Objective To evaluate the safety and efficacy of treating type Ⅱ endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms with coil embolization. Methods A retrospective review of patients with type Ⅱ endoleaks treated with coil embolization was performed. Data regarding the technical, clinical, and imaging outcomes during perioperation and followed-up were collected. Results The technical success rate and the initial clinical success rate of treating type Ⅱ endoleaks with coil embolization were 100% (14/14). The mean operating time was (124.3±11) min, a mean of (127±15) mL contrast agent and a mean of (7±2) coils were used. During perioperation, one patient suffered left limb paralysis, all the patients were discharged with no perioperative mortality. Twelve patients were followed-up. During the period of 3 to 57 months of followed-up (average: 17.3 months), Type Ⅱ endoleaks reoccurred in one patient with coil embolization of the feeding vessels alone and two patients with coil embolization of the aneurysm sac alone. Since the aneurysms did not enlarge during the followed-up, these 3 patients continued followed-up without reinterventions. Conclusion Treating type Ⅱ endoleaks with coil embolization appears to be safe, and it can prevent aneurysm sac enlargement effectively. Because of the high risk of reoccurrence, follow-up after embolization is important.
Objective To evaluate the effectiveness and prognosis of patients in advanced hepatocellular carcinoma (HCC) with portal vein (PV) tumor thrombus received external-beam radiation therapy (EBRT). Methods The clinical data of 126 HCC patients with PV tumor thrombus who were referred for EBRT at our institution from January 2000 to November 2009 were analyzed retrospectively. EBRT was designed to focus on the tumor thrombus with or without primary intrahepatic tumors， to deliver a median total conventional dose of 50 Gy (range of 30-60 Gy). Predictors of survival were identified using univariate and multivariate analysis. Results Unfavorable pretreatment predictors were associated by multivariate analysis with lower albumin and higher α-fetoprotein levels, poorer Child-Pugh liver function classification, poorer intrahepatic tumor control， lymph node metastases， and the two-dimensional EBRT technique. The dose of EBRT showed no significant in both univariate and multivariate survival analysis. Conclusions In patients with HCC， EBRT is effectively prevents progression in cases of PV tumor thrombus， but palliative dose of EBRT is not related to survival.EBRT is not related to survival.
ObjectiveTo investigate the clinical manifestations of patients with cardiac myxoma and the factors affecting the occurrence of embolic events. Methods A retrospective study of 38 patients with cardiac myxoma diagnosed and surgically removed from January 2010 to December 2017 was performed. There were 11 males and 27 females at age of 32-75 (50.00±16.12) years. The patients were divided into a non-embolized group and an embolized group. The clinical manifestations of the patients were summarized and the factors leading to embolism were analyzed. RseultsOf the 26 patients in the non-embolized group, 22 patients (84.62%) had dyspnea, 14 patients (53.85%) had palpitations, 4 patients (15.38%) had angina pectoris, and 1 patient (3.85%) had heart failure. Of the 12 patients in the embolized group, 4 patients (33.33%) had dyspnea, 3 patients (25%) had palpitations, and 1 patient (8.33%) had angina pectoris. The mean diameter of the non-embolized group was 5.71±1.63 cm, and the maximum diameter of the tumor in the embolized group was 4.52±1.88 cm. There was no significant difference between the maximum diameter of the tumor in the embolized group and the maximum diameter of the non-embolized group (P>0.05). Atrial fibrillation occurred in 2 patients in the non-embolized group before operation. Atrial fibrillation occurred in 5 patients in the embolized group. Atrial fibrillation was more likely to occur in the embolized group (P<0.05). Conclusion Atrial fibrillation in the patients with cardiac myxoma is closely related to embolic events. The size of myxoma is not related to the occurrence of embolic events.
ObjectiveTo evaluate the effects of combined TACE and PVC regarding the survival and diseasefree survival rate in hepatocellular carcinoma (HCC) patients. MethodsThe relevant articles were searchd by a database search of PubMed, EMBASE, Cochrane Library (CENTRAL) Databases, Web of Science, Sciencedirect, National Institute of Health Clinical Trials Database, CNKI, WANFANG Database, and VIP Database. The analysis of the data was performed using Revman 5.1 Software. ResultsBy searching and selecting, a total of ten articles met the inclusion criteria, of which 6 were in the postoperative group, and 4 were in the no-operative group. There were no statistical significance of heterogeneity in each group through subgroup analyzed. The pooled OR showed that combined TACE and PVC could significantly increase the 1-, 2-, and/or 3-year survival and disease-free survival rates compared with TACE alone for HCC patients. The pooled OR and 95% CI of the 1-, 2-and/or 3-year survival and disease-free survival rate, respectively, were as follows:In operative group, 1-year disease-free survival rate 2.09, 1.21-3.61; 3-year disease-free survival rate 3.62, 1.88-6.97; 1-year survival rate 2.25, 1.30-3.87; 3-year survival rate 1.96, 1.20-3.21. In no-perative group:1-year survival rate 3.90, 2.33-6.54; 2-year survival rate 5.30, 1.87-15.06. Conlusions Compared with TACE alone, postoperative adjuvant combined TACE and PVC can significantly increase the 1-, and 3-year survival and disease-free survival rates. For no-perative group, adjuvant combined TACE and PVC can significantly increase the 1-, and 2-year survival rates. Based on the limitations of this meta-analysis (this article is included in the high quality literature less), clinicians should be cautious by using our findings.
ObjectiveTo investigate the clinical efficacy and mechansim of massive hepatocarcinoma with different imaging appearance after transcatheter arterial chemoembolization(TACE). MethodsThe image data of 38 patients with massive hepatocarcinoma were collected and analized retrospectively. According to the tumor edge situation on CT images before TACE treatment, the patients were divided into two groups:the sharp-edged tumor group and indistinct-edged tumor group. The efficacy were evaluated according to the imaging appearance after treatment. ResultsThe differences of the positive cases of HbsAg and AFP, Child-Pugh class, maximum tumor diameter, and dosage of lipiodol between the two groups before procedure were not statistic significance(P > 0.05). Six months after TACE, the maximum tumor diameter of the sharp-edged tumor group and indistinct-edged tumor group was(8.2±1.48) cm and(12.2±1.67) cm, respectively, the difference between the two groups was statistic significance(P < 0.05). In accordance with lipiodol deposition, ⅠandⅡtype were found in the sharp-edged tumor group withoutⅢandⅣtype. Most wereⅡandⅢtype with lessⅠtype and severalⅣtype in the indistinct-edged tumor group. According to the size of tumor six months after TACE, the total effective rate(CR+PR) was 92.9% and 62.5%, respectively in the sharp-edged tumor group and indistinct-edged tumor group. There were significantly difference between the two groups in iodized oil distribution and tumor size after procedure(P < 0.05). No statistical difference was found between the incidence rate of complications in two groups(P > 0.05). ConclusionThe efficacy of massive hepatocarcinoma in patients with sharp-edged tumor on CT images is better than those with indistinct-edged tumor.
ObjectiveTo discuss the clinical value of internal radiation therapy with hepatic intraarterial iodine131 labeled material for the treatment of hepatocellular carcinoma (HCC). MethodsThis summarized paper was made on literature review. ResultsIodine131lipiodol and several reported iodine131labeled antibodies to HCC associated antigens were concentrated in the foci of HCC with a high tumortonormaltissue absorbed dose ratios. No severe side effects occurred. It was used in various kinds of HCC patients, and mostly showed a significant tumor response. Survival rate of HCC patients was raised in several clinical trials.Conclusion Internal radiotherapy with hepatic intraarterial iodine131 labeled material may be considered as an effective method to treat HCC.
ObjectiveTo compare the value of apparent diffusion coefficients (ADCs) of MR-DWI at different b values in evaluating the progression of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).MethodsAll of 168 patients with HCC who met the inclusion and exclusion criteria and received the TACE for the first time in the Characteristic Medical Center of PAPF were collected retrospectively, who were divided into a stable group and progressive group according to the results of MRI evaluation at the 6th month after the TACE treatment. The clinical and imaging data of the two groups were compared before the TACE treatment. The Cox proportional hazard regression model was used to analyze the risk factors for the disease progression after the TACE treatment. The receiver operating characteristic curve (ROC) was used to analyze the predicting of efficacy evaluation of TACE by the ADC values at different b values.ResultsCompared with the stable group, the proportions of hepatitis B cirrhosis history, portal vein tumor thrombus, and arteriovenous fistula were higher (P<0.05), and the BCLC stage and Child Pugh grade were worse (P<0.05), and the ADC values were higher (P<0.05) in the progressive group. The results of Cox analysis showed that the ADC values at b=600 and 800 s/mm2 before the TACE, history of hepatitis B cirrhosis, portal vein tumor thrombus, arteriovenous fistula, advanced BCLC stage and Child-Pugh grade were the risk factors for the progression at the 6th month after the TACE treatment. When the b value was 800 s/mm2, the ADC value had the highest efficacy in predicting the outcome of patients (area under ROC curve was 0.746), and the best diagnostic cut-off point was 1.20×10–3 mm2/s, the sensitivity was 73.3% and the specificity was 71.8%.ConclusionADC value of MR-DWI could predict progression after TACE in patients with HCC, and ADC value of 800 s/mm2 has a better predictive value for them.
【Abstract】Objective To investigate the change of vascular endothelial growth factor (VEGF) expression in HepG2 cells under hypoxia. Methods HepG2 cells were cultured under hypoxia（hypoxia group） and normal condition (control group). VEGF expression of HepG2 cells was examined by immunohistochemical staining. The growth of HepG2 cells was examined by MTT colorimetry and cell count. VEGF level in the culture medium was measured by ELISA.Results After 48 h and 72 h of culture, the growth rate of HepG2 cells in hypoxia group was lower than that in control group (P＜0.05). The cell count in hypoxia group (2.51×104/μl and 2.69×104/μl, respectively) was much lower than that in control group(3.01×104/μl and 3.52×104/μl) after 48h and 72h of culture (P＜0.05). In hypoxia group, VEGF level in the culture medium after 24 h and 48 h was higher than that in control group (P＜0.05, P＜0.01). Conclusion Hypoxia may enhance the VEGF expression in HepG2 cells and this could be the reason of high expression of VEGF after transcatheterized hepatic arterial chemoembolization.
ObjectiveTo investigate the effect and prognosis of emergency hepatectomy and second stage hepatectomy after transcatheter arterial chemoembolization (TACE) in spontaneous rupture and bleeding of resectable primary liver cancer.MethodsA total of 42 patients with spontaneous rupture and bleeding of resectable primary liver cancer in this hospital from January 2010 to January 2016 were retrospectively reviewed. Among them 24 cases had accepted the emergency hepatectomy in 24 h–48 h after admission (emergency hepatectomy group, n=24), 18 cases had accepted the second stage hepatectomy in 1 week–2 weeks after the TACE (second stage hepatectomy group, n=18), the intraoperative blood loss and intraoperative blood transfusion volume, perioperative mortality, postoperative incidence of hepatic insufficiency, recurrence rate and abdominal metastasis rate within 1 year after the operation, 1- and 3-year survival rates were compared between the emergency hepatectomy group and the second stage hepatectomy group.ResultsThere was no significant difference in the preoperative general data between these two groups (P>0.050). The intraoperative blood loss and transfusion volume of the emergency hepatectomy group were significantly more than those of the second stage hepatectomy group (P=0.028, P=0.017). There were no significant differences in the perioperative mortality (P=0.489), incidence of hepatic insufficiency (P=1.000), 1- and 3-year survival rates (P=0.650, P=0.463) and 1-year recurrence rate (P=0.601) between these two groups. No intraperitoneal implantation metastasis was found in these two groups.ConclusionBoth emergency hepatectomy and second stage hepatectomy after TACE are safe and effective in treatment of spontaneous rupture and bleeding of resectable primary liver cancer, appropriate treatment should be selected according to the specific conditions of patients.
ObjectiveTo explore the clinical efficacy of transcatheter arterial embolization or transcatheter arterial embolization combined with percutaneous transhepatic sclerotherapy injection for hepatic cavernous hemangioma with different blood supply. MethodsEighty-six patients with hepatic cavernous hemangioma with different blood supply received femoral artery pingyangmycin iodized oil embolization or transcatheter arterial embolization combined with percutaneous transhepatic injection of pingyangmycin iodized oil embolization from February 2004 to April 2013. ResultsForty-five cases (52.3%) of tumor decreased by over 50%; 26 (30.2%) decreased by about 20% to 50%; 11 (12.8%) decreased by less than 20%; and 4 (4.7%) had no significant change in the tumor diameter. Patients did not have serious complications. ConclusionThe effect of individualized intervention for hepatic cavernous hemangioma with different blood supply is obvious, and it is a safe and effective therapeutic method.