Inflammatory myofibroblastic tumor of the heart in an older woman with paroxysmal atrial fibrillation: a case report and review of the literature.

Inflammatory myofibroblastic tumors (IMTs) of the heart are rarely observed in the eldly. We report a case involving an elderly woman with an IMT situated on the right atrial wall. The tumor was fully excised. The patient had a smooth recovery post-surgery and remained free of recurrence for three years.

How should preoperative examinations be chosen for infants with a ventricular septal defect: transthoracic echocardiography, cardiac CTA, or a combination of these two technologies?

OBJECTIVE: To evaluate the accuracy of transthoracic echocardiography (TTE) and cardiac computed tomography angiography (CTA) in detecting the size and location of ventricular septal defects (VSD) in infants. METHODS: Data from 258 infants diagnosed with VSD between January 2020 and December 2022 were retrospectively analyzed. All infants underwent both TTE and cardiac CTA. The accuracy of these imaging modalities was assessed by comparing their findings with intraoperative observations of VSD size and location. RESULTS: Intraoperatively, the average VSD size was 6.1 ± 2.5 mm. The defects were classified as committed VSD (Type 1) in 45 patients, noncommitted VSD (Type 2) in 198 patients, inlet VSD (Type 3) in 12 patients, and muscular VSD (Type 4) in 3 patients. Echocardiography estimated the average VSD size at 5.6 ± 2.7 mm, with 42 patients identified as Type 1, 203 as Type 2, 10 as Type 3, and 3 as Type 4. Cardiac CTA estimated the average size at 5.9 ± 3.2 mm, with 48 patients identified as Type 1, 196 as Type 2, 11 as Type 3, and 3 as Type 4. The accuracy rates of TTE and cardiac CTA in diagnosing VSD location were 98.1% and 98.8%, respectively. A survey of surgeons indicated that 80% believe both TTE and cardiac CTA are essential preoperative evaluations. CONCLUSIONS: TTE accurately diagnoses the size and location of VSD, while cardiac CTA serves as a valuable complementary method to TTE. Most surgeons advocate for the combined use of these examinations for preoperative assessment.

A computerized resolution visual acuity test in preschool and school age children.

AIM: To develop a novel approach called the Autoacuity Tester, and to evaluate its validity, especially the sensitivity and specificity for detecting amblyopia. METHODS: Children aged from 3 to 12y (n=552) were enrolled in the study. The validity of the Autoacuity Tester was evaluated by comparing it to the Tumbling E Early Treatment Diabetic Retinopathy Study (ETDRS) acuity chart for school age children, and Lea Symbols and Teller acuity card (TAC) for preschool children. The repeatability was assessed by coefficient of repeatability (COR). The sensitivity and specificity for detecting amblyopia were calculated. RESULTS: The mean difference (95% limits of agreement) between the Autoacuity Tester and the ETDRS tests were -0.03 (-0.24, 0.19) logMAR for the school age group. In preschool children, the mean difference was 0.04 (-0.14, 0.21) logMAR between the Autoacuity Tester and the TAC and 0.00 (-0.17, 0.18) logMAR between the Autoacuity Tester and the Lea Symbols. For the school age group, the COR was 0.20 logMAR for the Autoacuity Tester and 0.18 logMAR for the ETDRS. For the preschool group, the COR was 0.13 logMAR for the Autoacuity Tester and 0.21 logMAR for TAC. The Autoacuity Tester (88%) is more sensitive than TAC (72%) in detecting amblyopia (P=0.04), while had similar specificity (92% vs 90%, P=0.20). CONCLUSION: The Autoacuity Tester provides a reliable alternative for assessing visual acuity, and offers advantage of higher testability and repeatability for preschool children.

[Effects of assisted-electroacupuncture on recovery of fast tracking anesthesia in mPCNL].

OBJECTIVE: To compare the effects on anesthesia recovery between assisted-electroacupuncture fast tracking anesthesia and simple fast tracking anesthesia in patients with minim ally invasive percutaneous nephrolithotomy (mPCNL). METHODS: Eighty cases of mPCNL were selected and randomly divided into a treatment group and a control group. Fentanyl (1-2 microg/kg), sevoflurane (8%) and rocuronium (0.5 mg/kg) were applied to perform anesthesia induction in both groups, and endotracheal inhalation of sevoflurane and intravenous pump injection of remifentanil were adopted to main anesthesia status during the operation. 20 min before anesthesia induction, bilateral Neiguan (PC 6), Neimadian, Hegu (LI 4), Yangxi (LI 5), Zhongji (CV 3), Qichong (ST 30), Zuwuli (LR 10) were selected and punctured in the treatment group, and elecctroacupuncture was given after arrival of qi until 30 min after the wake-up from anesthesia and withdrawal of endotracheal tube. The dosage for anesthesia maintenance, recovery time of awareness, extubation time, incidences of nausea, vomiting and chill and irritation of urethral catheters were observed and recorded. RESULTS: (1) The dosages of remifentanil and sevoflurane in the treatment group during the operation were obviously less than those in the control group [remifentanil: (5. 27 +/-1.23) micro g/kg h vs (7.35+/-1.70) micro g/kg . h; sevoflurane: (1.12+/-0.43) vol% vs (2.35+/-0.87) vol% , both P<0. 001]. (2) The recovery time of awareness and extubation time in the treatment group were significantly earlier than those in the control group [recovery time of awareness: (5.65 +/- 2.34) min vs (8. 87 +/- 6. 84) min, P<0. 01; extubation time : (7. 23+/-4. 35) min vs (10. 62+/-8. 16) min, P<0. 05]. (3) The incidences of nausea, vomiting and chill in the treatment group were significantly less than those in the control group (all P<0. 05). (4) The irritation of urethral catheters on urethra in the treatment group was significantly less than that in the control group (P<0. 001). CONCLUSION: The assisted-electroacupuncture anesthesia could reduce the dosage of remifentanil and sevoflurane in mPCNL fast tracking anesthesia in urinary surgery, reduce the incidences of nausea, vomiting, chill and irritation of urethral catheters during recovery stage, and prompt recovery of mPCNL patients.

[Significance of preoperative screening of deep vein thrombosis on the prevention from pulmonary embolism].

OBJECTIVE: To Explore the significance of preoperative screening of deep vein thrombosis (DVT) on the prevention from pulmonary embolism (PE) with color Doppler flow imaging (CDFI) in patients of lower limb fractures. METHODS: A total of 2 000 patients with lower limb fractures were retrospectively analyzed from January to September in 2010. All the patients were scheduled to be operated. There were 1 140 males and 860 females, ranging in age from 18 to 94 years, with a mean of (54.78 +/- 21.45) years. Swollen limbs could be observed in all patients when admitted and traditional Chinese medicine therapies were given by both internal and external administrations. Selective internal or external fixations were scheduled 3 to 14 days after injured and the swell relieved. CDFI screenings for DVT were applied to all the patients one day before operations and clinical data, such as gender, age, fracture site and course of diseases, were analyzed. RESULTS: Of all the 2 000 patients, 128 patients had lower limbs DVTs (6.4%). Among all the DVT patients, 52 patients had DVT within vena iliacas or femoral veins,20 patients had DVT within popliteal veins or vena crualis, 56 patients had DVT within small muscular veins of legs. Thrombolytic therapies or inferior vena cava filters were taken to 72 patients with DVTs proximal to vena cruralises and thrombi disappeared in 20 cases. Inferior vena cava filters were placed in 17 patients. There were 28 patients with either failed thrombolytic or no filters placement. All above 65 patients were treated with fracture reduction, and other 7 patients were treated with conservative methods. Of all the operated patients, one patient had PE during operation and recovered after immediately rescue. Among 56 patients with DVT within small muscular veins of legs, 51 patients were treated with reduction without other special treatment, and other 5 patients were treated with conservative methods. There was no relationship between DVT occurrence and gender. The youngest sufferer was 22 years old. DVT occurrences of patients over 41 years old were significantly higher than that of patients under 40 years old. Higher occurrences were also observed in patients with multiple fractures, fracture of femurs compared with those with tibia or fibula fractures. DVT was found as early as 3 days after injury in one case. The longer the time from injuries to operations, the higher the occurrences of DVTs. CONCLUSION: Routine CDFI screenings should be applied to traumatic fractured patients before operations no matter whether there are DVTs existing or not. That is very important for the prevention of fatal PE during both anesthesias and operations.