ObjectiveTo understand the effect of nitric oxide (NO) on the formation of hyperdynamic circulatory syndrome (HCS) and the influence of level of NO on HCS. MethodsAfter establishment of stable HCS in partial portal vein ligated rats,the quantity of NO in blood of portal vein and the activity of nitric oxide synthase (NOS) in liver were determined by pre and post injection of inhabitor of NOS (NGmethylLarginine) and hemodynamics was supervised simultaneously.ResultsThe quantity of NO was paralleled with the activity of NOS and was elevated markedly by 24 hours after operation and reached the top by 48 hours after surgery. These sequential changes were coincided with the dilation of general vascularture. There was a close relation between this changes and the formation of HCS.The quantity of NO and the activity of NOS were decreased significantly to the level of the control group after injection of NGmethylLarginine (LNMMA). LNMMA inhabited the activity of NOS and blocked the production of NO. HCS ameliorated obviously. ConclusionNO plays an important role in initiating the dilation of general vascularture and plays a critical role in the formation of HCS. HCS will be ameliorated obviously or be blocked completely by eliminating the effect of NO and the portal pressure will decreased significantly or recover to normal range.
To evaluate the biological tolerance of the human liver to prolonged warm ischemia, 20 patients who underwent liver resections with hepatic inflow occlusion are reported. Biopsy of liver were performed during and after consecutive periods of hepatic ischemia, and speciments were observed under light and electron microscope. The results showed that hepatic vascular occlusion for ＜30 min, resulted in atotissular temporary but reversible pathologic and ultrastructural changes in liver, even patients with liver cirrhosis had better recovery from the operation when the hepatic ischemia was lengthen up to 40 min.
Thirty-six partial hepatectomies for patients with symptomatic intrahepatic stones is reported.Partial liver resection should be done when the liver containing strictrue(s),dilated ducts and stones.Meanwhile,additional procedures should be performed togather with partial hepatectomy,i,e,common duct exploration and drainage,cholangiotomy and cholangioplanty,and cholangeoenterostomy,according to the location of stones and ductal strictures.Postoperative long-term follow-up in this series showed that the results of 86.2% of patients were satiffactory.Partial hepatectomy can be considered as a better treatment of choice for the stones confined to one segment or lobe of liver or combined with multiple strictures of ducts.
Objective To summarize the experiences of surgical treatment for partial atrioventricular canal defect. Methods The data of 66 patients of surgical treatment for partial atrioventricular canal defect from January 1984 to December 2007 were analyzed retrospectively. The cleft of mitral valve presented in all of those patients. There were 52 cases with direct suture on cleft, 8 cases with direct suture with commissurroplasty, 1 case with posterior leaflet plasty, 3 cases with direct suture St.Jude ring and 2 cases mitral valve replacement. The ostium primum atrial septal defects were repaired with patches of Dacron in 12 cases and autologous pericardium in 54 cases. Coronary sinus was situated on the left atrium in 5 and ostium primum atrial septal defects were repaired in Kirklin’s way; the others in MeGoon’way. Meanwhile other heart abnormalities were done. Results There were two early deaths (3.03%), one patient died of heart arrhythmia and one patient died of respiratory failure. Complications of total A-V block was in 2 cases. Both of them were replanted with pace makers.52 cases were followed up, followup time was 5 months to 22 years(mean follow-up 15 years). All patients had better life. Four patients have been re -operated for different reasons post primary operation. One had good result after re-mitral valve replacement. One case died of acute renal failure and the other two died of low cardiac output syndrome. Conclusions Early operation is definitely recommended when the diagnosis is confirmed. Because the structure or function of mitral valve is saved, pulmonary hypertension is avoided and the mortality is lower in the future. The key points of operation are to rectify the mitral insufficiency, repair ostium primum atrial septal defects and avoid atrioventricular block. The patients of mild regurgitation of mitral valve have good results. Provided in those have more than middle regurgitation of mitral valve then their longterm results are poor.
Abstract: Objective To summarize the 17-year clinical experience of coronary artery bypass grafting (CABG). Methods From April 1987 to May 2004, total 253 patients with coronary artery disease underwent CABG. The operation were performed in 217 patients under cardiopulmonary bypass (CPB) with moderate hypothermia, because of calcified ascending aorta, partial replacement of ascending aorta wall with apiece of Gore-Tex graft for the proximal anastomosis were done in 10 patients. Off-pump coronary artery bypass grafting (OPCAB) were performed in 30 patients. The operation under CPB with heart beating were performed in 6 patients. Cardiac valvular operations were performed in 15patients. Left atrium myxoma operation was performed in 1 patient. Left ventricular aneurysm plasty operation were performed in 10 patients. Results Total mortality rate was 7.9% (20/253). There was significant difference between the mortality rate of the first 10 years (16.0%,8/50) and that of the last 7 years (5.9%,12/203; χ2=5.62，Plt;0.05). The causes of death were: 3 patients died on table because of low cardiac output after valvular replacement though emergent CABG were conducted, 2 patients died of multiple organ failure after valvular replacement and emergent CABG had undergone, 3 patients died of ventricular fibrillation during closing the sternum, 6 patients died of multiple organ failure caused of severe lung infection, 2 patients died of ventricular fibrillation after operation, and 4 patients died of acute renal failure. One hundred and fiftyseven patients (67.4%, 157/233) were followed up, follow-up time was 6 months to 15 years. Three of them died of unknown causes, most of them have improved life quality. There were 87 patients in New York Heart Association (NYHA) class Ⅰ, 49 patients in NYHA class Ⅱ, 16 patients in NYHA classⅢ, and 2 patients in NYHA classⅣ. Conclusion When the experience of surgery and postoperative care is matured, CABG is a safe method for treatment of coronary artery disease. Partial replacement of ascending aorta wall with GoreTex graft for proximal anastomosis of the graft is acandidate method for the treatment of patients with calcified ascending aorta.
Objective To investigate the effect of partial liquid ventilation (PLV) with perfluorocarbon(PFC) and continuous pulmonary artery perfusion (CPP) on lung gas exchange and lung inflammatory reaction in acute lung injury(ALI) induced by cardiopulmonary bypass (CPB). Methods Eighteen of either sex piglets(weighting10.2±1.6kg) were randomly divided into three groups: Control group, CPP+CPB group (CPP group), PLV+CPP+CPB group (PLV group). Animals in control group received no treatment but conventional mechanical ventilation.In CPP group lung perfusion with oxygenated blood at 20-25ml/kg·min was given during aortic clamping. In PLV group PFC (FDC)12ml/kg was instilled into the trachea right after CPB stopping. The changes of gas exchange were mearsured before CPB and at 0h, 1h, 2h, 3h after CPB stopping. Histological sections were taken from right and left downsides of lung. Results Compared with control group, the partial pressure of oxygen in artery (PaO2) significantly increased and alveolar-aterial oxygen gradient(AaDO2) markedly decreased after 1h in PLV group(Plt;005) and partial pressure of carbon dioxide in artery (PaCO2) also became small after 3h (Plt;005).The change of gas exchange in CPP group was markedly improved. And role of lung protection of PLV was more better than that of CPP. Light microscopy: Express of intercellular adhesion molecule-1(ICAM-1) in the histopathological lesions of lung was bely positive in control group than that of PLV group and CPP group. Conclusion PLV and continuous pulmonary artery perfusion can improve the oxygenation of lung and inhibit inflammatory reaction of acute lung injury induced by CPB
Objective To summarize experiences of surgical treatment and long-term results of myasthenia gravis (MG). Methods Two hundred thirty-six patients underwent thymectomy for MG in our department from Jan.1978 to Dec. 2002. The perioperative management, relative factors of postoperative crisis and long-term results were analysed. Results In 236 patients postoperative crisis took place in 44 cases accounted for 18.6%. The occurrence of postoperative crisis was related to preoperative management, modified Osserman clinical classification and combination with thymoma. Three cases died in the postoperative periods. Among them, one died of acute respiratory distress syndrome induced by aspiration and the other died of crisis. The effective rate in 1, 3, 5 years was 84.6%, 91.0% and 89.0% respectively. Conclusions Thymectomy for MG is safe and effective. Delayed extubation could decrease the needs of tracheotomy in patients with high risk factors for postoperative crisis. The partial sternotomy approach is less traumatic but the long-term effects of surgery are identical to those reported by the most authors.
Objective To evaluate the surgical technique and effectiveness of arthroscopic treatment for lateral discoid meniscus injury. Methods Between January 2010 and May 2011, 38 patients (42 knees) with lateral discoid meniscus injuries underwent arthroscopic treatment. There were 23 males (24 knees) and 15 females (18 knees), aged 7-62 years (median, 32.8 years). The disease duration was 7 days to 40 years (median, 8.6 months). According to Watanabe’s classification of discoid meniscus, 22 knees were classified as complete type, 19 knees as incomplete type, and 1 knee as Wrisberg type. Meniscus plasty combined with suture was performed in 25 patients (28 knees), partial meniscectomy in 12 patients (13 knees), and complete meniscectomy in 1 patient (1 knee). After operation, the rehabilitation training programs (including straight-leg-raising exercise and range of motion exercise) were carried out. Results All incisions healed primarily. The patients basically had normal activities after 3-4 weeks. All the patient were followed up 12-18 months (mean, 14.3 months). No joint locked or clicking symptom occurred; no tear or revision was noted during follow-up. At 3 months, 6 months, and 1 year after operation, the range of flexion and extension were significantly improved when compared with ones at preoperation (P lt; 0.05). Based on Ikeuchi’s grading, the results were excellent in 22 knees, good in 16 knees, and fair in 4 knees with an excellent and good rate of 90.4%. The Lysholm score was significantly increased to 88.57 ± 2.95 at immediate, 91.02 ± 4.17 at 3 months, 92.90 ± 3.36 at 6 months, and 94.74 ± 3.52 at 12 months after operation from 69.38 ± 4.59 before operation (P lt; 0.05). C onclusion Treatment of lateral discoid meniscus injury under arthroscopy has the advantages of minor trauma, precise resection or repair meniscus, preservation of more meniscus function, and low incidence of osteoarthritis. If the operation is combined with standard rehabilitation training, the short-term effectiveness can be enhanced.
Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
Objective To explore the effects of changes in the length of the patella on patellofemoral contact areas and pressures, to provide a theoretical foundation for treatment of lower pole of patella fracture. Methods Using homemadeloadingequipment, pressure sensitive films of 100 mm × 100 mm in size were placed on the force platform, vertically downwardload (0-19.6 N) was given. The pressure-sensitive response curve was obtained by computer image analysis of the pressuresensitive tablets and calculation. Six male left fresh knee specimens from voluntary donation were placed in homemade-test fixed load device, and the double-layer pressure sensitive film was placed on the patellofemoral joint surface; under loading of 196 N at flexion of 0, 15, 30, 45, 60, 75, 90, 105, 120, and 135° for 2 minutes, respectively, the pressure sensitive film was removed as the control group. Patellas were transected cut and in situ fixed by Kirschner wire and steel-wire as in situ fixation group. Bone fragments obtained from the corresponding 1/6 and 2/6 of contralateral patella, were embedded in the interspace between osteotomy with internal fixation with Kirschner wire and steel-wire respectively as lengthening group. Followed by the amputating patella length of 1/6, 2/6, 3/6 from proximal to distal and internal fixation with Kirschner wire and steel wire by turns as a shortening group. Repeat the above steps of each experiment. By image analysis the pressure sensitive film, the patella joint contact area were measured, and patellar contact pressure (including the peak pressure and average pressure) was calculated according to pressure-sensitive response curve. Results The actural contact area were significantly smaller in the shortening groups than in the control group at flexion of 30-135° (P lt; 0.05); the pressure was significantly bigger in shortening 1/6 group at flexion of 0, 15, 60, and 75°, in shortening 2/6 group at flexion of 0° and 75-135°, and in shortening 3/6 group at flexion of 0-30°and 75-135° than in the control group (P lt; 0.05); the peak pressure was significantly bigger in shortening 1/6 group at flexion of0, 15, and 60-105°, in shortening 2/6 group at flexion of 0, 15, and 75-105°, and in shortening 3/6 group at flexion of 0, 30, and 60-135° than in the control group (P lt; 0.05). The actural contact area was significantly smaller in the lengthening groups than in the control group at flexion of 15, 60, and 90°, and it was bigger at flexion of 105, 135° in lengthening 2/6 group than in the control group (P lt; 0.05); the pressure was significantly bigger in the lengthening groups at flexion of 15-75° than in the control group and it was smaller in the lengthening groups at flexion of 105, 135°, and smaller in lengthening 2/6 group at flexion of 120° (P lt; 0.05); the peak pressure was significantly smaller in lengthening 1/6 group than in the control group at flexion of 0, 90, and 105° and smaller in lengthening 2/6 group at flexion of 0° (P lt; 0.05). The actural contact area was significantly bigger in all lengthening groups than in all shortening groups at flexion of 30, 45, and 75-135° (P lt; 0.05). The pressure was significantly bigger in shortening 1/6 group than in lengthening groups at flexion of 0, 60, and 90° (P lt; 0.05), in shortening 2/6 group at flexion of 0, 60, and 90-120° (P lt; 0.05), in shortening 3/6 group at flexion of 0-135° (P lt; 0.05). The peak pressure was bigger in shortening groups than in lengthening 1/6 group at flexion of 0, 90, and 105° (P lt; 0.05), bigger than lengthening 2/6 group at flexion of 0° (P lt;0.05余请见正文.....