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Gao RD, Qian SY, Wang HH, Liu YS, Ren SY. Strategies and challenges in treatment of varicose veins and venous insufficiency. World J Clin Cases 2022; 10:5946-5956. [PMID: 35949828 PMCID: PMC9254182 DOI: 10.12998/wjcc.v10.i18.5946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.
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Affiliation(s)
- Rong-Ding Gao
- Department of Laser and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Song-Yi Qian
- Department of Cardiac Surgery, Zhongshan Hospital (Xiamen Brach), Fudan University, Xiamen 361015, Fujian Province, China
| | - Hai-Hong Wang
- Department of Peripheral Vascular Disease, The Affiliated Hospital of Shanxi University of Chinese Medicine, Taiyuan 030024, Shanxi Province, China
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Shi-Yan Ren
- Department of Laser and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
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Ren SY, Wang WB, Gao RD, Zhou AM. Omicron variant (B.1.1.529) of SARS-CoV-2: Mutation, infectivity, transmission, and vaccine resistance. World J Clin Cases 2022. [PMID: 35071500 DOI: 10.12998/wjcc.v10.i1.1.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant Omicron (B.1.1.529) has caused panic responses around the world because of its high transmission rate and number of mutations. This review summarizes the highly mutated regions, the essential infectivity, transmission, vaccine breakthrough and antibody resistance of the Omicron variant of SARS-CoV-2. The Omicron is highly transmissible and is spreading faster than any previous variant, but may cause less severe symptoms than previous variants. The Omicron is able to escape the immune system's defenses and coronavirus disease 2019 vaccines are less effective against the Omicron variant. Early careful preventive steps including vaccination will always be key for the suppression of the Omicron variant.
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Affiliation(s)
- Shi-Yan Ren
- Laser Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 10012, China.
| | - Wen-Biao Wang
- Department of Stomatology, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Laser Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 10012, China
| | - Ai-Mei Zhou
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 10012, China
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Ren SY, Wang WB, Gao RD, Zhou AM. Omicron variant (B.1.1.529) of SARS-CoV-2: Mutation, infectivity, transmission, and vaccine resistance. World J Clin Cases 2022; 10:1-11. [PMID: 35071500 PMCID: PMC8727245 DOI: 10.12998/wjcc.v10.i1.1] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
The appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant Omicron (B.1.1.529) has caused panic responses around the world because of its high transmission rate and number of mutations. This review summarizes the highly mutated regions, the essential infectivity, transmission, vaccine breakthrough and antibody resistance of the Omicron variant of SARS-CoV-2. The Omicron is highly transmissible and is spreading faster than any previous variant, but may cause less severe symptoms than previous variants. The Omicron is able to escape the immune system’s defenses and coronavirus disease 2019 vaccines are less effective against the Omicron variant. Early careful preventive steps including vaccination will always be key for the suppression of the Omicron variant.
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Affiliation(s)
- Shi-Yan Ren
- Laser Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 10012, China
| | - Wen-Biao Wang
- Department of Stomatology, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Laser Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 10012, China
| | - Ai-Mei Zhou
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 10012, China
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Ren SY, Liu YS, Zhu GJ, Liu M, Shi SH, Ren XD, Hao YG, Gao RD. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases 2020. [PMID: 33269244 DOI: 10.12998/wjcc.v8.i21.5070.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
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Affiliation(s)
- Shi-Yan Ren
- Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China.
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, Beijing 100012, China
| | - Guo-Jian Zhu
- Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
| | - Meng Liu
- Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
| | - Shao-Hui Shi
- Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Xiao-Dong Ren
- Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
| | - Ya-Guang Hao
- Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
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Ren SY, Liu YS, Zhu GJ, Liu M, Shi SH, Ren XD, Hao YG, Gao RD. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases 2020; 8:5070-5085. [PMID: 33269244 PMCID: PMC7674718 DOI: 10.12998/wjcc.v8.i21.5070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
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Affiliation(s)
- Shi-Yan Ren
- Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, Beijing 100012, China
| | - Guo-Jian Zhu
- Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
| | - Meng Liu
- Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
| | - Shao-Hui Shi
- Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Xiao-Dong Ren
- Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
| | - Ya-Guang Hao
- Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
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Ren SY, Wang WB, Hao YG, Zhang HR, Wang ZC, Chen YL, Gao RD. Stability and infectivity of coronaviruses in inanimate environments. World J Clin Cases 2020; 8:1391-1399. [PMID: 32368532 PMCID: PMC7190947 DOI: 10.12998/wjcc.v8.i8.1391] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/02/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious virus that can transmit through respiratory droplets, aerosols, or contacts. Frequent touching of contaminated surfaces in public areas is therefore a potential route of SARS-CoV-2 transmission. The inanimate surfaces have often been described as a source of nosocomial infections. However, summaries on the transmissibility of coronaviruses from contaminated surfaces to induce the coronavirus disease 2019 are rare at present. This review aims to summarize data on the persistence of different coronaviruses on inanimate surfaces. The literature was systematically searched on Medline without language restrictions. All reports with experimental evidence on the duration persistence of coronaviruses on any type of surface were included. Most viruses from the respiratory tract, such as coronaviruses, influenza, SARS-CoV, or rhinovirus, can persist on surfaces for a few days. Persistence time on inanimate surfaces varied from minutes to up to one month, depending on the environmental conditions. SARS-CoV-2 can be sustained in air in closed unventilated buses for at least 30 min without losing infectivity. The most common coronaviruses may well survive or persist on surfaces for up to one month. Viruses in respiratory or fecal specimens can maintain infectivity for quite a long time at room temperature. Absorbent materials like cotton are safer than unabsorbent materials for protection from virus infection. The risk of transmission via touching contaminated paper is low. Preventive strategies such as washing hands and wearing masks are critical to the control of coronavirus disease 2019.
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Affiliation(s)
- Shi-Yan Ren
- Vascular Surgery, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Wen-Biao Wang
- Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Ya-Guang Hao
- Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Hao-Ran Zhang
- State Key laboratory of Natural and Biomimetic Drugs, Department of Chemical Biology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Zhi-Chao Wang
- Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Ye-Lin Chen
- College of Robotics, Beijing Union University, Beijing 100101, China
| | - Rong-Ding Gao
- Aviation General Hospital, China Medical University, Beijing 100012, China
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Ren SY, Wang WB, Hao YG, Zhang HR, Wang ZC, Chen YL, Gao RD. Stability and infectivity of coronaviruses in inanimate environments. World J Clin Cases 2020. [PMID: 32368532 DOI: 10.12998/wjcc.v8.i8.1391.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious virus that can transmit through respiratory droplets, aerosols, or contacts. Frequent touching of contaminated surfaces in public areas is therefore a potential route of SARS-CoV-2 transmission. The inanimate surfaces have often been described as a source of nosocomial infections. However, summaries on the transmissibility of coronaviruses from contaminated surfaces to induce the coronavirus disease 2019 are rare at present. This review aims to summarize data on the persistence of different coronaviruses on inanimate surfaces. The literature was systematically searched on Medline without language restrictions. All reports with experimental evidence on the duration persistence of coronaviruses on any type of surface were included. Most viruses from the respiratory tract, such as coronaviruses, influenza, SARS-CoV, or rhinovirus, can persist on surfaces for a few days. Persistence time on inanimate surfaces varied from minutes to up to one month, depending on the environmental conditions. SARS-CoV-2 can be sustained in air in closed unventilated buses for at least 30 min without losing infectivity. The most common coronaviruses may well survive or persist on surfaces for up to one month. Viruses in respiratory or fecal specimens can maintain infectivity for quite a long time at room temperature. Absorbent materials like cotton are safer than unabsorbent materials for protection from virus infection. The risk of transmission via touching contaminated paper is low. Preventive strategies such as washing hands and wearing masks are critical to the control of coronavirus disease 2019.
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Affiliation(s)
- Shi-Yan Ren
- Vascular Surgery, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China.
| | - Wen-Biao Wang
- Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Ya-Guang Hao
- Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Hao-Ran Zhang
- State Key laboratory of Natural and Biomimetic Drugs, Department of Chemical Biology, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Zhi-Chao Wang
- Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Ye-Lin Chen
- College of Robotics, Beijing Union University, Beijing 100101, China
| | - Rong-Ding Gao
- Aviation General Hospital, China Medical University, Beijing 100012, China
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Ren SY, Gao RD, Chen YL. Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. World J Clin Cases 2020. [PMID: 32149049 DOI: 10.12998/wjcc.v8.i4.652.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The current corona virus disease 2019 outbreak caused by severe acute respiratory syndrome coronavirus 2 started in Wuhan, China in December 2019 and has put the world on alert. To safeguard Chinese citizens and to strengthen global health security, China has made great efforts to control the epidemic. Many in the global community have joined China to limit the epidemic. However, discrimination and prejudice driven by fear or misinformation have been flowing globally, superseding evidence and jeopardizing the anti-severe acute respiratory syndrome coronavirus 2 efforts. We analyze this phenomenon and its underlying causes and suggest practical solutions.
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Affiliation(s)
- Shi-Yan Ren
- Vascular Surgery, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China.
| | - Rong-Ding Gao
- Vascular Surgery, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Ye-Lin Chen
- College of Robotics, Beijing Union University, Beijing 100101, China
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Ren SY, Gao RD, Chen YL. Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. World J Clin Cases 2020; 8:652-657. [PMID: 32149049 PMCID: PMC7052559 DOI: 10.12998/wjcc.v8.i4.652] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 02/05/2023] Open
Abstract
The current corona virus disease 2019 outbreak caused by severe acute respiratory syndrome coronavirus 2 started in Wuhan, China in December 2019 and has put the world on alert. To safeguard Chinese citizens and to strengthen global health security, China has made great efforts to control the epidemic. Many in the global community have joined China to limit the epidemic. However, discrimination and prejudice driven by fear or misinformation have been flowing globally, superseding evidence and jeopardizing the anti-severe acute respiratory syndrome coronavirus 2 efforts. We analyze this phenomenon and its underlying causes and suggest practical solutions.
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Affiliation(s)
- Shi-Yan Ren
- Vascular Surgery, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Vascular Surgery, Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Ye-Lin Chen
- College of Robotics, Beijing Union University, Beijing 100101, China
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Li X, Yang B, Li X, Ren S. Prospective Comparison of Effect of Ligation and Foam Sclerotherapy with Foam Sclerotherapy Alone for Varicose Veins. Ann Vasc Surg 2018; 49:75-9. [PMID: 29428536 DOI: 10.1016/j.avsg.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 09/29/2017] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND To compare the efficacy of ligation after foam sclerotherapy (FSL) with foam sclerotherapy (FS) alone for patients with varicose veins prospectively. METHODS Ninety-four patients with varicose veins underwent foam sclerothrapy alone and 88 patients with varicose veins received FSL. Patients were followed up at 1, 3, 6, and 12 months after treatment. The postoperative complications were documented prospectively. RESULTS In comparison with patients who underwent FSL, patients treated with FS only had higher incidence of phlebitis within 4 weeks (14.9% vs. 1.1%, P = 0.002) and at 6 months (10.6% vs. 0, P = 0.002) after treatment and had higher incidence of tenderness or discomfort (9.8% vs. 0, P = 0.003) and recanalization rate (8.5% vs. 1.1%, P = 0.007) at 6 months after treatment. All patients in both groups had no deep vein thrombosis and pulmonary embolism. CONCLUSIONS Patients treated with FSL have less postoperative complications than those with foam sclerotheray alone. FSL is an alternative procedure for management of patients with varicose veins. Also, a randomized prospective study is required to observe the long-term outcomes of the FSL.
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Abstract
BACKGROUND Foam sclerotherapy (FS) is a safe and effective approach for managing patients with varicose veins and venous ulcers in lower extremities. But, recanalization of the ablated varicose veins and phlebitis are common postoperative complications that jeopardize its clinical effects. We hypothesize that ligation of the ablated varicose veins after FS will improve the outcomes of patients with varicose veins and venous ulcer. This study was aimed to evaluate the clinical efficacy of ligation after FS in comparison with FS alone for the management of patients with varicose veins and venous ulcers in lower extremities. METHODS Eighteen patients underwent FS plus ligation (FSL) and 15 patients received FS alone. Aberdeen varicose veins questionnaire (AVVQ) and the revised venous clinical severity score (rVCSS), venous disability scores (VDSs), duplex sonography, ulcer healing rate, and ulcer healing time were documented to compare the outcomes in both groups. RESULTS The ulcer healing time in patients treated with FSL was shorter than that in patients who received FS (P = 0.022; log-rank test). The average healing time was significantly shorter in FSL group than in FS group (35.67 ± 24.62 days vs. 62.86 ± 47.43, P = 0.042). The mean rVCSS, VDS, and AVVQ at 3 months after treatment in both groups decreased significantly in comparison with baseline, respectively. There were no severe complications or side effects in both groups. CONCLUSIONS Ligation of the treated varicose veins after FS can improve the outcomes of patients with venous ulcers in comparison with FS alone. FSL is a safe, effective, and technically feasible procedure and can be used as a day surgery.
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Affiliation(s)
- Xin Li
- Department of Neurology, First Affiliated Hospital of Jiamusi University, Heilongjiang, China
| | - Lin Fan
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Shiyan Ren
- Department of Vascular Surgery, Aviation General Hospital, China Medical University, Beijing, China.
| | - Xianlun Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
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Sun Y, Li X, Chen Z, Li X, Ren S. Feasibility and safety of foam sclerotherapy followed by a multiple subcutaneously interrupt ligation under local anaesthesia for outpatients with varicose veins. Int J Surg 2017; 42:49-53. [PMID: 28419883 DOI: 10.1016/j.ijsu.2017.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To prospectively evaluate the feasibility and safety of foam sclerotherapy and ligation (FSL) for outpatients with varicose veins under local anaesthesia. METHODS 136 outpatients with varicose veins who were unwilling to be hospitalized underwent FSL. FSL is a technique in which the dilated varicose veins were ligated subcutaneously after foam sclerotherapy with an absorbable suture. Patients were reviewed at 1, 3, 6 and 12 months after FSL. Pain scores were recorded after FSL. The revised venous clinical severity scorer (rVCSS) and clinical, etiological, anatomical, and pathological classification (CEAP) were used to evaluate the improvement at 3 months after treatment. RESULTS 146 limbs in 136 outpatients with varicose veins were managed with FSL. The pain scores decreased following FSL, CEAP classification score, the rVCSS values improved 3 months postintervention. No significant postoperative complications were observed on follow-up. CONCLUSION FSL is feasible, safe and easily to perform under local anaesthesia for outpatients with varicose veins.
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Affiliation(s)
- Yan Sun
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China; Department of Vascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Xin Li
- Department of Neurology, First Affiliated Hospital of Jiamusi University, Helongjiang, 154002, China
| | - Zhong Chen
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Xianlun Li
- Cardiovascular Center, China-Japan Friendship Hospital, Beijing, 100019, China.
| | - Shiyan Ren
- Vascular Surgery, Aviation General Hospital, Beiijng, 100023, China.
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Zhou Y, Yang P, Li A, Ye X, Ren S, Li X. Prostaglandin E 2 reduces swine myocardial ischemia reperfusion injury via increased endothelial nitric oxide synthase and vascular endothelial growth factor expression levels. Biomed Rep 2016; 6:188-194. [PMID: 28357071 PMCID: PMC5351385 DOI: 10.3892/br.2016.834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/12/2016] [Indexed: 02/05/2023] Open
Abstract
Prostaglandin E2 (PGE2) has been demonstrated to attenuate cardiac ischemia-reperfusion (I/R) injury. However, the underlying mechanism of PGE2 in cardiac I/R injury remains unknown. Upregulated expression levels of vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) were reported in acute myocardial infarction (AMI), and were demonstrated to diminish I/R injury. In the current study the involvement of VEGF and eNOS in the myocardial protective effect of PGE2 were investigated in a catheter-based porcine model of AMI. Twenty-two Chinese miniature pigs were randomized into sham-surgery (n=6), control (n=8) and PGE2 (n=8) groups. PGE2 (1 µg/kg) was injected from 10 min prior to left anterior descending occlusion up to 1 h after reperfusion in the PGE2 group. Subsequently, the hemodynamic parameters were evaluated. Thioflavin-S and Evans Blue double staining were performed to evaluate the extent of the myocardial reperfusion area (RA) and no-reflow area (NRA). Immunohistochemical and western blot analysis were used to evaluate protein expression levels of VEGF and eNOS. Left ventricular (LV) systolic pressure significantly improved and LV end-diastolic pressure significantly decreased in the PGE2 group when compared with the control group 2 h after occlusion and 3 h after reperfusion (P<0.05, respectively). The RA and NRA were smaller in the PGE2 group than in the control group (P<0.05, respectively). Furthermore, PGE2 treatment increased the myocardial content of VEGF and eNOS when compared with the control group (P<0.05, respectively). Thus, the results of the present study demonstrate the cardio-protective mechanisms of PGE2, which may protect the heart from I/R injury via enhancement of VEGF and eNOS expression levels.
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Affiliation(s)
- Ying Zhou
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Peng Yang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Aili Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Xiaojun Ye
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Shiyan Ren
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Xianlun Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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Li X, Li C, Hou L, He M, Song G, Ren S, Han C. Higher Level of Serum Heme Oxygenase-1 in Patients With Intracerebral Hemorrhage. Int Surg 2015; 100:1220-4. [PMID: 26595496 DOI: 10.9738/INTSURG-D-14-00086.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The objective of this paper was to investigate the association of the serum level of heme oxygenase-1 in patients with intracerebral hemorrhage (ICH) with the risk of ICH. Heme oxygenase-1(HO-1) metabolizes heme into biliverdin, bilirubin, carbon monoxide, and iron, our recent study showed that serum level of HO-1 was increased in stroke patients, yet the association of HO-1 level with risk of intracerebral hemorrhage (ICH) is poorly known. Forty patients with ICH and another 40 patients without ICH were recruited. The serum level of HO-1, total, and direct bilirubin were measured. The level of HO-1, serum total bilirubin, and direct bilirubin, as well as blood pressure were increased in ICH group than in control group (P < 0.001). The level of HO-1, both systolic and diastolic blood pressure had a significant difference between subgroups (P < 0.05). Multivariate regression analysis showed that poor compliance to medicine for hypertension, the serum level of HO-1, and systolic blood pressure were associated with the prevalence of ICH. Blood pressure, serum HO-1, serum total bilirubin, and direct bilirubin were raised in patients with ICH who did not take medicine for hypertension compared with those who did, and increased in ICH patients in comparison with control group. Further investigation in multiple medical centers with large number of cohorts is warranted to verify these results.
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Lin F, Zhang S, Sun Y, Ren S, Liu P. The management of varicose veins. Int Surg 2015; 100:185-9. [PMID: 25594661 DOI: 10.9738/INTSURG-D-14-00084.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to review the current management modalities for varicose veins. There are a variety of management modalities for varicose veins. The outcomes of the treatment of varicose veins are different. The papers on the management of varicose veins were reviewed and the postoperative complications and efficacy were compared. Foam sclerotherapy and radiofrequency ablation were associated with less pain and faster recovery than endovenous laser ablation and surgical stripping. Patients undergoing endovenous laser ablation and radiofrequency ablation are most likely to have a faster recovery time and earlier return to work in comparison with those undergoing conventional high ligation and stripping. A randomized controlled study in multiple centers is warranted to verify which approach is better than others for the treatment of varicose veins.
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Li X, Song G, Jin Y, Liu H, Li C, Han C, Ren S. Higher level of heme oxygenase-1 in patients with stroke than TIA. J Thorac Dis 2014. [PMID: 24977002 DOI: 10.3978/j.issn.2072-1439.2014.06.28.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a reverse relationship between serum bilirubin level and incidence of stroke, heme oxygenase-1 (HO-1) can catalyze heme into bilirubin, it is unknown the association of HO-1 level with risk of stroke. METHODS Sixty patients with stroke and fifty patients with transient ischemic attack (TIA) were recruited. Serum level of HO-1, total and direct bilirubin, alanine transaminase, live function, lipid profile and infection status of patients were measured. RESULTS Significant differences were found between two groups in terms of serum levels of HO-1 (163.6±58.7 vs. 141.2±49.7, P=0.032), total bilirubin (10.1±4.6 vs. 15.8±2.7, P<0.001), direct bilirubin (3.2±2.1 vs. 5.9±1.2, P<0.001), fasting glucose (6.7±3.1 vs. 4.9±1.3, P<0.001), cholesterol (4.4±1.1 vs. 3.9±0.8, P=0.005) and diastolic blood pressure (DBP) (84.9±9.4 vs. 81.3±9.2, P=0.046). In multivariate analysis, serum direct bilirubin (OR, 2.83; P<0.001), total bilirubin (OR, 1.82, P=0.001), DBP (OR, 0.88, P=0.041), and fasting glucose (OR, 0.34, P<0.001) were independent predictors of stroke. CONCLUSIONS Serum HO-1 level is higher in patients with stroke than TIA, but the bilirubin level is lower in patients with stroke than TIA and is an independent predictor of stroke. Further studies are warranted to clarify the underlying link among HO-1, bilirubin and stroke.
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Affiliation(s)
- Xin Li
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
| | - Guangfu Song
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
| | - Yuling Jin
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
| | - Hongwei Liu
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
| | - Changqing Li
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
| | - Chengwu Han
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
| | - Shiyan Ren
- 1 Department of Neurology, 2 Department of Neurosurgery, 3 Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China ; 4 Department of Invasive Technology, Ditan Hospital, Capital Medical University, Beijing 100015, China ; 5 Clincical Laboratory, 6 Cardiovascular Surgery, China Japan-Friendship Hospital, Beijing 100029, China
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Liu P, Wang F, Ren S, Lin F, Yang Y, Fan X, Sun G, Zheng X, Liu J, Yuan J, Ye Z. A propensity score analysis on the effect of on-pump versus off-pump coronary artery bypass grafting for patients with coronary artery disease. J Thorac Dis 2014. [PMID: 24977010 DOI: 10.3978/j.issn.2072-1439.2014.05.08.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM The aim of this retrospective observational study was to investigate the effect of on-pump versus off-pump coronary artery bypass grafting (CABG) for patients with coronary artery diseases (CAD). METHODS A retrospective observational study was performed using a propensity score analysis in 290 consecutive patients undergoing CABG between April 2009 and March 2014, of them, 54 patients undergoing off-pump CABG (OPCABG) were matched with 54 patients undergoing on-pump CABG (ONCABG) by propensity score. The perioperative complications and hospital mortality were documented. RESULTS Preoperative characteristics were comparable in both groups following propensity matching. Postoperative myocardial infarction (MI) incidence was lower in OPCABG group than in ONCABG group (3.7% vs. 14.8%, P=0.046); both hospital mortality and the major complications rates were similar in the two groups after propensity adjustment for preoperative characteristics. CONCLUSIONS The perioperative complications are similar in both off-pump and on pump CABG groups, the short-term effect of OPCABG is similar to that of ONCABG.
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Affiliation(s)
- Peng Liu
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fei Wang
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shiyan Ren
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fan Lin
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuguang Yang
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xueqiang Fan
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Guang Sun
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xia Zheng
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jiangtao Liu
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jing Yuan
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhidong Ye
- Cardiovascular center, China-Japan Friendship Hospital, Beijing 100029, China
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Yao S, Zeng Q, Peng M, Ren S, Chen G, Wang J. Stop violence against medical workers in China. J Thorac Dis 2014. [PMID: 24977026 DOI: 10.3978/j.issn.2072-1439.2014.06.10.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The incidence of patient-doctor disputes are alarmingly increasing in China, this article reviews the current status and causes of violence against medical workers in China, six strategies to tackle the daily worrying problems have been proposed and hopefully could improve the medical working environment in China.
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Affiliation(s)
- Shukun Yao
- 1 Doctor-Patient Relationship Department, 2 Cardiovascular Centre, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qing Zeng
- 1 Doctor-Patient Relationship Department, 2 Cardiovascular Centre, China-Japan Friendship Hospital, Beijing 100029, China
| | - Mingqiang Peng
- 1 Doctor-Patient Relationship Department, 2 Cardiovascular Centre, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shiyan Ren
- 1 Doctor-Patient Relationship Department, 2 Cardiovascular Centre, China-Japan Friendship Hospital, Beijing 100029, China
| | - Gang Chen
- 1 Doctor-Patient Relationship Department, 2 Cardiovascular Centre, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jiangjun Wang
- 1 Doctor-Patient Relationship Department, 2 Cardiovascular Centre, China-Japan Friendship Hospital, Beijing 100029, China
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Qu Y, Xu J, Jiao C, Cheng Z, Ren S. Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg 2014; 99:286-90. [PMID: 24833154 DOI: 10.9738/INTSURG-D-13-00175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The long-term outcomes of laparoscopic splenectomy (LS) versus open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP) are not known. A retrospective analysis of 73 patients who underwent splenectomy (32 LS and 41 OS) for refractory ITP between April 2003 and June 2012 was conducted. LS was associated with shorter hospital stay (P = 0.01), less blood loss and blood transfusion during surgery, quicker resumption of oral diet (P < 0.0001), and earlier drain removal (P < 0.01). Conversion to OS was required in 4 patients (12.5%). Operation time was significantly longer in LS (P < 0.0001). Deep venous thrombosis (DVT) was observed in 1 patient after LS and in 4 patients after OS (P = 0.52). One patient died from intraperitoneal bleeding after OS, another patient developed pulmonary embolism. Median follow-up of 36 months was performed in LS group (29 of 32, 91%) and of 46 months in OS group (35 of 41, 85%), 25 patients (86%) in LS group and 32 (91%) in OS group reached sustained complete response (P = 0.792). Kaplan-Meier analysis showed that there was no significant difference in the relapse-free survival rate between the groups (P = 0.777). In conclusion, the long-term outcome of laparoscopic splenectomy is not different from that of open splenectomy for patients with ITP.
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Wang K, Ren S, Qian S, Liu P. Grey relational analysis of benefit of surgical management for abdominal aortic aneurysm. Int Surg 2014; 99:189-94. [PMID: 24670031 DOI: 10.9738/INTSURG-D-12-00012.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Grey relational analysis was used to compare the long-term outcomes of endovascular repair (EVAR) versus open repair for patients with abdominal aortic aneurysm (AAA). Patients with AAA undergoing open repair (n = 133) or EVAR (n = 88) from July 1995 to January 2009 were studied retrospectively. Compared with EVAR, longer periods of postoperative intubation and hospital stay (P < 0.001) were required for open repair. The operation time was significantly longer in open surgery than in EVAR (P < 0.001). Patients in the open repair group required larger volumes of intraoperative blood transfusion than those in EVAR (P < 0.001), and they had more of a trend of cardiac failure after surgery than those in the EVAR group. The operative mortality was similar in both groups. On follow-up, the all-cause mortality and the rates of ischemic legs within 5 years had no significant differences between the 2 procedures (P > 0.05). The grey relational grades in EVAR and open repair were 0.673 and 0.936, respectively. Compared with open repair, patients with AAAs undergoing EVAR had fewer complications in the short term and had a similar all-cause mortality in the long term.
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Ren S, Cao Y, Zhang X, Jiao S, Qian S, Liu P. Cephalosporin induced disulfiram-like reaction: a retrospective review of 78 cases. Int Surg 2014; 99:142-6. [PMID: 24670024 DOI: 10.9738/INTSURG-D-13-00086.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Concomitant ingestion of alcohol and cephalosporin may cause a disulfiram-like reaction; however its fatal outcomes are not commonly known. We retrospectively reviewed 78 patients who had cephalosporin induced disulfiram-like reaction (CIDLR). The patients who had a negative skin test to cephalosporin prior to intravenous antibiotics were included, and those who were allergic to either alcohol or antibiotics were excluded. The average age of 78 patients was 37.8±12.2 (21-60) years. Of the 78 patients, 93.58% of the patients were males, 70.51% of the patients consumed alcohol after use of antibiotics, and 29.49% patients consumed alcohol initially, followed by intravenous antibiotics; however, no significant difference of morbidity was observed in these two groups. All patients were administered antibiotics intravenously. Five of 78 patients (6.41%) developed severe CIDLR too urgently to be rescued successfully. In conclusion, it is important for clinicians to educate patients that no alcohol should be used if one is taking cephalosporin. Also, clinicians should keep in mind that cephalosporin should not be prescribed for any alcoholics.
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Ren S, Fan X, Peng L, Pan L, Yu C, Tong J, Zhang W, Liu P. Expression of NF-κB, CD68 and CD105 in carotid atherosclerotic plaque. J Thorac Dis 2013. [PMID: 24409354 DOI: 10.3978/j.issn.2072-1439.2013.12.36.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Atherosclerotic plaque vulnerability is associated with cerebrovascular events in patients with carotid atherosclerosis. The aim of this study was to investigate the expression of inflammatory factors in carotid artherosclerotic plaques in order to explore its clinical significance in patients with carotid stenosis. Forty three patients with carotid stenosis were divided into symptomatic group (n=24) and asymptomatic group (n=19) based on clinical manifestation. All patients were treated with selective standard carotid endarterectomy (CEA); the carotid atherosclerotic plaques were removed surgically and studied pathologically to investigate the expression of nuclear factor-kappa κ (NF-κB), CD68 and CD105. The plaques were grouped into stable and unstable plaques based on thickness of the fibrous cap and the area of lipid-rich core in the plaques. The proportion of unstable plaques were significantly higher in symptomatic group than in asymptomatic group (70.8% vs. 63.2%, P=0.026). Results of immunohistochemisty staining showed that the expression of NF-κB, CD68 and CD105 in unstable plaques was higher than stable plaques (P<0.001). The association of the higher expression of these factors with instability of carotid plaque needs to be clarified in future study.
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Affiliation(s)
- Shiyan Ren
- Cardiovascular Center, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Xueqiang Fan
- Cardiovascular Center, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Liang Peng
- Clinical research institute, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Lin Pan
- Clinical research institute, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Changan Yu
- Clinical research institute, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Jie Tong
- Department of Pathology, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Wenjian Zhang
- Clinical research institute, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
| | - Peng Liu
- Cardiovascular Center, China-Japan Friendship Hospital, Chaoyang District, Beijing 100029, China
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Ren S, Fan X, Ye Z, Liu P. Long-term outcomes of endovascular repair versus open repair of abdominal aortic aneurysm. Ann Thorac Cardiovasc Surg 2013. [PMID: 22790994 DOI: 10.5761/atcs.oa.11.01847.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the long-term outcomes of endovascular repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA). DESIGN We retrospectively reviewed consecutive AAA patients treated with EVAR (n = 89) or open repair (n = 136) from January 1998 to December 2008. RESULTS More patients in the open repair group had a longer duration of hospital stay. The operation time was significantly longer in open surgery than in EVAR (p <0.001), and the percentage of patients requiring a transfusion was higher in the open repair group than in EVAR. Patients in the open repair group had a higher incidence of cardiac insufficiency after surgery than did those in the EVAR group. Kaplan-Meier analysis indicated that the proportion of patients without complications in the EVAR group was significantly less than that in the open repair group (68.1% vs. 91.1%; p <0.0001), and the long-term survival rate in EVAR group was similar to open surgery group (87.5% vs. 91.1%; p = 0.555). Thrombosis was found inside of the aneurysm; postoperative complications in the EVAR group included ischemic legs, graft stenosis, and endoleaks that required further endoluminal treatment. CONCLUSIONS Endovascular repair of abdominal aortic aneurysm causes less trauma in patients with AAAs in the short term, and patients treated with EVAR have similar survival rate with open repair in the long term, but have postoperative complications requiring further interventional treatment.
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Affiliation(s)
- Shiyan Ren
- Vascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Ren S, Liu P, Ma G, Wang F, Qian S, Fan X. Long-term outcomes of synchronous carotid endarterectomy and coronary artery bypass grafting versus solely carotid endarterectomy. Ann Thorac Cardiovasc Surg 2013. [PMID: 22790995 DOI: 10.5761/atcs.oa.12.01928.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the effect of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) with solely CEA. METHODS During a five-year period ending December 2009, 25 consecutive patients received concomitant CEA and CABG, whereas, 62 consecutive patients underwent only CEA. They were followed at the median for 64.5 months. The Kaplan-Meier method was used to evaluate the survival rate of patients in both groups. RESULTS There was no significant difference in terms of age, proportion of gender, risk factors of coronary artery disease and carotid artery stenosis. The degree of carotid artery stenosis was identical in both study groups. One patient in CEA/CABG group had 60% stenosis of carotid artery with ulcerative plaque. There was no early death in the short postoperative period. Restenosis was found on ultrasonography in 4 patients in the CEA/CABG group, and 12 patients in the CEA group; no statistical difference was found between both groups (P = 0.952). The intubation time, ICU stay, and hospital stay in CEA/CABG group were longer than in solely CEA group (P <0.001). The median duration of follow-up was 64.5 months (IQR 24-84 months). The survival rate was 88 %(22/25) in CEA/CABG group and 80.6 %(50/62) in CEA group, product-limit analysis showed that there was no significant difference in survival rates between two groups (P >0.05). CONCLUSION concomitant carotid endarterectomy and CABG can be safely performed, it could prevent stroke and would not increase the overall risk of surgery.
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Affiliation(s)
- Shiyan Ren
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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Abstract
Primary large saccular aortic aneurysm with high grade stenosis of aortic arc is rare, and no standard therapy is available. We have encountered one case and successfully treated using a hybrid interventional approach. A 59-year-old woman with a 7-day history of headache, dizziness and chest pain, and a 5-year history of hypertension admitted and was diagnosed with transverse aortic aneurysm with sever aortic stenosis, the huge saccular aneurysm was located behind the transverse aortic arc. During surgery, a bypass with graft from ascending aorta to left external iliac artery was made initially in order to ensure the blood supply to the left leg, afterward, a 40 mm × 160 mm covered stent was implanted to cover the orifice of aneurysm and was used as a supporting anchorage in the descending aorta, a second covered stent (20 mm × 100 mm) was implanted to expand the stenosis of aortic arc. Follow-up at 1.5-year after surgery, the patient has been doing well without any surgical complication. A collateral pathway between internal mammary artery and inferior epigastric artery via the superior epigastric artery was found on3-dimensional reconstruction before surgery. Interruption of the compensatory arterial collateral pathway in the patient with severe stenosis of aortic arc should be prevented if possible in order to ensure the satisfactory perfusion of the lower limbs of the body.In conclusion, a patient with transverse aortic aneurysm accompanied with severe aortic stenosis can be treated by hybrid surgery.
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Affiliation(s)
- Shiyan Ren
- China-Japan Friendship Hospital, Beijing, China
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Ren S, Qian S, Wang W, Liu J, Liu P. Prospective study of sarpogrelate hydrochloride on patients with arteriosclerosis obliterans. Ann Thorac Cardiovasc Surg 2013; 19:30-4. [PMID: 23364237 DOI: 10.5761/atcs.oa.12.02061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the effect of sarpogrelate for patients with atherosclerotic obliterans (ASO). PATIENTS AND METHODS Patients with ASO were randomly divided into sarpogrelate group (n = 92) and control group (n = 84). The patients in sarpogrelate group received sarpogrelate (100 mg, tid), whereas in control group aspirin (100 mg, qd) was administered orally. The patients were followed up monthly to observe any side effect of medication. Clinical manifestation, painless walking distance, Rutherford type and ankle brachial Index (ABI) were studied. RESULTS In comparison with control group, the severity of pain, Rutherford type 0 and 1 were improved with statistic significance. Incidence of patients with intermittent claudication decreased from 56.6% before treatment to 28.3% after treatment; the painless walking distance was prolonged (116.3 ± 72.3m vs. 243.5 ± 175.3m, P <0.001); ABI values were increased (0.74 ± 0.17 vs. 0.86 ± 0.18; p <0.001). No side effect of medication was observed. CONCLUSION Sarpogrelate has a therapeutic effect on patients with atherosclerotic obliterans.
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Affiliation(s)
- Shiyan Ren
- Cardiovascular Surgery, China-Japan Friendship Hospital, the Chinese Ministry of Health, Beijing, China
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Ren S, Li X, Wen J, Zhang W, Liu P. Systematic review of randomized controlled trials of different types of patch materials during carotid endarterectomy. PLoS One 2013; 8:e55050. [PMID: 23383053 PMCID: PMC3561447 DOI: 10.1371/journal.pone.0055050] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/17/2012] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose Carotid endarterectomy (CEA) with patch angioplasty produces greater results than with primary closure; however, there remains uncertainty on the optimal patch material in CEA. A systematic review of randomized controlled trials (RCTs) was performed to evaluate the effect of angioplasty using venous patch versus synthetic patch material, and Dacron patch versus polytetrafluoroethelene (PTFE) patch material during CEA. Methods A multiple electronic health database screening was performed including the Cochrane library, Pubmed, Ovid, EMBASE and Google Scholar on all randomized controlled trials (RCTs) published before November 2012 that compared the outcomes of patients undergoing CEA with venous patch versus synthetic patch. RCTs were included if they compared carotid patch angioplasty with autologus venous patch versus synthetic patch material, or compared one type of synthetic patch with another. Results Thirteen RCTs were identified. Ten trials, involving 1946 CEAs, compared venous patch with synthetic patch materials. Two trials, involving 400 CEAs in 380 patients, compared Dacron patch with PTFE patch. The hemostasis time in CEA with PTFE patch was significantly longer than with venous patch (P<0.0001), and longer than with Dacron patch (P<0.0001). There was no significant difference of mortality rate, stroke rate, restenosis, and operative time in CEA with venous patch versus synthetic patch material, or in CEA with Dacron patch versus PTFE patch (all P>0.05). One RCT of 95 CEAs in 92 patients compared bovine pericardium with Dacron patch, and demonstrated a statistically significant decrease in intraoperative suture line bleeding with bovine pericardium compared with Dacron patch (P<0.001). Conclusions The hemostasis time in CEA with PTFE patch was longer than with venous patch or Dacron patch. The overall perioperative and long-term mortality rate, stroke rate, restenosis, and operative time were similar when using venous patch versus synthetic patch material or Dacron patch versus PTFE patch material during CEA. More data are required to clarify differences between different patch materials.
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Affiliation(s)
- Shiyan Ren
- Cardiovascular Center, China-Japan Friendship Hospital, Beijing, People's Republic of China.
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Qu Y, Ren S, Li C, Qian S, Liu P. Management of postoperative complications following splenectomy. Int Surg 2013; 98:55-60. [PMID: 23438277 DOI: 10.9738/CC63.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Complications of post-splenectomy, especially intra-abdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. The objective of this study was to investigate the cause, prompt diagnosis, and outcome of the fatal complications after splenectomy with a focus on early diagnosis and management of hemorrhage after splenectomy. The medical files of patients who underwent splenectomy between January 1990 and March 2011 were reviewed retrospectively. The cause, characteristics, management, and outcome in patients with post-splenectomy hemorrhage were analyzed. Fourteen of 604 patients (1.19%) undergoing splenectomy had intraperitoneal hemorrhage: reoperation was performed in 13 patients, and 3 patients died after reoperation, giving the hospital a mortality rate of 21.43%; whereas, 590 of 604 patients (98%) had no hemorrhage following splenectomy, and the mortality rate (0.34%) in this group was significantly lower (P < 0.001). The complications following splenectomy, including pneumonia pancreatitis, gastric fistula, gastric flatulence, and thrombocytosis, in patients with postoperative hemorrhage were significantly higher than those without hemorrhage (P < 0.001). According to the reasons for splenectomy, 14 patients with post-splenectomy hemorrhage were grouped into two groups: splenic trauma (n = 9, group I) and portal hypertension (n = 5, group II). The median interval between splenectomy and diagnosis of hemorrhage was 15.5 hours (range, 7.25-19.5 hours). No differences were found between groups I and II in terms of incidence of postoperative hemorrhage, time of hemorrhage after splenectomy, volume of hemorrhage, and mortality of hemorrhage, except transfusion. Intra-abdominal hemorrhage after splenectomy is associated with higher hospital mortality rate and complications. Early massive intraperitoneal hemorrhage is often preceded by earlier sentinel bleeding; careful clinical inquiry and ultrasonography are the mainstays of early diagnosis.
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Ren S, Liu P, Wang W, Yang Y. Retained foreign body after laser ablation. Int Surg 2012; 97:293-5. [PMID: 23294067 DOI: 10.9738/CC155.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Laser ablation for varicose veins is a common practice, and postoperative complications may happen. A retained foreign body could be left accidently in the treated leg. It is rarely reported in literature. We herein describe two cases of retained foreign body during the laser ablation for varicose veins. One patient with varicose veins received laser therapy 5 years earlier, and had experienced discomfort and pain. After investigation, an overlooked sheath fragment was removed surgically from the leg. Another patient with varicose veins had discomfort after laser ablation for 8 days, and has been asymptomatic after the removal of the retained foreign body in the leg. The essential preventive approach include to pinpoint the site of the tip of fiberoptic laser fiber and pull 1 to 2 cm of the sheath out of the patient, then withdrawal the fiberoptic fiber and sheath simultaneously. A white flash light in the trunk of the fiberoptic laser fiber is an important warning signal of an erroneous manipulation during the operation. The surgeon should routinely check the intact sheath and fiberoptic fiber after laser ablation. In conclusion, retained foreign body can be prevented by following some practical tips during laser ablation.
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Liu P, Ren S, Qian S, Wang F. Multiple cardiac perforations following radiofrequency catheter ablation: case report and literature reviews. Ann Thorac Cardiovasc Surg 2012; 18:370-4. [PMID: 22293306 DOI: 10.5761/atcs.cr.11.01730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Multiple cardiac ruptures after radiofrequency catheter ablation that requires surgical repair are uncommon. METHODS AND RESULTS We describe a 64-year old male patient with paroxysmal atrial fibrillation who had a cardiac tamponade following radiofrequency ablation. Surgical exploration demonstrated two ruptures in the left atrium, one in the right atrium, and one hematoma in the right atrium. MEDLINE, the Cochrane Library, and related databases were searched up to June 2011 without language restrictions, and related literature was reviewed and discussed. The patient has survived from prompt cardiac repair of cardiac ruptures and recovered from surgery without complications. CONCLUSIONS Urgent exploratory surgery with cardiopulmonary bypass is the key to salvage the patient.
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Affiliation(s)
- Peng Liu
- Cardiovascular Center, China-Japan Friendship Hospital, Beijing, China
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Liu P, Ren S, Lin F, Yang Y, Ye Z. Diagnosis and management of acute thromboembolic occlusion of the superior mesenteric artery. Hepatogastroenterology 2011. [PMID: 22024059 DOI: 10.5754/hge11251.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS Acute occlusion of the superior mesenteric artery (SMA) is rare and difficult to diagnose, the associated morbidity and mortality are still high. Here we review our experience in diagnosis and treatment of acute embolic occlusion of the SMA, determine factors for surgical complications and patient survival. METHODOLOGY Thirty-seven patients with acute embolic occlusion of the SMA between 1993 and 2009 were retrospectively analyzed. RESULTS There were 23 (62.16%) men and 14 (37.84%) women, with a mean age of 59 years. Abdominal pain associated with nausea and vomiting was present in 32 (86.49%) patients. Twenty patients had atrial fibrillation. Emergency mesenteric arteriography was performed in 89.19% (33/37) patients. Fifteen patients were managed medically and 17 patients underwent surgical exploration. Of the 37 patients treated, 21 (56.75%) survived and were grouped as the survival group, 16 (43.24%) died and were grouped as the mortality group. In comparison with the survival group, patients in the mortality group had been delayed longer before definitive treatment and had higher white blood cell counts and proportion of neutral cells, shorter length of remaining bowel after surgery and higher incidence of renal insufficiency. CONCLUSIONS Early diagnosis and intervention would improve the outcomes of patients with SMA. Identification of viable intestine and resection of the necrotic bowel during surgery are critical in improving the survival rate.
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Affiliation(s)
- Peng Liu
- Department of Surgerey, China-Japan Friendship Hospital, Beijing, China
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Liu P, Ren S, Yang Y, Liu J, Ye Z, Lin F. Intravenous catheter-guided laser ablation: a novel alternative for branch varicose veins. Int Surg 2011; 96:331-6. [PMID: 22808616 DOI: 10.9738/cc44.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
It is difficult to manage tributary varicose veins with endovenous laser ablation. Using the intravenous catheter-guided laser fiber to ablate the tributary varicose veins has been proposed. From April 2004 to December 2009, we randomly assigned 134 patients with 170 limbs for laser therapy, of which, 89 limbs in 74 patients were treated with laser ablation. The residual tortuous veins were abolished with the intravenous catheter-guided laser ablation (ICLA group), whereas residual varicose veins in 81 limbs in 60 patients were treated by stab avulsion (SA group). Patients were followed up with the median of 44.5 months after surgery. The outcomes and durability of treatment in both groups were evaluated. The primary end point was recurrence of varicose veins. In comparison with the SA group, patients in the ICLA group had fewer surgical incisions and morbidity, a shorter hospital stay, and returned to normal activity earlier. The overall 5-year recurrence of varicose veins was infrequent in the ICLA group but was much higher in the SA group (5.4% versus 20%, P = 0.022). ICLA provided better outcomes than conventional SA in managing the branched varicose veins and may be an alternative for the treatment of branch varicose veins.
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Ren S, Liu P, Zhou N, Dong J, Liu R, Ji W. Complications after pancreaticoduodenectomy for pancreatic cancer: a retrospective study. Int Surg 2011; 96:220-7. [PMID: 22216700 DOI: 10.9738/cc17.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Postoperative complications, such as pancreatic fistulae, after pancreaticoduodenectomy for pancreatic cancers are associated with surgical outcomes of patients with pancreatic cancers. A total of 160 patients with pancreatic cancers undergoing pancreaticoduodenectomy were retrospectively analyzed. Patients were grouped into a fistulae group (n = 34) and a nonfistulae group (n = 126). The fistulae group had a significantly higher morbidity rate than the nonfistulae group (P < 0.0001), but hospital mortality was not different in both groups (P = 0.481). There was a higher incidence of intra-abdominal hemorrhage in patients with pancreatic fistulae than in those without fistulae. Two patients in fistulae group underwent reoperation. Patients with pancreatic fistulae had significantly longer hospital stay than those without fistulae. Pancreatic duct diameter, smoking, years of tobaccos consumption, preoperative jaundice, and surgical hours were associated with risk of fistulae on univariate analysis. In a multivariate analysis, diameter of pancreatic duct, surgical hours, and preoperative jaundice were independent risk factors of pancreatic fistulae. Incidence of pancreatic fistulae after pancreaticoduodenectomy is significantly influenced by the size of pancreatic duct diameter, surgical time, and preoperative jaundice. Early postoperative hemorrhage could be cautiously prevented. The survival is not significantly impacted by pancreatic fistulae.
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Zhou NX, Chen JZ, Liu Q, Zhang X, Wang Z, Ren S, Chen XF. Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Robot 2011; 7:131-7. [PMID: 21412963 DOI: 10.1002/rcs.380] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreatoduodenectomy (PD) for pancreatic cancer is very challenging to many surgeons. Information regarding the advantage of using the Da Vinci robotic system over conventional open surgery for PD is rare. Therefore, a comparison of the outcomes of PD performed using the Da Vinci robotic system with outcomes using open surgery was conducted. METHODS Between January 2009 and December 2009 sixteen patients underwent PD, eight patients receiving robot-assisted surgery using the Da Vinci surgical robotic system (Group I) and eight being treated using conventional open surgery (Group II). RESULTS There was no significant difference in radical resection (R0) rate between the two groups, 87.5% vs 100%, P = 0.05. The operative time in group I was longer than in group II, 718 ± 186 vs 420 ± 127 min, P = 0.011, while the surgical blood loss in group I was less than in group II, 153 ± 43 vs 210 ± 53 mL, P = 0.045. The length of bed time and hospital stay after surgery in group I were shorter than in group II, 27.5 ± 7.1 vs 96 ± 18.1 h, P = 0.000; 16.4 ± 4.1 vs 24.3 ± 7.1 days, P = 0.04, respectively). Complication rate of group I was lower than that of group II, 25% vs 75%, P = 0.05. CONCLUSION It is feasible and safe to perform PD using the Da Vinci robot-assisted surgical system; patients recovered faster postoperatively with less blood loss during surgery.
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Affiliation(s)
- Ning-xin Zhou
- Institute of Hepatobiliary Gastrointestinal Disease, General Hospital of PLA Second Artillery, No. 16 Xinjiekouwai Avenue, Xicheng District, Beijing, China.
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