The efficacy of transcervical recanalization of obstructed postoperative Fallopian tubes

The efficacy of transcervical recanalization of obstructed postoperative Fallopian tubes was evaluated in 29 patients who were referred for recanalization. Nineteen had strictures at the site of Fallopian tube reconstruction, and five had strictures, three had fistulae, and two had fistulae and strictures at the site of reversal surgery. A 0.014-inch highly flexible guidewire was passed through the obstruction into the ampullary segment, followed by a 1.1–2.2 Fr bougie catheter to dilate the stricture. After recanalization, the distal tube was studied by selective salpingography. The method was technically successful in 17 of 19 patients with underlying inflammatory disease and resultant postoperative strictures. The tubes remained patent in 12 patients for a period of 12–48 months; three patients conceived, all delivering healthy babies. Significant disease of the distal tubes was present in seven patients. The technique succeeded in three of five patients with postoperative strictures following reversal surgery. One patient subsequently conceived and delivered a healthy baby. The technique failed in all five patients with fistulae complicating reversal surgery. Transcervical recanalization is thus recommended in the management of patients with postoperative strictures with underlying inflammatory obstruction and strictures complicating reversal surgery. Received 16 October 1995; Revision received 25 January 1996; Accepted 15 September 1997     

Corrosion of tungsten coils after peripheral vascular embolization therapy: influence on outcome and tungsten load.

The purpose of this study was to evaluate coil corrosion and the long-term outcome after peripheral vascular embolization therapy performed with tungsten coils. We studied 14 patients who received tungsten coils on an average of 26 months prior to follow-up. The protocol included plain radiography and contrast-enhanced magnetic resonance angiography to investigate corrosion of tungsten coils and recanalization of the embolized vessels. Whole blood, hair, and urine tungsten levels were assayed when available. Corrosion of tungsten coils was detected in 9 of 14 patients by plain radiography. No evidence of recanalization of the embolized vessel and no adverse clinical effects of tungsten resorption were detected. Blood levels of tungsten were elevated in 6 of 14 patients and urine levels of tungsten were elevated in all 12 patients tested. Tungsten coil corrosion and elevated tungsten levels in blood, hair, and urine were found in most patients, although no adverse clinical effects of tungsten resorption were detected. Since the overall effect of high tungsten blood levels remains unclear, its use as an implant should be avoided.     

Coronary artery stenting with high-pressure post-dilation followed by adjunctive thrombolysis after failed coronary angioplasty for acute myocardial infarction: Report of three cases

We successfully implanted coronary stents into refractory reoccluded lesions after failed coronary angioplasty in three patients with acute myocardial infarction (AMI). Lesion location was the proximal left anterior descending coronary artery in two patients and the dominant right coronary artery in one patient. The reference diameters of the lesions were 3.64, 3.33, and 3.50 mm, respectively. A stent with a luminal diameter of 3.0 mm was implanted in all patients. Poststenting dilation of the stent was performed at high pressure (18 atm), and urokinase was administered immediately thereafter. Heparin was administered for 24 h with maintenance of activated coagulation time within 180–200 s. Warfarin was then administered to keep the international normalized ratio within 2.5–3.5. Luminal diameters immediately after stenting were 3.14, 2.89, and 3.26 mm, and those at 1 month after stenting were 3.09, 2.81, and 3.12 mm, respectively, indicating good patency. Our experience in these cases suggests that coronary stenting can be applied after unsuccessful coronary angioplasty in selected patients with AMI. The present report includes informative reference data on diameter, postdilation, adjunctive thrombolytic agent administration, and adequate anticoagulation therapy in coronary stenting in this acute application.     

非急性颅外段颈内动脉闭塞再通可行性 及开通失败的预测因素研究

目的：分析非急性颅外段颈内动脉闭塞再通可行性及影响开通的因素,并建立一个可预测闭塞再通 失败的模型。方法：纳入自2015年1月到2021年9月我中心经全脑血管造影确诊的动脉粥样硬化性颅外 段颈内动脉闭塞并接受血管内闭塞再通治疗的患者83例,分析血管开通失败的因素（性别、年龄、既往史、 发病到开通的时间、颈内动脉闭塞残端的角度、是否眼动脉返流）,分析是否开通与相关自变量的多因素 Logistic回归分析,建立一个可预测颈内动脉闭塞开通失败的模型。结果：在83例患者中,成功开通48例, 手术的总体成功率为57.8%。多因素回归分析显示,颈内动脉闭塞开通失败的影响因素包括：年龄（OR 1.159,95%CI 1.041～1.328）、高血压（OR 6.213,95%CI 1.204～46.540）、冠心病（OR 0.025,95%CI 0.001～ 0.254）、糖尿病（OR 0.157,95%CI 0.014～1.108）、颈内动脉闭塞残端角度（OR 0.082,95%CI 0.008～ 0.550）、眼动脉未返流至海绵窦段（OR 0.002,95%CI 0～0.021）。将Logistic多因素回归分析得出的危险因 素纳入预测模型并绘制列线图,该模型的ROC曲线下面积（AUC值）为0.947（95%CI 0.898～0.996）。结 论：非急性颅外段颈内动脉闭塞再通技术上可行。男性、年龄越高、无冠心病、无糖尿病、颈内闭塞角度是 钝角、眼动脉无返流是开通失败的预测因子。     

关于利用磁力再通术治疗肝移植术后胆道吻合口狭窄的专家建议

胆道吻合口狭窄是肝移植术后的常见并发症之一。目前内镜下逆行性胰胆管造影术（ERCP）和经皮经肝胆道引流术（PTCD）为首选治疗。对于严重吻合口狭窄或闭塞的病例,常规方法难以完成后继的治疗,磁力再通技术为治疗此类病例提供了另一种选择。本文在系统回顾国内外文献的基础上,结合专家经验,在适应证和禁忌证、磁体的选择与设计、操作步骤、注意事项及并发症防治等方面形成磁力再通术治疗肝移植术后胆道吻合口狭窄的专家建议。     

经阴道选择性输卵管再通术治疗不孕症

经阴道输卵管导管扩通术是目前国际上治疗输卵管阻塞性不孕症的最先进方法,本文报告对50例输卵管阻塞性不孕症患者行此项治疗的研究结果。先行子宫造影,再行选择性输卵管口部造影,明确阻塞部位后行输卵管导管扩通术,再行造影观察其通畅程度。本组共95条输卵管行扩通术,3条扩通失败,1例穿孔,扩通有效率为94％,通畅度达Ⅵ度者占29％,Ⅴ度者占40％;宫腔剩余压由术前16.1±5.8kPa降为11±6.45kPa;11例妊娠,妊娠率为22％;14条输卵管发生再粘连,再粘连率为15％。作者还就此项技术的机理,适应证与妊娠率、禁忌证、并发症等进行了深入地探讨。此技术可作为近段输卵管阻塞的首选再通方法,并可达到诊断与治疗的双重目的。     

Empty Microcatheter Technique for the Deployment of a Self-Expanding Stent to Treat Refractory Middle Cerebral Artery Occlusion in the Setting of Severe Proximal Tortuosity

We report a case of an acute middle cerebral artery (M2 segment) occlusion that was refractory to intravenous tissue plasminogen activator (IV t-PA), thrombectomy with the Merci^® device, intra-arterial infusion of urokinase and eptifibatide, and balloon angioplasty. The artery was so tortuous that over-the-wire stent placement failed and a salvage technique was required to place the self-expanding stent.