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简介：AbstractCommon or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture. Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma following fall from motorbike. There was no immediate circulatory compromise. Contrasted CT of abdomen revealed an associated left lower abdominal wall traumatic hernia. The iliac artery was intervened with an endovascular stent to restore luminal flow and the hernia was repaired electively. The entire clinical course and management dilemma are described in this article.

简介：客观：在旧王牌上与骨膜调查免费的肠骨的冠接枝的治疗学的有效性平坦缺点。方法：从1996年2月到2005年6月，9patients与骨膜与免费的肠骨的冠接枝被对待重建旧acetabulardefects。有7男性和2女性，平均年龄是41。3年。acetabulardefects被交通事故在3种情况中在6种情况和秋天损害中引起。处理的从损害的时间是4-13月并且平均8个月。Intraoperatively，我们第一移开以后的墙的theacetabular破裂碎片。大腿骨的头当时是reducted。骨头接枝与骨膜从肠骨的冠被收获，它与骨钳被雕刻遵循缺点。凹面(肠骨的窝)接枝的方面被放向大腿骨的头。Thegraft被二～三个腿螺丝钉安全地修理。结果：手术后的症候群没在任何盒子中被发现。哈里斯“20个系统证明分数从32涨了。3pointspreoperatively手术后地指向81。新潮的功能在3种情况中作为优秀被评估，在在2种情况中的4种情况和交易会中好。结论：尽管这个过程不能确切复制新潮的关节的解剖，它启用恢复以后的稳定性，为新潮的关节的providebone股票并且阻止大腿骨的头的脱臼。

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简介：Massivehemoptysisisoneofthemostdreadedofallrespiratoryemergenciesandcanhaveavarietyofunderlyingcauses.Itismostlycausedbybleedingfrombronchialcirculation.Bronchialarteryembolizationisnowconsideredtobethetreatmentofchoiceforacutemassivehemoptysis.Bronchialarteryembolization(BAE)isasafeandeffectivenonsurgicaltreatmentforpatientswithmassivehemoptysis.However,nonbronchialsystemicarteriescanbeasignificantsourceofmassivehemoptysisandacauseofrecurrenceaftersuccessfulBAE.Soknowledgeofthebronchialarteryanatomy,togetherwithanunderstandingofthepathophysiologicfeaturesofmassivehemoptysis,areessentialforplanningandperformingBAEinaffectedpatients.Inaddition,interventionalradiologistsshouldbefamiliarwiththetechniques,results,efficacy,safetyandpossiblecomplicationsofBAEandwiththecharacteristicsofthevariousembolicagents.Bronchialarterialcatheterisationinhumanviaapercutaneousapproachhasbeenpracticedfor32years(1973)intheworldand20years(1986)inChina,initiallyfordirectchemotherapytreatmentforbronchialmalignanciesandthenfortheembolizationofpatientswithmassivehaemoptysis.Areviewofclinicalexperiencetoevaluatetechnique,embolicmaterials,outcomeandcomplicationsofBAEispresented.

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简介：DearEditor,Wearewritingthislettertoreportanunexpectedrarecaseofcentralretinalarteryocclusion(CRAO)happenedafterstent-assistedcoilingforinternalcarotidartery(ICA)aneurysminafemalepatient.CRAOisadevastatingocularemergencywithpoorvisualprognosisandnouniversalacceptedtreatmentatpresent.CRAOisusuallyassociatedwitharterialhypertension,diabetesmellitus,renaldisease.

简介：IntroductionandPatientDescription,Assessmentofpatientswithanginapectorisisachallengefortheclinicalcardiologist.Myocardialischemiaandanginapectoriscanbecausedbyvariousmechanisms,suchascoronaryatherosclerosis,vasospasm,orcoronarymicrovasculardysfunction[1].Moreover,thesemechanismsmayoverlapinagivenpatient,makingitdifficulttodeterminethecauseofangina.Wereportherethecaseofa57-year-oldfemalepatientwithahistoryofanginapectoristhatstarted3monthspreviously.Hersymptomsoccurredpredominantlyatrestbutalsowitheffort.Thepatientwasanactivesmokerwhosmokedabout15cigarettesperday(~20packyears).Moreover,shehadhypertensiontreatedwithenalapril.HerLDLlevelwas75mg/dlwithoutanycholesterol-loweringtherapy.Shewassentfordiagnosticcoronaryangiographyforsuspectedstenosingcoronaryarterydisease.

简介：AbstractPurpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury. CT has been applied for several decades to evaluate blunt pelvic trauma patients. However, it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury (HVI), especially in the early stage after injury. The delayed diagnosis of HVI could result in a high morbidity and mortality. The bowel injury prediction score (BIPS) applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary. We recently found another clinical variable (iliac ecchymosis, IE) which appeared at the early stage of injury, could be predicted for HVI. The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI, and thus reduce complications and mortalities.Methods:We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital. The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention. The exclusion criteria were abdominal CT insufficiency before operation, abdominal surgery before CT scan, and CT mesenteric injury grade being 5. The MBIPS was defined as BIPS plus IE, which was calculated according to 4 variables: white blood cell counts of 17.0 or greater, abdominal tenderness, CT scan grade for mesenteric injury of 4 or higher, and the location of IE. Each clinical variable counted 1 score, totally 4 scores. The location and severity of IE was also noted.Results:In total, 635 cases were hospitalized and 62 patients were enrolled in this study. Of these included patients, 77.4% (40 males and 8 females) were operated by exploratory laparotomy and 22.6% (8 males and 6 females) were treated conservatively. In the 48 patients underwent surgical intervention, 46 were confirmed with HVI (45 with IE and 1 without IE). In 46 patients confirmed without HVI, only 3 patients had IE and the rest had no IE. The sensitivity and specificity of IE in predicting HVI was calculated as 97.8% (45/46) and 81.3% (13/16), respectively. The median MBIPS score for surgery group was 2, while 0 for the conservative treatment group. The incidence of HVI in patients with MBIPS score ≥ 2 was significantly higher than that in patients with MBIPS score less than ≤ 2 (OR = 17.3, p < 0.001).Conclusion:IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity, which is a valuable sign for HVI in blunt pelvic trauma patients. MBIPS can be used to predict HVI in blunt pelvic trauma patients. When the MBIPS score is ≥ 2, HVI is strongly suggested.

简介：Thescopeofinterventionalcardiologyhasrapidlyexpandedoverthelastseveraldecades.Inafieldwhereproceduraltreatmentoptionsforavarietyofcomplexcardiovascularconditionshavegrownexponentially,theimportanceofproceduralsafetycontinuestocometotheforefront.Thisismostevidentinthemovementtowardradialaccessastheinitialapproachforoperatorsinthecardiaccatheterizationlaboratory.Astheevidencegrowsforthesuperiorityofradialaccessoverfemoralaccesswithregardtoreducingbleedingeventsandimprovingclinicaloutcomes,wediscussthemodernapproachtoobtainingaccess,andhighlightbestpractices.

简介：Thispaperpresentsthedevelopmentofthebloodflowsimulationintwodimensionsovertherealgeometryofthefemoralartery.TheNavier-Stokesequationsaresolvedusingthefiniteelementmethod,toobtainthedistributionsofthebloodpressureandflowvelocityinmultipleinstantsoftimeanddifferentplacesofthefemoralarteryandthusdeterminethecurrentconditionofthebloodvessels.Thevelocityfieldshowsalaminarbehavior,where,thevelocityishigherinthecenterofthearteryanddecreasesasthebloodflowapproachesarterywalls.Inspiteofallarteryandbloodflowpropertiesnotbeingconsidered,thevaluesofpressureandvelocityobtainedarewithinthenormalranges.Finallythemodelisusedtoverifyifthereexistirregularitiesinthebloodflowinbothhealthysubjectsandsickpatients.

简介：Surgicaloptionsdevelopedtotreatcarotidarterystenosishaveevolvedinthelastsixdecades,andstudieshaveshownthesuperiorityofcarotidendarterectomy(CEA)comparedtomedicaltherapy.Similarly,asendovasculartherapyhasevolvedoverthelasttwodecades,studiesreflectingsafety,feasibility,andequivalenceofcarotidarterystenting(CAS)toCEAhavebeenreplicatedinseveralstudiesforintermediatetohighsurgicalriskpatients.However,sinceitsinception,thefieldofCAShasbeenmiredinseveralcontroversiesandhasbeensubjecttointensescrutinyfrommultiplestakeholderswithinthefieldofmedicine.ThisreviewdiscussesspecificissuesconcerningCASthatarerelevantinthecurrentera.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

简介：BackgroundAnomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery(ALCAPA)isararecongenitalanomaly.Itdemonstratedthecombinedeffectsoftheabsenceofanormalcoronaryflowwithacoronarystealandtheprofoundischemiathatcanproduceleftventriculardysfunctionandmitralregurgitation.Wehereintroducethepostoperativemanagementofpatientswithrepairofanomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery,withanemphasisonitsoutcome.MethodsRecordsof31patientswithanomalousoriginoftheleftcoronaryarteryfromthepulmonaryarteryreceivingsurgeryfrom1998to2010werereviewedretrospectively,10ofwhichweretreatedwiththemitralvalvesurgicallyatthesametime.Theageofpatientswas4monthsto16years(median,1year)andweightofthosewas5to53kilograms(median,7.8kilograms),allofwhichwerediagnosedofanomalousoriginoftheleftcoronaryarteryfromthepulmonarybyechocardiographyandcardiaccatheterization.Aftersurgery,electrocardiogram,echocardiography,arterialbloodpressure,transcutaneousoxygensaturationandcentralvenouspressureweremonitored.Commonpostoperativecomplicationsinourgroupwereanalysed.Andpreoperativeandpostoperativedataincludingareaofmitralregurgitation,leftventricularsystolicdiameterandleftventriculardistolicdiameterwereobtained.Cardiopulmonarybypasstimeandmechanicalventilationtimeofpostoperativepatientswithnopneumoniawerecomparedwiththosewithpneumonia.Binarylogisticregressionwasappliedfortheanalysisoftheriskfactorsofpostoperativepneumonia.ResultsOf31patients,30survivedaftersurgerywithearlymortalityof3.23%.Onepatientdiedofseverelowcardiacoutputsyndrome.Mechanicalventilationtimewas4hoursto168hourshours(mean,39.68±50.52hours;median,18hours).ICUstaywas16hoursto425hours(mean,111.65±127.03hours;median,44hours).Inourgroup,commonpostoperativecomplicationsweremyocardialischemia(n=12,36.4%),infection(n=

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简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

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