Objective To summarize the clinical experiences and early-to median effect of coronary artery bypass grafting(CABG)in patients aged 70 years or above.Methods From Dec.2006 to Dec.2007,86 patients aged 70 or above underwent CABG,of whom 71 cases underwent off-pump coronary artery bypass grafting(OPCAB),15 cases had CABG with cardiopulmonary bypass(CPB).5 cases underwent mitral valve replacement,3 underwent aortic valve replacement besides CABG,and one case underwent removal of ventricular aneurysm.Their clinical data were retrospectively analyzed.Results There was one case who died of enterobrosis after operation.The average ICU stay time was(77.4±49.6)h,the average postoperative stay time was 15 d,and the average drainage was 530 ml.22 postoperative complications were found.76 cases were followed up for 10-22 months.Follow up effect was better showing cardiac classification I-II and no angina pectoris,myocardial infarction and late death.Conclusion Patients with coronary heart disease in good condition will have not remarkable improvement in mortality as compared with ordinary patients but attention should be paid to their preoperative pulmonary function and angina pectoffs.OPCABG would have encouraging result in reducing the rate of postoperative complications and hospital death,which should be recommended as the first choice for the elderly patients.

Objective To evaluate the effects of 'patch-skill'in the management of refractory bleeding during the process of open heart surgery.Methods Between May 2007 to Oetober 2008,7 patients undergoing open-heart surgery experienced active bleeding.Autologous perieardial patches were used in 6 patients, and polyester patch in the other one.The patches were sutured continuously by 5-0 Prolene suture.Results The 24 hour chest tube output was less than 500 ml in all 7 cases after operation.There were no death, secondly active bleeding,or mediastinal in-faction.Conclusion The'patch-skill' can effectively control the refractory bleeding during open heart surgery.Au-tologous perieardial patehe is the first choice because it has multiple advantages.The polyester patch ean be used al-ternatively when autologous pereardiurn cannot be used (for various reasons such as edema and infection).

OBJECTIVETo explore the influence on AM fungi infection rate and medicine quality of Pinellia ternate in the condition of three soil impact factors.

METHODSet the orthogonal test of three factors and levels. Determinate the AM fungi infection rate in early stage of mature & stage of mature of P. ternata, and the water content, water soluble extract, butanedioic acid content and alkaloid content of P. ternata tuber that be harvested also had be determinated.

RESULT AND CONCLUSIONWith the P levels to 30 mg x kg(-1) and 90 mg x kg(-1), AM fungi infection was the best when mixed inoculated of EM. Microbial agent inoculated played a decisive role in P. ternata growth and physiological activity, secondary influenced factor was P concentration, and the water stress was the minimal impact. Mixed inoculated of AM fungi and EM treatment with the low P levels (30, 90 mg x kg(-1)) proved better effect on enhancing the water extract content, anedioic acid and alkaloid content, while decreasing the water contents of P. ternata tuber.

Alkaloids ; chemistry ; Drugs, Chinese Herbal ; chemistry ; standards ; Fungi ; Pinellia ; chemistry ; microbiology ; Plant Extracts ; chemistry ; standards ; Soil

OBJECTIVETo summarize the diagnostic and therapeutic methods of asymptomatic aortic dissection (AD).

METHODSTen patients of asymptomatic AD were treated from January 2002 to June 2006. The patients were followed up and their data were reviewed retrospectively.

RESULTSTwo patients of type A AD treated by open surgery and the 6 patients of type B AD received endovascular stent-graft repair were successfully treated, and no in-hospital death and severe complication occurred. Furthermore, all of them survived during follow-up. One of the 2 patients of type B AD received medical treatment still survive, but the other suddenly died during follow-up. The most possible cause of his death was fatal aorta rupture.

CONCLUSIONSThe diagnosis of asymptomatic AD could be missed or mistaken easily because of its asymptomatic. Keeping a high clinical index of suspicion is crucial in establishing the diagnosis of asymptomatic AD. The asymptomatic AD also has high risk of fatal aorta rupture associated with re-dissection and aneurysmal dilatation. Therefore, type A and B asymptomatic AD should be treated by open surgery or endovascular repair respectively if possible. Endovascular stent-graft repair is a safe and effective method for the treatment of type B asymptomatic AD.

Adult ; Aged ; Aneurysm, Dissecting ; diagnosis ; therapy ; Aortic Aneurysm ; diagnosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo explore the effects of stent-graft on treating descending and abdominal aortic pseudoaneurysms.

METHODSSeven cases of descending and 6 cases of abdominal aortic pseudoaneurysms were treated with stent-graft, aging from 28 to 72 years, average 59 years.

RESULTSEight cases of aortic pseudoaneurysms were completely excluded after the procedure. Slight leakages were found in 5 cases. Leakages disappeared through balloon dilatation in 2 cases, and one more stent-graft cuff implanted in 1 case. Slight leakages were still presented after dilatation in the other 2 cases, however, the leakages disappeared 3 months later. Eleven cases were followed up from 4 to 30 months with a mean of 18.6 months. One case died of massive hemorrhage from upper digestive tract 5 months after operation. The stent-grafts of other cases maintained patent, and no migration occurred. The diameter of the pseudoaneurysm of all cases did not increased.

CONCLUSIONSIt is safe, effective and mini-invasive to use stent-graft in the treatment of descending and abdominal aortic pseudoaneurysm, however, the long-term investigation is needed.

Adult ; Aged ; Aneurysm, False ; surgery ; Angioplasty ; instrumentation ; methods ; Aortic Aneurysm ; surgery ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

BACKGROUNDH syndrome (OMIM 612391) is a recently described autosomal recessive genodermatosis characterized by indurated hyperpigmented and hypertrichotic skin, as well as other systemic manifestations. Most of the cases occurred in the Middle East areas or nearby countries such as Spain or India. The syndrome is caused by mutations in solute carrier family 29, member 3 (SLC29A3), the gene encoding equilibrative nucleoside transporter 3. The aim of this study was to identify pathogenic SLC29A3 mutations in a Chinese patient clinically diagnosed with H syndrome.

METHODSPeripheral blood samples were collected from the patient and his parents. Genomic DNA was isolated by the standard method. All six SLC29A3 exons and their flanking intronic sequences were polymerase chain reaction (PCR)-amplified and the PCR products were subjected to direct sequencing.

RESULTSThe patient, an 18-year-old man born to a nonconsanguineous Chinese couple, had more extensive cutaneous lesions, involving both buttocks and knee. In his genomic DNA, we identified a novel homozygous insertion-deletion, c. 1269_1270delinsA, in SLC29A3. Both of his parents were carriers of the mutation.

CONCLUSIONSWe have identified a pathogenic mutation in a Chinese patient with H syndrome.

Abnormalities, Multiple ; diagnosis ; genetics ; Adolescent ; Asian Continental Ancestry Group ; Genetic Predisposition to Disease ; Humans ; Male ; Mutation ; Nucleoside Transport Proteins ; genetics ; Skin Abnormalities ; diagnosis ; genetics

OBJECTIVETo evaluate the efficacy and safety of a phenylalanine-free amino acid-based enteral formula (AA-PKU2) in the treatment of children with phenylketonuria (PKU) aged 1-8 years.

METHODSA prospective, open, self-controlled, multi-center trial was performed, enrolling 121 PKU children (1-8 years in age) consecutively between July, 2009 and May, 2011. Enteral nutrition therapy was administered for 32 weeks. The data on blood phenylalanine (PHE) levels, metal development, weight, height, head circumference, serum nutritional biomarkers (total protein, pre-albumin, albumin, total cholesterol, total triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol), and measurements from routine blood and urine examinations and from renal and hepatic function tests were collected before the therapy and at 8 weeks and 32 weeks after the therapy and were comparatively analyzed.

RESULTSThe mean blood PHE level at 8 and 32 weeks of AA-PKU2 treatment was 353±253 and 361±280 µmol/L respectively, significantly lower than that before the treatment (487±327 µmol/L; P<0.01). The difference in intelligence quotient scores before and after AA-PKU2 treatment was not significant (P>0.05) when assessed by the Gesell tests in children aged 1-4 years but significant (P<0.01) when assessed by WPPSI or WISR-R tests in children over 4 years. The average height, weight and head circumference at 8 and 32 weeks after treatment were significantly increased as compared to these measurements before treatment (P<0.01) with absolute levels similar to those in the control children. In contrast, the mean values of total protein, pre-albumin, albumin, total cholesterol, total triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol at both time points were not different either from those prior to the treatment or from those in the control children. Mild diarrhea was the adverse events associated with AA-PKU2 treatment, which occurred in 3 (2.5%) cases. All these 3 patients fully recovered without treatment.

CONCLUSIONSThe phenylalanine-free amino acid-based formula, AA-PKU2, is effective and safe in controlling blood PHE levels and improving mental development with adequate nutritional support in PKU.

Child ; Child, Preschool ; Enteral Nutrition ; Female ; Humans ; Infant ; Intelligence ; Male ; Phenylalanine ; blood ; Phenylketonurias ; diet therapy ; psychology ; Prospective Studies

BACKGROUNDFew reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT). The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.

METHODSThe clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed. The effects of BDT and re-operation on prognosis were retrospectively analyzed.

RESULTSThe 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P>0.05). Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P<0.05). Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P<0.05). Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P>0.05).

CONCLUSIONSHepatectomy plus BDT removal is an effective treatment option for HCC with BDT. Obstructive jaundice is not a contraindication for surgery. Re-operation after relapse can provide good outcomes if the cases are appropriately selected.

Adult ; Bile Ducts ; pathology ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Thrombosis ; surgery ; Treatment Outcome ; Ultrasonography

OBJECTIVETo analyze characteristics of different hyperphenylalaninemia (HPA) and to discuss the clinical difference between southern and northern Chinese patients with tetrahydrobiopterin (BH4) responsive phenylalanine hydroxylase (PAH) deficiency.

METHODS(1)BH4 (20 mg/kg) loading test was performed in all 108 HPA patients. These patients, 63 males and 45 females, were at a mean age of 7.05 months. A combined phenylalanine (Phe) and BH4 loading test was carried out in the patients who had a basic blood Phe concentration less than 600 micromol/L. The urine pterine profile analysis and the dihydropteridine reductase (DHPR) activity in dry blood filter spot were analyzed simultaneously. (2)BH4 responsive patients were divided to southern and northern groups by their parent's native place and geographic boundary determined by Changjiang River. The change of Phe concentration after BH4 loading test was compared between the two groups.

RESULTS(1)Among the 108 HPA cases, 36 patients (33.3%) were BH4 responsive PAH deficiency, 49 (45.4%) were non-BH4 no responsive phenylketonuria (PKU)and 23(21.3%)were BH4 deficiency (BH4D). The Phe concentration of patients with BH4 responsive PAH deficiency decreased by 49.24% and 65.35% at 8 h and 24 h after oral BH4, 23 in southern group and 13 in northern group among 36 patients. (2)The mean Phe concentration at 24 h after loading test in southern and northern groups were (217.02+/-189.03) micromol/L and 458.75+/-342.54 micromol/L respectively (P<0.05), although the decrease percent of plasma Phe concentration at 2 h, 4 h, 8 h, 24 h was no distinct difference between southern and northern groups (P>0.05).

CONCLUSIONMost of mild and moderate HPA patients affected by PAH deficiency show plasma Phe concentration decrease >30% in 24 h after oral BH4 20 mg/kg, few are classic PKU. The responsiveness to BH4 is no difference between southern and northern Chinese patients with BH4 responsive PAH deficiency according to the decrease percent of plasma Phe concentration, although the Phe concentration is lower in southern patients than that in northern patients.

Biopterin ; analogs & derivatives ; pharmacology ; therapeutic use ; Child, Preschool ; China ; Dihydropteridine Reductase ; blood ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Phenylalanine ; blood ; Phenylketonurias ; blood ; drug therapy ; Time Factors

OBJECTIVETo evaluate the efficacy, toxicity and survival of intraoperative 125I brachytherapy combined with chemotherapy for advanced pancreatic cancer.

METHODSThirty-six patients with advanced pancreatic cancer were randomized to two groups: brachy-chemotherapy group (n = 18) and control group (n = 18). For the combined group, intraoperative 125I implantation and gemcitabine, 5-Fu were given. For the control group, intratumoral injection of absolute alcohol was done.

RESULTSThe CR + PR rate of brachy-chemotherapy group was 38.9% with pain relief in 77.8%, while that of control group was 0 with pain relief in 22.2% (P < 0.05). Although there were some toxicity in brachy-chemotherapy group, treatment was well tolerated. The 6-, 12-month survival rates of brachy-chemotherapy group were 71.4% and 21.4% and those of control group were 38.5% and 7.7%, respectively. The median survival time was 10.6 months and 5.2 months for the two groups, between which the difference was significant (P < 0.05).

CONCLUSIONInteroperative 125I brachytherapy combined with chemotherapy for advanced pancreatic cancer can control tumor, relieve pain and improve quality of life. It is safe and effective.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Brachytherapy ; Combined Modality Therapy ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Female ; Fluorouracil ; administration & dosage ; Humans ; Intraoperative Period ; Iodine Radioisotopes ; therapeutic use ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms ; drug therapy ; surgery ; therapy ; Quality of Life ; Survival Rate