Clinical analysis of modified technique for pectus bar removal after Nuss procedure / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the safety and efficacy of modified technique for removing Nuss bar after Nuss procedure.@*METHODS@#We reviewed 186 patients undergoing bar removal after repair of pectus excavatum with Nuss procedure at our institution from December 2008 to February 2012. All patients had unilateral incision (metallic stabilizers have been used on one side in all patients). Under general anesthesia with single lumen tracheal tube or laryngeal mask, with the patient lying down in supine position, the bar was pulled out along the thoracic wall without overturning or straightening.@*RESULTS@#Totally 132 patients (71.0%) had the bar removed 2 years after the Nuss procedure, 1 (0.5%) removed within 1 year and 53 (28.5%) removed over 2 and half years. The operation time for bar removal was 9-20 (13.1 ± 3.4) min, and the operative blood loss was 3-20 (5.2 ± 2.7) mL. There was no hemorrhage. Three patients (1.6%) developed mild pneumothorax and none showed infection of incision after the operation. All patients were discharged 1 day after the surgery and followed up for 4-48 (21.4 ± 6.8) months. Recurrence was found in the one who which had the bar removed within 1 year (0.5%).@*CONCLUSION@#With modified procedures, Nuss bar can be easily and safely removed 2 years or longer after the Nuss operation. After removing the metallic stabilizer, the bar should be turned and then pulled out along the original surgical incision without bending or turning.

Performance effect of rabbit carotid artery treated with decellularization and photo-oxidation / 中南大学学报(医学版)

OBJECTIVE@#To analyze and discuss the feasibility of rabbit carotid artery treated with decellularization and photo-oxidation.@*METHODS@#Sixty vascular slices of rabbit carotid artery were divided into a fresh group, a cryopreservation group, a glutaraldehyde group, and a decellularization plus photo-oxidation group 15 in each group. To evaluate the physical properties of all the rabbit carotid arteries by testing heat-shrinking temperature, tensile stress and the max elongation of each group. Then by buliding subcutaneous embedding model in SD rats we evaluated the biological stability and the anti-calcification function property of the above rabbit carotid arteries, and the detection means included HE stain, atomic absorption spectrometry and Von-Kossa calcium salt stain.@*RESULTS@#The heat-shrinking temperature, tensile stress and the max elongation in the cryopreservation group were lower or shorter than those of the other groups and the difference had statistical significance (P<0.05). Although the heat-shrinking temperature and the tensile stress in the decellularization plus photo-oxidation group were lower or shorter than those in the glutaraldehyde group (P<0.05), the max elongation in the decellularization plus photo-oxidation group was much longer than that in the glutaraldehyde group (P<0.05). The rabbit carotid artery treated with decellularization plus photo-oxidation showed lower immunogenicity and better biological stability and better anti-calcification property compared with the other groups.@*CONCLUSION@#Decellularization associated with photo-oxidation is a suitable and novel protocol for small caliber artery allograft with a diameter of less than 6 mm which is unbreakable to mechanical properties and conducive to biological stability, which has a broad prospect.

Video-assisted thoracoscopic sympathictomy plus bypass fiber resection for patients with primary palmar hyperhidrosis / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficiency of video-assisted thoracoscopic surgery for primary palm hyperhidrosis by T4 sympathicotomy plus bypass fiber resection, and to describe our experience regarding the prevention of related postoperative complications.@*METHODS@#Clinical data for 32 cases of primary palmar hyperhidrosis in patients who underwent bilateral video-assisted thoracoscopic sympathictomy plus bypass fiber resection from October 2008 to June 2011 were analyzed retrospectively.@*RESULTS@#The operation was performed successfully on all patients, and their palmar hyperhidrosis was completely alleviated after operation. No severe, surgery-related, postoperative complications occurred.@*CONCLUSION@#Video-assisted thoracoscopic sympathictomy is an effective, safe and minimally invasive procedure for primary palmar hyperhidrosis.

Application of laminated anastomosis with absorbable suture in cervical esophagogastrostomy / 中南大学学报(医学版)

OBJECTIVE@#To observe the clinical results of laminated anastomosis using absorbable suture in cervical esophagogastrostomy, and to reduce the incidence of cervical esophagogastric anastomotic stricture.@*METHODS@#A retrospective analysis was carried out on 210 patients who underwent cervical esophagogastrostomy after subtotal esophagectomy from January 2008 to June 2010. Among them, 96 cases were treated with traditional full layer interrupted varus suture (varus group) and the remaining 114 cases were treated with seromuscular layer and mucosal layer laminated anastomosis with absorbable suture (laminated group). Esophageal angiography was performed in 1 week, 1 month, and 3 months after the operation. The diameter of anastomatic stoma was measured on the anteroposterior and lateral angiography image respectively. The area of anastomatic stoma was calculated. The degree of stenosis was assessed according to the patients' dysphagia symptom.@*RESULTS@#There was no operative deaths, no serious pulmonary complications and chylothorax, no sever esophageal reflux in all patients. The ratio of cervical esophagogastric anastomotic leakage was 2.1% (2/96) in the varus group. No anastomotic leakage in the laminated group. Compared with the varus group, the area of the anastomatic stoma in the laminated group was significantly increased in all measured time points (P<0.01). The incidence of obstruction in the laminated group was decreased significantly (P<0.01) in 1 month or in 3 months after operation compared with the varus group.@*CONCLUSION@#Application of the laminated anastomosis with absorbable suture in cervical esophagogastrostomy can significantly reduce the incidence of anastomotic stenosis.

Evaluation of resection of local advanced upper lung cancer through median sternotomy / 中南大学学报(医学版)

OBJECTIVE@#To summarize the resection of local advanced upper lung cancer and radical bilateral mediastinal lymph node dissection through a median sternotomy.@*METHODS@#A total of 31 patients with local advanced upper lung cancer underwent lobectomy and radical complete dissection of bilateral superior mediastinal lymph node through a median sternotomy (the sternotomy group). The sternotomy group consisted of 8 females and 23 males, from 35 to 75 years old (average 57 years). Five patients underwent superior vena caval replacement or partial excision, 21 underwent upper sleeve lobectomy, and 6 patients combined with right pulmonary artery sleeve angioplasty or partial resection and reconstruction. Compared with the 30 patients who were operated through posterolateral incision, the surgery time, complications, and prognosis during the same period (the posterolateral incision group) were recorded.@*RESULTS@#There was no perioperative death. The average operation time in the sternotomy group was (170±30)min, while that in the posterolateral incision group was (140±30) min(P>0.05). Postoperative complications comprised atelectasis, cardiac arrhythmia, and pneumonia. In the sternotomy group it was 6.5%(2/31), 16.1%(5/31), and 6.5% (2/31),and that in the posterolateral incision group 3.3%(1/30), 20%(6/30), 10.0%(3/30),respectively. Postoperative pathological findings demonstrated the rate for pN3 disease in the sternotomy group was 29%(9/31), 2 patients died of brain and liver metastasis respectively 10 or 11 months after the operation. The 3 year survival rate of 9 patients with pN3 diagnosed as cN2 preoperatively was 33.3%(3/9). The total survival rate of 1,3 years in the sternotomy group was 90.3%(28/31) and 41.9%(13/31), in the posterolateral incision group 86.6%(26/30) and 40.0%(12/30),respectively(P>0.05).@*CONCLUSION@#Median sternotomy helps to resect local advanced upper lung cancer completely and to dissect bilateral mediastinal lymph node, and it can also provide more complete postoperative lymph node staging with no significant increase in complications.

Reoperative valve surgery after open-heart valve surgery: a report of 155 cases / 中南大学学报(医学版)

OBJECTIVE@#To summarize the characteristics of reoperative valve surgery after previous open-heart valve surgery.@*METHODS@#From 1996 to 2010, 155 patients who underwent reoperative valve surgery, either valve replacement or tricuspid annuloplasty or the repair of perivalvular leakage were included in the study. The reoperative interval was 1-266 (94.82 ± 85.37) months. All surgeries were carried out with extracorporeal circulation under moderated hypothermia. The cardioplegic solution in cold crystal or blood was used if heart beating was stopped during the surgery.@*RESULTS@#The total in-hospital mortality was 5.81%, while it was 2.75% from 2005 to 2010. The end-diastolic dimension, size of atrium and ventricles were reduced after the reoperation. Ventricular arrhythmia and low cardiac output were the most frequent complications.@*CONCLUSION@#The success rate of reoperative valve surgery can be improved by the distinctive therapeutic strategies based on the clinical characteristics and therapy principles obtained from practice experiences.

Prognostic factors for thymic epithelial tumor: a retrospective study of 137 cases / 中南大学学报(医学版)

OBJECTIVE@#To analyze the clinic and pathologic data of thymic epithelial tumor (TET) and to explore its prognostic factors.@*METHODS@#From June 1997 to September 2007, 137 patients with TET were surgically treated in our hospital. The data included age, gender, symptoms, histological type, stage and grade, pathological findings, and operation reports. The patients were followed up by telephones and mails. The patients were divided into Masaoka I/II group and III/IV group, and WHO A/AB/B1 group and B2/B3/C group. Kaplan-Meier method, log-rank test, and COX regression model were used to analyze the prognostic factors for TET.@*RESULTS@#Among the 137 patients, 124 (90.5%) received complete resection, 9 (6.6%) incomplete resection, and 4 (2.9%) surgical biopsy. The rate of complete resection was significantly higher in Masaoka stages I/II than that in stages III/IV (P<0.001). The overall 5-year and 10-year survival rate was 71.4å and 50.1å, respectively. Patients in stage I/II had better long-term survival than those in stage III/IV (P<0.001). According to WHO histological classification, the 5-year and 10-year survival rate in patients with Type A/AB/B1 TET was significantly higher than that in patients with Type B2/B3/C TET (P<0.001). The 5-year and 10-year survival rate in patients with complete resection was significantly higher than that in patients with incomplete resection and biopsy (P<0.001).Cox regression analysis showed that the prognosis of patients with TET was related to Masaoka stage, WHO histological classification, extent of resection, and age at operation.@*CONCLUSION@#Masaoka stage, WHO histological classification, extent of resection, and age at operation are important prognostic factors in patients with TET.

Expression of connective tissue growth factor in acute heart allograft rejection in rats / 中南大学学报(医学版)

Objective To detect the expression of connective tissue growth factor (CTGF) in acute heart allograft rejection in rats and to investigate the relationship between CTGF expression and cardiac allograft fibrosis. Methods Sixteen Wister rats served as donors and another 16 Sprague-Dawely (SD) rats served as recipients. Intra-abdominal heterotopic heart transplantation was performed. All rats received 10 mg/(kg·d) cyclosporine,40 mg/(kg·d)CellCept, and 3 mg/(kg·d)methylprednisolone immunosuppression after the surgery. Ten allografts were harvested 2 weeks postoperation while 10 normal Wister rats served as controls. The paraffin sections of harvested heart specimens were stained with hematoxylin and eosin (HE),and van Gieson(VG) for the examination of morphological changes to observe the lumen loss of myocardial coronary arteries and myocardial fibrosis. The expression of CTGF was studied by immunnohistochemical method and was measured semi quantitatively. The correlation between the CTGF expression and allograft fibrosis was studied. Results The allografts showed a typical symbol of acute rejection with excessive granulocyte infiltration around the vessel wall and myocardial interstice. There were also intimal proliferation and obvious fibrosis in the acute group and the differences between the acute and control group were significant (P<0.05). The expression of CTGF protein was mainly located around the vascular and myocardial lesions in the acute group while the control group showed no CTGF expression. The gray scale value of CTGF was (AR vs NH: 103.52±6.42 vs. 182.61±8.72,P<0.05). Strong negative correlations were found between the gray scale value and fibrosis formation(r=-0.734,P<0.01). Conclusion CTGF was overexpressed in acute allograft rejection rat hearts and might be involved in the pathogenesis of transplanted heart fibrosis.

Role and significance of connective tissue growth factor expression in a rat model of chronic heart allograft rejection / 中国组织工程研究

BACKGROUND: Chronic rejection limits the long-term success of cardiac transplantation and the underlying causes of the disease are unknown. Connective tissue growth factor (CTGF) is considered as a mitogenic and chemotactic factor for fibroblasts and is associated with cell proliferation and collagen synthesis.OBJECTIVE: To evaluate the role and significance of expression of CTGF in rat chronic rejection heart aliografta.DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the Laboratory Animal Center of the Second Xiangya Hospital between April and August 2007.MATERIALS: Twenty Wistar rats serving as donors and twenty Sprague-Dawely (SD) rats serving as recipients were included. An additional 10 Wistar rats were included as controls.METHODS: After intra-abdominal heterotopic heart transplantations, rats received cyclosporine A, mycophenolate, and methylprednisolone immunosuppression. Ten recipient rats were anesthetized and sacrificed for heart harvesting at 2 and 8 weeks postoperation, respectively.MAIN OUTCOME MEASURES: Coronary vessel density, fibrosis grade, and intimal occlusion were observed by hematoxylin-cosin staining and Van Gieson staining. Myocardial fibrosis was semi-quantitatively scored. CTGF expression was detected by immunohistochemistry. The associations between CTGF expression and allograft fibrosis and CAV formation were analyzed.RESULTS: Allografts harvested at 8-week post-surgery showed more obvious coronary intimal proliferation, fibrosis and higher CTGF expression compared with the 2-week allografts and the controls (P < 0.05-0.01 ) while the cardiac artery density was lower than the control group (P < 0.05). However, the control group in our study showed negligible CTGF expression. There were strong negative correlations between the gray value of CTGF protein expression and cardiac fibrosis and coronary intimal occlusion (r = -0.734, -0.713, P < 0.01), demonstrating that CTGF protein expression was positively correlated with cardiac fibrosis and coronary intimal occlusion.CONCLUSION: CTGF is expressed in cardiac myocyte with CAV. The increased expression of CTGF in the cardiac allograft is associated with CAV development and fibrosis formation and is involved in the pathogenesis of cbronic heart rejection

Sternal elevation and costal cartilageplasty in children with pectus excavatum / 中华胸心血管外科杂志

Objective To review the experience of costal cartilageplasty and sternal elevation on pectus excavatum (PE) children. Methods A transverse anterior wedge osteotomy of the sternum is made at the level of maximal depression. The posterior table of the sternum is gently fractured without displacement and then elevated to the desired position. Tight sutures are placed through the anterior table across the osteotomy with stainless-steel wire. The deformed costal cartilages are partially resected subperichondrially and plasty is performed. Between Jan 1994 and Oct 2003, 57 patients who underwent costal cartilageplasty and sternum elevation operation were followed-up. Results With the exception of one patient, all children had normal thoracic contour. The preoperative symptoms improved markedly. Conclusion The costal cartilageplasty and sternum elevation may yield satisfactory results.

Surgical Treatment of Univentricule / 中国医师杂志

Objectives To review the experience of surgical treatment of univentricule.Methods 26 patients with univentricule underwent surgical treatment were retrospectively analyzed. There were 17 cases of total cavopulmonary connection, 8 cases of bi-directional Glenn shunt and one case of pulmonary artery banding.Results Followed-up for 6～30 monthes(mean 11 months) showed 4 early postoperative death,there was mortality of 15 4%,no advanced death.Conclusions The result of this study suggests that surgical outcome is related to the selection of proper surgical indicators,perioperative management and complete correction of cardiac deformity.

Evaluation of Early Phase Change of Right Ventricular Hemodynamic after Lung Resection by Doppler Echocardiography / 中国医师杂志

Objectives To determine the changes of right ventricular hemodynamic in the early phase after lung resection and non-lung resection thoracotomy by Doppler echocardiography and to investigate the correlation with preoperative lung function.Methods 55 patients who underwent thoracotomy were divided into two groups. In group A: 15 patients underwent non-lung resection thoracotomy; in group B: 40 patients underwent lung resection. The group B were subdivided into group B1 (n=23) and group B2 (n=17), acording to the preoperative lung function results: Artery blood gas analysis were measured and right ventricular hemodynamic indices were calculated by Doppler echocardiography before and after operation,respectively.Results Right ventricular ejection fraction (RVEF) and artery oxygen pressure(PaO 2) significantly decreased (P

Effect of Pulmonary Artery Perfusion with Modified LPD Solution on Cardiopulmonary Bypass-induced Systemic Inflammatory Response / 中国医师杂志

Objective To study the effect of pulmonary artery perfusion with the modified low-potassium dextran(LPD) solution on cardiopulmonary bypass(CPB)-induced systemic inflammatory response. Methods 30 patients undergoing mitral valve replacement were randomly divided into control group (n=15) and lung perfusion group (n=15). The patients in the lung perfusion group were perfused with the modified LPD solution by pulmonary artery during CPB. The patients in the control group underwent the routine procedure of mitral valve replacement. The plasma concentrations of TNF-? and IL-8 were measured before and 0 h, 6 h after surgery by ABC-ELISA. Results The plasma levels of TNF-? and IL-8 significantly increased after surgery in both groups. The plasma levels of TNF-? and IL-8 were significantly lower(P

Augmentation of Neovascularization by Implantation of Autologous Bone Marrow Mononuclear Cells in a Rat Ischemic Limb Model / 中国医师杂志

Objective To investigate the effect of autologous bone marrow mononuclear cells (BM-MNCs) implantation on neovascularization in rat model of hind limb ischemia, and explore its mechanism. Methods Rat BM-MNCs were isolated from tibia and femur using density gradient centrifugation. A rat model of ischemic hind limb was made by the ligation of the right femoral artery and its branches in imbred Wistar rats. BM-MNCs were injected into 7 points of the ischemic muscles (20?l/point). The levels of VEGF, bFGF and IL-1? in the ischemic musles at the third, 7th and 14th days after ligation were measured by ELISA. Micro-vessel density (MVD) in the ischemic mulsles was evaluated at the second and 4th weeks after ligation. Results The levels of bFGF and IL-1? in the implantation group were significantly higher than those in the control group. The MVD of ischemic mulsles in the implantation group was also significantly higher than that in the control group at the second and 4th weeks after treatment. Conclusion The implantation of autologous BM-MNCs could induce neovascularization in a rat ischemic hind limb, and bFGF and IL-1? secreted by BM-MNCs might play a role in the neovascularization.

All-trans-retinoic Acid Decreases Smooth Muscle Cell Proliferation and Increases Apoptosis in an Animal Model of Vein Bypass Grafting / 中国医师杂志

Objective To examine the effect of all-trans-retinoic acid (atRA) on proliferation and apoptosis rates of smooth muscle cells in healing vein bypass grafts.Methods Autogenous vein graft model was established in 40 rats by transplanting the internal branch of the jugular vein to the carotid by end-to-end anastomosis.Animals were divided at random into two groups:atRA group and control group.The animals received atRA(10mg?kg -1 ?d -1 ) or same dosage vehicle(corn oil) from 4 days preoperation to 10 days postoperation.Animals were sacrificed and the grafted veins were harvested at 7,14 days,respectively after the operation .The grafted veins were then processed for staining and measurements.Hyperplasia,smooth muscle cell proliferation were detected by pathological and immunohistochemical methods.All the data were analyzed by a computerized system.The presence of apoptotic smooth muscle cells was demonstrated by terminal deoxynucleotidyl transferase biotin nick end-labeling (TUNEL) method.Results There was a significant decrease in the average intimal thickness at 7,14 days in the atRA group.Immunohistochemical analysis of proliferating cell nuclear antigen (PCNA) indicated decreased positive cells in the atRA group, compared with the control group at 1 or 2 weeks after the operation. Apoptosis of smooth muscle cells was higher in the atRA group than in the control group at 1 week or 14d postoperation.Conclusions These preliminary results demonstrated that atRA (10mg/kg/d) inhibits smooth muscle cell proliferation and induces smooth muscle cell apoptosis in rats.