Successful resuscitation after fatal carbon dioxide embolism during laparoscopic nephrectomy

Laparoscopic nephrectomy （LN） is a less invasive surgical option for patients with renal disease.However,it may be complicated with disastrous CO2 embolism,which is rare but a life-threatening consequence.Here,we present a case of lethal CO2 embolism during LN.Fortunately,the complication was detected early and managed successfully.Our case and literature review all revealed that gas embolism must be considered as a possible cause of sudden cardiocirculatory failure during LN;rapid diagnosis and definitive intervention can decrease fatality from such an injury.Possible mechanisms of CO2 embolism and the potential ways of handling such an event are also discussed.Keywords：laparoscopic nephrectomy; gas embolism; transesophageal echocardiography     

正常产后38小时发生急性肺栓塞1例

1病历简介患者25岁、孕1产0,孕38^＋1W,住院号58902,因“孕足月,阴道流水9h,阵发腹痛4h”为主诉,于2009年11月3日8Am以“G1P0孕338^＋1w临产、胎膜早破”急诊收住院。患者系G1P0,平素月经规律,孕期过程顺利,     

肺栓塞24例临床治疗分析

肺栓塞(pulmonary embolism)为内科常见病,其发病率呈逐年增高趋势,病情重,致死率高,已逐渐被临床医师所重视,肺栓塞近年发病率为0.5‰,未经治疗的肺栓塞病死率为25%～30%。目前,肺栓塞的漏诊率和误诊率普遍较高,本文分析总结肺栓塞的临床表现、诊断和临床的方法,进一步提高对肺栓塞的认识和重视。     

Laparoscopic left hemihepatectomy under occlusion of the left inflow and outflow

Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepatectomy, except for resection of the peripheral liver or left lateral segment when porta hepatis dissection is not indicated. Although both inflow and outflow control seems to be ideal in laparoscopic left hepatectomy, there have not been many reports of this. In addition to the high technical demands and the time required, any injury of the main hepatic veins or vena cava during the procedure will cause catastrophic bleeding and air embolism. Recently, we succeeded in achieving inflow and outflow occlusion during laparoscopic left hemihepatectomy in four cases, with satisfactory results.     

肺栓塞18例临床分析

肺栓塞是西方国家的常见病,病死率占全部疾病死因的第3位,仅次于肿瘤和心肌梗死[1]。我国目前尚无发病率的确切统计,但近年来随着临床诊断意识和临床检验手段不断提高,临床工作中肺栓塞的检出率逐渐增多。我院近2年诊断出急性肺栓塞18例,并对其进行溶栓抗凝治疗,效果良好,报道如下。1临床资料1.1一般资料18例为我院2004年5月至2006年10月的住院患者,男性13例,女性5例,年龄27岁～75岁。11例有烟酒嗜好,慢性反复性肺栓塞2例,有深静脉血栓史者7例,高血压9例,冠心病6例,肺源性心脏病5例,风湿性心脏病2例,左下肢骨折1例,胆囊手术1例,肿瘤1例,长期卧床2例。1.2临床表现突然起病14例,缓慢起病4例,其中6例为住院过程中长期卧床而发病。18例均有呼吸困难,10例严重呼吸困难。剧烈胸痛7例,伴压榨感4例,咯血5例、大咯血2例,咳嗽15例,剧烈干咳12例,面色苍白16例,烦躁不安18例,晕厥6例,休克8例。体征:颈静脉怒张7例,叩诊肺部浊音7例,听诊呼吸音减弱14例,两肺闻及湿啰音4例,左肺闻及湿啰音9例,闻及胸膜摩擦音5例,心界向左扩大10例,心动过速10例,肺动脉瓣第二音亢进12例,心尖部闻及收缩期杂...     

Kidney salvage by catheter guided thrombolysis in acute renal artery thromboembolic occlusions

Acute renal artery occlusion （ARAO） is a rare clinical entity. Typical clinical presentations of ARAO are non-specific and include acute lumbar or abdominal pain coexisting with nausea, vomiting and fever. Peripheral emboli are the major cause of ARAO, predominantly arising from cardiac diseases. Other, relatively frequent causes of ARAO include atherosclerosis, trauma, dissection or renal artery aneurysms.     

Surgical treatment of right atrial myxoma and pulmonary embolism

Myxomas are rare benign tumours,with an estimated incidence of 0.5 per million of population per year.1It is most commonly of left atrial origin （75% to 90%）,less commonly right atrial （10% to 25%）,and rarely ventricular （1% to 4%）.2 Right atrial myomata generally presents as right heart failure,with signs of tricuspid valve disease.The association of pulmonary embolism with right atrial myxoma has been recognized at autopsy for many years.     

Delayed cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma

Transcatheter arterial chemoembolization （TACE） has been an effective mean in treating hepatocellular carcinoma for nearly 30 years. The reported complications associated with TACE mainly include acute hepatic failure （accounting for 0.26%）, liver abscess （0.22%）, multiple intrahepatic aneurysms （0.17%）, hepatic artery occlusion （1.52%）, spontaneous rupture of tumor （0.15%）, gallbladder infarction （0.3%）, perforation of duodenum （0.05%）, acute renal failure （0.05%）,     

Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor: clinical presentation and chest imaging findings

Background Pulmonary lipiodol embolism after transarterial chemoembolization （TACE） was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven （2.3%） of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was （13.6＆#177;2.0） cm.All were hyper-vascular.The mean volume of lipiodol was （21.8＆#177;8.2） ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature.     

Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography

Background It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism.However,the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease.The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism （PE） severity using Mastora score.Methods This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography （CTPA）.The D-dimer level was noted.A pulmonary artery obstruction index （PAOI; Mastora score） ≥21.3% indicated severe obstruction of PE.A right ventricle/left ventricle （RV/LV） ratio 〉0.9 indicated RV dysfunction.Results The median D-dimer level and PAOI were 765 μg/L （95% C/：750-1 205 μg/L） and 16.77% （95% CI：16.32%-23.06%）,respectively.The D-dimer level was positively correlated with PAOI （r=0.417,P 〈0.000 1）.PAOI ≥21.3% was associated with high D-dimer levels （median,993 μg/L （95% C/：856-1 841 μg/L）,Z=-2.991,P=0.003）.The D-dimer level was correlated with the RV/LV ratio （r=0.272,P=0.024）.RV/LV ratios 〉0.9 were associated with high D-dimer levels （median,880 μg/L （95% CI：764-1 360 μg/L）,Z=-2.070,P=0.038）.PAOI was positively correlated with the RV/LV ratio （r =0.390,P=0.001）.After three months,both the PAOI and D-dimer levels decreased （Z=-7.009,P 〈0.000 1; Z=-6.976,P〈0.000 1,respectively）.Conclusion D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA,and can help monitor the therapeutic response.     

Major advances in respiratory medicine in China

Respiratory disease is the term for diseases of the respiratory system. These diseases range from mild and self-limiting such as the common cold to life-threatening such as bacterial pneumonia or pulmonary embolism. They are common and important causes of illness and death. In the US, people suffer 1 billion colds per year. One out of 7 people in the UK are affected by some kinds of chronic lung diseases, most commonly chronic obstructive pulmonary disease （COPD） and asthma. Respiratory disease accounts for over 10% of hospitalizations and over 16% of deaths in Canada.     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI）分子靶向治疗研究为肇始,转化性研究使基础实验和临床实践间的鸿沟迅速填平,改变着人们认识治疗肺癌的视角。无可否认,EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段,但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度,     

Pulmonary embolism with septicemia after N-butyl-2-cyanoacrylate injection for bleeding gastric varices

Despite many advances in the treatment of gastric variceal bleeding in the two past decades, its management continues to present a clinical challenge. Various treatment modalities have been proposed and since the first report in 1986 endoscopic injection sclerotherapy with cyanoacrylate tissue adhesives has become widely established in many countries as the treatment of choice for bleeding gastric varices. Severe complications of the treatment are infrequent.     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

Pulmonary embolism due to the right atrial thrombus mimicking atrial myxoma

Detection of a cardiac mass has a direct therapeutic implication because of its potential for pulmonary or systemic embolization. The choice of treatment is dependent upon the time of the embolization, clinical presentation and type of embolic mass. Imaging features in combination with clinical and laboratory findings are usually helpful in the differentiation of various cardiac masses with high probability. The case we are presenting is a 73-year-old man with occlusion of both pulmonary arteries and a right atrial thrombus initially diagnosed as a myxoma.     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.     

中医疗法治疗运动性疲劳的研究进展

随着竞技体育的发展，运动员经常承受着大负荷、超强度的体力训练，因此极易产生运动性疲劳。疲劳的出现使肌内压增高，局部缺血，造成氧化代谢、H^＋排出率与pH值降低，血乳酸增高，从而影响肌纤维神经传导速度和肌内收缩力量，减弱了肌肉保护能力。致使较多的冲击力传到骨骼上，故易导致疲劳骨折的发生,严重影响了运动员的训练和比赛成绩，对运动员身心产生不必要的伤害。运动性疲劳消除手段的研究一直是竞技体育工作和运动医学关注和研究的焦点。     

Effects of tacrolimus and cyclosporine treatment on metabolic syndrome and cardiovascular risk factors after renal transplantation: a meta-analysis

Background The therapeutic success of renal transplantation has been largely attributable to the development of effective and balanced immunosuppressive treatment regimens.This study provides a meta-analysis of a series of randomized controlled trials that compared the effects of tacrolimus and cyclosporine on metabolic syndrome （MetS） and cardiovascular risk factors after renal transplantation.Methods We searched various electronic databases and bibliographies,including MEDLINE,the Cochrane Central Register of Controlled Trials,and EMBASE,for relevant studies published prior to October 2012.Results Our meta-analysis included five randomized controlled trials that examined a total of 923 patients.The tacrolimus group and the cyclosporine group exhibited no significant differences in MetS incidence after renal transplantation; risk ratio （RR）：1.06,95％ confidence interval （C/）：0.73-1.55,P=0.76.Cyclosporine treatment was associated with a higher incidence of hyperlipidemia （RR：0.50,95％ CI：0.39-0.64,P ＜0.01）.Although there were no statistically significant differences,cyclosporine treatment was associated with a higher incidence of hypertension （RR：0.91,95％ CI：0.83-1.00,P=0.06） after renal transplantation compared to tacrolimus treatment,and tacrolimus treatment was associated with a higher incidence of diabetes after renal transplantation （RR：1.79,95％ CI：0.98-3.27,P=0.06） compared to cyclosporine treatment.Conclusions Compared to tacrolimus treatment,cyclosporine treatment was associated with a higher incidence of hyperlipidemia.Future large-scale studies are expected to be conducted to further confirm our findings.