Objective: Vascular injuries usually present immediately after the penetration, but the delayed onset of vascular symptoms caused by vessel dissection or aneurysm after a traumatic event is extremely rare. Vertebral a...Objective: Vascular injuries usually present immediately after the penetration, but the delayed onset of vascular symptoms caused by vessel dissection or aneurysm after a traumatic event is extremely rare. Vertebral artery injury is a low-frequency but high-mortality injury. We aim to report evidence of delayed onset of vascular symptoms following penetrating trauma in the neck. Materials and Methods: A case report. Results: A 19-year-old boy was referred to our hospital and complained of a mass in the right part of his neck (right mandibular angle). He gave a history of penetrating trauma to his neck 2 months ago. The mass was expanding during these 2 months and doesn’t respond to antibiotic therapy. In the examination, 3 × 3 cm, firm, nonmobile, and without tenderness and pain mass was palpated in the second level of his neck. Doctors ordered a Doppler sonography in the hospital where a yin-yang pattern was reported. A 36 × 43 × 40 mm heterogeneous, solid, and hypodense area close to C1-C2-C3 with vascular flow was discovered in the right submandibular area after computed tomography (CT)-angiography. The patient was referred to an interventional neurologist for angiography and due to the lack of flow at the distal of the V3 segment, he decided to sacrifice this artery by two coils. Conclusion: Penetrating neck injuries are usually asymptomatic, but these injuries are often accompanied by hemorrhage, neurological symptoms, dysphagia, odynophagia, and windpipe. Penetrating lesions of the vertebral artery are rare and very difficult to diagnose. Also, these lesions are challenging for surgeons due to complex anatomy and difficult surgical exposure. So, endovascular treatment was used to treat the patient.展开更多
BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlan...BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.展开更多
Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and dis...Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.展开更多
BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique h...BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.展开更多
The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the...The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the model group and the control group.The rabbits in the model group were injected with sclerosing agent next to transverse process of cervical vertebray,on the contrary,the rabbits in the control group were injected with nothing.Transcranial Doppler(TCD)was used to detect the average speed of blood(Vm),pulsatility index(Pi)and the resistant index(Ri)of the vertebral artery,hematoxylin and eosin(HE)staining was used to observe the morphological changes,and immunohistochemistry was used to detect the expression of α-smooth muscle actin(α-SMA)and matrix metallo-proteinase-2(MMP-2).TCD showed increased Pi,Ri and decreased Vm in the model group(P<0.05)compared with the control group.HE staining revealed hyperplasia and hypertrophied smooth muscle cells in the model group(P<0.05).Immunohistochemistry displayed up-regulation of α-SMA and MMP-2 in the model group(P<0.05).It was concluded that injecting sclerosing agent next to transverse process of cervical vertebra induces remodeling of vertebral artery in rabbits,suggesting it is a practical method to establish CSA animal model.展开更多
Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive t...Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.展开更多
Cervical spondylosis of vertebral artery type is one of the chief patterns of cervical spondylosis.It is often described as neck pain accompanied with radiating pain and neurologic symptoms,such as sudden dizziness,bl...Cervical spondylosis of vertebral artery type is one of the chief patterns of cervical spondylosis.It is often described as neck pain accompanied with radiating pain and neurologic symptoms,such as sudden dizziness,blurred vision,tinnitus,nausea,vomiting,memory loss,and sudden fainting.The incidence of cervical spondylosis increases and patients with cervical spondylosis become progressively younger.Acupuncture in the cervical spondylosis of vertebral artery type treatment has a local positive reaction“Liuhe point”,in order to dredge the local Qi and blood.More and more evidences into the effectiveness and safety of cervical spine acupuncture for cervical spondylosis,specific neck pain,cervical radiculopathy,etc.This article summarizes the recent literature on acupuncture and acupuncture combined with other therapies for cervical spondylosis of vertebral artery type treatment and provides a comprehensive review from the perspectives of acupuncture therapy,warm needle moxibustion therapy,electroacupuncture,and acupuncture combined with other therapies,in order to provide reference and reference for clinical treatment.展开更多
Objective:To investigate the clinical efficacy of acupuncture combined with massage on cervical spondylopathy of vertebral artery type and its effect on hemodynamics of patients.Methods:Sixty patients with vertebral a...Objective:To investigate the clinical efficacy of acupuncture combined with massage on cervical spondylopathy of vertebral artery type and its effect on hemodynamics of patients.Methods:Sixty patients with vertebral artery type cervical spondylosis treated in our hospital from July 2017 to October 2019 were selected as the research subjects and randomly divided into 2 groups of 30 cases each.The control group was treated with acupuncture,and the observation group was treated with acupuncture combined with massage,and the clinical efficacy and hemodynamic index of the two groups were compared after 1 month of treatment[peak systolic blood velocity(PSV),pulsatile index(PI),time mean flow velocity(TMFV)].Results:There was no statistical difference in the PSV,PI,and TMFV between the two groups before treatment(P>0.05).After treatment,the observation group had a higher treatment efficacy than the control group with PSV and TMFV increasing and PI decreasing in both groups,and the change in the observation group was greater than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Acupuncture combined with massage on cervical spondylopathy of vertebral artery type can improve the clinical efficacy and improve the hemodynamic index of patients,which is worthy of clinical application.展开更多
BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high morta...BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high mortality rate,especially in the case of multiple vascular injuries.CASE SUMMARY We report an extremely rare case of successive vertebral artery and subclavian artery pseudoaneurysms caused by swallowing a fishbone in a previously healthy 29-year-old female.She was transferred to the emergency department of our hospital because of hemorrhagic shock due to a vertebral artery pseudoaneurysm.We successfully managed the vertebral artery pseudoaneurysm with endovascular stent implantation and the patient's vital signs as well as hemodynamics once became stable.However,the patient died of the second subclavian artery pseudoaneurysm occurring within a short time,which was thought be related to the obvious displacement of the fishbone in the mediastinum.CONCLUSION Surgery and endovascular stent implantation may be the best choice for treating such complications.Early removal of the fishbone is of great significance in improving the survival of such patients.展开更多
Objective:To investigate the ultrasonographic characteristics of the hemodynamic changes of the contralateral vertebral artery(VA)in patients with different types of subclavian steal syndrome(SSS).Methods:A total of 1...Objective:To investigate the ultrasonographic characteristics of the hemodynamic changes of the contralateral vertebral artery(VA)in patients with different types of subclavian steal syndrome(SSS).Methods:A total of 152 cases of SSS diagnosed by carotid Doppler ultrasonography(CDU)and confirmed by CT angiography(CTA)were enrolled as the study group.The 152 cases of SSS were divided into type Ⅰ(47 cases of occult steal blood),type Ⅱ(60 cases of partial steal blood)and type Ⅲ(45 cases of complete steal blood).Meanwhile,46 cases of cardiovascular and cerebrovascular diseases were excluded from the health examination center as the control group.The diameter and hemodynamic changes of VA in healthy side of patients with different types of steal blood were analyzed and compared with the control group.Results:The hemodynamic parameters of VA on the contralateral side of three types of SSS in the study group were compared with those in the control group,there was no significant difference between type Ⅰ and the control group(P>0.05),and there was significant difference between type Ⅱ and type Ⅲ and the control group(P<0.05);The diameter and hemodynamic parameters of VA increased with the severity of steal blood(P<0.05).Conclusion:CDU examination of VA hemodynamic parameters in healthy side of SSS patients can be used to preliminarily evaluate SA lesions and VA-VA steal pathway.展开更多
Background: The management outcome of a series of ruptured vertebral artery (VA) aneurysms was reviewed. Method: This is a retrospective study of prospectively collected data of 60 cases with ruptured VA aneurysms in ...Background: The management outcome of a series of ruptured vertebral artery (VA) aneurysms was reviewed. Method: This is a retrospective study of prospectively collected data of 60 cases with ruptured VA aneurysms in the author’s database from the year 2004. All cases were managed with coiling, stent-assisted coiling, flow diversion or endovascular parent artery sacrifice. Nimodipine and hypertensive, hypervolemic therapy was applied as standard. Outcome was assessed at 6 months with modified Rankin score (mRS). Results: There were 26 females and 34 males. Age range is 18 to 70 with a mean age of 42. There were 27 dissecting aneurysms and 33 saccular aneurysms. 50 (83%) cases were World Federation of Neurological Surgeons (WFNS) grade one to three. There were four WFNS grade four and six WFNS grade five. 25 cases of dissecting aneurysms were managed with parent artery coil occlusion. Two dissecting aneurysms affecting the dominant VA were treated with flow diverters. At 6 months follow up 50 (83%) achieved good outcome with mRS one to two. There were eight cases with poor outcome and two deaths. Six-month follow-up MR angiogram documented stable occlusion for the 24 cases with dissecting aneurysms treated with parent artery coil occlusion who survived. The two treated with flow diversion demonstrated good remodelling at 6 months on angiography. Six-month follow-up angiogram for the 32 cases of saccular aneurysm who survived documented stable aneurysm obliteration. Conclusion: Good outcome can be achieved with endovascular treatment for ruptured VA aneurysms. Parent artery occlusion is a safe and effective technique for ruptured VA dissecting aneurysm.展开更多
Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circul...Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.展开更多
We encountered a 36-year-old female who developed extracranial vertebral artery dissociation (EVAD), which is a rare condition in Japan. The disease developed with sudden severe right side neck pain and right upper ar...We encountered a 36-year-old female who developed extracranial vertebral artery dissociation (EVAD), which is a rare condition in Japan. The disease developed with sudden severe right side neck pain and right upper arm pain. No abnormality was observed in the spinal canal, intervertebral discs, spinal cord, or nerve roots on MRI of the cervical spine, but dilation and double lumen were noted in the vertebral artery (VA) at the C4/5 level. The presence of aneurysm was confirmed by VA angiography, and EVAD was diagnosed. The symptoms were resolved by conservative treatment of pain, and the aneurysm shrank and disappeared with time on VA angiography. Even though neck and upper limb pain are the only clinical symptom and there is no brain dysfunction, such as disturbance of consciousness and vertigo, when symptoms develop acutely, this pathology should be included in differential diagnosis and orthopedists should carefully observe the vertebral artery, as well as the spinal canal, in evaluating cervical MRI.展开更多
Objective:To investigate the correlation between severe stenosis or occlusion of vertebral artery(VA)and posterior circulation ischemia(PCI).Methods:A retrospective study of 408 patients with severe stenosis or occlus...Objective:To investigate the correlation between severe stenosis or occlusion of vertebral artery(VA)and posterior circulation ischemia(PCI).Methods:A retrospective study of 408 patients with severe stenosis or occlusion of the V1-V4 segment with unilateral VA was confirmed by cervical vascular ultrasound(CDU),CT angiography(CTA),and/or DSA.According to the severe stenosis or occlusion lesions,the patients were divided into V1 segment lesion group(267 cases),V2 segment disease group(40 cases),and V3-V4 segment disease group(101 cases).Depending on whether there were symptoms of posterior circulation ischemia,408 patients were divided into symptom group(195 cases)and asymptomatic group(213 cases).CDU test recorded and analyzed hemodynamic parameters:systolic peak flow rate(PSV),end diastolic flow rate(EDV),resistance index(RI),VA tube diameter(VAD).Meantime,we had assessmented the correlation between severe stenosis or occlusion of VA and PCI.Results:1.Compariing the lesion sites in affected and healthy sides of VA,there were significant differences in PSV,EDV and VAD(p=0.000).There was no significant difference in intervertebral RI when V2 was severe stenosis(p=0.762).2.When the severely stenosis or occlusion happend in V1 or V3-V4 segment,the blood flow spectrum of the affected side was significantly different from the healthy side.3.The stenosis sexual lesion of V1 and V2 had no significant correlation with PCI symptoms(dependency coefficient was 1.06,p=0.053;0.123,p=0.323);and V3-V4 stenosis sexual lesions were moderately associated with PCI symptoms(dependency coefficient=0.217,p=0.027).Conclusions:Severe stenosis or occlusion of V3-V4 segment is likely to appear PCI.CDU can effectively diagnose lesion of VA's evere stenosis or occlusion,which provides a reliable basis of timely clinical treatment and evaluation.展开更多
Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebr...Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.展开更多
Objective:To evaluate the clinical value of synthetical therapy of acupuncture and massage for treating vertebral artery type cervical spondylosis (VACS). Methods: In the present study, triple-center, single-blind, ra...Objective:To evaluate the clinical value of synthetical therapy of acupuncture and massage for treating vertebral artery type cervical spondylosis (VACS). Methods: In the present study, triple-center, single-blind, randomized and control methods were adopted. Qualified subjects were randomly assigned to three groups: acupuncture-massage (acu-mas) group, acupuncture group, and massage group (60 subjects in each group). Bilateral Fengchi (风池GB 20), Jiaji (夹脊EX-B 2, C_ 4-7) and Baihui (百会GV 20) were punctured in combination with massage at the neck-shoulder and back region. The treatment was conducted once daily, 14 times altogether. Results: After treatment, of the 60 cases in each of acu-mas, acupuncture and massage groups, 28, 11 and 13 were cured, 13, 20 and 17 markedly effective, 12, 14 and 16 effective, and 7, 15 and 14 ineffective, with the total effective rates being 88.3%, 75.0% and 76.7% respectively. The therapeutic effect of acu-mas group was significantly superior to that of simple acupuncture and massage groups (P<0.05). The scores of clinical symptoms and signs in 3 groups all declined significantly after treatment (P<0.01), and the score of symptoms of acu-mas was markedly lower than those of acupuncture and massage groups (P<0.05). No significant differences were found among 3 groups in the score of clinical signs and between acupuncture and massage groups in the score of clinical symptoms (P>0.05). The time for producing therapeutic effects in acu-mas group was significantly shorter than those of acupuncture and massage groups (P<0.01, 0.05), meaning a faster of acu-mas group in producing clinical effect. No adverse events were found in all the 3 groups. Conclusion: Acupuncture and massage are effective and safe in the treatment of VACS, and the therapeutic effect of acupuncture combined with massage is superior to that of simple acupuncture and simple massage therapy.展开更多
Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading ...Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics;68% were male;mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.展开更多
Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of posto...Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.展开更多
Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a terti...Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.展开更多
Pyomoyoma is a rare complication of Uterine Artery Embolization (UAE). This case report reflects on this condition. A 45-year-old female, a known case of adenomyosis, presented with intermittent fever and foul vaginal...Pyomoyoma is a rare complication of Uterine Artery Embolization (UAE). This case report reflects on this condition. A 45-year-old female, a known case of adenomyosis, presented with intermittent fever and foul vaginal discharge. These symptoms occurred shortly after the patient underwent UAE for menorrhagia secondary to adenomyosis. Computed tomography scan of the abdomen and pelvis aided in the diagnosis of Pyomyoma secondary to UAE. After a trial of broad spectrum antibiotics and Suction and Evacuation of the uterus had little to no help in the patient’s condition, she underwent Total Abdominal Hysterectomy in which a big, organized pus collection was removed from the uterus. Conclusion: Pyomyoma should be considered in the differentials for patients presenting with fever and vaginal discharge post UAE.展开更多
文摘Objective: Vascular injuries usually present immediately after the penetration, but the delayed onset of vascular symptoms caused by vessel dissection or aneurysm after a traumatic event is extremely rare. Vertebral artery injury is a low-frequency but high-mortality injury. We aim to report evidence of delayed onset of vascular symptoms following penetrating trauma in the neck. Materials and Methods: A case report. Results: A 19-year-old boy was referred to our hospital and complained of a mass in the right part of his neck (right mandibular angle). He gave a history of penetrating trauma to his neck 2 months ago. The mass was expanding during these 2 months and doesn’t respond to antibiotic therapy. In the examination, 3 × 3 cm, firm, nonmobile, and without tenderness and pain mass was palpated in the second level of his neck. Doctors ordered a Doppler sonography in the hospital where a yin-yang pattern was reported. A 36 × 43 × 40 mm heterogeneous, solid, and hypodense area close to C1-C2-C3 with vascular flow was discovered in the right submandibular area after computed tomography (CT)-angiography. The patient was referred to an interventional neurologist for angiography and due to the lack of flow at the distal of the V3 segment, he decided to sacrifice this artery by two coils. Conclusion: Penetrating neck injuries are usually asymptomatic, but these injuries are often accompanied by hemorrhage, neurological symptoms, dysphagia, odynophagia, and windpipe. Penetrating lesions of the vertebral artery are rare and very difficult to diagnose. Also, these lesions are challenging for surgeons due to complex anatomy and difficult surgical exposure. So, endovascular treatment was used to treat the patient.
文摘BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.
文摘Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.
文摘BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.
基金supported by a grant from Key Program of Science and Technology of Hubei Province(No.2005AA302B07)
文摘The efficacy of injecting sclerosing agent next to transverse process of cervical vertebra to induce vertebral artery type of cervical syndrome(CSA)was observed.Twenty rabbits were randomly divided into two groups:the model group and the control group.The rabbits in the model group were injected with sclerosing agent next to transverse process of cervical vertebray,on the contrary,the rabbits in the control group were injected with nothing.Transcranial Doppler(TCD)was used to detect the average speed of blood(Vm),pulsatility index(Pi)and the resistant index(Ri)of the vertebral artery,hematoxylin and eosin(HE)staining was used to observe the morphological changes,and immunohistochemistry was used to detect the expression of α-smooth muscle actin(α-SMA)and matrix metallo-proteinase-2(MMP-2).TCD showed increased Pi,Ri and decreased Vm in the model group(P<0.05)compared with the control group.HE staining revealed hyperplasia and hypertrophied smooth muscle cells in the model group(P<0.05).Immunohistochemistry displayed up-regulation of α-SMA and MMP-2 in the model group(P<0.05).It was concluded that injecting sclerosing agent next to transverse process of cervical vertebra induces remodeling of vertebral artery in rabbits,suggesting it is a practical method to establish CSA animal model.
基金financially supported by the National Natural Science Foundation of China[grant numbers 81771951]
文摘Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.
文摘Cervical spondylosis of vertebral artery type is one of the chief patterns of cervical spondylosis.It is often described as neck pain accompanied with radiating pain and neurologic symptoms,such as sudden dizziness,blurred vision,tinnitus,nausea,vomiting,memory loss,and sudden fainting.The incidence of cervical spondylosis increases and patients with cervical spondylosis become progressively younger.Acupuncture in the cervical spondylosis of vertebral artery type treatment has a local positive reaction“Liuhe point”,in order to dredge the local Qi and blood.More and more evidences into the effectiveness and safety of cervical spine acupuncture for cervical spondylosis,specific neck pain,cervical radiculopathy,etc.This article summarizes the recent literature on acupuncture and acupuncture combined with other therapies for cervical spondylosis of vertebral artery type treatment and provides a comprehensive review from the perspectives of acupuncture therapy,warm needle moxibustion therapy,electroacupuncture,and acupuncture combined with other therapies,in order to provide reference and reference for clinical treatment.
文摘Objective:To investigate the clinical efficacy of acupuncture combined with massage on cervical spondylopathy of vertebral artery type and its effect on hemodynamics of patients.Methods:Sixty patients with vertebral artery type cervical spondylosis treated in our hospital from July 2017 to October 2019 were selected as the research subjects and randomly divided into 2 groups of 30 cases each.The control group was treated with acupuncture,and the observation group was treated with acupuncture combined with massage,and the clinical efficacy and hemodynamic index of the two groups were compared after 1 month of treatment[peak systolic blood velocity(PSV),pulsatile index(PI),time mean flow velocity(TMFV)].Results:There was no statistical difference in the PSV,PI,and TMFV between the two groups before treatment(P>0.05).After treatment,the observation group had a higher treatment efficacy than the control group with PSV and TMFV increasing and PI decreasing in both groups,and the change in the observation group was greater than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Acupuncture combined with massage on cervical spondylopathy of vertebral artery type can improve the clinical efficacy and improve the hemodynamic index of patients,which is worthy of clinical application.
文摘BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high mortality rate,especially in the case of multiple vascular injuries.CASE SUMMARY We report an extremely rare case of successive vertebral artery and subclavian artery pseudoaneurysms caused by swallowing a fishbone in a previously healthy 29-year-old female.She was transferred to the emergency department of our hospital because of hemorrhagic shock due to a vertebral artery pseudoaneurysm.We successfully managed the vertebral artery pseudoaneurysm with endovascular stent implantation and the patient's vital signs as well as hemodynamics once became stable.However,the patient died of the second subclavian artery pseudoaneurysm occurring within a short time,which was thought be related to the obvious displacement of the fishbone in the mediastinum.CONCLUSION Surgery and endovascular stent implantation may be the best choice for treating such complications.Early removal of the fishbone is of great significance in improving the survival of such patients.
基金The 16th batch of science and technology development plan of Suzhou in 2018(Minsheng science and Technology)(No.SS201859)Suzhou 2020 science and technology development plan(Livelihood Science and Technology)(No.SS202061)The 13th five-year plan major project of the Ministry of science and technology:demonstration application of digital diagnosis and treatment and clinical solutions for stroke(No.2017YFC0114300)。
文摘Objective:To investigate the ultrasonographic characteristics of the hemodynamic changes of the contralateral vertebral artery(VA)in patients with different types of subclavian steal syndrome(SSS).Methods:A total of 152 cases of SSS diagnosed by carotid Doppler ultrasonography(CDU)and confirmed by CT angiography(CTA)were enrolled as the study group.The 152 cases of SSS were divided into type Ⅰ(47 cases of occult steal blood),type Ⅱ(60 cases of partial steal blood)and type Ⅲ(45 cases of complete steal blood).Meanwhile,46 cases of cardiovascular and cerebrovascular diseases were excluded from the health examination center as the control group.The diameter and hemodynamic changes of VA in healthy side of patients with different types of steal blood were analyzed and compared with the control group.Results:The hemodynamic parameters of VA on the contralateral side of three types of SSS in the study group were compared with those in the control group,there was no significant difference between type Ⅰ and the control group(P>0.05),and there was significant difference between type Ⅱ and type Ⅲ and the control group(P<0.05);The diameter and hemodynamic parameters of VA increased with the severity of steal blood(P<0.05).Conclusion:CDU examination of VA hemodynamic parameters in healthy side of SSS patients can be used to preliminarily evaluate SA lesions and VA-VA steal pathway.
文摘Background: The management outcome of a series of ruptured vertebral artery (VA) aneurysms was reviewed. Method: This is a retrospective study of prospectively collected data of 60 cases with ruptured VA aneurysms in the author’s database from the year 2004. All cases were managed with coiling, stent-assisted coiling, flow diversion or endovascular parent artery sacrifice. Nimodipine and hypertensive, hypervolemic therapy was applied as standard. Outcome was assessed at 6 months with modified Rankin score (mRS). Results: There were 26 females and 34 males. Age range is 18 to 70 with a mean age of 42. There were 27 dissecting aneurysms and 33 saccular aneurysms. 50 (83%) cases were World Federation of Neurological Surgeons (WFNS) grade one to three. There were four WFNS grade four and six WFNS grade five. 25 cases of dissecting aneurysms were managed with parent artery coil occlusion. Two dissecting aneurysms affecting the dominant VA were treated with flow diverters. At 6 months follow up 50 (83%) achieved good outcome with mRS one to two. There were eight cases with poor outcome and two deaths. Six-month follow-up MR angiogram documented stable occlusion for the 24 cases with dissecting aneurysms treated with parent artery coil occlusion who survived. The two treated with flow diversion demonstrated good remodelling at 6 months on angiography. Six-month follow-up angiogram for the 32 cases of saccular aneurysm who survived documented stable aneurysm obliteration. Conclusion: Good outcome can be achieved with endovascular treatment for ruptured VA aneurysms. Parent artery occlusion is a safe and effective technique for ruptured VA dissecting aneurysm.
文摘Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
文摘We encountered a 36-year-old female who developed extracranial vertebral artery dissociation (EVAD), which is a rare condition in Japan. The disease developed with sudden severe right side neck pain and right upper arm pain. No abnormality was observed in the spinal canal, intervertebral discs, spinal cord, or nerve roots on MRI of the cervical spine, but dilation and double lumen were noted in the vertebral artery (VA) at the C4/5 level. The presence of aneurysm was confirmed by VA angiography, and EVAD was diagnosed. The symptoms were resolved by conservative treatment of pain, and the aneurysm shrank and disappeared with time on VA angiography. Even though neck and upper limb pain are the only clinical symptom and there is no brain dysfunction, such as disturbance of consciousness and vertigo, when symptoms develop acutely, this pathology should be included in differential diagnosis and orthopedists should carefully observe the vertebral artery, as well as the spinal canal, in evaluating cervical MRI.
基金Jiangsu Province Cadre Health Research Project(No.BJ17010)Suzhou Science and Technology Development Project(No.SS201714,No.SS201859)135 major projects of the Ministry of Science and Technology:Digital Diagnosis and Treatment Demonstration Application and Clinical Solution for Stroke(No.2017YFC0114302).
文摘Objective:To investigate the correlation between severe stenosis or occlusion of vertebral artery(VA)and posterior circulation ischemia(PCI).Methods:A retrospective study of 408 patients with severe stenosis or occlusion of the V1-V4 segment with unilateral VA was confirmed by cervical vascular ultrasound(CDU),CT angiography(CTA),and/or DSA.According to the severe stenosis or occlusion lesions,the patients were divided into V1 segment lesion group(267 cases),V2 segment disease group(40 cases),and V3-V4 segment disease group(101 cases).Depending on whether there were symptoms of posterior circulation ischemia,408 patients were divided into symptom group(195 cases)and asymptomatic group(213 cases).CDU test recorded and analyzed hemodynamic parameters:systolic peak flow rate(PSV),end diastolic flow rate(EDV),resistance index(RI),VA tube diameter(VAD).Meantime,we had assessmented the correlation between severe stenosis or occlusion of VA and PCI.Results:1.Compariing the lesion sites in affected and healthy sides of VA,there were significant differences in PSV,EDV and VAD(p=0.000).There was no significant difference in intervertebral RI when V2 was severe stenosis(p=0.762).2.When the severely stenosis or occlusion happend in V1 or V3-V4 segment,the blood flow spectrum of the affected side was significantly different from the healthy side.3.The stenosis sexual lesion of V1 and V2 had no significant correlation with PCI symptoms(dependency coefficient was 1.06,p=0.053;0.123,p=0.323);and V3-V4 stenosis sexual lesions were moderately associated with PCI symptoms(dependency coefficient=0.217,p=0.027).Conclusions:Severe stenosis or occlusion of V3-V4 segment is likely to appear PCI.CDU can effectively diagnose lesion of VA's evere stenosis or occlusion,which provides a reliable basis of timely clinical treatment and evaluation.
基金supported by the Natural Science Foundation of Yongchuan District of Chongqing in China,No.Ycstc,2013nc8031the Foundation of Chongqing Municipal Health Bureau in China,No.2010-2-250+1 种基金the Foundation of Chongqing Health and Family Planning Commission in China,No.20143001the Soft Science Foundation of Yongchuan District of Chongqing in China,No.Ycstc,2011BE5004
文摘Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.
文摘Objective:To evaluate the clinical value of synthetical therapy of acupuncture and massage for treating vertebral artery type cervical spondylosis (VACS). Methods: In the present study, triple-center, single-blind, randomized and control methods were adopted. Qualified subjects were randomly assigned to three groups: acupuncture-massage (acu-mas) group, acupuncture group, and massage group (60 subjects in each group). Bilateral Fengchi (风池GB 20), Jiaji (夹脊EX-B 2, C_ 4-7) and Baihui (百会GV 20) were punctured in combination with massage at the neck-shoulder and back region. The treatment was conducted once daily, 14 times altogether. Results: After treatment, of the 60 cases in each of acu-mas, acupuncture and massage groups, 28, 11 and 13 were cured, 13, 20 and 17 markedly effective, 12, 14 and 16 effective, and 7, 15 and 14 ineffective, with the total effective rates being 88.3%, 75.0% and 76.7% respectively. The therapeutic effect of acu-mas group was significantly superior to that of simple acupuncture and massage groups (P<0.05). The scores of clinical symptoms and signs in 3 groups all declined significantly after treatment (P<0.01), and the score of symptoms of acu-mas was markedly lower than those of acupuncture and massage groups (P<0.05). No significant differences were found among 3 groups in the score of clinical signs and between acupuncture and massage groups in the score of clinical symptoms (P>0.05). The time for producing therapeutic effects in acu-mas group was significantly shorter than those of acupuncture and massage groups (P<0.01, 0.05), meaning a faster of acu-mas group in producing clinical effect. No adverse events were found in all the 3 groups. Conclusion: Acupuncture and massage are effective and safe in the treatment of VACS, and the therapeutic effect of acupuncture combined with massage is superior to that of simple acupuncture and simple massage therapy.
文摘Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics;68% were male;mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.
文摘Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.
文摘Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.
文摘Pyomoyoma is a rare complication of Uterine Artery Embolization (UAE). This case report reflects on this condition. A 45-year-old female, a known case of adenomyosis, presented with intermittent fever and foul vaginal discharge. These symptoms occurred shortly after the patient underwent UAE for menorrhagia secondary to adenomyosis. Computed tomography scan of the abdomen and pelvis aided in the diagnosis of Pyomyoma secondary to UAE. After a trial of broad spectrum antibiotics and Suction and Evacuation of the uterus had little to no help in the patient’s condition, she underwent Total Abdominal Hysterectomy in which a big, organized pus collection was removed from the uterus. Conclusion: Pyomyoma should be considered in the differentials for patients presenting with fever and vaginal discharge post UAE.
