Computed tomography of renal cell carcinoma in patients with terminal renal impairment

PURPOSE: Current kidney surgery uses less invasive laparoscopic and nephron-sparring procedures. Thus, perfect imaging of the renal vasculature is essential for surgery planning. The aim of our retrospective study was to evaluate the accuracy of 16-detector-row CT-angiography in assessing the vascular anatomy of the kidney with a tumor. SUBJECTS AND METHODS: Referred for computed tomography (CT) because of a suspected renal tumor, 50 consecutive patients (mean age 58.6 years; range 43-82) were enrolled into our retrospective study. All examinations were performed with 16x0.75 mm collimation after the intravenous application of 80 ml of a non-ionic contrast material. The imaging protocol contained two-phase scanning in the arterial and then in the venous phase. The vascular anatomy of the kidney with tumor was evaluated using volume rendered (VRT) and maximum intensity images (MIP). Findings were compared with the anatomy found during surgery. RESULTS: Forty-seven patients underwent nephrectomy, with an advanced clinical stage (IV) found in the three remaining ones. Correct topography of the renal hilus, including a number of arteries and veins, and the anatomy of their branching, was described in 46 patients. A very small upper polar artery was overlooked in one patient. The accuracy for the only-arterial was 97.9% and only-venous anatomy was 100%. The parasitic vasculature of the tumor was discovered in 10 cases and all of them were confirmed by surgery (100% accuracy). Macroscopic intravenous spread of the tumor was discovered in two cases, but microscopic intravenous invasion was confirmed during histology of the kidney specimens in another two cases, the overall tumor staging accuracy reaching 95.7%. CONCLUSION: Two-phase multidetector CT is a valuable tool for assessing vascular supply of the kidney before surgery due to the tumor and can fully replace catheter-based angiography.     

Comprehensive management of severe intestinal bleeding in a patient supported for 94 days by the biventricular Levitronix CentriMag system

The use of short-term mechanical circulatory support during postcardiotomy acute heart failure provides an opportunity to stabilize the patient's hemodynamic state while determining the best long-term strategy. Because all of these devices require anticoagulation treatment of various intensities, management of major bleeding can be critical for the overall outcome of the therapy. In this regard, the newest generation of magnetically levitated centrifugal-flow pumps affords several potential advantages in terms of thrombogenicity and eventual discontinuation of anticoagulation treatment. We report the use of a short-term biventricular assist device (Levitronix CentriMag) for 94 days in a 55-year-old man with refractory ventricular arrhythmias after combined heart surgery. Despite serious complications while the patient was on the assist device, including severe intestinal bleeding with the necessity of discontinuing anticoagulation for 10 days and, ultimately, hemicolectomy, the circulatory support was completed with successful heart transplantation.     

2009年心胸血管麻醉热点问题

全文汇总了2009年心胸血管麻醉领域权威性和学术性较高的临床研究资料．对去年本专业相关热点问题进行了概括性介绍。杂交手术室是心外科、心血管麻醉和心内科介入治疗三种专业人员进行经导管治疗的场所．经导管行主动脉瓣膜置换术的开展证明人们对腔内治疗技术变革的认同。通过药物预处理和缺血预处理实施的心肌保护具安全、有效的临床特点．因此它们是目前多项临床试验关注的重点。血管紧张素抑制、贫血以及内窥镜取大隐静脉技术可对冠状动脉旁路移植术（CABG）的预后造成不良影响。不停跳CABG与停跳cABG的临床预后对低风险患者等同．但后者有利于改善高风险患者预后。经皮冠状动脉介入治疗（PCI）能明显降低心肌梗死患者的病死率．然而主动脉内球囊反搏技术对此类患者的有效性证据却不尽如人意。普拉格雷已被批准用于PCI后的血小板抑制．但有可能被替卡格雷取代。PCl与CABG技术对冠脉血管多支病变患者临床预后的影响相似．但CABG对降低患者行再血管化治疗可能性．对耱尿病和年龄〉65岁患者术后生存率的提高更有益。羟乙基淀粉和N-乙酰半胱氨酸都能够增加心脏手术患者围术期出血量和输血量。Vll因子能够治疗致命性出血．但它的安全性有待进一步论证。具有够刺激血小板生成作用的血小板生成紊拟肽等药物可能在未来改善心脏手术后止血功能方面发挥作用。非诺多泮、心房利钠肽以及碳酸氢钠的肾保护作用有待进一步试验证实。强化胰岛素治疗并无改善临床预后作用．却明显增加低血糖的发生率。     

Increasing social variation in birth outcomes in the Czech Republic after 1989.

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.     

Unilateral absence of the terminal nerve and distribution of gonadotropin-releasing hormone immunoreactive neurons in the brain of the common mole-rat (Cryptomys, Rodentia)

A paired terminal nerve with gonadotropin-releasing hormone-immunoreactive (GnRHir) neurons was found in five of six specimens of the Zambian common mole-rat (Cryptomys sp.). In these animals the distribution of GnRHir neurons in the CNS was approximately even on both sides. One adult female lacked a right terminal nerve, yet exhibited a comparable total number of GnRHir neurons, most of which were located on the left side of the brain, i.e., on that side where the terminal nerve was present. An additional population of GnRHir cells was detected in the area of the parafascicular and dorsomedial thalamic nuclei of three non-reproductive adult females, but not in young animals (one female, two males). The additional GnRHir cells, referred to as dark spot cells (DSCs) since their perikarya exhibit large or small strongly immunoreactive vacuoles, were present on both sides of the brain in equal numbers even in the specimen with unilateral absence of the terminal nerve. Obviously, the lack of one terminal nerve correlates with a drastic reduction in the number of ipsilateral genuine neurons but leaves the DSCs unaffected.     

Administration of bisphosphonates for malignant hepatic tumor with hypercalcemia

Background/Aims: Hypercalcemia is a paraneoplastic syndrome that is a serious condition requiring urgent treatment. We administered alendronate to hypercalcemia patients with advanced cancer with metastasized liver tumors or hepatocellular carcinoma (HCC) and then evaluated the mechanism and anticancer function of this compound. Methodology: We retrospectively studied 17 patients with hypercalcemia associated with metastatic liver tumor or HCC. Alendronate (10mg) was administered via the intravenous route for patients with metastatic liver tumor (n=12) and via the hepatic artery for patients with HCC (n=5). Results: Intravenous administration of alendronate resulted in decrease in serum calcium levels in all patients. The serum levels of tumor markers also decreased in 66.7% (8/12) of these patients. After intra-arterial alendronate administration, the serum calcium and parathyroid hormone-related protein levels decreased in all the patients. The serum levels of tumor markers such as AFP and PIVKA-II were decreased in 80% (4/5) of these patients. Electron microscopic examination of the resected hepatic tumor revealed an increase in the vascularization and formation of apoptotic vesicles in the vascular endothelial cells. Conclusions: Alendronate is effective not only for controlling hypercalcemia but also for directly enhancing the apoptosis of HCC cells.