Efficacy of unicompartmental knee arthroplasty in knees arthritis among elderly patients / 局解手术学杂志

Objective To investigate the efficacy of unicompartmental knee arthroplasty(UKA) on treating elderly patients with knee osteoarthritis in comparison with total knee arthroplasty(TKA),and discuss the indications of the procedure.Methods The clinical data of elderly patients(≥75 years) undergoing UKA in our institute from October 2011 to May 2015 were retrospectively reviewed.Patients treated with UKA were in UKA group.Patients who had no significant difference in the age,gender,BMI (body mass index) and HSS (hospital for special surgery) compared with UKA group and received TKA were selected as TKA group.The outcomes were assessed by HSS and satisfaction score(range,0 ～ 10).Results A total of 29 cases (41 knees) of UKA group were followed up for (30.3 ± 13.6) months (13 ～49 months),29 cases(39 knees) of TKA group.The postoperative HSS(P =0.00),surgery time(P =0.00),perioperative hemorrhage(P =0.00),hospital stay(P =0.04) and satisfaction(P =0.03) of UKA group were all better than those of TKA group.The pain location of the knee (P =0.86) and patellofemoral degeneration (P =0.24) did not affect the postoperative outcomes,11 knees presented with varus ＞ 15° with an average angle of 18.4 ° (15.7 ° ～ 20.1 °),4 knees were with flexion contracture ＞ 15 °,averaging at 18.8 ° (17.7 ° ～ 20.1 °),range of motion measured ＜ 100° in 6 knees with an average range of 79.0° (66.8° ～ 92.1 °).The aforementioned abnormalities were effectively corrected under anesthesia,the range of motion inproved significantly,but there was no significant difference in postoperative HSS among these patients (P =0.85).One case of UKA group had wound dehiscence and superficial infection,recovery occurred after debridement and suturing.Conclusion UKA is effective for elderly patients with satisfactory outcomes,which is superior to TKA with respect to trauma control and preservation of the limb function.Medial patellofemoral degeneration poses no negative effect on postoperative outcomes,medium knee varus (≤20°) and flexion contracture(≤20°) that are corrective under anesthesia among elderly patients might not be considered as contraindications for UKA.

Impact of smoking and smoking cessation on long-term outcome of patients after coronary artery bypass grafting / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the impact of smoking behaviors on long-term outcomes of coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>We conducted this survey in 2541 consecutive patients who underwent CABG in Fu Wai hospital from January 1, 2004 to December 30, 2005. The preoperative and postoperative smoking habits were obtained. The patients were divided into never smokers and ever smokers. The ever smokers were further divided into the current smokers who smoked before and after CABG and former smokers who stopped smoking before CABG, quitters who stopped smoking after CABG. Death, major adverse cardiovascular or cerebrovascular events and angina pectoris were observed. The relative risk of adverse events in different patients were analyzed by univariate and multivariate Cox analysis.</p><p><b>RESULTS</b>The patients were followed up for 4.27 to 6.41 years (average 5.09 years). After CABG, the percentage of persistent smoking patients was 22.1%. After adjusting baseline characteristics, relative risk for tumor related death (RR: 2.38, 95%CI: 1.06 - 5.36), major adverse cardiovascular or cerebrovascular events (RR: 1.26, 95%CI: 1.01 - 1.57) and angina pectoris (RR: 1.29, 95%CI: 1.04 - 1.59) were significantly higher in ever smokers than in never smokers. Similarly, relative risk of death from all causes (RR: 2.60, 95%CI: 1.53 - 4.46), cardiac death (RR: 2.51, 95%CI: 1.32 - 4.78), tumor cause death (RR: 5.12, 95%CI: 2.08 - 12.59), major adverse cardiovascular or cerebrovascular events (RR: 1.83, 95%CI: 1.42 - 2.34) and angina pectoris (RR: 1.69, 95%CI: 1.33 - 2.16) were also significantly higher in current smokers than in never smokers. Outcome was similar between patients who stopped smoking and never smokers (all P > 0.05).</p><p><b>CONCLUSIONS</b>Smoking prevalence is still high in patients after CABG in China. Persistent smoking is associated with higher rates of mortality and morbidity after CABG while smoking cessation is associated with reduction of morbidity and mortality in patients after CABG.</p>

Surgical treatment of aortico-left ventricular tunnel / 中华心血管病杂志

<p><b>OBJECTIVE</b>To review 9 aortico-left ventricular tunnel (ALVT) patients in our hospital, describe the clinical features, diagnosis, treatments and follow-up.</p><p><b>METHODS</b>We identified 9 patients from July 2002 to August 2008. Clinical and surgical details were reviewed. 7 patients were in NYHA class I and 2 in class III, 8 of 9 patients were diagnosed by echocardiography before operation.</p><p><b>RESULTS</b>All patients underwent surgery under standard cardiopulmonary bypass. 2 with direct suture, 5 by patch closure of the aortic end and 1 by patch closure of both aortic end and left ventricular end of the AVLT. 1 underwent aortic valve replacement after incision of the ALVT. One patient died 2 month after operation because of endocarditis and acute heart failure. At follow-up (3 month to 6 years), 3 patients were in NYHA class I, 3 in Class II, 1 in class III and missed 1. No aortic regurgitation or trace in 2, little in 1, little to moderate in 2. The aortic mechanical valve is normal in 1 and paravalvular leakage in 1 patient.</p><p><b>CONCLUSION</b>Aortico-left ventricular tunnel is a rare cardiac malformation with a good post-operative outcome. Surgery is an effective treatment. Long-term follow-up for post-operation is essential.</p>