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[Ventricular tachycardia inducible in a patient with recurrent syncope after Senning operation].

A 17 year old man with transposition of the great vessels who had two episodes of late recurrent syncope following Senning repair 2 months before hospital registration. One episode required basic cardiopulmonary reanimation. Holter monitoring documented isolated polytopic and coupled ventricular extrasystoles. Programmed left ventricular pacing induced polymorphous ventricular tachycardia, which converted to monomorphic sustained ventricular tachycardia after intravenous procainamide. A cardioverter defibrillator was implanted in left ventricle by intravenous approach. Twelve months later the patient presented an episode of polymorphic ventricular tachycardia and one appropriate therapy from the defibrillator discharge was done.

Adolescent↗

The ECO*SENS Project: a prospective, multinational, multicentre epidemiological survey of the prevalence and antimicrobial susceptibility of urinary tract pathogens-interim report.

The ECO*SENS Project is the first international survey to investigate the prevalence and susceptibility of pathogens causing community-acquired, uncomplicated urinary tract infections (UTIs) in women. At 240 centres in 17 countries, female patients presenting with symptoms of uncomplicated UTIs were asked to provide a urine sample for testing for the presence of leucocytes and bacteria. The bacteria were identified and their susceptibility to 12 antibiotics commonly used in the treatment of UTIs was determined. The objective of the survey was to collect 5000 urine samples to obtain approximately 3500 isolates of defined uropathogens. This interim report includes the results from 1960 urine samples, 75% of which contained a uropathogen. Escherichia coli accounted for the majority (80%) of uropathogens isolated in all 17 countries. The rates of resistance among E. coli strains were: ampicillin and sulphamethoxazole, 30%; trimethoprim alone or with sulphamethoxazole, 15%; nalidixic acid, 6%; ciprofloxacin, 3%; amoxycillin-clavulanic acid, mecillinam, cefadroxil, nitrofurantoin and fosfomycin, 2%. The use of ampicillin, sulphonamides and trimethoprim alone or with sulphamethoxazole needs to be reconsidered. The seemingly rapid increase in quinolone resistance among community-acquired E. coli in some of the countries gives cause for concern.

Journal Article↗

[Stenosis of the superior caval canal after Mustard and Senning procedures: treatment by dilatation and stent implantation. Two case reports].

The authors report two cases of stenosis of the superior caval canal after Mustard and Senning procedures for transposition of the great arteries in patients paced for atrial arrhythmia. During cardiac catheterisation, it was possible to treat the stenosis by perforation in one case and by balloon dilatation in the second, followed by the implantation of two stents to reestablish vascular patency. In one patient, two pacing catheters were implanted by an endovascular approach without complications three months after stenting; in the other case, epicardial pacing was required because the patient's condition could not wait for endothelialisation of the stent before implanting the pacing catheters. This technique of revascularisation may also be used in children with venous stenosis after implantation of endocavitary pacing catheters, in which the pacing system has to be changed.

Adolescent↗

[Double switch operation (Senning and Rastelli operation) with left atrial augumentation by in situ autologous pericardium: a case report].

A 23-month-old female infant with situs solitus, atrioventricular and ventriculoarterial discordance, pulmonary atresia, ventricular septal defect, who had received modfied right Blalock-Taussig shunt (4 mm Gore-Tex tube) at the age of 2 months, was carried out double switch operation with left atrial augumentation by in situ autologous pericardium. The spatial position of the heart was mesocardia. The systemic right ventricular end-diastolic volume was 100% of normal, and the pulmonic left ventricular end-diastolic volume was 105% of normal. Atrioventricular valvular regurgitation was not found. Postoperative course was uneventful. On the 28th postoperative day,she discharged from hospital. The disadvantage of double switch operation is difficulty of atrial switch procedure, because most patients have a small atrium due to dextrocardia or mesocardia. For the purpose of atrial augumentation without artificial materials, our modified Senning procedure is useful. But longer follow-up is necessary to determine whether this technique is indeed beneficial.

Aorta↗

Liver transplantation at the Sun Yat-Sen University of Medical Sciences in China.

OBJECTIVES: To summarize the results of liver transplantation for various end-stage liver diseases at the Sun Yat-Sen University of Medical Sciences (SUMS), define the role of liver transplantation in the treatment of hepatocellular carcinoma and fulminant hepatitis B, and assess the efficiency of lamivudine on preventing HBV recurrence. METHODS: Seventy liver transplants performed at the SUMS between April 1993 and December 2000 were retrospectively analyzed. The main indications for liver transplant were hepatocellular carcinoma (26 cases), liver cirrhosis (21 cases), fulminant hepatitis B (12 cases), sclerosing cholangitis (4 cases) and other terminal liver diseases (7 cases). Lamivudine was used in twelve patients suffering from fulminant hepatitis B. Logistic multivariate regression analysis was applied to determine the risk factors predicting liver transplantation outcomes. RESULTS: Fifty-four patients survived for more than one month, and 16 patients died within 30 days after orthotopic liver transplantation (OLT). The overall hospital survival rate was 77.1%. The hospital survival rates in the Child's A and B patients were 87.5% and 83.3%, respectively. Those rates were superior to those of the Child's C patients (P < 0.05). The outcome of patients with small hepatocellular carcinoma (HCC) was superior to that of patients with large HCC. Preoperative APACE III scores, the severity of ascites and serum creatine level had independent influence on outcome. Of the patients with fulminant HBV infection, 9 recipients survived for a follow-up period of 2 - 24 months. Treatment with lamivudine monotherapy was both well tolerated and efficacious in patients with fulminant hepatitis B. CONCLUSIONS: The results indicate that orthotopic liver transplantation could provide long-term cure and palliation for patients with HCC, and that patient selection is extremely important in predicting outcome. The results support the continued application of liver transplantation as a therapeutic modality for various end-stage liver diseases and that lamivudine is an effective and safe monotherapy in OLT for patients with HBV infection.

Adolescent↗

[The SEN virus--will there be another letter in the alphabet of viral hepatitis?] ].

The SEN virus (SENV) is a small nonenveloped single-stranded DNA virus which is probably a circovirus. By phylogenetic analysis it is possible to differentiate genotypes SENV A-H. The pathway of transmission of infection is not known so far but the infection by this virus is frequent in recipients of blood transfusions and liver grafts and in intravenous drug addicts. This suggests possible parenteral transmission of infection. Other routes of transmission of the infection are also possible as the virus can be detected also in a significant proportion of young subjects without the risk of parenteral infection in the case-history. Whether SENV causes hepatitis has not been proved unequivocally so far. The prevalence of this infection does not differ significantly in patients with different liver diseases, acute or chronic viral or non-viral. SENV infection very probably does not influence the course of chronic hepatitis C.

DNA Virus Infections↗

[SEN virus--novel hepatotropic agent causing hepatitis?].

The author presents the review of world literature on infection of novel discovered SEN virus (SENV) after the initials of the infected patients, a human immunodeficiency virus-infected injection drug user. This single-stranded DNA virus, distantly related to the TT virus (TTV) has been announced as a major cause of non-A-E hepatitis. Genotypes SENV-D and SENV-H were more prevalent in the serum samples of patients with transfusion-associated hepatitis and were of lesser prevalence in serum samples from healthy blood donors.

AIDS-Related Opportunistic Infections↗

[Detection of SEN virus in sera of patients with chronic hepatitis B and general population in 5 cities of China].

OBJECTIVE: To study the prevalence of SEN virus (SENV) infection in CHB patients in five cities of China. METHODS: A nest-polymerase chain reaction (nPCR) was used for detection of SENV-D and SENV-H in sera of 595 CHB patients from 5 cities of China and 96 normal individuals from Beijing. A total of 7 SENV strains were analyzed by direct sequencing. RESULTS: The prevalence rates of SENV in CHB patients and normal individuals were 61.3% and 62.5%, respectively (chi(2) = 0.047, P = 0.829). The prevalence rates of CHB patients between 5 cities were different. Nucleotide sequence analysis showed that the homology between 4 SENV-D strains was 91% - 98% and 95% - 98% between 3 SENV-H strains isolated from 5 cities in China. CONCLUSION: SENV-D/H were prevalent in CHB patients of China and their prevalence rates were similar to that in normal individuals.

China↗

[Two-stage Jatene procedure after Mustard or Senning operation].

We have successfully performed a two-stage Jatene procedure in four patients who showed severe anatomical right ventricular dysfunction after atrial switch (Mustard or Senning) operation for transposition of the great arteries. All four patients developed an adequate left ventricular pressure for the arterial switch operation by one or two-stage pulmonary artery banding. Left ventricular posterior wall thickness increased sufficiently enough after the banding although left ventricular ejection fraction showed significant decrease. After Jatene procedure left ventricular ejection fraction recovered, and RV end-diastolic volume which had been prominently enlarged preoperatively was dramatically normalized. Cardiac index increased from 3.6 +/- 1.6 l/min/m2 preoperatively to 5.3 +/- 6.1 l/min/m2 postoperatively with the decrease in left atrial pressure. Postoperative electrophysiological study revealed the recovery of sinus node function and atrial conduction by means of the take-down of atrial switch operation previously performed. We conclude that the Jatene procedure should be an ideal alternative in patients with right ventricular dysfunction after atrial switch operation. The left ventricle could be prepared by an effective pulmonary artery banding in most instances.

Cardiac Surgical Procedures↗

Early elective senning repair: optimal operative strategy for simple transposition of the great arteries.

After the inception of a new pediatric cardiovascular service, we reviewed the management of the first eight consecutive neonatal patients with simple transposition of the great arteries who underwent successful balloon atrial septostomy. Immediate cardiac catheterization and septostomy were performed, and all were discharged in good condition. Each returned at about 6 months of age for elective Senning repair in which the hypothermic arrest technique was used. All survived and are doing well at follow-up that now averages 20 months, and is over 1 year in every instance. While late follow-up is not yet available, it appears that this approach of early, elective repair of simple transposition can give optimal results, even within the context of a new clinical program.

Journal Article↗

[Long-term results of surgical treatment of stomach cancer: clinical experience of forty years from Sun Yat-sen University Cancer Center].

OBJECTIVE: To investigate the approaches to improve therapeutic effect of stomach cancer by analysis of the long-term results of surgical treatment of this disease. METHODS: Prognostic factors of stomach cancer were analyzed by Cox multivariate regression model based on clinical data of 2561 stomach cancer cases who underwent surgical treatment from 1964 to 2004 at Sun Yat-sen University Cancer Center. Survival rates were calculated by life table method. RESULTS: Gastrectomy was performed for 1950 cases with resectability of 76.1%, among which there were 1192 cases of curative resection (46.5%) and 758 cases of non-curative resection (29.6%). The other 611 cases of palliative operation included bypass procedures and laparotomy. Operative mortality of all cases was 0.8% and morbidity was 5.1%. For all cases the 1-, 3- and 5-year survival rate was 52.4%, 38.6% and 35.5%, respectively. The stage-specific 5-year survival rate was 86.8% (Stage I), 58.7% (Stage II), 28.4% (Stage III) and 7.6% (Stage IV), respectively. The 5-year survival after curative resection in the period of 40 years was 45.5%, and increased to 52.7% in the last two decades and 61.8% in recent decade. Stage-specific case proportion during the earlier two decades was 1.4% (Stage I), 10.6% (Stage II), 23.1% (Stage III) and 64.9% (Stage IV), respectively, and that during the recent two decades was 9.3%, 18.5%, 35.3% and 36.8%, respectively. The 5-year survival rate of cases during the earlier two decades was 18.0% and increased to 37.5% during the recent two decades. Multivariate analysis indicated that main prognostic factors of stomach cancer included TNM staging, curative resection and multidisciplinary treatment. CONCLUSIONS: Early detection and curative resection were the most important measures to improve therapeutic effect of stomach cancer. A surgery-predominant multidisciplinary treatment individualizing biological characteristics of tumor, staging of disease and tumor site will contribute to improvement of therapeutic effect of stomach cancer.

Adolescent↗

SEN virus prevalence among non-B and non-C hepatitis patients with high liver function tests in the south of Turkey.

We investigated the characteristics and detection rates of SEN virus (SENV) infection among 100 Turkish patients who had with high alanine aminotransferase (ALT) and aspartate aminotransferase levels but were negative for HBV DNA and HCV RNA and had no history of transfusion. As a control group, we also analyzed 50 healthy individuals who had normal ALT levels, were negative for HBV DNA and HCV RNA, and had no history of transfusion. The serum samples of patient and controls were analyzed by PCR to detect the presence of SENV DNA and its two genotypes (SENV-H and SENV-D). We detected SENV DNA in 13 of 100 (13%) patients. Five of 13 (38.46%) patients were positive for SENV-D and 8 of 13 (61.53%) patients were positive for SENV-H DNA. We also detected SENV DNA in 5 of 50 (10%) patients in the control group. Two of 5 (40%) patients were positive for SENV-D and 3 of 5 (60%) patients were positive for SENV-H DNA in the control group. SENV was detected at almost the same frequency in the patient and control group. SENV did not seem to contribute to the pathogenesis of liver disease (P > 0.05) in this cohort. Our results also showed that SENV transmission was not only associated with blood transfusion but also with some other possible routes.

Adult↗

[Surveillance of corrected transpositions by the Mustard or Senning operation].

One hundred eighteen patients who survived Mustard immunités (n = 103) or Senning operations (n = 15) performed between 1972 and 1984 for isolated transposition of the main arteries were followed-up for over a mean period of 3.67 yr (up to 12 yr). The authors have examined the potential complications which can alter the long-term prognosis in this type of atrial correction: heart rhythm disorders (regression of sinus rhythm of 3.82% yr), mechanical complications, haemodynamic dysfunction. After atrial correction the survival curve underwent an actuarial regression of 1.3% yr. All these potential complications should be detected by regular survey and may indicate anatomical correction, the results of which have yet to be fully evaluated.

Arrhythmias, Cardiac↗

[Enhancing effect of kang shuai sen fang on immune functions of mice].

In this report the authors studied the effects of kang shuai sen fang (KSSF) on the immune functions of mice. The results indicated that KSSF was able to enhance the proliferation response of spleen cells of mice to Con A and LPS. At the dosage of 400 mg/kg.d, KSSF could stimulate the production of plague forming cells (PFC), the DTH response induced by allogeneic splenocytes. The mixed lymphocyte reaction was much stronger in the drug-receiving group than that in the control group. Further study indicated that KSSF was able to enhance the activities of cytotoxic T lymphocyte and the production of interleukin 2.

Adjuvants, Immunologic↗

[Evaluation of Sen-SIR, a new microsystem for the identification and determination of bacterial sensitivity].

The use of semiautomatic methods for identification and study of bacterial sensitivity to antimicrobials is increasingly widespread in clinical Microbiology. In the present study, the evaluation of a new micromethod (Sen-SIR, BBL) for the identification and determination of bacterial sensitivity is reported. 115 clinical isolates of enterobacteria, 10 strains of Acinetobacter calcoaceticus and 57 gram positive cocci, previously identified as belonging to the geni Staphylococcus and Streptococcus were evaluated. In gram negative organisms, the concordance with classical identification methods was 98.4%. In gram positive organisms, the concordance was lower only for the differentiation between group D streptococci and enterococci. The observed sensitivities were similar to those seen with the disk method, except basically for Morganella morganii and Proteus vulgaris. This method is quick, simple and reliable; thus, it can represent an alternative to classical identification methods.

Bacteria↗

Budd-Chiari syndrome treated by Senning's procedure.

Two patients with Budd-Chiari syndrome who underwent a new surgical procedure developed by Senning are reported. A 33-year-old man was diagnosed as having Budd-Chiari syndrome with a membranous obstruction of the inferior vena cava (IVC) and right hepatic vein and short segmental obstruction of the left hepatic vein. Removal of the obstruction by dorsocranial resection of the liver and reconstruction of the veins by hepatoatrial anastomosis was carried out. In a 53-year-old female, the same procedure was carried out for a short segmental obstruction of the IVC and left hepatic vein. In both patients, postoperative examination revealed good patency of the IVC and the hepatic veins and increased portal venous flow as measured by Doppler-echography. This procedure is considered the method of choice for Budd-Chiari syndrome with membranous and/or short segmental obstruction of the IVC and hepatic veins.

Adult↗

To switch or not to switch? The Senning alternative.

We analyzed the fate of 100 consecutive patients with simple arterial transposition who were admitted within the first 2 weeks of life to the Hospital for Sick Children during the period 1978-1986. In contrast to current practice, these patients were managed with the objective of performing a Senning operation as the definitive procedure. Five of these 100 patients died on the first day of life of sequelae of perinatal hypoxia, four died within the first month of life (often of complications of catheterization and septostomy), and three died later than the first month but before definitive operation (12% preoperative mortality). There were four operative deaths, and two late deaths have occurred to date. Actuarial survival was 84% at 5 years and 81% at 9 years. The postoperative attrition rate was 0.4 deaths per 100 patient-years. Actuarial survival of all patients treated for simple arterial transposition seems to be the best index for comparing arterial switch with interatrial repair protocols, because each protocol is associated with different patterns of preoperative, perioperative, and postoperative mortality.

Actuarial Analysis↗

Successful modified Senning operation for the repair of Taussig-Bing malformation.

Surgical correction was carried out successfully in a severely cyanotic 3-year-old boy with Taussig-Bing malformation. The cardiac anomaly was associated with semilunar valves side by side, and at the same height, a bilateral conus without pulmonary-mitral continuity and subpulmonary ventricular septal defect, on which pulmonary valve overode. The surgical correction consisted of the closure of the VSD by a right atrial approach and modified Senning procedure under profound hypothermic cardiac arrest with surface cooling and limited cardiopulmonary bypass. The patient survived operation and was doing well 10 months after surgery. To our knowledge, no other identical case with Taussig-Bing malformation has been corrected successfully by this procedure nor has previously been reported.

Cardiopulmonary Bypass↗