Complete repair of tetralogy of Fallot was first achieved in 1954. Since it has become routine,the long term follow up is necessary. The late complications such as sudden death, right ventricular dilatation,heart failure and reduced exercise capacity are common. All of these are associated with right ventricular damage after repair. In this paper, we review the influencing factors in the operation, the methods of follow-up and progress of assessment of right ventricular function in order to find out the best way to keep the right ventricular function.

BACKGROUND: Vertebrobasilar transient ischemic vertigo (VBTIV) is the signal of cerebral apoplexy, which is mostly contributed to arteriosclerosis and can be the pre-symptom of cerebral infarction. 1/3 cases will suffer from cerebral infarction with its natural development in several years.Specially, it is the critical stage in 1-6 months after the 1st transient ischemic attack, for which, early treatment is especially important for it.OBJECTIVE: To observe the effects of time treatment on VBTIV and its regulation on blood lipid, lipoprotein and apolipoprotein (Apo).DESIGN: Complete randomized groups and controlled comparison.SETTING: Department of Traditional Chinese Medicine in Medical College of Qingdao University.METHODS:① Totally 66 inpatients of VBTIV were selected from Department of Traditional Chinese Medical of Songshan Hospital Affiliated to Medical College of Qingdao University from January 2003 to June 2004, of which, 47 cases were male and 19 cases female. All of the patients were in the known of the observation. Two groups were randomized, named timingment group,at certain time division(7:00 am-9:00 am),warming acupuncture was applied on Zusanli (ST 36), once everyday, needle retaining for 20 minutes each time. Besides, gegen tongluo tang was oral-administrated warmly in combination, one dose each day at the specific time division, 10 days made 1 course of treatment. In the control, except at the time division, the treatment was given at any time with the same method as the timing-treatment group. Before and after treatment, enzymatic method was used to assay total cholesterol (TC), triglyceride (TG), Apo-A1 and Apo-B100; the precipitation was applied to assay high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C). The therapeutic effects were evaluated at the end of 3-course treatment.③ χ2 and t tests were applied for the difference comparison of counting and measurement data.MAIN OUTCOME MEASURES:① Change of blood lipid before and after treatment in two groups.② Comparison of therapeutic effects after treatment between two groups.RESULTS:Totally 66 cases of VBTIV were all in result analysis.① At the end of 3-course treatment, the rate of significant improvement in timing-treatment group was higher remarkably than the control [79% (30/38),43％ (12/28), P ＜ 0.01].② Compared with the results before treatment and those after treatment in the control, the results of TC, TG, LDL-C,VLDL-C, Apo-B100 were lower remarkably (P ＜ 0.05-0.01) and the results of HDL-C and Apo-A1 were higher remarkably (P ＜ 0.05-0.01) after treatment in timing-treatment group. In the control, compared with the results before treatment, the results of TC, TG, LDL-C and Apo-B100 were lower remarkably (P ＜ 0.05-0.01) and the result of HDL-C was higher remarkably:CONCLUSION: The therapeutic effects of timing acupuncture in combination with medication are advantageous significantly compared with routine treatment on VBTIV and timing treatment reduces blood lipid much more effectively.

Diamond-Blackfan anemia(DBA)is a rare disease with depauperate red blood cells.For absence of its whole naturally successive information,it is very hard to know distinctly its diagnositic and curative viewpoints to evaluate its prognosis.Especially domestically,its systematic study is more insufficient.The paper approaches its diagnostic criteria and evaluates its feasibly curative viewpoints,including hormone drugs treatment,blood-transfusion treatment and transplanting haemopoietic stem cells.

Objective: To observe the therapeutic effect of treatment at selected time on acute ischemic apoplexy and changes of hemorheologic indexes. Methods: 58 cases of acute ischemic apoplexy were randomly divided into a group of treatment at selected time (observation group) and a group of treatment at any time (control group). The observation group were treated by moxibustion at Zusanli (ST 36)and Shenque (CV 8)at Chen hours (7-9 o'clock am)each day, 20min each session, in combination with Chinese drugs Tongluo Decoction, one dose daily, oral administration, once at Chen hours. The control group were treated by the same methods at any hours except Chen hours. The therapeutic effects were assessed after 3 treatment courses. Hemorheologic indexes were determined before and after treatment in both groups. Results: The cured rate and the markedly effective rate in the observation group were better than those in the control group (P

The 8p11 myeloproliferative syndrome is a rare hematologic malignancy that involves the fibroblast growth factor receptor 1 (FGFR1) gene at chromosome 8p11.The clonal change of the FGFR1 rearrangement is present in BM cells,and in the T-lymphoma cells in the LN.The hematological stem cells transplantation is the only method that can cure this rare hematologic neoplasma.

This paper reports the results of 105 cases of mitral stenosis treated with closed commissurotomy. 72 out of the 105 cases were simple mitral stenosis while the remaining 33 were mitral stenosis complicated with mitral insufficiency of mild degree.Before operation, the diameter of the stenosed orifice was smaller than 0.8 cm in 23 cases, between 0.8 and 1.2 cm in 57, and between 1.2 and 2.5 cm in 25. The leaflets of the valve were fibre-adhered in 6 cases and fibro-thickened in 90. In 9 cases the mitral valve was funnel in shape due to the shortening of chordae tendineae.The operation was performed through a left thoracoslomy in 98 cases and a right thoracostomy in 7. After dilatation, the diameter of the mitral orifice was smaller than 3 cm in 13 cases, between 3 and 3.5 cm in 87, and larger than 3.5 cm in 5. The largest diameter was 3.9 cm. Early postoperative death occurred in 2 cases and the mortality rate was 1.9%.75 cases (71.4%) were followed up for 7 months to 8 years respectively. Good results with marked improvement occurred in 67 cases (89.3%) , no change in 2, poor results with worsened condition in 2. Two cases died during the follow-up course.In addition, the role of closed commissurotomy in the treatment of mitral stenosis, the selection of patients, and the optimal dilatation of the orifice were discussed according to the clinical data.

Objective To investigate the variation of thyroid hormone therapy in patients with hypothyroidism before,during and postpartum pregnancy.Methods Thirty-eight patients who suffered from hypothyroidism and had successful pregnancy were collected.Among them,15 cases of hypothyroidism were caused by autoimmune thyroiditis caused,11 cases were induced by thyroid surgery; in 131I treatment induced hypothyroidism were 5 cases,7 patients had unclear reason pregnancy clinical thyroid dysfunctions.Thirty-eight cases of non-pregnant patients with hypothyroidism were also collected as the control group.They achieved efficacy standards by levothyroxine (L-T4) treatment and dose variation of L-T4 was statistically analyzed.Results There was a significant difference before pregnancy,postpartum and different periods of pregnancy.L-T4 dose had a significant increase after pregnancy.At 10-12 weeks,16-18 weeks,22-24 weeks,26-30 weeks,34-36 weeks respectively,L-T4 dose was significantly increasing compared with before pregnancy and postpartum 3 months((110.51 ± 10.42),(113.81 ± 21.04),(108.32 ± 21.01),(105.58 ±21.54),(105.89±10.24),(84.42 ±10.45) and (86.43 ±10.29) μg/L,F=15.631,P＜0.001),but between before and pregnancy postpartum,there was not significantly difference (P ＞ 0.05).Among the various stages of pregnancy,there was also no significant difference; In the patients with hypothyroidism due to thyroid surgery and 131I therapy,L-T4 dose were significantly higher than autoimmune thyroiditis and patients with no clear reason(before,during and after pregnancy,F =4.98,5.15,5.04,P ＜ 0.001).Conclusion Patients with hypothyroidism during pregnancy should increased therapeutic dose of thyroid hormone with average about 30％-40％ of the original dose,and in postpartum,levels before pregnancy could resume.High doses of L-T4 treatment should be taken in patients with hypothyroidism after 131I therapy and after thyroid surgeries.

Objective:To analyze the appearances of multiple MRI sequences and the accuracy of the assessment of resectability in caput pancreatic carcinoma.Methods:MRI appearances were analyzed retrospectively in nineteen patients with histopathology or clinical examination proved carcinoma in the head of pancreas,and the assessment of resectability was compared with the findings of surgical and histopathology.Plain MRI sequences included:coronal scanning with T2-weighted 2D true-fast imaging with steady-state free precession,axial scanning using T1-weighted fast low angle single shot with fat suppression,T2-weighted half-Fourier single shot turbo spin-echo with fat suppression,and MRI cholangiopancreatography.The contrast-enhanced scanning procedures were axial scanning using T1-weighted 3D volume interpolated breathhold examination with fat suppression,the imaging were obtained during arterial phase,portal vein and delayed phase scanning.Results:Of 19 lesions in these patients,17 lesions showed hypo-intensity on T1WI of plain sequences,and normal pancreats showed hyper-intensity.15 lesions showed hyper-intensity or immingled-intensity on T2WI,one appended with cyst.During pancreatic arterial phase,18 lesions did not show enhancement,contrasting with the normal pancreas showing evidently enhancement,so the borderline of carcinoma was clear.During portal vein and delayed phase,17 lesions showed inhomogeneous slight enhancement,peripheral vas of pancreas in 17 cases were contacted or involved by tumor.3 transfer lesions in hepar showed slight enhancement.13 cases showed dilatation at both common bile duct and pancreatic duct as a typical double duct sign on MRCP.According to the assessment of MRI,7 cases could be resected,and 12 cases could not be resected.The assessment of 14 cases agreed with the surgical and histopathological findings.Conclusion:Carcinoma of pancreatic head is shown with many features on multiple MRI sequences.MRI examination has a high accuracy for the diagnosis and the assessment of resectability in carcinoma of pancreatic head,which is helpful in choosing project of therapy.

Because of the medical industry valla,the medical market is in a state of oligopoly.Hospitals and patients are in a state of asymmetric information in the medical market,which could lead to moral hazard,adverse selection,and low social and medical efficiency.Based on the gaming model,we analyze the gaming process and equilibrium between hospitals and patients under the circumstances of asymmetric information.The analyzing result suggests that asymmetric information in the medical market is harmful for patient's benefit and the development of medical market as well.Therefore,it's necessary to strengthen the entire social medicare,set up an opening system of medical information and strengthen the national health education so as to relieve the asymmetric information between hospitals and patients,and improve the efficiency of medical market.

Focal segmental glomerulosclerosis (FSGS) is the main pathologic type that causes end-stage kidney diseases and the recurrence after kidney transplantation.So far, the pathogenesis of FSGS is still not entirely clear.However, more and more mutations have been reported on the FSGS, especially on the genetic FSGS.It is clear that podocyte plays an important role in the development of FSGS.At the same time, the role of soluble urokinase-type plasminogen activator receptor in the recurrence after kidney transplantation has become the research focus.This article will make a brief review on the progress of the pathogenesis of FSGS.