Effects of hemoperfusion plus high-flux hemodialysis in a patient with methotrexate toxicity

Acute methotrexate toxicity resulting from methotrexate-induced renal fáilue is a medical emergency requiring extracorporeal removal of methotrexate. The optimum method of methotrexate removal has not yet been established. We report a case of osteosarcoma with lung metastasis that was treated with high-dose methotrexate as adjuvant chemotherapy. Although no problems occurred after the first 5 courses of methotrexate, methotrexate-induced renal failure and methotrexate toxicity appeared after the sixth course. The patient was treated, either with hemoperfusion plus high-flux hemodialysis, or hemoperfusion alone, and pre- and post-treatment serum methotrexate concentrations were monitored. The reduction in methotrexate by hemoperfusion alone for 2 hours was 54%, compared to a mean reduction of 59% by hemoperfusion combined with high-flux hemodialysis, for 3 hours. Rebound increases in methotrexate levels were small (less than 1 μmol/L) with either method. The combination of hemoperfusion and hemodialysis resulted in good control of volume status, as well as improvement in serum chemistry values.     

Anaesthesia for cervical laminectomy in a patient with total anomalous pulmonary venous connection

A 45-yr-old male patient, having total anomalous pulmonary venous connection (TAPVC) underwent cervical laminectomy under general anaesthesia without complication. The case was diagnosed preoperatively by angiocardiography. An uncomplicated patient of TAPVC can undergo non-cardiac surgery with due precaution against air-embolism and hypoxaemia.     

A prospective crossover comparison study of the single-needle and multiple-needle techniques for facet-joint medial branch block

BACKGROUND AND OBJECTIVES: Medial branch blocks have been widely described in the literature as a diagnostic tool for facet joint pain. Recently, a new "single-needle' technique was described that is purported to be equally accurate, and in some respects, superior to the standard multiple-needle technique. To date, no studies have been performed that compared these 2 techniques. METHODS: In a multicenter setting, 24 subjects underwent 2 separate diagnostic medial-branch blocks in a randomized, single-blind crossover comparison of the single-needle and multiple-needle techniques. Multiple variables were compared between the 2 techniques, including procedure-related discomfort, post-procedure pain relief, volume of local anesthetic required, accuracy as determined by final needle position and contrast-media spread, and time needed to perform the procedure. RESULTS: In this pilot study, the single-needle technique resulted in less procedure-related pain (P = .0003), required less superficial local anesthesia (P =.0006), and took less time to complete (P < .0001) than did the multiple-needle approach. With regard to final needle position, contrast spread, and post-procedure pain relief (P = .8), no differences were noted between the 2 techniques. CONCLUSIONS: Our results indicate that the single-needle technique takes less time to perform and causes less patient discomfort than does the standard technique but provides the same degree of accuracy. More studies with larger sample sizes are needed to corroborate these results and explore the effect the single-needle approach has on the rate of false-positive medial branch blocks.     

关节镜下穿刺针改良缝合修复技术在治疗半月板纵行撕裂伤病例中的对照观察

目的:比较关节镜下穿刺针改良缝合技术和Fast-Fix 全内技术在缝合修复半月板纵行撕裂患者中的治疗效果.方法:回顾性研究2016 年7 月至2017 年7 月行半月板缝合修复手术的半月板纵行撕裂患者,穿刺针改良缝合组91 例,Fast-Fix 组77 例.两组患者年龄分别为(26.7±7.6)岁与(27.9±6.1)...     

Total cavopulmonary connection using a pedicled pericardial conduit for a patient with apicocaval juxtaposition

A 5-year-old boy, with a double inlet solitary ventricle, pulmonary atresia, and apicocaval juxtaposition underwent an extracardiac total cavopulmonary connection. A pedicled pericardial conduit was placed behind the ventricle to make a straight pathway between the inferior vena cava and pulmonary artery. This report presents a solution for managing patients with complicated heart defects with apicocaval juxtaposition during the completion of a total cavopulmonary connection.     

血液灌流联合血液透析治疗尿毒症的临床观察

Objective To compare the curative effect of hemodialysis (HD) with hemoperfusion combined hemodialysis (HP + HD). Methods 30 patients with uremia who needed long-term hemodialysis were considered as group-treated with HP + HD, another control group(n = 28) as interfered one- treated with HD alone. Blood uremia nitrogen(BUN), creatinine(Cr), β2- microglobulin(β2- MG) , parathyroid hor-mone(PTH), hemoglobin(Hb) and clinical manifestation of the patients were obscrved before and after the treatment of 1 month.Results Serum β2- MG and PTH in the group-treated significantly decreased, and Hb was significantly increased and the amelioration of clinical symptom was more superior as compared with those before treatment and in control group, there were no significant difference to the clearance rates of BUN and Cr. Conclusion Using HP + HD could clear up β- MG, PTH and ameliorate clinical symptom better than using HD alone.     

血液灌流联合血液透析治疗尿毒症的临床观察

目的 比较血液灌流联合血液透析与单独血液透析对尿毒症的治疗效果.方法 将30例血液透析患者进入血液灌流联合血液透析治疗(治疗组),并与单独血液透析治疗的28例患者(对照组)的疗效进行对比分析,观察比较临床症状改善情况、治疗前、治疗后1个月血液尿素氮、肌酐、β2-微球蛋白、甲状旁腺激素及血红蛋白的指标.结果 治疗组临床症状的改善优于对照组;治疗组β-微球蛋白、甲状旁腺激素、血红蛋白与治疗前比较差异有统计学意义(P<0.01);对照组β2-微球蛋白、甲状旁腺激素、血红蛋白与治疗前比较则无统计学意义(P>0.05);两组间各指标比较差异有统计学意义(P<0.01);两种方法在清除血液尿素氮、肌酐方面比较均无统计学意义(P>0.05).结论 血液灌流联合血液透析治疗能更好地清除体内β2-微球蛋白、甲状旁腺激素等中分子物质,临床症状改善效果优于血液透析.     

Predicted clinical factors associated with the intensive care unit length of stay after total cavopulmonary connection

Objectives

A longer length of stay (LOS) in the intensive care unit (ICU) after the total cavopulmonary connection (TCPC) is thought to be a predictive sign of late Fontan failure. This study was performed to determine the clinical risk factors for ICU LOS.

床旁血液灌流联合连续性静脉静脉血液滤过抢救苯巴比妥东莨菪碱中毒致呼吸停止一例

血液灌流(HP)和连续性静脉静脉血液滤过(CVVH)已成为抢救危重中毒患者的有效方法.我院使用床旁HP联合CVVH成功抢救苯巴比妥东莨菪碱中毒致呼吸停止1例.     

血液灌流对维持性血液透析患者生存质量的影响

目的采用简明健康测量量表SF-36评价间断血液灌流对维持性低通量血液透析患者生存质量的影响。方法选择慢性肾衰竭维持性血液透析患者41例,将其分为低通量透析组和联合间断血液灌流透析组。患者在纳入研究后采用SF36量表进行基础评分,并随访12周,再次填写调查表进行评分．同时测定血常规、。肾功能、电解质、全段甲状旁腺激素（iPTH）水平改变。结果联合间断血液灌流组与低通量透析组比较,生理功能、躯体疼痛、活力、情感职能和精神健康等多个生存质量维度上具有显著差异,血红蛋白水平前者高于后者,血iPTH水平前者显著低于后者。结论低通量透析联合间断血液灌流能进一步改善贫血和钙磷代谢,从而提高患者的生存质量。     

血液灌流联合血液透析治疗尿毒症的临床观察

由于慢性肾衰竭时甲状旁腺激素(PTH)升高,引起皮肤瘙痒、软组织钙化、贫血、失眠等,而血液透析(HD)对其清除很少.血液灌流(HP)可选择性地清除PTH及一些中分子物质,减轻皮肤瘙痒、失眠等症状.     

The polytrauma patient in the intensive care unit

Patients admitted to an intensive care unit with the diagnosis "polytrauma" differ from other patients by their typical trauma-associated morbidity (diffusive bleeding, traumatic brain injury, lung contusion), and by the staged surgical treatment of multiple injuries. The complexity of the clinical picture, and the complexity of the chronological order of the operative phases require a close cooperation of the medical specialist disciplines involved. The perioperative morbidity and mortality of polytrauma victims has been reduced significantly within the last 30 years due to an adapted transfusion- and substitution regime (rational utilization of anemia tolerance, calculated substitution of coagulation factors), due to modern therapeutic regimes for the patient with traumatic brain injury (stabilization of cerebral perfusion pressure, stabilization of adequate cerebral oxygenation), and due to the modern therapeutic strategies of mechanical ventilation (lung-protective ventilation, kinetic therapy, non-invasive ventilation). The aim of this review is to describe these modern therapeutic principles of the intensive care unit treatment of the polytrauma patient.     

Continuous venovenous hemofiltration and hemoperfusion in successful treatment of a patient with crush syndrome and acute pancreatitis

In this article, we report a patient with crush syndrome (CS) who developed acute renal failure (ARF) and acute pancreatitis. Continuous venovenous hemofiltration (CVVH) and intermittent hemoperfusion (HP) were successfully performed in this patient and satisfactory effects were achieved. The treatment of this patient suggested that early intervention with continuous renal replacement therapy (CRRT) may be useful and a multiple-mode treatment may be a better choice.     

Fixed-bed uncoated charcoal hemoperfusion in the treatment of intoxications: animal and patient studies.

We examined the efficacy of a new, fixed-bed, uncoated charcoal device in experimentally intoxicated dogs and in drug-intoxicated as well as chemically poisoned patients. In the animal studies, 4 h of hemoperfusion resulted in a significant decrease in the blood level of phenobarbital, salicylate, pentobarbital and glutethimide. The drug clearances varied between 97 +/- 10 and 129 +/- 6 ml/min. However, the total amount of drug removed was higher for phenobarbital and salicylate which have a small apparent volume of distribution (AVD) than for pentobarbital and glutethimide which have an AVD greater than total body water. We next treated 14 patients suffering from a wide variety of intoxications. Patients intoxicated with phenobarbital, methsuximide, chlordane and Amanita muscaria all showed a significant improvement in their clinical status. Patients intoxicated with ethchlorvynol, glutethimide, methaqualone, podophyllin and fluoroacetamide did not improve. Charcoal hemoperfusion may be useful in patients poisoned with drugs characterized by an AVD smaller than total body water. No major complications were encountered during the hemoperfusions.     

Never amputate a patient with diabetes without consulting with a specialized unit

This study presents a case report of a patient who underwent a severe infection following revascularization because dry necrosis became infected. A major amputation had been indicated because the infection did not respond to antibiotics and advanced wound care with topical negative pressure wound therapy with silver. The patient did not accept the major amputation and attended the authors' specialized unit. Persistent osteomyelitis was diagnosed with a simple X-ray, a cheap tool. Local surgery, antibiotics, appropriate wound care, and split-skin grafting achieved limb salvage in 12 weeks in this patient who had been scheduled for major amputation. Major amputation in patients with an infected foot can sometimes be avoided by correct diagnosis of infection and managing appropriately with specialized support.