Objective: We evaluated the cardiovascular pathologic condition in the recipient twin in twin- to- twin transfusion syndrome and the influence of amnioreduction. Study design: Fetal echocardiograms and medical records...Objective: We evaluated the cardiovascular pathologic condition in the recipient twin in twin- to- twin transfusion syndrome and the influence of amnioreduction. Study design: Fetal echocardiograms and medical records of 54 pregnancies that were complicated by twin-to-twin transfusion syndrome were reviewed. Recipient twin right and left ventricular wall thickness, diameters, systolic and diastolic function, valve regurgitation, and structural cardiac defects were assessed at examination and after amnioreduction. Results: At examination (n = 28 pregnancies), cardiomegaly because of right ventricular and/or left ventricular hypertrophy was observed in 58% of recipient twins, and biventricular hypertrophy was observed in 33% of recipient twins, without ventricular dilation. Biventricular diastolic dysfunction was present in two thirds of recipient twins, and right ventricular systolic dysfunction and significant atrioventricular valve regurgitation was observed in one third of recipient twins. Serial assessment (n = 21 pregnancies) revealed progressive biventricular hypertrophy and right ventricular systolic and biventricular diastolic dysfunction in most recipient twins. Steeper progression of hypertrophy, diastolic dysfunction, and structural or functional right ventricular outflow disease (20% incidence) were associated with an increased perinatal mortality rate. Conclusion: In twin- to- twin transfusion syndrome, the recipient twin has progressive biventricular hypertrophy with predominant right ventricular systolic and biventricular diastolic dysfunction. Despite amnioreduction, the cardiovascular disease persists and even progresses in many recipient twins.展开更多
Background -Preoperative brain injury is common in neonates with transposition of the great arteries(TGA). The objective of this study is to determine risk factors for preoperative brain injury in neonates with TGA. M...Background -Preoperative brain injury is common in neonates with transposition of the great arteries(TGA). The objective of this study is to determine risk factors for preoperative brain injury in neonates with TGA. Methods and Results -Twenty-nine term neonates with TGA were studied with MRI before cardiac surgery in a prospective cohort study. Twelve patients(41%) had brain injury on preoperative MRI, and all injuries were focal or multifocal. None of the patients had birth asphyxia. Nineteen patients(66%) required preoperative balloon atrial septostomy(BAS). All patients with brain injury had BAS(12 of 19; risk difference, 63%; 95%confidence interval, 41 to 85; P=0.001). As expected on the basis of the need for BAS, these neonates had lower systemic arterial hemoglobin saturation(SaO2)(P=0.05). The risk of injury was not modified by the cannulation site for septostomy(umbilical versus femoral, P=0.8) or by the presence of a central venous catheter(P=0.4). Conclusions -BAS is a major identifiable risk factor for preoperative focal brain injury in neonates with TGA. Imaging characteristics of identified brain injuries were consistent with embolism; however, the mechanism is more complex than site of vascular access for BAS or exposure to central venous catheters. These findings have implications for the indications for BAS, timing of surgical repair, and use of anticoagulation in TGA.展开更多
Purpose: The aim of this study was to determine if patients are in remission or weaning off medication after thymectomy for myasthenia gravis (MG) and to examine the thoracoscopic versus open approaches. Methods: A re...Purpose: The aim of this study was to determine if patients are in remission or weaning off medication after thymectomy for myasthenia gravis (MG) and to examine the thoracoscopic versus open approaches. Methods: A retrospective review of all patients who underwent thymectomy for MG at a tertiary referral center between 1992 and 2004 (N = 14). Six patients (42.9%) underwent thoracoscopic resection. Eight patients underwent open resection; 5 (35.7%) had median sternotomy and 3 (21.4%) by transcervical approaches. Follow-up was obtained in 12 (85.7%) of 14 patients by both chart review and telephone. The mean follow-up was 43.0 months (range, 4-111 months). Statistical significance was determined by Student’s t test or Fisher’s Exact Test. Results: The thoracoscopic group had a mean operating time of 138.8 minutes compared with 139.8 minutes in the open group (P = .9). The thoracoscopic group had a mean estimated blood loss of 7.5 mL compared with 52.5 mL in the open group (P = .02). The mean length of stay for the thoracoscopic group was 1.5 days (range, 1-2 days) and was 10.6 days (range, 3-41 days) in the open group (P = .13). Three (60%) of 5 patients were entirely off medication in the thoracoscopic group at the time of follow-up compared with 3 (50%) of 6 patients in the open group (P = 1.0). In the thoracoscopic group, 5 (83.3%) of 6 were in class 1 to 3 of the DeFilippi classification (compl-ete remission or improved with decreased medication requirements). One patient had no change in symptoms (class 4). In the open group, 5 (83.3%) of 6 were classified as DeFilippi 1 to 3 at the time of follow-up, and one patient had worsening symptoms (class 5). Conclusions: Both thoracoscopic and open approaches to thymectomy in patients with MG are effective, with more than 80%of patients in both groups in remission or with improvement at the time of follow-up. The thoracoscopic group has the added benefits of decreased estimated blood loss, decreased length of hospital stay, and improved cosmesis. We advocate the thoracoscopic approach for thymectomy in the treatment of juvenile MG.展开更多
Objective:In previous decades,glaucoma has been primarily attributed to elevated intraocular pressure (IOP),but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucom...Objective:In previous decades,glaucoma has been primarily attributed to elevated intraocular pressure (IOP),but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries.However,there still remain strong controversies in the definition of glaucoma in China.In this current review,we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries.Furthermore,we will briefly describe the "ocular-cranial pressure gradient"theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS)in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma. Data Sources:We performed a comprehensive search in both PubMed and SinoMed using the following keywords:(a)"primary glaucoma"and "guideline,"(b)"ocular-cranial pressure gradient,"and (c)"glaucoma,""Alzheimer's disease,"and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date. Study Selection:The primary references were Chinese and English articles including (a)original guidelines and expert consensuses of primary glaucoma,(b)reviews focusing on the differences between various versions of these guidelines and consensuses,and (c)papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases. Results:The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines.Chinese definitions and classifications put more emphasis on the IOP,while international guidelines put more emphasis on the presence of optic neuropathy.The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma. Conclusions:As regards the definition and classification of primary glaucoma,we find that there are still some discrepancies between Chinese expert consensuses and international guidelines.Glaucoma is a disease with complex etiologies,while its common characteristic is a specific optic neuropathy.The current definition and understanding of glaucoma is an ongoing and evolving process,reflecting our latest available evidence on its pathogenesis.Chinese ophthalmology community may need to update our guidelines,accommodating these latest developments.展开更多
文摘Objective: We evaluated the cardiovascular pathologic condition in the recipient twin in twin- to- twin transfusion syndrome and the influence of amnioreduction. Study design: Fetal echocardiograms and medical records of 54 pregnancies that were complicated by twin-to-twin transfusion syndrome were reviewed. Recipient twin right and left ventricular wall thickness, diameters, systolic and diastolic function, valve regurgitation, and structural cardiac defects were assessed at examination and after amnioreduction. Results: At examination (n = 28 pregnancies), cardiomegaly because of right ventricular and/or left ventricular hypertrophy was observed in 58% of recipient twins, and biventricular hypertrophy was observed in 33% of recipient twins, without ventricular dilation. Biventricular diastolic dysfunction was present in two thirds of recipient twins, and right ventricular systolic dysfunction and significant atrioventricular valve regurgitation was observed in one third of recipient twins. Serial assessment (n = 21 pregnancies) revealed progressive biventricular hypertrophy and right ventricular systolic and biventricular diastolic dysfunction in most recipient twins. Steeper progression of hypertrophy, diastolic dysfunction, and structural or functional right ventricular outflow disease (20% incidence) were associated with an increased perinatal mortality rate. Conclusion: In twin- to- twin transfusion syndrome, the recipient twin has progressive biventricular hypertrophy with predominant right ventricular systolic and biventricular diastolic dysfunction. Despite amnioreduction, the cardiovascular disease persists and even progresses in many recipient twins.
文摘Background -Preoperative brain injury is common in neonates with transposition of the great arteries(TGA). The objective of this study is to determine risk factors for preoperative brain injury in neonates with TGA. Methods and Results -Twenty-nine term neonates with TGA were studied with MRI before cardiac surgery in a prospective cohort study. Twelve patients(41%) had brain injury on preoperative MRI, and all injuries were focal or multifocal. None of the patients had birth asphyxia. Nineteen patients(66%) required preoperative balloon atrial septostomy(BAS). All patients with brain injury had BAS(12 of 19; risk difference, 63%; 95%confidence interval, 41 to 85; P=0.001). As expected on the basis of the need for BAS, these neonates had lower systemic arterial hemoglobin saturation(SaO2)(P=0.05). The risk of injury was not modified by the cannulation site for septostomy(umbilical versus femoral, P=0.8) or by the presence of a central venous catheter(P=0.4). Conclusions -BAS is a major identifiable risk factor for preoperative focal brain injury in neonates with TGA. Imaging characteristics of identified brain injuries were consistent with embolism; however, the mechanism is more complex than site of vascular access for BAS or exposure to central venous catheters. These findings have implications for the indications for BAS, timing of surgical repair, and use of anticoagulation in TGA.
文摘Purpose: The aim of this study was to determine if patients are in remission or weaning off medication after thymectomy for myasthenia gravis (MG) and to examine the thoracoscopic versus open approaches. Methods: A retrospective review of all patients who underwent thymectomy for MG at a tertiary referral center between 1992 and 2004 (N = 14). Six patients (42.9%) underwent thoracoscopic resection. Eight patients underwent open resection; 5 (35.7%) had median sternotomy and 3 (21.4%) by transcervical approaches. Follow-up was obtained in 12 (85.7%) of 14 patients by both chart review and telephone. The mean follow-up was 43.0 months (range, 4-111 months). Statistical significance was determined by Student’s t test or Fisher’s Exact Test. Results: The thoracoscopic group had a mean operating time of 138.8 minutes compared with 139.8 minutes in the open group (P = .9). The thoracoscopic group had a mean estimated blood loss of 7.5 mL compared with 52.5 mL in the open group (P = .02). The mean length of stay for the thoracoscopic group was 1.5 days (range, 1-2 days) and was 10.6 days (range, 3-41 days) in the open group (P = .13). Three (60%) of 5 patients were entirely off medication in the thoracoscopic group at the time of follow-up compared with 3 (50%) of 6 patients in the open group (P = 1.0). In the thoracoscopic group, 5 (83.3%) of 6 were in class 1 to 3 of the DeFilippi classification (compl-ete remission or improved with decreased medication requirements). One patient had no change in symptoms (class 4). In the open group, 5 (83.3%) of 6 were classified as DeFilippi 1 to 3 at the time of follow-up, and one patient had worsening symptoms (class 5). Conclusions: Both thoracoscopic and open approaches to thymectomy in patients with MG are effective, with more than 80%of patients in both groups in remission or with improvement at the time of follow-up. The thoracoscopic group has the added benefits of decreased estimated blood loss, decreased length of hospital stay, and improved cosmesis. We advocate the thoracoscopic approach for thymectomy in the treatment of juvenile MG.
文摘Objective:In previous decades,glaucoma has been primarily attributed to elevated intraocular pressure (IOP),but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries.However,there still remain strong controversies in the definition of glaucoma in China.In this current review,we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries.Furthermore,we will briefly describe the "ocular-cranial pressure gradient"theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS)in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma. Data Sources:We performed a comprehensive search in both PubMed and SinoMed using the following keywords:(a)"primary glaucoma"and "guideline,"(b)"ocular-cranial pressure gradient,"and (c)"glaucoma,""Alzheimer's disease,"and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date. Study Selection:The primary references were Chinese and English articles including (a)original guidelines and expert consensuses of primary glaucoma,(b)reviews focusing on the differences between various versions of these guidelines and consensuses,and (c)papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases. Results:The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines.Chinese definitions and classifications put more emphasis on the IOP,while international guidelines put more emphasis on the presence of optic neuropathy.The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma. Conclusions:As regards the definition and classification of primary glaucoma,we find that there are still some discrepancies between Chinese expert consensuses and international guidelines.Glaucoma is a disease with complex etiologies,while its common characteristic is a specific optic neuropathy.The current definition and understanding of glaucoma is an ongoing and evolving process,reflecting our latest available evidence on its pathogenesis.Chinese ophthalmology community may need to update our guidelines,accommodating these latest developments.
