Long-term outcome of correction of tetralogy of Fallot in 56 adult patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although most patients with tetralogy of Fallot undergo radical repair during infancy and childhood, patients that remain undiagnosed and untreated until adulthood can still be treated. This study aimed to evaluate longterm outcomes of adult patients with tetralogy of Fallot who were treated surgically, and to determine the predictors of postoperative pulmonary regurgitation.</p><p><b>METHODS</b>Fifty-six adult patients underwent complete surgical repair. Forty-three patients (76.8%) required a transannular patch. Systolic, diastolic, and mean pressure in the main pulmonary artery were measured after repair.</p><p><b>RESULTS</b>The early mortality rate was 3.6%. The 16-year survival rate was (84.4 ± 11.5)%. Late echocardiography revealed 41 patients with transannular patch who had pulmonary regurgitation, consisting of mild pulmonary regurgitation in 28 patients, moderate in eight, and severe regurgitation in five patients. In addition, there was right ventricular outflow tract stenosis in nine patients, moderate/severe tricuspid valve regurgitation in seven, and residual ventricular septal defect in five. Logistic regression analysis demonstrated that the mean pulmonary pressure measured just after repair predicted late pulmonary regurgitation.</p><p><b>CONCLUSIONS</b>The long-term survival of surgically treated adult patients with tetralogy of Fallot is acceptable. The mean pressure >20 mmHg in the main pulmonary artery measured right after surgical repair may be a feasible reference to time the reconstruction of the pulmonary valve.</p>

Diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue lymphoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Primary non-Hodgkin's lymphoma in lung is very rare, and the most common among them is mucosa-associated lymphoid tissue lymphoma (MALToma), whose clinical features and laboratory characteristics are poorly defined, making diagnosis difficult. The purpose of this study was to study the diagnosis and treatment of pulmonary MALToma.</p><p><b>METHODS</b>The clinical data of 12 patients treated for MALToma between August 1992 and December 2005 were analyzed.</p><p><b>RESULTS</b>No specific symptoms or signs, or results of bronchoscopy, ultrasonagraphy or bone marrow examination could be found in the 12 patients. Only radiography was useful in diagnosis, though the final diagnosis of all the patients was based on histology and immunohistochemistry. Two patients also had gastric MALToma. Operations were performed on 6 patients, including 5 radical operations and 1 partial resection: 4 patients also received adjuvant chemotherapy. One patient experienced recurrence 152 months after the operation, while the other 5 patients have survived disease-free. Four patients were treated with chemotherapy alone, two of whom experienced complete remission and the others partial remission. The final 2 patients received no treatment and had survived for 7 and 27 months respectively. All the patients were still alive at the most recent follow-up, 7 to 160 months (mean 71.3 months).</p><p><b>CONCLUSIONS</b>Except radiography, no specific clinical manifestations could be identified for pulmonary MALToma. The final diagnosis should be based on histology and immunohistochemistry. Several treatment methods can be used to achieve good outcomes.</p>

Effects of angiotensin converting enzyme inhibitor on the expression of angiotensin converting enzyme 2 in atrium of patients with atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the expression of angiotensin converting enzyme 2 (ACE2) and the changes treated with angiotensin converting enzyme inhibitor (ACEI), and its signal transduction pathway.</p><p><b>METHODS</b>Atrial tissues were obtained from 47 patients with RHD undergoing cardiac surgery. The mRNA of ACE2 and ACE were semi-qualified by RT-PCR and normalized to the gene beta-actin. Western blot analysis was employed to examine the expressions of ACE2, ACE, ERK1/2 and phosphorylated ERK (pERK1/2). The atrial tissue angiotensin II (Ang II) content was determined by radioimmunoassay detection.</p><p><b>RESULTS</b>The expression of ACE2 was significantly decreased (P < 0.05), the expression of ACE and pERK1/2 were significantly increased (P < 0.05), and the level of atrial tissue Ang II was significantly increased in patients with chronic atrial fibrillation group (CAF) compared with sinus rhythm group (SR) (P < 0.05). Compared with CAF patients treated without ACEI, the expression of ACE2 significantly increased (P < 0.01), and the relative activity of ERK1/2 significantly decreased (P < 0.05), whereas the expression of ACE and the level of atrial tissue Ang II remained unchanged in CAF patients treated with ACEI.</p><p><b>CONCLUSIONS</b>The study suggested that the dysequilibrium of ACE/ACE2 might play an important role in the process of atrial fibrillation, which may be related to the activation of ERK1/2 pathway. The clinical effect of long-term treatment of ACEI maybe associated with elevated ACE2 expression but not ACE expression.</p>

Surgical treatment of tricuspid valve disease combined with cardiac cachexia syndrome / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the surgical treatment of tricuspid valve disease combined with cardiac cachexia.</p><p><b>METHODS</b>Seven patients with heavy tricuspid valve disease combined with cardiac cachexia underwent tricuspid valve replacement. Heart function and nutrition status were improved in the perioperative period.</p><p><b>RESULT</b>All operations were performed successfully, but one patient died of heavy heart failure postoperatively. The mean follow-up length was 32 months, all patients had good heart function except one with minor right heart function failure.</p><p><b>CONCLUSION</b>Prosthetic heart valve replacement is an effective treatment for patients with serious tricuspid valve disease combined with cardiac cachexia. The perioperative nutrition support and heart function improvement are important in the treatment process.</p>

The diagnosis and surgical treatment for 56 cases with pulmonary and pleural aspergillosis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of diagnosis and surgical treatment for pulmonary and pleural aspergillosis.</p><p><b>METHODS</b>The clinical data of cases with pulmonary and pleural aspergillosis were analyzed retrospectively between September 1972 and June 2003. There were 53 cases with pulmonary aspergillosis and 3 cases with pleural aspergillosis. Aspergillus was found preoperatively in 8 patients by sputum culture (5 cases) or needle biopsy of the lung (2 cases) or fibro-bronchoscopic biopsy (1 case). All patients were treated with surgical procedures following X-ray film or CT scan.</p><p><b>RESULTS</b>Of 53 cases with pulmonary aspergillosis, 42 lobectomies, 3 segment-Pneumonectomies, and 8 wedge resections were performed. Of three cases with pleural aspergillosis following eliminating their diseased foci in residual pleural space, two underwent thoracoplasty, one underwent postoperative closed chest drainage for one and an half month with fluconazole injected into residual pleural space repeatedly for 1 month (200 mg/100 ml, 1 time per 2 or 3 days). No operative death and major postoperative complications occurred. None of the patients had recurrent symptoms at follow-up.</p><p><b>CONCLUSION</b>We recommend aggressive surgical resection for pulmonary and pleural aspergillosis, and the surgical result is excellent.</p>

Value of serum-vascular endothelial growth factor in the differential diagnosis of solitary pulmonary nodule / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate serum-vascular endothelial growth factor (S-VEGF) in the differentiation of solitary pulmonary nodule (SPN).</p><p><b>METHODS</b>Serum level of VEGF of 68 patients with SPN was measured by ELISA kit, and compared with the control group of 20 normal subjects. The nodules were diagnosed by operation and pathology.</p><p><b>RESULTS</b>The median level of S-VEGF was 42.5 (range from 10 to 170) pg/ml in the control, 44 (range from 18 to 360) pg/ml in benign nodule group and 75 (range from 18 to 890) pg/ml in lung cancer group, with significant difference observed between the nodule group and control (P < 0.01), and between the lung cancer group and the benign nodule group (P < 0.05), but not between the benign nodule group and the control. In addition, when S-VEGF in different pathologic types of the limited number of lung cancer patients were compared, no significant difference was observed.</p><p><b>CONCLUSION</b>S-VEGF is valuable in the differential diagnosis of solitary pulmonary nodule. An elevated S-VEGF level >or= 100 pg/ml in patients with SPN may strongly speak for a malignant nodule. Operation is suggested.</p>