Alveolar recruitment strategy and PEEP improve oxygenation,dynamic compliance of respiratory system and end‐expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease

Objective: Optimizing alveolar recruitment by alveolar recruitment strategy (ARS) and maintaining lung volume with adequate positive end‐expiratory pressure (PEEP) allow preventing ventilator‐induced lung injury (VILI). Knowing that PEEP has its most beneficial effects when dynamic compliance of respiratory system (Crs) is maximized, we hypothesize that the use of 8 cm H₂O PEEP with ARS results in an increase in Crs and end‐expiratory lung volume (EELV) compared to 8 cm H₂O PEEP without ARS and to zero PEEP in pediatric patients undergoing cardiac surgery for congenital heart disease. Methods: Twenty consecutive children were studied. Three different ventilation strategies were applied to each patient in the following order: 0 cm H₂O PEEP, 8 cm H₂O PEEP without an ARS, and 8 cm H₂O PEEP with a standardized ARS. At the end of each ventilation strategy, Crs, EELV, and arterial blood gases were measured. Results: EELV, Crs, and P_aO₂/FiO₂ ratio changed significantly (P < 0.001) with the application of 8 cm H2O + ARS. Mean P_aCO₂– PETCO₂ difference between 0 PEEP and 8 cm H2O PEEP + ARS was also significant (P < 0.05). Conclusion: An alveolar recruitment strategy with relative high PEEP significantly improves Crs, oxygenation, P_aCO₂– PETCO₂ difference, and EELV in pediatric patients undergoing cardiac surgery for congenital heart disease.     

枳椇子中甾类化合物的分离

从枳椇子Hovenia acerba中分离得到3个化合物,分别为β-谷甾醇(-βsitosterol)(Ⅰ);3β-Hydroxy-3-de-oxymoron ic ac id(Ⅱ)和胡萝卜苷(Ⅲ)。上述三个化合物均为自该属植物中首次获得。     

Pleomorphic adenoma of the vulva: a review illustrated by a clinical case

The pleomorphic adenoma of the vulva is an extremely scarce diagnosis. This form of neoplasm is more frequently observed in other topographic sites of the human body. Treatment modalities largely derive from experiences with the pleomorphic adenoma located in these other sites. As a result of similarity with other tumors and scarcity of the neoplasm, the diagnosis of pleomorphic adenoma of the vulva is easily missed in daily routine practice. Recurrences of this neoplasm are frequently observed with an estimated incidence of malignant transformation of 25%. Addressing this previously mentioned issue, an extensive surgical excision and long-term follow-up is advocated. This report is illustrated by the case of a 66-year-old woman who was admitted to our hospital with a pleomorphic adenoma of the vulva, diagnosed by pathologic assessments following surgical excision. As a result of the rarity of this diagnosis, characteristics and treatment of extravulvar in addition to vulvar localizations of the pleomorphic adenoma are reviewed.     

DNA content and Ks8.12 binding of the psoriatic lesion during treatment with the vitamin D3 nalogue MC903 and betamethasone

Twenty patients with psoriasis were treated with the vitamin D3 analogue MC903 and betamethasone ointment in a double-blind trial with a left-right comparison. In addition to the clinical severity scores, Ks8.12 binding which detects keratin 16 expression and the DNA synthesis were quantified using flow cytometry. Both markers decreased significantly with treatment, but remained above the normal range even in those who had total clearance of the lesions. Treatment with MC903 with regard to Ks8.12 binding was significantly better than with betamethasone.