Anesthetic management of conjoined twins undergoing one-stage surgical separation: A single center experience.

OBJECTIVE: To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. METHODOLOGY: Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby's side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results : All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery.

Establishing models of portal vein occlusion and evaluating value of multi-slice CT in hepatic VX2 tumor in rabbits.

AIM: To establish models of portal vein occlusion of hepatic VX2 tumor in rabbits and to evaluate the value of multi-slice CT. METHODS: Forty New Zealand rabbits were divided into 4 groups according to digital table: Immediate group (group A; transplantation of tumor immediately after the portal vein occlusion), 3-wk group (group B; transplantation of tumor at 3 wk after the portal vein occlusion), negative control group (group C) and positive control group (group D), 10 rabbits in each group. Hepatic VX2 tumor was transplanted with abdominal-embedding inoculation immediately after the portal vein occlusion and at 3 wk after the portal vein occlusion. Meanwhile, they were divided into negative control group (Left external branch of portal vein was occluded by sham-operation, and left exite was embedded and inoculated pseudoly) and positive control group (Transplanted tumor did not suffer from the portal vein occlusion). All rabbits were scanned with multi-slice CT. RESULTS: All 40 animals were employed in the final analysis without death. Tumor did not grow in both immediate group and 3-wk group. In 3-wk group, left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was significantly smaller than that in positive control group (2.55 +/- 0.46 vs 3.59 +/- 0.37 cm, t = 5.57, P < 0.001). Incidences of metastasis in the liver and lung were lower in 3-wk group than those in positive control group (10% vs 40%, and 90% vs 100%, respectively). The expression intensities of the vascular endothelium growth factor (VEGF) in groups A, B, C and D were 0.10 +/- 0.06, 0.66 +/- 0.21, 0.28 +/- 0.09 and 1.48 +/- 0.32, respectively. VEGF expression level in the test group A was significantly lower than that in the negative control group C (t = 5.07; P < 0.001). In addition, VEGF expression in the test group B was significantly lower than that in the positive control group D (t = 6.38; P < 0.001). Scanning with multi-slice CT showed that displaying rate of hepatic artery branches was obviously lower in grade III (40%) than that in grade I (70%) and II (100%) (P < 0.05); but there was no significant difference in displaying rate of the portal vein at various grades. Values of blood flow (BF) of the liver, blood volume (BV), mean transit time (MTT) and permeability of vascular surface (PS) were lower in the immediate group and 3-wk group than those in control groups, but values of hepatic arterial fraction (HAF) were increased. Significant positive correlations were existed between BF and BV (r = 0.905, P < 0.01), and between BF and PS (r = 0.967, P < 0.01), between BV and PS (r = 0.889, P < 0.01). A significant negative correlation existed between PV and HAF (r = -0.768, P < 0.01), between PS and HAF (r = -0.557, P < 0.01). The values of BF, BV and PS had a positive correlation with VEGF (r(BF) = 0.842, r(BV) = 0.579, r(PS) = 0.811, P < 0.01) . However, there was no significant correlation between the values of MTT and HAF and the VEGF expression (r(MTT) = 0.066, r(HAF) = -0.027). CONCLUSION: Ligating the left external branch of portal vein is an ideal way to establish models of portal vein occlusion in rabbits with hepatic VX2 tumor. Multi-slice CT plays a key role in evaluating effect of portal vein occlusion.

CT angiography of cervical anterior spinal artery and anterior radicular artery: preliminary study on technology and its clinical application.

Spinal cord ischemia significantly threatens patient health. Cervical spinal cord ischemia is mainly caused by anterior spinal artery (ASA) or anterior radicular artery (ARA) injury. Because of the complex hemodynamics in cervical spinal cord arteries, conventional CT angiography (CTA) does not satisfactorily show the ASA and ARA. In this study, cervical cord CTA was done to 20 patients suspected of cervical spinal cord ischemia with an increased dose of contrast medium and an extra 6-s delay from the peak time determined on the test bolus. The visualization quality of ASA and ARA in the cervical cord CTA was compared with conventional craniocervical CTA using a four-grade visual analogue scale, and injuries to ASA and ARA were evaluated. Our initial experience indicated that cervical cord CTA can efficiently display the anatomical features and comprehensively evaluate injury of the ASA and ARA.

[Imaging diagnosis of the vertebral injury in earthquake].

OBJECTIVE: To explore the clinical value of imaging diagnosis of the vertebral injury in earthquake. METHODS: Twenty-two cases of the vertebral injury in earthquake with clinical and imaging data were analyzed retrospectively. All of the cases were performed X-ray plain film examination, CT in 20 cases and MRI in 15 cases. RESULTS: Imaging examination can establish definitive diagnosis in all cases. In the 22 cases, the vertebral compression fracture was found in 20 cases, and vertebral bursting fracture in 2 cases,single-level vertebral fracture in 12 case,and multiple-level vertebral fracture in 10 case. Among the 31 vertebral bodies of fracture, the fracture of cervical vertebra, thoracic vertebra, lumbar vertebra and sacral vertebra was found in 3, 12, 14, 2 vertebral bodies, respectively. CONCLUSION: Imaging examination is the most valuable examination method in diagnosis of the vertebral injury in earthquake. It can not only make definitive diagnosis, but also play an important role in selection of therapeutic method.