Clinical feasibility and safety of a novel miniature mobile cardiac catheterization laboratory in diagnosis and treatment for coronary heart disease

Background The lack of medical facilities causes delayed diagnosis and treatment of coronary heart disease in remotemountainous area and/or at disaster site. The miniature mobile cardiac catheterization laboratory was developed to be anintervention platform for coronary heart disease diagnosis and treatment by our team. Pre-clinical research indicated thatthe miniature mobile cardiac catheterization laboratory performed well in the rescue of critical cardiovascular diseases,even ST-segment elevation myocardial infarction. The present study aimed to evaluate the clinical safety and timeliness ofthe miniature mobile cardiac catheterization laboratory for emerqent coronary interventional diaqnosis and treatment.     

Long-Term Follow-Up of Chinese Herbal Medicines Combined with Conventional Treatment in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Multicenter Randomized Controlled Trial

Objective: To evaluate the prognosis effect of Chinese herbal medicines(CHMs) for benefiting qi and activating blood circulation adjunctive to conventional treatment in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). Methods: A total of 702 patients with ACS who underwent PCI were enrolled and randomly assigned to receive conventional treatment plus CHMs for benefiting qi and activating blood circulation(treatment group, 351 cases) or conventional treatment alone(control group, 351 cases) for 6 months. Six months later, all patients received conventional treatment alone. Follow-ups were scheduled at 6th, 12 th, 18 th, 24 th month after enrollment in April 2008, and the final follow-up visit was during September 2011 and November 2011. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction or revascularization(PCI or coronary artery bypass grafting); and the secondary endpoint was the composite of re-admission for ACS, congestive heart failure, nonfatal stroke or other thrombus events. Results: A total of 621(88.59%) patients completed 35.4±3.8 months follow-up, while 80(11.41%) patients withdrew from the trial(41 in the treatment group and 39 in the control group). The incidence of primary endpoint was 5.7%(20 patients) in the treatment group versus 10.86%(38 patients) in the control group [relative risk(RR): 0.53; 95% confidence interval(CI): 0.30, 0.88; P=0.013; absolute risk reduction(ARR): –0.052, 95% CI: –0.06, 0.01]. The incidence of secondary endpoint was 5.98%(21 patients) in the treatment group versus 10.28%(36 patients) in control group(RR: 0.58, 95% CI: 0.33, 0.97, P=0.037; ARR: –0.043, 95% CI: 0.06, 0.01). Most of the primary and secondary endpoints were occurred in 18 months(84.50% in the treatment group versus 78.10% in the control group). Conclusion: CHMs for benefiting qi and activating blood circulation adjunctive to conventional treatment improved clinical outcomes for patients with ACS after PCI in long-term follow-up.     

SEVEN CASES OF EPITHELIAL OVARIAN CARCINOMA WITH BRAIN METASTASIS

Objective To summarize the clinical characteristics, treatment, and prognosis of brain metastasis in patients with epithelial ovarian carcinoma. Metbods Retrospective analysis was conducted in 7 cases of brain metastases of epithelial ovarian carcinoma from January 1986 to March 2007 in Peking Union Medical College Hospital for summarizing therapy results and prognosisaffecting factors. Results Incidence of brain metastases of epithelial ovarian carcinoma was about 0. 66% （7/1 055 ）. Serous adenocarcinoma was the predominant pathological type in 4 cases and the subsequent was adenocarcinoma in 3 cases. All the patients were diagnosed at late stage, 6 cases with the International Federation of Gynecology and Obstetrics （HGO） stage Ⅲc and 1 with FIGO stage IV. The mean duration from diagnosis of ovarian carcinoma to brain metastasis was 32.7 ± 20. 0 months （range, 23-73 months）. Single metastasis focus occurred in 43% of cases and multiple metastases in 57% of cases. Fifty-seven percent of patients presented extracranial metastasis. Serum CA125 played a role in monitoring reoccur- rence and brain metastases. The average survival time was about 12 months. Better treatment with prolonged survival could be achieved by combination of operation and chemotherapy or combination of radiotherapy with chemotherapy. Concltusions As a rare condition, brain metastasis of epithelial ovarian carcinoma is rising in incidence with improved treatment of ovarian carcinoma and prolonged survival. However, brain metastasis indicates bad prognosis which can be improved by combined therapy.     

Application of interventional diagnostic and therapeutic technique for coronary artery fine branch fistula

Objective：To explore the value of angiographic diagnosis and interventional therapy of the coronary artery fine branch fistula. Methods：All of the 18 patients with coronary artery fine branch fistula underwent selective coronary arteriography, 7 underwent interventional therapy, while 8 underwent prosthesis for coronary artery fistula （CAF） under extracorpored circulation. Results：Among 18 cases of coronary artery fine branch fistula, 7 happened in right coronary artery （38. 9%）, 11 in left coronary artery （61. 1%）. Among the 11 cases in left coronary artery,5 happened in descending anterior branch, 5 occurred in left circumflex branch, 1 arised from both left anterior branch and left circumflex branch. Among the 18 cases, there are 10 cases of coronary-to-pulmonary artery fistula （55.6%）, 5 cases of fistula draining into right atrium （27.8%）, 2 cases of fistula draining into left atrium （1 1.1% ） and 1 draining into right ventricle （5.6%）. Interventional treatment was successful in 7 patients. During the 12 months＇ follow-up, there was no cardiovascular events. Conclusion： Selective coronary angiography is the first choice for diagnosing the coronary artery fine branch fistula. In respect of therapy, besides of surgical treatment, intervention is still a rather good measure presently.     

Endovascular embolization of pulmonary arteriovenous malformations

Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients （n=-23） with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases. Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from （78.04＋8.22）% to （95.13＋3.67）% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization （t=9.101, P 〈0.001）. Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood oxygen saturation between 85% and 90%. Symptoms of hypoxia never recurred in the other cases. Conclusions Endovascular embolization of pulmonary arteriovenous malformations can significantly improve blood oxygen saturation and reduce serious complications such as cerebral infaction. Therefore, this kind of interventional procedure is a safe and effective treatment method with a low complication rate.     

Safety and feasibility of transulnar versus transradial artery approach for coronary catheterization in non-selective patients

Background Transradial approach catheterization is now widely used in coronary angiography and angioplasty.The ulnar artery,which is one of the two terminal branches of the brachial artery,may be a potential approach for cardiac catheterization.The aim of this study was to evaluate the safety and feasibility of a transulnar approach for coronary catheterization in non-selective patients.Methods A total of 535 consecutive patients were randomly assigned to transulnar approach （TUA） group （n=271） or transradial approach （TRA） group （n=264） upon arrival at the catheterization laboratory.Allen＇s test and inverse Allen＇s test were not routinely performed.Ultrasound-Doppler assessment of the forearm artery was performed before the procedure,two days after the procedure,and 30 days after the procedure.The primary endpoints of study were the rate of successful artery cannulation and the access-site related complications.The secondary endpoints included the number of needle punctures,total time for the procedure,and major adverse cardiac events （MACE）.Results Successful puncture of the objective artery was obtained in 91.5％ of the patients in the TUA group,and 95.1％ of the patients in the TRA group （P ＞0.05）.There was no significant difference in hematoma complications between the two groups （7.7％ vs.4.2％,P=0.100）.A motor abnormality of the hand was observed in one patient in the TUA group.There were no arteriovenous fistula or pseudoaneurysm observed in our study.Three （1.1％） patients in the TUA group and 8 （3.0％） patients in the TRA group had occlusion of the access artery （P=0.137）,but none of the patients had symptoms or signs of hand ischemia.There were no significant differences in MACE between the two groups during follow-up.Conclusion The transulnar approach is an effective and safe technique for coronary catheterization in non-selective patients.     

Minimally invasive two-incision total hip arthroplasty: a short-term retrospective report of 27 cases

Background Total hip arthroplasty (THA) is widely applied for the treatment of end-stage painful hip arthrosis. Traditional THA needed a long incision and caused significant soft tissue trauma. Patients usually required long recovery time after the operation. In this research we aimed to study the feasibility and clinical outcomes of minimally invasive two-incision THA. Methods From February 2004 to March 2005, 27 patients, 12 males and 15 females with a mean age of 71 years (55–76), underwent minimally invasive two-incision THA in our department. The patients included 9 cases of osteoarthritis, 10 cases of osteonecrosis, and 8 cases of femoral neck fracture. The operations were done with VerSys cementless prosthesis and minimally invasive instruments from Zimmer China. Operation time, blood loss, length of incision, postoperative hospital stay, and complications were observed. Results The mean operation time was 90 minutes (80–170 min). The mean blood loss was 260 ml (170–450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average 400 ml). The average length of the anterior incision was 5.0 cm (4.6–6.5 cm) and of the posterior incision 3.7 cm (3.0–4.2 cm). All of the patients were ambulant the day after surgery. Nineteen patients were discharged 5 days post-operatively and 8 patients 7 days post-operatively. The patients were followed for 18 months (13–25 months). One patient was complicated by a proximal femoral fracture intraoperatively. No other complications, including infections, dislocations, and vascular injuries, occurred. The mean Harris score was 94.5 (92–96). Conclusions Two-incision THA has the advantage of being muscle sparing and minimally invasive with less blood loss and rapid recovery. However, this technique is time consuming, technically demanding, and requires fluoroscopy.     

DIAGNOSIS AND TREATMENT OF IDIOPATHIC NECROSIS OF THE FEMORAL HEAD

Fifteen cases,27 hips,of idiopathic necrosis of the femoral head (INFH) were included iour series.The role of radiography,isotopic bone scanning,intraosseous pressure measure-ment and intraosseous venography in the diagnosis of INFH were evaluated.Radiologicalexamination could not reveal early cases,while isotopic bone scanning was more sensitive.There was an increase of intraosseous pressure in most of the diseased hips.and intraos-seous venography showed abnormalities in all examined hips.The latter two tests couldtherefore detect early INFH.Core decompression was performed in 23 hips,21 of whichwere followed for 7 to 27 months.Functional evaluation was good or excellent in 18 hips.Radiological re-examination remained unchanged in 19 hips.Postoperative intraosseouspressure measurement and intraosseous venography revealed a decrease of intraosseous pres-sure and improvement of venous drainage.Core decompression is therefore an ideal methodof treatment for early INFH.     

A Randomized Trial to Assess the Long-term Safety of NeuroAiD among Caucasian Patients with Acute Ischemic Stroke

Objective：To assess the long-term（up to 6 months）safety profile of a 3-month regimen of NeuroAiD for acute ischemic stroke.Methods：A total of 190 patients with acute ischemic stroke were identified for eligibility in a randomized,double-blind,placebo-controlled clinical trial,of which 150 patients allocated to either receiving NeuroAiD（80 cases）or placebo（70 cases）were analyzed after dropouts due to absence of baseline data,early death,or noncompliance.Both groups received treatment for three months and followed up for another three months after the completion of the treatment.Occurrence of clinical adverse events and laboratory parameters were assessed at 1 month,3 months（while under treatment）and 6 months（3 months after the completion of treatment）.Statistical comparisons between groups were performed using chi-square test or t-test whenever appropriate.Results：The two groups had comparable baseline characteristics.Mild nausea was more commonly reported in patients taking NeuroAid compared with placebo（P=0.01）,of which 9 out of10 were observed only during the first month of treatment.However,none of the adverse events reported were considered severe or required discontinuation of the study drug.There was no significant change observed in mean arterial blood pressure,haemoglobin,renal and liver laboratory parameters during treatment with NeuroAid and up to 3 months after completion of a 3-month regimen.Conclusion：NeuroAiD is safe and does not affect hematologic,hepatic,and renal functions during and long after completion of treatment.     

SIMPLE OBESITY AND OBESITY HYPERLIPEMIA TREATED WITH OTOACUPOINT PELLET PRESSURE AND BODY ACUPUNCTURE

161 cases of simple obesity with or without hyperlipemia were treated by pellet pressure onauricular acupoints plus body acupuncture for 3 months in a single-blind experiment.Pa-tients on Capsulae Oiei Oenothera Erythrosepalae were taken as positive controls.Bodyweight,circumference of chest,abdomen,arms and legs,the appetite,sleep,bowelmovement,blood TC,TG and HDL-C were recorded for comparison.The results indicatedthat treatment in the auricular and body acupoint group was superior to treatment in thecontrol group.In the acupoint group body weight dropped by an average of 5.04 kg in84.55% of the patients,who also showed decreased appetite,blood TC and TG.     

超声引导下瘤腔内注射凝血酶治疗IFAP合并动静脉瘘

目的采用超声引导下瘤内注射凝血酶（UGTI）治疗医源性股动脉假性动脉瘤（IFAP）合并动静脉瘘。方法冠状动脉介入诊治术后IFAP患者32例,其中9例合并动静脉瘘。所有患者均接受UGTI治疗,并于术后3、14和30d定期进行超声复查。结果 31例患者一次治疗成功,1例失败转行外科手术治疗。31例患者术后随访,均无IFAP复发以及栓塞和过敏反应等并发症发生。结论 UGTI治疗IFAP具有较高的临床价值,对合并动静脉瘘者同样安全、有效。     

股静脉穿刺置管临床并发症发生及处理分析

目的探讨双腔股静脉穿刺置管术患者临床并发症的发生情况及处理方法,总结以后穿刺及对并发症的处理经验。方法以2008年9月～2011年9月我科243例因各种原因需行血液净化治疗而建立临时双腔股静脉穿刺置管术的患者为研究对象,分析其临床并发症的发生情况及处理方法。结果 243例双腔股静脉置管患者中,置管成功者239例(98.4%),置管失败者4例(1.6%)。置管术后至2周内出现导管不通畅或导管完全阻塞16例(6.5%);导管相关性菌血症10例(4.1%);留置导管周围渗血9例(3.7%),留置导管滑脱4例(1.6%),局部血肿形成3例(1.2%),术侧下肢肿胀3例(1.2%),动静脉瘘1例(0.4%)。结论股静脉穿刺留置导管作为肾内科常规治疗手段,具有穿刺置管成功率高,操作技术相对简单,风险小,能保证足够血流量的优点。在急慢性肾衰竭、中毒及内外科其他多种危急重症的抢救、治疗中有重要的应用价值。     

股动脉穿刺术后三种止血方法的效果比较

目的：对股动脉穿刺术后三种止血的方法进行效果比较,探讨怎样减少外周血管出血并发症的发生。方法：收集156例股动脉穿刺术后病例的资料,其中,48例采用Angiolink^TM血管缝合器止血,50例采用普通绷带止血,58例采用Coban^TM自粘式绷带止血。对三种方法的效果进行比较。结果：Angiolink^TM血管缝合器止血组,外周血管出血并发症的发生率为2．1％,低于采用Coban^TM自粘式绷带止血组（2．1％vs9．0％,P〈0．05）和普通绷带止血组（2．1％vs24％,P〈0．01）。Coban^TM自粘式绷带止血组比普通绷带止血组明显降低,外周围血管出血并发症率（9．0％vs24％,P〈0．05）。结：Angiolink^TM血管缝合器用于股动脉穿刺术后止血,能明显的减少外周血管并发症的发生,但对那些无力支付昂贵血管缝合器的患者,选用Coban^TM自粘式绷带止血,也是一个好的替代方法。     

水化治疗联合乙酰半胱氨酸预防冠心病并糖尿病患者发生造影剂肾病的临床研究

目的探讨水化治疗联合乙酰半胱氨酸（N—Acetyl—L—cysteine,NAC）对冠心病并糖尿病患者发生造影剂肾病（contrast—induced nephropathy,CIN）的防治作用。方法选择接受冠状动脉介入诊疗的冠心病并糖尿病患者96例,随机分为水化治疗联合NAC研究组55例和常规治疗对照组41例。检测所有患者术前3天（任意一天）、术后第1天、第2天、第3天、第6天的血清肌酐水平。结果术后第1、2、3、6天对照组较研究组血清肌酐均明显增高,差异有统计学意义（P〈0．05）。研究组发生CIN1例（1．82％）,对照组发生CIN8例（19．51％）,两组对比差异有高度统计学意义（P〈0．01）。结论水化治疗联合NAC较常规治疗可显著减少CIN的发生。     

彩色多普勒超声在医源性假性动脉瘤诊疗中的应用价值

目的探讨彩色多普勒超声在医源性假性动脉瘤诊断及治疗中的应用价值。方法 17例经皮冠状动脉介入术后所致股动脉假性动脉瘤患者,全部病例均经彩色超声多普勒确诊后,采用超声引导下局部压迫和注射凝血酶共同治疗假性动脉瘤。结果 17例假性动脉瘤均一次性治疗成功。结论彩色多普勒超声是诊断医源性假性动脉的首选方法,超声引导下局部压迫和注射凝血酶共同治疗假性动脉瘤,安全、有效、简便、费用低廉,具有较高的临床价值,值得推广。     

经两种穿刺途径行冠心病介入诊疗术后的护理

目的探讨经股动脉和桡动脉两种穿刺途径行冠状动脉介入诊疗方法的利弊,以及针对不同途径的特点采取相应护理措施。方法将261例冠心病患者按介入途径不同随机分两组,桡动脉途径组121例,股动脉途经组140例,观察比较两组患者局部渗血与血肿、假性动脉瘤、动静脉漏、迷走神经反射、排便困难、主观不适等发生的情况及采取相应的护理措施。结果两种的穿刺成功率、假性动脉瘤及动静脉漏的发生率比较,差异无统计学意义（P〉0．05）;经桡动脉途径组局部渗血与血肿、迷走神经反射、排便困难及主观不适发生率显著低于经股动脉穿刺途径组,差异有统计学意义（P〈0．01）。结论两种途径行冠脉介入诊疗是安全可行的,但经桡动脉途径不良反应发生率低,可减轻患者痛苦,术后护理相对简单,患者更易接受。     

An iatrogenic complication of internal jugular vein catheterization for hemodialysis

Background

Central venous catheterization is increasingly performed as a temporary vascular access for hemodialysis therapy in developing countries and it can be associated with serious complications. Iatrogenic common carotid artery-jugular vein arteriovenous fistula is a rare but serious complication of internal jugular vein catheterization for hemodialysis access. Few cases of such complication of uremic patients on hemodialysis have been reported in the literature.

Aim

To report a case of iatrogenic common carotid artery-jugular vein arteriovenous fistula caused by internal jugular vein catheterization of a hemodialysis patient and its surgical repair.

Result

The iatrogenic arteriovenous fistula was repaired.

Conclusion

Acquaintance of anatomical landmarks, careful preparation, experience of the physician and the ultrasound guidance are important factors to reduce the risk of complications during internal jugular vein catheterization. Surgical repair should be performed earlier in order to avoid the development of other serious complications.     

12例脑动静脉畸形Onyx胶栓塞治疗的体会

目的探讨应用Onyx栓塞治疗脑动静脉畸形的应用价值。方法全麻下经股动脉穿刺插管,微导管超选择插管到达病变部位后,用Onyx栓塞治疗颅内动静脉畸形12例。结果12倒脑动静脉畸形患者,共行20次栓塞治疗,畸形血管团栓塞达80％以上者6例,其中3例完全栓塞,栓塞50％-80％者4例,栓塞50％以下者2例。发生颅内出血并发症1例,脑缺血I例。经过相应处理后好转。结论Onyx是治疗脑动静脉畸形较为理想的栓塞材料,血管内栓塞是脑动静动静脉畸形综合治疗中重要的组成部分。     

弹性绷带对脑瘫患儿立位及步行功能的作用观察

目的:探讨弹性绷带的应用对脑瘫儿立位及步行功能的影响。方法:立位及步行功能异常的脑瘫患儿71例,随机分为矫正组50例和对照组21例,两组均采用以Bobath技术为主的综合康复治疗,矫正组同时据患儿情况配备弹性绷带进行训练。2组治疗前后用粗大运动功能评定量表(GMFM)对爬和跪、立位、步行等项进行功能评定。结果:治疗3个月后2组患儿GMFM得分较治疗前明显提高(P<0.001),矫正组得分高于对照组(P<0.05)。结论:配备弹性绷带并采用神经生理学疗法为主的综合康复治疗更有利于患儿立位及步行功能的提高。     

后颅窝开颅术后枕部皮下积液的临床分析

目的：分析后颅窝开颅术后枕部皮下积液形成的原因,并探讨其防治措施。方法：回顾性分析8例后颅窝开颅术后枕部皮下积液患者的临床资料。结果：8例患者均治愈,其中5例经积液腔置管持续引流枕颈部加压包扎治愈,2例经积液腔置管持续引流枕颈部加压包扎＋腰椎穿刺持续引流治愈,1例并发脑积水经脑室—腹腔分流术后积液腔置管持续引流枕颈部加压包扎治愈,无一例再次打开切口手术处理。结论：术中硬膜、枕下肌肉层和皮下组织缝合不严密及局部遗留死腔是枕部皮下积液形成的主要原因,积液腔置管持续引流枕颈部加压包扎效果肯定。