Preoperative evaluation value of carotid and cerebral arteries by CT angiography in acute type A aortic dissection / 医疗卫生装备

Objective To investigate the feasibility of combined CT angiography(CTA)of head,neck and aorta in acute type A aortic dissection (ATAAD) and whether the incremental craniocervical information benefits the surgeon and leads to improved clinical outcomes.Methods One hundred and twenty ATAAD patients in a CAC group underwent combined aortic CTA and 123 ATAAD patients in a control group underwent conventional aortic CTA.In the CAC group,the image quality was analyzed and critical CTA findings in craniocervical arteries were determined for further surgery procedure.The radiation dose,intraoperative cerebral protection method,and postoperative intensive care units(ICU)time,in-hospital time,neurologic dysfunction(ND)and all-cause mortality were compared between the two groups.Results The CAC group had all the carotid and cerebral arteries diagnosed successfully. There were 13 patients replaced conventional unilateral antegrade selective cerebral perfusion with bilateral one according to the head and neck CTA images in the CAC group. The CAC group had effective radiation dose,postoperative ND,ICU time and in-hospital time significantly lower than those of the control group (P<0.05).There were no statistical differences between the all-cause morbidities of the two groups (P>0.05).Conclusion A combined CTA of head, neck and aorta in ATAAD is feasible. The incremental craniocervical information may lead to improved clinical outcomes.

Imagings of coronary total occlusion using dual-source computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the imaging characteristics of coronary arteries with total occlusion (TO) lesions shown by dual-source computed tomography CT (DSCT) coronary angiography.</p><p><b>METHOD</b>The clinical data of patients who were diagnosed as coronary heart disease together with total occlusion lesions between March 2008 and March 2010 were retrospectively analyzed.</p><p><b>RESULTS</b>In a cohort of 140 patients with 152 TO lesions, TO vessels in right coronary artery, left anterior descending artery, left circumflex coronary artery, or left main coronary artery were 68, 48, 20, and 1, respectively. Side branch TO were found in 15 vessels, in which 13 cases were found to be with TO in two coronary arteries. The length of TO was 5-58 mm, mean (16.8 ± 3.9) mm. TO lesions with a length ≥ 1 cm accounted for 91.4%. The appearance of stump in TO were abrupt occlusion (n=68) , blunt occlusion (n=64) , and mouse-tail occlusion (n=20) . Among all the TO lesions, 73% were soft plaque or mainly soft plaque together with minimal calcification. Mixed plaque and calcified plaque were less seen. Ten TO segments presented with dilated lumens were thrombogenesis. There were 25 TO segments angulated or tortuosity, which were most frequently shown in right coronary artery. DSCT only presented 3 TO with clear collateral vessels and no TO with bridge collateral vessels was shown.</p><p><b>CONCLUSIONS</b>DSCT can provide most necessary information of coronary TO lesions. Therefore, it can be used to guide surgeries on TO lesions and improve the success rates of surgeries.</p>

Influence of preoperative range of motion on the early clinical outcome of total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA).</p><p><b>METHODS</b>From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one <or= 90 degrees (range, 5 degrees - 90 degrees ) and the other > 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty.</p><p><b>RESULTS</b>The patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened.</p><p><b>CONCLUSIONS</b>TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.</p>