Clinical effectiveness of valve-sparing aortic root replacement in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot / 中国胸心血管外科临床杂志

@#Objective     To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods     A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results     Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion     VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.

Advances in cardiovascular diseases in children with Turner syndrome / 国际儿科学杂志

Turner syndrome（TS），a condition among females with a karyotype containing one X chromosome and complete or partial absence of the second sex chromosome，affects 20～50 in 100 000 newborn girls. Congenital or acquired cardiovascular diseases are present in about half of patients with TS. The congenital defects occur in about 25%～50% of TS patients；aortic dilatation as an important risk factor for aortic dissection is common in adult patients with TS. Furthermore，arrhythmias are found more frequently in patients with TS. A higher prevalence of hypertension in children and adolescents with TS has also been reported，and the application of 24h ambulatory blood pressure monitoring may facilitates the diagnosis of hypertension among these children and adolescent.Thus，active health education，correct follow-up and timely intervention are crucially needed.

Current status of vascular preparation modalities for endoluminal treatment of lower limb arteriosclerosis obliterans / 国际外科学杂志

With the increasing use of lower-extremity arterial angioplasty and the clinical use of a variety of vascular preparation devices. Vascular surgeons have more vascular preparation equipment such as cutting balloon, double wire balloon, chocolate balloon, shock wave balloon, AngioJet, Roterax and Acostream. These options can improve clinical outcomes, improve patient experience, and reduce stent placement and associated complications. This article will review the available vascular preparation devices for volume reduction, endovascular lithotripsy, and other special balloons to help clinicians choose the appropriate vascular preparation for their condition to improve perioperative safety and long-term patency.

Combining balloon catheter expansion with swallowing training can better improve the swallowing of tracheotomy patients after pontine hemorrhage / 中华物理医学与康复杂志

Objective:To observe any effect of supplementing basic swallowing training with balloon catheter dilation on the swallowing function of tracheostomy patients with pontine hemorrhage.Methods:A total of 40 pontine hemorrhage patients with tracheostomy and swallowing disorders were divided randomly into an observation group and a control group, each of 20. Both groups were given nutritional neurodrugs and basic swallowing training, but the observation group also received 25 minutes of balloon catheter dilation, five times a week for 6 weeks. Before and after the 6 weeks of treatment one swallowing therapist evaluated the feeding ability and leakage-aspiration status of each subject assigning functional oral intake (FOIS) ratings and Rosenbek Leakage/Aspiration Rating Scale (PAS) ratings double-blinded. The Watian water swallowing test was also applied.Results:After the treatment the average FOIS and PAS scores of both groups had improved significantly, with those of the observation group then significantly better than among the control group on average. The total treatment effectiveness rate was 70% in the observation group, significantly better than the 30% in the control group.Conclusion:Supplementing swallowing training with balloon catheter dilation can better improve the swallowing of patients recovering from a tracheotomy after pontine hemorrhage.

Diagnosis and management of diabetes insipidus complicated with upper urinary tract dilatation: a single-center experience / 现代泌尿外科杂志

【Objective】 To investigate the urinary tract characteristics of diabetes insipidus (DI) complicated with upper urinary tract dilatation (UUTD), and to summarize the treatment experience. 【Methods】 The clinical data of 28 DI patients treated in China Rehabilitation Research Center were retrospectively analyzed with UUTD and all urinary tract dysfunction (AUTD) systems to evaluate the urinary tract characteristics. The relevant laboratory results, video-urodynamic recordings (VUDS), UUTD, neurophysiologic tests, treatment regimens and follow-up data were summarized. 【Results】 There were 21 DI cases (75.0%) and 7 cases of DI with neurogenic bladder (NB). Polyuria, polydipsia, urine specific gravity, urine osmotic pressure and water deprivation vasopressin test had diagnostic value for DI. In addition, detailed history, neurological examination, VUDS and neurophysiologic tests had significant diagnostic value for DI with NB. Enterocystoplasty was recommended for 2 DI with NB patients with poor bladder capacity, compliance and renal impairment. For the remaining 26 patients, individualized medication combined with bladder neck incision and appropriate bladder management, including intermittent catheterization, catheter indwelling and regular voiding, achieved satisfactory results. High serum creatinine decreased from (269.8±105.7)μmol/L to (164.4±90.2)μmol/L in 13 patients with abnormal renal function. Forty-eight dilated ureters showed significant improvement in the UUTD grade, and the median grade decreased from 3 to 2. 【Conclusion】 Bladder distension, trabeculation and decreased or absent sensations were common features for DI patients with UUTD. Individualized therapy by medication combined with appropriate bladder management can improve the dilatation and renal function.

Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation / 器官移植

Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.

Association of TP53 germline variant and choledochal cyst among clinically diagnosed Filipino pediatric patients

@#Background and Objective. Choledochal cysts (CC) are rare congenital, cystic dilations of the biliary tree occurring predominantly in Asian populations and in females. Patients are usually children presenting with any of the following: abdominal pain, palpable abdominal mass, and jaundice. Its congenital nature hints at a potential genetic cause. A possible causal gene is TP53, a tumor suppressor with a germline variant called rs201753350 (c.91G>A) that changed from a G allele to an A allele, decreasing the cell proliferation suppressing activity of its functional protein. Currently, there is no information on the TP53 rs201753350 germline variant available for the Filipino population. This study determined the prevalence of rs201753350 and the association between the functional G allele, the rs201753350 germline variant A allele, and the occurrence of CCs in Filipino pediatric patients in a tertiary government hospital. Methods. Genomic DNA was extracted from blood samples of pediatric patients clinically diagnosed with CC. Controls were DNA samples collected from a previous study. The samples underwent PCR, electrophoresis, and sequencing. Results. A total of 109 participants (22 cases and 87 controls) were included in the study. The A allele (22.94%) occurs at a lower frequency than the G allele (77.06%) among both cases and controls. More individuals have a homozygous G/G genotype (54.13%) than a heterozygous A/G genotype (45.87%) while the homozygous A/A genotype was not observed. The estimated risk of choledochal cyst occurrence is significantly lower in individuals with the A allele (PR: 0.08, 95% CI: 0.01 – 0.55) and the A/G genotype (PR: 0.06, 95% CI: 0.01 – 0.40). Conclusion. There is no significant evidence to suggest an association between the TP53 rs201753350 germline variant and the occurrence of choledochal cysts in Filipinos. It is recommended that other mutations within and beyond the TP53 gene be investigated for possible associations with choledochal cyst occurrence.

Treatment For Infected Frozen Elephant Trunk Prosthesis Caused by Propionibacterium acnes: A Surgical Challenge

ABSTRACT In this article, we present the case of a 47-year-old man who underwent Bentall-Bono procedure and frozen elephant trunk prosthesis implantation due to severe aortic regurgitation and aortic dilatation with a second-time endovascular stent-graft repair in descending aorta. Over eight years, a subacute graft infection by Propionibacterium acnes was developed, culminating in cardiogenic shock secondary to severe aortic regurgitation due to a complete aortic root dehiscence because of multiple aortic pseudoaneurysms. The patient underwent emergency surgery in which the replacement of the graft by a biological valve tube was performed accompanied by a complete debranching of the three supra-aortic vessels.

Corneal ectasia following photorefractive keratectomy: a confocal microscopic case report and literature review / Ectasia corneana após ceratectomia fotorrefrativa: relato de caso de microscopia confocal e revisão da literatura

ABSTRACT The occurrence of corneal ectasia after photorefractive keratectomy is a rare but serious complication of refractive surgery. Possible risk factors are not well assessed, but a probable reason is the failure to detect keratoconus preoperatively. In this report, we describe a case of corneal ectasia after photorefractive keratectomy in a patient who presented a suspicious tomography pattern preoperatively but had no degenerative alterations associated with pathologic keratoconus, as revealed by in vivo corneal confocal microscopy. We also review eligible case reports of post-photorefractive keratectomy ectasia to find similar characteristics.

RESUMO A ocorrência de ectasia corneana após ceratectomia fotorrefrativa é uma complicação rara, porém grave, em cirurgia refrativa. Os possíveis fatores de risco não são bem avaliados, mas a opinião atual é que a falha na detecção de ceratocone pré-operatório possa ser o principal motivo. Neste relato, descrevemos um caso de ectasia corneana após ceratectomia fotorrefrativa em paciente apresentando padrão tomográfico suspeito no pré-operatório, mas sem alterações degenerativas associadas a ceratocone patológico, conforme revelado por microscopia confocal in vivo da córnea. Além disso, revisamos, na literatura, relatos de casos elegíveis de ectasia pós-ceratectomia fotorrefrativa para encontrar características semelhantes.

Application of Computed Tomography Angiography in Preoperative Diagnosis of Coarctation of Aorta and Evaluation of Aortic Dilatation in Infants

ABSTRACT Objective: To evaluate the occurrence of aortic dilatation and its associated predictors with coarctation of the aorta (CoA) in infants using multi-slice computed tomography (MSCT). Methods: The clinical data of 47 infantile patients with CoA diagnosed by MSCT and 28 infantile patients with simple ventricular septal defect were analyzed retrospectively. Aortic diameters were measured at six different levels, and aortic sizes were compared by z score. The coarctation site-diaphragm ratio was used to describe the degree of narrowing. Relevant clinical data were collated and analyzed. Results: The dilation rate and z score of the ascending aorta in the severe CoA group were significantly higher than those in the mild CoA group (11 [52.38%] vs. 21 [80.77%], P=0.038 and 2.00 ± 0.48 vs. 2.36 ± 0.43, P=0.010). Pearson's correlation analysis found that the z score of the ascending aorta was negatively correlated with the coarctation site-diaphragm ratio value (r=-0.410, P=0.004). A logistic retrospective analysis found that an increased degree of coarctation was an independent predictor of aortic dilatation (adjusted odds ratio 0.002; 95% confidence interval 0.00-0.819; P=0.043). The z score of the ascending aorta in the severe CoA group was significantly higher than that in the ventricular septal defect group (P<0.05). Conclusion: Most infants with CoA can also have significant dilatation of the ascending aorta, and the degree of this dilatation is related to the degree of coarctation. Assessment of aortic diameter and related malformations by MSCT can predict the risk of aortic dilatation in infants with CoA.

Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

ABSTRACT Introduction: Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. Methods: A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. Results: A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. Conclusion: Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

Post-Bader procedure: a long-term follow-up case study / Procedimento pós-Bader: estudo de caso com acompanhamento de longo prazo

ABSTRACT Keratoconus is a progressive disorder that manifests as a cone-like steepening of the central or paracentral inferior cornea and irregular stromal thinning. There is a gradual decrease in visual acuity due to corneal asymmetry, irregular astigmatism, and increased optical aberrations, consequently impacting the quality of life. Several procedures have been developed in an attempt to slow or reverse the progression. The Bader procedure, which includes a pattern of incisions around the circumference of the cornea and at the base of the protruding cone, is one such surgery. These incisions penetrate 70-90% of the cornea's depth. Its goal is to flatten the topography and reduce corneal asymmetry and irregular astigmatism. Though prior research found these to be highly promising, we report a patient who was given contact lenses to restore and maintain his vision while his corneal ectasia and thinning progressed over the following decade.

RESUMO O ceratocone é uma doença progressiva que se manifesta como uma elevação semelhante a um cone da cór­nea central ou paracentral inferior e é associada a uma re­dução irregular da espessura do estroma. Há uma diminuição gradual da acuidade visual devido à assimetria da córnea, ao astigmatismo irregular e a um aumento das aberrações ópticas, o que prejudica a qualidade de vida. Foram desenvolvidos vários procedimentos para tentar interromper ou mesmo reverter a evolução da doença. Um deles é o chamado procedimento de Bader, que inclui um padrão de incisões em volta da circunferência da córnea e na base do cone protuberante. Essas incisões penetram até 70%-90% da profundidade da córnea e têm o objetivo de achatar a topografia e diminuir a assimetria da córnea e o astigmatismo irregular. Embora essa técnica seja muito promissora, segundo um estudo anterior, aqui se apresenta o caso de um paciente no qual esses objetivos não foram atingidos. Esse paciente recebeu lentes de contato para restaurar e manter sua visão, enquanto sua ectasia corneana e a redução da espessura progrediram ao longo da década seguinte.

Reflexões da pandemia de COVID-19: a tomada de decisão médica na abordagem terapêutica pós-aborto em dois hospitais públicos do Distrito Federal / Reflections of the COVID-19 pandemic: medical decision-making in the post-abortion therapeutic approach in two public hospitals in the Federal District, Brazil / Reflexiones de la pandemia de COVID-19: toma de decisiones médicas en el abordaje terapéutico postaborto en dos hospitales públicos del Distrito Federal, Brasil

Objetivo: identificar possíveis alterações da tomada de decisão médica para esvaziamento uterino pós-aborto de primeiro trimestre no cenário da COVID-19em dois hospitais públicos do Distrito Federal. Metodologia: abordagem qualitativa, que usou dois procedimentos metodológicos­documental e entrevistas­,cuja coleta de dados ocorreu entre maio e junho de 2022. No hospital A, coletou-se, em 25 registros consecutivos do livro do centro cirúrgico, a técnica de esvaziamento uterino pós-aborto prevalecente em 2020. No hospital B, coletou-se o mesmo dado em 48 prontuários clínicos, 23 de 2019 e 25 de 2020. As entrevistas semiestruturadas foram realizadas com onze profissionais de saúde: três médicos, quatro enfermeiros e quatro técnicos de enfermagem, lotados na obstetrícia/centro cirúrgico de cada hospital. Resultados: ambos os hospitais, no recorte temporal do estudo de 2019 a 2020, dispuseram de insumos para a eleição por quaisquer das técnicas de esvaziamento uterino. No hospital A, em 2020, a tomada de decisão médica foi 100% pela aspiração manual intrauterina. Em2019, no hospital B, a eleição foi 100% pela dilatação e curetagem; em 2020, período da COVID-19, apesar da dilatação e curetagem manter-se prioritária em 78% dos casos, notabilizou redução em relação a 2019. Evidenciou-se, ainda, no hospital B um maior quantitativo de atendimentos e internações de mulheres em processo de pós-aborto, se comparado como período anterior à COVID-19. Conclusão: o fator determinante para a tomada de decisão médica em ambos os hospitais é a aptidão técnica do médico para a abordagem eleita.

Objective: to discern potential shifts in medical decision-making regarding the selection of uterine evacuation techniques post-abortion in the first trimester within the context of the COVID-19 scenario at two public hospitals in the Federal District. Methods: employing a qualitative approach, the study utilized two methodological procedures - documents and interviews. Data collection occurred between May and June of 2022. At Hospital A, prevalent post-abortion uterine evacuation techniques in 2020 were obtained from 25 consecutive records sourced from the surgical center book. At Hospital B, similar data was collected from 48 clinical records, encompassing 23 from 2019 and 25 from 2020. Semi-structured interviews were conducted with eleven health professionals, including three doctors, four nurses, and four nursing technicians, working in the obstetrics/surgical center of each hospital. Results: during the study period (2019 and 2020), both hospitals maintained supplies for adopting various uterine evacuation techniques. In Hospital A in 2020, medical decision-making predominantly favored manual intrauterine aspiration. Conversely, in 2019 at Hospital B, dilation and curettage were the preferred technique in 100% of cases, and despite remaining a priority in 78% of cases in 2020 during the COVID-19 period, there was a noticeable reduction compared to 2019. Hospital B also witnessed a heightened number of consultations and hospitalizations of women in the post-abortion process during the COVID-19 period compared to the pre-pandemic period. Conclusion: the pivotal factor influencing medical decision-making in both hospitals is the technical proficiency required for executing the chosen uterine evacuation technique.

Objetivo: identificar posibles cambios en la toma de decisiones médicas al elegir la técnica de evacuación endouterina después de un aborto en el primer trimestre en el escenario COVID-19en dos hospitales públicos del Distrito Federal. Metodología:enfoque cualitativo, que utilizó dos procedimientos metodológicos, documentos y entrevistas, cuya recolección de datos se realizó entre mayo y juniode 2022. En el hospital A se recogió la técnica de evacuación endouterina postaborto prevalente en el año 2020 en 25 registros consecutivos del libro del centro quirúrgico, en el hospital B se recogieron los mismos datos en 48 historias clínicas, 23 del 2019 y, 25 del año 2020. Se realizaron entrevistas semiestructuradas a once profesionales de la salud: tres médicos, cuatro enfermeras y cuatro técnicos de enfermería, trabajando en el centro obstetricia/quirúrgico de cada hospital. Resultados:ambos hospitales en el período de estudio, 2019 y 2020, contaron con insumos disponibles para elegir cualquiera de las técnicas de evacuación endouterina. En el hospital A, en 2020, la toma de decisiones médicas se basó en la aspiración intrauterina manual. En 2019, en el hospital B, la elección fue del 100% para dilatación y legrado; En 2020, durante el período COVID-19, a pesar de que la dilatación y el legrado siguieron siendo una prioridad en el 78% de los casos, hubo una reducción notable en relación a 2019. En el hospital B, también hubo un mayor número de consultas y hospitalizaciones de mujeres en proceso postaborto, en comparación con el período anterior al COVID-19. Conclusión: el factor determinante para la toma de decisiones médicas en ambos hospitales es la capacidad técnica para realizar la técnica elegida.

Dilatación idiopática de la aurícula derecha. Reporte de caso y revisión de la literatura / Idiopathic dilatation of the right atrium. Case report and literature review

Resumen La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.

Abstract Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.

Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia

Abstract Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student's t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.

Histopathological changes in the uterus in women with abnormal uterine bleeding – A 2-year hospital-based retrospective study in a tertiary care center in Assam, India

Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.

A comparative study on efficacy of different dilutions of phenylephrine and tropicamide combination eye drops on pupil dilatation

Background: In ophthalmology (OPD), cycloplegics or mydriatics were needed for doing correct refraction and evaluation of fundus on a daily basis. Aims and Objectives: The objectives of this study were to compare the clinical efficacy and systemic side effects of different dilutions of phenylephrine and tropicamide combinations drops on pupil dilatation and to measure and compare pulse rate and blood pressure before and after giving the drug. Materials and Methods: The present study is a hospital-based interventional study conducted among patients attending to OPD of Regional Eye hospital, Visakhapatnam during April 2012–August 2012. Eighty-one patients randomly allocated to two groups (41 patients in Group 1 and 40 patients in Group 2). Dilution of phenylephrine 5% and Tropicamide 0.8% mixture was applied to patients of Group A in both eyes and dilution of phenylephrine 2.5% and Tropicamide 0.4% mixture was applied to Group B patients in both eyes. Pupil diameter and pulse rate BP were measured and compared. Results: Mean age of Group 1 patients was 55.39 ± 11.47 and Group 2 was 49.95 ± 13.71. Among 36 males, 50% in Group 1 and 50% in Group 2 and among 45 females 51.1% in Group 1 and 48.9% in Group 2. Among both Group 1 and Group 2 patients, both left and right pupil size was significantly increased after application of dilutions, but there was more increase in the pupil size among Group 1 patients compared to Group 2 patients 15 min after and 30 min after application of drug. Conclusions: The combination of 0.8% tropicamide and 5% phenylephrine was effective compared to alternate application of 0.4% tropicamide and 2.5% phenylephrine for rapid and sustainable pupil dilatation for indirect ophthalmoscopy.

Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Ureteroscope/flexible combined with balloon in the treatment of ureteral stricture with stones in transplanted kidney: a report of 9 cases in a single center / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of ureteroscope or flexible ureteroscope combined with balloon dilatation in the treatment of ureteral stricture with renal calculi in transplanted kidney. 【Methods】 The clinical data of 9 patients treated in our hospital during 2016 and 2022 were reviewed. The changes of the width of hydronephrosis, levels of creatinine and urea nitrogen, reoperation, and re-dwelling of stents were analyzed. 【Results】 One patient failed the operation because the guide wire could not be inserted, and the other 8 patients successfully completed the surgery. The stents were removed 6 to 8 weeks after surgery. During the follow-up of 8 to 48 months, no recurrence of renal calculi occurred; 5 patients had no recurrence of ureteral stricture; 3 patients (cases 4, 6, 9) underwent regular ureteral stent replacement due to hydronephrosis; the width of hydronephrosis, creatinine and urea nitrogen levels of 8 patients were significantly improved (P<0.05). 【Conclusion】 Ureteroscope/flexible with balloon dilatation is safe and effective in the treatment of transplanted kidney with ureteral stricture and kidney stones.