Objective: We assessed whether inhalation of low dose of nitric oxide comparing with administering 100% oxygen during cardiac catheterization would be as a method to screen patients with congenital heart disease and pulmonary hypertension for operation. Methods: We chose 67 cases of congenital heart disease with pulmonary hypertension undergoing cardiac catheterization. While spontaneously breathing room air (FiO 2, 0 21), the pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) were recorded as baseline. Patients continued to breathing 40 ppm nitric oxide with FiO 2 0.30 and 100% oxygen, for 30 minutes. Effects of inhalation of nitric oxide on pulmonary vasculature were studied. Results: Comparing with breathing room air, after inhalation of 100% oxygen or 40 ppm nitric oxide, PAP, PVR and PRV/SVR were decreased significantly. Conclusion: Comparing with administer 100% oxygen, inhalation of nitric oxide is more sensible and reliable predictor in selecting patients with congenital heart disease and pulmonary hypertension for operation.

Objective To evaluate the accuracy of enhanced CT scan in clinical staging of colorectal cance by detecting the general sit-uation and T and N staging through plain scan combined with enhanced CT scan.Methods Totally 49 cases of colorectal cancer patients were enrolled in this study from May 2015 to October 2015,and it showed no distant metastasis of colorectal cancer in clinical examination. Evaluated the general situation (location,size,and pathologic type)and T and N staging of colorectal cancer through plain scan and enhanced CT scan and multiplanar restructuring.Compared the imaging staging with pathological staging,and respectively calculated the sensitivity,spe-cific degree and accuracy of T and N staging.Evaluated the accuracy of T and N staging with the consistency test,and the differences were statistically significant with P <0.05.Results The location and pathological type of tumor detected by CT scan were compared with the re-sults of operation,and the coincidence rate was 100%.The maximum diameter of the tumor was (2.26 ±1.40)cm from CT image and (2.37 ±1.38)cm from operation measure,and the data were highly correlated (r =0.906,P =0.000).The coincidence rate of T staging was 65.3%,and the consistency was good (k =0.467,P =0.000).The coincidence rate of N staging was 63.3%,and the consistency was good (k =0.440,P =0.000).Conclusion Enhanced CT scan can provide sufficient information for the preoperative evaluation of colorectal cancer,and it has important clinical application value.

Objective To investigate the effects of the free radical scavenger,edaravone,on patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods Thirty patients,including 7 males and 23 females,at a mean age of 41.4?10.4 (23 to 63),undergoing mitral or/and aortic valve replacement (MVR or AVR) under CPB from March to December 2009 in our hospital were subjected,and then divided into 2 matched groups by means of random number table,study group (n=14) and control group (n=16).Inclusion criteria: patients received valve replacement surgery under CPB; aging from 20 to 65; heart function: class Ⅰto Ⅲ; liver,kidney and lung function properly; blood gas and electrolyte properly. Exclude criteria: preoperatively used scavenger and the like; there was a history of cerebrovascular or neuropsychiatric symptoms; had a history of myocardial infarction or other coronary artery disease. In the intervention group,0.5 mg/kg of edaravone was diluted to 20 ml and introduced into CPB unit at the beginning,while the same dose of saline water was given in control group in the same way. Blood samples were collected from radial artery at following 5 time points,the beginning of CPB (T0),the end of CPB (T1),30 min (T2),6 h (T3),and 24 h (T4) after CPB. After the blood samples of all cases were collected,the serum level of hematocrit (HCT),malondialdehyde (MDA),inducible nitric oxide synthase (iNOS),cardiac troponin I (cTnI),creatine kinase-MB (CK-MB),myoglobin (Myo),S100 protein and neuron-specific enolase (NSE) was detected. Cardiac resuscitation and critically postoperative complications were observed. Results The level of HCT at T1-T3,cTnI at T4 was lower in study group than that in control (P

Objective To review our experiences of diagnostic methods and surgical treatment of the left superior vena cava (LSVC) draining into the left atrium.Methods Nineteen patients with LSVC draining into the left atrium were diagnosed and treated surgically from February 1998 to January 2012.All the cases were combined with other congenital heart diseases including patent ductus arteriosus,ventricular septal defect,atrial septal defect,single atrium,triatriatum,partial endocardial cushion defect,anomalous pulmonary venous drainage,right ventricle outflow stenosis,pulmonary valve stenosis,tetralogy of Fallot,double outlet right ventricle,complete endocardial cushion defect,tricuspid atresia.The patients were diagnosed through different methods including echocartiographic examination,cardiac catheterization,computer tomography,and explored during the operation,even postoperatively.All were treated surgically with four techniques including simple ligation to the LSVC,including ligation during a redo procedure; intra atrial rerouting to drainage the flow from the LSVC to the right atrium,atrial septum reconstruction to make the outlet of the LSVC lying in the right side of the patched atrial septal,and bidirectional Glenn shunt to get a physiological result.Results No mortality postoperatively.All the cases were uneventful postoperatively.And the main postoperative course was related only to the main diagnosis of congenital heart disease,not to the left superior vena cava draining into the left atrium.The echo examination result was satisfied before the discharge.The early and long term follow-up(1-11 years) results are excellent,no arrhythmia,no cardiac deficits after echo examination,including stenosis obstruction and residual shunt.No death.Conclusion The diagnostic methods of the LSVC draining into the left atrium are difficult,the only way to make the diagnosis clearly enough before the operation is depending on improving of more and more comprehending to this rare cardiac anomaly,by the pediatric cardiologists,the sinologist,the intensive care unit,and the pediatric cardiae surgeons.The choice of different surgical treatment is depending on the diagnosis and the findings during the operations,and the results are excellent after a suitable choice made.

BACKGROUND: The degradable poly (3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) has superior mechanical property and biocompatibility.OBJECTIVE: To elucidate the intravascular biocompatibility of PHBHHx in vivo.METHODS: We developed hybrid materials based on decellularized xenogenic vascular scaffolds that were coated with PHBHHx and implanted it into the abdominal aorta of New Zealand rabbits. The decellularized xenogenic pulmonary artery patch without PHBHHx coating served as the control. The implanted patches were determined for the histology, immunofluorescence staining, scanning electron microscopy and calcium contents at 1, 4 and 12 weeks after the surgery.RESULTS AND CONCLUSION: Hybrid patches exhibited smooth lumen surface without thrombus, the intimal hyperplasia was mild and recellularization was complete; immunofluorescence staining showed that the endothelial cells in the neointima were positive for CD31, with continuous single-layer arrangement, interstitial cells were positive for smooth muscle actin; the calcium content in hybrid patches was obviously lower than that in uncoated patches. PHBHHx shows a remarkable intravascular biocompatibility in vivo and is believed as an ideal candidate for lumen coating of cardiovascular tissue engineering.

Objective To analyze and summarize the applicative experience and operative effective of the diaguostictreatment-repair strategy in the transpossion of great arteries(TGA) infants with ventricular septal defect and severe pulmonary hypertension more than 6 months.Methods From January 2010 to October 2011,17 TGA cases with ventricular septal defect and severe pulmonary hypertension.There were 13 male and 4 female.≥0.5-＜ 1.0 years old 6 cases,≥ 1.0-＜ 3.0 years old 3,≥3.0 years old 8 cases.Combine anomalies: patent ductus arteriosus in 6 cases,atrial septal defect in 5 cases,valve insufficency in 2 cases.All preoperative cases were performed echocardiography,right-sided heart catheterization 3 cases,coronary CT examinationll cases.After diagnostic-treatment 2-4 weeks,all cases performed arterial switch operation under compound intravenous and inhaled anesthesia.Results No operative death.After diagnotic-treatment,SPO2 improved 10％-21％,and mPAP decreased 10-20 mm Hg.Follow-up 11.2 (6,20) months,one dead.Postoperative residual pulmonary arterial hypertension in 35.29％,6/17cases,all of them were ≥3 years old.Continue to pulmonary arterial hypertension targeted drugs treatment for 6-20 months later,pulmonary artery pressure decreased obviously.Conclusion The TGA infants with ventricular septal defect pulmonary arterial hypertension more than 6 months,can be selectively performed arterial switch operation under went diagnostic-treatment-repair strategy,continue to pulmonary arterial hypertension targeted drug therapy postoperation,the effect is good.

Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.

OBJECTIVETo explore whether bulbourethral suspension procedure is effective for the treatment of male urinary incontinence of post-prostatectomy and posterior urethroplasty.

METHODSTwelve male patients with urinary incontinence undergone bulbourethral suspensive operation were reviewed and analyzed with regard to the operation method, postoperative urinary dynamics and clinical results.

RESULTSTen patients resumed complete control of urination and 1 was improved. In one patient, postoperative difficulty occurred in voiding but corrected by transurethral bladder neck revision for free passage of urine and continence. Urodynamic study showed that the maximum urethral pressure ranged from 85 to 115 cm H(2)O (mean 98 cm H(2)O, 1 cm H(2)O = 0.098 kPa). The functional urethral length ranged from 3.5 to 4.5 cm (mean 3.75 cm).

CONCLUSIONBulbourethral suspension procedure is effective in the treatment of male urinary incontinence after prostatectomy and posterior urethroplasty.

Adult ; Aged ; Humans ; Male ; Middle Aged ; Prostatectomy ; adverse effects ; Suture Techniques ; Urethra ; surgery ; Urinary Incontinence ; etiology ; surgery

OBJECTIVETo investigate the possibility of urethral reconstruction with a free colonic mucosal graft.

METHODSTen female dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. A urodynamic study was performed before the operation and sacrifice. The dogs were sacrificed 8 to 16 weeks after the operation for histological examination of the urethra.

RESULTSUrethral stricture developed in 1 dog. The results of urody namic studies showed that the difference in maximum urethral pressure between pre-operation and pre-sacrifice in the remaining 9 dogs was not of significance (P > 0.05). Histological examination revealed that the colonic free mucosa survived inside the urethral lumen of the 9 dogs. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was observed in dogs sacrificed 8 weeks after the operation. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was not observed and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in dogs sacrificed 12 weeks after the operation.

CONCLUSIONSUrethral mucosa can be replaced by colonic mucosa without damaging the continence mechanism in female dogs. This technique is useful when local or preputial skin and buccal or bladder mucosa are not available.

Animals ; Colon ; transplantation ; Dogs ; Female ; Intestinal Mucosa ; transplantation ; Urethra ; pathology ; surgery ; Urologic Surgical Procedures

OBJECTIVETo investigate the possibility of urethral reconstruction with colonic mucosa for the treatment of complex longer urethral stricture (>/= 10 cm).

METHODSFrom October 2000 to September 2001, 6 patients with complex longer urethral stricture were treated with colonic mucosal graft urethroplasty. They had under gone 3 previous unsuccessful urethral repairs on average. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 15 cm (mean 12.17 cm). Follow-up included retrograde urethrography, urethroscopy, and uroflowmetry.

RESULTSThe patients were followed up 3 - 14 months postoperatively (mean 7.8 months). Meatal stenosis developed in one patient 3 months after operation needed reoperation. The patient voided very well with urinary peak flow 28.7 ml per second duing follow-up for 12 months postoperatively. The other patients voided well with urinary peak flow greater than 15 ml per second. At urethroscopy, colonic mucosa was macroscopically difficult to distinguish from normal original urethral mucosa in 4 patients over 6 months after the operation.

CONCLUSIONSColonic mucosa graft urethroplasty is feasible for the treatment of complex longer anterior urethral stricture. The technique is useful for urethral reconstruction when penial skin and bladder mucosa are not available.

Colon ; Humans ; Intestinal Mucosa ; Treatment Outcome ; Urethra ; Urethral Stricture ; Urologic Surgical Procedures, Male