Clinical outcomes in patients with renal artery stenosis treated with stent placement with embolic protection compared with those treated with stent alone

Purpose: To compare the clinical outcomes in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS) following renal artery (RA) stent placement with and without embolic protection device (EPD) usage. Materials and Methods: Eighteen patients who had RA stent placement with EPD were matched to control patients (RA stent only). Blood pressure, number of hypertensive medications, and estimated glomerular filtration rate (eGFR) at 3 months before the procedure and after 12 months were determined. An increase of ≥ 20% in eGFR at 12 months from baseline was defined as "improvement," decrease of ≥20% as "deterioration," and an eGFR change between those values as "stabilization" at 12 months. Results: At 12 months, stage 4 patients treated with EPD had significantly higher eGFR than controls (P = .01). There was no statistical difference in blood pressure outcomes between the 2 groups. Conclusions: Patients with stage 4 CRI did significantly better with EPD than those treated without it.     

Intubation with propofol augmented with intravenous lignocaine

Sixty patients of ASA grade 1 and aged 18 to 55 years were admitted to a double-blind study. Anaesthesia was induced with propofol 2.5 mg/kg after intravenous pretreatment with lignocaine 1.5 mg/kg or a similar volume of isotonic saline. The quality of subsequent tracheal intubation was graded and the pressor response to tracheal intubation assessed. There were no significant differences between treatment groups.     

510例腹腔镜联合纤维胆道镜胆总管切开取石术的临床应用

目的探讨腹腔镜联合纤维胆道镜治疗胆总管结石的可行性及临床应用价值。方法1998年～2007年对510例患者行腹腔镜胆总管切开取石(laparoscopic common duct exploration,LCDE),与同期300例开腹(opensurgery,OS)手术者比较。术前确诊者,术中直接行胆总管切开胆道镜取石;术前有黄疸史、胰腺炎史和(或)直接胆红素增高、胆系酶(AKP、GGT)增高者,或胆总管在0.8cm以上者行术中造影,明确有胆总管结石的切开胆总管胆道镜取石。405例置T管引流(留置T管组),105例行胆总管Ⅰ期缝合(I期缝合组)。结果手术均获成功,与OS组比较,手术时间、术中出血量、术后并发症发生率(胆瘘、出血)差异无统计学意义;住院日、术后镇痛药使用次数、腹腔或切口感染率、残石率明显减少。无中转开腹。30例T管引流口靠近肋弓而引起术后疼痛,2例术后2dT管才引流出胆汁。留置T管组有24例胆总管残余结石,3月后经胆道镜取石成功。留置T管组手术时间平均(110±15)min,平均术后住院8d;Ⅰ期缝合组手术时间(95±8)min,平均术后住院5d。结论LCDE是治疗胆总管结石安全、有效的方法,同样可起到创伤小、痛苦轻、恢复快、住院时间缩短等微创效果,如能在取净结石的情况下行胆总管Ⅰ期缝合,微创效果尤为明显。     

阿昔洛韦联合纳洛酮治疗小儿病毒性脑炎的临床体会

目的:探讨阿昔洛韦联合纳洛酮在小儿病毒性脑炎治疗中的作用。方法:将在本院入院的108例小儿病毒性脑炎患儿随机分为观察组和对照组,对照组患儿在综合治疗的基础上加服阿昔洛韦,观察组在对照组的基础上再静滴纳洛酮。对两组患儿的疗效及后遗症进行比较。结果:经治疗后,观察组的总有效率为92.6%,对照组的总有效率为72.2%,两组疗效比较,差异具有统计学意义(P<0.05)。结论:应用阿昔洛韦联合纳洛酮治疗病毒性脑炎,在提高总有效率和减少后遗症的发生率方面,疗效满意,值得在临床推广。     

腹腔镜与胆道镜联合取石术治疗肝内胆管结石的临床研究

目的:探讨腹腔镜联合胆道镜治疗肝内胆管结石的临床价值。方法:随机将80例肝内胆管结石患者分为2组,实验组(n=45)行腹腔镜联合胆道镜取石术,对照组(n=35)行单纯腹腔镜手术。结果:实验组45例手术均获成功,手术时间110～118 min,平均(160±15)min;术中出血量45～280 ml,平均(140±60)ml;住院6～8天,平均(7±2)天;42例结石完全取净,结石清除率93.3%,术后无一例发生胆漏、出血、脓肿等并发症。对照组手术时间130～220 min,平均(150±30)min;术中出血量80～350 ml,平均(180±75)ml;住院8～12天,平均(9±1)天;32例结石完全取净,结石清除率91.4%,术后2例发生胆漏。两组患者手术时间、术中出血量、住院时间差异有统计学意义(P<0.05),结石完全取净率及并发症发生率差异无统计学意义(P>0.05)。术后随访所有患者3～6个月,经胆道镜复查无一例复发。结论:腹腔镜术中联合胆道镜治疗肝内胆管结石安全有效,值得推广应用。     

Variables associated with survival in patients with invasive bladder cancer with and without surgery

We recorded the survival of 141 patients assessed for radical cystectomy, which included cardiopulmonary exercise testing. The median Kaplan-Meier survival estimates were: 1540 days for the whole cohort; 2200 days after cystectomy scheduled (n = 108); and 843 days without surgery. The mortality hazard remained double that expected for a matched general population, but survival was better in patients scheduled for surgery than those who were not: the mortality hazard ratio (95%CI) after cystectomy was 0.43 (0.26–0.73) the mortality hazard without surgery, p = 0.001. The mortality hazard ratios for the three-variable Bayesian Model Averaging survival model for all 141 patients were: referral for surgery (0.5); haemoglobin concentration (0.98); and efficiency of carbon dioxide output (1.05). Efficiency of carbon dioxide output was the single variable in the postoperative model (n = 108), mortality hazard 1.08 (per unit increase). The ratio of observed to expected peak oxygen consumption associated best with mortality in 33 patients not referred for surgery, hazard ratio 0.001. Our results can inform consultations with patients with invasive bladder cancer and suggest that interventions to increase fitness and haemoglobin may improve survival in patients who do and who do not undergo radical cystectomy.     

Severe thrombopenia associated with treatment with pentosan polysulfate

Two cases of severe thrombocytopaenia associated with acute thrombo-embolic manifestations during treatment by pentosan polysulphate, a low molecular weight heparinoid, are reported. Plasma samples from both patients caused in vitro aggregation in the presence of pentosan polysulphate. Interruption of the drug led to the recovery of the platelet count. The hypothesis of an immunoallergic mechanism similar to heparin associated thrombocytopaenia is supported. Furthermore, it seemed likely to be found with all the polysulphated X glycosaminoglycans. During treatment by pentosan polysulphate, platelet count should be monitored to avoid this potentially life-threatening syndrome.