The quality upgrading and deashing of inferior coal by chemical method still faces great challenges.The dangers of strong acid,strong alkali,waste water and exhaust gas as well as high cost limit its industrial produc...The quality upgrading and deashing of inferior coal by chemical method still faces great challenges.The dangers of strong acid,strong alkali,waste water and exhaust gas as well as high cost limit its industrial production.This paper systematically investigates the ash reduction and desilicification of two typical inferior coal utilizing ammonium fluoride roasting method.Under the optimal conditions,for fat coal and gas coal,the deashing rates are 69.02%and 54.13%,and the desilicification rates are 92.64%and 90.27%,respectively.The molar dosage of ammonium fluoride remains consistent for both coals;however,the gas coal,characterized by a lower ash and silica content(less than half that of the fat coal),achieves optimum deashing effect at a reduced time and temperature.The majority of silicon in coal transforms into gaseous ammonium fluorosilicate,subsequently preparing nanoscale amorphous silica with a purity of 99.90%through ammonia precipitation.Most of the fluorine in deashed coal are assigned in inorganic minerals,suggesting the possibility of further fluorine and ash removal via flotation.This research provides a green and facile route to deash inferior coal and produce nano-scale white carbon black simultaneously.展开更多
Lysine content is a criterion of the nutritional quality of rice.Understanding the process of lysine biosynthesis in early-flowering superior grain(SG)and late-flowering inferior grain(IG)of rice would advance breedin...Lysine content is a criterion of the nutritional quality of rice.Understanding the process of lysine biosynthesis in early-flowering superior grain(SG)and late-flowering inferior grain(IG)of rice would advance breeding and cultivation to improve nutritional quality.However,little information is available on differences in lysine anabolism between SG and IG and the underlying mechanism,and whether and how irrigation regimes affect lysine anabolism in these grains.A japonica rice cultivar was grown in the field and two irrigation regimes,continuous flooding(CF)and wetting alternating with partial drying(WAPD),were imposed from heading to the mature stage.Lysine content and activities of key enzymes of lysine biosynthesis,and levels of brassinosteroids(BRs)were lower in the IG than in the SG at the early grainfilling stage but higher at middle and late grain-filling stages.WAPD increased activities of these key enzymes,BR levels,and contents of lysine and total amino acids in IG,but not SG relative to CF.Application of 2,4-epibrassinolide to rice panicles in CF during early grain filling reproduced the effects of WAPD,but neither treatment altered the activities of enzymes responsible for lysine catabolism in either SG or IG.WAPD and elevated BR levels during grain filling increased lysine biosynthesis in IG.Improvement in lysine biosynthesis in rice should focus on IG.展开更多
BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-...BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.展开更多
AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen ca...AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen cases(23 affected eyes)of V-pattern exotropia with inferior oblique muscle overaction(+or++)who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed.The amount of V-pattern,grade of inferior oblique overaction,degree of vertical strabismus,abnormal head posture,and the fovea-disc angle were evaluated before and after surgery.RESULTS:The V-pattern was corrected in all cases,and the amount of V-pattern reduced by 17.85±5.13 prism diopter(PD)on average(t=16.07,P<0.001).The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0%(20/23).The degree of the foveadisc angle has a mean reduction of 5.45°±2.87°(t=3.95,P=0.003)after surgery.The mean vertical deviation in 5 cases with a small-angle hypertropia(5.23±3.06 PD)in the primary position reduced by 3.15±1.86 PD(t=6.10,P<0.001).No serious complications were observed.CONCLUSION:The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern,which is safe and easy to perform.展开更多
Budd-Chiari syndrome(BCS)is a rare condition characterized by hepatic venous outflow obstruction.Balloon angioplasty,with or without stenting,is the recommended first-line treatment modality in Asian countries.As a su...Budd-Chiari syndrome(BCS)is a rare condition characterized by hepatic venous outflow obstruction.Balloon angioplasty,with or without stenting,is the recommended first-line treatment modality in Asian countries.As a supplement to balloon angioplasty,expandable metallic Z-stent deployment can effectively improve long-term inferior vena cava(IVC)patency.Although stent placement is a standard and frequently performed treatment,very few IVC stent-related complications,such as stent fractures,have been reported.Here we present a case series and a comprehensive review of IVC stent fractures in patients with BCS.The most common characteristic of IVC stent fractures is a protrusion of the proximal segment of the IVC stent into the right atrium and its systolic and diastolic movements along with heart rhythms.Accurate stent deployment,large-diameter balloon dilation,patient breath-holding training,preferential selection of a triple stent,and the use of an internal jugular vein approach to stent deployment may ensure precise stent localization and avoid postoperative complications.展开更多
BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually pr...BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon.However,it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze,especially after the unilateral operation.CASE SUMMARY We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP.The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle,the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers.Postoperatively,both hypertropia and floating were improved,and no obvious complications occurred.CONCLUSION In these cases,the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.展开更多
BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irrever...BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.展开更多
Duplicated inferior vena cava with bilateral iliac vein compression is extremely rare.We report a case of an 87-year-old man presented with bilateral lower extremity swelling,who was noted to have duplicated inferior ...Duplicated inferior vena cava with bilateral iliac vein compression is extremely rare.We report a case of an 87-year-old man presented with bilateral lower extremity swelling,who was noted to have duplicated inferior vena cava,as revealed by computed tomography angiography(CTA).This revealed bilateral iliac vein compression caused by surrounding structures.Anticoagulant treatment combined with stent implantation completely alleviated this chronic debilitating condition during the follow-up of 2 months with no recurrence.展开更多
BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmon...BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and ra...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.展开更多
BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of...BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.展开更多
Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right v...Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.展开更多
Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2...Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.展开更多
AIM:To compare the changes in excyclotorsion after inferior oblique(IO)recession in patients with primary and secondary inferior oblique overaction(IOOA).METHODS:We retrospectively analyzed the data obtained from pati...AIM:To compare the changes in excyclotorsion after inferior oblique(IO)recession in patients with primary and secondary inferior oblique overaction(IOOA).METHODS:We retrospectively analyzed the data obtained from patients with IOOA who underwent graded IO recession.The patients were followed up for at least 3 mo after surgery.Fundus photographs were taken preand postoperatively,and the sum of the angles of torsion in both eyes was used to analyze changes in excyclotorsion.Patients were divided into two groups:those diagnosed with primary IOOA were enrolled in the 1’IOOA group,and those diagnosed with secondary IOOA caused by superior oblique palsy(SOP)were enrolled in the 2’IOOA group.Excyclotorsion before and after surgery were compared between the two groups.RESULTS:A total of 78 patients were enrolled in this study:34 eyes in the 1’IOOA group and 44 eyes in the 2’IOOA group.In the 78 patients,torsional angle significantly decreased from 15.31°±7.40°to 12.11°±6.53°after IO recession(P<0.001).Mean preoperative torsional angle was larger in the 2’IOOA group than in the 1’IOOA group(P=0.03).In both groups,excyclotorsion significantly decreased after IO recession(P=0.001 and P<0.001,respectively);however,there was no significant difference in the amounts of changes in excyclotorsion between the two groups.CONCLUSION:Excyclotorsion is significantly larger in secondary IOOA than in primary IOOA,and a significant decrease in the torsional angle occurs after IO recession in both types of IOOA.展开更多
AIM To investigate the vascular anatomy of inferior mesenteric artery(IMA) in laparoscopic radical resection with the preservation of left colic artery(LCA) for rectal cancer. METHODS A total of 110 patients with rect...AIM To investigate the vascular anatomy of inferior mesenteric artery(IMA) in laparoscopic radical resection with the preservation of left colic artery(LCA) for rectal cancer. METHODS A total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3 D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery(SA) andsuperior rectal artery(SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein(IMV) and LCA was also evaluated.RESULTS Three vascular types were identified in this study. In type A, LCA arose independently from IMA(46.4%, n = 51); in type B, LCA and SA branched from a common trunk of the IMA(23.6%, n = 26); and in type C, LCA, SA, and SRA branched at the same location(30.0%, n = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases. CONCLUSION The vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.展开更多
BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate....BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS: We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS: Type Ⅰ IVCTT (10 patients) was posterior to the liver and below the diaphragm; type Ⅱ IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type Ⅲ IVCTT (1 patient) was above the diaphragm and in the right atrium. Type Ⅰ was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type Ⅱ was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type Ⅲ was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1-and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION: Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.展开更多
The changes in activities of key enzymes involved in sucrose-to-starch conversion and concentrations of hormones in superior and inferior spikelets of super rice were investigated and their association with grain fill...The changes in activities of key enzymes involved in sucrose-to-starch conversion and concentrations of hormones in superior and inferior spikelets of super rice were investigated and their association with grain filling was analyzed.Four super rice cultivars,Liangyoupeijiu,IIyou 084,Huaidao 9 and Wujing 15,and two high-yielding and elite check cultivars,Shanyou 63 and Yangfujing 8,were used.The activities of sucrose synthase (SuSase),adenosine diphosphoglucose pyrophosphorylase (AGPase),starch synthase (StSase) and starch branching enzyme (SBE),and the concentrations of zeatin + zeatin riboside (Z + ZR),indole-3-acetic acid (IAA) and abscisic acid (ABA) in superior and inferior spikelets were determined during the grain filling period and their relationships with grain filling rate were analyzed.Maximum grain filling rate,the time reaching the maximum grain-filling rate,mean grain filling rate and brown rice weight for superior spikelets showed a slight difference between the super and check rice cultivars,but were significantly lower in the super rice than in the check rice for inferior spikelets.Changes of enzyme activities and hormone concentrations in grains exhibited single peak curves during the grain filling period.The peak values and the mean activities of SuSase,AGPase,StSase and SBE were lower in inferior spikelets than in superior ones,as well as the peak values and the mean concentrations of Z + ZR and IAA.However,the peak value and the mean concentration of ABA were significantly higher in inferior spikelets than in superior ones and greater in the super rice than in the check rice.The grain filling rate was positively and significantly correlated with the activities of SuSase,AGPase and StSase and the concentrations of Z + ZR and IAA.The results suggested that the low activities of SuSase,AGPase and StSase and the low concentrations of Z + ZR and IAA might be important physiological reasons for the slow grain filling rate and light grain weight of inferior spikelets in super rice.展开更多
BACKGROUND: Hepatobiliary cystadenocarcinoma represents a rare epithelial malignant tumor derived from the intrahepatic bile duct. METHODS: A 71-year-old woman, who had undergone laparoscopic drainage of a cystic lesi...BACKGROUND: Hepatobiliary cystadenocarcinoma represents a rare epithelial malignant tumor derived from the intrahepatic bile duct. METHODS: A 71-year-old woman, who had undergone laparoscopic drainage of a cystic lesion of the right hepatic lobe, was misdiagnosed as having hepatic echinococcal disease, and received intracystic infusion of 95% ethanol four years ago. She was admitted to our hospital for further treatment. RESULTS: Physical examination revealed dilated superficial veins across the right abdominal wall. After mapping the direction of blood flow in these vessels, we assumed that this was a sign of inferior vena cava obstruction. Abdominal ultrasound, computed tomography, magnetic resonance imaging combined with magnetic resonance angiography showed a large cystic mass in the right upper quadrant and epigastrium, displacing the adjacent structures, adherent to the inferior vena cava, which was not patent, resulting in dilation of superficial epigastric veins. The patient underwent an exploratory laparotomy. Total excision of the huge mass measuring 16×15 cm was possible under selective vascular exclusion of the liver. Removal of the tumor resulted in immediate restoration of flow in the inferior vena cava. On the basis of the pathology and findings of immunohistochemical analysis, a hepatobiliary cystadenocarcinoma was diagnosed.CONCLUSIONS: In the present case, hepatobiliary cystadenocar-cinoma was accompanied by dilated superficial venous collaterals due to inferior vena cava obstruction. Selective vascular exclusion of the liver allowed a safe oncological resection of the tumor.展开更多
AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (P...AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (PVR).METHODS: A retrospective, consecutive and case series study of 40 patients with inferior break RD and PVR≥C1 was conducted. All patients underwent a standard 3-port 20-gauge pars plana vitrectomy (PPV) with gas or silicone oil tamponade without supplementary scleral buckling. The vitreous and all proliferative membrane were completely removed, and retinectomy was performed when necessary. The mean follow-up was 12.5 months. The primary and final anatomic success rate, visual acuity and complications were recorded and analyzed. RESULTS: Primary anatomic success rate was achieved in 35 of 40 eyes (87.5%) and the final anatomic success rate was 100%. The most common cause of redetachment was recurrent PVR. The best-corrected visual acuity (BCVA) at final follow-up was improved in 34 eyes (85%), remained stable in 1 eye (2.5%), and worsened in 5 eyes (12.5%). The mean visual acuity at final follow-up was improved significantly (P=0.000).CONCLUSION: This retrospective study provides evidence that vitrectomy without scleral buckling seemed to be an effective treatment for inferior break RD with PVR. With complete removal of vitreous and proliferative membranes and timing of retinectomy, the inferior breaks which complicated with PVR could be closed successfully without additional scleral buckling.展开更多
BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic...BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic veins (IRHVs) is thicker than that of short hepatic veins or more than 1 cm occasionally. Adults have a higher incidence rate of the IRHV. DATA SOURCES: A literature search of the PubMed database was conducted and research articles were reviewed. RESULTS: The size of IRHVs is related to the size of the right hepatic vein, i.e. the larger the diameter of the right hepatic vein, the smaller the diameter of the IRHVs, and vice versa. The IRHVs are divided into superior, medial and inferior groups, separately named the superior, medial and inferior right hepatic veins according to the position of the IRHV entering the inferior vena cava. The superior right hepatic vein mainly drains the superior part of segment Ⅶ, and the medial right hepatic vein drains the middle part of segment Ⅶ. A thicker IRHV mainly drains segment Ⅵ and the inferior part of segment Ⅶ and a thinner IRHV drains the inferior part of segment Ⅴ. CONCLUSIONS: The clinical significance of these studies on IRHVs is varied: (1) Hepatic caudate lobe resection could be introduced after study on the veins of that lobe. (2) It is very important to identify the draining region of the IRHV for guiding hepatic segmentectomy. The postero-inferior area of the right lobe can be preserved along with the hypertrophic IRHV even if the entire main right hepatic vein is resected during segmentectomy of Ⅶ and Ⅷ with right hepatic vein resection for patients with primary liver cancer. (3) The ligation of the major hepatic vein for the treatment of juxtahepatic vein injury is recommended because of severe hemorrhagic shock and difficulty in exposure. (4) It is very helpful to decide therapeutic modalities for Budd-Chiari syndrome.展开更多
文摘The quality upgrading and deashing of inferior coal by chemical method still faces great challenges.The dangers of strong acid,strong alkali,waste water and exhaust gas as well as high cost limit its industrial production.This paper systematically investigates the ash reduction and desilicification of two typical inferior coal utilizing ammonium fluoride roasting method.Under the optimal conditions,for fat coal and gas coal,the deashing rates are 69.02%and 54.13%,and the desilicification rates are 92.64%and 90.27%,respectively.The molar dosage of ammonium fluoride remains consistent for both coals;however,the gas coal,characterized by a lower ash and silica content(less than half that of the fat coal),achieves optimum deashing effect at a reduced time and temperature.The majority of silicon in coal transforms into gaseous ammonium fluorosilicate,subsequently preparing nanoscale amorphous silica with a purity of 99.90%through ammonia precipitation.Most of the fluorine in deashed coal are assigned in inorganic minerals,suggesting the possibility of further fluorine and ash removal via flotation.This research provides a green and facile route to deash inferior coal and produce nano-scale white carbon black simultaneously.
基金This work was supported by the National Natural Science Foundation of China(32071943,32272198).
文摘Lysine content is a criterion of the nutritional quality of rice.Understanding the process of lysine biosynthesis in early-flowering superior grain(SG)and late-flowering inferior grain(IG)of rice would advance breeding and cultivation to improve nutritional quality.However,little information is available on differences in lysine anabolism between SG and IG and the underlying mechanism,and whether and how irrigation regimes affect lysine anabolism in these grains.A japonica rice cultivar was grown in the field and two irrigation regimes,continuous flooding(CF)and wetting alternating with partial drying(WAPD),were imposed from heading to the mature stage.Lysine content and activities of key enzymes of lysine biosynthesis,and levels of brassinosteroids(BRs)were lower in the IG than in the SG at the early grainfilling stage but higher at middle and late grain-filling stages.WAPD increased activities of these key enzymes,BR levels,and contents of lysine and total amino acids in IG,but not SG relative to CF.Application of 2,4-epibrassinolide to rice panicles in CF during early grain filling reproduced the effects of WAPD,but neither treatment altered the activities of enzymes responsible for lysine catabolism in either SG or IG.WAPD and elevated BR levels during grain filling increased lysine biosynthesis in IG.Improvement in lysine biosynthesis in rice should focus on IG.
基金Supported by The Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT),No.RS-2023-00220408.
文摘BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.
文摘AIM:To investigate the effectiveness of a modified inferior oblique muscle belly transposition for treatment of V-pattern exotropia combined with mild to moderate inferior oblique muscle overaction.METHODS:Thirteen cases(23 affected eyes)of V-pattern exotropia with inferior oblique muscle overaction(+or++)who underwent the modified inferior oblique muscle belly transposition procedure were retrospectively reviewed.The amount of V-pattern,grade of inferior oblique overaction,degree of vertical strabismus,abnormal head posture,and the fovea-disc angle were evaluated before and after surgery.RESULTS:The V-pattern was corrected in all cases,and the amount of V-pattern reduced by 17.85±5.13 prism diopter(PD)on average(t=16.07,P<0.001).The surgical cure rate for mild to moderate inferior oblique muscle overaction was 87.0%(20/23).The degree of the foveadisc angle has a mean reduction of 5.45°±2.87°(t=3.95,P=0.003)after surgery.The mean vertical deviation in 5 cases with a small-angle hypertropia(5.23±3.06 PD)in the primary position reduced by 3.15±1.86 PD(t=6.10,P<0.001).No serious complications were observed.CONCLUSION:The modified inferior oblique muscle belly transposition procedure can effectively treat mild to moderate inferior oblique overaction and relieve the V-pattern,which is safe and easy to perform.
文摘Budd-Chiari syndrome(BCS)is a rare condition characterized by hepatic venous outflow obstruction.Balloon angioplasty,with or without stenting,is the recommended first-line treatment modality in Asian countries.As a supplement to balloon angioplasty,expandable metallic Z-stent deployment can effectively improve long-term inferior vena cava(IVC)patency.Although stent placement is a standard and frequently performed treatment,very few IVC stent-related complications,such as stent fractures,have been reported.Here we present a case series and a comprehensive review of IVC stent fractures in patients with BCS.The most common characteristic of IVC stent fractures is a protrusion of the proximal segment of the IVC stent into the right atrium and its systolic and diastolic movements along with heart rhythms.Accurate stent deployment,large-diameter balloon dilation,patient breath-holding training,preferential selection of a triple stent,and the use of an internal jugular vein approach to stent deployment may ensure precise stent localization and avoid postoperative complications.
基金Supported by The Natural Science Foundation of Shandong Province,No.ZR2018BH013The China Postdoctoral Science Foundation,No.2017M612214.
文摘BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon.However,it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze,especially after the unilateral operation.CASE SUMMARY We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP.The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle,the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers.Postoperatively,both hypertropia and floating were improved,and no obvious complications occurred.CONCLUSION In these cases,the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.
文摘BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
文摘Duplicated inferior vena cava with bilateral iliac vein compression is extremely rare.We report a case of an 87-year-old man presented with bilateral lower extremity swelling,who was noted to have duplicated inferior vena cava,as revealed by computed tomography angiography(CTA).This revealed bilateral iliac vein compression caused by surrounding structures.Anticoagulant treatment combined with stent implantation completely alleviated this chronic debilitating condition during the follow-up of 2 months with no recurrence.
基金the National Natural Science Foundation of China,No.81701888Science-Technology Support Plan Projects of Sichuan Province,No.2019YFS0239 and No.2023YFS0206.
文摘BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.
基金Supported by Key Laboratory Opening Topic Fund Subsidization:The Regulation of Sympathetic Nerve in Liver Regeneration in Hepatic Alveolar Echinococcosis,No.2021D04024.
文摘BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.
文摘Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.
文摘Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.
文摘AIM:To compare the changes in excyclotorsion after inferior oblique(IO)recession in patients with primary and secondary inferior oblique overaction(IOOA).METHODS:We retrospectively analyzed the data obtained from patients with IOOA who underwent graded IO recession.The patients were followed up for at least 3 mo after surgery.Fundus photographs were taken preand postoperatively,and the sum of the angles of torsion in both eyes was used to analyze changes in excyclotorsion.Patients were divided into two groups:those diagnosed with primary IOOA were enrolled in the 1’IOOA group,and those diagnosed with secondary IOOA caused by superior oblique palsy(SOP)were enrolled in the 2’IOOA group.Excyclotorsion before and after surgery were compared between the two groups.RESULTS:A total of 78 patients were enrolled in this study:34 eyes in the 1’IOOA group and 44 eyes in the 2’IOOA group.In the 78 patients,torsional angle significantly decreased from 15.31°±7.40°to 12.11°±6.53°after IO recession(P<0.001).Mean preoperative torsional angle was larger in the 2’IOOA group than in the 1’IOOA group(P=0.03).In both groups,excyclotorsion significantly decreased after IO recession(P=0.001 and P<0.001,respectively);however,there was no significant difference in the amounts of changes in excyclotorsion between the two groups.CONCLUSION:Excyclotorsion is significantly larger in secondary IOOA than in primary IOOA,and a significant decrease in the torsional angle occurs after IO recession in both types of IOOA.
基金Supported by the National Natural Science Foundation of China,No.81471020Shandong Medical and Health Technology Development Project,No.2014WS0148+1 种基金Qilu Hospital of Shandong University Scientific Research Funding,No.2015QLMS32Shandong University Basic Scientific Research Funding(Qilu Hospital Clinical Research Project),No.2014QLKY21
文摘AIM To investigate the vascular anatomy of inferior mesenteric artery(IMA) in laparoscopic radical resection with the preservation of left colic artery(LCA) for rectal cancer. METHODS A total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3 D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery(SA) andsuperior rectal artery(SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein(IMV) and LCA was also evaluated.RESULTS Three vascular types were identified in this study. In type A, LCA arose independently from IMA(46.4%, n = 51); in type B, LCA and SA branched from a common trunk of the IMA(23.6%, n = 26); and in type C, LCA, SA, and SRA branched at the same location(30.0%, n = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases. CONCLUSION The vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.
基金supported by a grant from the Chinese Key Project for Infectious Diseases (2008ZX10002-025)
文摘BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS: We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS: Type Ⅰ IVCTT (10 patients) was posterior to the liver and below the diaphragm; type Ⅱ IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type Ⅲ IVCTT (1 patient) was above the diaphragm and in the right atrium. Type Ⅰ was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type Ⅱ was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type Ⅲ was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1-and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION: Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.
基金supported by the grants from the National Natural Science Foundation of China(NSFC-IRRI Joint Research Project 31061140457)General Project (Grant Nos. 31071360 and 31271641)+2 种基金the National Basic Research Program (Grant No.2009CB118603)the National Key Technology Support Program of China (Grant Nos. 2011BAD16B14 and 2012BAD04B08)the Basic Scientific Research Special Operation Cost of the Central Research Institutions in 2011 (Grant No. 201103003)
文摘The changes in activities of key enzymes involved in sucrose-to-starch conversion and concentrations of hormones in superior and inferior spikelets of super rice were investigated and their association with grain filling was analyzed.Four super rice cultivars,Liangyoupeijiu,IIyou 084,Huaidao 9 and Wujing 15,and two high-yielding and elite check cultivars,Shanyou 63 and Yangfujing 8,were used.The activities of sucrose synthase (SuSase),adenosine diphosphoglucose pyrophosphorylase (AGPase),starch synthase (StSase) and starch branching enzyme (SBE),and the concentrations of zeatin + zeatin riboside (Z + ZR),indole-3-acetic acid (IAA) and abscisic acid (ABA) in superior and inferior spikelets were determined during the grain filling period and their relationships with grain filling rate were analyzed.Maximum grain filling rate,the time reaching the maximum grain-filling rate,mean grain filling rate and brown rice weight for superior spikelets showed a slight difference between the super and check rice cultivars,but were significantly lower in the super rice than in the check rice for inferior spikelets.Changes of enzyme activities and hormone concentrations in grains exhibited single peak curves during the grain filling period.The peak values and the mean activities of SuSase,AGPase,StSase and SBE were lower in inferior spikelets than in superior ones,as well as the peak values and the mean concentrations of Z + ZR and IAA.However,the peak value and the mean concentration of ABA were significantly higher in inferior spikelets than in superior ones and greater in the super rice than in the check rice.The grain filling rate was positively and significantly correlated with the activities of SuSase,AGPase and StSase and the concentrations of Z + ZR and IAA.The results suggested that the low activities of SuSase,AGPase and StSase and the low concentrations of Z + ZR and IAA might be important physiological reasons for the slow grain filling rate and light grain weight of inferior spikelets in super rice.
文摘BACKGROUND: Hepatobiliary cystadenocarcinoma represents a rare epithelial malignant tumor derived from the intrahepatic bile duct. METHODS: A 71-year-old woman, who had undergone laparoscopic drainage of a cystic lesion of the right hepatic lobe, was misdiagnosed as having hepatic echinococcal disease, and received intracystic infusion of 95% ethanol four years ago. She was admitted to our hospital for further treatment. RESULTS: Physical examination revealed dilated superficial veins across the right abdominal wall. After mapping the direction of blood flow in these vessels, we assumed that this was a sign of inferior vena cava obstruction. Abdominal ultrasound, computed tomography, magnetic resonance imaging combined with magnetic resonance angiography showed a large cystic mass in the right upper quadrant and epigastrium, displacing the adjacent structures, adherent to the inferior vena cava, which was not patent, resulting in dilation of superficial epigastric veins. The patient underwent an exploratory laparotomy. Total excision of the huge mass measuring 16×15 cm was possible under selective vascular exclusion of the liver. Removal of the tumor resulted in immediate restoration of flow in the inferior vena cava. On the basis of the pathology and findings of immunohistochemical analysis, a hepatobiliary cystadenocarcinoma was diagnosed.CONCLUSIONS: In the present case, hepatobiliary cystadenocar-cinoma was accompanied by dilated superficial venous collaterals due to inferior vena cava obstruction. Selective vascular exclusion of the liver allowed a safe oncological resection of the tumor.
基金supported by the Health Bureau of Zhejiang Province, China (No.20100580)
文摘AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (PVR).METHODS: A retrospective, consecutive and case series study of 40 patients with inferior break RD and PVR≥C1 was conducted. All patients underwent a standard 3-port 20-gauge pars plana vitrectomy (PPV) with gas or silicone oil tamponade without supplementary scleral buckling. The vitreous and all proliferative membrane were completely removed, and retinectomy was performed when necessary. The mean follow-up was 12.5 months. The primary and final anatomic success rate, visual acuity and complications were recorded and analyzed. RESULTS: Primary anatomic success rate was achieved in 35 of 40 eyes (87.5%) and the final anatomic success rate was 100%. The most common cause of redetachment was recurrent PVR. The best-corrected visual acuity (BCVA) at final follow-up was improved in 34 eyes (85%), remained stable in 1 eye (2.5%), and worsened in 5 eyes (12.5%). The mean visual acuity at final follow-up was improved significantly (P=0.000).CONCLUSION: This retrospective study provides evidence that vitrectomy without scleral buckling seemed to be an effective treatment for inferior break RD with PVR. With complete removal of vitreous and proliferative membranes and timing of retinectomy, the inferior breaks which complicated with PVR could be closed successfully without additional scleral buckling.
文摘BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic veins (IRHVs) is thicker than that of short hepatic veins or more than 1 cm occasionally. Adults have a higher incidence rate of the IRHV. DATA SOURCES: A literature search of the PubMed database was conducted and research articles were reviewed. RESULTS: The size of IRHVs is related to the size of the right hepatic vein, i.e. the larger the diameter of the right hepatic vein, the smaller the diameter of the IRHVs, and vice versa. The IRHVs are divided into superior, medial and inferior groups, separately named the superior, medial and inferior right hepatic veins according to the position of the IRHV entering the inferior vena cava. The superior right hepatic vein mainly drains the superior part of segment Ⅶ, and the medial right hepatic vein drains the middle part of segment Ⅶ. A thicker IRHV mainly drains segment Ⅵ and the inferior part of segment Ⅶ and a thinner IRHV drains the inferior part of segment Ⅴ. CONCLUSIONS: The clinical significance of these studies on IRHVs is varied: (1) Hepatic caudate lobe resection could be introduced after study on the veins of that lobe. (2) It is very important to identify the draining region of the IRHV for guiding hepatic segmentectomy. The postero-inferior area of the right lobe can be preserved along with the hypertrophic IRHV even if the entire main right hepatic vein is resected during segmentectomy of Ⅶ and Ⅷ with right hepatic vein resection for patients with primary liver cancer. (3) The ligation of the major hepatic vein for the treatment of juxtahepatic vein injury is recommended because of severe hemorrhagic shock and difficulty in exposure. (4) It is very helpful to decide therapeutic modalities for Budd-Chiari syndrome.
