An elderly female patient, with systemic multiple organ dysfunction, suffered from severe aortic valve stenosis, was to undergo transcatheter aortic valve replacement (TAVR). She was intolerance of the computed tomography examination before surgery. Bedside echocardiography was employed to evaluate the patient’s aortic valve stenosis, valve anatomy and type, the condition of aortic root, the distance from coronary to aortic root, and lower-extremity vascular access. Finally, the emergent TAVR was successfully performed under general anesthesia, and the aortic valve trans-prosthetic gradient met a remarkable decrease after surgery.
目的 评价依托芬那酯凝胶治疗腱鞘炎在超声引导下微创术后肿痛的有效性和安全性。 方法 采用随机、对照的设计，将2011年5月－2012年7月，在四川省人民医院门诊接受腱鞘炎超声引导微创术后的患者157例，分为两组，治疗组（n=81）采用依托芬那酯凝胶外用，对照组（n=76）不使用外用药物。 结果 两组治疗后24 h及3 d的疼痛评分、压痛及关节功能缓解率与治疗前自身比较及组间比较，差别均有统计学意义（P＜0.05），7 d时治疗组临床总有效率为90.12%，对照组为89.47%，组间比较无统计学意义（P＞0.05），治疗组在使用应急药物上明显优于对照组。两组安全性评价比较差异无统计学意义（P＞0.05）。 结论 依托芬那酯凝胶能快速、有效、安全地缓解腱鞘炎超声引导微创术后局部肿胀疼痛的症状。
ObjectiveTo analyze the safety and effectiveness of ultrasound-guided endovascular treatment for femoropopliteal arteriosclerosis obliteran (ASO). MethodsThe clinical data of patients with femoropopliteal ASO were collected and analyzed. The patients were treated by ultrasound-guided endovascular intervention in the Xijing Hospital of Air Force Military Medical University, from March 2015 to June 2021. The endovascular intervention methods included the arterial balloon dilation (ABD) alone, stent implantation (SI), Rotarex mechanical thrombus removal (Abbreviationas: Rotarex), and thrombolytic catheter implantation (CDT), etc. ResultsAll 112 patients (121 affected extremities) who met the research criteria were collected. Among them, there were 13, 68, and 40 affected extremities by the Rutherford classification of 2, 3, and 4, respectively, while 41, 39, and 41 affected extremities by the Trans-Atlantic Inter-SocietyConsensus Ⅱ classification of A, B, and C, respectively. Among 121 affected extremities, 61 underwent the ABD alone, 27 underwent ABD plus Rotarex, 12 underwent ABD plus SI, 6 underwent ABD plus SI plus Rotarex, 3 underwent ABD plus SI plus CDT, 7 underwent ABD plus CDT plus Rotarex, and 5 underwent ABD plus CDT. The ultrasound-guided endovascular treatments were completed successfully in 118 affected extremities (the success rate was 97.5%), and 3 affected extremities were not completely completed by ultrasound guidance. After operation, 5 affected extremities had pseudoaneurysm and 7 affected extremities had hematoma at the puncture site, which were cured after conservative management. The ankle-brachial index (ABI) of the affected extremities immediately after surgery was statistically higher than that before surgery [0.89±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.36 (0.34, 0.38), paired t-test (t=–25.17), P<0.001]. After a follow-up of 12 months, one patient had a metatarsal amputation and one patient died (acute myocardial infarction). The restenosis rate and reintervention rate of the target lesions were 25.0% (30/120) and 15.0% (18/120) at 12 months postoperatively, and the late loss of diameter was (0.88±0.25) mm. The ABI was still higher than before surgery [0.78±0.13 vs. 0.53±0.09, mean difference (95% confidence interval)=0.25 (0.22, 0.27), paired t-test, t=–17.61, P<0.001]. ConclusionFrom analysis results of this data, it can be seen that, ultrasound-guided endovascular intervention is a safe and effective treatment for selective femoropopliteal ASO.
Objective To discuss the nursing measures for thyroid nodule patients who undergo core-needle biopsy (CNB) guided by ultrasound. Methods We retrospectively analyzed the experiences and main points of nursing for 1 900 thyroid nodule patients who underwent CNB guided by ultrasound between June 2010 and May 2014. Results All the 1 900 patients underwent CNB successfully. The nursing time was between 5 and 15 minutes, averaging (8.0±3.7) minutes. Complications included hematoma in 25 patients (1.3%) and needle syncope reaction in 30 patients (1.6%), which were cured through symptomatic treatment. No complications such as nerve injury, anesthesia accident or death occurred. No medical disputes happened due to specimen errors or loss. The success rate of specimen collection was 98.4% (1 870/1 900), and the diagnostic accuracy was 95.3% (1 812/1 900). Conclusions Ultrasonography-guided CNB is a safe and reliable operation with a high success rate, high diagnosis accuracy and few complications. Being familiar with the process of nursing cooperation and correct disposal and transfer of biopsy specimens are crucial for successful CNB in patients with thyroid nodules.
Objective To study clinical efficacy of irreversible electroporation in the treatment of advanced hepatic carcinoma. Methods Between July 2015 and September 2015, 8 patients with advanced hepatic carcinoma (10 tumors) were treated by ultrasound-guided irreversible electroporation, using pertacuneous, laparoscope or open surgery in the Rockets Army General Hospital of PLA. Prospectively collected and summarized the clinical data. Finally, analyzed the therapeutic effect of irreversible electroporation. Results Compared with before treatment, the quality of life score significantly increased 〔(37.75±4.65) scores vs. (22.25±2.87) scores, P=0.000〕 in 3 months after treatment of irreversible electroporation, but value of serum total bilirubin (56.37 mmol/L vs. 150.40 mmol/L, P=0.046), direct bilirubin (58.69 mmol/L vs. 71.60 mmol/L, P=0.012), alanine aminotransferase 〔(52.63±12.14) U/mL vs. (87.28±27.94) U/mL, P=0.003〕, asperate aminotransferase 〔(48.45±13.75) U/mL vs. (74.40±21.09) U/mL, P=0.000〕, and alpha fetoprotein (82.10 ng/mL vs. 159.20 ng/mL, P=0.042) significantly decreased. One patient suffered from persistent upper abdominal pain after irreversible electroporation, but no serious complications, such as infection, biliary fistula, hemorrhage, and liver or kidney failure occurred in all 8 patients. Abdominal enhanced CT scanning or MRI in 3 months after irreversible electroporation showed complete ablation in 7 patients and incomplete ablation with some residual in 1 patient. Eight patients were followed up for 3-5 months 〔an average of (4.0±0.9) months〕. During follow-up period, all patients had been alive with 1 case of recurrence. Conclusion The effect of ultrasound-guided irreversible electroporation in the treatment of advanced hepatic carcinoma is remarkable, and it may deserve clinical application in consideration of its safety and efficacy.
Objective To assessment of the echogenicity of the ultrasound-guided catheter and its associated delivery system. Methods The study consisted of in vitro characterization experiments and animal studies. In the in vitro phase, the acoustic and mechanical properties of the ultrasound-guided catheter were compared with those of the traditional MPA2 catheter, including parameters such as echo intensity, recognizability, and angle dependence. In the animal experiments, a ventricular septal defect (VSD) model was established in miniature pigs to compare the procedural performance of the ultrasound-guided delivery system versus the conventional system. Evaluation indicators included the time required for the system to cross the VSD, the detection rate of the system within the right ventricle, and the occurrence of intraoperative complications. Results The ultrasound-guided catheter demonstrated a significantly higher mean echo intensity than the MPA2 catheter[ (237.3±1.8) dB vs. (190.9±13.1) dB, P<0.001] and a markedly improved recognizability rate (82.3%±5.6% vs. 26.7±3.2%, P<0.001), along with better angle independence and image quality. In animal experiments, the ultrasound-guided delivery system significantly reduced the time required to cross the VSD (18.5±5.7 min vs. 30.3±4.5 min, P<0.001) and substantially increased the detection rate within the right ventricle (100% vs. 30%). No severe complications occurred in any experimental animal. Conclusion The ultrasound-guided catheter and its corresponding delivery system exhibited superior ultrasound visibility and operational performance in both in vitro and animal experiments, indicating strong potential for clinical application.