AIM To determine whether serum vascular endothelial growth factor (VEGF) levels correlates with the severity of liver cirrhosis and whether portal hypertension impacts on the expression of serum VEGF protein. METHOD...AIM To determine whether serum vascular endothelial growth factor (VEGF) levels correlates with the severity of liver cirrhosis and whether portal hypertension impacts on the expression of serum VEGF protein. METHODS Fifty three patients (mean age 56±2 years) with HCV ( n =26), HBV ( n =13), and cryptogenic liver cirrhosis ( n =14) (Child Pughs class A: 24, B: 19 and C: 12) and normal renal function constitute the patient population, who were all diagnosed by clinical, histological and radiological findings. Six healthy people and six patients with acute hepatitis served as controls. Severity of liver disease was evaluated by the CP score. Serum levels of IGF 1 and VEGF were measured by radioimmunoassay and ELISA, respectively. Portal hypertension was assessed using pulsed Doppler ultrasound. RESULTS The mean serum VEGF levels in all cirrhotic patients (73±58) were significantly lower than those of healthy controls (360±217, P <0 01) and acute hepatitis (1123±1261, P <0 01) respectively. No significant difference in median serum VEGF levels were noted among the different Child Pughs classes (class A: median, 49 4ng/L , range, 21ng/L - 260ng/L , Class B: median 59 9ng/L ; range 21-92, and Class C: median 69; range 20ng/L - 247ng/L ). A significant correlation was noted between serum VEGF and two accurate parameters of portal hypertension: portal blood flow velocity ( r =0 6) and spleen size ( r =0 55). No correlation was found between VEGF serum levels and serum albumin, IGF 1, platelets count and aminotrasnferases ( r =0 2, r =0 1, r =0 2 and r =0 2, respectively). CONCLUSION Circulating VEGF level in patients with liver cirrhosis could not serve as an indicator of the progression of chronic liver disease but rather, they may reflect increased portal hypertension or decreased hepatic regenerative activity or the combination of both.展开更多
AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The fi...AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.展开更多
Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb.Endovascular procedures are currently preferred for these patients.We describe the case of an 80-year-...Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb.Endovascular procedures are currently preferred for these patients.We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb.The patient had history of left femoral popliteal bypass surgery,femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago.Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery(SFA) and popliteal artery and of all three infra-popliteal arteries.Due to severe comorbidities,the patient was scheduled for a digital subtraction angiography.An antegrade approach was first attempted,however the occlusion could not be passed.After revision of the angiography acquisition,a stent was identified at the level of the mid SFA,which was subsequently directly punctured,facilitating the retrograde crossing of the occlusion.Thereafter,balloon angioplasty was performed in the SFA,popliteal artery and posterior tibial artery.The result was considered suboptimal,but due to the large amount of contrast agent used,a second angiography was planned in 4 wk.In the second session,drug coated balloons were used to optimize treatment of the SFA,combined with recanalization of the left fibular artery,to optimize outflow.The post-procedural course was uneventful.Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.展开更多
Inferior vena cava pseudo aneurysms are rare clinical entities with an uncertain natural history due to its rarity and limited follow up information. IVC injuries are managed according to the patient’s presentation a...Inferior vena cava pseudo aneurysms are rare clinical entities with an uncertain natural history due to its rarity and limited follow up information. IVC injuries are managed according to the patient’s presentation and hemodynamic status. This case report describes clinical presentation of a 30 years old man with history of fall from height, infra renal IVC pseudoaneurysm found with FAST and CT scan abdomen, our treatment plan and his clinical outcome.展开更多
Background: Incomplete ureteric duplication can be associated with either ureteropelvic obstruction involving the lower moiety or reflux between the ureters (yo-yo reflux). Yo-yo reflux can be a cause of repeated urin...Background: Incomplete ureteric duplication can be associated with either ureteropelvic obstruction involving the lower moiety or reflux between the ureters (yo-yo reflux). Yo-yo reflux can be a cause of repeated urinary tract infection with subsequent renal damage. Aim of the work: The current study evaluated the presence of yo-yo reflux as reason of upper moiety dilation in cases with incomplete duplication of upper urinary tract. Methodology: 10 cases with a dilated upper moiety of duplex renal pelvicalyceal system were examined with color duplex ultrasonography. All were further investigated with intravenous pyelography (IVP), and ascending/micturating cystography. Results: 9 cases with upper moiety dilation showed complete duplication of the pelvicalyceal systems and ureters and 1 case with dilated upper moiety showed incomplete ureteric duplication in which the diagnosis of Yo-yo reflux was confirmed by color duplex ultrasound in addition to the intravenous pyelography findings. Conclusion: The presence of antegrade/retrograde flow within the dilated moiety of a duplex kidney during color duplex study in addition to the intravenous pyelography findings can confirm the diagnosis of yo-yo reflux.展开更多
文摘AIM To determine whether serum vascular endothelial growth factor (VEGF) levels correlates with the severity of liver cirrhosis and whether portal hypertension impacts on the expression of serum VEGF protein. METHODS Fifty three patients (mean age 56±2 years) with HCV ( n =26), HBV ( n =13), and cryptogenic liver cirrhosis ( n =14) (Child Pughs class A: 24, B: 19 and C: 12) and normal renal function constitute the patient population, who were all diagnosed by clinical, histological and radiological findings. Six healthy people and six patients with acute hepatitis served as controls. Severity of liver disease was evaluated by the CP score. Serum levels of IGF 1 and VEGF were measured by radioimmunoassay and ELISA, respectively. Portal hypertension was assessed using pulsed Doppler ultrasound. RESULTS The mean serum VEGF levels in all cirrhotic patients (73±58) were significantly lower than those of healthy controls (360±217, P <0 01) and acute hepatitis (1123±1261, P <0 01) respectively. No significant difference in median serum VEGF levels were noted among the different Child Pughs classes (class A: median, 49 4ng/L , range, 21ng/L - 260ng/L , Class B: median 59 9ng/L ; range 21-92, and Class C: median 69; range 20ng/L - 247ng/L ). A significant correlation was noted between serum VEGF and two accurate parameters of portal hypertension: portal blood flow velocity ( r =0 6) and spleen size ( r =0 55). No correlation was found between VEGF serum levels and serum albumin, IGF 1, platelets count and aminotrasnferases ( r =0 2, r =0 1, r =0 2 and r =0 2, respectively). CONCLUSION Circulating VEGF level in patients with liver cirrhosis could not serve as an indicator of the progression of chronic liver disease but rather, they may reflect increased portal hypertension or decreased hepatic regenerative activity or the combination of both.
文摘AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.
文摘Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb.Endovascular procedures are currently preferred for these patients.We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb.The patient had history of left femoral popliteal bypass surgery,femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago.Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery(SFA) and popliteal artery and of all three infra-popliteal arteries.Due to severe comorbidities,the patient was scheduled for a digital subtraction angiography.An antegrade approach was first attempted,however the occlusion could not be passed.After revision of the angiography acquisition,a stent was identified at the level of the mid SFA,which was subsequently directly punctured,facilitating the retrograde crossing of the occlusion.Thereafter,balloon angioplasty was performed in the SFA,popliteal artery and posterior tibial artery.The result was considered suboptimal,but due to the large amount of contrast agent used,a second angiography was planned in 4 wk.In the second session,drug coated balloons were used to optimize treatment of the SFA,combined with recanalization of the left fibular artery,to optimize outflow.The post-procedural course was uneventful.Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.
文摘Inferior vena cava pseudo aneurysms are rare clinical entities with an uncertain natural history due to its rarity and limited follow up information. IVC injuries are managed according to the patient’s presentation and hemodynamic status. This case report describes clinical presentation of a 30 years old man with history of fall from height, infra renal IVC pseudoaneurysm found with FAST and CT scan abdomen, our treatment plan and his clinical outcome.
文摘Background: Incomplete ureteric duplication can be associated with either ureteropelvic obstruction involving the lower moiety or reflux between the ureters (yo-yo reflux). Yo-yo reflux can be a cause of repeated urinary tract infection with subsequent renal damage. Aim of the work: The current study evaluated the presence of yo-yo reflux as reason of upper moiety dilation in cases with incomplete duplication of upper urinary tract. Methodology: 10 cases with a dilated upper moiety of duplex renal pelvicalyceal system were examined with color duplex ultrasonography. All were further investigated with intravenous pyelography (IVP), and ascending/micturating cystography. Results: 9 cases with upper moiety dilation showed complete duplication of the pelvicalyceal systems and ureters and 1 case with dilated upper moiety showed incomplete ureteric duplication in which the diagnosis of Yo-yo reflux was confirmed by color duplex ultrasound in addition to the intravenous pyelography findings. Conclusion: The presence of antegrade/retrograde flow within the dilated moiety of a duplex kidney during color duplex study in addition to the intravenous pyelography findings can confirm the diagnosis of yo-yo reflux.
