Abstract We report the initial 5‐year follow‐up of a novel mini‐invasive procedure for epicardial ablation for the treatment of atrial fibrillation. The initial 5‐year survival rate is acceptable and comparable with that of hybrid ablation. And this shared procedure has the advantages of shorter operation time and less surgical trauma.
Abstract Background The left atrial maze IV (LAM‐IV) alone has been used to eliminate atrial fibrillation (AF) without severe right heart diseases. However, we felt that it could be improved and developed a modified LAM‐IV (MLAM‐IV). In this prospective trial, we aimed to investigate 5‐year clinical outcomes of AF in patients treated by the novel MLAM‐IV technique. Methods Between September 2012 and October 2013, 120 patients who underwent valve surgery and bipolar radiofrequency ablation for AF were randomized into the LAM‐IV group ( n = 60) or MLAM‐IV group ( n = 60). At postoperative follow‐up examinations, data were recorded at 1, 3 and 6 months, and annually thereafter. Results The mean ablation time and postoperative ventilation time were shorter in the MLAM‐IV group than in the LAM‐IV group ( P < 0.001 and P = 0.03, respectively). At 5 years, the rate of freedom from AF was 69.0% in the MLAM‐IV group and 60.0% in the LAM‐IV group (hazard ratio 0.71, 95% confidence interval 0.39 to 1.32, P = 0.42). There were no differences with respect to the early operative mortality and major complications, late mortality, and major adverse events. Conclusions The MLAM‐IV provides a technically simpler ablation process. The MLAM‐IV was associated with less ventilation support in the early postoperative period. The long‐term efficacy of the MLAM‐IV in the treatment of AF is comparable to that of the LAM‐IV.
Objective To investigate the effect and safety of Ropivacaine mesylate in combined spinal-epid uaral anesthesia of hypogastric operations of elder patient.Methods 90 cases patients scheduled for the lower abdominal surgery were randomly divided into two groups(appendectomy and Oblique inguinal hernia neoplasty).group Ropivacaine mesylate(group A,n=45),group upivacaine hydrochloride(group B,n=45),A,B groups,punctures were selected between L2～L3 ,Hyperbaric solution of Ropivacaine mesylate were injected intrathecaly respectively in two groups,(compounding:group A:0.894% Ropivacaine hydrochloride 1.5ml+10% Glucose lml)and group B;(0.75% Bupivacaine hydrochloride 1.5ml+10% Glucose lml).The two groups after the subarachnoid medication Indwelling catheter to the cephalic in the epidural space.The time of anaesthetic emergence,maintainance,and the anaesthetic level were observed;the analgetic effect was assessed;movement signs of the lower limbs were observed;blood pressure,respiration and SpO2 .postoperative complications were observed.Results There was apparent differentiation between group A which Systob'c blood pressure declined 8.9% ,heart rate decreased 6.7% ,intraoperative nausea came up to 6.7% after anaesthesia and group B which was 28.9% ,20% ,17.8% ,respectively(P ＜ 0.05).The effective time of anaesthetic emergence was(52.0 ±21.5)s and(13.2 ±3.3)min in group A longer than group B was(41.2±18.2)s and(11.3 ±3.6)min(P＜0.01).There was no difference in Sp02,Bromage Score about extreme movement blockage degree(2.3 ±0.7;2.2 ±0.5),the incidence of postoprative headache(0% ;2.2%)between the group A and group B(P ＞ 0.05).Conclusion Ropivacaine mesylate can be used effectively and safetly in combined spinal-epiduaral anesthesia applied in hypogastric operations of elder patients,for cardiovascular stability is superior to bupivacaine.
Key words:
Anesthesia; epiduaral; Ropivacaine mesylate; Bupivacaine; Aged
Aortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. We summarize the safety and convenient profile of the central cannulation strategy using the guidance of transesophageal echocardiography (TEE) in comparison to traditional femoral cannulation strategy. Sixty-two patients with acute Stanford type A aortic dissection underwent aortic arch surgery in our hospital. All the patients were operated by the same surgeon. Cannulation was performed in 33 patients through the aortic arch under the guidance of TEE (Group A) and in 29 patients through the femoral artery (Group F). Under moderate hypothermic circulatory arrest, the brain is continuously perfused in an anterograde manner through the brachiocephalic and left common carotid arteries. Preoperative characeristics and surgical information were collected for each patient. Additionally, 30-day mortality rate and the incidence of the temporary neurological dysfunction were recorded as the outcomes. To compare the categorical variables, we used the chi-squared test. Continuous variables were compared using the t-test. Preoperative characteristics were almost similar between the two groups. The mean operation time (7.33 ± 1.14 h vs. 8.93 ± 2.59 h, P = 0.002) and the mean cardiopulmonary bypass (CPB) time (260.97 ± 45.14 min vs. 298.28 ± 95.89 min, P = 0.024) were significantly shorter in Group A than those in Group F. The 30-day mortality rates were 9.09 and 27.59% in Groups A and F, respectively (P = 0.057). And the incidences of temporary neurological dysfunction were 39.39 and 65.52% in Group A and F, respectively (P = 0.040). Aortic arch cannulation with the guidance of TEE during the aortic arch surgery is a simple, fast, safe, and less invasive technique for establishing cardiopulmonary bypass for Stanford type A aortic dissection.
Papillary fibroelastoma (PFE) is a rare primary cardiac neoplasm that is usually discovered incidentally at autopsy or during cardiac surgery. PFE combined with rheumatic heart disease (RHD) is extremely rare, and only a few cases have been reported. Additionally, the growth rate of the tumor is unknown. Here, we present a very rare case of PFE of the aortic valve combined with RHD, which were identified in a female patient who survived for 5 years without surgical intervention, and who subsequently underwent successful surgical treatment. PFEs may be generally slow-growing tumors, however, the better treatment of choice may be surgery because it produces good curative effects with very low risk of complications, while preventing serious disease consequences.
Abstract Background Distal pancreatectomy fistula risk score (D-FRS) and DISPAIR-FRS has not been widely validated for predicting postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). Methods We retrospectively analyzed 104 patients undergoing DP. The predictive value of the D-FRS and DISPAIR were compared. Risk factors associated with POPF were investigated by multivariate analysis. Results Of the 104 patients, 23 (22.1%) were categorized into the POPF group (all grade B). The areas under the ROC (AUCs) of the D-FRS (preoperative), D-FRS (intraoperative), and DISPAIR-FRS were 0.737, 0.809, and 0.688, respectively. Stratified by the D-FRS (preoperative), the POPF rates in low-risk, intermediate-risk, and high-risk groups were 5%, 22.6%, and 36.4%, respectively. By the D-FRS (intraoperative), the POPF rates in low-risk, intermediate-risk, and high-risk groups were 8.8%, 47.1%, and 47.4%, respectively. By the DISPAIR-FRS, the POPF rates in low-risk, intermediate-risk, and extreme-high-risk groups were 14.8%, 23.8% and 62.5%, respectively. Body mass index and main pancreatic duct diameter were independent risk factors of POPF both in preoperative (P = 0.014 and P = 0.033, respectively) and intraoperative (P = 0.015 and P = 0.039) multivariate analyses. Conclusions Both the D-FRS (preoperative), D-FRS (intraoperative), and DISPAIR-FRS has good performance in POPF prediction after DP. The risk stratification was not satisfactory in current Asian cohort.
[Objective] To prepare cationic liposome gels containing paeonol, and to study its stability and cutaneous penetration kinetics in vitro. [Method] To prepare the liposome gel by dispersion-ultrasonic and gridding method, and study the stability with the impact factor experiments, and compare the penetration rate of liposome gel with conventional gel in vitro using the Franz-diffusion cell. [Result] Mean diameter of the liposome was (132.7±14.1) nm with Zeta potential of (+33.54±1.95) mV and mean entrapment efficiency of (73.04±1.24)% (n=3). Drug content of the liposome was (3.17±0.13) mg/g (n=3). The liposome gel had a promising appearance. It was stable at the humidity and the room temperature while was sensitive at the light and the temperature from 40 to 60 ℃. The cumulative penetration amount of the liposome gel was higher than that of the conventional gel (P0.05). Its cutaneous penetration rate and cumulative amounts in skin were higher than those of the conventional gel (P0.05). [Conclusion] The cationic liposome gels containing paeonol was stable and feasibly prepared, and enhanced the cutaneous penetration efficiency and guaranteed the persistent release rate.
Prepancreatic postduodenal portal vein (PPPV) is a rare congenital variation, with only 17 cases reported in the literature and five of them undergoing pancreaticoduodenectomy (PD). Of these, four were L-shaped PPPV with a thin wall that was difficult to isolate, while only one normal-shaped PPPV was reported previously. For patients undergoing PD, recognizing this variation is important to prevent PPPV injury, which could lead to liver ischemia or intraoperative hemorrhage. We here present a case of normal-shaped PPPV who underwent PD.A 68-year-old woman underwent PD for bile duct carcinoma at our hospital. Preoperative enhanced CT revealed that the portal vein was located anterior to the pancreas and posterior to the duodenum, and the L-shaped splenic vein was longitudinally located posterior to the pancreatic neck. During surgery, there was a loose tissue area between the PPPV and the pancreatic head, and the PPPV could be isolated safely. The morphology of PPPV was similar to normal portal vein. Due to the presence of the PPPV, a superior mesenteric artery (SMA)-first approach from the anterior was at high risk of vascular injury, and the pancreatic neck could not be dissected at the dorsal face of PV. Therefore, the SMA was revealed by the classic right posterior approach after transection of the pancreatic neck on the dorsal surface of L-shaped spleen vein, and the specimen was successfully resected without significant intraoperative bleeding. The patient was discharged 18 days after surgery without complications. The final pathology was bile duct carcinoma with R0 resection.PPPV is a rare variant that can be diagnosed by preoperative imaging. In PD procedure, knowledge of PPPV helps in surgical decision-making, approach selection and avoid major bleeding due to PPPV injury. The origin of normal-shaped and L-shaped PPPV might be different. Normal-shaped PPPV can be safely isolated in this case.
Purpose: Previous research on incremental hemodialysis transition has mainly focused on one or two benefits or prognoses. We aimed to conduct a comprehensive analysis by investigating whether incremental hemodialysis was simultaneously associated with adequate dialysis therapy, stable complication indicators, long-lasting arteriovenous vascular access, and long-lasting preservation of residual kidney function (RKF) without increasing mortality or hospitalization. Patients and Methods: Incident hemodialysis patients from Huashan Hospital in Shanghai, China, over the period of 2012 to 2019, were enrolled and followed every three months until death or the time of censoring. Changes in complication indicators from baseline to all post-baseline visits were analyzed by mixed-effects models. The outcomes of RKF loss, arteriovenous vascular access complications, and the composite of all-cause mortality and cardiovascular events were compared between incremental and conventional hemodialysis by Cox proportional hazards model. Results: Of the 113 patients enrolled in the study, 45 underwent incremental and 68 conventional hemodialysis. There were no significant differences in the changes from baseline to post-baseline visits in complication indicators between the two groups. Incremental hemodialysis reduced the risks of RKF loss (HR, 0.33; 95% CI, 0.14– 0.82), de novo arteriovenous access complication (HR, 0.26; 95% CI, 0.08– 0.82), and recurrent arteriovenous access complications under the Andersen–Gill (AG) model (HR, 0.27; 95% CI, 0.10– 0.74) and the Prentice, Williams and Peterson Total Time (PWP-TT) model (HR, 0.31; 95% CI, 0.12– 0.80). There were no significant differences in all-cause hospitalization or the composite outcome between groups. Conclusion: Incremental hemodialysis is an effective dialysis transition strategy that preserves RKF and arteriovenous access without affecting dialysis adequacy, patient stability, hospitalization risk and mortality risk. Randomized controlled trials are warranted. Keywords: incremental hemodialysis, arteriovenous vascular access, residual kidney function, hospitalization, mortality
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