Abstract： Objective To summarize the clinical characteristics of young patients with Stanford type A aortic dissection. Methods We retrospectively analyzed 54 patients with Stanford type A aortic dissection who received surgical treatment in General Hospital of PLA between March 2004 and June 2011. All the patients were divided into two groups: a young patient group with patients’ age less than 40 years and a control group with patients’ age more than or equal to 40 years. There were 23 patients including 17 males and 6 females with an average age of 34.2±6.3 years in the young patient group and 31 patients including 27 males and 4 females with an average age of 51.5±6.8 years in the control group. The clinical characteristics and surgical treatment outcomes of the two groups were compared. Results There was no statistical difference in cardiopulmonary bypass（CBP）time（224.4±83.1 min vs. 215.0±88.0 min, t=0.39, P=0.69） and aortic cross-clamping time（152.3±60.8 min vs. 130.9±51.2 min, t=1.34, P=0.18）between the two groups. Compared with the patients in the control group, young patients were more likely to have congenital malformations with rate at 34.7%（8/23） vs. 6.4%（2/31） with χ2=5.27, P=0.02, such as Marfan syndrome and bicuspid aortic valve. The mortality of the young patients was similar to patients in the control group at rate of 13.0%（3/23）vs.12.9%（4/31） with χ2=0.15 and P=0.69, but postoperative mental and neurological complications rate in the young patient group were less frequent than those in the control group at 4.3%（1/23）vs. 32.2%（10/31） with χ2=5.32 and P=0.02. Conclusion Young patients with Stanford type A aortic dissection have fewer cardiovascular risk factors for aortic dissection but are more likely to have congenital malformations. The surgical methods are more active for young patients with less frequency of postoperative mental and neurological complications.
Objective To determine whether the basal characteristics and survival of young patients undergoing surgical resection of nonsmall cell lung cancer (NSCLC) differ from those of elderly patients. And, we would discuss the special perioperative management in elderly patients with NSCLC. Methods 178 NSCLC patients who underwent surgery in our hospital between Jan. to Dec. in 2002 were divided into two groups according to age. Young group comprised 89 patients aged 50 years or younger and elderly group comprised 89 patients aged 70 years or older. The patients’ clinical data, operative style,postoperative complications and survival results were reviewed and analysed. Results The proportion of the elderly group squamous cell carcinoma patients was higher than that of the younger group （χ2=9.281,P=0.000.）,but there was no significant difference between the gender, smoking, histology, TNM stage, type of resection, post operation chemotherapy or radiotherapy（χ2≤5.569，Pgt;0.05）. The incidence of the preoperative cardiovascular disease, chronic bronchitis in the elderly group patients were higher than those of younger group（χ2=14.053，P=0.000;χ2=13.044，P=0.000）.The incidence of postoperative complications was significantly higher in elderly group than those of younger group（χ2=12842，P=0.000）. The 1, 3 and 5year survival rates were 71.43％，33.53％ and 27.83％ in elderly group, and 77.78％，46.67％ and 44.07％ in young group, respectively. However, the 1, 3 and 5year survival rates for patients in two groups showed no difference between two groups（Pgt;0.05）. Conclusion The elderly patients have higher operative risk than that of young patients. We should pay more attention to the perioperative management of elderly patients. The elderly patients could get acceptable long term survival rates through surgical treatment. Operation is still the first choice for elderly patients with NSCLC.
Objective To analyze the influence of the body mass index (BMI) and age on deep vein thrombosis (DVT) after the total hip arthroplasty(THA) or total knee arthroplasty(TKA) in Chinese patients who received prophylactic treatment for DVT. Methods We used a randomized clinical case-control study. From April 2004 to August 2004, weperformed THA and TKA for 95 patients (128 hips and knees). There were 27 men and 68 women with an average age of 60 years (range, 23-78) at surgery, and withan average BMI of 25.88 kg/m2 (range, 14.34-40.39) before surgery. All the patients were given low-molecular-weight heparin for 7-10 days pre-and postoperatively to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all the patients before operation and 7-10 days after operation.The patients were divided into 4 groups according to their BMI:the non-obese group (BMI≤25.00 kg/m2), the overweight group (BMI, 25.01-27.00 kg/m2), the obese group (BMI, 27.01-30.00 kg/m2), and the morbidly obese group (BMIgt;30.00 kg/m2); and they were also divided into 4 groups according to their ages (≤40, 4160, 61.70, gt;70 yr) so as to analyze the influence of the BMI and age on DVT. Results The total incidence ofDVT in all the patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. Forty-five patients had DVT and 50 patients had no DVT. The average BMI of the patients with DVT was significantly higher than that of the patients with no DVT (Plt;005). The overweight, obese, and morbidly obese patients had an odds ratio of 7.04, 4.8,and 9.6 for DVT compared with the nonobese patients (P＜0.05); but the obese group had a less risk than the other 2 groups.The 41-60, 61-70, and gt;70-year-old patients had an odds ratio of 24.0, 38.2, and 24.4 for DVT compared with the ≤40year-old patients (P＜0.05). Conclusion Obesity (BMIgt;25 kg/m2) and an increasing age (gt;40 yr) are identified as statistically significant risk factors for DVT after THA or TKA, and patients aged 61-70 years are more likely tohave DVT than the other patients. We should pay more attention to those obesity and aged patients when they are undergoing the total joint replacement, and we should give them enough prophylaxis and closely observe the symptoms in their bilateral lower extremities after operation, taking ultrasonography or venography to check DVT if necessary, so that we can give them prompt treatment and prevent fatal pulmonary thromboembolism.
Objective To investigate the relationship between velopharyngeal functions and factors such as age at operation , cleft type, performing procedure.Methods FFT technique and velopharyngeal X-ray examination were used to evaluate the velopharyngeal functions of 82 patients. The relatively important factors affecting velopharyngeal functions were searched out through regression analyse and pearson correlation. Results A significant positive correlation was confirmed between AAO(age at operation) and A1/A2(velopharyngeal incompetence), Plt;0.001. AAO also showed linear regression with A1/A2. Model was significant, Plt;0.001. Quotation: A1/A2(velopharyngeal incompetence)=0.005 852×AAO+0.961. Conclusion AAOwas an important affecting factor on velopharyngeal functions. The earlier the cleft is repaired, the more normal velopharyngeal functions will be obtained.
Objective To compare neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) in age at diagnosis, gender and disease laterality. Methods One hundred fourteen nAMD patients (114 eyes) and 145 PCV patients (186 eyes) diagnosed by fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this retrospective study. The age at diagnosis, gender and disease laterality of all the patients were collected. Independent sample t-test, chi;2 test and Fisher's exact test were used to compare the age at diagnosis, gender and disease laterality between nAMD and PCV patients. Results The mean age at diagnosis of nAMD group and PCV group were (68.30plusmn;9.86), (65.67plusmn;9.04) years respectively, the difference was statistically significant (t=-2.168, P=0.031). The patients under 70 years old accounts for 50.88% in nAMD group, which is lower than that in PCV group (63.45%), the difference was statistically significant (chi;2 =4.138, P=0.042). The male/female ratio of nAMD group and PCV group were 3.56∶1 and 2.02∶1 respectively, the difference was statistically significant (chi;2 =3.937, P=0.047). Thirty patients (26.32%) and 41 patients (49.46%) were affected unilaterally in nAMD and PCV group, respectively. The difference of bilateral incidence between two groups was not statistically significant (chi;2 =0.123, P=0.726). There were 69 right eyes (47.92%) and 75 left eyes (52.08%) in nAMD group, 92 right eyes (49.46%) and 94 left eyes (50.54%) in PCV group. The difference of disease laterality between two groups was not statistically significant (chi;2 =0.078，P=0.637). Conclusions PCV patients present at younger age than nAMD. nAMD is more prone to affected males than PCV. Nearly a quarter patients are bilateral in nAMD or PCV, there is no difference in bilateral incidence between these two diseases.
ObjectiveTo compare the effects of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) on classifications and locations of choroidal neovascularization (CNV) located under subretinal hemorrhage in age-related macular degeneration, and on the areameasuring of subretinal hemorrhage.MethodsThe medical record of 177 patients with subretinal hemorrhage associated with AMD confirmed by photochrome of ocular fundus, FFA and ICGA examinations were retrospectively reviewed. The locations and classifications of CNV on the images of FFA and ICGA in the 177 patients and the area of subretinal hemorrhage of 30 patients randomly selected from the 177 patients were analyzed and measured. ResultsOn the images of FFA, the locations and classifications of CNV could be defined in 160 patients (90.4%), and CNV was considered eligible for laser therapy in 24 patients (13.6%). On the images of ICGA, the locations and classifications of CNV could be defined in 175 patients （98.9%），and CNV was considered eligible for laser therapy in 51 patients (28.8%). There was no statistical difference of the locations（Z=-0.383，P=0.701） and classifications （ χ2=2.993，P=0.810） of CNV on the images of FFA and ICGA. The areas of blocked fluorescence measured on the images of FFA (x-=26.610 mm2 and M=13.548 mm2) were larger than those of ICGA (x-=24.714 mm2，M=12.875 mm2) with statistical differences （Z=-3.000，P=0.003） between FFA and ICGA. ConclusionsICGA is beneficial for imaging CNV located under subretinal hemorrhage, and may increase the number of the patients who are considered eligible for laser treatment. The effect of measurement of the area of subretinal hemorrhage in AMD evaluated by FFA is better. (Chin J Ocul Fundus Dis,2003,19:149-151)
Objective To assess the vision-related quality of life(VRQL) in patients with age-related maculopathy (AMD) and the related factors in Shanghai. Methods The VRQL of 105 patiens with AMD and 105 without (the control group) in Shanghai was investigated via Chinese-version low vision quality of life questionnaire. Resutls The Cronbach α coefficient of the questionnaire is 0.97 in the patients with AMD, whose scores of the various quality of life were significantly lower than those in the control group. The more the exudative defect happened, or the longer the disease course developed, the lower the sccores were. All the scores of the scales and the total questionnaire were significantly related to the better or worse monocular visual acuity. The better monocular visual acuity was the first independent risk factor affecting all aspects of VRQL in pateints with AMD. Conclusions Decreased visual acutiy may gradually impair the VRQL in patients with AMD. Chinese-version questionnaire of low vision quality of life can provide the general information of the VRQL in patients with AMD.(Chin J Ocul Fundus Dis，2004，20：303-306)
Objective To verifying the characteristics of optical coherence tomography(OCT) in exudative age-related macular degeneration (AMD). Methods The patients being investigated in this series included 16 cases (19 eyes) of exudative age-related macular degeneration diagnosed by FFA and OCT examinations, among them 4 cases (6 eyes) were examined with ICGA. The color photographs of ocular fundi, FFA, ICGA and OCT were investigated by contrasting each other. Results As compared with the FFA and ICGA examinations, the characteristic findings found in OCT in patients with exudative AMD in this series were as the following:①serous detachment of neurosensory epithelium in 11 eyes,②retinal hemorrhage in 2 eyes,③serous detachment of retinal pigment epithelium in 5 eyes,④hemorrhagic detachment of retinal pigment epithelium in 10 eyes,⑤disciform scar in 4 eyes,⑥fibrovascular pigment epithelial detachment and occult CNV in 12 eyes. Conclusion OCT can supply a comprehensive survey of exudative AMD, in making the diagnosis as an important complementary examination of FFA and ICGA. (Chin J Ocul Fundus Dis,2000,16:220-223)
Purpose To investigate the histopathologic changes of macula lutea retinae in the elderly Chinese population,and to provide information for the cause of visiual disturbance in an autopsy study. Methods Two hundred and twelve eyes from 108 consecutive cases of postmortem (mean age of 78.4 years old) sections of the area of macula lutea retinae were studied by histopathology. Results Among the 212 eyes,hard drusen were found in 36.3% of eyes and soft drusen in 19.3% of eyes.The eyes with both of the above mentioned 2 types of drusens were found to be combined with RPE atrophy and RPE detachment;and subretinal neovascularization were found in 5.7% of these eyes and they were associated with obvious RPE atrophy and photoreceptor loss;3.2% eyes had posterior scleral staphyloma showing thinning of the sclera and choroid,RPE atrophy and apparent photoreceptor loss;2.4%eyes showed CME with the history of cataract surgery. Conclusion The macular affections,age-related macular degeneration,myopic macular degeneration and post-perative cystoid macular edema are varying in number in the above mentioned order successively,in elderly Chinese at an autopsy study. (Chin J Ocul Fundus Dis,2000,16:233-235)
PURPOSE:Toinvestigate the classification and the age incidence of Coats disease. METHODS:75 cases(79 eyes)of Coats disease were analysed,which were diagnosed by fundus fluorescein angiograpy(FFA)between Jan.1981 and Dec.1994. RESULTS:The patients included 59 males and 16 famales.Average age of the first presentation was 26 years old,and there were 45(60%)cases aged from 19 to 60 years old.In 5 eyes,the ophthalmoscopic examination revealed no obviously abnormal retinal blood vessel,but a number of dilated retinal vessels and microaneuryms were demonstrated by FFA. CONCLUSIONS:The autors consider that there is no essential distinction between type Ⅰand type ⅡCoats disease and it is no longer suitable to apply the traditional classification.Coats disease affects not only juvenile patients but also persons of all ages. （Chin J Ocul Fundus Dis,1996,12: 77-79）