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ABSTRACT: Carotid body tumors (CBT) are rare chemical receptor tumors. We report nine cases of CBT who were diagnosed at our center during 2004 to 2008 with a literature review. Of these nine patients, eight underwent complete resection, one received palliative resection due to the malignant nature of the tumor, and the other one refused surgery. No perioperative mortality and stroke occurred. During a mean follow up of 2.2 years, no deaths related to CBT occurred. Surgical treatment for CBT is relatively safe. The surgeon should be careful to maintain the integrity of carotid artery, and prevent cerebral ischemia and cranial nerve injuries in order to improve outcome.
Journal of Geriatric Cardiology 03/2013; 10(1):116-8.
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Xue-Feng Li,
Yong-Quan Gu,
Yang Hua,
Fu-Liang He,
Jian Zhang,
Jian-Xin Li,
Lian-Rui Guo,
Zhu Tong,
Xin Wu,
Jian-Ming Guo, Zhong-Gao Wang
Chinese medical journal 01/2013; 126(2):389-90. · 0.86 Impact Factor
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Zhonghua yi xue za zhi 12/2012; 92(47):3313-3316.
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Chengchao Zhang, Zhong-Gao Wang,
Ji-Min Wu,
Yungang Lai,
Feng Ji,
Xiang Gao,
Zhiwei Hu,
Guangchang Zhu,
Yachan Ning,
Zhitong Li,
Hong Liu,
Jing Zhao
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ABSTRACT: : Extraesophageal syndromes are more difficult to identify and treat than the usual esophageal symptoms. The current study explores the efficacy of laparoscopic Nissen fundoplication (LNF) on gastroesophageal reflux disease (GERD)-related respiratory symptoms (RSs) during a 12-month follow-up observation.
: From April 2008 to September 2009, LNF was performed on 198 patients (107 men and 91 women) with GERD-related RSs according to underlying esophageal motility. A questionnaire form ranging from 0 to 5 was the basic requirement for recording pretreatment and posttreatment and for making detailed evaluation of the symptoms. All scores of GERD-related RSs, such as heartburn, regurgitation, coughing, breathe holding, wheezing, shortness of breath, and choking, significantly decreased at the 12th month.
: All the patients who participated in the current study were adults and elders aged 22 to 84 years with a mean age of 49±12.89. The median length of stay was 4.3 days with a range of 2 to 8 days. The median score of heartburn, regurgitation, coughing, wheezing, shortness of breath, choking, and chest pain decreased from 4.92±1.99, 4.98±1.81, 7.23±1.87, 7.50±1.88, 5.83±2.13, 5.94±2.22, and 4.92±1.88 to 1.62±2.33, 0.64±1.43, 2.79±2.82, 2.53±2.96, 1.37±2.10, 1.28±2.09, and 1.57±2.55 (P<0.01), respectively. A total of 173 patients had various relieved symptom scores, 16 patients (8.1%) had different scale recurrence of symptoms after laparoscopic fundoplication treatment, and 13 patients had to retreat to omeprazole as an auxiliary medical therapy. Three other patients rejected any therapy, and no deaths occurred. A single patient converted from laparoscopic surgery to open surgery. Several short-term symptoms included retrosternal uneasiness or pain (n=63; 31.8%), dysphagia (n=45; 22.7%), abdominal distension (n=87; 43.9%), and diarrhea (n=23; 11.6%). Early dysphagia lasting <6 weeks was common, and 45 patients (22.7%) underwent an early esophagogastroduodenoscopy or contrast swallow. Five patients (2.5%) who had prolonged dysphagia during the 6-month clinical review required esophageal dilatation, and the outcomes were successful.
: LNF can be an effective means for treating RSs in patients with GERD.
Surgical laparoscopy, endoscopy & percutaneous techniques 10/2012; 22(5):406-9. · 1.23 Impact Factor
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ABSTRACT: Gastroesophageal reflux disease (GERD) is a commonly encountered condition in children, which at times causes respiratory distress, such as asthmatic symptoms, and results in serious morbidity and even mortality. The complexity is sometimes so obscure, that it can cause paradoxical diagnoses and treatment. Here we present two cases of children with difficult-to-treat asthmatic symptoms, which were eventually found to be related to GERD. The two children were treated with anti-reflux procedures and both became symptom free. Literature was also reviewed to shed a light into this complex disease.
Multidisciplinary respiratory medicine. 09/2012; 7(1):28.
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ABSTRACT: Left renal vein hypertension secondary to left renal vein compression has been described as a cause of persistent hematuria in nutcracker syndrome. Malformation of the inferior vena cava (IVC), although rare and frequently asymptomatic, may also result in left renal vein hypertension, with resultant hematuria when it is severely compressed. We report a 20-year-old man with persistent hematuria due to compression of left-sided IVC. The patient was successfully treated by means of superior mesenteric artery (SMA) transposition and division of the fibrous bundle at the origin of the SMA. His postoperative course was uneventful. Compression of the left IVC is a unique form of nutcracker syndrome. SMA transposition, together with division of a fibrous bundle at the origin of the SMA if present, is a safe and effective surgical procedure for this special entity.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 07/2012; 56(3):816-8. · 3.52 Impact Factor
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ABSTRACT: Gastroesophageal reflux disease (GERD) was diagnosed and fundoplication was performed, which relieved the symptoms. This paper
explores the effect of fundoplication on GERD-related respiratory symptoms. From January 2007 to October 2008, 64 patients
with respiratory symptoms related to GERD were consecutively enrolled for laparoscopic fundoplication. Of these, 60 patients
had respiratory symptoms mainly combined with gastroesophageal reflux, while four had respiratory symptoms only. All patients
had GERD confirmed, and medical treatment provided before surgery resulted in an insufficiently favorable effect or even producing
further complications. All the patients were requested to fill a questionnaire form regarding the severity of symptoms and
their medication so as to make an evaluation score for the follow-up. The outcome of respiratory symptoms after surgery was
as follows: excellent in 23 cases (35.9%); good in 28 (43.8%); fair in 5 (7.8%); poor in 8 (12.5%). The mean respiratory symptom
score decreased from 6.3±2.65 to 2.33±2.37. Laparoscopic fundoplication can be an effective treatment for the majority of
patients with GERD-related respiratory symptoms.
Keywordsgastroesophageal reflux disease-pH monitoring-laparoscopic fundoplication-respiratory symptom
Frontiers of Medicine in China 04/2012; 4(2):254-258.
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ABSTRACT: Takayasu’s arteritis (TA) is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the
coronary tree. Here we report a case of TA complicated by severe stenosis of the left coronary ostium with multivessel brachiocephalic
involvement. A combination of these abnormalities could complicate underlying illness in patients, posing an increased risk
of surgical morbidity. Simultaneous surgical treatment of the ascending aorta to left carotid artery bypass and coronary artery
bypass using the great saphenous vein were performed. We discuss the choice of simultaneous surgery and the options for surgical
treatment of complicated lesions due to TA.
Key wordsTakayasu’s arteritis–Coronary occlusion–Multivessel–Brachiocephalic surgery
Surgery Today 04/2012; 41(4):552-555. · 1.22 Impact Factor
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ABSTRACT: Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis. However, the decision to perform this procedure has recently raised considerable debate. The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients, especially as it relates to blood pressure control and renal function improvement.
A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital. We compared blood pressure, number of oral antihypertensive medications, and renal function changes pre and post-procedure at 24 months follow-up.
A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed. At 24 months follow-up, both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P < 0.05). Overall, the estimated glomerular filtration rate did not change significantly (P > 0.05); however, a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P < 0.05).
Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients, providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications.
Chinese medical journal 04/2012; 125(8):1363-8. · 0.86 Impact Factor
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Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2012; 50(1):4-6.
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Cheng Chao Zhang, Zhong Gao Wang,
Chun Min Li,
Hong Yong Duan,
Jian Xin Li,
Yong Quan Gu,
Heng Xi Yu,
Li Xing Qi,
Bing Chen,
Zhen Li,
Ce Bian
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ABSTRACT: A case of mesocavoatrial shunting for the treatment of Budd-Chiari syndrome (BCS) with long-term follow-up is reported.
A 25-year-old man with stage II BCS was treated with a mesocavoatrial shunt to decompress the portal and IVC hypertension. During the 6-year follow-up, the patient was able to resume work as a salesperson and has since led a normal life. His graft remains patent.
A mesocavoatrial shunt can simultaneously decompress portal and IVC hypertension and has satisfactory long-term patency. A mesocavoatrial shunt can be used to treat patients with severe BCS who could not be successfully treated with medical therapy and intervention.
Annals of Vascular Surgery 11/2011; 26(2):277.e11-4. · 1.03 Impact Factor
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ABSTRACT: Diagnosis and treatment for respiratory symptoms (RSs) of gastroesophageal reflux disease (GERD) is more difficult than that for common esophageal symptoms. The goal of this study was to evaluate the efficacy and safety of radiofrequency (RF) treatment on RSs of GERD in a preliminary 12-month follow-up observation.
From April 2006 to October 2008, 505 GERD patients with mainly respiratory presentations such as wheezing, chronic cough or hoarseness, were treated by endoscopic RF. A questionnaire was completed before and after treatment, using a six-point scale ranging from 0 to 5 to assess symptom severity and frequency. The symptom score was the sum of frequency and severity.
Symptom scores were significantly improved at the end of the follow-up period. The mean heartburn score decreased from 5.31 to 1.79. The mean regurgitation score decreased from 5.02 to 1.64; mean cough score decreased from 6.77 to 2.85; mean wheezing score decreased from 7.83 to 3.07; and mean hoarseness score decreased from 5.13 to 1.81 (P < 0.01). No major complications or deaths occurred. Minor complications included temporary post-procedural retrosternal unease or pain (n = 106; 21.0%), mild fever (n = 86; 17.0%), transient nausea/vomiting (n = 97; 19.2%), and transient dysphagia (n = 42; 9.3%). Thirty-five (6.9%) patients had recurrence of symptoms. Endoscopic RF treatment was repeated in six patients, and laparoscopic fundoplication was performed in seven.
Endoscopic RF is an effective and safe means to treat RSs in patients with GERD.
Chinese medical journal 04/2011; 124(7):1006-9. · 0.86 Impact Factor
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ABSTRACT: Takayasu's arteritis (TA) is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the coronary tree. Here we report a case of TA complicated by severe stenosis of the left coronary ostium with multivessel brachiocephalic involvement. A combination of these abnormalities could complicate underlying illness in patients, posing an increased risk of surgical morbidity. Simultaneous surgical treatment of the ascending aorta to left carotid artery bypass and coronary artery bypass using the great saphenous vein were performed. We discuss the choice of simultaneous surgery and the options for surgical treatment of complicated lesions due to TA.
Surgery Today 04/2011; 41(4):552-5. · 1.22 Impact Factor
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ABSTRACT: We report a case of a mesojugular shunt for Budd-Chiari syndrome (BCS) with long-term follow-up.
A 32-year-old woman presented with late stage BCS. She was treated with a mesojugular shunt to relieve her portal hypertension. In a 17-year follow-up, she had a pregnancy, a postpartum period, and was diagnosed with systemic lupus eythematosus. She has resumed work as an operating room nurse and is having a normal life. Her graft remains patent.
A mesojugular shunt has less surgical trauma and satisfactory long-term patency than other shunts. It can be used to treat severe patients with BCS who are not candidates for intervention.
Annals of Vascular Surgery 10/2010; 24(7):953.e1-5. · 1.03 Impact Factor
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ABSTRACT: Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.
From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.
There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months.
When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.
Chinese medical journal 05/2010; 123(9):1122-6. · 0.86 Impact Factor
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ABSTRACT: To evaluate medium-long term patency of below-knee bypass on patients who suffered from diabetic lower limb ischemia.
Clinical and follow-up data of 51 patients was retrospectively analyzed who underwent 56 below-knee bypass because of diabetes from November 2001 to December 2006. There were 35 male and 16 female with an average age of 68 years. They endured 26 months ischemic time lag in average, and had suffered from diabetes for 11 years. All of the patients were performed bypass to below-knee (posterior tibial, anterior tibial or peroneal) arteries. Kaplan-meier method was applied. The subgroups of different operative methods and different out-flow vessels were compared by Log-rank tests.
An average follow-up time of 23 months was achieved, and lost-follow-up rate was 15%. The total 1- and 5-year primary patent rates were 68% and 54% respectively, secondary patent rate were 70% and 60% respectively, limb salvage rates were 69% and 65%, survival rates were 82% and 60%. One year (3 years) of patent rate(s) of operative method subgroups of femoral-popliteal-infrageniculate bypass with composite grafts, femoral/popliteal-infrageniculate bypass with artificial grafts and femoral/popliteal-infrageniculate bypass with autologous veins were 70% (50%), 33% (33%) and 70% (70%) respectively. One year (4 years) of patent rate(s) of out-flow vessel subgroups of posterior tibial artery, anterior tibial artery and peroneal artery were 65% (60%), 80% (53%) and 77% (66%) respectively. However, both subgroups did not show any statistic differences by log-rank tests.
Partial or whole autologous veins as bypass grafts should be chosen when infrageniculate bypass is considered in diabetic patients. Considerable patent rates are acceptable no matter what kinds of out-flow vessels are chosen.
Zhonghua wai ke za zhi [Chinese journal of surgery] 02/2010; 48(4):257-60.
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Ke-qin Wang, Zhong-gao Wang,
Bao-zhong Yang,
Chao Yuan,
Wang-de Zhang,
Biao Yuan,
Tong Xing,
Sheng-han Song,
Tan Li,
Chuan-jun Liao,
Yang Zhang
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ABSTRACT: Endovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.
Between June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.
We achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.
Endovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.
Chinese medical journal 01/2010; 123(1):45-50. · 0.86 Impact Factor
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Yong-quan Gu,
Jian Zhang,
Li-xing Qi,
Heng-xi Yu,
Xue-feng Li,
Lian-rui Guo,
Bing Chen,
Shi-jun Cui,
Ying-feng Wu,
Zhu Tong,
Yi-xia Qi,
Sheng-jia Yang,
Jian-ming Guo, Zhong-gao Wang
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ABSTRACT: To explore the method and effectiveness of treatment for severe acute deep venous thrombosis (DVT) in lower extremity.
Eighteen patients with severe acute DVT treated in our hospital from January 1, 2002 to December 31, 2008 were retrospectively analysed. All the patients had limb edema and pain, sixteen had limb cyanochroia(one had calf skin ulcer and foot gangrene), two had limb pallor, ten had weakened dorsalis pedis artery pulsation, eight had silent dorsalis pedis artery pulsation. Colour Doppler ultrasonography revealed DVT and superficial venous thrombosis in all diseased limbs. One patient underwent above knee amputation for limb gangrene. Seventeen underwent surgical thrombectomy, of which three were simple thrombectomy, five were supplemented with suprapubic saphenous vein bypass, six with suprapubic PTFE graft bypass, three with iliac vein lysis angioplasty.
One patient died (5.6%) on the third day after surgery. Limb edema relieved in seven patients (41.2%), reduced in ten patients (58.8%). All diseased limbs regained normal artery pulsation and skin appearance except for one limb amputated. Sixteen patients (94.1%) were followed up by a mean of 34 months. Limb edema disappeared in five patients (31.3%), reduced in eight patients (50%), recurrent in three patients (18.7%). Among three recurrent patients, one died of malignant tumor 9 months after operation, two had their graft occluded resulting from intimal hyperplasia.
Surgical thrombectomy is an effective method for treating severe acute DVT in lower extremity.
Zhonghua yi xue za zhi 12/2009; 89(45):3186-8.
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ABSTRACT: Gastroesophageal reflux disease with extra-esophageal symptoms, especially those with respiratory distress was attracting more and more attention. The related mechanisms were still in controversy. The purpose of the work was to explore airway inflammation triggered by gastroesophageal reflux.
Sixteen Sprague-Dawley rats were used as study group and 9 as control. In the study group, a plastic extender with a trumpet-shaped distal end was inserted into the lower esophagus to dilate the cardia, the pylorus was ligated. One ml of 0.1 mol/L hydrochloric acid was injected into the stomach. While a simple laparotomy was performed for control animals. All animals from two groups were sacrificed 24 hours after operation. Then tracheotomy was carried and the bronchoalveolar lavage fluid was collected in all animals. Cells in the fluid were counted and levels of interleukin (IL)-5, -6, -8 in it were measured.
Compared with control group, the study group presented a neutrophil pattern of airway inflammation and an elevated concentration of IL-5, -6, -8 with no significant difference regarding eosinophil count.
The gastroesophageal reflux-triggered airway inflammation is characterized by a neutrophilic airway inflammation which differed from that caused by asthma, and enhanced levels of IL-5, -6 and -8, which are similar to that caused by asthma.
Chinese medical journal 11/2009; 122(22):2775-8. · 0.86 Impact Factor
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ABSTRACT: Therapy for patients with Budd-Chiari syndrome is well established. For those with commonly seen localized lesions, percutaneous transluminal angioplasty or stenting is the first-line treatment. Treatment methods for severely ill patients in whom intervention has failed, or those in a poor general condition, are worth exploring. From February 2002 to July 2008, 31 patients were referred to us. Eighteen patients had a failed intervention, 4 had undergone surgery, and 10 had conservative therapy. All had intractable ascites or/and hematemesis. The procedures carried out in this series included mesocavoatrial shunt in 10 patients, radical correction in 9, mesocavojugular shunt in 7 (including 2 mesojugular shunts), mesocaval shunt in 2, cavoatrial shunt in 2 (including a revision of cavoatrial shunt), and cavojugular shunt in 1. Surgical mortality and postoperative complications were both 3.2%. Twenty-eight patients had a mean follow-up of 40 months. Outcome of follow-up was measured as excellent, good, fair, poor, and death (28.6%, 53.6%, 10.7%, 3.6%, and 3.6%, respectively). The total mortality of the group is 6.5%. After appropriate preoperative evaluation and preparation, active and cautious treatment individualized to the underlying disease may help severely ill patients with Budd-Chiari syndrome.
Annals of Vascular Surgery 11/2009; 24(3):301-7. · 1.03 Impact Factor
