Utility of DRG and ICD-9-CM classification codes for the study of transfusion issues. Transfusions in patients with digestive diseases

Red cell transfusions in all patients within specific medical or surgical diagnosis-related groups (DRGs) and International Classification of Diseases (ICD-9-CM) classes were analyzed by a unique body of data that combined abstracted patient discharge records with the numbers of red cell units transfused. Informative measures of transfusion practice within an ICD-9-CM class were the proportion of patients transfused, the mean units transfused per patient, and the ratio of standard deviation to the mean of units transfused. Transfusion frequency plots (percentage of patients against units of red cells transfused per patient) revealed the existence of a modal transfusion frequency, as well as an asymmetric tail on the high frequency side. These and other features make it possible to characterize transfusion practice in specific ICD-9-CM classes. The mean units of red cells transfused for all patients in a DRG is a measure of blood resource utilization and should be useful in planning to meet future needs.     

Oocyte retrieval in an in vitro fertilization-embryo transfer program: comparison of four methods

The records of 191 patients involved in 316 treatment cycles over 3 years in an in vitro fertilization-embryo transfer program were reviewed. Follicular aspiration, oocyte retrieval, pregnancy rates, technical difficulty, and complications were compared in four oocyte retrieval methods: 117 laparoscopic retrievals, 116 ultrasound (US)-guided percutaneous transvesical retrievals, 43 US-guided transvaginal retrievals, and 40 combined US and laparoscopic retrievals. The mean number of aspirated follicles (9.14) was greatest in the transvaginal retrieval group, but the ratio of oocytes to punctured follicles was not statistically greater in any of the groups. The overall clinical pregnancy rate per cycle was highest in the transvaginal retrieval group: 12 of 43 cycles resulted in pregnancy, or 27.9%. The number of delivered babies (16.3%) was also highest in the transvaginal retrieval group. US-guided transvaginal oocyte retrieval is recommended as the method of choice.     

Percutaneous transluminal renal angioplasty: initial and long-term results

Renal artery stenosis in 201 patients with hypertension was treated with percutaneous transluminal renal angioplasty (PTRA). A total of 213 procedures were performed as treatment of 262 separate stenosis. The stenosis was caused by atherosclerosis in 134 cases and by fibromuscular dysplasia (FMD) in 52 cases; the cause was indeterminate in 27 cases. Of the 213 procedures, 172 were successful or resulted in improvement, for a technical success rate of 80.8%. The initial clinical results could be evaluated in 210 cases; cure or improvement was achieved in 80%. There were 23 cases in which neither technical nor clinical success was achieved. Data on the remaining 187 cases were the basis of this long-term follow-up study. The cumulative patency rate at 5 years was 80% in the atherosclerosis group, 89% in the FMD group, and 74% in the indeterminate group. The mortality was less than 1%. Because spasm occurred in 33 cases, causing an infarction in ten instances, antispasmodic medication seems warranted. These long-term results indicate that PTRA is the treatment of choice in patients with renovascular hypertension.     

Chronic traumatic diaphragmatic hernia: the significance of pleural effusion

Five patients with chronic traumatic diaphragmatic hernia presented with symptoms of acute intestinal obstruction and unilateral pleural effusion. In each case, infarcted herniated abdominal structures were found at surgery. The presence of an ipsilateral pleural effusion is an important radiographic sign, which may indicate strangulation in patients with chronic traumatic diaphragmatic hernia.     

Fat suppression by section-select gradient reversal on spin-echo MR imaging. Work in progress

A method to decrease the intensity of fat by reversal of the section-select gradient is demonstrated. This technique takes advantage of the chemical shift in section location.     

参三七皂甙Rg1对实验性血栓形成的影响及其机制探讨

用大鼠动静脉血栓形成模型，研究参三七皂甙Ｒｇ１抗血栓作用。结果表明，参三七皂甙Ｒｇ１可明显降低实验性血栓形成，对大鼠血浆纤溶系统亦有明显作用，可升高血浆中组织纤溶酶原激活物（ｔＰＡ）活性和活性型ｔＰＡ百分比，降低组织纤溶酶原激活物抑制剂（ＰＡＩ）活性。同时利用培养大鼠血管内皮细胞实验，发现Ｒｇ１可以剂量依赖性提高血管内皮细胞一氧化氮（ＮＯ）释放。提示Ｒｇ１抗血栓作用与增强纤溶系统活性，促进血管内皮ＮＯ释放有关