Congenital heart disease (CHD) is a series of structural cardiac abnormalities resulting from abnormal fetal heart development. With the prolongation of survival time, their cognitive function problems begin to be concerned. From fetus period to adulthood, people with complex CHD are more likely to have abnormalities in brains. Children with complex CHD have a significantly increased risk of developmental disorders in cognitive functions, such as intelligence, attention and psychosocial disorders. These diseases persist into their adulthood. Adults with CHD have earlier neurocognitive decline, poorer performance in intelligence, executive function, attention and academic achievement, and are more likely to have mood disorders, higher incidence of mental disorders and lower quality of life. This paper reviews the studies on cognitive function of adult patients with CHD from the dimension of the whole life cycle.
Abstract: Objective To evaluate the longterm results of surgical treatment of tetralogy of Fallot (TOF) in adults and discuss the perioperative treatment skills. Methods From January 2000 to March 2008, 149 patients older than 14 years with tetralogy of Fallot received surgical treatment in Changhai Hospital. Among the patients, there were 78 males and 71 females with ages ranged from 14 years to 53 years and the average age was 26.3 years. Twenty patients had previous pulmonary arterial shunts before radical treatment. A total of 129 patients underwent primary radical treatment. Thirtyeight patients received a right ventricular outflow tract patch, 107 patients had transannular patch, and 4 patients had homograft aorta with valves. Results Hospital mortality was 4.0%(6/149). Four patients died of low cardiac output syndrome (LCOS), and multiple organ failure, and 2 patients died of acute renal failure. The postoperative complications included pleural effusion in 11 patients, pulmonary edema in 10 patients, severe LCOS in 9 patients, severe cardiac arrhythmia in 7 patients, reoperation for excessive bleeding in 7 patients, reintubation in 6 patients, and residual ventricular septal defect (VSD) in 5 patients (two of them had reoperation for residual VSD repair and 2 received transcatheter closure of VSD). One hundred and thirtyfour patients were followed up for 3 to 102 months (47.2±28.6 months) with a followup rate of 93.7%(134/143). Late death occurred in 2 patients, one of whom died of secondary infective endocarditis and the other had a sudden death 29 months after operation. During the followup, one patient had residual VSD (2 mm), but had a normal life. The peak systolic right ventricletopulmonary artery pressure gradient exceeded 40 mmHg in 4 patients. Two patients had severe pulmonary regurgitation. A total of 132 patients survived and had an improved life. One hundred and twentyone patients had class Ⅰ heart function (NYHA), and 11 patients in class Ⅱ. Conclusion The pathophysiologic conditions of the patients with tetralogy of Fallot in adults are very complicated due to longterm right ventricle outlet stricture and chronic hypoxia. Preoperative evaluations and postoperative treatment of complications are necessary. The systemicpulmonary arterial shunts should be performed when hypotrophy of the pulmonary arteries or left ventricles exists. Repair of tetralogy of Fallot in adults has acceptable morbidity and mortality rates with goodlongterm outcomes.
Objective To summarize the experience of the prevention of early arterial compl ications after hepatic artery (HA) reconstruction in adult-to-adult l iving donor l iver transplantation (A-A LDLT). Methods Between January 2002and March 2008, 127 patients underwent A-A LDLT. Of the 131 donors (127 cases of right lobe graft, 4 cases of left lobe graft), there were 69 males and 62 females with a mean age of 36.2 years (range, 19-65 years); in 127 recipients, there were 109 males and 18 females with a mean age of 41.9 years (range, 18-64 years). All patients underwent microsurgical reconstruction of HA between grafts and recipients. The artery of graft was anastomosed to the right HA in 62 cases, to the proper HA in 34 cases, to the left HA in 7 cases, to the common HA in 6 cases, and aberrant right HA rising from superior mesenteric artery in 8 cases. Interposition bypass using great saphenous vein (GSV) was performed between the donor right HA and recipient common HA in 5 cases. Bypass was performed between the donor right HA and recipient abdominal aorta using GSV in 2 cases, or using cryopreserved cadaveric il iac vessels in 3 cases. Results Of these 127 cases, hepatic artery thrombosis (HAT) occurred in 2 recipients (1.6%) at 1 day and 7 days following A-A LDLT, which were successfully revascularized with GSV between right HA of donor and abdominal aorta of recipient, HAT in 1 patient occurred on the 46th postoperative day with no symptom. No other arterial compl ication such as HA stenosis and aneurysm occurred in recipients. All patients were followed up 9-67 months. At 1, 2, and 3 years, actual survival rateswere 82.2%, 64.7%, and 59.2%. No death was related to HA compl ication in peri-operative period. Conclusion The anatomic structure and variation of HA, the pathological changes, as well as surgical technique in HA reconstruction, have direct impact on the risk of postoperative compl ications of HA reconstruction.
Objective To review the progress in clinical and biomechanical study on soft tissue reconstruction of adult-acquired flatfoot deformity (AAFD). Methods The recent original articles of soft tissue repair and tendon transfer for AAFD were extensively reviewed. Results The soft tissue procedures for AAFD can be divided into two components: static restoration of medial column stability and dynamic reconstruction of the posterior tibial tendon. The most important static structure to be repaired for AAFD is the spring ligament. On the other hand, various methods can be used for dynamic reconstruction. The flexor digitorum longus transfer is widely used, but results of biomechanical studies do not support the advantage of this method. For patients having normal function of the posterior tibial muscle, the Cobb procedure may be more suitable. Conclusion The soft tissue reconstruction procedures of AAFD should be chosen individually based on the stage and type of the deformity.
OBJECTIVE: To explore the expression of basic fibroblast growth factor(bFGF) during the wound healing of human fetal and adult skin and its significance. METHODS: We established the animal model of fetal scarless healing by transplanting full-thickness skin grafts from human fetus to a subcutaneous location on the athymic mouse recipient, and then making the linear incisions. The expression of bFGF was observed in the normal adult skin, normal fetal skin and during wound healing by immunohistochemical method. The positive staining cells were counted under selected high-power focus randomly. RESULTS: bFGF staining was not observed in the normal fetal skin and the wounded one. However, bly positive staining was shown around the vessels in normal adult skin. Moreover, the positive straining became ber in the wounded skin, especially in dermal fibroblasts and endotheliocytes. The number of positive staining cell was 2.1 +/- 0.1 in normal fetal skin, and 2.2 +/- 0.1, 2.1 +/- 0.3, 2.1 +/- 0.3 and 2.0 +/- 0.1 in the fetal skins after 12 hours, 1 day, 3 days and 7 days of wound respectively. The number of positive staining cell were 23.2 +/- 4.2 in normal adult skin and 40.5 +/- 3.6 in the wound adult skin. There was significant difference between the fetal skin and adult skin (P lt; 0.01). CONCLUSION: The negative expression of bFGF in the fetal skin may be one of the important reasons for fetal scarless healing.
Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.
ObjectivesTo systematically review the influence of antiepileptic drugs on bone mineral density and bone metabolism in adults.MethodsPubMed, EMbase, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the influence on antiepileptic drugs on the bone mineral density and bone metabolism in adults from inception to April 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 studies were included. The results of meta-analysis showed that: VPA could decline the bone mineral density of lumbar spine (SMD=–0.39, 95%CI –0.65 to –0.13, P=0.003); CBZ (SMD=–0.71, 95%CI –1.08 to –0.33, P=0.000 2) and VPA (SMD=–0.3, 95%CI –0.58 to –0.02, P=0.03) could decline the bone mineral density of femoral neck; CBZ could decline the bone mineral density of total hip (SMD=–0.47, 95%CI –0.84 to –0.10, P=0.01). Serum 25-hydroxy vitamin D3 was decreased in OXC group (SMD=–0.67, 95%CI –1.28 to –0.05, P=0.03); serum calcium was decreased in CBZ (SMD=–0.49, 95%CI –0.78 to –0.20, P=0.000 8), LEV (SMD=–0.83, 95%CI –1.15 to –0.51, P<0.000 01) and OXC (SMD=–0.48, 95%CI –0.90 to –0.05, P=0.03) group; serum phosphorus was decreased in LEV group (SMD=–11.36, 95%CI –12.97 to –9.76, P<0.000 01). Serum alkaline phosphatase was increased significantly in LEV (SMD=6.79, 95%CI 5.78 to 7.80, P<0.000 01) and CBZ (SMD=1.90, 95%CI 1.35 to 2.44, P<0.000 01) group.ConclusionsCurrent evidence shows that treatment with antiepileptic drugs may be associated with an decreasing bone mineral density and influence bone metabolism in epileptic adults. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectiveTo measure and analyze the radiographic characteristics of the leg length discrepancy in adult patients with unilateral developmental dysplasia of the hip (DDH).MethodsThe clinical data of 112 patients with unilateral DDH who met the selection criteria between January 2016 and June 2018 were retrospectively analyzed. There were 16 males and 96 females with an age of 20-76 years (mean, 42.9 years). According to the Crowe classification, there were 25 hips of type Ⅰ, 26 hips of type Ⅱ, 15 hips of type Ⅲ, and 46 hips of type Ⅳ (26 hips of type ⅣA without secondary acetabular formation, and 20 hips of type ⅣB with secondary acetabular formation). Full-length X-ray films of the lower limbs in the standing position were used to measure the following parameters: greater trochanter leg length (GTLL), greater trochanter femoral length (GTFL), lesser trochanter leg length (LTLL), lesser trochanter femoral length (LTFL), tibial length (TL), and intertrochanteric distance (ITD). The above parameters on the healthy and affected sides were compared and the difference of each parameter between the healthy and affected sides was calculated. Taking the difference of 5 mm between the healthy side and the affected side as the threshold value, the number of cases with the healthy side was greater than 5 mm and the affected side was greater than 5 mm were counted respectively. The difference of the imaging parameters between the healthy side and the affected side were compared between different Crowe types and between type ⅣA and type ⅣB.ResultsThere was no significant difference in GTLL and LTFL between healthy and affected sides (P>0.05); LTLL and TL of affected side were longer than healthy side, GTFL and ITD were shorter than healthy side, and the differences were significant (P<0.05). The constituent ratio of long cases on the affected side of TL and LTLL was greater than the constituent ratio of long cases on the healthy side, while the constituent ratio of long cases on the healthy side of GTFL and ITD was greater than the constituent ratio of long cases on the affected side; there was no obvious difference in the constituent ratio of long cases on the healthy side or the affected side of GTLL and LTFL. The comparison between different Crowe types showed that only the difference in TL between type Ⅰ and type Ⅳ was significant (P<0.05), the difference of each imaging parameter among the other types showing no significant difference (P>0.05). Compared with type ⅣB, the differences of GTLL, TL, and ITD of type ⅣA were bigger, and the differences were significant (P<0.05); the differences of other parameters between type ⅣA and type ⅣB were not significant (P>0.05).ConclusionIn adult unilateral DDH patients, the leg length on the healthy side and the affected side is different, and the difference mainly comes from the TL and ITD, which should be paid attention to in preoperative planning.
Objective To investigate the results of the surgical treatment of adult congenital heart disease (ACHD). Methods We retrospectively analyzed the clinical data of 502 patients with ACHD underwent operation treatment in Fu Wai Hospital between January 2012 and June 2015. There were 205 males and 297 females at age of 18-65(34.01±11.97) years and weight of 19-96 (58.60±12.60) kg. Results Atrial septal defect had the highest incidence of ACHD, the proportion accounted for 43.8%.The followed was ventricular sepal defect, accounting for 26.6%. And the third is tetralogy of Fallot, accounting for 5.4%. The age ranged from 18 to 65 years. A percentage of 65.13% patients received operation when they are younger than 40 years, with the most patients at age of 20-29 years, the least patients at age of 30-39 years. We completed a total of 471 patients of early orthodontic treatment with operation success rate at 99.57%. We completed 29 patients palliative operation with early operation success rate at 96.55%. And there were 2 patients with re-operation at success rate of 100.00%. The postoperative patients with ventilator assisted time was 19.03 h. The mechanical ventilation time was 19.03 h. ICU treatment time was 2.22 d. Postoperative complications occurred in 51 patients with incidence rate at 10.15%. Conclusion It is very important to impose proper surgical method on different patients. The operation doctor should be trained skillfully. Perioperative management is also a key stage to the success of the operation.
ObjectiveTo investigate the value of cementless total hip arthroplasty (THA) for the treatment of Crowe type Ⅲ developmental dysplasia of hip (DDH) in adults. MethodsBetween September 2013 and September 2015, 50 patients (51 hips) with Crowe type Ⅲ DDH were treated. There were 20 males (20 hips) and 30 females (31 hips), with the average age of 39 years (range, 19-55 years). The left side was involved in 34 cases, the right side in 15 cases, and both sides in 1 case. All patients had the symptoms of limp walking and hip pain. The disease duration was 10-47 months (mean, 26 months). The sign of "4" number test and Trendenleburg sign were positive; the Harris score was 38.9±7.1. The bilateral lower extremities discrepancy was 2.5-4.0 cm (mean, 3.3 cm) before operation. All the patients underwent cementless THA, and acetabulum by structural femoral head autograft was performed in 28 cases (28 hips). ResultsAfter operation, the incision healed by first intention. Only 2 patients (2 hips) had femoral nerve palsy, and 7 patients (7 hips) had leg swelling, which were cured after symptomatic treatment. All the patients were followed up 6-18 months (mean, 10 months). The sign of limp walking was improved after operation, hip pain was relieved in 46 patients (46 hips) and only 4 patients (5 hips) still had mild pain. The X-ray films showed bony healing at 3-6 months (mean, 5 months) after operation. At last follow-up, the patients had equal limb length with the discrepancy less than 1 cm (mean, 0.4 cm). At last follow-up, the Harris score was significantly increased to 91.2±2.8 (t=-79.77, P=0.00). ConclusionThe cementless THA is an effective method to treat Crowe type Ⅲ DDH in adults.