Objective To review the results of surgical management of cicatricial esophageal stenosis secondary to chemical burn. Methods Retrospective study was carried out on 30 children ( male 20, female 10 ) with esophagageal...Objective To review the results of surgical management of cicatricial esophageal stenosis secondary to chemical burn. Methods Retrospective study was carried out on 30 children ( male 20, female 10 ) with esophagageal cicatricial stenosis. The mean age was 29 months (17 to 60 months) and body weight ranged from 5 to 20 kilograms. One child ingested pesticide whereas the remaining ingested acidic of caustic solutions. There children had complete obliteration of cervical esophagus, 5 had near-complete obliteration and the remaining showed stringy esophageal outline on barium meal study. Five children developed stridor and inspiratory dyspnea. Six children had previous gastrostomy. All patients underwent retrosternal colonic replacement based on left ascending colonic artery. Results Post-operatively, one patient developed anastomotic leakage and one anastomotic stenosis. One patient underwent a post-operative tracheostomy. There was no mortality. All patients were followed-up for 4-20 years with normal展开更多
Objective Infracardiac total anomalous pulmonary venous connection,a rare congenital cardiac defect,is associated with high mortality. A modification was designed for the procedure to reduce the post-operative obstruc...Objective Infracardiac total anomalous pulmonary venous connection,a rare congenital cardiac defect,is associated with high mortality. A modification was designed for the procedure to reduce the post-operative obstruction in the pulmonary vena. Methods From September 2005 to展开更多
Objective To evaluate results of one stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants. Methods Two infants with congenital stenosis associated with Tetralogy of ...Objective To evaluate results of one stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants. Methods Two infants with congenital stenosis associated with Tetralogy of Fallot were operated on at the age of 1. 5 and 3 years respectively. In the younger child, the 1. 2 cm long of tracheal stenosis was excised and anastomosed. The other case with 3 cm in length of stenosis at the mid-segment of trachea was excised and repaired with a patch. Results The postoperative progress was uneventful. The patients were followed-up for 6 months to 1 year without any complications. Conclusion One stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants has got satisfactory results. With cardiopulmonary bypass, the operation can be carried out safely. 6 refs,2 figs.展开更多
To evaluate the effects of leucocyte-depleting filtration on systemic inflammatory response in patients undergoing valve surgery.Methods Fifty-two patients underwent elective mitral valve or mitral and aortic valves r...To evaluate the effects of leucocyte-depleting filtration on systemic inflammatory response in patients undergoing valve surgery.Methods Fifty-two patients underwent elective mitral valve or mitral and aortic valves replacement surgery in this study.Patients were randomly divided into two groups.Each group (n=26) was placed on the same cardiopulmonary bypass (CPB) circuit except for the arterial line filter.One group of patients (CG) used the TERUMO ordinary arterial line filter as a control,and the Pall LG-6 leucocyte-depleting arterial line filter and TERUMO ordinary arterial line filter were incorporated into the arterial line of extracorporeal circuit in a parallel way in the EG.The leukocyte-depleting filters were used from 5-10 minutes before aortic cross clamp release to the end of CPB.Intra- and postoperative variables consist of leucocyte counts,serum levels of cytokines and complement C3,body temperature and the usage of antibiotics.Statistical analysis with indepent-samples t-tests,paired-samples t-test,correlate and chi-square (SPSS11.5) was performed on all data to test for significan differences.A P value of <0.05 was considered significant.Results The counts of leucocyte,neutrophil and monocyte were reduced significantly before cardiopulmonary reperfusion in the patients undergoing leucocyte-depleting filtration.Serum levels of IL-6 between the two groups were similar at all time points.Serum levels of IL-8 were significantly elevated in the patients undergoing leucocyte depletion at pre-decrossclamping and 15 minutes reperfusion (P<0.01 and <0.05).Serum level of TNFα was significantly elevated (P<0.05) in the EG at pre-decrossclamping compared to the CG.No significant differences in serum levels of complement C3 were detected between the two groups at all time points observed.No difference in the usage of antibiotics between the two groups.Conclusion Leucocyte depletion filtration before and during reperfusion did not affect inflammatory parameters.14 refs.1 tab.展开更多
To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis,postoper...To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis,postoperative blood loss and transfusion requirements.Methods Forty patients (24 males,16 females )aged 17～43 yr undergoing valve replacement with CPB were randomized to receive EACA 200 mg·kg -1 (group A) or normal saline (group B) added to the priming solution.The patients were premedicated with intramuscular morphine 0.2 mg·kg -1 and scopolamine 0.3 mg.Anesthesia was induced with midazolam 0.2 mg·kg,fetanyl 10 μg·kg -1 and vecuronium 0.1 mg·kg -1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and vecuroniu.The patients were mechanically ventilated (VT=10 mg·kg -1 ,RR=10～12 bpm,I∶E=1∶2) after tracheal intubation.Blood samples were taken before skin incision (baseline),8 and 30 min on CPB,10 min after protamine administration and 2 h after operation for determination of tissue type plasminogen activator (t-PA) activity,plasminogen activator inhibitor (PAI) activity,plasmin (Plm) activity and D-dimer.The amount of blood drained from chest-and bank blood infused within 24 h after operation were recorded.Results (1) Group B (control group):PAI activity was maintained stable perioperatively.The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation.D-dimer level also significantly increased during and after operation.The Plm activity increased significantly at 8 h on CPB and 10 min after protamine administration compared to the baseline value.(2) The t-PA activity and t-PA/PAI ratio were significantly lower in group A than in group B.The D-dimer lever and Plm activity were also significantly lower in group A than in group B during and after operation.The amount of blood loss and bank blood infused within 24 h after operation was 40% and 37% less than that in group B.Conclusion Fibrinolytic system is activated during CPB as shown by the increase in plasminogen and t-PA/PAI ratio.EACA in effective in reducing postoperative blood loss and blood transfusion through inhibition of the activation of fibrinolytic system.8 refs,2 tabs.展开更多
Objective To present the clinical experience in treating thymomas and thymomas with myasthenia gravis (MG). Methods Between 1975 to 1997,285 patients with thymoma were surgically treated. 168 cases of thymus tumor (TT...Objective To present the clinical experience in treating thymomas and thymomas with myasthenia gravis (MG). Methods Between 1975 to 1997,285 patients with thymoma were surgically treated. 168 cases of thymus tumor (TT,Group Ⅰ ) were compared to 90 cases of thymus tumor with myasthenia gravis (TTMG, Group Ⅱ ). Results In group Ⅰ , the average age was 38. 4 years, the youngest was 4 years old. In 93. 4%, the diameter of tumors was 5 cm. 61. 2% were in stages Ⅲ and Ⅳ of clinical pathology. In group Ⅱ ,the average age was 46.2 with the youngest of 20 years old,the diameter of tumor under 3 cm and 5 cm was 34.6 % and 65.6 % . 55.2 % was in stage Ⅰ of clinical pathology. Conclusion Many cases of thymoma in early stage received early treatment. The diagnostic standard of thymoma in early stage is: (1) the diameter of tumor is below 3 cm. (2) In stage I of clinical pathology. The clinical characteristics of TTMG are: short history, the rapid progress, serious MG symptoms,and the high incidence of thymus-展开更多
Objective To sumarize the experience of corrective surgery for Ebstein’ s anomaly. Methods 139 patients with Ebstein’s anomaly were operated on from June, 1980 to January, 2000. Among them, 111 cases received atrial...Objective To sumarize the experience of corrective surgery for Ebstein’ s anomaly. Methods 139 patients with Ebstein’s anomaly were operated on from June, 1980 to January, 2000. Among them, 111 cases received atrialized ventricle plication, tricuspid valve plasty and Devega tricuspid annuloplasty, 27 cases undergoing tricuspid valve repkcement. One case of right ventricular hypoplasia received extra total cavopulmonary connection (ETCPC). Results In the whole group, there were 12 operative deaths, with mortality rate of 8.6%. While in the later 10 years,operative mortality rate was reduced to 3.3%. In the group of plastive operation, 10 cases were re-operated with valve replacement and all survived. Conclusion Operative method of Ebstein’ s anomaly should be decided according to the pathologicoanatomic feature. For mild type, tricuspid valve plasty should be chosen. For medium A type, plastic operation should be performed. For medium B type, plasty or valve replacement should be cautiously selected.展开更多
Objective To evaluate the protective effect of bone marrow stromal cells (BMSCs) transferred by AD·ANG ex vivo on ischemic myocardium. Methods ELISA method was used to assay the expression and secretion of angiog...Objective To evaluate the protective effect of bone marrow stromal cells (BMSCs) transferred by AD·ANG ex vivo on ischemic myocardium. Methods ELISA method was used to assay the expression and secretion of angiogenin (ANG) after Ad·ANG transfection of BMSCs ex vivo. Then BMSCs with Ad · ANG were transplanted into ischemic myocardium of isogenic Lewis rats. 4 weeks later, the parameters of hear function, such as EF and EDLV, were examined by echocardiography. Surival and differentiation of transplanted BMSCs and angiogenesis were appraised by histology and transmission electron electron micrography. Results ANG was found in both lysate and culture medium after transfection of BMSCs. A maximum expression of ANG was observed at 4-7 days after transfection and could still be assayed 15 days later. 4 weeks later after transplantation in the BMSCs with Ad· NAG, heart function improved better than the single BMSCs group (P【0.05), Ad·ANG group (P【0.01)and blank control group (P【0.01). Angiogenesis in展开更多
Objective To evaluate the long-term outcome of dynamic cardiomyoplaty in patients with dilated cardiomyopathy. Methods Three male patients with dilated cardiomyopathy at age of 36,45 and 62 years were underwent dynami...Objective To evaluate the long-term outcome of dynamic cardiomyoplaty in patients with dilated cardiomyopathy. Methods Three male patients with dilated cardiomyopathy at age of 36,45 and 62 years were underwent dynamic cardiomyoplasty from 1994 to 1995. Postoperative follow-up were performed. The data of hemodynamic parameters, functional grade and dimension of heart were analyzed. Results There was no operative death in these patients. All patients recovered eventlessly. From early postoperative stage, the hemodynamic parameters and clinical symptoms were improved and the patients’ exercise tolerance augmented. The quality of life of patients was enhanced significantly. All patients showed NYHA functional grade I . One patient died of severe arrhythmia at the 19th postoperative month. In 2 long-term survivors, the hemodynamic parameters and heart function were declined and the heart tended to be dilated after 3 postoperative years. One patient died of congestive heart failure at 4. 5 postoperative展开更多
To summarize the experience of mitral valve replacement (MVR) using video-assisted thoracoscope.Methods 28 cases of MVR were performed through three right anterior ports under thoracoscopy using femorofemoral extracor...To summarize the experience of mitral valve replacement (MVR) using video-assisted thoracoscope.Methods 28 cases of MVR were performed through three right anterior ports under thoracoscopy using femorofemoral extracorporeal circulation.The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold cardioplegic.33 patients underwent routine open approach MVR as control group.Results There was no death and no morbidity directly related to this approach.Comparing with control control gorup,time of extracorporeal circulation was 82～146 (96±38) min vs. 80～132(92±31) min,cross-clamped 37～76(47±18) min vs. 34～72(45±13) min and ventilation time were 8.6～14.8(10.2±3.1)h vs. 8.3～15.9(11.3±3.4)h.The volume of drainage was 50～230(72±28)ml in VATS group while 7～460(108±4.2)ml in control group (P<0.01),and hospital day were 8～12(10.1±2.2)d vs. 10～28(15.6±4.2)d (P<0.05).The pain in the VATS group was less postoperatively.Conclusion Video-assisted thoracoscopic MVR is a safe and effective technique with less drainage,shortened hospital stay and minor postoperative pain.4 refs,1 tab.展开更多
Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to Oct...Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25展开更多
To summarize experiences in surgical treatments of 18 patients suffered from Ebstein’s anomaly with intracardiac repair and bi-directional cavopulmonary shunt from January 1999 to June 2003.Methods Of 18 patients,10 ...To summarize experiences in surgical treatments of 18 patients suffered from Ebstein’s anomaly with intracardiac repair and bi-directional cavopulmonary shunt from January 1999 to June 2003.Methods Of 18 patients,10 male (55.6%) and 8 female (44.4%),mean age was (18.47±13.85) years old (range from 9 months～54 years old),and mean weight of body (36.09±19.78) kg (range from 8.5～80.0 kg).All patients were in type Ⅱ of Ebstein’s anomaly according to WANG Zenwei’s classification,while 18 (83.3%) were in type B,and 3 (16.7%) in type C according to Carpentier’s classification.Danielson repair of Ebstein’s malformation and other intracardiac repair were performed on all patients,followed by bi-directional cavopulmonary anastomosis,on pump with heart beating.Results There was no death,and no severe heart dysfunction and refractory low cardiac output in all patients postoperatively.No reoperation for residual or recurrent tricuspid incompetence was required in all patients.At follow-up of 13(72.2%) patients ranging from 1 to 53 months,12 patients were in New York Heart Association (NYHA) class Ⅰ,1 in class Ⅱ.Four were with 1 grade,2 with 2 grades tricuspid regurgitation.The patency of bi-directional cavopulmonary anastomoses was verified by echocardiography.Conclusion Ventricular unloading added to intracardiac repair appears to be effective to improve left and right ventricular function and tricuspid valve performance in Ebstein’s anomaly with moderate or massive tricuspid dysfunction and physiological right ventricular outlet tract obstruction.6 refs.展开更多
To investigate the change of intestine mucosal permeability during cardiopulmonary bypass (CPB) and its effect on gut barrier in rats model.Methods The rats model of CPB was established and samples of tissue and plasm...To investigate the change of intestine mucosal permeability during cardiopulmonary bypass (CPB) and its effect on gut barrier in rats model.Methods The rats model of CPB was established and samples of tissue and plasma were collected at different intervals.Plasma D-lactate and LPS concentrations were detemined and gut tissue was examined microscopically.Results The plasma concentration of D-lactate and LPS increased gradually at 1 h CPB,and increased markedly 1 h after CPB.They recovered to normal 8 th after CPB,respectively.In addition,it was noted that there was a significant positive correlation between the plasma concentrations of LPS and D-lactate (r=0.8312,P<0.05).Desquamation of intestine villi and infiltration of inflammatory cells in the lamina propria were observed 1 h after CPB.Conclusion The results surggested that the gut mucosal barrier was impaired during early stage of CPB,which resulted in increased mucosal permeability,intestine derived endotoxemia,and organ dysfunction.It was found that plasma D-lactate can reflect the degree of gut barrier injury,which contributes to judging the course of disease and preventing the complications after CPB.10 refs,1 tab.展开更多
Objective-Double outlet right ventricle,which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects,has been considered a risk factor for biventricular repair proce...Objective-Double outlet right ventricle,which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects,has been considered a risk factor for biventricular repair procedure. To reviewed cases treated by biventricular repair for endocardial cushion defects with double outlet right ventricle. Methods From July to November of 2009,6展开更多
To investigate the localization and expression of endothelial nitric oxide synthase (eNOS) within the wall of the human internal mammary arteries (LMA),radial arteries (RA) and the great saphenous veins (SV) using imm...To investigate the localization and expression of endothelial nitric oxide synthase (eNOS) within the wall of the human internal mammary arteries (LMA),radial arteries (RA) and the great saphenous veins (SV) using immunohistochemistry method.Methods Specimens were harvested from 20 patients undergoing coronary artery bypass grafting and submitted to light microscope analysis using immunohistochemistry method.Results The expression of eNOS was evident in the intima of LIMA,RA and SV and in the media of muscular LIMA and RA.No eNOS expression was found in the media of great saphenous veins.Semiquantitative and the imaging analysis indicated by gray level values revealed a higher eNOS expression in the wall of internal mammary artery,particulary at the level of the media.Conclusion Different expression of eNOS in the intima and media of LIMA,RA and SV may provide a histological explanation for the better results of the LIMA when used for coronary artery hypass grafting.9 refs,3 figs,1 tab.展开更多
Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associ...Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease,and the concentrations of endothelin-1 was correlated with severity degree展开更多
To study the pathological characteristics of delayed xenograft rejection and the expression of donor ICAM-1 in mouse-to-rat cardiac xenografts.Methods BALB/c mice and Lewis rats served as donors and recipients respect...To study the pathological characteristics of delayed xenograft rejection and the expression of donor ICAM-1 in mouse-to-rat cardiac xenografts.Methods BALB/c mice and Lewis rats served as donors and recipients respectively.The model of mouse-to-rat heterotopic heart xenotransplantation was established.The cardiac xenografts were harvested at 12 h,24 h,36 h,48 h after transplantation and at the time when no pulsations could be detected in the transplanted heart respectively.The normal BALB/c mouse hearts were harvested as control group.The grafts were collected to receive pathological and immunohistochemical examinations as well as to detect the level of ICAM-1 mRNA in the xenografts.Quantitive measurement of ICAM-1 expression in the grafts was done by using multimedia pathology imaging analysis system.RT-PCR products of xenografts were separated by agrose gels and the densities of the bands were determined by density scanning.Results The pathologic examination of xenografts showed hyperemia,hemorrhage with inflammatory cells infiltred at 12 h after transplantation and they became more and more serious as time went on.The pathologic examination of rejected xenografts showed widespread intravascular thrombosis,hyperemia,hemorrhage,coagulative necrosis with a large number of inflammatory cells infiltrated.The stained color of vascular endothelial cells and cardiac myocytes was significantly more intensive in the xenografts than that of normal BALB/c mouse hearts in the control group.The relative density values (ICAM-1/β-actin) were also significantly higher in the xenografts than that of the control group.Conclusion ICAM-1 expression in the xenografts was up-regulated,which was related with the development of the delayed xenograft rejection.8 refs,2 tabs.展开更多
文摘Objective To review the results of surgical management of cicatricial esophageal stenosis secondary to chemical burn. Methods Retrospective study was carried out on 30 children ( male 20, female 10 ) with esophagageal cicatricial stenosis. The mean age was 29 months (17 to 60 months) and body weight ranged from 5 to 20 kilograms. One child ingested pesticide whereas the remaining ingested acidic of caustic solutions. There children had complete obliteration of cervical esophagus, 5 had near-complete obliteration and the remaining showed stringy esophageal outline on barium meal study. Five children developed stridor and inspiratory dyspnea. Six children had previous gastrostomy. All patients underwent retrosternal colonic replacement based on left ascending colonic artery. Results Post-operatively, one patient developed anastomotic leakage and one anastomotic stenosis. One patient underwent a post-operative tracheostomy. There was no mortality. All patients were followed-up for 4-20 years with normal
文摘Objective Infracardiac total anomalous pulmonary venous connection,a rare congenital cardiac defect,is associated with high mortality. A modification was designed for the procedure to reduce the post-operative obstruction in the pulmonary vena. Methods From September 2005 to
文摘Objective To evaluate results of one stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants. Methods Two infants with congenital stenosis associated with Tetralogy of Fallot were operated on at the age of 1. 5 and 3 years respectively. In the younger child, the 1. 2 cm long of tracheal stenosis was excised and anastomosed. The other case with 3 cm in length of stenosis at the mid-segment of trachea was excised and repaired with a patch. Results The postoperative progress was uneventful. The patients were followed-up for 6 months to 1 year without any complications. Conclusion One stage repair of congenital tracheal stenosis associated with complex congenital heart disease in infants has got satisfactory results. With cardiopulmonary bypass, the operation can be carried out safely. 6 refs,2 figs.
文摘To evaluate the effects of leucocyte-depleting filtration on systemic inflammatory response in patients undergoing valve surgery.Methods Fifty-two patients underwent elective mitral valve or mitral and aortic valves replacement surgery in this study.Patients were randomly divided into two groups.Each group (n=26) was placed on the same cardiopulmonary bypass (CPB) circuit except for the arterial line filter.One group of patients (CG) used the TERUMO ordinary arterial line filter as a control,and the Pall LG-6 leucocyte-depleting arterial line filter and TERUMO ordinary arterial line filter were incorporated into the arterial line of extracorporeal circuit in a parallel way in the EG.The leukocyte-depleting filters were used from 5-10 minutes before aortic cross clamp release to the end of CPB.Intra- and postoperative variables consist of leucocyte counts,serum levels of cytokines and complement C3,body temperature and the usage of antibiotics.Statistical analysis with indepent-samples t-tests,paired-samples t-test,correlate and chi-square (SPSS11.5) was performed on all data to test for significan differences.A P value of <0.05 was considered significant.Results The counts of leucocyte,neutrophil and monocyte were reduced significantly before cardiopulmonary reperfusion in the patients undergoing leucocyte-depleting filtration.Serum levels of IL-6 between the two groups were similar at all time points.Serum levels of IL-8 were significantly elevated in the patients undergoing leucocyte depletion at pre-decrossclamping and 15 minutes reperfusion (P<0.01 and <0.05).Serum level of TNFα was significantly elevated (P<0.05) in the EG at pre-decrossclamping compared to the CG.No significant differences in serum levels of complement C3 were detected between the two groups at all time points observed.No difference in the usage of antibiotics between the two groups.Conclusion Leucocyte depletion filtration before and during reperfusion did not affect inflammatory parameters.14 refs.1 tab.
文摘To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis,postoperative blood loss and transfusion requirements.Methods Forty patients (24 males,16 females )aged 17～43 yr undergoing valve replacement with CPB were randomized to receive EACA 200 mg·kg -1 (group A) or normal saline (group B) added to the priming solution.The patients were premedicated with intramuscular morphine 0.2 mg·kg -1 and scopolamine 0.3 mg.Anesthesia was induced with midazolam 0.2 mg·kg,fetanyl 10 μg·kg -1 and vecuronium 0.1 mg·kg -1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and vecuroniu.The patients were mechanically ventilated (VT=10 mg·kg -1 ,RR=10～12 bpm,I∶E=1∶2) after tracheal intubation.Blood samples were taken before skin incision (baseline),8 and 30 min on CPB,10 min after protamine administration and 2 h after operation for determination of tissue type plasminogen activator (t-PA) activity,plasminogen activator inhibitor (PAI) activity,plasmin (Plm) activity and D-dimer.The amount of blood drained from chest-and bank blood infused within 24 h after operation were recorded.Results (1) Group B (control group):PAI activity was maintained stable perioperatively.The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation.D-dimer level also significantly increased during and after operation.The Plm activity increased significantly at 8 h on CPB and 10 min after protamine administration compared to the baseline value.(2) The t-PA activity and t-PA/PAI ratio were significantly lower in group A than in group B.The D-dimer lever and Plm activity were also significantly lower in group A than in group B during and after operation.The amount of blood loss and bank blood infused within 24 h after operation was 40% and 37% less than that in group B.Conclusion Fibrinolytic system is activated during CPB as shown by the increase in plasminogen and t-PA/PAI ratio.EACA in effective in reducing postoperative blood loss and blood transfusion through inhibition of the activation of fibrinolytic system.8 refs,2 tabs.
文摘Objective To present the clinical experience in treating thymomas and thymomas with myasthenia gravis (MG). Methods Between 1975 to 1997,285 patients with thymoma were surgically treated. 168 cases of thymus tumor (TT,Group Ⅰ ) were compared to 90 cases of thymus tumor with myasthenia gravis (TTMG, Group Ⅱ ). Results In group Ⅰ , the average age was 38. 4 years, the youngest was 4 years old. In 93. 4%, the diameter of tumors was 5 cm. 61. 2% were in stages Ⅲ and Ⅳ of clinical pathology. In group Ⅱ ,the average age was 46.2 with the youngest of 20 years old,the diameter of tumor under 3 cm and 5 cm was 34.6 % and 65.6 % . 55.2 % was in stage Ⅰ of clinical pathology. Conclusion Many cases of thymoma in early stage received early treatment. The diagnostic standard of thymoma in early stage is: (1) the diameter of tumor is below 3 cm. (2) In stage I of clinical pathology. The clinical characteristics of TTMG are: short history, the rapid progress, serious MG symptoms,and the high incidence of thymus-
文摘Objective To sumarize the experience of corrective surgery for Ebstein’ s anomaly. Methods 139 patients with Ebstein’s anomaly were operated on from June, 1980 to January, 2000. Among them, 111 cases received atrialized ventricle plication, tricuspid valve plasty and Devega tricuspid annuloplasty, 27 cases undergoing tricuspid valve repkcement. One case of right ventricular hypoplasia received extra total cavopulmonary connection (ETCPC). Results In the whole group, there were 12 operative deaths, with mortality rate of 8.6%. While in the later 10 years,operative mortality rate was reduced to 3.3%. In the group of plastive operation, 10 cases were re-operated with valve replacement and all survived. Conclusion Operative method of Ebstein’ s anomaly should be decided according to the pathologicoanatomic feature. For mild type, tricuspid valve plasty should be chosen. For medium A type, plastic operation should be performed. For medium B type, plasty or valve replacement should be cautiously selected.
文摘Objective To evaluate the protective effect of bone marrow stromal cells (BMSCs) transferred by AD·ANG ex vivo on ischemic myocardium. Methods ELISA method was used to assay the expression and secretion of angiogenin (ANG) after Ad·ANG transfection of BMSCs ex vivo. Then BMSCs with Ad · ANG were transplanted into ischemic myocardium of isogenic Lewis rats. 4 weeks later, the parameters of hear function, such as EF and EDLV, were examined by echocardiography. Surival and differentiation of transplanted BMSCs and angiogenesis were appraised by histology and transmission electron electron micrography. Results ANG was found in both lysate and culture medium after transfection of BMSCs. A maximum expression of ANG was observed at 4-7 days after transfection and could still be assayed 15 days later. 4 weeks later after transplantation in the BMSCs with Ad· NAG, heart function improved better than the single BMSCs group (P【0.05), Ad·ANG group (P【0.01)and blank control group (P【0.01). Angiogenesis in
文摘Objective To evaluate the long-term outcome of dynamic cardiomyoplaty in patients with dilated cardiomyopathy. Methods Three male patients with dilated cardiomyopathy at age of 36,45 and 62 years were underwent dynamic cardiomyoplasty from 1994 to 1995. Postoperative follow-up were performed. The data of hemodynamic parameters, functional grade and dimension of heart were analyzed. Results There was no operative death in these patients. All patients recovered eventlessly. From early postoperative stage, the hemodynamic parameters and clinical symptoms were improved and the patients’ exercise tolerance augmented. The quality of life of patients was enhanced significantly. All patients showed NYHA functional grade I . One patient died of severe arrhythmia at the 19th postoperative month. In 2 long-term survivors, the hemodynamic parameters and heart function were declined and the heart tended to be dilated after 3 postoperative years. One patient died of congestive heart failure at 4. 5 postoperative
文摘To summarize the experience of mitral valve replacement (MVR) using video-assisted thoracoscope.Methods 28 cases of MVR were performed through three right anterior ports under thoracoscopy using femorofemoral extracorporeal circulation.The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold cardioplegic.33 patients underwent routine open approach MVR as control group.Results There was no death and no morbidity directly related to this approach.Comparing with control control gorup,time of extracorporeal circulation was 82～146 (96±38) min vs. 80～132(92±31) min,cross-clamped 37～76(47±18) min vs. 34～72(45±13) min and ventilation time were 8.6～14.8(10.2±3.1)h vs. 8.3～15.9(11.3±3.4)h.The volume of drainage was 50～230(72±28)ml in VATS group while 7～460(108±4.2)ml in control group (P<0.01),and hospital day were 8～12(10.1±2.2)d vs. 10～28(15.6±4.2)d (P<0.05).The pain in the VATS group was less postoperatively.Conclusion Video-assisted thoracoscopic MVR is a safe and effective technique with less drainage,shortened hospital stay and minor postoperative pain.4 refs,1 tab.
文摘Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25
文摘To summarize experiences in surgical treatments of 18 patients suffered from Ebstein’s anomaly with intracardiac repair and bi-directional cavopulmonary shunt from January 1999 to June 2003.Methods Of 18 patients,10 male (55.6%) and 8 female (44.4%),mean age was (18.47±13.85) years old (range from 9 months～54 years old),and mean weight of body (36.09±19.78) kg (range from 8.5～80.0 kg).All patients were in type Ⅱ of Ebstein’s anomaly according to WANG Zenwei’s classification,while 18 (83.3%) were in type B,and 3 (16.7%) in type C according to Carpentier’s classification.Danielson repair of Ebstein’s malformation and other intracardiac repair were performed on all patients,followed by bi-directional cavopulmonary anastomosis,on pump with heart beating.Results There was no death,and no severe heart dysfunction and refractory low cardiac output in all patients postoperatively.No reoperation for residual or recurrent tricuspid incompetence was required in all patients.At follow-up of 13(72.2%) patients ranging from 1 to 53 months,12 patients were in New York Heart Association (NYHA) class Ⅰ,1 in class Ⅱ.Four were with 1 grade,2 with 2 grades tricuspid regurgitation.The patency of bi-directional cavopulmonary anastomoses was verified by echocardiography.Conclusion Ventricular unloading added to intracardiac repair appears to be effective to improve left and right ventricular function and tricuspid valve performance in Ebstein’s anomaly with moderate or massive tricuspid dysfunction and physiological right ventricular outlet tract obstruction.6 refs.
文摘To investigate the change of intestine mucosal permeability during cardiopulmonary bypass (CPB) and its effect on gut barrier in rats model.Methods The rats model of CPB was established and samples of tissue and plasma were collected at different intervals.Plasma D-lactate and LPS concentrations were detemined and gut tissue was examined microscopically.Results The plasma concentration of D-lactate and LPS increased gradually at 1 h CPB,and increased markedly 1 h after CPB.They recovered to normal 8 th after CPB,respectively.In addition,it was noted that there was a significant positive correlation between the plasma concentrations of LPS and D-lactate (r=0.8312,P<0.05).Desquamation of intestine villi and infiltration of inflammatory cells in the lamina propria were observed 1 h after CPB.Conclusion The results surggested that the gut mucosal barrier was impaired during early stage of CPB,which resulted in increased mucosal permeability,intestine derived endotoxemia,and organ dysfunction.It was found that plasma D-lactate can reflect the degree of gut barrier injury,which contributes to judging the course of disease and preventing the complications after CPB.10 refs,1 tab.
文摘Objective-Double outlet right ventricle,which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects,has been considered a risk factor for biventricular repair procedure. To reviewed cases treated by biventricular repair for endocardial cushion defects with double outlet right ventricle. Methods From July to November of 2009,6
文摘To investigate the localization and expression of endothelial nitric oxide synthase (eNOS) within the wall of the human internal mammary arteries (LMA),radial arteries (RA) and the great saphenous veins (SV) using immunohistochemistry method.Methods Specimens were harvested from 20 patients undergoing coronary artery bypass grafting and submitted to light microscope analysis using immunohistochemistry method.Results The expression of eNOS was evident in the intima of LIMA,RA and SV and in the media of muscular LIMA and RA.No eNOS expression was found in the media of great saphenous veins.Semiquantitative and the imaging analysis indicated by gray level values revealed a higher eNOS expression in the wall of internal mammary artery,particulary at the level of the media.Conclusion Different expression of eNOS in the intima and media of LIMA,RA and SV may provide a histological explanation for the better results of the LIMA when used for coronary artery hypass grafting.9 refs,3 figs,1 tab.
文摘Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease,and the concentrations of endothelin-1 was correlated with severity degree
文摘To study the pathological characteristics of delayed xenograft rejection and the expression of donor ICAM-1 in mouse-to-rat cardiac xenografts.Methods BALB/c mice and Lewis rats served as donors and recipients respectively.The model of mouse-to-rat heterotopic heart xenotransplantation was established.The cardiac xenografts were harvested at 12 h,24 h,36 h,48 h after transplantation and at the time when no pulsations could be detected in the transplanted heart respectively.The normal BALB/c mouse hearts were harvested as control group.The grafts were collected to receive pathological and immunohistochemical examinations as well as to detect the level of ICAM-1 mRNA in the xenografts.Quantitive measurement of ICAM-1 expression in the grafts was done by using multimedia pathology imaging analysis system.RT-PCR products of xenografts were separated by agrose gels and the densities of the bands were determined by density scanning.Results The pathologic examination of xenografts showed hyperemia,hemorrhage with inflammatory cells infiltred at 12 h after transplantation and they became more and more serious as time went on.The pathologic examination of rejected xenografts showed widespread intravascular thrombosis,hyperemia,hemorrhage,coagulative necrosis with a large number of inflammatory cells infiltrated.The stained color of vascular endothelial cells and cardiac myocytes was significantly more intensive in the xenografts than that of normal BALB/c mouse hearts in the control group.The relative density values (ICAM-1/β-actin) were also significantly higher in the xenografts than that of the control group.Conclusion ICAM-1 expression in the xenografts was up-regulated,which was related with the development of the delayed xenograft rejection.8 refs,2 tabs.
