Objective: Peripheral arterial disease (PAD) is a chronic occlusive disease mainly occurred in elderly adults. Arteriosclerosis obliterans (ASO) mainly occurring from small or medium sized arteries of the lower extremities is one of the most common causes of PAD. The gender-related differences of circulating risk factors in diabetic patients with ASO in China remain unknown. The aim of this study is to investigate the gender-related differences in the pattern of several potential risk factors between male and female patients with ASO and type 2 diabetes mellitus (T2D).Design and methods: Clinical profiles and risk factors were analyzed in 323 Chinese patients with ASO and 112 patients were confirmed with T2D. Severities of limb ischemia were staged according to Fontaine classification.Results: The significant inverse correlation was seen between the increased age and hemoglobin. The significant positive correlation was seen between the increased age, urea and creatinine both in the non-diabetic and diabetic male patients. The expression levels of hemoglobin significantly correlate with the classification of Fontaine clinical symptoms in Chinese male patients with T2D/ASO.Conclusion: The study is the first report indicating that the gender-related differences of circulating risk factors are associated with T2D patients with ASO in China. Anemia in Chinese male patients with T2D/ASO may play an important role in peripheral arterial disease progression. (C) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Thromboangiitis obliterans (TAO), also known as Buerger's disease, is segmental non-atherosclerotic inflammatory disease, which affects the small and medium-sized peripheral arteries, veins and nerves of young adult smokers. The paper reports two TAO female patients, 26-year-old and 42-year-old, with prolonged clotting time. We compared 13 male patients and 2 female patients with TAO. The prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) were normal in the male patients, whereas the clotting times were prolonged in the female patients. Coagulation tests including PT, APTT and TT evaluation could be the potential markers to female patients with TAO.

<正>感染性心内膜炎合并下肢动脉栓塞较少见,但下肢动脉栓塞易造成病人截肢或死亡等严重后果。我科自2001年9月至2010年9月收治9例此类病人。报告如下。1资料与方法1.1一般资料本组9例,男4例,女5例。年龄21～67岁,平均37岁,均为单下肢栓塞。

The general characteristics, outcomes and risk factors of the patients with aortic dissection (AD) were evaluated in a single medical center. From January 2002 to December 2008, 284 patients with AD were treated and followed-up at our institution, including 105 cases of type A AD and 179 cases of type B AD. The patients in each type were divided into three groups according to management: medical treatment group (A or B), open surgery group (A or B), and stent-graft group (A or B). The characteristics and follow-up outcomes were compared between the groups or subgroups. The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group, but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group. Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis (HR, 3.807; 95% confidence interval [CI], 1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR, 4.687; 95% CI, 1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR, 3.734; 95% CI, 1.613 to 8.643; P=0.002), pleural effusion (HR, 2.210; 95% CI, 1.080 to 4.521; P=0.030), branch vessel involvement (HR, 2.747; 95% CI, 1.202 to 6.278; P=0.016) and surgical treatment (HR, 0.177; 95% CI, 0.063 to 0.502; P=0.001). And there were insignificant independent predictors for mortality of the patients with type B AD. It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD, but after one year, there was no significant difference in the mortality and complications of them. There were several discordant risk factors of AD, such as female gender, age, thrombus, abrupt onset of pain that were considered as the risk factors in some papers. And there was no definite risk factor of mortality in this study in the patients with type B AD.

<正>腔静脉内肿瘤是指腔静脉外生长的肿瘤沿腔静脉的属支进入到腔静脉内或原发于腔静脉内的肿瘤,沿腔静脉向心脏生长,并占据和填塞腔静脉而出现一系列的临床症状[1]。该疾病临床上少见,本院近年来收治腔静脉内肿瘤患者10例,现将其诊治经验总结如下。

目的 总结颈动脉体瘤诊断、手术治疗以及并发症防治的经验.方法 对我科自1989年2月至2008年2月19年间共收治颈动脉体瘤患者72例(81个)进行回顾性分析.结果 采用血管造影术、彩超以及CTA或MRA明确术前诊断.根据瘤体和颈动脉的关系,81个肿瘤均一期切除,其中行单纯瘤体剥除48例(57个);瘤体连同颈外动脉一同切除5例;瘤体连同部分颈内动脉、颈外动脉,及颈总动脉一并切除后行颈动脉搭桥重建术13例;颈总动脉,颈内动脉吻合2例;颈内动脉结扎术4例.术后15例发生声嘶,8例发生饮水呛咳,经积极治疗后症状消失.3例发生偏瘫,经积极治疗及出院后随访肌力均恢复至两级以上.经5个月至4年随访,8例失访,3例复发,其余无一例手术死亡及其他并发症的发生.结论 术前选择性血管造影、CTA或MRA等检查以明确诊断,应尽早手术治疗,根据肿瘤与颈动脉的关系选择适宜术式.手术中脑神经的保护和减少脑缺血时间是预防术后严重并发症的关键.

Severe diffuse cavernous hemangioma of the lower limb is rarely seen among young people and sometimes can be a fatal challenge for operation. We reported a case of diffuse cavernous hemangioma involving both skin and muscles of the left lower limb and perineal region in an adolescent patient. The patient who had previously undergone a local hemangioma resection of the foot ultimately ended in superficial femoral artery ligation and supergenual thigh amputation of the left upper leg because of uncontrollable massive bleeding of anastomotic stoma.

A referral patient who had previously undergone varicose vein surgery was admitted as an emergency case. On admission, the patient complained of intolerable pain, paralysis and paresthesia of the affected limb, which was characterized by acute arterial ischemia symptoms. Color Doppler of the artery of the affected limb indicated that no blood flow signal existed in the superficial femoral artery. During exploratory operation, we found that the right superficial femoral artery instead of the great saphenous vein of the affected limb had been stripped and ligated. Therefore, the intact right great saphenous vein was taken for auto-transplantation by inverse end-to-end anastomosis to the proximal and distal residual superficial femoral artery, which resulted in gradual recovery. Except for ischemic reperfusion injury, no other post-operative complications occurred after a 10 month follow-up; however, the long-term curative effect needs further observation. Here we report our treatment experience.

Objective To investigate the effect of comprehensive therapy for Cockett syndrome.Methods We retrospectively compared and analyzed the curative effects of comprehensive treatments involving cava filter placement,embolectomy and venous thrombolysis on 7 cases of Cockett syndrome complicated with phlegmasia cerulea dolens(PCD).Results The 7 cases showed classical PCD manifestations with absence of pulsation of dorsalis pedis and posterior tibial arteries,and the diagnosis of Cockett syndrome with associated PCD was confirmed by doppler ultrasound All cases received embolectomy combined with venous thrombolysis,3 underwent cava filter placement,3 underwent Fogarty catheter interruption,and 1 underwent PALMA operation.After operation,the dorsalis pedis artery pulsation was restored,pain and swelling disappeared,and there were no postoperative complications in all the 7 cases.Six months to three years follow-up showed no recurrent thrombosis or other complications occarred.Conclusions Comprehensive therapy with intervention procedure,open operation and thrombolysis for treatment of Cockett syndrome complicated with phlegmasia cerulea dolens is effective and safe,and with high short-term success rate.

患者 女,19岁.因"发现左颈部包块逐渐增大1年余"入院,曾在外院接受过手术探查,因发现包块与颈部血管关系密切而未能切除瘤体,自感偶有眩晕,余未诉其它异常.

Objective To investigate the diagnosis and surgical treatment of intracaval venous tumors. Methods Clinical data of 6 cases were retrospectively analyzed, including signs and symptoms diagnostic means such as type-B ultrasound, CTA, MRA, surgical procedures and prognosis. Results All six cases received type-B ultrasonic examination, final definite diagnosis was achieved by CTA exam in 2 cases and through MRA in 4 cases. Heart involvement was found in 3 cases. All patients underwent a surgery. According to the extent of the tumor,3 cases had thoraco-abdominal incision,3 cases with extracorporeal circulation and right atrium opening. All of the tumors were completely resected. Pathological exam revealed that 4 cases were of leiomyomatosis and 2 cases were of leiomyosarcoma. One case with leiomyosarcoma died of liver disfunction postoperatively.The other 5 cases recovered without major complications. An average 51 months of follow-up found no recurrence. Conclusions CT and MRI are the mainstay for the diagnosis,and MRI can provide clear anatomy image to the surgeons, help choose the surgical procedures. The one-stage operation is effective. During the operation, the main branches of the vena cava system should be detected, and the attachment of the tumor should be found and removed thoroughly to prevent the recurrence of the tumor. When the attachment point is lower than the iliac vein level, ligation of the involved iliac vein should be mandatory. Key words: Leiomyoma; Leiomyosarcoma;  Venae cavae; Diagnosis;  Sargical procedures,operative

Objective To evaluate the effect of surgical treatment to Takayasu’s arteritis with severe cerebral ischemia.Methods Arterial bypass with prosthesis-graft was carried out in 15 cases: ascending aorta-bilateral axillar arteries and unilateral ICA bypass in 6 cases,ascending aorta -bilateral axillar arteries bypass in 3 cases,ascending aorta-unilateral axillar arteries and unilateral ICA bypass in 5 cases,and in one case of complicated TA combined with abdominal aorta,ascending aorta-bilateral axillar arteries and unilateral ICA bypass were performed,followed by unilateral axilla-femeral bypass.Results All the cases treated with above-mentioned methods had obviously released the symptoms of severe cerebral ischemia caused by TA.None of the 15 cases was dead after operation.After follow-up for 3～50 months,there was no recurrence of the cerebral ischemia.Conclusion If patients with TA suffered severe cerebral ischemia,without efficacy by treatment of hydrocortisone in active phase,or in the inactive phase,arterial bypass with prosthesis-graft is strongly recommended.The result of the methods is definitive and effective,and it can save the life of the patients and avoid blindness and hemiplegia.The long-term effect is positive,and combined with medical treatment,it can reach the result of complete heal from TA.

The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells（HVECs） was investigated.HVECs from one case of hemangioma in proliferative phase were cultured.Both primary culture and sub-culture were conducted in M199 medium.The HVECs of passage 3 were divided into 4 groups based on the concentrations of anti-KDR antibody.Cell count was performed and inhibitory rate of HVECs was measured before and 9 days after interference.The results showed that the number of HVECs in the anti-KDR antibody-treated groups was significantly decreased and the inhibitory rate of HVECs by anti-KDR antibody（50,10 and 2 μg/mL） was 84%,63% and 39% respectively at 9th day after interference,with the difference being significant.In the control group,the number of HVECs was increased significantly.In was concluded that the anti-KDR antibody could suppress the activity of VEGF through blocking the KDR,indicating the potential clinical applications of anti-KDR antibody in the treatment of hemangioma.

目的分析下肢缺血再灌注引起再次损伤的可能机制以及他汀类药物的保护作用。方法实验大鼠分为三组:假手术组、缺血再灌注组、佛伐他汀干预组。测定各组各时间段血浆CK、LDH、NOS、NO、SOD的活性,并观察腓肠肌的显微结构和肌肉的干/湿重比值。结果再灌注4小时后,缺血再灌注组大鼠血浆中CK、LDH较缺血2小时末进一步升高,SOD、NOS、NO有所下降,而使用佛伐他汀可以降低血浆CK、LDH的值,并在一定程度上保护SOD、NOS、NO的活性,同时肌肉的显微结构也较缺血再灌注组有所改善。肌肉的水肿比缺血再灌注组减轻。结论短期佛伐他汀预处理可以对下肢缺血再灌注损伤起保护作用,其机制可能与提高NO的活性有关。