Guidance value of cerebrospinal fluid and serum procalcitonin in the ventricular catheter indwelling time of intracranial pressure monitoring / 中国综合临床

Objective To explore the guidance value of cerebrospinal fluid(CSF)and serum procalcitonin(PCT)in the ventricular catheter indwelling time of intracranial pressure monitoring(ICP).Methods Fifty-eight cases patients with moderate and severe craniocerebral trauma who were given ICP ventricular catheter and external ventricular drainage(EVD)were selected,5 ml CSF and 2 ml venous blood were collected at operation,1st,7th,14th d after operation.The change of CSF and serum PCT and WBC levels were compared among different time,the correlation among each indicators and diagnosis value for intracranial infection were analyzed.Results The level of CSF and serum PCT and WBC increased with the lengthen of ventricular catheter indwelling time(CSF PCT:(0.09±0.02)μg/L of operation,(1.17±0.25)μg/L of 14 d after the operation;CSF WBC:(24.33±12.75)×106/L of operation,(431.52±140.26)×106/L of 14 d after the operation;serum PCT:(0.16±0.05)μg/L of operation,(4.57±1.41)μg/L of 14 d after the operation;serum WBC:(4.14±0.46)×106/L of operation,(14.24±3.05)×106/L of 14 d after the operation;P＜0.05).The CSF PCT was positively correlated with CSF WBC and serum PCT(r=0.614,0.711,P＜0.05).The diagnostic sensitivity of CSF and serum PCT for prognosis of intracranial infection were 95.2％,81.0％,the specificity were 94.6％,78.4％,the specificity of CSF PCT was significantly higher than that of serum PCT(P=0.041).Conclusion CSF and serum PCT has high early diagnosis value for intracranial infection in patients with ICP ventricular catheter,which can contribute to guide the reasonable timing of tube drawing,brings out the best of ICP and cerebrospinal fluid drainage,improve the level of treatment in patients with traumatic brain injury.

Progress of Application of Navigation Technology in Spinal Surgery / 中国微创外科杂志

[Summary] This article briefly reviewed the application of advanced navigation technology in spinal surgery .By comparing advantages and disadvantages of the current application of navigation equipment , we pointed out the development direction of spinal navigation technology .

Role of echocardiography in case selection in transcatheter closure of perimembranous ventricular septal defect using occluder / 中华超声影像学杂志

Objective To study the role of echocardiography in case selection in transcatheter closure of perimembranous ventricular septal defect (VSD) with occluder.Methods Transcatheter closure was conducted on 26 patients with perimembranous VSD. Occluders were made of China. The images were acquired with transthoracic echocardiography. Results Twenty four patients were implanted with occluders successfully. The VSD diameter by echocardiography was 4-10 mm, average was 6.4 mm.The implanted occluder device was 2 mm larger than VSD,the maximal one was 12 mm. Perimembranous VSDs were classified by subinfracristal ( 5 cases ),membranous(6 cases), submembranous (13 cases),and the minimum distance between VSD and aortic valve annulus was 2 mm,between VSD and tricuspid valve was 3 mm. Membranous VSD was easy to be occluded. Echocardiography immediately after placement showed no residual shunt in 21 patients. The one week follow up examination showed complete closures in 21 patients. Echocardiography immediately after placement showed mild residual shunts in 3 VSD, the residual shunt disappeared after one month in one patient, two patients had mild shunt. Two VSD abandoned the occlusion because of aortic valve regurgitation increasing. Conclusions Echocardiography plays an important role in case selection.

Giant left atrium combined with mitral valvular disease: morphologic classification and its clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To study the morphologic classification and its clinical significance of giant left atrium (GLA) combined with mitral valvular disease.</p><p><b>METHODS</b>Between January 1993 and December 1999, a total of 62 consecutive patients with mitral valvular disease, whose preoperative left atrial endodiastolic volume index >/= 300 ml/m(2) or endosystolic diameter >/= 6.0 cm, were enrolled as research candidates. Morphologically, GLA was classified by Q Hierarchical cluster analysis according to the right or left side cardiothoracic ratio of the left atrium (r- or l-LATR) on an anteroposterior chest roentgenogram and the ratio of the distant diameter of the left main bronchus to the approximate diameter of the left main bronchus (LBDd/Dp) or to the trachea (LB/TR) on an left anterior oblique chest roentgenogram.</p><p><b>RESULTS</b>According to r-LATR and l-LATR, the morphology of GLA was classified clinically into three types: type L (l-LATR >/= 0.6 and r-LATR < 0.58), type R (r-LATR >/= 0.58 and l-LATR < 0.6) and type B (r-LATR >/= 0.58 and l-LATR >/= 0.6). According to LBDd/Dp and LB/TR, GLA in type L and B was further classified into two subtypes, respectively: left posterior downward type (L(I) and B(I)), in which LBDd/Dp is equal or exceeds 0.38 or LB/TR is equal or exceeds 0.33, and left posterior upward type (L(II) and B(II)), in which LBDd/Dp is less than 0.38 or LB/TR less than 0.33.</p><p><b>CONCLUSION</b>The morphologic classification of GLA may represent the main pathophysiological changes of GLA and might be a guideline for the selection of the optimal plication procedures of GLA in patients with valve diseases.</p>

Echocardiography in the therapeutic evaluation of aortic valve replacement with autologous pericardial valve / 第二军医大学学报

Objective: To evaluate the surgical results of aortic valve replacement with autologous pericardial valve. Methods: Nine patients underwent aortic valve replacement with autologous pericardial valve were studied by color Dopplor echocardiography (HP 1000 type). The mobility, thickness, opening amplitude, valve orifice areas, regurgitant stroke volume and transorifice pressure gradient of the autologous pericardial valves were measured and analysed intraoperatively and postoperatively. Results: 10 days postoperation, there was no significant difference in above mentioned indices between patients and normal group. Two years after operation, the mobility, thickness, opening amplitude, valve orifice areas, regurgitant stroke volume and transorifice pressure gradient of the autologous pericardial valves showed no significant changes, the EDV and LVEDD significant reduced as compared with 10 days postoperatively. Conclusion: Two years after operation, the structure and function of the autologous pericardial valve may maintain good condition.

Investigation of the morphologic and functional changes of the valve after tricuspid valve prosthesis by color Doppler echocardigraphy / 第二军医大学学报

Objective: To study the morphologic and functional changes of the valve after tricuspid valve prosthesis. Methods: Sixty five patiens whose ages averaged (44.6?10.6) years underwent valve replacement and tricuspid value reconstruction. Color Doppler echocardiography were performed before and after operation. Results: Follow up averaged 12 months after operation, the morphology of tricuspid valve was normal. The diameter of the annulus decreased to (2.2?0.2) cm ( P

Long-term follow-up of tricuspid valve function by color Doppler echocardiography after mitral valve replacement / 中华胸心血管外科杂志

Objective To investigate the long-term morphologic and functional changes of the tricuspid valve after mitral valve replacement. Methods The tricuspid valve function was evaluated by Doppler echocardiography in 903 patients who underwent mitral valve replacement during recent 10 years. Tricuspid regurgitation and annular dilatation in various degrees were found in all patients preoperatively. 686 patients underwent Kay annuloplasty or DeVega annuloplasty, 106 patients underwent tricuspid ring annuloplasty, and 201 untreated. Results Among 201 patients who did not undergo tricuspid annuloplasty, severe tricuspid regurgitation developed in 46 during 2 to 3 years follow-up. One out of 16 patients who underwent tricuspid ring annuloplasty developed moderate tricuspid regurgitation 2 years after operation. Of 686 patients who underwent Kay annuloplasty or DeVega annuloplasty, 150 developed moderate or severe tricuspid regurgitation during 3~5 years after operation. Conclusion Tricuspid annular dilatation, right heart impairment and severe pulmonary hypertension are responsible for the development of late tricuspid regurgitation after mitral valve replacement. For the patient who underwent mitral valve replacement ,tricuspid annuloplasty should be performed when annular dilatation was found, even without tricuspid regurgitation and tricuspid ring annuloplasty should be performed in patient with severe tricuspid regurgitation and obvious tricuspid annular dilatation.