Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To explore the application value of artificial intelligence (AI) pulmonary artery assisted diagnosis software for suspected pulmonary embolism patients. Methods The data of 199 patients who were clinically suspected of pulmonary embolism and underwent pulmonary artery CT angiography (CTA) from June 2016 to December 2021 were retrospectively analyzed. Images of pulmonary artery CTA diagnosed by radiologists with different experiences and judged by senior radiologists were compared with the analysis results of AI assisted diagnostic software for pulmonary artery CTA, to evaluate the diagnostic efficacy of this software and low, medium, and senior radiologists for pulmonary embolism. The agreement of pulmonary embolism based on pulmonary artery CTA between the AI software and radiologists with different experiences was evaluated using Kappa test. Results The agreement of the AI software and the evaluation of pulmonary embolism lesions by senior radiologists based on pulmonary artery CTA was high (Kappa=0.913, P<0.001), while the diagnostic results of pulmonary artery CTA AI software was good after judged by senior radiologists based on pulmonary artery CTA (Kappa=0.755, P<0.001). Conclusions The AI software based on pulmonary artery CTA diagnosis of pulmonary embolism has good consistency with diagnostic images of radilogists, and can save a lot of reconstruction and diagnostic time. It has the value of daily diagnosis work and worthy of clinical promotion.
Objective To evaluate the safety and efficacy of transcatheter angiographic embol ization (AE) in the control of massive haemorrhage from large wound due to crush syndrome after Wenchuan earthquake. Methods From May 12 to May 26, 2008, 11 injured persons in Wenchuan earthquake with massive haemorrhage from large wound due to crush syndrome were treated, including 6 males and 5 females aged 16-36 years old (average 21 years old). All 19 wounds were infected.The hemorrhage was from the hip in 7 cases, the thigh stump in 3 cases, and the shoulder in 1 case. Six patients had hemorrhagic shock. All patients underwent arteriography to locate the bleeding artery, and transcatheter AE was performed according to the result of arteriography. Contrast-enhanced spiral CT scan and three-dimensional angiography were performed 48 hours after AE to evaluate leakage of contrast media and collapse of distal artery of embol ism site. Results Angiography for 11 injured persons after AE showed no occurrence of contrast media leakage, faint shadow to the distal branch artery of embol ic level, and significant increase of blood pressure of the bleeding artery, indicating the embol ization was successful. No active hemorrhage was evident in the wounds 48 hours after AE. For the 6 patients with hemorrhagic shock, obvious decrease of hemorrhage was observed after AE, gradual recovery of blood pressure and vital signs, and stabil ity of their condition were evident after supportive therapy. During the first 24 hours after AE, total volume of infusion was 6 750-19 600 mL (average 8 740 mL), and total volume of blood and plasma transfusion was 1 800-6 400 mL (average 3 500 mL). In 6 cases, contrast-enhanced spiral CT scan demonstrated faint shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography showed collapse of the distal artery; in the rest 5 cases, contrast-enhanced spiral CT scan demonstrated shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography displayed the full-fill ing of distal artery with obviously decreased vascular cavity. No severe compl ications such as muscle necrosis in the buttock and hip, bladder necrosis,dysuria, fecal incontinence, and impotence occurred. Conclusion The transcatheter AE is a safe, fast, effective and miniinvasive method of controll ing massive haemorrhage from large wound caused by crush syndrome after Wenchuan earthquake.
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.
ObjectiveTo summarize the experience of combined treatment of conventional transcatheter arterial chemoembolization (cTACE) and drug-eluting-bead chemoembolization(D-TACE) in a case of advanced hepatocellular carcinoma with intrahepatic metastasis.MethodsA patient with advanced hepatocellular carcinoma who was admitted to The Second Affiliated Hospital of Chongqing Medical University in October 2018 was treated with TACE for three times.ResultsAfter MDT discussion, three interventional operations were performed on this patient in The Second Affiliated Hospital of Chongqing Medical University. CT examination after the first treatment with cTACE showed that lipiodol deposited in liver lesions and the lesions were more stable than before; after the second treatment with cTACE and D-TACE, CT examination showed more lipiodol deposited in the tumors, and the tumors were more limited and significantly reduced; after the third treatment with cTACE, CT examination showed that the tumors were effectively controlled and no progress was made. This patient was followed-up for 2 months after the fourth cTACE, tumors were effectively controlled and no progress occurred.ConclusionsIn advanced hepatocellular carcinoma with intrahepatic metastasis, TACE is the best treatment. Combination of D-TACE and cTACE can achieve better clinical efficacy.
ObjectiveTo investigate the safety and efficacy of intermittent pneumatic compression (IPC) in the treatment of deep venous thrombosis (DVT). MethodsThe clinical data of 496 patients with DVT who were treated in our hospital from January 2010 to October 2014 were analyzed retrospectively, to compare the time of venous pressure decreased to normal (T1) and time of circumference difference decreased to normal (T2) in patients received pure therapy (control group) and pure therapy combined with IPC (combination group), according to different types of patients in acute, sub-acute, and chronic phase. In addition, comparison of the remission rate of pulmonary embolism (PE), incidence of PE, and recurrence of DVT was performed between the control group and combination group too. Results① For DVT patients in acute stage, the time of T1 and T2 of patients in central type, peripheral type, and mixed type who received anticoagulant therapy/systemic thrombolysis/catheter thrombolysis+IPC, were significantly shorter than those patients who received only anticoagulant therapy/systemic thrombolysis/catheter thrombolysis (P<0.05). For DVT patients in sub-acute stage, the time of T1 and T2 of patients in central type and mixed type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.05), the time of T1 of patients in peripheral type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.01), but the time of T2 of patients in peripheral type didn't differed between patients who received only anticoagulant therapy/systemic thrombolysis and anticoagulant therapy/systemic thrombolysis +IPC (P>0.05). For DVT patients in chronic stage, the time of T1 and T2 of patients in central type and mixed type didn't differed between patients who received only anticoagulant therapy and anticoagulant therapy +IPC (P>0.05); the time of T1 of patients in peripheral type who received anticoagulant therapy+IPC, were significantly shorter than those of patients who received only anticoagulant therapy (P<0.05), but the time of T2 didn't differed with each other (P>0.05). ② There were 63 patients in control group and 47 patients in combination group had PE before treatment. After the treatment, the PE symptom of control group relieved in 56 patients (88.89%, 56/63) and maintained in 7 patients (11.11%, 7/63), the symptom of combination group relieved in 44 patients (93.62%, 44/47) and maintained in 3 patients (6.38%, 3/47), so the remission rate of PE symptom in combination group was higher (P<0.05). There were 6 patients suffered from new PE in control group[4.26% (6/141)] and 0 in combination group[0 (0/245)] after treatment in patients who hadn't PE before treatment, and the incidence of PE was lower in combination group (P<0.05). ③ There were 325 patients were followed up for 3-36 months with the median time of 27 months, including 157 patents in control group and 168 patients in combination group. During the follow-up period, 74 patients recurred[47.13% (74/157)] in control group and 46 patients recurred[27.38% (46/168)] in combination group, and the recurrence rate was lower in combination group (P<0.05). In addition, 41 patients suffered from post-thrombotic syndrome[26.11% (41/157)] in control group and 27 patients[16.07% (27/168)] in combination group, and the incidence of post-thrombotic syndrome was lower in combination group (P<0.05). ConclusionsIPC can significantly shorten the time of venous pressure and the circumference difference decreased to normal for DVT patients in acute stage and majority DVT patients in sub-acute stage, and it can relieve the clinical symptoms of PE, reduce the incidence rate of PE and recurrence rate of DVT. Therefore, IPC is a safe, reliable, and effective treatment for DVT patients in acute stage and majority DVT patients in sub-acute stage.