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91.
Thomas H Ottens Maarten WN Nijsten Jan Hofland Jan M Dieleman Miriam Hoekstra Diederik van Dijk Joost MAA van der Maaten 《Critical care (London, England)》2015,19(1)
IntroductionBlood lactate levels are increasingly used to monitor patients. Steroids are frequently administered to critically ill patients. However, the effect of steroids on lactate levels has not been adequately investigated. We studied the effect of a single intraoperative high dose of dexamethasone on lactate and glucose levels in patients undergoing cardiac surgery.MethodsThe Dexamethasone for Cardiac Surgery (DECS) trial was a multicenter randomized trial on the effect of dexamethasone 1 mg/kg versus placebo on clinical outcomes after cardiac surgery in adults. Here we report a pre-planned secondary analysis of data from DECS trial participants included at the University Medical Center Groningen. The use of a computer-assisted glucose regulation protocol—Glucose Regulation for Intensive care Patients (GRIP)—was part of routine postoperative care. GRIP aimed at glucose levels of 4 to 8 mmol/L. Primary outcome parameters were area under the lactate and glucose curves over the first 15 hours of ICU stay (AUC15). ICU length of stay and mortality were observed as well.ResultsThe primary outcome could be determined in 497 patients of the 500 included patients. During the first 15 hours of ICU stay, lactate and glucose levels were significantly higher in the dexamethasone group than in the placebo group: lactate AUC15 25.8 (13.1) versus 19.9 (11.2) mmol/L × hour, P <0.001 and glucose AUC15 126.5 (13.0) versus 114.4 (13.9) mmol/L × hour, P <0.001. In this period, patients in the dexamethasone group required twice as much insulin compared with patients who had received placebo. Multivariate and cross-correlation analyses suggest that the effect of dexamethasone on lactate levels is related to preceding increased glucose levels. Patients in the placebo group were more likely to stay in the ICU for more than 24 hours (39.2%) compared with patients in the dexamethasone group (25.0%, P = 0.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P = 0.759).ConclusionsIntraoperative high-dose dexamethasone increased postoperative lactate and glucose levels in the first 15 hours of ICU stay. Still, patients in the dexamethasone group had a shorter ICU length of stay and similar mortality compared with controls.
Trial registration
ClinicalTrials.gov . Registered 16 February 2006. NCT00293592Electronic supplementary material
The online version of this article (doi:10.1186/s13054-015-0736-9) contains supplementary material, which is available to authorized users. 相似文献92.
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Venous renal tumor extension: a prospective US evaluation 总被引:1,自引:0,他引:1
To evaluate the ability of ultrasonography (US) to determine venous tumor extension, we studied 120 consecutive patients with renal neoplasms. The incidence of renal vein involvement in this group was 18%; caval tumor extension occurred in 11% of the patients. Real-time US clearly visualized the entire retrohepatic inferior vena cava (IVC) in 96% of the examinations, and the ipsilateral renal vein was well seen on 88% of the scans. Of the caval sonograms that could be evaluated (115/120), intravascular tumor thrombi were detected in all 13 cases (sensitivity and specificity = 100%). Of the assessable sonograms of the renal vein (105/120), tumor invasion was identified by US in 21 of 22 cases (sensitivity = 95.5%, specificity = 100%). Venous tumor involvement was seen with intravascular lesions of different echogenicity, which caused a neoplastic-induced renal or caval vein enlargement in most cases. Our findings show that US is of great value in the preoperative assessment of intravascular tumor extension and provides a useful alternative to inferior venacavography. 相似文献
96.
May-Thurner syndrome 总被引:1,自引:0,他引:1
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Rachel W. Kubiak Leila R. Zelnick Andy N. Hoofnagle Charles E. Alpers Christi M. Terry Yan-Ting Shiu Alfred K. Cheung Ian H. de Boer Cassianne Robinson-Cohen Michael Allon Laura M. Dember Harold I. Feldman Jonathan Himmelfarb Thomas S. Huber Prabir Roy-Chaudhury Miguel A. Vazquez John W. Kusek Gerald J. Beck R. Star 《European journal of vascular and endovascular surgery》2019,57(5):719-728
100.
Dialysis-related amyloidosis is a complication of end-stage renal disease (ESRD) that results from retention of beta2-microglobulin (beta2M) and its deposition as amyloid fibrils into osteoarticular tissue. The clinical manifestations usually develop after several years of dialysis dependence and include carpal tunnel syndrome, destructive arthropathy, and bone cysts and fractures. High-flux membranes, daily dialysis, and hemofiltration all would be expected to delay the onset of dialysis-related amyloidosis because, to varying degrees, each increases the clearance of beta2M from the plasma. Thus what is currently a late complication of ESRD might become an even later complication as dialysis practices change. The significance of histologically evident but clinically silent beta2M amyloid, detectable not only in osteoarticular tissue but also in blood vessels, is unclear. Accumulating evidence that amyloidogenic proteins have direct and specific effects on cell processes irrespective of the extent of amyloid deposition raises the possibility that early, clinically silent beta2M amyloid deposits have unrecognized importance. 相似文献