In situ reconstruction of ruptured mycotic iliac artery aneurysm with autologous fascial-peritoneal tissue: a case report and literature review.

BACKGROUND: Infectious aneurysms are rare in clinic with poor therapeutic outcomes. When artery rupture occurs, the disease tends to progress resulting in a high mortality, and there remains no ideal treatment. CASE PRESENTATION: We report a case of rupture of infectious iliac artery pseudoaneurysm, who was assigned to receive artery reconstruction with autologous fascial-peritoneal tissue and obtained satisfied short-term outcome. The follow-up of 6 months after operation was good and long-term follow-up is continuing. CONCLUSION: The posterior rectus fascia-peritoneal layer seems to be a feasible autologous biomaterial for vascular substitution in urgent setting when no other autologous material was available.

Pooled-analysis of efficacy and safety of minimally invasive versus standard percutaneous nephrolithotomy.

BACKGROUND: This study aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) versus standard percutaneous nephrolithotomy in patients with renal and upper ureteric stones. METHODS: We conducted a pooled analysis on randomized controlled trials (RCTs). The eligible RCTs were selected from the following databases: MEDLINE, Embase, Web of Science, and the Cochrane Library. The reference lists of retrieved studies were also investigated. RESULTS: Our analysis included 10 RCTs with 1612 patients. Pooled data from 10 RCTs revealed the following: stone-free rate (odds ratio = 1.46, 95% confidence interval (CI) [1.12,1.88], P = .004), operative time (mean difference [MD]  = 4.10, 95% CI [-1.37,9.56], P = .14), length of hospital stay (MD = -15.31, 95% CI [-29.43,-1.19], P = .03), hemoglobin decrease (MD = -0.86, 95% CI [-1.19,-0.53], P < .00001), postoperative fever (MD = 0.83, 95% CI [0.49,1.40], P = .49), and urine leakage (MD = 0.59, 95% CI [0.25,1.37], P = .22). Besides, we performed sub-group analysis based on vacuum suction effect and multiple kidney stones. For vacuum suction effect, it revealed the following: stone-free rate in vacuum suction group (P = .007) and in non-vacuum suction group (P = .19). Operative time in vacuum suction group (P = .89), non-vacuum suction group (P = .16). Postoperative fever in vacuum suction group (P = .49), non-vacuum suction group (P = .85). CONCLUSION: This pooled analysis indicated that MPCNL was a safe and effective method for treating renal stones compared with standard percutaneous nephrolithotomy. Besides, the vacuum suction effect in MPCNL played a more important role. When it comes to multiple or staghorn stones, the longer operative time in MPCNL could not be ignored.

Guidance of Venous Stent Implantation after Catheter-directed Thrombosis in Patients with Acute Left Lower Extremity Deep Venous Thrombosis based on Pressure Gradient Differences between the Iliac Vein and Inferior Vena Cava: A Single-center Retrospective Study.

BACKGROUND: Iliac vein compression syndrome (IVCS) can lead to acute deep venous thrombosis (DVT) and post-thrombotic syndrome (PTS). Endovascular venous stenting has become a preferred treatment for IVCS. In this article, we guide stent implantation by the pressure gradient of iliac vein and inferior vena cava. To evaluate the feasibility of guidance of venous stent implantation based on venous pressure gradient difference. METHODS: A retrospective analysis was performed on patients with acute left lower extremity DVT who were treated in our center from March 2012 to December 2017. The patients were divided into 2 groups: group 1: from January 2015 to December 2017, patients were treated with catheter-directed thrombolysis (CDT) and stent implantation was guided by the pressure gradient of iliac vein and inferior vena cava after thrombectomy; group 2: from May 2012 to December 2014, patients underwent CDT treatment without stent implantation. In group 1, the patients were divided into 2 groups according to the difference in pressure gradient after CDT: the stent group (>2 mm Hg) and the control group (≤2 mm Hg). All patients were evaluated by color Doppler ultrasound at 1, 3, and 6 months after the operation to evaluate the patency of the iliofemoral vein. The Villalta score was used to evaluate the incidence of PTS. RESULTS: The primary and secondary patency rate of group 1 at 1, 3, and 6 months after operation were higher than that in group 2 (P < 0.05). In group 1, there was no significant difference in the primary and secondary patency rate between the stent group and the control group at 1, 3, and 6 months after the operation. The incidence of PTS in group 1 at 6 months after the operation was lower than that in group 2 (P < 0.05). In group 1, there was no significant difference in the incidence of PTS between the stent group and the control group at 6 months after the operation. CONCLUSIONS: Practice proves that it is simple and effective to guide stent implantation according to differences in pressure gradients. Two millimeter of mercury is the traditional standard for venous pressure interference in the pelvic area, and the effectiveness of this method was proved.

Popliteal Vein Puncture Technique Based on Bony Landmark Positioning in Catheter-Directed Thrombolysis of Deep Venous Thrombosis: A Retrospective Review.

BACKGROUND: Catheter-directed thrombolysis (CDT) is an effective method for the treatment of deep venous thrombosis (DVT). The most widely used puncture technique involves the popliteal vein of the affected leg. We introduce a new puncture technique based on bony landmark positioning. METHODS: Between May 2012 and December 2014, we performed CDT in 96 cases of DVT using the puncture technique. The procedure is performed with the patient in the prone position on the angiography table. The popliteal vein is punctured according to tibial bony landmarks under fluoroscopic guidance. The needle puncture is made from the popliteal crease, along the direction of tibial lateral intercondylar eminence and parallel to the vertical axis. An introducer sheath is inserted after successful puncture followed by placement of a perfusion catheter of appropriate length in the thrombus. RESULTS: Technical success was achieved in 83 cases, with a success rate of 86.46% (83/96). The mean operation time was 38.6 ± 16.8 min, the mean fluoroscopy time was 11.3 ± 4.9 min, the mean effective dose (ED) was 77.2 ± 25.4 mGy, the mean dose-area product (DAP) was 3,927.5 ± 1,261 cGy cm(2). Compared with catheterization via incised ipsilateral small saphenous and contralateral femoral veins, the technique significantly shortened the operation and the X-ray exposure and reduced the dosage of ED and DAP. CONCLUSIONS: Popliteal vein puncture technique based on bony landmark positioning is a user-friendly alternative to CDT, especially in the absence of ultrasound localization.

Effects of repeated high dosage of chloral hydrate and pentobarbital sodium anesthesia on hepatocellular system in rats.

This study aims to investigate the possible effects of repeated high dosage of chloral hydrate and pentobarbital sodium anesthesia on hepatocellular system in rats. Thirty Sprague Dawley rats were randomly divided into 3 groups: control group (group A), chloral hydrate group (group B) and pentobarbital sodium group (group C). Antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione s transferase (GST) and catalase (CAT) activities and thiobarbituric acid-reactive substances (TBARS) level as well as serum biochemical parameters alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin (T-BIL) were determined. Liver histopathological examinations were performed at termination. Furthermore, Bax and Bcl-2 expression, and caspase-3 activity were also evaluated. The SOD, GSH-Px, GST and CAT activities significantly decreased but TBARS levels increased in group B and C compared with group A. Hepatic injury was evidenced by a significant increase in serum ALT, AST and ALP activities in group B and C, which also confirmed by the histopathological alterations. Moreover, administration of chloral hydrate and pentobarbital sodium could induce certain hepatic apoptosis accompanied by the upregulated Bax expression, the downregulated Bcl-2 expression and Bcl-2/Bax ratio, and the increase of caspase-3 activity. Repeated high dosage of chloral hydrate and pentobarbital sodium anesthesia could produce hepatotoxicity.