Risk Stratification and Radiologic Evaluation of Central Venous Port Malfunction

BackgroundAppropriate indications for radiologic evaluation of central venous ports are not fully understood. We aimed to quantitatively assess the utility of clinical history and imaging in the evaluation of malfunctioning central venous ports.MethodsClinical history, plain radiographs, and line injections intended to evaluate central venous port malfunction in 153 consecutive cases over a nearly 4-year period were retrospectively reviewed by 2 radiologists. Radiographs and line injections were separately categorized as normal or abnormal, and a consensus was reached on the final imaging diagnosis. The likelihood of a port-related abnormality necessitating immediate intervention was determined for all represented combinations of clinical history, radiographic findings, and line injection results.ResultsA radiologic diagnosis was made in 96.1% of cases; 19.7% of these diagnoses were classified as critical, requiring prompt intervention. Very low risk histories had a 0.0% incidence of critical port abnormalities in our cohort, regardless of imaging findings. Low risk histories had a 10.5% incidence of a critical abnormality and were best evaluated either by line injection, either directly or following an abnormal chest radiograph. Intermediate and high risk histories were associated with a 30.5% and 61.1% incidence of critical port abnormalities, respectively, and were best evaluated by line injection without preceding chest radiograph.ConclusionsThere are several scenarios in which imaging does not meaningfully affect management of malfunctioning central venous ports. Recognizing these inefficiencies may allow for more appropriate and cost-effective use of radiographs and line injections to evaluate the cause of port malfunction.     

肝癌介入治疗患者家属对健康教育需求的调查

目的调查分析肝癌介入治疗患者家属对健康教育的需求。方法选择某院2010年6月～2011年11月的肝癌介入治疗患者家属113位,采用自设问卷对家属就健康教育的需求进行调查。结果家属对患者现状及预后需求性占首位,占100%,其次是病因,占87.61%,占第3位的是介入治疗后注意事项,占94.69%,其后依次是介入治疗方法、饮食与营养、用药知识和复查及随访指导,6种需求具有代表性,P﹤0.05。家属除对患者出血的预防措施和方法、患者感染的预防措施和方法、最佳饮食组合、术后绝对卧床时间的知晓率较高外,对其他护理方法的知晓率较低。要求通过医护人员的宣传的82人,占72.57%,健康教育宣传录像的24人,占21.24%,通过书刊的仅7人,占6.19%,通过医护人员的宣传的方法具有代表性,差异有统计学意义,P﹤0.05。结论通过调查,可全面掌握肝癌介入治疗患者家属的健康教育需求,从而采取多种形式对肝癌介入治疗患者家属进行全面的健康教育,减轻患者及家属的心理压力,提高肝癌介入治疗患者的家庭支持,改善患者的生存质量。     

全国恶性肿瘤介入治疗数据库及登记系统设计初探

目的本课题是十一五国家科技支撑计划课题常见恶性肿瘤介入治疗方法规范化的比较研究和中远期疗效评估的一个子课题,根据计划书需要采用国际标准化的登记方法,建立全国恶性肿瘤介入治疗登记系统,整合多中心的病历资料,构建肿瘤介入治疗数据库。方法采用软件下载、自主管理、自动整合的技术方案,实现全国恶性肿瘤介入治疗数据库及登记系统的建立。结果建立完成全国肿瘤介入治疗数据库及登记系统,实现肿瘤介入治疗的信息化管理,可以进行数据的简单或复合查询,在院内调试及初运行良好。结论全国恶性肿瘤介入治疗数据库及登记系统的建立,不仅可以明确肿瘤介入治疗的全国普及率,不同肿瘤介入治疗的疗效,最新介入手段应用情况,便于不同医院之间的技术交流,提高介入医师诊治水平,而且能了解介入人才的分布结构,介入器材的消耗品种及数量,优化资金,节约医疗成本。     

Multiple Concealed Accessory Pathways Associate with Antegrade Triple AV Nodal Pathways and Catheter Ablation

This article describes a 54-year-old man with incessant supraven-tricular tachycardia refractory to antiarrhythmic drugs. Multiple concealed accessory pathways associated with antegrade triple AV nodal pathways were documented by a series of successful catheter ablations and detailed electrophysiological studies. After the left-wall accessory pathways were abolished with two courses of multiple low energy shocks, another two accessory pathways, one near the os of coronary sinus and the other near the site of the His bundle, were documented by programmed premature ventricular stimulation. This was followed by a third course of shocks to the os of coronary sinus for ablating posteroseptal AP and a fourth course of shock to proximal His bundle for control of SVT with a septal accessory pathway as a retrograde limb and AV nodal pathways as an antegrade limb. Without medications, the patient has remained asymptomatic even during moderate physical activity over a follow-up period of 36 months. His ECG showed sinus rhythm with persistence of right bundle branch block.     

老年心血管病联合介入诊疗技术的临床应用

目的 评价联合介入技术在老年心血管病诊疗中的有效性和安全性。方法 对连续2年的成年介入病例按年龄分为老年组和普通组，比较如下指标：①年龄；②性别；③心血管病种类；④介入指征；⑤联合介入情况；⑥总操作时间；⑦透视时间；⑧成功率；⑨并发症率；⑩病死率。结果 ①全组1。785例患中，具备联合介入诊疗指征14．5％(258／1785)，普通组4．6％(44／961)，老年组26．0％(214／824)。其中50％(129/258)实际施行联合介入诊疗，普通组59％(26／44)，老年组48．1％(103／214)；②老年组冠脉、外周和肾血管支架置入、起搏器安装及心肌激光打孔操作明显多于普通组，导管射频消融、瓣膜球囊扩张和先心病介入封堵操作明显少于普通组，老年组需接受≥2项联合介入操作明显多于普通组；③老年组和普通组联合介入诊疗的成功率、并发症和病死率基本相同，但前的费用、操作和透视时间及造影剂用量明显多于后。结论 ①与普通组相比，老年心血管患需进行联合介入诊疗术的比例明显增高；②对老年心血管病患谨慎施行合理的联合介入诊疗方案能取得与单一介入方案相同的手术效果，并发症和病死率增加不明显；③老年心血管病联合介入诊疗术的缺点是手术费用高、操作和透视时间长及造影剂用量大。     

Paradoxical emboli through the patent foramen ovale as the suspected cause of myocardial and renal infarction in a 48-year-old woman.

We review the case of a 48-year-old woman who underwent elective percutaneous patent foramen ovale closure following successive renal and myocardial infarction with normal renal and coronary arteries, probably as a consequence of paradoxical emboli.     

探讨心脏介入性治疗中并发心脏压塞的原因及诊断治疗

目的:探讨分析心脏介入性治疗中并发心脏压塞的原因、诊断及治疗方法。方法:分析该院2010年1月-2014年11月间收治的487例心脏介入性治疗患者的临床资料,根据患者的临床表现、超声心动图检查以及X线检查诊断心脏压塞。一旦发现患者出现心脏压塞的症状,立即停止心脏介入性治疗,采取心包穿刺术引流、心包切开引流术、冠状动脉搭桥术和冠状动脉修补术等治疗。结果:本院收治的487例心脏介入性治疗患者中发生心脏压塞并发症患者为3例,发生率为0.62%。发病原因为:房间隔穿刺时误穿左心房壁、左心房壁受损,冠状动脉破裂及心包压塞。2例患者病情经X线片检查得以证实,另外1例患者X线片检查无异样,后经超声心动图检查证实病情。1例患者行心包穿刺术治疗,1例患者行心包切开引流术治疗,另1例患者行冠状动脉搭桥术和破裂冠状动脉修补术,治疗后3例患者均未出现不良反应,血流动力学指标正常,病情恢复稳定,预后状况良好。结论:心脏压塞是心脏介入性治疗中一种极为少见并且较为危险的并发症,及时发现、快速认清病因并进行恰当处理,是患者有良好预后的保证。     

Effectiveness and safety profiling of zolpidem and acupressure in CKD associated pruritus: An interventional study

Background:Chronic kidney disease (CKD)-associated pruritus (CKD-aP) contributes to poor quality of life, including reduced sleep quality and poor sleep quality is a source of patient stress and is linked to lower health-related quality of life. This study aimed to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-aP.Method:A multicenter, prospective, randomized, parallel-design, open label interventional study to estimate the effectiveness of zolpidem (10 mg) oral tablets versus acupressure on sleep quality and quality of life in patients with CKD-aP on hemodialysis. A total of 58 hemodialysis patients having sleep disturbance due to CKD-aP completed the entire 8-week follow-up. The patients were divided into a control (acupressure) group of 28 patients and an intervention (zolpidem) group of 30 patients.Results:A total of 58 patients having CKD-aP and sleep disturbance were recruited. In the control group there was a reduction in the PSQI score with a mean ± SD from 12.28 ± 3.59 to 9.25 ± 3.99, while in the intervention group the reduction in PSQI score with a mean ± SD was from 14.73 ± 4.14 to 10.03 ± 4.04 from baseline to endpoint. However, the EQ5D index score and EQ-visual analogue scale (VAS) at baseline for the control group with a mean ± SD was 0.49 ± 0.30 and 50.17 ± 8.65, respectively, while for the intervention group the values were 0.62 ± 0.26 and 47.17 ± 5.82, respectively. The mean EQ5D index score in the control group improved from 0.49 ± 0.30 to 0.53 ± 0.30, but in the intervention group there was no statistical improvement in mean EQ5D index score from 0.62 ± 0.26 to 0.62 ± 0.27 from baseline to week 8. The EQ 5D improved in both groups and the EQ-VAS score was 2.67 points higher at week 8 as compared to baseline in the control group, while in the intervention group the score was 3.33 points higher at week 8 as compared to baseline. Comparing with baseline, the PSQI scores were significantly reduced after week 4 and week 8 (P =  < .001). Furthermore, at the end of the study, the PSQI scores were significantly higher in the control as compared to the intervention group (P = .012).Conclusion:An improvement in sleep quality and quality of life among CKD-aP patients on hemodialysis has been observed in both the control and intervention groups. Zolpidem and acupressure safety profiling showed no severe adverse effect other that drowsiness, nausea and daytime sleeping already reported in literature of zolpidem.     

The history of interventional therapy for liver cancer in China

In China interventional therapy of liver cancer started in the 1980s. It is well-known that Professor Lin Gui is the founding father of Interventional radiology. Under the leadership of Lin Gui and other professors, interventional therapy of liver cancer has swiftly progressed in China. Indeed, TAI, TAE, TACE and ablation therapy have witnessed great innovations in hardware facilities, technical means, and therapeutic philosophy, while incorporating Chinese characteristics. As with the development of combined interventional therapy in China, interventional treatment of liver cancer has gradually started the process of precision and individualization. Actually, multidisciplinary, multimodal, and polymorphic treatments will be the most suitable pattern for liver cancer in the future, among which combination of interventional therapy with targeted, immunological treatments and information technology (IT) tools may bring a revolutionary breakthrough in liver cancer treatment.     

Uterine artery embolization in association with methotrexate infusion for the treatment of tubal ectopic pregnancy

Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate (MTX) infusion for the treatment of tubal ectopic pregnancy.Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50–100 mg methotrexate (MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure.Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy (92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days (mean +/− SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level.Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.