Objective To evaluate midterm and longterm clinical outcome of bilateral internal mammary artery composited Y grafts for coronary artery bypass grafting (CABG)， analyze risk factors for late death ，and to improve surgical results. Methods Between January 2000 and May 2004, One hundred and sixtyfive patients underwent bilateral internal mammary artery grafts for CABG, The clinical data, postoperative complications and survival results were retrospectively reviewed and analyzed. The preoperative and postoperative cardiac function was compared. All factors that may have affected the survival were analyzed by logistic regression, to identify significant variables associated with late death. Results Total 561 anastomosis sites of internal mammary arteries were completed with each patient received an average of 3.4 grafts. There were no perioperative deaths. There were 16 patients with postoperative complications including recurrent angina, myocardial infarction, low cardiac output syndrome, sternal infection and so on. All patients were treated conservatively without reoperation. One hundred sixty patients（97%）were followed up of 5.6±1.2 years, there were 23 late deaths including 10 patients of cardiac related death in which 3 had recurrent myocardial infarction, 4 heart failure, and 3 arrhythmia; 13 patients of nocardiac related death in which 4 upper gastrointestinal hemorrhage, 3 cancer and 6 uncertain cause. 25 patients had major cardiac related events including recurrent angina 18, myocardial infarction 4, repeated revascularization 3. Left ventricular ejection fraction [CM(159mm]was significantly improved as compared with that before operation（54%±6% vs. 43%±12%, Plt;0.05）. The 1-, 3-, 5-year actuarial survival rates and eventfree rates were 98.2%±0.3%, 96.2%±0.5%, 90.5%±1.9% and 95.5%±1.2%, 91.3%±2.1%, 86.6%±1.5%, respectively. According to statistical analysis, univariate analyses had proved that advancing age＞65 years，diabetes，ejection fraction(EF) less than 30%，the New York Heart Association (NYHA) class Ⅲ/Ⅳ, and low cardiac output syndrome required placement of the intraaortic balloon pump were predictors associated with hospital major adverse cardiac events (Plt;0.05). Those variables entered into the logistic regression model and found to be independent predictors associated with increased late cardiac death included advancing age ＞65 years(OR=11.6), diabetes (OR=21.4), EF less than 30%(OR=37.5) and NYHA class Ⅲ/Ⅳ(OR=40.2). Conclusion Patients receiving bilateral internal mammary artery composited Y grafts have better longterm survival and reduced cardiac related events. Independent risk factors for late death are NYHA function class Ⅲ/Ⅳ, EF less than 30%, diabetes and advancing age ＞65 years.
【Abstract】 Objective To evaluate the effectiveness of artifical humeral head replacement in treatment of complicatedfractures of the proximal humerus. Method Between January 2005 and January 2011, 18 patients with proximal humerusfracture were treated with artifical humeral head replacement. There were 8 males and 10 females with a mean age of 71 years (range, 52-84 years). Fractures were caused by falling in 11 cases, by traffic accident in 3 cases, and by bruise in 4 cases. The time between injury and admission was 2 hours to 3 days (mean, 1.5 days). According to Neer classification, 8 cases had three-part fracture, 7 four-part fracture, and 3 cleavage fracture of humeral head; 5 cases complicated by shoulder joint subluxation, 2 cases by femoral fracture, 1 case by radial fracture, and 11 cases by osteoporosis. All the patients were treated with modular cemented prostheses. Results The operation time was 60-180 minutes with an average of 80 minutes; the blood loss was 100-400 mL with an average of 200 mL. All incisions healed by first intention without infection or neurovascular injury. Sixteen patients were followed up 3 years on average (range, 1-6 years). No loosening, dislocation of prothesis or heterotopic ossification occurred. According to the Neer scores, the results were excellent in 5 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case at 1 year after operation. The excellent and good rate was 81.2%. Conclusion Artificial humeral head replacement is a good therapy for patients with complicated fractures of the proximal humerus, especially for elderly patients.
Objective To determine the effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures and analyze the method to promote the bone union. Methods From December 2003 to June 2006, thirtyfive patients with open tibial and fibula fracture were treated with emergency debridement, interlocked intramedullary fixation for tibia and fixed fibula at the same time. During operation, the bone marrow was collected and grafted into the fracture gaps. Among them, there were 27 males and 8 females, involving in 22 left legs and 13 right legs. Their ages ranged from 19 to 65 years, with an average of 34.7 years. The location of fracture was the middle of the tibia and fibula in 16 cases, the distal 1/3 of the tibia and fibula in 12 cases and the proximal 1/3 in 7 cases. According to the Gusitilo classification of open injuries, there were 7 cases of type I, 19 cases of type II, 8 cases of type III a and 1 case of type III b. The mean range of knee motion was 48.3° (45-70°). The mean time from injury to operation was 4.3 hours (50 minutes to 7 hours). Results The mean operation time was 94 minutes (60-132 minutes) and the mean blood loss was 122 mL (100-350 mL). The wound healed by first intention in 32 patients. Incision was sutured in 2 cases of type III a fractures after operation 4 days, gastrocnemius flap graft was performed in 1 case of type III b fracture 1 week after operation. They all achieve good heal ing. No fractures spl it off, no iatrogenic nerve and vascular injury occurred, no osteofascial compartment syndromes or deep vein thrombus happened. Tension bl isters appeared in 1 case of type II fracture after operation and subsided after 5 days. Patients were followed up for 14-43 months (mean 22 months). The X-ray films showed that fracture union was observe in 30 cases after 14 weeks of operation, in 3 cases after 18 weeks and in 1 caseafter 22 weeks of operation. The fractures union time was 15.2 weeks on average. About 2 cm nonunion in lateral tibial appeared in 1 case of type I fracture. No fracture occurred again. The mean range of knee motion was 127° (121-135°). The mean HSS score was 96.5 (87-100) at the end of the follow-up. The excellent and good rate was 100%. Conclusion The curative effect of interlocking intramedullary nail is definite in treatment of open tibial and fibula fractures and it can enhance fracture union to plant bone marrow into the fracture gaps.
Object ive To explore the ef fect s of di f ferent surgical methods on plantar ulcer s in leprosy. Methods The cl inical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A, 34 cases underwent debridement, including 26 males and 8 females aged 53-88 years old (average 72.4 years old); the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 11 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 25 cases andsevere in 9 cases according to the self-designed evaluation system. In group B, 22 cases received foot pressure rebuilding surgery, including 19 males and 3 females aged 48-83 years old (average 69.8 years old); the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 12 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C, 15 cases were repaired with the transposition of toe flap, foot arch flap, acrotarsium flap, or medial tibia flap, including 11 males and 4 females aged 43-73 years old (average 64.6 years old); the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm × 3 cm × 2 cm to 11 cm × 5 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information (P gt; 0.05), except for the difference between group A and group C on age (P lt; 0.05). Results Group A: 19 out of 34 cases healed and the average heal ing time was 46.8 days; all patients were followed up for 2-45 years (average 17.2 years); the rate of ulcer heal ing 1 year after operation was 55.9% (19/34); 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate ofulcer heal ing at last follow-up was 20.6% (7/34). Group B: 18 out of 22 cases healed and the average heal ing time was 29.2 days; all patients were followed up for 2-50 years (average 13.3 years); the rate of ulcer heal ing 1 year after operation was 81.8% (18/22); 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer heal ing at last follow-up was 50.0% (11/22). Group C: 14 out of 15 cases healed and the average heal ing time was 27.1 days; all patients were followed up for 3-12 years (average 8.8 years). The rate of ulcer heal ing 1 year after operation was 93.3% (14/15); 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer heal ing at final follow-up was 46.7% (7/15). For the rate of ulcer heal ing 1 year after operation, there was a significant difference between group A and group B, and between group A and group C (P lt; 0.05), but no significant difference was evident between group B and group C (P gt; 0.05). For the rate of ulcer heal ing at the final follow-up visit, there was a significant difference between group A and group B (P lt; 0.05), but no significant difference was evident between group A and group C, and between group B and group C (P gt; 0.05). Conclusion The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps, providing good short-term and long-term therapeutic effect.
Objective To evaluate the effect of music therapy for childbirth. Methods Such databases as The Cochrane Library, PubMed, EMbase, EBSCO host, SpringerLINK Online Journals, CBM and WanFang Data were searched from January of 2000 to December of 2010 to collect randomized controlled trials (RCTs) of music therapy for childbirth. The quality of RCTs was appraised and the data were extracted. Meta-analyses were conducted with RevMan5.02 software for the standarded RCTs. Results A total of nine RCTs were included. Five RCTs indicated the music therapy could alleviate the labor pain; five RCTs indicated the music therapy could reduce the event risk of cesarean section due to the failure of transvaginal trial labor; three RCTs indicated the music therapy could shorten the first stage of labor; two RCTs indicated the music therapy could stabilize the systolic pressure and heart rate when complete cervical dilation was done, and three RCTs indicated the music therapy could relieve anxiety. In addition, music therapy had no influence on neonate Apgar’s score; and the result of meta-analyses on postpartum hemorrhage was not reliable through sensitivity analyses. Conclusion The music therapy applied during childbirth can relieve the labor pain and anxiety, stabilize the heart rate and systolic pressure when complete cervical dilation is done, reduce the event risk of cesarean section due to the failure of transvaginal trial labor, shorten the first stage of labor, and is beneficial to the mind and body of parturient.
Objective To evaluate the effectiveness of terazosin, tamsulosin and finasteride for benign prostatic hyperplasia (BPH). Methods We searched the related original studies all over the world, and only included randomized controlled trials (RCT) and quasi-randomized controlled trials (CCT). MEDLINE (1966 to Dec. 2004), EMBASE (1984 to Dec. 2004), The Cochrane Library (Issue 4, 2004) and four Chinese databases were electronically searched and 10 related journals were handsearched. The studies included in the references of eligible studies were additionally searched. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were consulted by a third party. Meta-analysis was performed by using RevMan 4.2 software. Results Twelve original studies involving 2 471 participants met inclusion criteria. Compared with terazosin, tamsulosin could improve international prostatic symptom score, with WMD 0.75, 95% confidence interval (CI) 0.03 to 1.46, P=0.04. There was no statistical difference between terazosin and tamsulosin in improving the average rate of urine flow (WMD 0.23, 95%CI -0.39 to 0.85, P=0.46), the residual urine volume (WMD 0.82, 95%CI -2.92 to 4.57, P=0.67) and in diminishing the volume of prostate (WMD 2.20, 95%CI -3.99 to 8.39, P=0.49). There was no statistical difference between finasteride and tamsulosin in improving the international prostatic symptom score (WMD 0.65, 95%CI -0.45 to 1.75, P=0.25) or the max rate of urine flow (WMD 0.39, 95%CI -0.72 to 1.51, P=0.49). Only two studies compared finasteride with terazosin and had different conclusions. Only one study compared finasteride or terazosin with a combination of these drugs suggested that the combination had higher effective power than finasteride alone but no difference with terazosin alone. Conclusions Although the effectiveness in some aspects is higher in the tamsulosin group, there is not enough evidence to show which one is the best among these three drugs. The combination of finasteride and terazosin does not show more effectiveness than terazosin alone. This review suggests that tamsulosin alone should be used for the treatment of BPH and the combination needs to be identified by better evidence. It is important to improve the quality of original studies.
目的 观察多西他赛三药及两药联合对胃癌根治术后辅助化学疗法（化疗）的疗效比较及不良反应。 方法 回顾性分析解放军总医院2006年1月－2011年12月42 例胃癌根治术后患者的临床资料，其中有22例、20例患者分别接受以多西他赛为基础的三药、两药联合辅助化疗。三药联合：多西他赛注射液+铂类+氟尿嘧啶/卡培他滨片/替吉奥；两药联合：多西他赛注射液+氟尿嘧啶/卡培他滨片/替加氟或多西他赛注射液+铂类；主要观察终点：无疾病生存期（DFS），次要观察终点：预后因素分析、复发转移情况、不良反应及亚组分析。 结果 两组中位DFS分别为9.530、7.170个月（P=0.646）；性别、年龄、肿瘤浸润深度、脉管癌栓、淋巴结清扫范围是患者早期复发转移的不良预后因素，三药联合组肝转移率高于两药联合组（P=0.008）；主要不良反应为恶心、呕吐、白细胞减少、腹泻、脱发、血小板减少等，多为1～2级，可耐受，三药联合组较两药联合组易出现不良反应（P=0.011），以恶心、呕吐为主。 结论 胃癌根治术后以多西他赛为基础的辅助化疗三药、两药联合对患者疗效及预后无明显差异，且两种辅助疗法不良反应基本可耐受。