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This study investigated the correlation between periprostatic fat thickness (PPFT) measured on magnetic resonance imaging and lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia (BPH) progression. A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included. Patients were divided into two groups according to the median value of PPFT: high (PPFT >4.35 mm) PPFT group and low (PPFT <4.35 mm) PPFT group. After the initial evaluation, all patients received a combination drug treatment of tamsulosin and finasteride for 12 months. Of the 286 enrolled patients, 244 completed the drug treatment course. Patients with high PPFT had larger prostate volume (PV; P = 0.013), higher International Prostate Symptom Score (IPSS; P = 0.008), and lower five-item version of the International Index of Erectile Function (IIEF-5) score (P = 0.002) than those with low PPFT. Both high and low PPFT groups showed significant improvements in PV, maximum flow rate, IPSS, and quality of life score and a decrease of IIEF-5 score after the combination drug treatment. The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group. In addition, more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group. Moreover, Pearson's correlation coefficient analysis indicated that PPFT was positively correlated with age, PV, and IPSS and negatively correlated with IIEF-5 score; however, body mass index was only negatively correlated with IIEF-5 score.
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Objective To evaluate the feasibility and safety on closing ventricular septal defects (VSDs) under cardiopulmonary bypass(CPB) in neonatal patients with VSD and congestive heart failure.Methods From Oct.2010 to Sep.2012,16 newborn infants with VSD and congestive heart failure in Neonatal Intensive Care Unit(NICU),the Bayi Children's Hospital Affiliated to Beijing Military General Hospital,were selected as the observed group,VSD repair operation was done under CPB.As the control group,18 patients in Pediatrical Cardiac Surgical Department were randomly selected in the same period in hospital,and selective VSD repair operations were done under CPB.Between the 2 groups,demographics(body weight,gender,VSD diameter),clinical characteristics (CPB time,aortic crossclamp time) and early outcomes were compared.Results For the diameter of VSD and gender,there were no significant difference between the 2 groups (P ＞ 0.05).For the body weight,the patients in control group [(8.27 ± 3.39) kg] were more heavier than those in observed group [(3.69 ± 0.72) kg] (P ＜ 0.01).In the operation period,there were no significant differences in CPB time and aortic crossclamp time between 2 groups(all P ＞ 0.05).The lactate value of the patients in observed group [(2.76 ± 1.12) mmol/L] was significantly higher than that in control group [(1.65 ±0.34) mmol/L] (P ＜ 0.01).At the same time,the ventilation time [(3.69 ± 1.66) days] and PICU stay [(9.75 ± 3.44) days] were significantly longer than those in control group[(2.00 ±0.89) days and (6.17 ± 1.98) days] (all P ＜ 0.01).All the patients in the 2 groups discharge out of the hospital,there was no significant difference in outcome.Conclusions The newborns with VSD and congestive heart failure in NICU,can be not improved after the medical management,then closing the VSD is feasible and safe under CPB.
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Objective To investigate the outcomes of hybrid treatment of pulmonary valve's balloon valvuloplasty via right ventricle without cardiopulmonary bypass for pulmonary atresia with intact ventricular septum(PA/IVS) and critical pulmonary stenosis(PS) in neonates.Methods The clinical features and data of 3 children(1 case of PA/ IVS and 2 cases of critical PS),who underwent hybrid treatment of balloon valvuloplasty,were recorded and retrospectively analyzed.All patients' right ventricle grow well,tricuspid valve Z score ＞-2,and underwent pulmonary valve balloon valvuloplasty via fight ventricle without cardiopulmonary bypass.Results All the 3 children underwent pulmonary valve balloon valvuloplasty via fight ventricle without cardiopulmonary bypass,and there was no death.The mean arterial blood oxygen saturation after operation went up,and there was no complication related to balloon valvuloplasty.The children were followed up for 3 to 6 months,and all the patients had mild pulmonary stenosis,but they did not need any treatment.Conclusions Pulmonary valvuloplasty with hybrid technique is effective in treatment of selective PA/IVS children(fused leaflets of pulmonary valve) and critical PS in neonates.Hybrid therapy may provide adequate pulmonary blood flow and promote further growth of tricuspid valve and right ventricular cavity with less trauma and more safety.
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Objective To summarize the clinical experience of comprehensive management of critical newborns with transposition of great arteries (TGA) by neonatologists and cardiac surgeons.Methods Seventeen critical newborns with TGA rescued by combined efforts of neonatologists and pediatric cardiac surgeons from Oct.2010 to Oct.2012were retrospectively analyzed.Results Of the 17 newborns(14 cases were male,3 cases were female),9 cases were TGA with ventricular septal defect(TGA/VSD),8 cases TGA with intact ventricular septal defect (TGA/IVS).The babies aged from 1-45 days,weighed from 2.7-4.6 kg at operation.Of the 9 cases TGA/VSD babies,3 cases were treated with prostaglandins E (PGE) for hypoxemia correction and selective operation opportunity ;2 cases underwent emergency arterial switch operation (ASO) for severe cardiac shock.All of the 8 cases TGA/IVS babies received PGE treatment preoperatively for life threatening hypoxemia,and 4 cases of them underwent emergency ASO.There were 12 cases delayed sternal closure and 5 cases of them were emergency babies.Peritoneal dialysis was employed for 6 cases and extracorporeal membrane oxygenation (ECMO) for l case.There were 6 cases with postoperative incision infection,including 5 emergencies.Thirteen newborns survived and 4 cases died at hospital:one case complicated with postoperative septicemia and severe mediastinitis which leaded to pericardium patch rupture and fatal pulmonary arterial hemorrhage;one case with abnormal inferior vena cava connection and severe low cardiac output syndrome;one case with disseminated intravascular coagulation (DIC) due to septicemia and severe mediastinitis postoperatively,one case with abnormal coronary artery during surgery and difficult coronary artery transplantation and insufficient blood supply after aorta was open.Conclusions Correcting hypoxemia and stabilizing the severe babies are critical in NICU to avoid emergency surgery.Emergent ASO is the optimized medical therapy for those with persistent severe hypoxemia and heart failure.
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<p><b>OBJECTIVE</b>Acute lung injury is a severe complication after cardiac surgery performed with cardiopulmonary bypass in infant patients. Pulmonary surfactant has been successfully used in treating neonatal respiratory distress syndrome for many years. This study focused on exploring the clinical efficacy of exogenous pulmonary surfactant in treating infant patients with acute lung injury after cardiac surgery with the use of extracorporeal circulation.</p><p><b>METHOD</b>Twenty-three infants with ventricular septal defect (VSD) were enrolled in the study. None of the patients needed oxygen treatment nor ventilation before heart surgery. VSD repair operation was done under cardiopulmonary bypass, and acute lung injury was found postoperatively. Ten infant patients in the treatment group were given pulmonary surfactant by tracheal instillation during mechanical ventilating postoperatively. Thirteen patients in control group were randomly selected in the same period in hospital, and acute lung injury was diagnosed without pulmonary surfactant treatment after cardiopulmonary bypass. Blood samples were obtained from all the patients, and blood gas analysis was performed every 6 hours. Demographics (body weigh, age, gender, VSD diameter) and clinical characteristics (CPB time, oxygenation index, mean airway pressure, pH and PCO2) of all the patients were collected, and statistical analysis was done to compare the data between treatment and control group.</p><p><b>RESULT</b>In the first 24 hours after heart surgery, compared with the control group, a more increased oxygenation index (from 89.36 ± 12.69 to 285 ± 16.51) was observed in treatment group, and it was from 93.71 ± 11.82 to 133 ± 19.62 in the control group. There was a significant difference in oxygenation index between the two groups (P < 0.05). At the same time, the MAP (from 17.5 ± 3.18 to 10.4 ± 3.37) of the patients in comparison with the control group (from 18.2 ± 2.63 to 13.8 ± 2.55), a more significantly decreased MAP was observed in the treatment group (P < 0.05). There was no significant difference in pH and PCO2 between the two groups. The ventilation time in cardiac care unit was shorter in treatment group (17.43 ± 9.12) h compared with the control group [(30.97 ± 14.85) h, P < 0.05]. ICU stay time of treatment group (3.90 ± 1.34) d was shorter than that of control group [(6.18 ± 1.90) d, P < 0.05].Two infants of the control group died, but none in treatment group died.</p><p><b>CONCLUSION</b>In this study, a satisfactory curative effect was observed for the treatment of acute lung injury with PS intratracheal instillation after heart surgery under cardiopulmonary bypass in infant patients. It can reduce the duration of mechanical ventilation and cardiac care unit stay and improve prognosis. In addition, this study was a pilot study and the limited sample size was probably the cause of insufficient statistical power. Further study of larger scale is needed.</p>