Temporary strecker stent for management of acute dissection in popliteal and crural arteries

Stent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. Stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided.     

纤维支气管镜诊断儿童支气管结核的研究

目的　探讨儿童支气管结核 (EBTB)的纤维支气管镜 (纤支镜 )诊断及分型。方法　回顾性总结、分析临床治疗不顺利的肺结核或可疑肺结核的住院患儿 110例 ,均经纤支镜诊查 ,归纳EBTB病变在纤支镜下表现 ,并分型为 :粘膜型、干酪型、管腔型和混合型。 110例均摄胸部X线片 (其中做胸部CT检查 6 2例 ) ,追踪临床诊疗过程和最终诊断 ,以验证纤支镜诊断。再评估纤支镜在儿童EBTB诊查中的作用 ,提出EBTB诊断标准。结果　纤支镜诊断 10 8例EBTB ,其中混合型 78例、粘膜型 18例、管腔型 9例、干酪型 3例。临床合并各型儿童肺结核 91例。在纤支镜确诊的 17例EBTB中 ,胸部X线片均未提供特异性结核证据 ,气道分泌物结核菌阳性 15例。本文结核菌阳性率为 5 3%。结论　儿童EBTB并非少见 ,其诊断在临床有重要意义 ;儿童EBTB可以原发 ;本文试行的儿童EBTB分型方法简便易行。纤支镜是诊断EBTB的必需工具。     

腹腔镜联合纤维胆道镜胆总管探查82例

目的 探讨腹腔镜联合纤维胆道镜胆总管探查术的方法及临床应用价值。方法 回顾分析我院应用腹腔镜联合纤维胆道镜施胆总管探查取石术82例临床资料。结果 82例手术均获成功，胆总管切开取石T管引流术64例，胆总管Ⅰ期缝合18例，平均手术时间110min，Ⅰ期缝合后胆漏1例，T管引流术后第21天拔T管出现胆漏1例，术后结石残留3例。结论 腹腔镜联合纤维胆道镜胆总管探查术治疗肝内外胆管结石是安全、可行的，治疗效果肯定，微创意义明显。     

双镜种联合技术治疗复杂输尿管狭窄的疗效

目的：探讨双镜种联合技术处理复杂输尿管狭窄的可行性及临床效果。方法：回顾性分析2016年2月至2018年6月在中南大学湘雅医院运用该技术治疗的16例复杂输尿管狭窄患者的临床资料。16例患者均为医源性狭窄。术前患侧肾脏重度积水4例,中度积水7例,轻度积水5例。根据输尿管狭窄的具体位置及长度选择相应的手术方式。结果：所有患者顺利完成手术,无中转开放手术和脏器损伤。术后随访患者8~18个月,患者患侧肾积水均不同程度减轻,未发生输尿管再狭窄。结论：双镜种联合技术在术中能精准定位狭窄段、检验吻合效果、扩张炎性狭窄、提高远端输尿管狭窄行端-端吻合术的可能性,是一种治疗复杂输尿管狭窄疗效确切且安全可行的新技术。     

Utility of Flexible Bronchoscopy in the Evaluation of Pulmonary Infiltrates in the Hematopoietic Stem Cell Transplant Population – A Single Center Fourteen Year Experience

IntroductionPulmonary infiltrates are common within the hematopoietic stem cell transplant (HSCT) population and unfortunately portend an increased mortality. Bronchoscopy is often utilized as an initial diagnostic tool, but the literature supporting its diagnostic utility and effect on clinical management varies significantly. The aim of this study was to investigate the diagnostic ability, complication rate, and clinical impact of flexible bronchoscopy (FB) in evaluating pulmonary infiltrates in a large HSCT population.Patients and methodRetrospective review of all patients undergoing FB after HSCT in the Bone Marrow Transplant Unit from 1996 to 2009.ResultsFB was performed 162 times in 144 patients with pulmonary infiltrates yielding positive results in 52.5%. The most common positive results were bacterial pneumonia (31%), fungal pneumonia (15%), and alveolar hemorrhage (11%). Treatment changes occurred in 44% of patients after FB. Treatment changes included antibiotic modification (59%), addition of corticosteroids (21%), antifungal modification (12%), and antiviral modification (7%). The overall complication rate associated with FB was 30%, although 84% of these complications were considered minor.ConclusionsFB in patients with pulmonary infiltrates after HSCT should still be considered a valuable tool in the evaluation and management of pulmonary infiltrates in the HSCT population. Future prospective, multicenter randomized studies are needed to evaluate the overall clinical impact that bronchoscopic results and management changes have in this unique population.     

Recent progress and prospects in the electrode materials of flexible sodium-ion battery

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Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm

To compare the outcomes of flexible ureterorenoscopy (F-URS) and mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyceal stones smaller than 2?cm. Patients who underwent F-URS and mini-PNL for the treatment of lower calyceal stones smaller than 2?cm between March 2009 and December 2014 were retrospectively evaluated. Ninety-four patients were divided into two groups by treatment modality: F-URS (Group 1: 63 patients) and mini-PNL (Group 2: 31 patients). All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. Success rates for F-URS and mini-PNL at postoperative first month were 85.7% and 90.3%, respectively. Operation time, fluoroscopy time, and hospitalization time for F-URS and mini-PNL patients were 44.40?min, 2.9?min, 22.4?h, and 91.9?min, 6.4?min, and 63.8?h, respectively. All three parameters were significantly shorter among the F-URS group (p?0.001). Postoperative hemoglobin drop was significantly lower in F-URS group compared to?mini-PNL group (0.39?mg/dL vs. 1.15?mg/dL, p?=?0.001). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p?=?0.001). More patients in the F-URS groups require antibiotics due to urinary tract infection, and more patients in the?mini-PNL group required ureteral double J catheter insertion under general anesthesia. Although both F-URS and?mini-PNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favorable due to shorter fluoroscopy and hospitalization times; and lower hemoglobin drops. Multicenter and studies using higher patient volumes are needed to confirm these findings.     

A fluid—structure interaction study on the biomechanical behaviour of a curved artery with flexible wall

Research has shown that thrombus, stenosis, aneurysm, atherosclerosis and other vascular diseases are likely to occur in curved arteries such as aortic arch, coronary artery and cerebral artery. It is found that fatigue damage and failure of arteries are closely associated with the dynamic physiological environment where the arteries are situated. Based on these considerations, the behaviour of curved arteries subjected to a physiological environment is presented in this paper. The fluid–structure interaction (FSI) effect is considered. Wall stress distribution and its variation over time are investigated. Artery deformation regularity throughout the cardiac cycle has been analysed. It is believed that this study may provide insights into clinical research in the future.