Objective To assess the value of pulmonary ventilation test in evaluating the prognosis of cardiac surgery patients. Methods Data were collected retrospectively from consecutive patients with coronary heart disease or valvular disease, who were prepared for cardiac surgery in Zhongshan Hospital from January 2007 to December 2008. The main outcome indices were mortality of surgery, the prolonging time of using artificial airway ( ≥3 days) , and the prolonging time in intensive care units ( ICU) ( ≥5 days) . Then the relationship between the poor outcome and ventilation disorder was analyzed. Results In the 422 cases,the incidence of ventilation disorder was 55% , included 27. 5% restrictive ventilation disorder, 15. 6% obstructive ventilation disorder, and 11. 8% mixed ventilation disorder. And the severity of pulmonaryventilation disorder was mild of 34. 6% , moderate of 15. 2% , and severe of 5. 2% . Among the 42 patients who gave up surgery,50% were due to ventilation dysfunction, and the patients were prone to give up surgery with the deterioration of pulmonary function( P lt; 0. 001) . But comparing with the patients with normal pulmonary function, the risk of poor outcome after surgery did not significantly increase in the patients with ventilation disorder ( P gt; 0. 05 ) . The logistic regression analysis indicated that cardiopulmonary bypass ( CPB) was an absolute risk factor ( P lt; 0. 05) . Conclusions The incidence of ventilation disorder in patients with cardiac disease is quite high. Severe pulmonary ventilation disorder is the significant cause of giving up surgery, but may be not the absolute contraindication of cardiac surgery.
Objective To investigate clinical characteristics of community acquired pulmonary crypyococcosis（PC）.Methods A total of 30 cases of PC diagnosed at Zhongshan Hospital of Fudan University from Jan 2003 to Dec 2007 were retrospectively analysed.All cases were identified by pathological study.Results The patients consisted of 19 males and 11 females，with median age of 44 years（16 to 70 years），66.7% of whom without underlying deseases and with normal immune function.9 patients（30%） were asymptomatic，and 21 patients（70%） had respiratory and/or constitutional symptoms.The most common symptoms were dry cough（16.7%），expectoration（46.7%），fever（23.3%），chest pain（13.3%） and dyspnea on exertion（13.3%）.All symptoms were mild and often showed a self-limiting trend.The common imaging features were nodule and mass，either solitary or multiple（53.3%），infiltrates and consolidation（40%） or diffused and mixed lesions.Non-caseous granulomas was the main character of patholgical study（96.7%），in which 93.1% with multinucleated giant cells containing abundant vacuolus yeast forms with the periodic acid schiff（PAS） reaction and/or Grocott Gomori’s methenamine silver（GMS） staining postive.Only one case found Cryptococcus neoformans spores in biopsy tissue smear and another in sputum smear.16.7% of the patients had positive biopsy tissue cultures for Cryptococcus neoformans，and 3.3% were positive of sputum cultures.15 patients underwent latex agglutination test for pulmonary cryptococcosis，and 93.3% were positive.Conclusions Some immunocompetent healthy people may compromised with community acquired PC with mild symptoms or even not at all and heterogeneous imaging appearance.Pathology，etiology，and serology were valuable diagnostic tools.