Inferior Phrenic Arterial Embolization for Massive Hemoptysis of Tuberculosis / 中国医学影像学杂志

Purpose Bronchial arterial embolization is the preferred hemostasis method for hemoptysis when medical treatment is invalid. This paper aims to discuss the safety and efficacy of inferior phrenic artery (IPA) embolization in the treatment of hemoptysis of tuberculosis when IPA is involved. Materials and Methods Twenty-eight patients who were confirmed that IPA got involved in the hemoptysis due to pulmonary tuberculosis by IPA angiography underwent embolization. CT scan was performed before the procedure and IPAs arteriography were performed during the interventional procedure. Once the blood supply was identified, catheterization and embolization was carried out with gelatin sponge particle, sodium polymannuronate microsphere or microcoil according to the patients' conditions. After the procedure, the IPA angiographic manifestations, clinical efficacy and complications were evaluated. Results Thirty-three IPAs were identified as getting involved in the blood supply in the 28 patients. Among those patients, 12 had left IPA involved, 11 had right IPA involved and the rest 5 had IPAs involved in both sides. The selective IPA angiography showed IPAs had enlargement, with numberous and disordered branches and hypervascularity. IPA-pulmonary artery shunt was found in 22 cases. None of the cases was found extravasation of contrast medium. The hemoptysis reoccurred in 4 patients on the second day, sixth day and 6 months after the first embolization, thus the procedures were performed three times in 1 patient and twice in the other 3 patients. Nine patients had fever as complication, 19 patients had chest pain and 5 suffered from mild dyspnea. These complications usually disappeared in 3-7 days after symptomatic treatment. Conclusion IPA embolization is technically feasible and safe, whose complications are likely to be few and self-restrictive.

Evaluation on the chemosensitivity of hepatocellular carcinoma during mimetic transcatheter arterial embolization / 中华肝胆外科杂志

Objective To investigate whether 5 different chemotherapeutic drugs and their combination of either two drugs could further promote the inhibition on the cell growth of HCC cell line (HepG2) in vitro in the hypoxic and hyponutritional culture medium (HHCM) mimicking the different scenarios of transcatheter arterial chemoembolization (TACE).Methods The cells were treated by 5 drugs for 2 h, 4 h,6 h and 24 h, which include epirubicin (EPI), cisplatin (DDP), mitomycin-C (MMC), oxaliplatin (OXA) and 5-fluorouracil (5-FU) in four concentrations of HHCM (5％, 10％, 25％ and 50％) mimicking the scenarios during TACE and the cell viability was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.The combinations of dual drugs treated for 24 h were also tested.Results The sensitive drugs with inhibition rates more than 30％ were EPI, MMC and OXA in 4 different concentrations of HHCM.The sensitivity of the drugs treated for 24 h was significantly increased compared with that for 2 h in 5％, 10％ and 25％ HHCM.The dual combinations did not increase the chemosensitivity of HepG2 cells.Conclusions EPI, MMC and OXA exhibited cytotoxic activity against HepG2 cells in various hypoxia and hyponutrition states.Prolonging the exposure time could increase the sensitivity of drug in HHCM, and the combination of dual drugs cannot enhance the cytotoxic effect.

Study on the crazy-paving pattern：83 cases of thin-section CT findings / 中国医学装备

Objective:The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the thin-section CT findings with the histopathological findings. Methods: A retrospective review of the medical records of our radiological computed tomography database was performed from January 2010 until December 2012,searching for patients reported to have a crazy-paving pattern on a thin-section CT of the chest. In total, 83 patients with a crazy-paving pattern were retained and reviewed. Results:The crazy-paving pattern consists of interlobular septal and intralobular interstitial thickening superimposed on an area of ground-glass attenuation on thin-section CT scans. We identified 83 cases that presented with the crazy-paving pattern, inclould infection(bacterial infection n=6,viral infection n=16,fungal infection n=1,and mixed infection n=12); ARDS n=4; acute pulmonary oedema n=3; interstitial lung disease (UIP, NSIP) n=18; adenocarcinomas n=3; lymphangitis carcinomatosis n=3;lymphoma pulmonary infiltration n=2;radiation pneumonitis n=5;sarcoidosis n=1;alveolar proteinosis n=4;alveolar hemorrhage n=4; lipid pneumonia n=1. Conclusion: The crazy-paving pattern on thin-section CT is a non-specific signs, can be seen in infections, tumor, as well as some cryptogenetic diseases. Nevertheless, familiar with these common diseases, allows us to narrow the differential diagnosis, even prompted the diagnosis of certain diseases in the appropriate clinical setting.

Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results.

PURPOSE: Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. METHODS: Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. RESULTS: Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. CONCLUSIONS: In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

Interventional therapy of biliary tract stricture by percutaneous transhepatic biliary tract drainage after orthotopic liver transplantation in 30 cases / 中华器官移植杂志

Objective To discuss feasibility and therapeutic effect of the interventional management through biliary tract drainage with percutaneous transhepatic puncture technique for biliary tract stricture after orthotopic liver transplantation. Methods A retrospective review of the clinical and imaging materials of 292 postoperative orthotopic liver transplantation cases was made. Of these 292 cases, 30 patients suffered from biliary tract complications and treated with billiary balloon dilatation, bile drainage and biliary stenting techniques. Results After biliary balloon dilatation, 3 cases of biliary tract strictures and leaks, 3 cases of simple biliary anastomosis site strictures and 7 out of the 8 cases of multiple biliary tract strictures were cured. In one of the multiple biliary tract stricture patients, a hepatic hematoma after biliary balloon dilatation was found and a second liver transplantation was done. In the 14 cases of multiple biliary tract strictures accompanied with biliary sludge, balloon dilatation technique was repeatedly performed. In 12 of the 14 cases, the strictures were improved remarkably and jaundice was subsided; In one of 14 cases, biliary tract stenting procedure was performed, but liver re-transplatation was carried out because of stent obstruction by much sludge. In the remaining 1 of the 14 cases, because there was no improvement of the strictures and relief of jaundice was revealed after the repeated procedures, liver re-transplantation was finally done In 2 cases of strictures at the opening segment of the T tube, the procedure of percutaneous transhepatic puncture for bile drainage was managed. After the procedure, the strictures were alleviated and the jaundice relieved. Conclusion The interventional managements through percutaneous transhepatic puncture techniques were effective, convenient and minimally invasive for treating biliary tract strictures after orthotopic liver transplantation.

Regional intra-arterial infusion chemotherapy for pancreatic cancer of dogs with the mixture of lipid emulsion-cisplatin: an experimental study / 中华放射学杂志

Objective To approach the mechanism and efficacy of regional intra-arterial infusion chemotherapy with the mixture of lipid emulsion-CDDP (LE-CDDP) for treatment of locally advanced pancreatic cancer. Methods Twenty-four health dogs were divided into four groups (group A, B, C, and D). The dosage of CDDP was used in 4 mg/kg/body weight for each animal The 20% LE, as a solvent, was used in the experimental animals with 2 ml/kg/ body weight (group A) and 1 ml/kg/bedy weight (group B), respectively. Normal sodium (NS) as a solvent was used as control with 2 ml/kg/bedy weight (group C) and 1 ml/kg/body weight (group D), respectively. The LE-CDDP mixture and the NS-CDDP mixture were infused into the proximal segment of splenic artery under the DSA, with transfemoral arterial approach. Blood samples were collected after infusion at 0,3,5,10,20,30,40,50,60 min and the tissues were obtained after the 60 min's blood sample was collected. Blood samples, absorbent gland in peripancreas, liver, spleen, kidney, heart, portal vein, the superior segment of jejunal and pancreas and parapancreatic tissues were obtained for CDDP concentration analysis and histopatholngic examination. Results The values of the area under curve (AUC), the incipient serum concentration ( C0 ) and the elimination half-life (t1/2 ) of the serum CDDP concentration-time curve in four groups were A (54. 5 ± 10.1)%,(2.6±0.5) mg/L, (16.7±3.6) min;B (18.3±6.0)%,(1.5±0.2) mg/L, (47.9 ± 11.1) min; C (116.7±20.6)%, (6.5±0.4) mg/L, (10.5±2.8) min and D (126.6±30.7)%, (5.5±0.4) mg/L, ( 10. 1±3. 1 ) min, respectively. There were significant difference among these four groups ( F(AUC) = 42. 42, F(C0) = 249. 61, F( t1/2 ) = 12. 48, P < 0. 01 ). The values of AUC and C0 in the group A were significantly lower than those in the group C (t(AUC) = 6. 64,t(C0) = 16. 34, P <0. 01 ), and the corresponding values in the group B being also significantly lower than those in the group D (t(AUC) = 8.49, t(C0) =22. 30, P<0. 01 ). The value t1/2 in the group A was significantly longer than that of in the group C ( t = 3.36, P < 0. 01 ), and that of group B was also significantly longer than that of group D ( t = 3.71, P <0. 01 ). The values of AUC and C0 in the group B were significantly lower than those in the group A (t(AUC) = 7. 57, t(C0) = 5.48, P < 0. 01 ), and the value t1/2 in the group B was significantly longer than that in the group A (t = 3.22, P < 0. 05 ). The concentrations of the left lobe and horn of pancreas were higher in the group B (0. 18, 0. 18 mg/L) than those in the group A (0. 05, 0. 05 mg/L) (t =2. 52, 2. 73, P < 0. 05). The tissue CDDP concentration of the right lobe of pancreas and spleen were no significant difference between group A ( 0. 11, 0. 29 mg/L ) and group B ( 0. 07, 0. 24 mg/L) ( P > 0. 05 ). Perivascular lymphocytic and neutrophilic infiltration, congestion and hemorrhage were found in the pancreas, parapancreatic absorbent gland, liver and spleen in the group A and group B. The micro-particles of intralipid were present in the capillary vessel of these tissues. No specific pathological changes were found in other groups and organs. Conclusions The regional intra-arterial infusion with LE-CDDP mixture could increase the pancreatic CDDP concentration, meanwhile, it also could decrease the serum CDDP concentration. The more of the CDDP concentration in the LE-CDDP mixture, the more CDDP concentration at the pancreatic tissue accordingly.

Preparation of Isoniazid-contained Drug Layer Alloy Stent and Its Dissolution in Vitro / 中国药房

OBJECTIVE:To prepare a nickel-titanium alloy stent coated by anti-tuberculotic isoniazid and study the dissolution of isoniazid in vitro.METHODS:The polyurethane which was used as film-former was mixed with isoniazid before being coated uniformly on the stent,then the stend was torrefied and dried so that the drug layer alloy stent was obtained.The content and accumulated dissolution in vitro of isoniazid from the stent was determined by ultraviolet spectrophotometry.RESULTS:The linear range of isoniazid was 5.0～30.0 ?g?mL-1(r=0.999 9)and its recovery rate was 99.67%(RSD=1.06%).A high accumluated dissolution rate of isoniazid was achieved,over 60% within the first 30 minutes,followed by a sustained dissolution in the following 8 h.CONCLUSION:The preparation method of the stent is simple and the quality is controllable.

X-ray and CT manifestation of tuberculosis of ankle joint:an analysis of 5 cases / 中国矫形外科杂志

[Objective] To investigate X-ray and CT manifestations of tobereulosis of ankle joint and to discuss the differentiation with other diseases.[Method]The X-ray and CT findings in 5 cases with pathalogically proved tuberculosis of ankle joint were retrospectively analyzed.The differentiation with other diseases was discussed.[Result]The lesions involved entire right ankle joint in all 5 cases,The typical signs were as follows:(1)indistlnct and erosive joint surface,insect bitten-like of bony destruction ofjotht surface,digging-like shape of cancellous bone's destruction;(2)narrowed or irregular widened joint space;(3)ostooporosis of diseased region and surrounding;(4)extensive periostoal reaction of distal fibia and fibula;(5)to form cold abscess and sinus tract.[Conclusion]The tuberculosis of ankle joint earyies certain characteristic X-ray and CT signs,CT is better than X-ray in diagnosis.Highly alert of ankle joint tuberculosis is the key of early correct diagnosis.

Transcatheter Arterial Chemoembolization for Hepatic Carcinoma with Blood Supply from the Intercostal Arteries / 中国微创外科杂志

Objective To study the safety of transcatheter arterial chemoembolization(TACE)via the intercostal artery(ICA)for hepatic carcinoma.Methods A total of 24 patients with hepatic carcinoma(HCC)fed by the ICA underwent TACE via the artery in our hospital.Among the cases,15 were mass type and 9 were nodular type.Plain and enhanced CT or MRI scan were performed before the operation.During the procedure,we carried out intercostal arteriography.Selected catheterization of the feeding branch and then TACE were done.The ICA angiographic features,tumor location,clinical observation,laboratory tests,and imageology were evaluated after the surgery.Results In our cases,the HCCs supplied by the ICA collaterals were located at segments six and/or seven.Angiography showed that all the ICA collaterals originated from the right side at the levels of T8(7.5%,3/40),T9(15.0%,6/40),T10(47.5%,19/40),or T11(30.0%,12/40).The procedure was completed in 22 of the patients.CT scan performed after the procedure showed that the tumor was completely filled with lipiodol in 87.5%(21/24)of the cases.The serum level of AFP decreased significantly in 82.6%(19/23)of the patients.Three patients complained of severe pain at the shoulder after the operation,1 patient had skin itching during TACE,and 5 developed skin erythema after the procedure.Conclusions HCC supplied with ICA collaterals are often detected in the patients who have the tumor at the right posterior segment(S6 and S7)and had received TACE for several times.TACE via the ICA is safe but may leads to skin injuries.

Preliminary Applicaton of Placing Freka R Trelumina guided by DSA / 医疗卫生装备

Objective To evaluate the initial clinical application value of placing the Freka R Trelumina guided DSA. Methods The Freka(R) Trelumina was placed guided by DSA in 10 patients with disease of digestive tract post operation complicated with stomal leak or/and stomal stegnosis or various kinds of patients with gastric emptying disorder. Results The Freka(R) Trelumina could be put 20 cm away from Treize anadesma guided by DSA. The achievement ratio was 90%. The putting time was 1 to 3 weeks. The localization of the Freka(R) Trelumina was well. The process of feeding was successfully. The effectiveness of decompression of stomach intestine was also good. Stomal leak healed up quickly. The appearance of gastric emptying disorder disappeared. Conclusion Placing the Freka(R) Trelumina guided by DSA is a simple, safe and reliable method for jejunum nourishment and gastrointestinal decompression.

Appearance of Chest CT of Relapsing Polychondritis / 医疗卫生装备

Objective To analyze the chest CT appearance of relapsing polychondritis with severer tracheobronchial malacia and improve diagnosis veracity.Methods Five patients with relapsing polychondritis received CT examination and the CT appearances were studied.Results The characteristic appearances in CT were throat tracheal and branch stenosis.The tracheal cartilages thickened and membranous wall was normal.Conclusions Distinguishability of CT is high,which can display the area and characteristics of the pathological changes CT examination is an efficient method of diagnosis of relapsing polychondritis,and can direct selecting treating methods.[Chinese Medical Equipment Journal,2008,29(2):84-85]