, was observed. CONCLUSIONS: WCS was proved to be an alternative treatment method for complex DCCFs through reconstruction and preservation of the internal carotid artery. Our study also confirmed the safety, efficacy, and midterm durability of WCSs for complex DCCFs without any serious delayed complications.

[Clinical management and prognostic analysis of primary peritoneal neoplasms].

OBJECTIVE: To investigate the clinical management strategies and prognostic factors of primary peritoneal neoplasms. METHODS: We retrospectively reviewed the clinical and pathological records of 24 cases with primary peritoneal neoplasms treated in the People's Hospital, Peking University during May 1995 and April 2004. RESULTS: Among 24 cases, 15 patients were diagnosed as serous papillary adenocarcinoma (9 highly and intermediately differentiated, and 6 lowly differentiated), 6 as mixed epithelial carcinoma and 3 as mixed malignant Mullerian tumor (MMMT). All patients underwent cytoreductive surgery, 21 cases having, suboptimal debulking one. Then they received a platinum-based chemotherapy. Thirteen cases received paclitaxel + cisplatin (TP) and 9 received cisplatin + doxorubicin + cyclophosphamide (PAC) combination chemotherapy. The primary response reached 80% (complete response 55% and partial response 25%). The median survival of all patients was 42 months (95% CI = 22-62 months). Survival for patients with primary peritoneal serous papillary carcinoma (PPSPC), mixed epithelial carcinoma and MMMT was 44, 19 and 13 months respectively, with a significant difference between PPSPC and MMMT (P < 0.05). Patients receiving TP combination also exhibited longer survival than those receiving PAC regimen (mean survival 75 vs 28 months, P < 0.05). CONCLUSIONS: Patients with primary peritoneal neoplasms should be treated with appropriate cytoreductive surgery. A primary surgical protocol is bilateral salpingo-oophorectomy and omentectomy. Overestimating an optimal debulking surgery may have no benefit on the survival. TP combination therapy may bring longer survival than PAC regimen. Histopathologic types and chemotherapy regimens are the essential factors of the prognosis.

[Effects of land use change on soil active organic carbon in deep soils in Hilly Loess Plateau region of Northwest China].

Response of soil active organic carbon to land-use change has become a hot topic in current soil carbon and nutrient cycling study. Soil active organic carbon distribution characteristics in soil profile under four land-use types were investigated in Ziwuling forest zone of the Hilly Loess Plateau region. The four types of land-use changes included natural woodland converted into artificial woodland, natural woodland converted into cropland, natural shrubland converted into cropland and natural shrubland converted into revegetated grassland. Effects of land-use changes on soil active organic carbon in deep soil layers (60-200 cm) were explored by comparison with the shallow soil layers (0-60 cm). The results showed that: (1) The labile organic carbon ( LOC) and microbial carbon (MBC) content were mainly concentrated in the shallow 0-60 cm soil, which accounted for 49%-66% and 71%-84% of soil active organic carbon in the profile (0-200 cm) under different land-use types. Soil active organic carbon content in shallow soil was significantly varied for the land-use changes types, while no obvious difference was observed in soil active organic carbon in deep soil layer. (2) Land-use changes exerted significant influence on soil active organic carbon, the active organic carbon in shallow soil was more sensitive than that in deep soil. The four types of land-use changes, including natural woodland to planted woodland, natural woodland to cropland, natural shrubland to revegetated grassland and natural shrubland to cropland, LOC in shallow soil was reduced by 10%, 60%, 29%, 40% and LOC in the deep layer was decreased by 9%, 21%, 12%, 1%, respectively. MBC in the shallow soil was reduced by 24% 73%, 23%, 56%, and that in the deep layer was decreased by 25%, 18%, 8% and 11%, respectively. (Land-use changes altered the distribution ratio of active organic carbon in soil profile. The ratio between LOC and SOC in shallow soil increased when natural woodland and shrubland were converted into farmland, but no obvious difference was observed in deep soil. The ratio of MBC/SOC in shallow soil decreased when natural shrubland was converted into farmland, also, no significant difference was detected in the ratio of MBC/SOC for other land-use change types. The results suggested that land-use change exerted significant influence on soil active organic carbon content and distribution proportion in soil profile. Soil organic carbon in deep soil was more stable than that in shallow soil.

[Characteristics of Soil Respiration along Eroded Sloping Land with Different SOC Background on the Hilly Loess Plateau].

This study aimed to characterize soil respiration along eroded sloping land at erosion and deposition area under different soil organic carbon(SOC) levels, and linked the relationship between soil respiration and soil temperature, soil moisture, SOC and slope position. Experiments were carried out in the plots of S type slopes include five different soil organic carbon levels in the Loess Hilly Region. The S type slopes were divided into control area at the top of the slope, erosion area at the middle of the slope and deposition area at the toe of the slope. We found that soil temperature had a greater impact on soil respiration in the deposition area, whereas soil moisture had a greater impact on soil respiration in the erosion area compared among control area, erosion area and deposition area. In addition, SOC was the most important factor affecting soil respiration, which can explain soil respiration variation 54. 72%, followed by soil moisture, slope position and soil temperature, which explain soil respiration variation 18. 86% , 16. 13% and 10. 29%, respectively. Soil respiration response to erosion showed obvious on-site and off-site effects along the eroded sloping land. Soil respiration in the erosion area was reduced by 21. 14% compared with control area, and soil respiration in the deposition area was increased by 21. 93% compared with control area. Erosion effect on source and sink of carbon emission was correlated with SOC content of the eroded sloping land. When SOC content was higher than 6. 82 g.kg-1, the slope. erosion tended to be a carbon sequestration process, and when SOC content was lower than 3.03 g.kg-1, the slope erosion tended to be a process of the carbon emission source. The model could reflect the relationship between soil respiration and independent variables of soil organic carbon content, soil temperature and moisture.

Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials.

AIM: To assess the safety and efficacy of different intravenous chemotherapeutic regimens in patients with gastric carcinomas who had undergone gastrectomy. METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. Language was restricted to Chinese and English. RCTs were identified from Medline and Embase (1980-2001/4), and Chinese Bio-medicine Database (1990-2001/1). Literature references were checked at the same time. We included randomized and quasi-randomized trials comparing the efficacy of intravenous chemotherapy after gastrectomy with that of surgery alone in patients with confirmed gastric carcinomas who had undergone gastrectomy. Selection criteria were: randomized or quasi-randomized trials with following-up results; Trials could be double-blind, single-blind or not blind; Chemotherapy groups were given intravenous chemotherapy after gastrectomy without neo-adjuvant chemotherapy, intraperitoneal hyperthermic perfusion, radiotherapy or chemoimmunotherapy; Controlled group included those receiving gastrectomy alone. The following data were extracted: the number of survival and death by the end of the follow-up; the different agents and doses of the intravenous chemotherapy; the baseline of the chemotherapy group and the controlled arm; the serious adverse events; the statistical consideration; cost-effectiveness analysis. The statistical analysis was performed by RevMan4.1 software which was provided by the Cochrane Collaboration. A P value of <0.05 was considered statistically significant. Meta-analysis was done with random effects model. Heterogeneity was checked by chi-square test. Sensitivity analysis was performed by excluding the trials in which Jadad-scale was only 1 score. The result was expressed with odds ratio (OR) for the categorical variable. RESULTS: Fourteen trials involving 4543 patients were included. Meta-analysis was done with random effects model. Heterogeneity and sensitivity analysis were performed also. The effect of intravenous chemotherapy after gastrectomy was better than surgery alone (odds ratio 0.56, 95 %CI 0.40-0.79). There was a significant difference between the two groups by u-test (P=0.0008). Sensitivity analysis revealed the same difference (odds ratio 0.81, 95 % CI 0.70-0.94). Of fourteen trials, only three studies were of high quality according to the Jadad-scale (with three score). There was one meta-analysis trial and the others, about ten trials, were of low quality. There was no trial which mentioned sample-size calculation, allocation concealment, intention-to-treat analysis. Most of the trials didn't describe the blind-procedure. There were five trials which detailed the side-effects according to the toxicity grade by WHO standard. The side-effects halting treatment were haematologic and biochemical toxicity, debilitating nausea and vomiting. There were two patients died of chemotherapy toxicity. CONCLUSION: Based on the review, intravenous chemotherapy after gastrectomy may have positive treatment effect on gastric cancer. However, the evidence is not strong because of the general low methodologic quality of the RCTs. Therefore, we can't make the conclusion that intravenous chemotherapy after gastrectomy may have better treatment effect on gastric cancer than that of surgery alone. Rigorously designed, randomised, double-blind, placebo-controlled trials are required.

Gonadotropin-releasing hormone agonists cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients.

BACKGROUND: Recently, conservative surgery is acceptable in young patients with borderline ovarian tumor and ovarian cancer. The preservation of these patients' future fertility has been the focus of recent interest. This study aimed to observe the effect of gonadotropin-releasing hormone agonists (GnRHa) cotreatment during chemotherapy in borderline ovarian tumor and ovarian cancer patients. METHODS: Sixteen patients who were treated with fertility preservation surgery for borderline ovarian tumor and ovarian cancer and then administered GnRHa during chemotherapy in Peking University People's Hospital from January 2006 to July 2010 were retrospectively analyzed. This group was compared with a control group of 16 women who were treated concurrently with similar chemotherapy (n = 5) without GnRHa or were historical controls (n = 11). The disease recurrence, the menstruation status and reproductive outcome were followed up and compared between the two groups. RESULTS: There were no significant differences between both groups regarding age, body weight, height, marriage status, classification of the tumors, stage of the disease, as were the cumulative doses of each chemotherapeutic agent. One (1/16) patient in the study group while 2 (2/16) patients in the control group relapsed 2 years after conclusion of the primary treatment (P > 0.05). All of the 16 women in the study group compared with 11 of the 16 patients in the control group resumed normal menses 6 months after the termination of the treatment (P < 0.05). There were 4 spontaneous pregnancies in the study group while 2 in the control group, all of the neonates were healthy. CONCLUSIONS: GnRHa administration before and during chemotherapy in borderline ovarian tumor and ovarian cancer patients who had undergone fertility preservation operation may bring up higher rates of spontaneous resumption of menses and a better pregnancy rate. Long-term follow up and large scale clinical studies are required.

Endovascular treatment of traumatic pseudoaneurysm presenting as intractable epistaxis.

OBJECTIVE: To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. MATERIALS AND METHODS: For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. RESULTS: Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. CONCLUSION: In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.

Giant cavernous aneurysm associated with a persistent trigeminal artery and persistent otic artery.

Primitive trigeminal artery (PTA) and primitive otic artery (POA) is a very rare entity in adult life. We present a case of PTA and POA associated with a giant unruptured cavernous aneurysm in a 54-year-old woman. The PTA and the POA arose from the sac of the aneurysm directly, which greatly complicated endovascular therapy management.