Clinical literature review of 1858 Crohn's disease cases requiring surgery in China.

AIM: To summarize the clinical characteristics of Crohn's disease (CD) patients who underwent surgery in China. METHODS: We searched four main Chinese electronic databases: CBM, VIP, CNKI, and Wanfang (from January 1990 to October 2013). Then, we selected and carefully read 97 studies and extracted the surgical data for CD. We found that 1858 patients with CD underwent surgery between 1961 and 2012. The patients were stratified into two groups according to the year of surgery: 1961-2000 and 2000-2012. The clinical characteristics of these CD cases were compared between the two groups. RESULTS: The mean age at the time of surgery was 38.13 years. The most common locations of disease were the small intestine (40.84%), the colon (33.60%) and the ileocolon (23.09%). The primary indications for surgery were intestinal obstruction or stricture (23.84%), failure of drug therapy (14.80%), acute abdominal disease (13.46%), abdominal mass (10.93%), intestinal fistulae (9.90%), intestinal perforation (8.45%), perianal disease (6.73%), gastrointestinal bleeding (4.79%), and abdominal abscess (4.04%). The rate of diagnosis of CD before surgery was low (34.78%), and the misdiagnosis rate was 20.49%. The predominant surgical procedure for CD was bowel resection (69.54%). The rate of surgical complications was 20.34%, and the primary complications of surgery were infection (39.44%) and intestinal fistulae (26.09%). The relapse rate after surgery was 27.71%. For the periods of 1961-2000 and 2000-2013, the rates of both misdiagnosis before surgery and surgery related-death decreased (34.90% vs 12.10%, P < 0.001, and 23.53% vs 5.26%, P < 0.001, respectively). CONCLUSION: The rates of surgical complications and misdiagnosis were higher, whereas the rate of CD-associated tumor and the relapse rate were lower in China than in West countries.

Assessment of regional right ventricular longitudinal functions in fetus using velocity vector imaging technology.

OBJECTIVES: The velocity vector imaging (VVI) technique is useful to assess regional myocardial mechanics. The aim of this study was to evaluate the usefulness of this technology in assessing regional right ventricular longitudinal functions in the fetus and to establish a nomogram of the right ventricle (RV). METHODS: We studied 170 healthy fetuses that were divided into five groups based on gestational age. Dynamic digital images of four chambers were collected and analyzed off-line. The longitudinal VVI parameters were calculated in the right free wall and ventricular septum, respectively. RESULTS: A total of 151 out of 170 fetuses (89%) were successfully analyzed using VVI, with good inter- and intra-observer agreements. Normal values for velocity, strain, and strain rate were established. The tissue velocity gradually decreased from basal to apical segment (P < 0.05), whereas strain and strain rate remained stable. The tissue velocity increased with gestational age (P < 0.05), whereas strain and strain rate were stable (P > 0.05). CONCLUSION: Fetal myocardial velocity, strain, and strain rate measurements are easy to obtain and are reproducible. From mid-to-late gestation, the longitudinal tissue velocity of the RV increases with gestational age, whereas strain and strain rate remain stable. These results indicate that myocardial contractility is established in mid-gestation and remains constant throughout gestation.

Four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation in the assessment of congenital heart defects.

OBJECTIVE: The objective of the present study was to evaluate the role of four-dimensional ultrasound with B-flow imaging and spatiotemporal image correlation (STIC) in the detection of congenital heart defects. METHODS: Automated longitudinal and transverse sweeping of the fetal chest was utilized to obtain the volume datasets of the heart. Among the fetuses recruited in the study, 20 were normal and 13 were fetuses with congenital heart anomalies. Reconstructed images of abnormal hearts were compared with those of normal fetuses. RESULTS: Of the 20 normal fetuses, all extracardiac vessels such as aorta, pulmonary artery, ductus artery, inferior vena cava, and ductus venosus could be detected on reconstructed images of 16 fetuses. In five normal cases, a four-dimensional image was recorded to allow simultaneous visualization of all four pulmonary veins. In the 13 fetuses with cardiac anomalies, four-dimensional sonography with B-flow imaging and STIC detected the 'digital casts' of the outflow tracts, great arteries, and veins draining into the heart. These results demonstrate spatial relationship among these structures which provide important anatomical information. CONCLUSIONS: The use of four-dimensional ultrasound examination with B-flow imaging and STIC is a very useful technique in identifying anatomical features of different congenital cardiac anomalies.

Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging.

OBJECTIVE: The purpose of this study was to investigate the clinical value of velocity vector imaging (VVI) in the assessment of normal fetal regional myocardial performance and to establish a normative data set for normal Chinese fetuses. METHODS: One hundred and fifty-one healthy Chinese fetuses were divided into five groups according to their gestational age. Digital dynamic four-chamber views were collected and analyzed offline. The regional tissue velocity, strain, and strain rate of the interventricular septum and left lateral wall were measured in systole and diastole. RESULTS: Normal systolic and diastolic values for tissue velocity, strain, and strain rate were established. Tissue velocity decreased gradually from the basal segment to the apical segment (P < 0.01), whereas the strain and strain rate were stable among all segments in every group (P > 0.05). Tissue velocity was dependent on gestational age (P < 0.05), whereas strain and strain rate were stable throughout gestation (P > 0.05). CONCLUSION: VVI is a novel noninvasive tool for quantitative assessment of regional systolic and diastolic function of the fetal heart. Fetal myocardial velocity, strain, and strain rate measurements can be measured easily and reproducibly. This technique is useful for evaluating cardiac function.

Assessment of regional myocardial function in patients with dilated cardiomyopathy by velocity vector imaging.

OBJECTIVE: To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients with dilated cardiomyopathy (DCM) by syngo Velocity Vector Imaging (VVI). METHODS: Digital dynamic images of 30 DCM patients and 30 healthy subjects were collected; then the longitudinal velocity, strain, and strain rate were measured in systolic early and late diastolic periods, and the time to peak systolic velocity, strain, and strain rate were measured and recorded. The parameters of the two groups were compared. RESULTS: All of the parameters of the DCM were significantly lower than those of the normal group (P < 0.05-0.01), except that the parameter of late diastolic strain was not different between the two groups (P > 0.05). CONCLUSIONS: VVI is a novel noninvasive tool to assess quantitatively and objectively LV regional systolic and diastolic function in patients with DCM; it provides another useful modality for evaluating cardiac function.

[Comparison of five different ultrasonographic parameters for diagnosis of lethal fetal pulmonary hypoplasia].

OBJECTIVE: To evaluate the clinic value of five different ultrasonographic fetal parameters for prenatal diagnosis of pulmonary hypoplasia. METHODS: Two hundred and seventy-one normal singleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish normal reference range of five different ultrasonographic fetal parameters. The five parameters, which could reflect fetal lung mass, were as follows: lung area/body weight ratio, lung area, thoracic circumference/ abdominal circumference ratio, lung area/thoracic area ratio and lung area/head circumference. Thirty pregnancies with risk factors for pulmonary hyperplasia were studied for the usefulness of five parameters. Two or more standard deviations below the mean control group measurement were considered abnormal. The prenatal ultrasonic diagnoses of pulmonary hyperplasia were confirmed at neonatal follow-up examinations, on autopsy and by pathologic findings. RESULTS: Lung area and lung area/head circumference increased with gestational age, lung area /body weight ratio decreased with gestational age. The relationships among the two ratios (thoracic circumference/abdominal circumference ratio, lung area/thoracic area ratio) and gestational age were relatively constant. Abnormal lung area/body weight ratio had a higher diagnostic accuracy than other parameters. Sensitivity of the parameters, including lung area, lung area/body weight ratio, thoracic circumference/abdominal circumference ratio, lung area/thoracic area ratio and lung area/head circumference were 83%, 97%, 50%, 70% and 87% , respectively. Sensitivity of the lung area/body weight ratio was 95% (20/21 fetuses); specificity, 9/9 fetuses; positive predictive value, 100% (20/20 fetuses); negative predictive value, 9/10; and accuracy 97% (29/30 fetuses). CONCLUSION: Lung area/ body weight ratio is a good predictor of pulmonary hypoplasia.

Utilising ductus venosus Doppler waveform and four-chamber view to screen for foetal cardiac malformation in early second trimester of pregnancy.

BACKGROUND: Foetal echocardiography has become a diagnostic method to detect foetal congenital heart disease with high probability. However, it is not only time consuming and but also difficult to visualize outflow tract of foetus early in the second trimester of pregnancy, even for an experienced obstetric ultrasonographer. Recently, many methods for screening foetal cardiac anomalies were explored, but much more work is needed to develop an effective and suitable screening method. The aim of this study was to investigate the clinical significance of utilising the ductus venosus (DV) Doppler examination and the four-chamber view of heart to screen for foetal cardiac malformation in early second trimester of pregnancy. METHODS: Heart and DV of 401 consecutive foetuses in early second trimester (12(+1) - 17(+6) weeks) in high risk pregnancies were examined with Acuson 128 xp/10 or Sequoia 512 ultrasound diagnostic systems. Absent or reversed flow during atrial contraction (A-wave) in the DV was defined as sufficiently abnormal to screen for foetal cardiac malformations. The foetal echocardiographic diagnosis was confirmed by postnatal echocardiography (or postmortem). The sensitivities of screening tests were compared among the three methods: DV Doppler examination, four-chamber view alone, and the combination of both techniques. RESULTS: Satisfactory examinations were obtained in 383/401 foetuses (95%). Thirty foetuses with cardiac abnormalities were confirmed by neonatal echocardiography (or postmortem). The sensitivity of DV Doppler examination or four-chamber view alone is 63% (19/30) and 60% (18/30), respectively. The sensitivity of combining information, DV Doppler flow waveform and four-chamber view, to screen for foetal cardiac malformation is 83% (25/30) and significantly better than that of either DV Doppler flow waveform or four chamber view alone (P < 0.05). CONCLUSION: Doppler flow waveform of DV can be used to screen for foetal cardiac malformation early in the second trimester. Combining information from Doppler flow waveform of DV and four-chamber view will improve the overall sensitivity of the screening.