Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of ...Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection(ERTAAD)were the subjects of the present analysis.Results 326(8.4%)patients were aged≥80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0%in patients aged≥80 years and 20.0%in younger patients(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged<80 years,and 0.46 in patients aged≥80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age≥85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score≤1 was observed in 68.4%of patients,and their in-hospital mortality was 20.9%.Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged≥80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.展开更多
Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expecta...Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expectancy,as a key factor for selecting the most tailored treatment,has grown.The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement(AVR)vs.TAVI at our department.Methods From September 2017 to December 2020,673 consecutive patients with severe aortic valve stenosis were enrolled for AVR(n=283)or TAVI(n=390).Inclusion criteria was isolated severe aortic stenosis,while exclusion criteria were redo surgery,valve-in-valve procedure and the need for concomitant surgical procedures.Based on the Lee index,patients were divided into four groups according to their 4-year life expectancy.Four-year survival was assessed and reported using the Kaplan-Meier method.A multivariate regression analysis of risk factors for 4-year mortality was performed.Results Four years survival is always superior in the AVR patients(89.8%vs.75.6%,P<0.001).Surgery is associated with a higher incidence of acute kidney injury(23%vs.5.1%,P<0.001),while TAVI is related to a higher incidence of new onset left bundle branch block(0 vs.23.8%,P<0.001),pace-maker implantation(2.5%vs.11.8%,P=0,02)and mild-to-moderate paravalvular leak(0.3%vs.5.4%,P<0.001).The independent risk factors for 4-years mortality are post-procedural AKI,poor mobility and transcatheter procedure.Conclusion In our analysis,4 years survival is always superior in the AVR patients.Life expectancy is a key factor for selecting the most appropriate approach for each patient.A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.展开更多
Objective To investigate the relationship between hypothermia duration and postoperative complications in patients undergoing gynecological surgery.Methods Patients who underwent elective gynecological surgery at our ...Objective To investigate the relationship between hypothermia duration and postoperative complications in patients undergoing gynecological surgery.Methods Patients who underwent elective gynecological surgery at our hospital were consecutively enrolled between October 2020 and January 2022.Core temperature was continuously monitored intraoperatively,and early postoperative complications were collected.By adjusting the logistic regression model for potential confounding factors,the association of postoperative complications with the duration of hypothermia,the lowest body temperature below 36°C,and the hypothermia upon admission to postanesthesia care unit(PACU)or intensive care unit(ICU)were analyzed.Additionally,the potential inflection point in the relationship between the duration of hypothermia and the risk of postoperative complications was explored by using cumulative probability scatter plots and moving average sequences.Results The study included 370 patients,with 193(52.2%)experiencing hypothermia and 177(47.8%)not.Among them,92(24.9%)developed complications.The duration of hypothermia(adjusted odds ratio[OR]for each one-minute increase:1.003;95%confidence interval[CI]:1.000-1.006,P=0.047)and hypothermia upon admission to PACU or ICU(adjusted OR:1.980;95%CI:1.135-3.454,P=0.016)were associated with early postoperative complications.Notably,the cumulative incidence of postoperative complications tended to rise as the duration of hypothermia increased,with a potential inflection point observed at 120 minutes.Conclusions In gynecological surgery,the duration of hypothermia as well as hypothermia upon admission to PACU or ICU are associated with postoperative complications.Minimizing the duration of hypothermia may be clinically beneficial.展开更多
Background:Whether surgical axillary staging as part of breast-conserving therapy can be omitted without compromising survival has remained unclear.Methods:In this prospective,randomized,noninferiority trial,we invest...Background:Whether surgical axillary staging as part of breast-conserving therapy can be omitted without compromising survival has remained unclear.Methods:In this prospective,randomized,noninferiority trial,we investigated the omission of axillary surgery as compared with sentinel-lymph-node biopsy in patients with clinically node-negative invasive breast cancer staged as T1 or T2(tumor size,≤5 cm)who were scheduled to undergo breast-conserving surgery.展开更多
Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in s...Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion(for fusion surgery P = 0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P < 0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion(for fusion surgery P < 0.001, OR: 6.487, 95%CI: 2.349-17.915; for scoliosis surgery P < 0.001, OR: 3.636, 95%CI: 2.389-5.231).Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.展开更多
Objective To summarize the management of anastomotic leak following surgery for esophageal car-cinoma. Methods The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma...Objective To summarize the management of anastomotic leak following surgery for esophageal car-cinoma. Methods The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. Results A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0±31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. Conclusions Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method.The efficacy of stent implantation needs further investigation to confirm.展开更多
Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternativ...Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis;LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy(LESS-PN),so as to assess its utility, safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases.The mean operative duration was 226.3(210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min(19-48 min).One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days(12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.展开更多
BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to th...BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.展开更多
Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE...Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.展开更多
Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular ...Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery （HFS）. We used high sensitive troponin I （hs-TnI） assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events （MACE） in elderly hip frac^u＇e patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure （HF）, new-onset atrial fibrillation （AF）, myocardial infarction （MI） and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 （24.8%）. Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-Tnl and N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher revised cardiac risk index. A preoperative hs-TnI≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, pre-operative independent predictors for MACE were age 〉 80 years [adjusted hazard ratio （HR）： 1.79, 95% confident interval （CI）： 1.03-3.13, P = 0.04], left ventricular ejection fraction （LVEF） 〈 50% （adjusted HR： 3.17, 95% CI： 1.47-5.82, P 〈 0.01） and hs-TnI 〉 6.5 ng/L （adjusted HR： 3.75, 95% CI： 2.09~5.17, P 〈 0.01）. Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.展开更多
Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. The...Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.展开更多
Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV ha...Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.展开更多
Objective To understand the perception for the use of cataract surgical services in a population acceptors and non-acceptors of cataract surgery in urban Beijing. Methods From a community-based screening program a to...Objective To understand the perception for the use of cataract surgical services in a population acceptors and non-acceptors of cataract surgery in urban Beijing. Methods From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. Results At the follow-up examination 116 of the 158 patients were available and 36 （31.0%） had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery （OR=2.64, 95% CI： 1.08-6.63, P=0.02）. There were no significant differences in vision function （P=0.11） or quality of life scores （P=0.16） between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need （50.0%）, feeling of being ＂too old＂ （19.2%）, and worry about the quality of surgery （9.6%）. Cost was seeking surgery. cited by 1 （1.9%） subject as the main reason for not展开更多
Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies. Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our depart...Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies. Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (176%). Results. Complications occured in 34 cases, the overall complication rate was 192%. Unintended laparotomies occured in 6 cases(034%). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 353% of all complications of this series. Five intraoperative complications (147%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities. Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.展开更多
A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature,short and stubby hands and feet,language disorders and mental retardation.He developed bilateral angle closu...A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature,short and stubby hands and feet,language disorders and mental retardation.He developed bilateral angle closure glaucoma,ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome.The child was successfully treated by combined CO_(2) laser-assisted sclerectomy surgery and trabeculectomy.展开更多
BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).ME...BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.展开更多
BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pa...BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.展开更多
BACKGROUND N-terminal pro-B-type natriuretic peptide(NT-proBNP)is often viewed as an indicator for heart failure.However,the prognostic association and the predictive utility of NT-proBNP for postoperative major adver...BACKGROUND N-terminal pro-B-type natriuretic peptide(NT-proBNP)is often viewed as an indicator for heart failure.However,the prognostic association and the predictive utility of NT-proBNP for postoperative major adverse cardiovascular events(MACEs)and myocardial injury after noncardiac surgery(MINS)among older patients are unclear.METHODS In this study,we included 5033 patients aged 65 years or older who underwent noncardiac surgery with preoperative NT-proBNP recorded.Logistic regression was adopted to model the associations between preoperative NT-proBNP and the risk of MACEs and MINS.The receiver operating characteristic curve was used to determine the predictive value of NT-proBNP.RESULTS A total of 5033 patients were enrolled,63 patients(1.25%)and 525 patients(10.43%)had incident postoperative MACEs and MINS,respectively.Analysis of the receiver operating characteristic curve indicated that the cutoff values of ln(NT-proBNP)for MACEs and MINS were 5.16(174 pg/mL)and 5.30(200 pg/mL),respectively.Adding preoperative ln(NT-proBNP)to the Revised Cardiac Risk Index score and the Cardiac and Stroke Risk Model boosted the area under the receiver operating characteristic curves from 0.682 to 0.726 and 0.787 to 0.804,respectively.The inclusion of preoperative NT-proBNP in the prediction models significantly increased the reclassification and discrimination.CONCLUSIONS Increased preoperative NT-proBNP was associated with a higher risk of postoperative MACEs and MINS.The inclusion of NT-proBNP enhances the predictive ability of the preexisting models.展开更多
Objective To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Un...Objective To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Union Medical College Hospital from January 1998 to August 2006 and identified 24 patients who subsequently underwent noncardiac surgery.Results There were no intraoperative cardiac events.Postoperative cardiac events were identified in 3 patients including 1 death due to acute myocardial infarction and 2 episodes of transient hypotension.Conclusions The risk of anesthesia and noncardiac surgery is low in patients with hypertrophic cardiomyopathy.During the perioperative period,beta-blockers and/or calcium channel blockers should be given;vasodilator and inotropic agents should be avoided due to the side effects on hemodynamics.展开更多
Objective To investigate whether somatostatin analog octreotide long acting release (LAR) shrinks growth hormone (GH) secreting adenomas, and improves the results of subsequent transsphenoidal surgery. Methods Sevente...Objective To investigate whether somatostatin analog octreotide long acting release (LAR) shrinks growth hormone (GH) secreting adenomas, and improves the results of subsequent transsphenoidal surgery. Methods Seventeen previously untreated active acromegalic patients with pituitary adenomas were treated with LAR (30 mg intramuscular injection every 28 days) for 3 months prior to transsphenoidal surgery. Clinical reaction, mean GH secretion, and tumor volume were measured under basal conditions and after LAR treatment. Results Presurgical treatment improved acromegaly symptoms and induced a significant reduction of GH under the 5 ng/mL limit in microadenoma (P < 0.05), while only 18.2% (2/11) in macroadenoma. Meanwhile, tumor shrinkage occurred in 58.8% (10/17) patients, with 1 case in the microadenoma group. All marked shrinkage (> 25%) occurred in the macroadenoma group. Statistical analysis showed tumor shrinkage caused by LAR was greater in macroadenoma group than that in microadenoma group (P < 0.05). During operation, adenoma was soft in 15 cases, with the exception of 2 cases in which the soft tumor was divided by fibrous septa, but all tumor removal was smooth. Conclusions A short term administration of preoperative LAR may induce a significant decrease in GH-secretion level and adenoma volume. Presurgical use of octreotide LAR improves surgical results especially in macroadenomas.展开更多
基金supported by the Finnish Heart Associationby the Sigrid Jusélius Foundation.
文摘Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection(ERTAAD)were the subjects of the present analysis.Results 326(8.4%)patients were aged≥80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0%in patients aged≥80 years and 20.0%in younger patients(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged<80 years,and 0.46 in patients aged≥80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age≥85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score≤1 was observed in 68.4%of patients,and their in-hospital mortality was 20.9%.Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged≥80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.
文摘Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expectancy,as a key factor for selecting the most tailored treatment,has grown.The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement(AVR)vs.TAVI at our department.Methods From September 2017 to December 2020,673 consecutive patients with severe aortic valve stenosis were enrolled for AVR(n=283)or TAVI(n=390).Inclusion criteria was isolated severe aortic stenosis,while exclusion criteria were redo surgery,valve-in-valve procedure and the need for concomitant surgical procedures.Based on the Lee index,patients were divided into four groups according to their 4-year life expectancy.Four-year survival was assessed and reported using the Kaplan-Meier method.A multivariate regression analysis of risk factors for 4-year mortality was performed.Results Four years survival is always superior in the AVR patients(89.8%vs.75.6%,P<0.001).Surgery is associated with a higher incidence of acute kidney injury(23%vs.5.1%,P<0.001),while TAVI is related to a higher incidence of new onset left bundle branch block(0 vs.23.8%,P<0.001),pace-maker implantation(2.5%vs.11.8%,P=0,02)and mild-to-moderate paravalvular leak(0.3%vs.5.4%,P<0.001).The independent risk factors for 4-years mortality are post-procedural AKI,poor mobility and transcatheter procedure.Conclusion In our analysis,4 years survival is always superior in the AVR patients.Life expectancy is a key factor for selecting the most appropriate approach for each patient.A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.
基金Capital's Funds for Health Improvement and Research(2018-2-4013).
文摘Objective To investigate the relationship between hypothermia duration and postoperative complications in patients undergoing gynecological surgery.Methods Patients who underwent elective gynecological surgery at our hospital were consecutively enrolled between October 2020 and January 2022.Core temperature was continuously monitored intraoperatively,and early postoperative complications were collected.By adjusting the logistic regression model for potential confounding factors,the association of postoperative complications with the duration of hypothermia,the lowest body temperature below 36°C,and the hypothermia upon admission to postanesthesia care unit(PACU)or intensive care unit(ICU)were analyzed.Additionally,the potential inflection point in the relationship between the duration of hypothermia and the risk of postoperative complications was explored by using cumulative probability scatter plots and moving average sequences.Results The study included 370 patients,with 193(52.2%)experiencing hypothermia and 177(47.8%)not.Among them,92(24.9%)developed complications.The duration of hypothermia(adjusted odds ratio[OR]for each one-minute increase:1.003;95%confidence interval[CI]:1.000-1.006,P=0.047)and hypothermia upon admission to PACU or ICU(adjusted OR:1.980;95%CI:1.135-3.454,P=0.016)were associated with early postoperative complications.Notably,the cumulative incidence of postoperative complications tended to rise as the duration of hypothermia increased,with a potential inflection point observed at 120 minutes.Conclusions In gynecological surgery,the duration of hypothermia as well as hypothermia upon admission to PACU or ICU are associated with postoperative complications.Minimizing the duration of hypothermia may be clinically beneficial.
文摘Background:Whether surgical axillary staging as part of breast-conserving therapy can be omitted without compromising survival has remained unclear.Methods:In this prospective,randomized,noninferiority trial,we investigated the omission of axillary surgery as compared with sentinel-lymph-node biopsy in patients with clinically node-negative invasive breast cancer staged as T1 or T2(tumor size,≤5 cm)who were scheduled to undergo breast-conserving surgery.
文摘Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion(for fusion surgery P = 0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P < 0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion(for fusion surgery P < 0.001, OR: 6.487, 95%CI: 2.349-17.915; for scoliosis surgery P < 0.001, OR: 3.636, 95%CI: 2.389-5.231).Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.
文摘Objective To summarize the management of anastomotic leak following surgery for esophageal car-cinoma. Methods The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. Results A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0±31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. Conclusions Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method.The efficacy of stent implantation needs further investigation to confirm.
基金Supported by the Military Major Project for Clinical High-tech and Innovative Technology of China(2010gxjs057)the Municipal Hospitals' Project for Emerging and Frontier Technology of Shanghai(SHDC12010115)the Project for the Key Discipline of Shanghai
文摘Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis;LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy(LESS-PN),so as to assess its utility, safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases.The mean operative duration was 226.3(210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min(19-48 min).One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days(12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.
文摘BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.
文摘Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.
文摘Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery （HFS）. We used high sensitive troponin I （hs-TnI） assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events （MACE） in elderly hip frac^u＇e patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure （HF）, new-onset atrial fibrillation （AF）, myocardial infarction （MI） and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 （24.8%）. Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-Tnl and N-terminal pro-brain natriuretic peptide （NT-proBNP） and higher revised cardiac risk index. A preoperative hs-TnI≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, pre-operative independent predictors for MACE were age 〉 80 years [adjusted hazard ratio （HR）： 1.79, 95% confident interval （CI）： 1.03-3.13, P = 0.04], left ventricular ejection fraction （LVEF） 〈 50% （adjusted HR： 3.17, 95% CI： 1.47-5.82, P 〈 0.01） and hs-TnI 〉 6.5 ng/L （adjusted HR： 3.75, 95% CI： 2.09~5.17, P 〈 0.01）. Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.
文摘Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.
文摘Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.
文摘Objective To understand the perception for the use of cataract surgical services in a population acceptors and non-acceptors of cataract surgery in urban Beijing. Methods From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. Results At the follow-up examination 116 of the 158 patients were available and 36 （31.0%） had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery （OR=2.64, 95% CI： 1.08-6.63, P=0.02）. There were no significant differences in vision function （P=0.11） or quality of life scores （P=0.16） between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need （50.0%）, feeling of being ＂too old＂ （19.2%）, and worry about the quality of surgery （9.6%）. Cost was seeking surgery. cited by 1 （1.9%） subject as the main reason for not
文摘Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies. Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (176%). Results. Complications occured in 34 cases, the overall complication rate was 192%. Unintended laparotomies occured in 6 cases(034%). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 353% of all complications of this series. Five intraoperative complications (147%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities. Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.
文摘A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature,short and stubby hands and feet,language disorders and mental retardation.He developed bilateral angle closure glaucoma,ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome.The child was successfully treated by combined CO_(2) laser-assisted sclerectomy surgery and trabeculectomy.
文摘BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.
文摘BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
基金supported by the National Key Research and Development Program of China(2018 YFC2001900)the Beijing Nova Program(Z211100002121171)。
文摘BACKGROUND N-terminal pro-B-type natriuretic peptide(NT-proBNP)is often viewed as an indicator for heart failure.However,the prognostic association and the predictive utility of NT-proBNP for postoperative major adverse cardiovascular events(MACEs)and myocardial injury after noncardiac surgery(MINS)among older patients are unclear.METHODS In this study,we included 5033 patients aged 65 years or older who underwent noncardiac surgery with preoperative NT-proBNP recorded.Logistic regression was adopted to model the associations between preoperative NT-proBNP and the risk of MACEs and MINS.The receiver operating characteristic curve was used to determine the predictive value of NT-proBNP.RESULTS A total of 5033 patients were enrolled,63 patients(1.25%)and 525 patients(10.43%)had incident postoperative MACEs and MINS,respectively.Analysis of the receiver operating characteristic curve indicated that the cutoff values of ln(NT-proBNP)for MACEs and MINS were 5.16(174 pg/mL)and 5.30(200 pg/mL),respectively.Adding preoperative ln(NT-proBNP)to the Revised Cardiac Risk Index score and the Cardiac and Stroke Risk Model boosted the area under the receiver operating characteristic curves from 0.682 to 0.726 and 0.787 to 0.804,respectively.The inclusion of preoperative NT-proBNP in the prediction models significantly increased the reclassification and discrimination.CONCLUSIONS Increased preoperative NT-proBNP was associated with a higher risk of postoperative MACEs and MINS.The inclusion of NT-proBNP enhances the predictive ability of the preexisting models.
文摘Objective To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Union Medical College Hospital from January 1998 to August 2006 and identified 24 patients who subsequently underwent noncardiac surgery.Results There were no intraoperative cardiac events.Postoperative cardiac events were identified in 3 patients including 1 death due to acute myocardial infarction and 2 episodes of transient hypotension.Conclusions The risk of anesthesia and noncardiac surgery is low in patients with hypertrophic cardiomyopathy.During the perioperative period,beta-blockers and/or calcium channel blockers should be given;vasodilator and inotropic agents should be avoided due to the side effects on hemodynamics.
文摘Objective To investigate whether somatostatin analog octreotide long acting release (LAR) shrinks growth hormone (GH) secreting adenomas, and improves the results of subsequent transsphenoidal surgery. Methods Seventeen previously untreated active acromegalic patients with pituitary adenomas were treated with LAR (30 mg intramuscular injection every 28 days) for 3 months prior to transsphenoidal surgery. Clinical reaction, mean GH secretion, and tumor volume were measured under basal conditions and after LAR treatment. Results Presurgical treatment improved acromegaly symptoms and induced a significant reduction of GH under the 5 ng/mL limit in microadenoma (P < 0.05), while only 18.2% (2/11) in macroadenoma. Meanwhile, tumor shrinkage occurred in 58.8% (10/17) patients, with 1 case in the microadenoma group. All marked shrinkage (> 25%) occurred in the macroadenoma group. Statistical analysis showed tumor shrinkage caused by LAR was greater in macroadenoma group than that in microadenoma group (P < 0.05). During operation, adenoma was soft in 15 cases, with the exception of 2 cases in which the soft tumor was divided by fibrous septa, but all tumor removal was smooth. Conclusions A short term administration of preoperative LAR may induce a significant decrease in GH-secretion level and adenoma volume. Presurgical use of octreotide LAR improves surgical results especially in macroadenomas.
