Consensus among Chinese experts on standard interventional therapy for deep venous thrombosis of lower extremity (second edition)

This is an update on the first edition of the expert consensus. This document discusses the indications and contraindications of interventional treatment methods for deep venous thrombosis such as anticoagulation, catheter-directed thrombolysis, percutaneous mechanical thrombectomy, percutaneous transluminal angioplasty and stent implantation. The operational procedures, considerations, preoperative management, and prevention of complications were also updated, supplemented, and revised. Emphasis is placed on the interventional treatment of acute and subacute deep venous thrombosis to effectively reduce the incidence of post-thrombosis syndrome.     

Karnofsky活动状态评分在肝癌介入治疗患者护理中的应用效果及对患者肝功能指标的影响

目的探讨Karnofsky活动状态评分在肝癌介入治疗患者护理中的应用效果及对患者肝功能指标的影响。方法选择2018年1月至2019年1月本院接受介入治疗的肝癌患者80例,按电脑数字表法随机分为对照组(40例)与试验组(40例)。对照组行常规护理,试验组通过Karnofsky活动状态评分展开护理。比较两组患者的疾病不确定感、癌因疲乏情况、并发症发生情况及肝功能指标。结果护理后,两组患者的MUIS、CFS评分均下降,且试验组低于对照组,差异具有统计学意义(P<0.05);试验组患者的并发症总发生率为5.00%,低于对照组的22.50%,差异具有统计学意义(P<0.05);护理后,两组患者的ALT、TBil水平均降低,且试验组低于对照组,差异有统计学意义(P<0.05)。结论通过Karnofsky活动状态评分展开护理可有效改善肝癌介入治疗患者的疾病不确定感、癌因疲乏,并减少并发症的发生,改善患者肝功能,值得临床推广应用。     

基于跨理论模型协同护理模式在急性心肌梗死介入治疗病人中的应用

目的:探讨基于跨理论模型(TTM)协同护理模式在急性心肌梗死(AMI)介入治疗病人中的应用效果。方法:根据随机数字表法将2018年6月—2019年6月收治的88例AMI介入治疗病人分为观察组及对照组各44例,对照组实施常规护理,观察组实施基于TTM的协同护理模式。比较两组干预前及干预6个月后自我效能、疾病管理能力及生活质量改善情况,记录两组不良心脏事件发生率、再入院率及治疗依从率。结果:两组病人干预后自我效能、疾病管理能力、西雅图心绞痛量表(SAQ)总评分比较差异有统计学意义(P<0.05)。观察组病人不良心脏事件发生率(2.27%)、再入院率(4.54%)低于对照组的18.18%、20.45%,差异有统计学意义(P<0.05);观察组病人用药依从率、生活方式管理依从率分别为97.73%和95.45%,高于对照组的75.00%和72.73%,差异有统计学意义(P<0.05)。结论:基于TTM协同护理模式能有效改善AMI介入治疗病人自我效能,提高病人遵医行为及疾病管理能力,减少不良心脏事件的发生,改善病人生活质量。     

中晚期肺癌介入治疗疗效分析

目的研究经支气管动脉灌注化疗药物及栓塞治疗中晚期肺癌的疗效。方法对本院近几年20例确诊的肺癌,并无法手术的中晚期肺癌患者,采用seldinger技术穿刺股动脉,进行选择性支气管动脉插管,然后注入化疗药物,部分患者使用明胶海绵颗粒进行栓塞治疗,观察改善情况,后1～3个月后复查CT观察肿瘤变化。结果肿瘤减小,咳嗽、胸痛、咯血、胸水等症状缓解。结论支气管动脉灌注化疗及栓塞治疗肺癌具有创伤小,效果确切等优点,是治疗肺癌的一种有价值的方法。     

脑灌注成像在颈动脉狭窄介入治疗中的应用

对于目前临床常用的脑灌注成像检查技术的原理、优缺点及脑灌注成像在颈动脉狭窄介入治疗术术前筛选、术后评估及预防并发症等方面的应用进行总结.     

Intra- and Peri-Hepatic Effects of Ethanol Injections in the Pig Liver

Vehmas T, Taari K, Kivisaari L, Laurila P, Taavitsainen M. Intra- and peri-hepatic effects of ethanol injections in the pig liver. Scand J Gastroenterol 1993;28:791-794.

We studied the intrahepatic (spread and scarring) and perihepatic effects of percutaneous ethanol injection therapy and its dose-necrosis relationship in normal pig livers. Ethanol (99.5%) was injected in volumes of 0.5-2.0 ml into the livers of six pigs during laparotomy. The livers were dissected and studied histopathologically 30 min and 2 weeks after the injections. Ethanol-induced liver necrosis, the diameter of which could roughly be calculated by dividing the injected dose by 2 (inversely: volume (ml) = 2 × diameter (cm)). Two weeks after the injections all pigs showed intra-abdominal adhesions and severe intrahepatic scar formation, unlike three control pigs similarly operated on without ethanol injections. The 30-min lesions showed thin projections extending into the neighboring liver tissue. Major escape of ethanol outside the needle tip area in the liver occurred twice. Uncontrolled spread of ethanol may be a potential hazard of this treatment.     

Opportunities of improvement in the management of pancreatic and periampullary tumors

Abstract

Objective. The first objective of the present study was to identify opportunities of improvement for clinical practice, assessed by local quality indicators, then to analyze possible reasons why we did not reach defined treatment quality measures. The second objective was to characterize patients, considered unresectable according to present criteria, for future arrangement of interventional studies with improved patient selection. Material and methods. Prospective observational cohort study from October 2008 to December 2010 of patients referred to the authors' institution with suspected pancreatic or periampullary neoplasm. Results. Of 330 patients, 135 underwent surgery, 195 did not, 129 due to unresectable malignancies. The rest had benign lesions. Perioperative morbidity rate was 32.6%, mortality 0.7%. Radical resection (R0) was obtained in 23 (41.8%) of 55 patients operated for pancreatic adenocarcinoma and 6.3% underwent reconstructive vascular surgery. Diagnostic failure/delay resulted in unresectable carcinoma, primarily misconceived as serous cystic adenoma in two patients. One resected lesion turned out to be focal autoimmune pancreatitis. One case with misdiagnosed cancer was revised to be a pseudoaneurysm. Palliative treatment was offered to 144 patients with malignant tumors, 62 due to locally advanced disease and all pancreatic adenocarcinomas. Conclusions. Quality improvement opportunities were identified for patient selection and surgical technique: Too few patients underwent reconstructive vascular surgery. The most important quality indicators are those securing resectional, radical (R0) surgery. Altogether 143 patients (57.9%) of those with malignant tumors were found unresectable, most of these patients are eligible for inclusion in future interventional studies with curative and/or palliative intention.     

Monitoring cerebral oxygenation during balloon occlusion with multichannel NIRS

We report on oxygenation changes noninvasively recorded by multichannel continuous-wave near infrared spectroscopy (CW-NIRS) during endovascular neuroradiologic interventions requiring temporary balloon occlusion of arteries supplying the cerebral circulation. Digital subtraction angiography (DSA) provides reference data on the site, timing, and effectiveness of the flow stagnation as well as on the amount and direction of collateral circulation. This setting allows us to relate CW-NIRS findings to brain specific perfusion changes. We focused our analysis on the transition from normal perfusion to vessel occlusion, i.e., before hypoxia becomes clinically apparent. The localization of the maximal response correlated either with the core (occlusion of the middle cerebral artery) or with the watershed areas (occlusion of the internal carotid artery) of the respective vascular territories. In one patient with clinically and angiographically confirmed insufficient collateral flow during carotid artery occlusion, the total hemoglobin concentration became significantly asymmetric, with decreased values in the ipsilateral watershed area and contralaterally increased values. Multichannel CW-NIRS monitoring might serve as an objective and early predictive marker of critical perfusion changes during interventions—to prevent hypoxic damage of the brain. It also might provide valuable human reference data on oxygenation changes as they typically occur during acute stroke.