[Clinical analysis of re-operative management for residual partial anomalous pulmonary venous connection after previous cardiac surgery].

Objectives: To analyze the reasons of residual partial anomalous pulmonary venous connection (PAPVC) after previous cardiac surgery, and summarize the strategies and experience for diagnosis and treatment of secondary correction operation. Methods: The clinical data of 18 patients who were admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019 were retrospectively analyzed. All the patients underwent secondary cardiac surgery to treat PAPVC. The preoperative and intraoperative characteristics and postoperative complications of the patients were summarized and analyzed. Results: Totally, there were 7 male and 11 female cases, aged 1-49 years (median age: 4.5 years). In the first cardiac surgery, 3 patients were diagnosed with PAPVC, which existed after surgery. One patient was diagnosed with total anomalous pulmonary venous connection (TAPVC), but left PAPVC after surgery. The remaining 14 patients were all missed preoperative and intraoperative diagnosis. After the initial surgery, most patients had no significant symptoms (11/18), but PAPVC was found in 11 cases due to postoperative cardiac murmur or transthoracic echocardiography (TTE). In the secondary surgery, there were 4 cases of type A, 10 cases of type B, 2 cases of type C, no type D, and 2 cases of mixed type, respectively, according to Bordy classification. The diagnostic accuracy of TTE and CT angiography (CTA) was 50.0% and 92.9%, respectively. There was no death after the second surgery, but pulmonary vein occlusion, pericardial effusion, anastomotic stenosis and other complications occurred in 4 patients. Conclusions: The main causes of missed diagnosis of PAPVC are the undefined cardiac structural deformities before operation and the lack of careful exploration during the operation. TTE is simple and feasible to diagnose PAPVC, and it can improve the diagnostic accuracy when combined with CTA.

Three cases of stroke following peripheral venous interventions.

We report three cases of stroke in association with peripheral venous interventions that each included foam ultrasound-guided sclerotherapy (UGS). All three female patients experienced a right middle cerebral artery (MCA) stroke causing dysphasia and left hemiparesis. A patent foramen ovale was found in each patient. The first incident occurred two days after foam UGS to treat small tributaries of a great saphenous vein (GSV). Paradoxical clot embolism was presumed in this case where concurrent deep vein thrombosis with non-occlusive thrombus in a medial gastrocnemius vein extending to the popliteal vein was detected on ultrasound. The second case occurred immediately at the completion of foam UGS and ambulatory phlebectomy to treat GSV tributaries. Paradoxical gas embolism was demonstrated in this patient confirmed by visualization of bubbles in the right MCA on CT angiography. The third case occurred one day after endovenous laser ablation (1470 nm) and foam UGS to treat both great and small saphenous veins. No specific cause could be confirmed in this patient. Sodium tetradecyl sulphate foam was used in all three cases (3%, 16 mL; 1.5%, 4 mL and 3%, 25 mL, respectively). All three patients recovered completely within a few days.

A systematic review of the effect of diet in prostate cancer prevention and treatment.

Dietary therapy has been proposed as a cost effective and noninvasive means of reducing the risk of prostate cancer (PC) and its progression. There is a large volume of published studies describing the role of diet in the prevention and treatment of PC. This article systematically reviews the data for dietary-based therapy in the prevention of PC, as well as in the management of patients with PC, aiming to provide clarity surrounding the role of diet in preventing and treating PC. Although conclusive evidence is limited, the current data are indicative that a diet low in fat, high in vegetables and fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium intake, is possibly effective in preventing PC. However, caution must be taken to ensure that members of the public do not take excessive amounts of dietary supplements because there may be adverse affects associated with their over consumption. The dietary recommendations for patients diagnosed with PC are similar to those aiming to reduce their risk of PC.