Objective To summarize the experiences of reoperations on Ebstein's anomaly. Methods Clinical data of 17 cases of Ebstein's anomaly (6 males and 11 females, aged from 3 to 54 years old, averaged 23) were analyzed retrospectively. All the patients felt short breath and palpitation after exertion, and cyanosis was found in two patients. In the first operation, downwards displaced tricuspid valve leaflet was suspended and atrialized right ventricle was replicated in 14 cases, tricuspid anuloplasty and atrial septal defect were repaired in 2 cases, and tricuspid valve was replaced in 1 case. The interval time between two operations was 1-20 years in an average of 8 years. Before second operation, the cardiac function was NYHA Ⅱ in 6 cases, NYHA Ⅲ in 11 cases. Eight cases received Ebstein's anomaly anatomic correction, including transplanting downward displaced tricuspid valve and excising atrialized right ventricle. Seven cases received tricuspid valve replacement. Two cases received tricuspid valveplasty. All of operations were performed on arrested heart with moderate hypothermic cardiopulmonary bypass. The time of cardiopulmonary bypass was 70-287 (89.3?11.1)min, the time of aorta clamping was 70-287 (64.0?8.6)min. The transesophageal echocardiography was routinely performed before the operations and after the hearts rebeating. Results No case died in hospital, and all the patients were followed up for 1-3 years. Transesophageal echocardiography showed the tricuspid valve was closed well (non-reflow in 9 cases, mild reflow in 1 case) in 10 cases which received Ebstein's anatomic correction and tricuspid valveplasty. The cardiac function states of patients were significantly improved (NYHA Ⅰ-Ⅱ). Conclusion Most of patients with reoperations on Ebstein's anomaly can received anatomic correction. Tricuspid valve replacement is available if the pathology of tricuspid valve is severe.

112.33mmHg).PaO2 of group B was significantly higher than those of group A after 30 minutes of reperfusion(54.42-118.87mmHg vs 112.33-183.73mmHg,P

Objective Metabonomics method based gas chromatography-mass spectrometry (GC/MS)were used to analyze the urine samples of patients with hyperlipidemic pancreatitis (HLP) to describe the characteristics of metabolism changes of HLP,identify potential biomarkers,and investigate the role of metabonomics study in the management of AP.Methods 24 patients of HLP and 40 age,sex matched volunteers were enrolled and their urine samples were collected.The urine samples underwent preparation,derivation and GC/MS analysis,Orthogonal-Projection to Latent Structures-Discriminant Analysis (OPLS-DA)were performed to detect the metabolic profile difference between the HLP and control group.Results HLP patients can be precisely distinguished from healthy controls.21 metabolites (credibility ＞ 700 ) were identified using the reference compounds available in the libraries of NIST and Wiley.It was identified that levels of nicotinic acid,aconitie acid,citric acid,hippurie acid,hydroxyphenylacetic acid,hydroxyphenylpropionicacid were decreased,while the levels of tryptophan,tyrosine,tyramine,16-hexadecanoic acid,18octadecanoie acid were increased.It was also suggested that there was change in tricarboxylic acid cycle and gut bacterial flora,as well as fat metabolism and metabolism of amino acid.Conclusions There are differences between healthy controls and HLP patients in the term of GC/MS metabolic profiling,and the biomarkers in the metabolites could be found through metabonomics analysis,and the mechanisms of the metabolic changes could be explored.It was noted that the research of metabolites in the urine samples may be a useful tool to help diagnose and understand the pathogenesis of HLP.Metabonomics analysis is a promising research method.

Objective To summarize the experience of perioperative management of coronary artery bypass graft(CABG) in high-risk patients with coronary heart disease.Methods The clinical data of 164 patients underwent CABG from March 2004 to November 2005 were analyzed.Of 164 patients,151(92.05%) cases had severe coronary heart disease.Results Totally 144 artery-vessels and 353 venous-vessels were transplanted to patients.Combined operative procedures included 11 cases of ventricular aneurysm resect,5 cases of valve replacement,5 cases of valve repair,and 1 case of surgical repair of perforation of ventricular septum.Post-operative complications included 2 cases of low cardiac output,1 case of respiratory failure,1 case of renal failure,and 1 case of cerbral infarction.Two patients died and the operative mortality was 1.22%.Conclusion CABG procedure is safe in the treatment of high-risk patients with coronary heart disease.Proper preoperative and perioperative treatment can improve the curative effects significantly.

Objective To summarize the MRI characteristics of fat-containing hepatocellular carcinoma (HCC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with fat-containing HCC who were admitted to the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between January 2015 and April 2016 were collected.All patients underwent MRI examination.Observation indicators:(1) imaging examination;(2) pathological features;(3) treatment and follow-up.Follow-up using outpatient imaging examination was performed to detect tumor recurrence once at 1 month postoperatively and once every 3 months postoperatively up to December 2016.Measurement data with normal distribution were represented as-x±s.Results (1) Imaging examination:plain scans of MRI:of 18 patients,lesions of 9,7 and 2 patients were respectively located in left,right and caudate lobes of liver,and lesions were round-like,with a diameter of 1.6-9.0 cm.Tumors were single,and tumor thrombosis in the hepatic vein was seen in 1 patient.T2WI on fat-suppression of 15 and 3 patients showed respectively high signals and iso-signal;MRI examination showed that out-phase signal on T1WI was variously decreased than in-phase signal,showing focal or diffuse signal decreasing;lipid phase on T1WI showed diffuse distribution in 10 patients,patchy fat-containing regions were scattered within the peritumoral zone in 7 patients,and lipid of 1 patient was located in the central area.Dynamic contrast enhancement MRI showed that fast-in and fast-out,fast-in and slow-out,and slow-in and slow-out types were detected in 16,1 and 1 patients,respectively.Sixteen patients had capsule-like enhancement in delayed phase.Diffusion weighted imaging (DWI) showed high signals in 10 patients,slightly high signals in 6 patients and iso-signal in 2 patients.Apparent diffusion coefficient (ADC) value was (1.19± 0.20)×10-3 mm2/s,including (1.37±0.20) × 10-3 mm2/s in lipid-rich type,(1.17±0.13) × 10-3 mm2/s in clear cell type and (1.11±0.17)× 10-3 mm2/s in thick beam type.Of 18 patients,2 were preoperatively misdiagnosed as hepatic angiomyolipoma and 1 as hepatic adenoma.(2) Pathological features:pathological types of 18 patients with fat-containing HCC:5 and 13 patients were respectively in lipid-rich and non-lipid-rich types (4 in clear cell type and 9 in thick beam type);steatosis tumor cells,rich and translucent cytoplasms and large vacuolated lipid droplets were seen under the microscope;steatosis tumor cells were diffused or scattered within the lesions,some of which showed plaque-like performance of different sizes.Degree of microvascular invasion:grade M0,M1 and M2 were found in 12,3 (2 in thick beam type and 1 in clear cell type) and 3 (2 in thick beam type and 1 in lipid-rich type) patients,respectively.(3) Treatment and follow-up:18 patients underwent surgery and were followed up for 6-13 months,with a median time of 8 months.During the follow-up,5 patients in lipid-rich type and 4 in clear cell type had no recurrence;among 9 patients in thick beam type,1 of 4 with microvascular invasion had no recurrence,2 and 1 of 4 with microvascular invasion had respectively recurrence at 3 months postoperatively and 4 months postoperatively,and 5 without microvascular invasion had no recurrence.The lesions of 3 patients with recurrence is single,3 patients received local minimally invasive therapy and continuous follow-up.Conclusion MRI characteristics of fat-containing HCC include that decreased out-phase signal on T1WI compared with in-phase signal,high signal on DWI,low ADC value,fast-in and fast-out enhancement and capsule-like enhancement in delayed phase.