Objective To summarize the diagnosis and treatment of spontaneous rupture of bronchial artery aneurysm in mediastinum.Methods Two cases diagnosed as bronchial artery aneurysmby methods of enhanced-CT plus independent post-procedure techniques and bronchial artery selective angiography were cured by different intervention surgeries in our hospital. The clinical data of these two patients and different interventional treatments were summarized.Results Case 1 was a 38-year old male.He was given coils and PVC micro-particles, and bronchial artery selective angiography showed distal vascular occlusion and aneurysmsize decreased. Case 2 was a 59-year old female. She was also given coils, but digital subtraction angiography showed bleeding of bronchial artery whose opening was near to the aorta.Then a stent was implanted in the descending aorta to isolate the bleeding bronchial artery, and bronchial artery selective angiography showed blood flow was completely blocked. Conclusions Enhanced-CT plus vascular three-dimensional reconstruction and bronchial artery selective angiography is a chief method to diagnose bronchial artery aneurysm. Bronchial artery embolization and/ or isolating surgery with covered stent are minimally invasive, efficient, trustworthy treatment for spontaneous rupture of bronchial-artery aneurysmin mediastinum. Different techniques of interventional treatment are selected depending on lesion.
Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
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 summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion.MethodsWe retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation.ResultsThe mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism.ConclusionCTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.
ObjectiveTo analyze the clinical characteristics of thrombo embolism (TE) in Chinese hypertrophic cardiomyopathy (HCM) patients. MethodsThis study retrospectively analyzed HCM patients admitted to West China Hospital of Sichuan University. The endpoints were defined as a composite of TE events, including ischemic stroke, transient ischemic attack, and peripheral arterial embolization. ResultsA total of 537 HCM patients were included with a median follow-up of 4.2 years. Forty-two patients reached the TE endpoint and the incidence was 1.9%. The annual incidence of TE was approximately 1.1% and 6.6% for HCM patients without/with atrial fibrillation, respectively. The recurrence rate of TE was high (approximately 26.2%). The mean age was 66.4±13.7 years for the first TE, and the incidence of TE was significantly increased at age ≥70 years. ConclusionThe incidence of TE is high in HCM patients, especially in those with atrial fibrillation, and the recurrence rate of TE is also high.