[Show abstract][Hide abstract] ABSTRACT: Heart transplantation has become a routine procedure and promising therapy resource for patients suffering from end-stage myocardial failure around the world. Since 1987, the number of heart transplantation in our country has been increasing gradually. We reported our experience of heart transplantation during the past 15 years.
From Jul 1987 to Jun 2002, the collection of 40 patients undergoing heart transplantation was presented. We evaluated the clinical outcome of heart transplantation for the patients of end-stage myocardial failure at Taipei Veterans General Hospital.
Our heart transplantation project has been embarrassed by the shortage of donors, therefore, the marginal donor and even recipient were considered acceptable. The clinical results revealed that the 30-day mortality rate was 8% and the 1-year, 2-year, 3-year and 5-year survival rates were 90%, 72%, 68% and 62%, respectively.
With adequate patient selection and improvement of peri-operative care during the past 15 years, heart transplantation seems to be an efficient therapy for end-stage myocardial failure.
Preview · Article · Aug 2003 · Journal of the Chinese Medical Association
[Show abstract][Hide abstract] ABSTRACT: The results of femoropopliteal bypass surgery using various prosthetic materials are frustrated until the expanded polytetrafluorethylene (PTFE) was introduced as a vascular prosthesis in 1973. Since then, the techniques of femoropopliteal bypass improved rapidly, but the long-term patency rate, compaired with autogenous saphenous vein graft, remained unsatisfied. The stretch PTFE graft developed in 1991 became available for clinical usage. The objective of this study is to compare the long-term results between stretch and non-stretch PTFE prosthetic conduits in patients who underwent femoropopliteal vascular reconstruction.
From Jun. 1993 to Jun. 1998,68 femoropopliteal bypass operations were performed in 59 patients between stretch and non-stretch PTFE conduits. The stretch PTFE group included 34 patients, 40 surgery (above knee 22, below knee 18). The non-stretch PTFE group included 25 patients, 28 surgery (above knee 17, below knee 11). The patency of grafts was followed by Doppler segmental pressure for at least 2 years. The indication for the bypass grafting operation was disabling claudication and critical ischemia. Patients were observed every 3 months for the first year and every 6 months thereafter. All patients were instructed to take aspirin (100 mg) daily in the whole period of study. Doppler-derived ankle-brachial indices (ABIs) were determined preoperatively and serially postoperatively. A bypass graft was considered to be patent when the Doppler-derived postoperative ABI remained significantly improved (more than 0.15 units higher than their preoperative value). Patency rates were compared by using the Kaplan-Meier life table analysis.
Reconstructions above knee had significantly different patency rates (83% vs 66%, p < 0.05): the stretch PTFE group had more acceptable clinical result than the non-stretch PTFE group. Below-knee bypass made no significantly different results between groups, (59% vs 53%, p > 0.10).
The stretch PTFE stretches farer and makes better long-term patency for femoropopliteal bypass. We suggested that the stretch PTFE prosthetic conduits is a reasonable alternative for the above knee popliteal artery lesions and reserved for patients lacking autogenous tissues for below knee artery reconstruction.
Preview · Article · May 2002 · Zhonghua yi xue za zhi = Chinese medical journal; Free China ed
[Show abstract][Hide abstract] ABSTRACT: Apoptosis, or programmed cell death, is a physiological cell death process that allows a tissue or organ to remove unwanted cells and responsible for the maintenance of stable cell numbers in tissues even in primary atherosclerotic or restenotic lesion of coronary artery. Previous studies on the apoptosis of coronary atherosclerosis are usually prone to run into qualitative description without the aid of "quantitative" evaluation. To eliminate such subjective errors, we have designed a triple immunofluorescent stain assessed by digital camera and computer-aided analysis system so that the actual quantitative apoptotic expression of coronary atherosclerotic development can be more precisely evaluated.
Specimens of coronary artery were obtained from consecutive patients undergoing coronary endarterectomy or cardiac transplantation. Twenty-seven blocks of paraffin tissue specimens from 16 patients were analyzed. According to the American Heart Association (AHA) classification of atherosclerotic lesion, type I, II, III lesions were defined as early lesions and the other three types: IV, V, and VI as advanced lesions. Apoptosis and cell types were recognized simultaneously by triple immunofluorescent stain combined with Hoechst, Terminal deoxynucleotidyl transferase-mediated dUTP Nick End-Labeling (TUNEL) and smooth muscle cell (SMC) marker staining. Apoptotic index deduced from TUNEL-positive nucleus number divided by Hoechst-positive nucleus number. Apoptotic cell-type index deduced from TUNEL-positive nuclei, which are surrounded by cell type fluorescent marker, divided by total TUNEL-positive nuclei.
Fourteen early lesions and 13 advanced lesions of tissue specimens were analyzed in this study. The mean apoptotic index of early lesions was 2.60 +/- 1.72%, which is significantly lower than that of the advanced lesions (7.42 +/- 3.07%). The apoptosis between the tapering portion and lesion portion obtained from 10 coronary endarterectomy specimens was also significantly different (2.59 +/- 1.90% vs 8.10 +/- 3.20%). In either early or advanced lesions, the predominant cell type of apoptosis was SMC.
The identical counting and quantification analytic method we designed is more accurate and quantitative than the traditional investigation in detecting and affirming the "homeostasis" role of apoptosis in the atherosclerotic pathogenesis process of coronary artery disease.
No preview · Article · Apr 2002 · Zhonghua yi xue za zhi = Chinese medical journal; Free China ed