ObjectiveTo summarize the various treatment methods for reducing jaundice in the elderly patients with malignant obstructive jaundice (MOJ), and provide reference for the treatment of elderly MOJ.MethodUsing “malignant obstructive jaundice” as the Chinese keyword and the English keyword, a computer search of the literatures on the treatment of elderly MOJ patients was conducted and reviewed.ResultsThe treatment methods of reducing jaundice in elderly MOJ included radical surgery, cholangiojejunostomy, endoscopic ultrasound-guided biliary drainage, endoscopic biliary stent implantation, percutaneous transhepatic biliary drainage and stent implantation. Radical surgery was the most effective, but it was traumatic and had many complications for elderly patients. Cholangiojejunostomy was effective and suitable for elderly patients who cannot tolerate major surgery. Endoscopic ultrasound-guided biliary drainage was less traumatic to elderly patients, but technical difficulty. Endoscopic biliary stent implantation was currently the first-line choice for the treatment of elderly patients with advanced MOJ. Percutaneous transhepatic biliary drainage and stent implantation were suitable for elderly and frail patients with high obstruction.ConclusionThe treatment of elderly MOJ needs to be individualized and regionalized, and appropriate treatment methods should be selected according to the patient’s condition and the medical level of the medical center.
ObjectiveThis study was aimed to evaluate the clinical efficacy of mechanical thrombectomy using the AngioJet System for the treatment of lower extremity acute arterial embolism and thrombosis.MethodsThe clinical data of 20 patients with acute lower extremity arterial embolism and thrombosis admitted to the Department of Vascular Surgery in the People’s Hospital in Gansu Province where the author worked from September 2016 to March 2017, were retrospectively analyzed. All patients were treated with the AngioJet mechanical thrombectomy system. Clinical data of the patients were retrospectively collected. The clinical efficacy of AngioJet mechanical thrombectomy wasanalyzed.ResultsEighteen (90.0%) of the 20 patients successfully completed the mechanical thrombectomy by using the AngioJet System. The mean time for hospital stay and operation was (4.2±1.4) d and (1.3±0.4) h, respectively. The average doses of urokinase and heparin during operation were (35.80±12.30) ×104 U and (45.10±8.30) mg, respectively. Two patients received a complementary treatment of incision for removing the thrombus. Two patients received catheter-directed thrombolysis after the mechanical thrombectomy, 5 patients received bare-metal stent implantation after balloon expansion. Clinical success was in 16 cases. According to the Cooley standard, 10 patients were in excellent condition,6 in good condition, 2 in fair condition, and 2 in poor condition. There were 2 cases of distal arterial embolization,2 cases of antecardial discomfort of bradycardia, and 4 cases of bleeding at the puncture point, but no serious bleeding complications such as gastrointestinal and intracranial hemorrhage occurred. A total of 16 patients presented myoglobinuria during and after operation. All patients were followed up for 6–12 months. The results of ultrasound examination showed that the artery was patency in 15 cases. One patient died of myocardial infarction in 9 months after surgery,2 patients developed lower extremity ischemia symptoms again after surgery, and 2 patients had lower extremity ulcer caused by lower extremity ischemia symptoms. During the follow-up period, no lower limb necrosis, amputation, and death occurred in the remaining patients.ConclusionsThe AngioJet mechanical thrombectomy system is safe and effective. Combined with the use of catheter-directed thrombolysis and stent implantation, the AngioJet mechanical thrombectomy could lead to quick recovery of the perfusion of the lower extremity and improve the limb salvage rates, exhibiting excellent clinical value.
Objectives To evaluate the clinical efficacy and safety of coronary artery drug injection for slow flow/no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2009), PubMed, EMbase, CBM, CNKI, VIP, and WanFang databases from their inception to April 2009. Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed by RevMan 5.0 software. Results Eight randomized controlled trials (RCTs) involving 593 patients were included. The results of meta-analyses showed that urokinase, adenosine, and anisodamine could significantly improve the thrombolysis in myocardial infartion (TIMI) flow. In addition, anisodamine could improve the coronary blood pressure. Urokinase significantly reduced the incidence of malignant ventricular arrhythmias and non-fatal of heart failure during hospitalization, but it could not change the mortality and the incidence of unstable angina, recurrence of myocardial infarction, and ischemic target revascularization. Conclusion Evidence shows that anisodamine, urokinase, urapidil and adenosine can improve TIMI flow and improve myocardial perfusion on the no-reflow patients post coronary stent implantation and urokinase can significantly reduce the incidence of main adverse cardiovascular events. Their clinical application is worthy to be advocated.
ObjectiveTo investigate the effects of a new anti-anxiety-depression drug tandospirone on heart rate variability (HRV) and QT-dispersion in patients with anxiety and depression after intracoronary stent implantation. MethodsEighty-six anxious and depressive patients after intracoronary stent implantation during May 2011 and May 2013 were treated by tandospirone for 6 weeks. We evaluated the changes of HRV and QT dispersion before and after anti-anxiety-depression treatment. ResultsAfter six weeks of treatment, the HRV was increased obviously (P<0.05) and the QT dispersion was decreased significantly (P<0.01). ConclusionThe new anti-anxiety-depression drug tandospirone is effective on cardiac autonomic nervous system in patients with anxiety and depression after intracoronary stent implantation. And the drug is secure with a low rate of adverse reactions.
Objective To systematically review the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) in the treatment of patients with unprotected left main coronary artery disease (ULMCA). Methods Databases including The Cochrane Library (Issue 2, 2012), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that: comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate (OR=0.45, 95%CI 0.31 to 0.66, Plt;0.000 1), but there was no significant difference between the two groups in reducing the myocardial infarction incidence (OR=1.28, 95%CI 0.47 to 3.48, P=0.63), mortality rate (OR=1.36, 95%CI 0.80 to 2.34, P=0.26), and the incidence of major adverse cardio-cerebral vascular events (OR=0.92, 95%CI 0.66 to 1.28, P=0.61). Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
Currently, transcatheter intervention has emerged as a first-line treatment for coarctation of the aortic. Due to the radiation exposure associated with catheter interventional therapy, there are numerous restrictions, which harms both patients and medical personnel and is dependent on sizable radiation apparatus. Here, we report for the first time a case of echo-guiding percutaneous aortic stent implantation for a 27 years female patient of reproductive age. After discharge, the patient's aortic coarctation pressure decreased to 18 mm Hg, and the surgical results were satisfactory.
Objective To evaluate the clinical efficacy and safety of nicorandil injection for preventing slow-flow/ no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2009), PubMed, MEDLINE, EMbase, CBM, CNKI, VIP, Wanfang database, etc. from their inception to April 2009. Some relevant journals were handsearched as well. Two reviewers independently evaluated the quality of included studies and extracted the data. Meta-analysis was performed by RevMan 5.0 software. Results Seven randomized controlled trials (RCTs) involving 630 patients were included. The results of meta-analyses showed that intracoronary and intravenous nicorandil could reduce the incidence of no-reflow/ low-flow, reduce Corrected TIMI Frame Count (CTFC), and improve left ventricular ejection fraction (LVEF). Intravenous nicorandil could reduce the incidence of ventricular tachycardia/ventricular fibrillation (VT/VF), pericardial effusion, heart failure, but couldn’t reduce the incidence of death and recurrent myocardial infarction (MI) death. Conclusion Evidence shows that intracoronary nicorandil could prevent no-reflow/ slow-flow, reduce CTFC, improve LVEF, and reduce adverse reaction in patients after coronary stent implantation. However, there is a moderate possibility of selection bias, performance bias and publication bias in this review because of the small number of the included studies, which weakens the strength of the evidence of our results. More large sample size, high-quality RCTs are needed.
ObjectiveTo investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation. MethodsWe retrospectively studied the patients performing coronary angiography (CAG) who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data: coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors. ResultsA total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and unconjugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05 or P < 0.01). The serum total bilirubin at baseline and the serum total bilirubin and unconjugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events (P < 0.05 or P < 0.01). The serum unconjugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05). The results of logistic regression analysis showed that multi-vessel coronary artery disease (two-vessel coronary artery disease: OR=10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease: OR=16.047, 95%CI 4.121 to 62.481, P=0.000) and low serum unconjugated bilirubin (OR=0.873, 95%CI 0.773 to 0.987, P=0.03) were independent risk factors of recurrent coronary events. ConclusionMulti-vessel coronary artery disease and low serum unconjugated bilirubin are independent risk factors of recurrent coronary events in patients after coronary artery stent implantation.
ObjectiveTo evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.MethodsThe PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.ResultsA total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).ConclusionCompared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.
Objective To explore the influence of applying the fast-track surgery (FTS) to optimize the process in the perioperative period of cardiac intervention on the rehabilitation of patients with radial artery stenting surgery. Methods A total of 190 patients with radial artery stenting surgery in the Department of Cardiology, West China Hospital from June 2017 to May 2018 were enrolled. They were randomized into a control group (n=95) and a FTS group (n=95) by random umber table. There were 60 males and 35 females aged 35-88 (65.2±9.6) years in the control group as well as 62 males and 33 females aged 34-86 (61.5±11.3) years in the FTS group. Patients in the control group received routine perioperative care, but patients in the FTS group received individual precision interventions by applying the FTS concept to optimize the process of perioperative care, including individual care management before being admitted into hospital, during hospital, and after discharge from hospital. Duration of hospital stay, satisfaction scores, number of comorbidities after surgery, disease self-management ability, and readmission rates were compared between the two groups. Results Compared to the control group, the FTS group had significantly shorter duration of hospital stay, less comorbidities, higher satisfaction scores and disease self-management ability, and lower readmission rate to hospital (P<0.05). Conclusion Applying FTS into the perioperative period of cardiac interventions to optimize its process can help patients recover from radial artery stenting surgery, increase patients’ self-management abilities, shorten duration of hospital stay and decrease comorbidities and cardiac adverse events.