The prognosis of patients with hepatocellular cardnorna （HCC） accompanied by portal vein tumor thrombus （PVTT） is generally poor if leo untreated： a median survival time of 2.7-4.0 mo has been reported. Furthermo...The prognosis of patients with hepatocellular cardnorna （HCC） accompanied by portal vein tumor thrombus （PVTT） is generally poor if leo untreated： a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization （TACE） has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 （range 4.5-11.8） mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.展开更多
Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myoc...Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.展开更多
BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The prese...BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interv展开更多
Background This study evaluated the clinical application of CT guided ^125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods The ten patients （9 males and 1 f...Background This study evaluated the clinical application of CT guided ^125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods The ten patients （9 males and 1 female, aged from 36 to 72 years） with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery, transcatheter arterial chemoembolization, radiotherapy ablation, microwave ablation or percutaneous ethanol injection. The average diameter of each tumor thrombus was 21.5 mm × 30.5 mm. Seeds of 30 MBq ^125I were implanted 5 mm apart within the portal vein tumor thrombus. The follow-up after 4 months included enhanced spiral CT. Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy, 5 partial response and 1 stable disease. Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase, which were controlled by medical management. Severe complications such as haemorrhage, biliary fistula hepatic abscess, pancreatic fistula and hepatic function failure were not observed. Implanted seeds migrated to lung and left hepatic lobe in 1 case. Conclusion CT guided implantation of ^125iodine seeds, can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.展开更多
文摘The prognosis of patients with hepatocellular cardnorna （HCC） accompanied by portal vein tumor thrombus （PVTT） is generally poor if leo untreated： a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization （TACE） has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 （range 4.5-11.8） mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.
文摘Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.
文摘BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interv
文摘Background This study evaluated the clinical application of CT guided ^125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods The ten patients （9 males and 1 female, aged from 36 to 72 years） with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery, transcatheter arterial chemoembolization, radiotherapy ablation, microwave ablation or percutaneous ethanol injection. The average diameter of each tumor thrombus was 21.5 mm × 30.5 mm. Seeds of 30 MBq ^125I were implanted 5 mm apart within the portal vein tumor thrombus. The follow-up after 4 months included enhanced spiral CT. Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy, 5 partial response and 1 stable disease. Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase, which were controlled by medical management. Severe complications such as haemorrhage, biliary fistula hepatic abscess, pancreatic fistula and hepatic function failure were not observed. Implanted seeds migrated to lung and left hepatic lobe in 1 case. Conclusion CT guided implantation of ^125iodine seeds, can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.
