OBJECTIVETo analyse the prognostic factors and the neck treatment strategy of early tongue squamous cell carcinoma (SCC).

METHODSTotal of 152 cases of early tongue SCC underwent surgery between January 1994 December 2003 were reviewed. The patients, according to their neck managements, were divided into two groups, or wait-whach group (n = 32) and neck dissection group (n = 120), and the neck dissection group was subdivided into supraomohyoid neck dissection (SND) group and comprehensive neck dissection(CND) group (including radical neck dissection and modified radical neck dissection).

RESULTSAll patients were followed up over 5 years or until death and the 5-year follow-up rate was 94.7%. The regional recurrence rates of wait-whach group and neck dissection group were 34.4% and 14.2% respectively (χ(2) = 6.865, P < 0.01) and 5-year overall survival rates of the two groups were 68% and 79% respectively (χ(2) = 1.699, P > 0.05). There were no significant difference in the regional recurrence rate or 5-year survival rate between SND group and CND group (P > 0.05). The patients with pathologically node positive had a low 5-year survival rate compared to those with node negative. The patients with regional recurrence had a significant low 5-year survival rate compared to patients without regional recurrence (P < 0.01).

CONCLUSIONSOccult lymph node metastasis and regional recurrence were important prognostic factors for early tongue cancer. Supraomohyoid neck dissection can not improve the 5-year survival rate, but significantly reduce the rate of neck recurrence. The results suggest that the selective neck dissection for ipsilateral level I-III should be applied to the patients with early tongue carcinoma which does not cross the midline.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; pathology ; Neck Dissection ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate ; Tongue Neoplasms ; diagnosis ; pathology ; surgery ; Young Adult

OBJECTIVEPrimary indications for endomyocardial biopsy (EMB) include heart transplant rejection surveillance and identifying cardiomyopathy or myocarditis. EMB procedures have not yet gained widespread acceptance because of concerns about possible complications associated with EMB procedures. In this single-center retrospective study, we analyzed the incidence of major and minor EMB procedure-related complications of 439 EMBs during the past 4.5 years.

METHODSFrom May 2004 to November 2008, 15 patients with cardiomyopathy and 1 patient with suspected cardiac tumor underwent 16 EMB procedures and 131 heart transplant recipients underwent 423 EMB procedures with the use of a modified Cordis bioptome. All EMB procedures were made via the right internal jugular vein approach and RV septum EMBs were performed under fluoroscopic guidance without additional echocardiographic monitoring. Operators were allowed to perform EMB procedure alone if a minimum of 50 EMB procedures had been previously supervised by a senior operator and all EMBs were performed by 4 operators. All patients underwent a 12-lead electrocardiogram (ECG), 12-hour continuous ambulatory ECG monitoring, chest X-ray and transthoracic echocardiography before and after EMB procedures to obtain a detailed evaluation of the incidence of conduction abnormalities, arrhythmias, pericardial effusions and worsening valve insufficiency.

RESULTSThere was no major complications like cardiac tamponade, hemothorax and pneumothorax. Minor complications such as conduction abnormalities including temporary RBBB (lasting < 24 h after EMB procedures) were found in 2 cases (0.47%) and sustained RBBB (> 24 h) was evidenced in 1 case (0.23%). There were no A-V block, complex ventricular arrhythmias or episodes of atrial fibrillation during and post procedure. In addition, 4 cases (0.91%)of EMB induced mild-moderate tricuspid regurgitation during the procedure were diagnosed by echocardiography.

CONCLUSIONThe EMB procedure via the right internal jugular vein approach under fluoroscopic guidance is safe and associated with a very low complication rate when performed by experienced operators.

Adolescent ; Adult ; Aged ; Biopsy ; adverse effects ; methods ; Endocardium ; pathology ; Humans ; Middle Aged ; Myocarditis ; pathology ; Retrospective Studies ; Safety ; Young Adult

OBJECTIVETo summarize and analyze clinical outcomes and experience about using extracorporeal membrane oxygenation (ECMO) in supporting heart transplant patients in the peri-operative period of in Fuwai Hospital retrospectively.

METHODSWe performed 131 orthotopic heart transplantations from June 2004 to December 2008. Fourteen cases used veno-artery ECMO (Medtronic Ltd) for mechanical circulatory support in the peri-operative period of heart transplantation. Active clotting time(ACT) was maintained between 160 - 200 seconds, mean blood flow was 1.8 - 3.3 L/min during ECMO assistant period.

RESULTSTwelve survivals discharged with NYHAI, two patients died of multiple orgen failure with severe infection and complication of central nervous system. The ECMO time was 75 - 824 h and mean time 149 h. 12 survivals with ECMO assistance decreases the dose of vasoactive drugs, after bedside UCG evaluating heart function recovery with stable circulation, ECMO could be weaned off uneventfully after 100 h. Five patients with seven times bleeding complication and one patient with catheter-associated arterial thrombosis of distal limb, all ECMO patients with low-albuminemia and hyperbilirubinemia at some degree, eleven patients with increasing blood creatine and five patients were treated with continous renal replacement therapy, one patient with pertinacious hyperbilirubinemia was treated with plasma exchange and molecular absorbent recirculating system. Seven patients were extension incision healing and six patients were tracheotomy.

CONCLUSIONSECMO can bridge patients with end-stage heart failure to heart transplant, and extend the use of marginal donors, grasp the ECMO indication and timing of application, avoiding irreversible dysfunction of the vital organs and preventing complication during ECMO, ECMO may decrease mortality of severe patients in the peri-operative period of heart transplantation.

Extracorporeal Membrane Oxygenation ; adverse effects ; methods ; Heart Failure ; therapy ; Heart Transplantation ; mortality ; Hospital Mortality ; Humans ; Perioperative Care ; methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVEThe aim of this study was to identify the long-term character of the domestic bileaflet mechanical valve in the chronic implanted sheep model and to evaluate the potential value of the modal.

METHODSSix adult sheep underwent implanted mechanical bileaflet valve in pulmonary position under the cardio-pulmonary bypass with beating heart. The chronic implanted sheep model was built up and observed in the respects of a long-term survival, function of prosthesis and pathological specimen.

RESULTSSix adult sheep survived with good condition after operation. The average survival period of six sheep was (221 +/- 208) days. Two sheep were postoperatively sacrificed in 41 and 71 days, respectively. The necropsy revealed normal valve function without thrombosis, periprosthetic leakage and overgrowth of fibrous tissue. One sheep died from dysfunction of prosthetic valve at the postoperative 196 days. The reason was the prosthetic thrombosis with slight overgrowth of fibrous tissue in periprosthesis. The other two sheep died from severe anemia at the postoperative 196 days and 234 days, and the autopsy revealed no abnormal finding else. And one remained to survive with good condition up to now (over 617 days) and was checked by Doppler echocardiogram twice at the postoperative 438 days and 479 days, respectively. The results showed normal function of the bileaflet valve in pulmonary position.

CONCLUSIONThe long-term good effects would be achieved by using the implanted new domestic bileaflet valve in pulmonary position of sheep.

Animals ; Heart Valve Prosthesis Implantation ; methods ; Male ; Models, Animal ; Pulmonary Valve ; surgery ; Sheep

OBJECTIVEThe purpose of this study was to explore the association of gender and age on in-hospital mortality after coronary artery bypass graft (CABG) among the Chinese population.

METHODSA total of 2682 patients (male: 2316, female: 366) who underwent CABG surgery were retrospectively investigated between January 1st, 1997 and December 31st, 2001 for perioperative risk factors and in-hospital mortality rate after CABG.

RESULTSPreoperative comorbidity rate and postoperative complication rate were higher in women than that in men, although left ventricular ejection fraction was higher and the number of diseased vessels fewer in women than in men. The in-hospital mortality rate was three times higher in women than that in men (3.01% vs. 1.12%, P = 0.001), especially in the younger age group (2.6% vs. 0.5%, P = 0.001, risk-adjusted odds ratio 4.844, 95% CI: 1.549 - 15.142). In older patients, there was no notable difference in in-hospital mortality between the genders (3.7% for women vs. 2.4% for men, P = 0.383).

CONCLUSIONSChinese woman, especially in younger age, had a higher in-hospital mortality rate post CABG than that in men, suggesting that younger female gender is an independent risk factor for in-hospital mortality after CABG. Future studies are warranted to clarify the underlying mechanisms.

Age Factors ; Aged ; China ; epidemiology ; Coronary Artery Bypass ; mortality ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Postoperative Period ; Risk Factors ; Sex Factors

OBJECTIVETo summarize our 5 years experiences of one-stop hybrid procedure (OHP) for the management of congenital heart disease (CHD) in neonates and young children (< 2 years old).

METHODSClinical data derived from consecutive 152 young children and neonates with CHD underwent OHP between March 2004 to March 2009 were analyzed. Patients were divided into 3 groups: Balloon plasty group (n = 72), device closure group (n = 43) and collateral arteries occlusion group (n = 37). All procedures were image-guided and performed in a specially designed hybrid operation room. Incidence of major adverse cardiovascular events was obtained.

RESULTSPatients received successful per-ventricular valvuloplasty or per-aortic balloon angioplasty in balloon plasty group. Two patients in this group with severe right ventricle outflow obstruction received regular open-heart outflow tract reconstruction immediately (n = 1) or selective conventional open-heart operation after discharge (n = 1). One neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 month after OHP. In device closure group, device closure was failed in 3 cases (2 with atrial and 1 with ventricular septum defects), 1 young child with ventricular septum defects died from pneumonia after successful device closure. No device malposition was observed in device closure group during the follow-up. All patients received major collateral arteries occlusion and open-heart correction were discharged without complication.

CONCLUSIONOHP could avoid or shorten the application of cardiopulmonary bypass and reduce the surgical trauma in selected young children with CHD. Although OHP was feasible and safe, the image outfits, image-guided technology and OHP-related device should be further developed and improved for better procedure outcome.

Cardiopulmonary Bypass ; Cardiovascular Surgical Procedures ; methods ; mortality ; Catheterization ; Heart Defects, Congenital ; surgery ; Hospital Design and Construction ; Humans ; Infant ; Infant, Newborn ; Operating Rooms ; Postoperative Complications ; Surgery, Computer-Assisted

Objective: To explore the classification and reconstruction strategy of defects in lateral face region after operation of malignant tumors. Methods: Eighteen cases with the reconstruction of complicated defects after resection of tumors in the region of lateral face from January 2015 to January 2018 in Hunan Cancer Hospital were retrospectively reviewed. There were 14 males and 4 females, aged from 32 to 68 years. According to the presence or absence of bony scaffold, complicated defects were divided into two main categories: soft tissue perforating defects and soft tissue defects combined with bony scaffold defects. All soft tissue perforating defects in 5 cases were repaired with free anterolateral femoral flaps. Among 13 cases with soft tissue plus bony scaffold defects, 3 were repaired with free fibular flaps, 6 with free fibular flaps combined with free anterolateral femoral flaps, and 4 with chimeric deep circumflex iliac artery perforator flaps combined with anterolateral femoral flaps. Results: All flaps survived well. Two patients complicated with fistula in floor of mouth, but the wound healed after dressing change. Transoral feeding was resumed within 2 weeks after surgery in all patients. One year follow-up evaluation showed that 14 cases had symmetrical face and 10 cases had mouth opening more than 3 transverse fingers. After 36-50 months of follow-up, 6 patients died, with an overall 3-year survival rate of 66.7%. Conclusion: The classification of defects with or without bony stent loss is conducive to the overall repair design, the recovery of facial contour stent, the effective fill of dead space and the maintain of residual occlusal relationship. Good reconstruction results require a multi flap combination of osteocutaneous and soft tissue flaps.
Facial Neoplasms ; Female ; Free Tissue Flaps ; Humans ; Male ; Perforator Flap ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Thigh/surgery*

Objective: To explore the clinical application and efficacy of lateral upper arm free flap (LUAFF) for one-stage repairing of soft tissue defect after oral cancer surgery. Methods: This article was a retrospective analysis of clinical data of 46 patients receiving treatment of one-stage repairing of soft tissue defect with LUAFF after oral cancer surgery in Hunan Cancer Hospital, from June 2019 to June 2021. Among these cases, 40 were males, and 6 were females. The patients' ages were from 23 to 64 years old. The clinical data of patients were reviewed and outcomes were evaluated. SPSS 23.0 software was used for statistical analysis. Results: In the LUAFF of 46 patients, flap area ranged from 5.0 cm×3.5 cm to 15.0 cm×7.0 cm; the mean pedicle length was 8.15±1.42 cm; the mean artery diameter was 1.20±0.41 mm (range, 1.5 to 2.5 mm); the mean diameter of the largest veins was 2.15±0.52 mm; and the median number of perforators was 2.6 (range, 1 to 4). All donor sites were closed primarily. Two cases had arterial anastomosis thrombosis, but their flaps were successfully saved with urgent re-anastomosis of the vessels. The overall flap survival rate was 93.5%(43/46), with flap necroses after operation in three cases. No patient received tracheotomy. The average hospital stay time of patients after operation was 9.4 days. The follow-up time was 6-24 months, elbow and wrist movements on the operative side were normal, and the upper limb muscle strength was not affected. Conclusions: LUAFF is a suitable choice for the repairs of small-moderate tissue defects in oral cancer surgery, with consistent perforators in the flap, simple harvest method, concealed donor-site scar, and high survival rate.
Female ; Male ; Humans ; Young Adult ; Adult ; Middle Aged ; Retrospective Studies ; Free Tissue Flaps ; Mouth Neoplasms ; Postoperative Period ; Cicatrix