Bladder cancer within a direct inguinal hernia: CT demonstration

We present a case of a urothelial neoplasm arising within a direct bladder hernia in the inguinal canal. Bladder hernias are rarely found preoperatively and are exceptional sites of neoplasm. Spiral computed tomography with gaseous insufflation of the bladder demonstrated the bladder hernia and the extension of the neoplasm in the inguinal canal more accurately than other computed tomographic techniques with nonopacified and iodinated urine.     

Peritoneopleural communication associated with cirrhotic ascites: scintigraphic demonstration

Demonstration of peritoneopleural communication in patients with cirrhotic ascites has an important impact on treatment planning. We studied 12 such patients and found presence of peritoneopleural communication in five. Two had bilateral, one right-side and two left-side, pleural effusion. Pleural fluid protein content was less than 2 g/dL in all patients. Received: 30 January 1995/Accepted: 4 March 1995     

Laser assisted balloon angioplasty: bypassing the traditional methods

No two procedures will be identical as each patient will have different needs. Therefore, knowledge of sizes and limitations of catheters and laser probes is imperative to facilitate the LABA procedure. Advance preparation of the OR suite facilitates the procedure, which can proceed quickly after guidewire passage. Laser safety guidelines must be established and enforced throughout the procedure. A laser nurse, not responsible for circulating the case, should be identified and is responsible for laser safety during the procedure.     

Albumin infusion fails to restore circulatory function following paracentesis of tense ascites as assessed by beat-to-beat haemodynamic measurements

Aims: To study whether circulatory changes during large volume paracentesis (LVP) in patients with liver cirrhosis and tense ascites as assessed by novel non‐invasive haemodynamic measuring technology are reversed by subsequent albumin infusion. Materials and methods: Eleven patients with portal hypertensive ascites secondary to liver cirrhosis of Child's class B or C were studied during LVP (10.7 ± 4.4 l) and subsequent infusion of albumin. Digital arterial pulse waves were continuously measured by vascular unloading technique providing data for beat‐to‐beat values of systolic (P_s), diastolic (P_d) and mean arterial pressures (P_m), respectively, as well as for heart rate (F_h), stroke volume (V_s), cardiac output (Q_co) and peripheral resistance (R). Data extrapolated to the end of paracentesis, albumin infusion and follow‐up phases were compared with the end of the equilibration phase. Results: At the end of paracentesis, P_s, P_m and P_d changed by ?14 ± 15% (p < 0.05), ?16 ± 11% (p < 0.01) and ?17 ± 11% (p < 0.001), respectively, whereas Q_co and F_h did not change substantially. There was a highly significant increase in V_s by +21 ± 25% (p < 0.01). The largest change was seen in R which significantly decreased by ?29 ± 24% (p < 0.01). This change was not reversed by infusion of albumin and persisted up to the end of follow‐up. Conclusion: The haemodynamic changes following LVP appear to be first and foremost controlled by changes in peripheral resistance with insufficient cardiac compensation. Further studies combining albumin with vasopressors for prevention of paracentesis‐induced circulatory changes are needed.     

Mechanism of direct spread of abdominal neuroblastoma: CT demonstration and clinical implications

Neuroblastoma, a malignant tumor of neural crest origin, is the most common extracranial solid tumor in children. In 1971 Evans et al. introduced a clinical staging for neuroblastoma. Over sixty percent of patients present with neuroblastoma beyond stage I. Despite more aggressive therapy there has been only minimal improvement in survival.Since 1978, all patients with neuroblastoma have had CT scanning as part of their initial evaluation at our institution. Children with abdominal neuroblastoma beyond stage I form the basis of this report.Selected cases illustrating the permeative nature of neuroblastoma and the mechanism of direct abdominal spread by CT scanning are presented. The tumor originates in the retroperitoneum and spreads to the abdominal aorta where it gains access to the subperitoneal space via the celiac axis and superior mesenteric artery. These vessels course from the aorta to their ultimate destination within their peritoneal folds. These folds form the interconnecting space (subperitoneal space) between the retroperitoneum and the peritoneal organs.Such scanning is extremely sensitive in detecting neuroblastoma with early infiltration into adjacent tissues and contiguous spread through abdominal spaces. The clinical implications of the permeative nature of neuroblastoma and the mechanism of contiguous abdominal spread are discussed.     

临床护理路径模式在肝硬化腹水中的实施效果

目的:探讨临床护理路径模式在肝硬化腹水规范化护理中的作用.方法:选择我院120例肝硬化腹水患者,随机分为观察组与对照组各60例,观察组采取临床护理路径模式,对照组采取传统护理模式,观察两组护理质量评分,治疗前后患者健康知识掌握情况意义、患者满意度、住院时间及医疗费用等差异.结果:观察组患者满意度、健康知识、平均住院时间、住院费用等与对照组比较有统计学意义.结论:采用临床护理路径模式能规范护理流程,提高护理质量,提高患者满意度,缩短住院时间,减少住院费用.     

直接穿刺建立血液透析血管通路连接方法的改进

目的提高血液透析中直接穿刺动、静脉成功率,减少穿刺点肿胀.方法将直接穿刺动静脉行血液透析的患者(300例次)随机分为2组,观察组150例次,采用改进的血管通路连接方法,对照组150例次,采用传统的血管通路连接方法.结果2组的肿胀率经统计学分析,χ2=3.94,p＜0.05,有显著性差异.结论改进的血液透析血管通路连接方法优于传统方法.     

Transforming growth factor signalling: a common pathway in pulmonary arterial hypertension and systemic sclerosis

Pulmonary arterial hypertension (PAH) is a clinical condition characterised by the presence of precapillary pulmonary hypertension (PH). Included within the subcategorisation of PAH are heritable (HPAH) and PAH associated various conditions (APAH) including systemic sclerosis (SSc). The pathogenesis of HPAH and SSc has been linked to both a genetic predisposition and epigenetic factors. TGF-β superfamily signalling has also been implicated in the development of these conditions. In this review, we discuss the role of genetic predisposition, epigenetic factors along with dysregulation in TGF-β superfamily signalling in the pathogenesis of PAH and SSc.     

Vascular reactivity to phenylephrine and angiotensin II: comparison of direct venous and systemic vascular responses.

The objective of this study was to determine the relationship between peripheral venous responsiveness (use of the dorsal hand vein compliance technique) and systemic vascular responsiveness (measurement of blood pressure changes) to phenylephrine and angiotensin II in humans. There was a significant correlation (r = 0.70, p less than 0.02) between the dose causing a 20 mm increase in mean arterial pressure and the dose producing half-maximal response in the hand vein (log ED50) for phenylephrine but not for angiotensin II. There was no correlation between the systemic responses to angiotensin II and phenylephrine, but there was a significant correlation (r = 0.70, p less than 0.02) between the log ED50 measurements for phenylephrine and angiotensin II in the hand vein experiments. These findings suggest that systemic and hand vein responsiveness to phenylephrine are similar. Consequently, in evaluating alpha-adrenergic receptor mediated responses, the dorsal hand vein compliance approach offers a satisfactory alternative to the use of systemic hemodynamic changes.     

Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis

The diagnosis of tuberculosis (TB) ascites using standard diagnostic tools is difficult. The aim of the present meta-analysis was to establish the overall diagnostic accuracy of adenosine deaminase (ADA) levels in ascites for diagnosing TB ascites. A systematic review was performed of English language publications prior to April 2013. Sensitivity, specificity, and other measures of the accuracy of ADA for the diagnosis of TB ascites using ascites fluid were summarized using a random-effects model or a fixed-effects model. Receiver operating characteristic curves were used to summarize overall test performance. Seventeen studies involving 1797 subjects were eligible for the analysis. The summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under cure of overall analysis were: 0.93, 0.94, 13.55, 0.11, 169.83, and 0.976, respectively; the results of sensitivity analysis of studies that used Giusti method were 0.94, 0.94, 12.99, 0.08, 183.18, and 0.977, respectively. Our results suggest that ADA in the ascites can be a sensitive and specific target and a critical criterion for the diagnosis of TB ascites.     

Bench-to-beside review: Acute-on-chronic liver failure - linking the gut,liver and systemic circulation

The concept of acute-on-chronic liver failure (ACLF) was introduced recently to describe a subset of patients with chronic liver disease presenting with profound deterioration of liver function and rapidly evolving multi-organ failure. ACLF is frequently accompanied by the development of severe inflammatory response syndrome and has a high mortality. To date, treatment options are limited and exclusively supportive. Over the last few years, some insights have been generated in the pathophysiology of ACLF. A key role for the interaction of innate immune dysfunction, enhanced bacterial translocation from the gut, and circulatory dysfunction has been proposed. In this respect, therapeutic strategies have been examined, with variable success, in experimental studies in animals and humans. This review focuses on potentially relevant pathophysiological elements in the development of ACLF and points out promising treatment modalities in ACLF.     

Atrial function in the Fontan circulation: comparison with invasively assessed systemic ventricular filling pressure

The International Journal of Cardiovascular Imaging - Abnormal atrial mechanics in biventricular circulations have been associated with elevated left heart filling pressures. Similar associations...     

Following the cytokine signaling pathway to leukemogenesis: a chronology

Studies over the past 50 years revealing the molecular events that promote normal T lymphocyte cycle competence and progression led to a detailed understanding of how cytokines function to regulate normal hematopoietic cell proliferation. During that same period, the molecular and genetic changes introduced by the Philadelphia chromosome in chronic myelogenous leukemia were unraveled, and these have led to an understanding of how mutations that constitutively activate normal cytokine signaling pathways can cause unregulated cell proliferation and malignant transformation. Based on the paradigm established by these data, it is inescapable that going forward, investigators will operate under the hypothesis that transformation of additional cells and tissues will have a similar pathogenesis.