2019年 · 第57卷第08期

Endovascular embolization is an effective method for the treatment of intracranial aneurysms. Its core is to promote the formation of thrombosis in the tumor cavity and maintain long-term stability^[1]。 Many new materials, including coated coils, are designed and developed for this purpose. However, there are some problems in clinical application, such as overall hard material and hydrocephalus induced by the absorption process of coated materials^[2]。 In 2016, Jiang et al. reported the direct electrocoagulation method of intra-arterial microguide wire, which successfully treated microaneurysms that could not be packed with coils^[3]。 From May to October 2018, a total of 10 patients with intracranial aneurysms who underwent intravascular coil embolization were treated with intraarterial microwire electrocoagulation in the neurosurgery department of our hospital, and the clinical results were satisfactory. The recent efficacy and experience of this procedure are reported as follows.

At present, coronary artery bypass grafting (CABG) is the most effective treatment for patients with severe coronary heart disease that are difficult to control with drugs and interventions^[1]。 However, with the aging of the population, the extensive development of medical interventional techniques, and the rapid increase of diabetes incidence, more and more patients with coronary artery disease show diffuse stenosis, and it is difficult for CABG alone to completely revascularize the diseased coronary artery and the long-term effect is poor^[2]。 For these patients, some scholars recommend coronary endarterectomy before coronary revascularization, but its clinical effect is still controversial^[3,4,5]。 on the basis of summarizing the previous literature at home and abroad and our own surgical experience, we used the left internal thoracic artery on-lay technique to reconstruct the anterior descending artery of diffuse lesions to complete CABG. The surgical experience is reported as follows.

Brucellosis is a zoonotic infectious disease caused by gram-negative bacilli of the genus Brucella^[1]Over 500,000 cases are reported worldwide every year^[2]。 Large-scale prevention and control of animal Brucella infection was carried out in China in the 1960s and 1970s^[3]This has significantly reduced the prevalence of brucellosis, but since the 1990s, the number of cases has increased significantly^[4]。

Male, 88 years old. 8 hours ago, he suddenly developed severe pain in the middle and lower abdomen and blood in the stool and was admitted to the hospital on February 18, 2018. The patient had a history of chronic atrial fibrillation for more than 10 years and chronic bronchitis for 8 years. Three years ago, he suffered from hemiplegia of his left limb due to cardiogenic cerebral embolism. Since then, he has been treated with oral warfarin anticoagulation, and the international standardized ratio (INR) has remained at 2~3. Physical examination after admission: abdominal tenderness, no rebound pain, normal intestinal sound. Laboratory results: white blood cell count 15×10⁹/L, C-reactive protein 10 mg/L; CT angiography (CTA) of the abdominal aorta showed: the filling defect of the middle segment of the superior mesenteric artery and the thickening and delayed enhancement of the intestinal wall; Radiography of the celiac trunk and inferior mesenteric artery was normal. Acute superior mesenteric artery embolism was diagnosed at admission.

Male, 47 years old, was admitted to hospital on June 30, 2018 due to numbness of both lower limbs with intermittent claudication for half a year, aggravated for more than one month. The patient had a history of smoking for more than 20 years (20 cigarettes/d) and quit smoking for half a year; Deny history of hypertension and diabetes; Six months ago, he was diagnosed with Takayasu arteritis in a local hospital; I underwent exploratory laparotomy + appendectomy 4 years ago for abdominal pain, and I still have paroxysmal abdominal distension after the operation. Admission physical examination: bilateral thoracic symmetry without deformity, clear breathing sounds in both lungs, heart rate 76 beats/min, homogeneous rhythm, no additional heart sounds and pathological murmur in the precordial area; An old surgical scar about 12 cm long can be seen in the middle of the abdomen, with soft abdomen, no tenderness and rebound pain, no palpable mass, and bowel sounds 4 times/min; Weak pulsation was palpable in bilateral femoral arteries, but no pulsation was palpable in bilateral popliteal arteries and dorsal pedis arteries. The ankle brachial index (ABI) of both lower limbs was 0.4. Ultrasound examination showed that strong echogenic light mass was detected in the lumen of abdominal aorta and iliac artery below the level of renal artery, and there was no blood flow signal. Blood flow signal could be detected in bilateral femoral artery, popliteal artery, dorsal pedis artery and posterior tibial artery, and blood flow velocity decreased. CT angiography (CTA) showed the possibility of mural thrombosis in the left subclavian artery, aortic arch and lower descending thoracic aorta, and intramural hematoma was not excluded. Shell-like calcification of the abdominal aorta wall, occlusion of the abdominal aorta and bilateral common iliac arteries below the level of the renal artery opening combined with multiple collateral circulation formation, dilatation and tortuosity of the internal thoracic artery, superior and inferior abdominal wall arteries, circumflex iliac artery, and lumbar artery (FIG. 1A）； There were no obvious abnormalities in electrocardiogram and various laboratory indexes. Clinical diagnosis: Leriche syndrome, Trans-Atlantic Inter-Society Consensus (TASC) type D (TASC-D). Low molecular weight heparin calcium was given after admission and discontinued on the day of surgery. Surgical treatment was performed on 4 Jul 2018.

Abdominal infection is a common surgical disease, and its etiology and disease spectrum cover a wide range. Appendicitis, biliary tract infection and infection secondary to abdominal surgery are the most common causes of complex abdominal infection^[1]。 If abdominal infection is not treated promptly and effectively, it can rapidly progress to sepsis, which is an important cause of death. Therefore, early diagnosis and timely and effective intervention are of great significance to improve the prognosis of patients.

A 65-year-old male was admitted with the diagnosis of "primary liver cancer of the right liver, hepatitis B cirrhosis and type 2 diabetes". The oncology index was negative, blood routine and liver function were normal. Preoperative enhanced MRI of the liver revealed a tumor in the right posterior lobe of the liver, approximately 5 cm ×6 cm in size (Figure 1）。 Laparoscopic right posterior lobectomy was proposed for Child-Pugh class A with indocyanine green 15 min retention rate of 6.8%.

Professor Feng Chuanhan, a member of the Communist Party of China, a famous orthopedic scientist and medical educator, a national first-class professor and doctoral supervisor, former vice president of Beijing Medical College, former president of Peking University People's Hospital, founder of the Department of Orthopedics of Peking University People's Hospital, the first chairman of the Orthopedic Branch of Chinese Medical Association, a member of the editorial board of the second, third, fourth and fifth editorial committee of Chinese Journal of Surgery, and deputy editor-in-chief of the sixth editorial committee, died at 9: 40 on June 16, 2019 at the age of 105.