Embolism Research Articles

Clinical value of CT pulmonary angiography in diagnosis of pulmonary embolism and evaluation of clinical anticoagulant and thrombolytic efficacy

目的 探讨肺动脉栓塞(PE)的CT肺动脉造影(CTPA)征象及其在抗凝溶栓治疗疗效评价中的价值。 方法 选取绍兴市中心医院2016年5月至2018年10月PE患者38例，行CT平扫和肺动脉造影，采用多平面容积重组(MPVR)、容积再现(VR)技术进行肺动脉血管成像，结合多平面重建(MPR)以最佳显示肺动脉主干及其分支血管；并对其中20例PE患者采用抗凝溶栓治疗，观察治疗前、后相应PE血管充盈缺损及肺动脉分支的栓塞情况。 结果 肺动脉1～5级分支显示率达100%(38/38)，完全能满足临床对PE诊断的要求。CTPA显示中心型PE 6例，周围型PE 4例，混合型PE 28例；主要象征为肺动脉管腔中心或边缘性低密度充盈缺损，钝角附壁型偏心性狭窄，肺动脉管腔狭窄或完全闭塞。间接象征包括肺梗死、右心室增大、胸腔积液等；抗凝溶栓治疗显效16例，其中3例再发栓塞后溶通，有效4例。 结论 CTPA可对PE作出及时正确的定性、定量诊断，是临床选择治疗和动态监测评价抗凝溶栓疗效的有效手段。

Preliminary study of treatment for chronic symptomatic internal carotid artery long-segmental occlusion

Objective To evaluate the feasibility, safety and efficacy of the treatment of chronic symptomatic internal carotid artery long-segmental occlusion. Methods Fifty-one cases of chronic symptomatic internal carotid artery long-segmental occlusion (arterial occlusion more than 2 anatomical segments) who were treated with hybrid surgery (plaque located at the carotid sinus) or endovascular revascularization (plaque located at the distal end of the internal carotid artery occlusion) from May 2015 to May 2018 were reviewed. Recanalization, perioperative complications, stroke events, and reocclusion events during the follow-up period were recorded. Results The occlusion was recanalized successfully in 45 of 51 patients (88.2%, 45/51), 6 patients failed because the guidewire could not cross the distal arterial occlusion. And the technical success rate was 96.0% (24/25) in hybrid surgery and 80.8% (21/26) in endovascular revascularization. Perioperative complications occurred in 2 patients who underwent combined endovascular treatment. One patient had a small branch embolism due to intraoperative thrombus shift, and 1 patient had large area cerebral infarction. The complications occurred in 2 patients who underwent thybrid surgery, including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery. Forty-four patients with successful operation received clinical follow-up, with the median follow-up time of 24 months (7-43 months). No recurrent stroke and death occurred during the follow-up period. Clinical symptoms were improved in 34 cases. Totally 44 patients received imaging follow-up, and during the median imaging follow-up time of 8 month (4-28 months), 6 cases had reocclusion, and 2 cases had restenosis. Conclusion The treatment of chronic symptomatic internal carotid artery long-segmental occlusion is technically feasible and safety with good short-term efficacy. However, its exact efficacy remains to be confirmed by long-term follow-up studies with large samples. Key words: Carotid artery, internal; Arterial occlusive diseases; Radiology, interventional; Endovascular procedures

Case of Deep Venous Thrombosis Secondary to May-Thurner Syndrome

May-Thurner syndrome (MTS) remains an underdiagnosed cause of venous thromboembolism (VTE) because most individuals with MTS anatomy are asymptomatic. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae. Clinical features include chronic venous hypertension that usually presents as lower extremity pain and swelling. Acute VTE almost exclusively affects the left lower extremity. In cases of acute VTE of an unknown etiology, MTS should be considered when other more common pathologies have been ruled out. A 65-year-old African American gentleman with past medical history of hypertension and coronary artery disease presented with left lower extremity pain and swelling of the leg for five days. He had no history of leg trauma, recent surgery, bed rest, travel, malignancy, previous clotting episodes or family history of hypercoagulable disorders. Patient regularly ambulates. He is a lifetime non-smoker and does not take any medication. His left lower extremity was swollen from the calf down to the ankle and foot, tense, erythematous and tender to palpation. Dorsalis pedis and posterior tibial pulses were weakly palpable. Homan’s sign was appreciated while the rest of the physical exam was unremarkable. Duplex ultrasound of the left lower extremity showed thrombi in the left popliteal, posterior tibial and peroneal veins. CT abdomen and pelvis with IV contrast demonstrated significant compression of the left common iliac vein as it crosses posterior to the left internal iliac artery, consistent with MTS. Spiral chest CT was significant for subsegmental emboli in the bilateral lobe pulmonary arteries. Patient was started on anticoagulation, then he was referred to an advanced vascular center to consider the need for angioplasty and stenting and for possible thrombolysis. MTS was first described in 1908 by Virchow, who observed that iliofemoral vein thrombosis was five times more likely to occur in the left leg than in the right leg. May and Thurner discovered an anatomical variant where the right iliac artery compressed the left iliac vein against the fifth lumbar vertebra. Clinicians should have a high index of suspicion for MTS in the presence of unprovoked DVT in the left lower extremity, and/or signs of chronic venous hypertension. Angioplasty and stenting of the affected lesion is the definitive treatment for MTS, while anticoagulation management is similar to patients with provoked VTE. Therefore, it can be argued that in patients with an unexplained cause of VTE, investigation for MTS if clinically suspected can impact management decisions.

Revascularization treatment for complex intracranial aneurysms

Objective To investigate the role of revascularization in the treatment of complex intracranial aneurysms. Methods From January 2014 to March 2019, a total of 22 patients with complex intracranial aneurysms were treated with extracranial-intracranial (14 cases) or intracranial-intracranial (8 cases) revascularization at Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. The treatment methods of intracranial aneurysm included intraoperative isolation, proximal ligation, distal ligation, plastic clamping, encapsulation, intravascular embolism and postoperative embolism. The patency of anastomotic vessels, obliteration of the aneurysms and postoperative complications were observed after operation. Outcomes of patients were evaluated with Glasgow Outcome Scale (GOS). Results In this series, 22 cases successfully underwent revascularization. Intraoperative fluorescein angiography or DSA revealed the patency of anastomotic vessels. Postoperative angiographies were performed and patency of anastomotic vessels was confirmed in 18 patients (81.8%) and obliteration of aneurysms was confirmed in 20 patients (90.9%). Five patients (22.7%) developed various degrees of cerebral infarction. One patient was discharged because of poor prognosis and lost to follow-up. The other 21 patients were followed up for 1-59 months. No aneurysm recurred or ruptured during the follow-up period. GOS was Ⅴ in 20 cases and Ⅳ in 1 case. Conclusion With the proper selection of individualized revascularization based on the characters of aneurysms and cerebral blood flow requirement, revascularization seems an effective and safe method for the treatment of complex intracranial aneurysms. Key words: Intracranial aneurysm; Cerebral revascularization; Treatment outcome

Application of indocyanine green fluorescence imaging in open hepatectomy

Objective To investigate the clinical application of indocyanine green fluorescence imaging in open hepatectomy. Methods A total of forty-five patients who underwent liver resection in Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University from July 2017 to December 2018 were included in this prospective study. There were 26 males and 19 females, aged between 29 to 74 (51±10) years. Indocyanine green was injected intravenously 72~96 hours prior to surgery in all these patients. An intraoperative fluorescence imaging system was used to locate and remove the tumor, the liver parenchymal transection planes and surgical margins were detected by fluorescence again after tumor resection. The fluorescence profiles of the tumor specimens in relation to the tumor differentiation were analyzed. Results Indocyanine green fluorescence imaging was performed in 45 patients. A total of 66 lesions were detected by preoperative CT (or MRI), abdominal ultrasound and intraoperative fluorescence imaging. After excision of the primary liver cancer, the surgical margins of the remnant liver stumps and fluorescence in the excised liver specimens were studied. Thirteen small lesions were found in 10 patients, most of which were located at the surgical margin, and the smallest tumors detected were less than 5 mm in diameter. Five venous cancer emboli were found in 5 patients, 3 of which were not detected by preoperative imaging examinations. The fluorescence profile images of the excised hepatocellular carcinoma specimens showed homogeneous fluorescence in most highly differentiated hepatocellular carcinoma, and partial fluorescence or ring fluorescence in moderately differentiated hepatocellular carcinoma. Conclusion Indocyanine green fluorescence imaging technology can identify liver surface lesions, as well as detect small residual lesions at the cutting edge and venous thrombus, which improves the efficiency of hepatocellular carcinoma resection. Key words: Hepatectomy; Margins of excision; Indocyanine green; Fluorescence imaging

Short-term therapeutic effect of flow diverter on small unruptured intracranial aneurysms

Objective To summarize the short-term therapeutic effect and safety of flow diverter (FD) in the treatment of small unruptured intracranial aneurysms. Methods From April 2014 to March 2019, clinical data were collected from 110 patients with 145 small (diameter < 10 mm) unruptured intracranial aneurysms who were admitted to Department of Neurosurgery, People′s Hospital of Zhengzhou University. Among those, 133 aneurysms were treated with FD alone and 12 aneurysms were treated with FD combined with coiling. Radiological outcomes were assessed based on the Raymond grading. Clinical outcomes were assessed based on the modified Rankin scale score (mRS). Results A total of 121 FD were used for 145 aneurysms. The successful rate of stent implantation was 99% (120/121). For 17 FD, balloon dilatation or massage were performed for better cell opening and wall apposition. There were no hemorrhagic complications. Ischemic complications occurred in 5 cases (4.5%). At 6 months post surgery, DSA results showed that Raymond grade Ⅰ embolism rate was 67.6% (50/74). Asymptomatic stenosis of parent artery was found in 2 cases. The 6-month follow-up results showed the mRS score of 0 in 101 cases, 1 in 4 cases, 2 in 3 cases, and 4 in 1 case and 5 in 1 case. Conclusions Treatment of small unruptured intracranial aneurysms with FD is associated with high success rate and safety. The 6-month follow-up results seem satisfactory and the long-term treatment results still need further follow-up. Key words: Intracranial aneurysm; Treatment outcome; Flow diverter; Unruptured; Small

Another Assessment of Pulmonary Embolism Prevalence in Syncope Patients

Recent literature suggests conflicting estimates of the prevalence of pulmonary embolism (PE) in patients who present with syncope. Based on these

Prospective study of percutaneous vertebroplasty through unilateral extreme extrapedicular approach for osteoporotic vertebral compression fracture

Objective To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture. Methods A prospective cohort study was performed. Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital, Capital Medical University. There were 36 males and 61 females, aged (72.19±7.41) years, with an age range of 60-80 years. All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n=52) and bilateral puncture group(n=45). PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle, and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group. All patients completed at least one year of follow-up after operation. The operation time, fluoroscopy times, cement volume, incidence of cement leakage, visual analogue score (VAS) of 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation (Mean±SD), count data were expressed as percentage, the independent sample t test and the χ2 test were used for comparison between groups, and the paired t test was used for comparison within the group. Results The operation was successfully completed in both groups. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. In the unilateral puncture group, the operation time were (21.90±3.16) min, the fluoroscopy times were (15.46±2.86) times, the cement volume were (3.47±0.41) ml and the incidence of cement leakage was 44.23% (23/52), in the bilateral puncture group, the operation time were (31.64±6.90) min, the fluoroscopy times were (23.31±2.39) times, the cement volume were (4.66±0.61) ml and the incidence of cement leakage was 68.89% (31/45). The operation time, fluoroscopy times, cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group. The difference was statistically significant (P 0.05). Conclusions Compared with bilateral transpedicular puncture, PVP through unilateral extrapedicular puncture can achieve the same clinical effect. However, the latter can significantly reduce the operation time, the cement volume, fluoroscopy times and the incidence of cement leakage. Key words: Osteoporotic fractures; Spinal fractures; Fractures, compression; Vertebroplasty

Research progress on DNA methylation in deep vein thrombosis

The incidence of deep vein thrombosis has increased year by year in the world, and it has become one of the serious diseases that threaten human life. In severe cases, it can lead to fatal pulmonary embolism. The pathogenesis of deep vein thrombosis is the result of the interaction of multiple genetic environmental factors. Therefore, regulation of gene expression by modification of DNA and histones may help to further reveal the pathogenesis of deep vein thrombosis, and reactivation or silencing of some genes that are inhibited or overexpressed by aberrant methylation may be a major therapeutic target for deep vein thrombosis. The author reviews the current status of DNA methylation studies related to deep vein thrombosis. Key words: Venous thrombosis; Gene; DNA methylation; MicroRNAs

Research progress in mechanical thrombectomy device for deep venous thrombosis treatment

Mechanical thrombectomy is a minimally invasive interventional method. Embolization device is too close to the blood vessel wall and venous valve in clinical applications, and it can cause blood vessel damage when it is sucked into the lumen. Embolization device is easy to cause hemolysis. Optimal design can reduce the damage to red blood cells, but it cannot be completely avoided; Shedding emboli can complicate the pulmonary artery. The clinical application studies of mechanical thrombectomy devices in the world was reviewed, including 74 experimental studies and 166 clinical application studies. The current status and causes of vascular injury, hemolysis and pulmonary embolism caused by mechanical thrombectomy were analyzed. This paper aims to make recommendations for the optimization of mechanical thrombectomy devices. Key words: Deep venous thrombosis; Mechanical thrombectomy device; Optimization

Study on risk factors of catheter-related venous thrombosis and prevention effect of low-molecular-weight heparin in patients with hematological malignancies

Objective To investigate the incidence and risk factors of catheter-related venous thrombosis (PICC-DVT) after peripherally inserted central catheter (PICC) in patients with hematologic malignancies, and to analyze the safety of anti-coagulation therapy with low-molecular-weight heparin. Methods From August 2016 to June 2018, 43 patients with hematologic malignancies received PICC in Baoan District People's Hospital of Shenzhen City were enrolled. The patients were divided into low-molecular-weight heparin anticoagulation group (22 cases) and blank control group (21 cases) according to the random number table method. The blood routine, coagulation quadruple, D-dimer, protein C activity, protein S activity, and antithrombin Ⅲ activity before and after catheterization were compared between the two groups. Results Of the 43 patients, 5 cases (11.62%) occurred PICC-DVT within 1 month after PICC, including 2 cases (9.09%) in the low-molecular-weight heparin anticoagulation group, and 3 cases (14.29%) in the blank control group, the difference between the two groups was not statistically significant (P = 0.664). No pulmonary embolism occurred in all patients with PICC-DVT. One case in the blank control group developed PICC-DVT and catheter-associated staphylococcus aureus infection, the patient was extubated after anti-infection and thrombolytic therapy, the other patients with PICC-DVT were not extubated, and the thrombus was dissolved after anticoagulant therapy. There were no significant differences in the white blood cell count, platelet count, prothrombin time, activated partial thromboplastin time, D-dimer, protein C activity, protein S activity, and antithrombin Ⅲ activity between the low-molecular-weight heparin anticoagulation group and blank control group (all P > 0.05). The anticoagulant index (protein C, protein S or antithrombin Ⅲ activity) was decreased in 5 patients with PICC-DVT, and in 38 non-thrombotic patients, the anticoagulant index was reduced in 16 patients (42.11%), the difference was statistically significant (P = 0.021). Conclusions The incidence of protein C, protein S or antithrombin Ⅲ activity reduction in hematological malignancies patients with PICC-DVT is higher than that in non-thrombotic patients. Low-molecular-weight heparin anticoagulant therapy can not reduce the occurrence of PICC-DVT within 1 month after PICC in patients with hematological malignancies, but the treatment is safe and has no relevant bleeding event. Key words: Hematologic neoplasms; Peripherally inserted central catheter; Antithrombin Ⅲ; Protein C; Protein S; Catheter-related thrombus

Application of cognition-belief-behavior oriented intervention model in patients with cerebral aneurysm embolism

Objective To explore the application effect of cognition-belief-behavior oriented intervention model in patients with cerebral aneurysm embolism. Methods By convenience sampling, a total of 200 patients with cerebral aneurysm embolism admitted in People's Hospital of Cangnan from January of 2016 to August of 2018 were selected as the research objects and divided into the study group (n=100) and control group (n=100) based on the random number table. The control group was given the traditional nursing intervention and the cognition-belief-behaviour oriented intervention was carried out in the study group. The effect of intervention was evaluated by Health Education Content Mastery Questionnaire and Quality Of Life Scale. Results After intervention, the mastery of health related education content in the study group was better than that in the control group, with statistical significance (P<0.05) . After the intervention, the scores of each dimension of Quality of Life Scale in the study group were higher than those in the control group, and the differences were statistically significant (P<0.05) . Conclusions The application of cognitive-belief-behavior-oriented interventions in patients with cerebral aneurysm embolism can improve their mastery of health related education knowledge and improve their quality of life. Key words: Cerebral aneurysm embolism; Cognition-belief-behaviour; Quality of life

Efficacy comparison between operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism

Objective To investigate efficacy of operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism. Methods A retrospective case control study was conducted to analyze the clinical data of 18 hip fracture patients complicated with pulmonary embolism admitted to Dongyang People's Hospital from May 2017 to January 2019. There were 11 males and seven females, aged 59 to 96 years[(80.0±9.3)years]. There were 10 patients with intertrochanteric fractures, one with femoral subtrochanteric fracture and seven with femoral neck fractures. After diagnosis of pulmonary embolism, the patients were given anticoagulant therapy with low molecular weight heparin for at least one week. The re-examination showed that pulmonary embolism absorption improved and D-dimer did not increase. Eleven patients chose surgical treatment (operation group) with intramedullary nail internal fixation or artificial hip replacement. Seven patients chose non-surgical treatment (non-operation group) with skin traction. The Harris score of hip function was compared between the two groups. Visual analogue scale (VAS) was used to evaluate hip joint pain. At the last follow-up, fracture healing, prognosis of pulmonary embolism and mortality within 3 months were recorded. Results All the patients were followed up for 3-22 months [(11.2±6.0)months]. At last follow-up, the Harris score was (92.1±2.2)points in the operation group and (28.8±18.8)points in the non-operation group (P<0.01); the VAS was 0 point (0-1 point) in the operation group and 3 points (1-3 points) in the non-operation group (P<0.01). At the last follow-up in the operation group, five patients obtained fracture healing after internal fixation, and among the six patients receiving artificial joint replacement, five patients recovered well except for one deceased patient. At the last follow-up, pulmonary embolism was absorbed and no recurrence of pulmonary embolism was found. None of the patients died within 3 months in operation group, while 14% of the patients (1/7) in the non-operation group died within 3 months. Conclusions For hip fracture patients complicated with pulmonary embolism, compared with non-operation treatment, operation treatment is more beneficial to restore hip function and relieve pain, with lower mortality rate within 3 months. Operation treatment is feasible for patients who showed improved absorption of pulmonary embolism and no secondary increase of D-dimer after one to two weeks of full anticoagulation treatment before operation. Key words: Hip fractures; Pulmonary embolism; Operation

Efficacy of evidence-based nursing program in patients with pulmonary embolism in non-acute stage

Objective To explore the clinical effect of evidence-based nursing program for patients with pulmonary embolism in non-acute stage, and provide data support for high-quality clinical care for such groups. Methods From March 2014 to February 2016, 49 patients with non-acute pulmonary embolism admitted to the hospital were selected as the control group to carry out traditional nursing.50 patients with pulmonary embolism in non-acute stage admitted to the hospital from March 2016 to February 2018 were selected as the study group, and evidence-based nursing scheme was introduced on the basis of traditional nursing intervention in the control group.The anxiety, depression and prognosis of the two groups before and after intervention were compared. Results After intervention, SAS and SDS scores in the study group were lower than those in the control group, and the excellent rate of disease prognosis in the study group was higher than that in the control group, with statistically significant differences (P<0.05). Conclusion The application of evidence-based nursing program to patients with pulmonary embolism in non-acute phase can reduce the mortality and incidence, and reduce the recurrence rate of the disease. Key words: Pulmonary embolism; Non-acute phase; Evidence-based nursing; Case fatality rate

Outcome of open abdomen procedure with Bogota bag for temporary abdominal closure: our experience in Alexandria University Hospital

Aim To evaluate the outcome of abdomen (OA) procedure with Bogota bag as a temporary measure to close the abdomen in patients with abdominal catastrophes in terms of mortality and morbidity. Patients and methods The study included adult patients who were treated for abdominal catastrophes with OA and Bogota bag for temporary abdominal closure during the period 2007–2016 in Alexandria Main University Hospital. Delayed definite abdominal closure was performed by edge-to-edge closure of the fascia if possible or by approximation of the fascia to the nearest available distance and filling the gap by Dexon mesh in a tension-free manner. Results A total of 74 patients were included, with a mean age of 38.19±13.60 years. The etiology was blunt trauma in 32.4%, whereas 67.6% had nontraumatic causes. Ten (13.5%) patients died: six patients owing to their original pathology and four patients owing to pulmonary embolism. Old age and high leukocyte count were significant factors for mortality. Regarding postoperative complications, no patients had abdominal compartment, nine patients had wound infection, two patients had intestinal fistulas, one patient had evisceration, whereas 24 patients had incisional hernia. Conclusion Bogota bag for temporary abdominal closure after OA is an easy and efficient technique for management of abdominal catastrophes by which serious complications of either exposure or closure under tension could be prevented. Postoperative mortality was 13.5% but not related to the technique. Old age and high leukocyte count were found to be significant risk factors affecting mortality.

P2758Role of echocardiographic findings and blood culture in embolic complications in patients with infective endocarditis

Abstract Echocardiography is essential for the diagnosis of infective endocarditis (IE), treatment choice and follow-up. Prognosis in IE is multifactorial and includes both structural changes of the heart induced by IE and extra-cardiac IE complications. Aims Aims of the study were to analyse: 1) relation between embolic complications of IE and structural changes of the heart detected by echocardiography in IE patients; 2) association between embolic complications of IE and IE causative microorganism. Methods 335 patients with definitive IE from the single tertiary center were enrolled in the study between 2009–2018. Echocardiographic changes are defined in accordance with 2015 ESC guideline. Associations between embolic complication and structural heart changes, as well as between IE causative microorganism and embolic complications were tested by Chi square test. Results Observed embolic complication were: ischemic stroke (in 12.5% of patients), haemorrhagic stroke (2.1%), neuroinfection (9.6%), brain abscess (1.8%), discitis (3%), pulmonary embolism (1.5%), spleen abscess (7.8%) and peripheral arterial embolization (1.5%). There were several significance associations: vegetations larger than 15 mm were associated with ischemic stroke (p=0.041) and peripheral arterial embolization (p=0.05); perivalvular abscess was associated with brain abscess (p=0.037) and peripheral arterial embolization (p=0.019). Staphylococcus aureus isolated from blood cultures was associated with discitis (p&lt;0.001), brain abscess (p&lt;0.001) and neuroinfection (p&lt;0.001). Bacterias from HACEK group were associated with peripheral arterial embolisation (p&lt;0.001) and non-HACEK bacterias were associated with ichemic stroke (p=0.016). Patients with more than one isolated bacteria from blood culture had more often spleen abscess (p=0.003) and ichemic stroke (p=0.049). Conclusion Results point that large vegetations, but also perivalvular abscesses are coupled with higher rate of embolic complications in patients with IE. Staphylococcus aureus, HACEK group and non-HACEK bacteria are, more than other causative IE microorganisms, associated with embolism. These results might be clinically important for treatment chose and prognosis of the patients with IE.

EP27.06: Amniotic fluid embolism: successful recovery after amniotic fluid embolism – three cases

EP27.06: Amniotic fluid embolism: successful recovery after amniotic fluid embolism – three cases

Application of lung ventilation/perfusion imaging in non-pulmonary embolic diseases

Lung ventilation/perfusion (V/Q) imaging is the recommended diagnostic technique for pulmonary embolism. With the development of imaging equipments, radiopharmaceuticals and new quantitative techniques, lung V/Q imaging has been increasingly used in other lung diseases. This article reviews the clinical application of lung V/Q imaging in non-pulmonary embolic diseases. Key words: Lung disease; Ventilation/perfusion imaging; Trends

The value of preoperative lymphocytes-to-monocytes ratio in predicting lymph node metastasis in gastric cancer

Background: This study was aimed to evaluate value of preoperative lymphocytes-to-monocytes ratio (LMR) as a predictor for lymph node metastasis in gastric cancer. Methods: Patients with pathologically diagnosed malignant gastric tumor were reviewed retrospectively. Patients’ demographic data, clinical manifestations and LMR were collected. The postoperative pathology data including the tumor size, tumor sites, differentiation degree of tumor, depth of tumor invasion, metastatic lymph nodes, total dissected lymph nodes, distant metastasis, vessel carcinoma embolus, neural invasion, Lauren’s classification, Ki-67 and TNM stage were collected. Receiver operating characteristic curve (ROC) was used to determine the cut-off point of LMR. The association between LMR and the clinicopathologic factors was further analyzed. Results: A total of 177 subjects were enrolled into the study. LMR =3.79 was used as cut-off point; the patients with LMR ≥3.79 were classified as high-LMR group (123 cases) and the patients with LMR Conclusions: Low preoperative LMR was positively correlated with lymph node metastasis in gastric cancer patients, and had predictive value for lymph node metastasis in gastric cancer patients.

The efficacy of green surgery pathway on senile hip fractures

Objective To evaluate the efficacy of green surgery pathway on senile hip fractures. Methods The green surgery pathway was implement in senile (≥75 years) hip fracture cases in our department since March 2016. A historically controlled trial study was designed: 97 senile hip fracture patients admitted between March 2016 and March 2017 were included in the intervention group and 78 senile hip fracture patients admitted between March 2015 and March 2016 were included in the control group. The patients’ general information were recorded, including gender, age, type of fracture, internal medical conditions, surgery method, the American Association of Anesthesiologists classification of physical status (ASA) classification, et al. The hip function was evaluated by the Harris score system at one week,6 months and one year after surgery. The waiting time for operation, operation time, length of hospital stay, complications during hospitalization and hip Harris score were compared between the two groups. Results For the baseline data between the two groups in terms of gender, age, fracture type, surgery method, ASA classification, and combined underlying disease, the differences were not statistically significant. The waiting time for operation of the green surgery pathway group (36.3±7.8 h) was significantly shorter than that in the control group (46.9±11.4 h, t=6.995, P=0.000). The operation time of the green surgery pathway group was 45.4±17.5 min, and that of the control group was 43.8±20.8 min, the differences were not statistically significant. The length of hospital stay in the green surgery pathway group (6.8±2.4 d) was significantly shorter than that in the control group (9.5±2.8 d), the difference was statistically significant (t=6.866, P=0.000). In the green surgery pathway group, one patient developed acute myocardial infarction at 15 h after surgery and died of invalid rescue. In the control group, one patient developed acute cerebral hemorrhage 3 d after surgery and died of invalid rescue. The incidence of pulmonary infection, urinary tract infection, and acne in the green surgery pathway group were lower than that in the control group, the differences were statistically significant (χ2PI=5.081, PPI=0.024; χ2UI=6.841, PUI=0.009; χ2acne=11.768, Pcne=0.001). For the incidence of acute myocardial infarction, acute cerebrovascular accident, pulmonary embolism and deep vein thrombosis between the two groups, the differences were not statistically significant. The Harris score of hip in the green surgery pathway was higher than that in the control group (72.6±13.1 points vs 62.2±15.4 points, t=4.826, P=0.000) one week after the surgery, the difference was statistically significant. While the score was slightly higher than that of the control group in the half year (93.8±16.8 vs 90.5±14.7) and one year (94.1±18.3 vs 92.4±15.9) after surgery, but the differences were not statistically significant. The mortality rate of the green surgery pathway was slightly lower than that of the control group within one year after surgery (6.19% vs 8.97%), but the difference was not statistically significant. Conclusion The implementation of green surgery pathway can reduce the occurrence of complications in bed, promote the early hip rehabilitation, effectively shorten the hospitalization time. It is worth further promotion because of its social benefits and health economic benefits. Key words: Hip fractures; Case-control studies; Treatment outcome; Postoperative complications