Angiographic demonstration of recanalization of the basilar artery

Summary This report details the clinical course and angiographic findings of a patient with intermittent vertebrobasilar insufficiency. Recanalization of the basilar artery was demonstrated during anticoagulant therapy. A review of the literature failed to disclose a previous report of this occurrence.     

Ulnar artery vasculopathy in systemic sclerosis

Although digital ulceration frequently occurs in patients with systemic sclerosis, there have been few reports on macrovascular involvement. Macrovascular disease in systemic sclerosis has recently been described. We retrospectively reviewed the medical records and brachial angiographic findings of 19 systemic sclerosis patients, who exhibited Raynaud’s phenomenon and digital ulceration. We found that ulnar artery involvement is frequent in systemic sclerosis, although the precise mechanism is not known. There was no significant difference in risk factors of macrovascular disease between ulnar artery-involved patients and not-involved subjects. Thirteen patients underwent surgical intervention; five of the 13 patients had vascular graft performed due to ulnar artery involvement. We suggest that angiographic screening and early surgical intervention such as revascularization should be considered in patients with systemic sclerosis who manifest a severe form of Raynaud’s phenomenon and/or digital ulceration and especially in patients with diffuse sclerosis.     

Arteriography of three models of gastric oesophagoplasty: the whole stomach, a wide gastric tube and a narrow gastric tube

The esogastric anastomotic fistula,occurring after the replacement of esophagus by the stomach, is a post-operative complication always feared and awaited. Apart from other causes, there exist the anatomical dispositions notably the vascular and technical factors that stress this potential risk despite certain advantages of esophagogastroplasty. The goal of our study was to study the arterial distribution of the gastric transplants in order to identify the better modalities of their making. We used 39 stomachs taken from fresh cadavers of autochtone subjects. After a modeling treatment using three different techniques, they were subjected to a radiographic opacification of the right gastro-epiploic artery with sulphate of barium follow by an x-rays in incidence full-face (25 kv, 10 mAS). It was a matter of 15 entire stomachs (E.E.) with denudation of the small curvature, of 12 wide gastric tubes (W.T.) prepared according to the Akiyama technique modified and of 12 narrow tubes (N.T.) tubulized according to the Marmuse method. We studied the anastomotic type of the gastro-epiploic arterial circle according to the classification of Koskas, the collateral branches of the arterial circles of the gastric curvatures, the antral and corporeal anastomosis of these circles and the distribution anastomotic at the level of the summit of the anastomotic. Only 28 pieces (15 E.E., 8 W.T. and 5 N.T.) were able to be the object of a complete angiographic exploitation. The anastomosis of the arterial circle was type I in 64.1% of the cases, type II in 15.4% of the cases, type III in 15.4% of the cases and type IV in 5.1% of the cases. The average number of collateral branches originating from gastro-epiploic arterial circle was respectively 24, 17 and 22 for the E.E., the W.T. and the N.T. Only the two first ones presented collateral branches being borne of the small curvature circle. Fifty per cent of the N.T. did not possess any antral or corporeal anastomosis between the two arterial circles; some of them were even for a quarter of the W.T. In the case of gastric tubulization there existed an irrigation defect of the summit of the plasty for a third of the N.T. and a quarter of the W.T., despite a constant intramural bridge anastomosis between the two gastro-epiploic arteries. The usage of the entire stomach must be recommended for gastric oesophagoplasty; but when the operative indications require a resection of the small curvature it is preferable to use a wide gastric tube whose diameter respects the two left third of the initial width of the organ.     

老年2型糖尿病性下肢动脉病变的腔内治疗

目的 观察并总结腔内治疗老年2型糖尿病严重下肢动脉病变的临床疗效及技术经验.方法 收集2010年2月-2012年2月55例老年2型糖尿病性下肢动脉疾病患者,采用INVATEC-DEEP长球囊,进行下肢动脉经皮穿刺血管腔内成形术（percutaneous transluminal angioplasty,PTA）治疗,观察治疗前后的临床症状、体征及踝肱指数（ankle brachial index,ABI）的改变,并进行随访.结果 55例患者共55条肢体接受了腔内治疗,技术成功率为74.5％（41/55）,无并发症发生.共随访6m,失访率为0;其中,技术成功组所有患肢血供明显增加,相应节段肢体皮温升高,足背动脉搏动增强,麻木感和痛感显著减轻,生存率为95.1％,肢体存活率97.6％;技术失败组患者生存率为78.6％,肢体存活率71.4％,随访期间ABI为（0.78±0.13）.结论 腔内治疗老年2型糖尿病性下肢动脉疾病技术成功率高,临床疗效显著,但远期效果有待进一步随访.     

肝癌肝动脉灌注化疗与栓塞40例疗效观察

目的：观察肝动脉插管化疗及栓塞对肝脏恶性肿瘤的治疗效果。探讨影响疗效的有关因素。方法;在Ｘ线电视监视下将导管选择性地插至肝动脉及肿瘤供血动脉进行数字减影血管造影,根据造影结果进行肿瘤组织的栓塞及灌注化疗。结果：共插管治疗１５４例次,血管造影显示门静脉癌栓４例,肝动脉－门静脉瘘７例,肝动脉－肝静脉瘘３例。经治疗生存期超过半年者占５２．５％（２１／４０）,结论：经导管肝动脉化疗栓塞是肝癌的有效治疗途径     

Effectiveness of an informative video on reducing anxiety levels in patients undergoing elective coronarography: An RCT

Background

Anxiety levels have a considerable effect on patients during hospitalization. Cardiology Departments are characterized by a high turn-over of patients and it is necessary to give clear and exhaustive information routinely in compliance with legal and deontological requirements.

Aims

The aim of the study was to evaluate the effectiveness of an informative video, devised for patients undergoing coronarography, on reducing anxiety levels and getting more satisfaction from the received information.

Methods

A two arm RCT design was chosen.The patients in both study arms received standard care while the informative video was shown in the treatment group. The Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as to the received information was measured using a scale with semantic indications.

Results

Ninety-three patients accepted to take part in the study. The weighted mean difference (WMD) between the anxiety levels of the treated and controlled groups was − 8.24 (CI 95%: − 12.04/− 4.44; p < 0.00001).The WMD of the level of satisfaction for the received information was + 22.23 (CI 95%: + 12.73 /+ 31.73; p < 0.00001).

Conclusions

The use of the informative video in Cardiology Departments proves to be highly recommended as an instrument to lower anxiety levels and increase significantly the level of satisfaction deriving from the received information.     

支气管扩张大咯血的DSA表现及介入治疗

目的:探讨支气管扩张大咯血的支气管动脉造影表现及栓塞效果。方法:选择支气管扩张大咯血患者43例,进行支气管动脉造影观察血管异常情况,进行支气管动脉栓塞观察术后即时止血率及长期随访止血率。结果:全部病例支气管动脉造影均可见血管异常,为支气管动脉增粗、分支增生、增多、扭曲,部分伴有出血灶,并可见支气管动脉畸形;经支气管动脉栓塞后即时止血效果及长期止血效果较好。结论:支气管扩张大咯血行支气管动脉造影和支气管动脉栓塞为一种安全有效的诊断、治疗方法。     

Laparoscopic enucleation of a renal cell carcinoma

The purpose of this study was to report on the feasibility of laparoscopic excision of renal cell carcinoma. An 81-year-old female with renovascular disease underwent a laparoscopic excisional operation for a 2-cm tumor localized in the left kidney.Pathological evaluation showed a low-grade tumor without any extension through the renal capsule (grade I Hand Broder, stage I Robson). The postoperative course was uneventful; there was minimal postoperative pain. The patient was discharged home on the sixth day. Laparoscopic excision would appear to be a safe and effective technique in selected cases.     

双层螺旋CT血管造影与冠状动脉钙化积分诊断冠心病的临床评价

目的评价双层螺旋CT血管造影(DHCTA)与冠状动脉钙化(CAC)积分诊断冠心病(CHD)的临床价值。方法对52例疑有CHD的患者行冠状动脉造影(CAG)、双层螺旋CT扫描检测CAC积分,并行DHCTA扫描,源像输入HP4.1工作站后作多模式三维重建。以CAG结果为金标准来分析DHCTA和CAC积分对CHD的诊断效能。结果DHCTA和CAC积分诊断CHD的灵敏度、特异性、准确性分别为70%、90.9%、78.8%和93.3%、63.6%、80.8%。二者比较DHCTA的灵敏度低于CAC积分,而特异性明显高于CAC积分,准确性比较差异无统计学意义(P>0.05)。将二者结合起来诊断CHD,则灵敏度、特异性、准确性分别为93.3%、90.9%、92.3%。结论在诊断CHD方面,CAC积分具有较高的灵敏度,DHCTA具有较高的特异性,将二者优势结合运用可进一步提高诊断的准确性。     

Refractory rapidly progressive Takayasu’s arteritis successfully treated with surgery

We describe a case of a patient with rapidly progressive Takayasu’s arteritis (TA) refractory to conventional immunosuppressive therapy in whom bypass surgery was successfully performed. A 38-year-old woman had 2 years history of symptoms of compromised cerebral circulation, severe claudication of upper and lower limbs and stenocardial symptoms. Serial arteriography revealed occlusions of the right subclavian and right common iliac arteries and later on stenosis of the abdominal aorta and complete obliteration of the left subclavian artery. Coronarography did not show coronary stenosis. Completely occluded left subclavian artery resulted in a characteristic subclavian steal syndrome. Therapy with combined immunosuppressants was ineffective, severe ischaemic symptoms related to arterial occlusions progressed and surgical intervention was inevitable. She underwent aorto–bifemoral and 10 months later left carotid-axillary bypass grafting. The ischaemic symptoms were resolved after surgery. At 3 years follow-up, the patient remained asymptomatic with no evidence of restenosis. This case indicates that patients with progressive TA with no improvement while on conventional immunosuppressive therapy could have satisfactory outcome and excellent long-term clinical remission after multiple arterial bypass grafting.