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Results of the Ross operation in a pediatric population 总被引:1,自引:0,他引:1
Mark G. Hazekamp Heynric B. Grotenhuis Paul H. Schoof Marie E.B. Rijlaarsdam Jaap Ottenkamp Robert A.E. Dion 《European journal of cardio-thoracic surgery》2005,27(6):975-979
Objective: To analyse the results of the mid-term clinical and echocardiographic follow-up of the pediatric Ross operation. Methods: Echo-Doppler follow-up of 53 consecutive pediatric Ross procedures performed between 1994 and 2003. Median age was 9.7 years at time of operation (2 weeks–17.7 years). Six patients were younger than 3 months. Median age at follow-up was 15.6 years. Aortic valve/left ventricular outflow tract (LVOT) anomalies were congenital in 49 (92%). Seventy percent had previous surgery or balloon valvuloplasty. Root replacement was used in all. Thirteen patients (25%) had LVOT enlargement. Mean cross-clamp time was 113 (69–189) minutes. Results: Early mortality occurred in 3 patients after emergency surgery following balloon failure (n=1) and extended Ross following interrupted arch/VSD repair (n=2). Late mortality was due to LV fibroelastosis in 2 patients and complicated pulmonary artery stenting in another. RVOT reoperations were required because of late homograft obstruction in 2 patients and because of pulmonary artery stenosis in another. Five patients (9.4%) were reoperated for pulmonary autograft dilatation (n=3) and for leaflet fibrosis or perforation (n=2). Autografts were repaired in two patients, while a mechanical valve was inserted in 3 cases. At 9 years the actuarial survival and event free survival were 89 and 74%, respectively. At last follow-up 90% of autograft diameters indexed to body surface area was above the 90th percentile of normal aortic root diameters. LVOT and RVOT gradients were low and autograft insufficiency was trivial to mild in 84% and mild to moderate in 16%. Autograft stenosis was not noticed. Conclusions: The pediatric Ross procedure remains an important tool but autograft dilatation also occurs in the pediatric population. The significance of this finding has yet to be determined. 相似文献
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Marcel Stokkel Aeilko Zwinderman Jaap Zwartendijk Ernest Pauwels Berthe van Eck-Smit 《European journal of nuclear medicine and molecular imaging》1997,24(10):1215-1220
Between 10% and 25% of patients with newly diagnosed prostate cancer without bone metastases at the time of diagnosis will
develop metastases during follow-up. To determine the value of clinical and biochemical parameters for assessment of prognosis
at the time of diagnosis, a retrospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer
without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients developed metastases.
Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated with
age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tumour grade, T-stage and N-stage. In patients with a class
2 scan, additional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including
therapy, were finally correlated with the development of metastases and survival. For survival 38 patients with proven metastases
were used as controls. For all parameters tested, no statistically significant differences were found between the three bone
scan classifications. The interval between diagnosis and the development of metastases ranged from 12 to 72 months. For the
risk of development of metastases only PSA was found to be a significant correlate (P=0.0075). However, when tumour stages were clustered in limited disease (T0–2) and extensive disease (T3–4), the incidence
of metastases was significantly higher in patients with extensive disease than in those with limited disease (P=0.0021). Finally, age, PSA and Anderson classification were found to be significant correlates of survival, but in stepwise
analysis PSA was selected as the most prognostic variable (P<0.0001). In contrast with a typical pattern of metastases on bone scintigraphy, an abnormal scan (class 1 and 2) at the time
of diagnosis is not a poor prognostic parameter of the risk of death. In conclusion, in patients with prostate cancer without
bone metastases at the time of diagnosis, pretreatment PSA and tumour stage can be used for the assessment of risk of development
of metastases during follow-up and survival. For this purpose, tumour stage should be clustered in limited and extensive disease.
Received 14 April and in revised form 9 June 1997 相似文献
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Gysèle S Bleumink Anna F C Schut Miriam C J M Sturkenboom Jaap W Deckers Cornelia M van Duijn Bruno H Ch Stricker 《Genetics in medicine》2004,6(6):465-474
Heart failure is a complex clinical syndrome. There is evidence for a genetic contribution to the pathophysiology of heart failure. Considering the fundamental role of neurohormonal factors in the pathophysiology and progression of cardiac dysfunction and hypertrophy, variants of genes involved in this system are logical candidate genes in heart failure. In this report, genetic polymorphisms of the major neurohormonal systems in heart failure will be discussed. Studies on polymorphisms of the renin-angiotensin-aldosterone system (RAAS), adrenergic receptor polymorphisms, endothelin (receptor) polymorphisms, and a group of miscellaneous polymorphisms that may be involved in the development or phenotypic expression of heart failure will be reviewed. Research on left ventricular hypertrophy is also included. The majority of genetic association studies focused on the ACE I/D polymorphism. Initial genetic associations have often been difficult to replicate, mainly due to problems in study design and lack of power. Promising results have been obtained with genetic polymorphisms of the RAAS and sympathetic system. Considering the evidence so far, a modifying role for these polymorphisms seems more likely than a role of these variants as susceptibility genes. Besides the need for larger studies to examine the effects of single nucleotide polymorphisms and haplotypes, future studies also need to focus on the complexity of these systems and study gene-gene interactions and gene-environment interactions. 相似文献
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TomJ. Snijders Frank-Erik Leeuw UrsulaM.H. Klumpers L.Jaap Kappelle Jan Gijn 《Journal of neurology》1992,239(Z2):S1-S3
Oral session 1: General neurology 相似文献
8.
Johannes M. A. Van Gerven Johan P. Boot Herman H. P. J. Lemkes Jaap A. Van Best PhD 《Documenta ophthalmologica. Advances in ophthalmology》1992,80(2):183-188
The morphological base for the impaired function of the blood retinal barrier was studied in 50 eyes of 10 insulin dependent and 21 non-insulin dependent patients with various levels of diabetic retinopathy. The permeability of the blood retinal barrier (PBRB) was determined by vitreous fluorophotometry with correction for autofluorescence, lenstransmission and non-protein bound plasma fluorescein concentration. Morphological abnormalities of diabetic retinopathy assessed by fundus photography and fluorescein angiography were individually scored on a decimal scale and related to the PBRB by multiple regression analysis. The Pbrb was not correlated to morphological abnormalities of non-proliferative retinopathy [(1) microaneurysms, (2) hard exudates, (3) soft exudates, (4) intraretinal hemorrhages, (5) fluorescein leakage, and (6) capillary closure, p > 0.3]. The PBRB was correlated to morphological abnormalities of (pre)proliferative retinopathy [(1) intraretinal microvascular abnormalities (Sirma) and (2) new vessels (Sneo): pbrb = A – B.SIRMA – C.Sneo with PBRB in nm/sec, A = 1.5 ± 0.5, B = 0.9 ± 0.2 and C = 1.7 ± 0.4, R2 = 0.65, p < 0.0001]. It can be concluded that the increased blood retinal barrier permeability in diabetic patients is mainly due to (pre)proliferative abnormalities and not to non-proliferative abnormalities. 相似文献
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Peter F. Bruning Jaap Van Doorn Johannes M. G. Bonfrr Paul A. M. Van Noord Catharina M. Korse Theodora C. Linders Augustinus A. M. Hart 《International journal of cancer. Journal international du cancer》1995,62(3):266-270
Insulin-like growth factor 1 (IGF-1) is a potent mitogen for human breast-cancer cells in vitro. In circulation, most of IGF-1 is bound to IGF-binding protein 3 (IGFBP-3). This high-affinity binding is thought to have an important limiting effect on the availability of IGF-1 for biological activity. To assess the availability of IGF-1 for receptor binding, we determined serum levels of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 ratios. In a case-control study, 150 women aged 38 to 75 years presenting with stage-l or-II breast cancer were investigated just prior to surgery (n = 76), or to irradiation one month after surgery (n = 74). The population-based control group consisted of 441 women of the same age having no breast cancer. Women reporting diabetes mellitus or other hormonal abnormalities were excluded. Premenopausal cases showed elevated IGF-1 serum concentrations, decreased IGFBP-3 levels and increased IGF-1/IGFBP-3 ratios. The IGF-1/IGFBP-3 ratio was a significant breast-cancer risk factor, also after adjustment for age, family history, height, body-mass index, body-fat distribution, and serum levels of C-peptide. The relative risk was 7.34 for the highest compared with the lowest quintile of IGF-1/IGFBP-3. The presence or absence of tumor had no influence on these results. Increased levels of available IGF-1 in the circulation of pre-menopausal women may contribute to the development of breast cancer. © 1995 Wiley-Liss Inc. 相似文献