Despite the availability of effective treatments for Graves' disease, there are patients who are unable to tolerate, or choose not to accept, current therapies (oral medication, radioactive iodine, or surgery). In this study, we have examined the use of thyroid arterial embolization as an option for patients who suffer from Graves' disease and who fit into one of the preceding patient groups. Selective arteriography, followed by embolization of thyroid arteries, was performed using Seldinger's technique in 22 patients with Graves' disease. Six of the patients received both arterial embolization and surgery at 2-3 wk after embolization. No serious complications were noted in any patient. In those who were treated with only interventional embolization, 14 of 22 (63.6%) became euthyroid and remained in this state for the duration of the study. The remaining 2 patients required a maintenance dose of antithyroid drug therapy (tapazole, 5-10 mg/d; or propylthiouracil, 50-100 mg/d). Patients were followed for a median time of 27 months (range, 6-50). At the end of the follow-up period, all 22 patients were euthyroid, the size of thyroid gland had decreased by one third to one half its original volume, but 2 patients continued to require antithyroid drugs. Histologic analysis of thyroid tissue from 6 patients who had embolization followed by surgery showed that embolization blocked both the superior and inferior thyroid arteries plus most of their branches. Evidence of chemical inflammation, necrosis, and fibrosis were observed in embolized thyroid tissue. The average diameter of capillary network within the body of the thyroid adjacent to superior and inferior artery was 0.12-0.25 mm, with the smallest ones ranging from 0.04-0.11 mm. The diameter of the capillaries in the isthmus ranged from 0.13-0.15 mm. The average diameters of the superior and inferior arteries were 2-5.5 and 3-3.75 mm, respectively, measured using radiographs from angiography. Based on the measured diameters of arteries, the appropriate size of embolizing granules can be selected, and complete embolization of the majority of the thyroid glands was achieved with a high frequency of therapeutic success. Histological examination of the thyroid tissue and clinical follow-up after embolization indicate that this procedure is an effective, minimally invasive, and safe method for the treatment of Graves' disease patients who cannot, or choose not to, accept current therapies.

目的 筛选和克隆原发性下肢深静脉瓣膜功能不全的大隐静脉曲张的致病相关基因。方法 利用mRNA荧光差异显示技术比较原发性下肢深静脉瓣膜功能不全患者的曲张大隐静脉隐-股瓣膜区组织中mRNA表达与对照组的差异，获得的差异表达cDNA片段经Northernblot验证后进行克隆和测序以探明其基因来源。结果 共获得37条差异表达的cDNA条带，经杂交验证其中30条为阳性（阳性率80%）。克隆及测序结果显示C610片段（NO.18克隆）与麦-考综合征（Mckusick-Kaufmansyndrome，MKKS）基因的mRNA序列有96%的同源性。结论 C610片段（NO.18克隆）与麦-考综合征基因高度同源，与下肢大隐静脉曲张的发病密切相关。

Tumor progression largely depends on blood supply and neovessel formation, and angiogenesis is emerging as a promising target for cancer therapy. Vascular endothelial growth factor (VEGF), a major proangiogenic molecule, stimulates angiogenesis via promoting endothelial proliferation, urvival and migration. VEGF has been found to be up-regulated in various types of tumors and to be associated with tumor progression and poor prognosis. Inhibition of VEGF or its signaling pathway has been shown to suppress tumor angiogenesis and tumor growth. In the present study, we tested the antiangiogenic and antitumor effects of soluble VEGF receptor-1 [soluble Flt (sFlt)-1] on the growth of follicular thyroid carcinoma (FTC). We constructed a 293 embryonic kidney cell line (293-Flt1-3d) that expresses sFlt-1, which is composed of the first three extracellular domains of Flt-1. The 293-Flt1-3d cells inhibited the in vitro growth of human umbilical vein endothelial cells in a paracrine manner. The in vivo antitumor and antiangiogenic activities of the 293-Flt1-3d cells were tested. When 293-Flt1-3d cells were inoculated at a site remote to the FTC-133 tumor transplant, the growth of FTC-133 tumors were inhibited by 70.37%, as compared with the control treatment with 293 cells expressing control gene LacZ. Immunohistochemical analysis of microvessel densities in treated tumors demonstrated that 293-Flt1-3d cells robustly suppressed intratumoral angiogenesis. Our data suggest that a mammalian cell-mediated approach could effectively deliver sFlt-1 gene therapy and inhibit tumor angiogenesis and tumor growth.

目的 总结内镜筋膜下交通静脉结扎术（subfascial endoscopic perforator surgery，SEPS）治疗重度慢性下肢静脉功能不全的临床经验。方法 从1999年11月至2002年8月采用SEPS治疗重度慢性下肢静脉功能不全51例，共64条肢体。采用临床分级、静脉功能评分、彩色多普勒超声、彩色多普勒剖面流速图、静脉造影、空气体积描记仪等方法在手术前后对患肢状况进行分析。结果 术后随访率90.6%（58/64），随访3～35个月。全组浅静脉曲张未见复发，有40条肢体溃疡愈合（97.6%），愈合时间平均（32±5）d，手术前后静脉功能综合评分均值分别为（13.9±1.7）分vs.（6.4±0.8）分、手术前后彩超剖面流速图静脉返流量均值分别为（61.2±7.7）ml/svs.（45.6±5.7）ml/s和空气体积描记仪3项指标术前后均值比较均差异有显著意义（P<0.01）。结论 SEPS对于重度慢性下肢静脉功能不全，特别是合并静脉性溃疡者具有良好疗效，如同时行浅静脉缝扎和深静脉瓣膜修复成形可取得更好的疗效。