Objective To investigate the therapeutic effects of throm bolytic drug infusion via carotid artery on experimental central retinal artery occlusion (CRAO), and observe the changes of fibrinolytic activity in the system ic circulation. Methods To dissolve the thrombi in 15 cats (30 eyes) with CRAO established by laser irradiating a branch of central retinal a rtery after intravenous injection of photochemical drugs, urokinase (UK) was dir ectly infused via carotid artery in 5 cats (10 eyes) in group A or intravenously injected in 5 cats (10 eyes) in group B, and isotonic saline solution was intra venously injected in 5 cats (10 eyes) in group C respectively. The patency of the artery was evaluated by fundus fluorescein angiography. Moreover, the changes of fibrinolitic activity in the blood were observed by blood biochemical examination. Results Four hours after UK infusion, the complete repatency proportion was 80% (5 cats 8 eyes) in group A, and 50% (4 cats 5 eyes) in group B. There was significant difference between the two groups. Besides, after the infusion, the indexes of coagulation, fibrinolysis, and anti-fibrinolysis in group A were better than those in group B and C (Plt;0.01). Conclusion In the treatment of experimental CRAO, thrombolytic drug infusion via carotid artery is better and more effective than via intravenous injection, which may provide a new method of thrombolytic drug delivery and animal models. (Chin J Ocul Fundus Dis，2004，20：186-188)
Objective To set up a new animal model of branch retinal vein occlusion (BRVO), which was quite similar to the clinical features and pathogenesis of this disease. Methods The animal model was set up by laser (krypton green 90 ～150 mW) irradiating a branch of central retinal vein after intravenous injection of photochemical drug (3% rose bengal) to 5 pigmented rabbits, and the model was confirmed by fundus fluorescein angiography (FFA) and pathological examination. Results The model of BRVO was successfully set up, which was confirmed by clinical examination and FFA. Pathological examination showed that the occlusion was caused by intra-venousthrombosis. Conclusion An experimental BRVO model, which has the similar pathological processes of occlusion of central retinal vein and intra-venous thrombosis as those in clinic can be set up by using photochemical method. The method is quite simple, and it offers a better animal model for clinical therapeutic research. (Chin J Ocul Fundus Dis,2002,18:23-25)
Objective To inspect the effects of recombinant staphylokinase (r-Sak) and the changes of fibrinolytic activity in the systemic circulation in the treatment of experimental central retinal artery occlusion (CRAO)． Methods The animal model of CRAO in 15 cats (30 eyes) was set up by laser irradiating a branch of central retinal artery after intravenous injection of 3% rose bengal，and then the arterial thrombi were dissolved by intravenous injection of r-Sak and urokinase (UK)．The pat ency of the arteries was evaluated by FFA．Moreover，the changes of fibrinolitic activity in the blood were examined by phlebotomizing． Results The model of CRAO was successfully set up.Four hours after injection of thrombolysis drugs,the completely reopened proportion in r-Sak group was 100%，while in UK group the proportion was 60%．At the same time， no significant systemic fibinnolytic activation was observed in r-Sak group． Conclusions An experimental CRAO model,which has the similar pathological processes of occlusion of central retinal artery and intra arterial thrombosis as those in clinic，can be set up by using photochemical method，and r-rak is capable of lysing thrombus without significant activation of circulating plasminogen． (Chin J Ocul Fundus Dis，2000，16：71-138)
Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group (n=6), grade B liver function group (n=18), and grade C liver function group (n=26); according to the type of stent implantation, the patients were divided into covered stent group (n=29) and bare stent group (n=21). The 1-week and 1-, 3-, 6-, and 12-month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% (50/50), and the success rate of emergency surgery was 100.0% (3/3) in 3 patients with active bleeding. The portal vein pressure decreased from (39.46±2.82) cm H2O (1 cm H2O=0.098 kPa) before the surgery to (25.62±2.13) cm H2O after the surgery, and the difference was statistically significant (P<0.05). In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant (P>0.05); in grade C liver function group, the 1-week, 1-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant (P<0.05). The postoperative 2-year rebleeding rate was 12.0% (6/50), and the postoperative 2-year incidence of hepatic encephalopathy was 16.0% (8/50). The postoperative 2-year stent stenosis rate was 26.0% (13/50) in the 50 cases, which was 13.8% (4/29) in covered stent group and 42.9% (9/21) in bare stent group, respectively. The postoperative 2-year survival rate was 90.0% (45/50). Conclusions TIPS combined with gastric coronary vein embolization in the treatment of liver cirrhosis with gastroesophageal varices bleeding has the exact effect, low rebleeding rate, fewer complications, and can be repeated. The preoperative evaluation of patients’ liver function, the application of stent of diameter 8 mm, paying attention to the perioperative period and regular follow-up treatment are helpful to reduce or prevent the occurrence of hepatic encephalopathy, stent stenosis and other complications.
ObjectiveTo investigate the trend of serum bilirubin in patients with liver cirrhosis before and after transjugular intrahepatic portosystemic shunt (TIPS).MethodsThe data of patients with cirrhotic portal hypertension who underwent TIPS between October 2016 and June 2018 were collected retrospectively, including liver function before and after surgery (1 week, 1 month, 3 months, and 6 months after surgery), preoperative and postoperative portal vein pressure, and the Child-Pugh scores, model for end-stage liver disease (MELD) scores, and albumin-bilirubin (ALBI) scores. Paired t-test was used for the statistical measurement data. The total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels at five time points were analyzed by analysis of variance of repeated measurement data with its own before and after comparison, and Wilcoxon signed ranks test was used for the ordered data.ResultsA total of 60 patients were included.The portal vein pressure was (27.86±2.53) mm Hg (1 mm Hg=0.133 kPa) before TIPS and (17.22±2.33) mm Hg after TIPS, and the difference was statistically significant (P<0.05). The common logarithm of the serum TBIL level [lg(TBIL)] before surgery and 1 week, 1 month, 3 months, and 6 months after surgery were (1.27±0.23), (1.44±0.21), (1.51±0.20), (1.56±0.22), (1.48±0.19) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum DBIL level [lg(DBIL)] at the five time periods were (0.90±0.26), (1.14±0.24), (1.18±0.25), (1.21±0.28), (1.08±0.21) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). The common logarithm of the serum IBIL level [lg(IBIL)] at the five time periods were (1.00±0.23), (1.13±0.22), (1.20±0.23), (1.26±0.21), (1.22±0.23) lg(μmol/L), respectively, and the difference was statistically significant (P<0.001). There were no statistically significant differences in the three liver reserve function scores (Child-Pugh, MELD, and ALBI, respectively) before and six months after operation (P>0.05). The differences in the composition of Child-Pugh and ALBI before and after surgery were not statistically significant (P>0.05).ConclusionsTIPS has a significant effect on reducing portal hypertension. Serum bilirubin levels continue to increase during a period after TIPS, but begin to decrease within 6 months.