Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus

ObjectivesThe aim of our study was to evaluate the long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the pulmonary valve (PV) annulus.MethodsFrom 1989 to 2000, 84 of 222 patients (37.8%) with tetralogy of Fallot and PV stenosis underwent definitive repair with preservation of the PV annulus without right ventriculotomy. PV commissurotomy was concomitantly performed in 74 patients (88.1%). The PV was bicuspid in 56 patients (66.7%); the mean Z value was −1.2 ± 1.5 (range, −4.9 to 2.4). The mean follow-up period was 15.8 ± 5.7 years (maximum, 22.8), and follow-up data were complete for 75 patients (89.3%).ResultsThe actuarial survival and freedom from reoperation rates at 20 years was 98.6% and 95.8%. The freedom from ventricular arrhythmia at 5, 10, 15, and 20 years was 98.7%, 89.6%, 74.1%, and 58.0%, respectively. All detected ventricular arrhythmias were isolated monofocal premature ventricular contractions. Freedom from moderate or greater pulmonary regurgitation at 5, 10, 15 and 20 years was 50.4%, 44.9%, 38.4%, and 35.7%, respectively. A bicuspid PV (hazard ratio, 2.910; 95% confidence interval, 1.404-6.204, P = .004) and a Z-value of less than −2 (hazard ratio, 1.948; 95% confidence interval, 0.915-5.857; P = .034) were the risk factors for developing moderate or greater pulmonary regurgitation.ConclusionsThe long-term outcomes after definitive repair of tetralogy of Fallot with preservation of the PV annulus were excellent. Although isolated, monofocal premature ventricular contractions were frequently observed, fatal ventricular arrhythmia was not. The indication should not only be decided by the PV annulus size, but also by the valvular morphology to maintain long-term PV competency

ジドウ ソウサホウ ニヨル ガン チリョウヨウ 125 Ｉ シード ホウシャセン キョウド ケンテイ システム ノ カイハツ

A new scanning system using a NaI(Tl) scintillation survey meter, copper slit and drive-unit has been developed for quality control of radioactive seeds. Radioactive seed implants, also called brachytherapy, are widely used modality in the treatment of early stage prostate cancers. Seeds containing the iodine-125 are most commonly used for permanent implant prostate brachytherapy. These seeds are commercially available and delivered in a sterile environment in the form of packaged cartridge. It is impractical to re-sterilize and re-load seeds after calibration. This paper describes a new method to calibrate all seeds in the seed cartridge in a sterile package

The Association between Nutrition and the Functional Outcomes of Elderly Women with Acute Vertebral Compression Fractures

Background: Vertebral compression fracture (VCF) is a major injury that occurs in elderly individuals.　The aim of this study is to predict the functional outcomes of elderly female patients with acute VCF based on their nutritional status. 　Methods: A total of 69 female patients with acute VCF were included in the present study.　The age, fracture location, body mass index, grasping power, the amount of the patientʼs daily nutritional intake, Mini-Mental State Examination (MMSE) score and nutritional status (determined from laboratory findings) were evaluated at the time of admission.　After in-hospital rehabilitation, the patients were divided into two groups based on their motor Functional Independence Measure (mFIM) scores at the time of discharge.　A multivariable logistic regression analysis was performed to identify factors that predicted the outcome.　Results: The patients were divided into the high mFIM (score ≥ 79, n＝36) and the low mFIM (score＜79, n＝33) groups.　The multivariate logistic regression analysis showed that the amount of the patient’s nutritional intake and the MMSE score were associated with the outcome.　Conclusions: he cognitive status and the amount of the patient’s nutritional intake were associated with the prognosis of elderly women with acute VCF

Death, reoperation, and late cardiopulmonary function after truncus repairCentral MessagePerspective

Objective: To identify the late surgical outcomes of truncus arteriosus. Methods: Fifty consecutive patients with truncus arteriosus who underwent surgery between 1978 and 2020 at our institute were enrolled in this retrospective, single institutional cohort study. The primary outcome was death and reoperation. The secondary outcome was late clinical status, including exercise capacity. The peak oxygen uptake was measured by a ramp-like progressive exercise test on a treadmill. Results: Nine patients underwent palliative surgery, which resulted in 2 deaths. Forty-eight patients went on to truncus arteriosus repair, including 17 neonates (35.4%). The median age and body weight at repair were 92.5 days (interquartile range, 10-272 days) and 3.85 kg (interquartile range, 2.9-6.5 kg), respectively. The survival rate at 30 years was 68.5%. Significant truncal valve regurgitation (P = .030) was a risk factor for survival. Survival rates were similar between in the early 25 and late 25 patients (P = .452). The freedom from death or reoperation rate at 15 years was 35.8%. Significant truncal valve regurgitation was a risk factor (P = .001). The mean follow-up period in hospital survivors was 15.4 ± 12 years (maximum, 43 years). The peak oxygen uptake, which was performed in 12 long-term survivors at a median duration from repair of 19.7 years (interquartile range, 16.8-30.9 years), was 70.2% of predicted normal (interquartile range, 64.5%-80.4%). Conclusions: Truncal valve regurgitation was a risk factor for both survival and reoperation, thus improvement of truncal valve surgery is essential for better life prognosis and quality of life. Slightly reduced exercise tolerance was common in long-term survivors