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<11/17>
共339条结果
  • 1.

    【2hr】Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

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    机译 高危患者常规主动脉瓣置换的长期结果：我们站在哪里？
    摘要：Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era.Methods: This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy).Results: Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality.Conclusion: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.
  • 2.

    【2hr】Pulmonary Myofibroblastic Tumour Involving the Pericardium and Left Atrium in an 18 Month Infant

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    机译 18个月婴儿涉及心包和左心房的肺肌纤维母细胞瘤
    摘要：Inflammatory myofibroblastic tumor (IMT) is the most frequent primary lung tumor in children and it may be locally aggressive. The management of a locally advanced pulmonary IMT in an 18 month-old female child is presented.A left pulmonary mass was incidentally found on the computerized tomography (CT) scan of a child with persistent systemic inflammatory syndrome. Biopsy confirmed the diagnosis; after preoperative corticotherapy, left pneumonectomy was performed. The pericardium and left atrium were invaded and resected, requiring pericardial reconstruction. There is no relapse at four years of follow-up.Steroids play a role in tumor size reduction, but marginal resection is the gold standard. Extended approaches are feasible and often required in advanced cases.
  • 3.

    【2hr】Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature

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    机译 股动脉囊性囊性疾病。病例报告及文献复习
    摘要：Purpose: Cystic adventitial artery disease is an uncommon non-atherosclerotic peripheral vessel disease. Furthermore cystic adventitial disease of the common femoral artery is an extremely rare entity. We report the case of a 54 year-old man complaining of intermittent claudication who was referred to our vascular service.Methods and Results: Doppler ultrasound and multidetector-row computed tomography (CT) with 3-dimensional volume rendering revealed severe stenosis with cystic an adventitial cyst in the common femoral artery. Intra-operative Doppler ultrasound showed the cyst to be multilocular type. Reversed great saphenous vein interposition was successfully placed.Conclusion: Removal of cyst together with artery and interposition using reversed great saphenous vein is the optimal treatment procedure to prevent recurrence.
  • 4.

    【2hr】Heparin-Induced-Thrombocytopenia Causing Massive Aortic Thrombosis after Ascending Aortic Replacement for Type A Acute Aortic Dissection

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    机译 肝素诱导的血小板减少症引起升主动脉置换后A型急性主动脉夹层的大规模主动脉血栓形成。
    摘要：A 77-year-old woman underwent emergency ascending aortic replacement for type A acute aortic dissection. Fifteen days after the operation, she had motor and sensory disturbances in the lower limbs. Computed tomography revealed multiple aortic thrombi and disrupted blood flow in the right external iliac and left common iliac arteries. She underwent an emergency thrombectomy for acute limb ischemia. Because heparin- induced-thrombocytopenia (HIT) was suspected to have caused the multiple aortic thrombi, we postoperatively changed the anticoagulant therapy from heparin to argatroban. Seventeen days after the first operation, gastrointestinal bleeding developed, and the patient died of mesenteric ischemia caused by HIT. Arterial embolization caused by HIT after cardiovascular surgery is a rare, but fatal event. To avoid fatal complications, early diagnosis and early treatment are essential. Use of a scoring system would probably facilitate early diagnosis.
  • 5.

    【2hr】Importance of Cardiopulmonary Bypass Period on Systemic Inflammatory Response

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    机译 心肺搭桥期对全身炎症反应的重要性
    摘要：
  • 6.

    【2hr】Current Topics on Salvage Thoracic Surgery in Patients with Primary Lung Cancer

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    机译 挽救原发性肺癌患者胸外科的最新话题
    • 作者：Hidetaka Uramoto
    • 刊名：Annals of Thoracic and Cardiovascular Surgery
    • 2016年第2期
    摘要：Salvage primary tumor resection is sometimes considered for isolated local failures after definitive chemoradiation, urgent matters, such as hemoptysis (palliative intent), and in cases judged to be contraindicated for chemotherapy or definite radiation due to severe comorbidities, despite an initial clinical diagnosis of stage III or IV disease. However, salvage surgery is generally considered to be technically more difficult, with a potentially higher morbidity. This review discusses the current topics on salvage thoracic surgery such as the definition of salvage surgery and its outcome, and future perspectives.
  • 7.

    【2hr】Cardiac Valve Noise Reduction by Non-Drug Interventions Improves the Sleep Quality of Patients after Mechanical Cardiac Valve Implantation

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    机译 通过非药物干预降低心脏瓣膜噪声可改善机械心脏瓣膜植入术后患者的睡眠质量
    摘要：Purpose: To investigate the effects of non-drug interventions on the sleep quality of patients after mechanical cardiac valve implantation.Methods: In this prospective, randomized, controlled trial, 64 patients scheduled for mechanical mitral valve replacement were recruited. Patients underwent cognitive behavioral therapy and wore noise cancelling earplugs and eye mask. Sleep quality was evaluated on the 4th after admission and the 5th days after operation. The primary outcome was the total sleep quality score differences between the 4th day after admission and the 5th day after operation.Results: All patients had been suffering from poor sleep quality for a month before admission. There was no difference between both groups on the 4th day after admission. Overall sleep quality in the intervention group was better than in the control group on the 5th day after operation. The subjective sleep quality of the patients in each group was significantly lower on the 5th day after the operation than on the 4th day after admission (P <0.05).Conclusion: Non-drug intervention could improve the sleep quality of patients after mechanical cardiac valve implantation and help the postoperative recovery of the patients. (Trial registration: ChiCTR-TRC-14004405, 21 March 2014.)
  • 8.

    【2hr】An Analysis of the Effects and the Molecular Mechanism of Deep Hypothermic Low Flow on Brain Tissue in Mice

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    机译 深低温低流量对小鼠脑组织的影响及其分子机制分析
    摘要：Objectives: This study examined the effects and molecular mechanisms of deep hypothermic low flow (DHLF) on brain tissue in three genotypes of 3-week-old C57BL/6 mice (N = 180).Methods: Mice in the model condition were subjected to cerebral ischemia-reperfusion (I-R) while undergoing DHLF, then reperfused and rewarmed. Brain tissue damage was measured with 2,3,5-triphenyltetrazolium chloride (TTC) staining, and protein expression was measured by Western blot at 2 h, 24 h, and 72 h after treatment; messenger ribonucleic acid (mRNA) expressions were measured by real-time polymerase chain reaction (PCR) at 2 h, 24 h, and 72 h.Results: The expressions of p-Akt1 and p-GSK-3β were significantly higher in the model condition than the condition across genotypes, but both were significantly lower in the Akt1 mice. The expressions of Akt1 mRNA and Akt3 mRNA, but not Akt2 mRNA, were significantly higher in the model condition across genotypes. Brain damage was significantly greater in the Akt1 knockout gene mice compared with Akt2 gene knockout and wild type mice at 24 h and 72 h.Conclusion: These results suggest that the neuroprotective effects of DHLF reflect increased expression of p-GSK-3β induced through the PI3K/Akt signal pathway. Findings of real-time PCR imply that Akt1 mRNA and Akt3 mRNA may influence the expression of p-Akt1 and p-GSK-3β in mice undergoing DHLF.
  • 9.

    【2hr】Right Axillary Artery Cannulation in Aortic Valve Replacement

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    机译 右腋动脉插管在主动脉瓣置换术中
    摘要：Objective: This retrospective study aimed to evaluate the results of our experience with axillary artery cannulation via a side graft in aortic valve replacement in patients with ascending aortic atherosclerotic disease.Methods: From January 2002 to 2012, we operated on 76 patients for aortic valve disease with the use of the axillary artery for arterial inflow in our institute. The indications for cannulation of the axillary artery were aortic aneurysm in 37 patients, severe aortic atherosclerosis in 28 patients, and re do surgery in 11 patients.Results: Right axillary artery cannulation via a side graft provides sufficient antegrade aortic flow of 2.6 ± 0.1 L/m2 during cardiopulmonary bypass. No additional arterial cannulation was necessary to obtain sufficient perfusion during cardiopulmonary bypass. Although permanent perioperative stroke was observed in two patients, this did not occur during the operation. There were no problems with cannulation or wound and graft infections. During the follow-up period, there were no thrombotic events due to an axillary graft stump in the right upper extremities.Conclusions: Axillary artery cannulation via a side graft is a useful and safe option for cardiopulmonary bypass in patients with atherosclerotic disease of the ascending aorta undergoing aortic valve replacement.
  • 10.

    【2hr】Chordal Reconstruction versus Leaflet Resection for Repair of Degenerative Posterior Mitral Leaflet Prolapse

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    机译 腱索重建与小叶切除术修复退化性二尖瓣后叶脱垂
    摘要：Objective: To review our experience of mitral valve repair for degenerative posterior mitral leaflet prolapse, comparing the outcomes of chordal reconstruction and leaflet resection.Methods: From 2000 to 2014, 205 patients underwent successful repair for degenerative posterior mitral leaflet prolapse. One hundred and four (51.5%) underwent leaflet resection (group R) and 98 (48.5%) underwent chordal reconstruction (group C). Follow-up was 96.5% complete with a mean follow-up of 6.1 ± 4.0 years.Results: Mean age was 57.0 ± 11.0 years. Males accounted for 73.8%. Ring annuloplasty was performed in 195 (96.5%). There were no operative mortalities within 30 days. Overall survival was 97.8% ± 1.3% at 7 years. Outcomes at 6 years: freedom from severe mitral regurgitation (group R 97.1% ± 2.0%, group C 100%, P = 0.288), freedom from moderate or severe mitral regurgitation (group R 97.1% ± 2.0%, group C 94.4% ± 5.4%, P = 0.541). Group C patients received larger annuloplasty rings and had significantly lower postoperative transmitral gradients.Conclusions: Leaflet resection and chordal reconstruction are effective techniques for repair of degenerative posterior mitral leaflet prolapse. Both techniques result in a low incidence of recurrent mitral regurgitation. Chordal reconstruction accommodates larger annuloplasty rings and is associated with lower transmitral gradients.
  • 11.

    【2hr】Early Postoperative Outcome of Off-Pump Coronary Artery Bypass Grafting: A Report from the Highest-Volume Center in Japan

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    机译 体外循环冠状动脉旁路移植术的早期术后结果：日本最高容量中心的报告
    摘要：Background: Off-pump coronary artery bypass grafting (OPCAB) has evolved into a standard technique in coronary artery bypass grafting. However, a detailed investigation in Japanese population undergoing OPCAB has not yet been fully elucidated.Methods: A total of 1109 consecutive patients undergoing isolated OPCAB between 2006 and 2013 at Juntendo University were reviewed. The data was evaluated in the light of previously published OPCAB-associated reports.Results: There were 904 male (81.5%) and a mean was 67.5 ± 9.8 years. Eight patients (0.5%) died within 30 days postoperatively or before discharge, which was equivalent to or rather better than the previously reported mortality rates, including the European System for Cardiac Operation Risk Evaluation II (2.1 ± 2.1) data. A morbidity analysis revealed that prolonged intubation (>24 h) occurred in 43 patients (3.6%), surgical site infections in 18 (1.9%), neurological complications in 13 (1.3%). A reduced preoperative left ventricular ejection fraction (less than 40%) was found to be a risk factor for early postoperative death (odds ratio 10.58, respectively, p <0.05) in our cohort.Conclusions: Early postoperative mortality and morbidity rates in Japanese population after OPCAB were rather satisfactory and similar to those reported by other countries.
  • 12.

    【2hr】Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic Position

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    机译 镶嵌生物假体在主动脉位置植入后瓣下Pan足过度生长
    摘要：Purpose: Although pannus overgrowth by itself was not the pathology of structural valve deterioration (SVD), it might be related to reoperation for SVD of the bioprostheses.Methods: We retrospectively reviewed patients undergoing reoperation for SVD after implantation of the third-generation Mosaic aortic bioprosthesis and macroscopic appearance of the explanted valves was examined to detect the presence of pannus.Results: There were 10 patients and the age for the initial aortic valve replacement was 72 ± 10 years old. The duration of durability was 9.9 ± 2.0 years. Deteriorated valve presented stenosis (valvular area of 0.96 ± 0.20 cm2; pressure gradient of 60 ± 23 mmHg). Coexisting regurgitant flow was detected in two cases. Macroscopically, subvalvular pannus overgrowth was detected in 8 cases (80%). The proportion of overgrowth from the annulus was almost even and pannus overgrowth created subvalvular membrane, which restricted the area especially for each commissure. In contrast, opening and mobility of each leaflet was not severely limited and pannus overgrowth would restrict the area, especially for each commissure. In other two cases with regurgitation, tear of the leaflet on the stent strut was detected and mild calcification of each leaflet restricted opening.Conclusion: In patients with the Mosaic aortic bioprosthesis, pannus overgrowth was the major cause for reoperation.
  • 13.

    【2hr】A Rare Case of Laparoscopic Repair of Simultaneously Occurring Morgagni and Paraesophageal Hernias

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    机译 腹腔镜同时发生Morgagni和食管旁疝修补的一例
    摘要：Simultaneously occurring Morgagni hernia and paraesophageal hernia is an extremely rare clinical condition with only six case reports in the English-language literature and only two laparoscopic repair reports. We report a 73-year-old woman with both Morgagni hernia and paraesophageal hernia who underwent successful laparoscopic repair of the hernia defects using transabdominal wall suturing. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. This case report reported the concurring Morgagni and paraesophageal hernias and validated the feasibility of laparoscopic repair both hernias simultaneously.
  • 14.

    【2hr】Lung Cancer Detected 5 Years after Resection of Cancer of Unknown Primary in a Mediastinal Lymph Node: A Case Report and Review of Relevant Cases from the Literature

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    机译 纵隔淋巴结切除未知原发癌后5年检测到肺癌：一例病例报告并文献复习
    摘要：We report the rare and interesting case of a primary lung cancer detected 5 years after cancer of unknown primary (CUP) of a mediastinal lymph node (LN) was resected. A 40-year-old male was diagnosed with adenocarcinoma of unknown primary in a mediastinal lymph node after resection of the mediastinal tumor. Five years after resection of the CUP in mediastinal LN, a small, abnormal nodular shadow in left upper lobe was detected by chest CT. This pulmonary tumor was diagnosed as a lung adenocarcinoma. The pathological and immunohistological findings of the resected pulmonary tumor resembled those of the LN resected 5 years before. We speculated that the pulmonary lesion represented primary lung cancer that enlarged later than the metastatic mediastinal LN. This case illustrates the importance of careful observation and long-term follow-up in patients treated for CUP of a thoracic LN.
  • 15.

    【2hr】Invasive Thymoma Protruding into the Superior Vena Cava through the Thymic Vein

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    机译 通过胸腺静脉伸入上腔静脉的侵袭性胸腺瘤
    摘要：We report a rare case of protrusion of an invasive thymoma with intraluminal growth through the thymic vein into the superior vena cava (SVC) without direct invasion of the vessel walls. The tumor and left brachiocephalic vein were resected, and the tumor in the SVC was removed with temporal bypass of the right brachiocephalic vein and right auricle. Histopathological finding showed that the thymoma had protruded via a thymic vein. During resection of a thymoma, a detailed examination of thymic vein is necessary to ensure that no tumor tissue remains in the vessels.
  • 16.

    【2hr】Surgical Strategy for Ischemic Mitral Regurgitation AdoptingSubvalvular and Ventricular Procedures

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    机译 缺血性二尖瓣关闭不全的手术策略瓣膜下和心室手术
    • 作者：
    • 刊名：Annals of Thoracic and Cardiovascular Surgery
    • 2016年第2期
    摘要：
  • 17.

    【2hr】Factors Determining the Choice of Surgical Procedure in Elderly Patients with Non-Small Cell Lung Cancer

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    机译 影响老年非小细胞肺癌患者手术方式选择的因素
    摘要：Background: In the elderly patients, optimal surgical treatment can be difficult to achieve, because of comorbidity. Therefore, we aimed to clarify the preferred surgical management in this patient group.Methods: A retrospective study was conducted between April 2008 and March 2015 that included patients with non-small cell lung cancer (NSCLC) aged ≥75 years.Results: We included 44 patients who underwent partial resection (n = 20) or lobectomy (n = 24). There were no significant differences between the two groups on most variables, except for some character. Survival analysis revealed a significant difference in overall survival (OS) between the two groups; however, no significant differences existed in the disease-free survival or in the OS for stage I disease. Postoperative complications led to poor prognoses. Cox regression analysis revealed statistical significance for the Brinkman Index, the ratio of the pulmonary artery diameter to the ascending aorta diameter (PA:A), and the alveolar–arterial oxygen gradient. Only the PA:A ratio remained significant after multivariate analysis, with a higher ratio associated with better survival.Conclusion: In elderly patients with NSCLC, surgical resection should not be denied because of age alone. However, partial resection should be favored to lobectomy when possible.
  • 18.

    【2hr】The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy

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    机译 网状小梁状结构的存在增加了胸腔镜牛肝切除术后原发性自发性气胸复发的风险。
    摘要：Introduction: Deteriorated alveolar structure at the base of blebs and bullae is known as the reticulated trabecula-like structure. Its clinical significance in primary spontaneous pneumothorax (PSP) remains unclear. This study aimed to investigate the impact of the structure on recurrence of PSP after video-assisted thoracoscopic surgery (VATS) bullectomy.Methods: Between April 2010 and March 2014, 80 cases of PSP in 76 patients who underwent VATS bullectomy using endoscopic staplers were included. The staple line was covered with polyglycolic acid sheets and fibrin glue. Cases were assigned to a normal alveolar structure (NAS) group (n = 54) and a reticulated trabecula-like structure (RT) group (n = 26) based on the histological analysis. Factors associated with recurrence were analysed using logistic regression.Results: The reticulated trabecula-like structure was significantly related to apical lung blebs. The recurrence rate of PSP was significantly higher in the RT group than in the NAS group (38.5% vs. 3.7%; P <0.001). On multivariate analysis, the reticulated trabecula-like structure was an independent factor for recurrence of PSP after VATS bullectomy.Conclusion: The change of alveolar structure at the base of apical lung blebs would increase the risk for recurrence of PSP after VATS bullectomy.
  • 19.

    【2hr】Impact of Airflow Limitation on Comorbidities and Postoperative Complications in Patients Undergoing Thoracic Surgery: A Retrospective Observational Study

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    机译 气流受限对胸外科患者合并症和术后并发症的影响：一项回顾性观察研究
    摘要：Purpose: To assess the frequency of airflow limitation (AFL), and the relationship between AFL and preoperative comorbidities or postoperative complications in patients who had undergone thoracic surgery.Methods: The medical records of patients who underwent non-cardiac thoracic surgery at our institution between August 1996 and January 2013 were retrospectively reviewed. On the basis of preoperative pulmonary function tests, patients were classified with those with FEV1/FVC <70% [AFL(+) group] or with FEV1/FVC ≥70% [AFL(−) group]. Patient characteristics, preoperative comorbidities and postoperative complications were compared between the groups.Results: Of the 3667 patients assessed, 738 (20.1%) were allocated to the AFL(+) group. AFL was an independent risk factor for three preoperative comorbidities: chronic obstructive pulmonary disease (odds ratio [OR]: 4.65), bronchial asthma (OR 4.30) and cardiac diseases (OR 1.41). Airflow limitation was also an independent risk factor for postoperative respiratory failure including long-term oxygen therapy (OR 2.14) and atelectasis (OR 1.90) in the patients who underwent lobectomy or partial resection of the lung.Conclusions: Our retrospective study revealed that careful attention needs to be paid to airflow limitation in patients who undergo non-cardiac thoracic surgery since it appears to be an important feature of preoperative comorbidities and to increase postoperative complications.
  • 20.

    【2hr】Experimental Reconstruction of the Trachea with Urinary Bladder Wall

    包量

    机译 膀胱膀胱壁气管的实验重建
    摘要：Purpose: To investigate tracheal reconstruction with autologous bladder wall using modern refined surgical procedures.Methods: Experiments were performed on 16 female beagle dogs. Six tracheal cartilages were resected to create a tracheal deficit, then tracheal replacement with autologous bladder wall was performed. In the first 10 dogs (first series), the transplant site was covered with pedicled omental flap. In the next six dogs (second series), we performed tracheal reconstruction without omental covering, and secured tracheal cartilages above and below the graft with sutures to prevent excessive graft stretching.Results: No surgical mortality or lethal infection of the transplant site was encountered in either series. Complications in the first series comprised tracheal stenosis in four dogs. One dog died suddenly at 4 months postoperatively due to stent migration, so cartilage sutures were adopted in the second series. The lumen surface of the grafts was covered with squamous metaplastic epithelium. Osseous tissue was present in the submucosa of grafts, particularly prominently in areas lacking omental covering.Conclusions: Tracheal reconstruction using bladder wall may become clinically useful. A pedicled omental covering does not appear always necessary to prevent graft necrosis and infection. Ischemic stimulation may be involved with bone formation in grafts.
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