Extracardiac Right Atrium-to-Right Ventricle Homograft for Uncorrectable Tricuspid Valve Disease

Surgically uncorrectable tricuspid valve disease in children is rare. However, when it happens the surgical options are very limited. Tricuspid valve replacement using a mechanical valve or stented bioprosthesis is impractical. Use of homografts in the “anatomic position” has its limitations. We report here the use of an extracardiac homograft connection between the right atrium and right ventricle in a 16-month-old boy in whom severe tricuspid valve stenosis developed after surgical repair of a complex ventricular septal defect associated with dextrocardia and anomalous systemic venous drainage. The patient remains well receiving no cardiac medication 12 months after the procedure.     

超微孔膨体聚四氟乙烯人工心脏瓣膜体外流体力学的评价

目的采用新型高分子材料制备人工心脏瓣膜,并对其体外流体力学特征作出评价。方法将片状超微孔膨体聚四氟乙烯材料缝制于弹性支架上做成人工心脏瓣膜,以Baxter人工双叶机械瓣作对照,对新型瓣膜进行了静态泄漏和定常流测试。结果两种瓣膜静态泄漏率无显著差异(P>0.05),定常流下高分子瓣膜跨瓣压差更低,两组间存在显著差异(P<0.001)。结论新型高分子人工心脏瓣膜体外流体动力学性能优于Baxter机械瓣。     

连续性肾脏替代治疗在慢性肾衰竭并发急性心肌梗死中的应用

目的:总结日间连续性肾脏替代治疗(CRRT)救治慢性肾衰竭并发急性心肌梗死的经验.方法:对9例慢性肾衰竭常规透析时发生急性心肌梗死的患者改行CRRT,观察临床效果,监测血生化、肾功能.结果:所有患者经CRRT治疗,心前区疼痛、胸闷、憋气均有不同程度缓解,7例患者度过急性期,平均治疗时间90～146 h,转为常规血透,目前仍存活;2例患者因并发症死亡.结论:CRRT操作简便,对血流动力学影响小,日间CRRT同样能有效救治病人,使其度过急性期,降低急性心肌梗死的病死率.     

Analgesic nephropathy in Hungary: the HANS study.

BACKGROUND: The diagnosis of analgesic nephropathy has improved significantly with modern imaging techniques. We reviewed a large portion of the Hungarian dialysis population to obtain additional insight into the problem. METHODS: Twenty-two participating dialysis units enrolled 1400 patients on renal replacement therapy between 1 January 1995 and 1 January 1998. Patients with no known aetiology (n = 284) were interviewed and studied with renal imaging. We assessed the presence of decreased renal mass combined with either bumpy contours, papillary calcification, or both. The subjects studied were interrogated extensively. RESULTS: Our survey suggested analgesic nephropathy in 47 of 1400 patients (3.3%), 3-fold higher than the EDTA database estimate for Hungary. The analgesics most commonly abused were phenacetin-containing mixtures. The driving symptoms were mainly headache and joint pain. Cardiovascular complications were more common than in the rest of the dialysis population, independent of smoking and lipid values (P<0.01). CONCLUSIONS: Phenacetin should be banned. Our study results support the need for longitudinal cohort and case-control studies in Hungary.     

腹主动脉瘤动脉壁血管平滑肌细胞增殖及凋亡的研究

目的研究腹主动脉瘤 (abdominalaorticaneurysm ,AAA)在发病不同时期动脉壁平滑肌细胞 (smoothmusclecells,SMC)增殖与凋亡的改变。方法建立大鼠AAA模型 ,分别于术后 3d、1、2、3、4周切取腹主动脉 ,应用原位DNA片段末端标记 (TUNEL)和免疫组织化学方法检测腹主动脉壁中SMC凋亡和相关基因bcl 2、bax蛋白以及增殖细胞核抗原 (PCNA)、α 血管平滑肌肌动蛋白(α actin)的表达。结果TUNEL及PCNA表达高峰时段分别为术后 2～ 3周和 1周 ;术后 3d至 1周凋亡细胞少于PCNA阳性SMC ,2～ 4周多于PCNA阳性SMC且SMC数量明显减少 ;bcl 2与bax蛋白表达分别于术后 1、3周达到峰值 (P <0 0 1)。结论动脉壁SMC增殖和凋亡的失衡与AAA发病密切相关 ;bcl 2与bax基因参与了对AAA动脉壁中SMC凋亡的调控。     

人工全膝关节置换术治疗膝关节骨关节炎

[目的]评价人工膝关节置换术治疗骨关节炎的临床疗效。[方法]本院自1994年10月～2003年10月采用人工全膝关节置换术治疗膝关节骨关节炎81例（95膝），男10例，女71例；平均年龄65．5岁（50—82岁）；左膝35例，右膝26例，双侧同时置换17例；保留后交叉韧带假体18膝，后方稳定性假体62膝，活动衬垫15膝。[结果]本组平均随访42个月（14—108个月），应用HSS膝关节评分系统进行分析，优：80膝（84．21％），良：10膝（10．53％），可：3膝（3．16％），差：2膝（2．10％）。优良率94．74％。[结论]作者认为人工全膝关节置换术能有效的缓解膝关节骨关节炎的疼痛，改善膝关节功能。正确的选择假体、精细的手术操作和严格的术后康复是保证手术效果的关键。     

The posterior urethral valve uropathy: Results of treatment

Nineteen children treated for posterior urethral obstruction due to congenital valve in the University of Benin Teaching Hospital, Benin City, Nigeria, over a 9-year period have been analysed. Their ages ranged from birth to 12 years. Results show that associated kidney pathology may be irreversible even after successful excision of the valve. This determines the final prognosis, which is worse the younger the child at presentation.     

Aortic valve injury 10 years after tetralogy of Fallot repair

Summary Although recognized by pediatric cardiac surgeons, aortic insufficiency as a technical complication after tetralogy of Fallot repair is poorly documented, especially if it occurs late. The case of a boy with aortic insufficiency 10 years after complete tetralogy repair is described. No documentation in the literature other than summary statements in textbooks of this occurence was found.     

MRI visualization of the aortic nipple

The aortic nipple, a small “pseudotumor” adjacent to the aortic arch, is the left superior intercostal vein. In our series of 40 patients it was demonstrated in six; all had a right upper thoracic mass and four had a superior vena caval syndrome. Coronal magnetic resonance, images (MRI) of the thorax were superior to all other imaging methods in demonstrating the nipple. It is concluded that in patients with masses in the right upper chest, coronal MR chest examinations are valuable in demonstrating an aortic nipple, a sign of impending present superior vena caval or innominate, vein obstruction.