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61.
Luis Gajate Ascensión Martín Elena Elías Maria T Tenorio Angélica de Pablo Cristina Carrasco Adolfo Martínez Angel Candela Javier Zamora Fernando Lia?o 《Liver transplantation》2006,12(9):1371-1380
Although renal dysfunction is common after liver transplantation, postoperative renal function after split liver transplantation (SLT) has not been well studied. Renal function immediately after surgery was analyzed retrospectively in 16 patients that received a SLT (SLT group). The results were compared with corresponding data from 31 matched patients that received a full-size liver transplant (FSLT group) during the same period. Serum creatinine (SCr) was measured before surgery, and, after transplantation, daily during the first week and at days 14, 21, and 28. Renal dysfunction (RD) was defined as the requirement for renal replacement therapy (RRT) or a 100% increase in SCr if the basal value had been <1.0 mg/dL or a 50% increase in SCr if the basal value had been >1.0 mg/dL. SCr had to be at least 1.5 mg/dL for a diagnosis of RD to be considered. The classification of RD was: mild, SCr 1.5-2.4 mg/dL; moderate, SCr 2.5-4.0 mg/dL; or severe, SCr >4.0 mg/dL (the requirement for RRT). Both donor and recipient age and cold ischemia time were lower in the SLT group than in the FSLT group (P < 0.05). Length of surgery was longer in the SLT group (P < 0.05). There were no significant differences between groups with respect to Model for End-Stage Liver Disease scores, the need for transfusions, the length of admission to the intensive care unit (ICU), survival rate, individual severity index, or sepsis-related organ failure assessment scores at the time of diagnosing RD. Immunosuppression regimens were similar in both groups. RD developed in 82% of SLT patients, but in only 58% of FSLT patients (P = not significant [NS]). Among SLT patients, RD (23.0% mild, 15.5% moderate, and 61.5% severe) was more severe (P = 0.007) than in FSLT patients (63.1% mild, 15.8% moderate, and 24.1% severe). The requirement for RRT in the SLT group (43.7%) was significantly greater (P < 0.05) than that in the FSLT group (12.9%). This finding may be due to the different incidence of sepsis in the 2 groups (SLT 37.5% vs. FSLT 9.7%; P < 0.05). In conclusion, although the number of patients studied was small, our data suggest a higher incidence of RD and a greater requirement for RRT in patients that receive a split liver graft than in those that receive a full size liver graft. 相似文献
62.
L González-Bayón S González-Moreno G Ortega-Pérez 《European journal of surgical oncology》2006,32(6):619-624
The new treatment strategy for Peritoneal Surface Malignancy combines a cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cytoreduction removes all macroscopic tumor. Intraperitoneal chemotherapy avoids implantation of microscopic residual tumor cells on intra-abdominal surfaces when it is administered intraoperatively and/or early in the postoperative period. Delivering cytotoxic drugs directly into the peritoneal cavity maximizes dose intensity and minimizes systemic toxicity. Hyperthermia is selectively cytotoxic for malignant cells and potentiates the effect of chemotherapy. Implementation of this procedure makes the perioperative personnel to face a risk of exposure to cytotoxic agents. Furthermore, peritonectomies and electro-evaporation of tumor nodules are performed with high voltage electrocautery, generating a large amount of surgical smoke during several hours. Inhalation of these fumes may be also a risk for healthcare workers. In this article, we analyse in depth these new risks of the operating room personnel, we review the literature, and we give guidelines for secure performance of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy, as well as for early postoperative intraperitoneal chemotherapy administration. These new procedures are safe techniques for patients and healthcare workers provided adequate policies are adopted to avoid occupational exposure. 相似文献
63.
Benedita Sampaio-Maia Mónica Moreira-Rodrigues Paula Serr?o Manuel Pestana 《Nephrology, dialysis, transplantation》2006,21(2):314-323
BACKGROUND: A primary tubular sodium handling abnormality has been implicated in the edema formation of nephrotic syndrome. Dopamine synthesized by renal proximal tubules behaves as an endogenous natriuretic hormone by activating D(1)-like receptors as a paracrine/autocrine substance. METHODS: We examined the time courses of the urinary excretion of sodium, protein and dopamine in puromycin aminonucleoside (PAN)-treated and control rats. The rats were sacrificed during greatest sodium retention (day 7) as well as during negative sodium balance (day 14) for the evaluation of renal aromatic l-amino acid decarboxylase (AADC) activity, the enzyme responsible for the synthesis of renal dopamine. Also, the influence of volume expansion (VE) and the effects of the D(1)-like agonist fenoldopam (10 microg/kg bw/min) on natriuresis and on proximal tubular Na(+),K(+)-ATPase activity were examined on day 7. RESULTS: The daily urinary excretion of dopamine was decreased in PAN-treated rats, from day 5 and beyond. This was accompanied by a marked decrease in the renal AADC activity, on days 7 and 14. During VE, the fenoldopam-induced decrease in proximal tubular Na(+),K(+)-ATPase activity was more pronounced in PAN-treated rats than in controls. However, the urinary sodium excretion during fenoldopam infusion was markedly increased in control rats but was not altered in PAN-treated animals. CONCLUSION: PAN nephrosis is associated with a blunted renal dopaminergic system activity which may contribute to enhance the proximal tubular Na(+),K(+)-ATPase activity. However, the lack of renal dopamine appears not to be related with the overall renal sodium retention in a state of proteinuria. 相似文献
64.
Gábor Márk Somfai Kata Miháltz Eszter Tulassay János Rigó 《Hypertension in pregnancy》2006,25(1):11-20
OBJECTIVE: Visual symptoms are common in patients with preeclampsia, and are caused by various underlying pathological changes in the retina. Blurred vision may be one of these symptoms. We describe three cases in which the underlying retinal pathology of blurred vision was clarified using optical coherence tomography (OCT), a novel, non-invasive ophthalmic imaging technique that provides micrometer-scale resolution images of the human retina. METHODS: Three patients with preeclampsia complained of blurred vision postpartum. In all cases, ophthalmoscopy was performed at the bedside, followed by the assessment of best corrected visual acuity, slit-lamp biomicroscopy, fluorescein angiography (FLA), and OCT. In all cases, the presence of central visual defects was examined by an Amsler-grid. RESULTS: In one case, the symptoms were bilateral. In all affected eyes, the patients complained of a relative central scotoma. Ophthalmoscopy showed edema in the affected maculae, while OCT examination clarified a serous neurosensory detachment of the macula. In one case, a neurosensory detachment was also detected in the papillomacular region of a fellow eye with no symptoms. In two cases, FLA was performed, but only in one case could we detect late leakage and subretinal exudates. The serous detachments observed showed total resolution in all cases within 5 to 10 weeks, with restoration of visual acuity. CONCLUSION: In patients with preeclampsia, OCT may provide a useful method for the precise assessment of retinal changes, distinguishing retinal edema from serous neurosensory detachments. This finding may help to clarify the pathophysiological circulatory changes seen in preeclampsia. 相似文献
65.
Indices of surgical site infection risk and prediction of other adverse outcomes during hospitalization. 总被引:2,自引:0,他引:2
Miguel Delgado-Rodríguez Silvia Palma Antonio Gómez-Ortega Gabriel Martínez-Gallego Marcelino Medina-Cuadros 《Infection control and hospital epidemiology》2006,27(8):825-828
OBJECTIVE: To assess which adverse postsurgical outcomes are best predicted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance system (NNIS) index. DESIGN: Prospective cohort study. SETTING: The service of general surgery at a tertiary care hospital. PATIENTS: A consecutive series of patients hospitalized for more than 1 day (n=2,989). RESULTS: The outcome best predicted by the SENIC and NNIS indices was assessed by estimating the area under the receiver operating characteristic (ROC) curve. The areas under the ROC curves for nosocomial infection and in-hospital death were higher for the NNIS index than they were for the SENIC index (P<.05). The NNIS index predicted in-hospital death better than it predicted surgical site infection (area under the ROC curve+/-SE, 0.836+/-0.022 vs 0.689+/-0.017; P=.001). CONCLUSIONS: The NNIS index is superior to the SENIC index for all adverse postsurgical outcomes. Its ability to predict in-hospital mortality is clearly better than its ability to predict surgical site infection. 相似文献
66.
The differences between the postprandial mixing or propulsion and the interdigestive motility of the gastrointestinal (GI)
tract are already known. Earlier studies showed dose-dependent differences in the effects of erythromycin on interdigestive
motility. The various GI side-effects (vomiting, diarrhoea) also suggest that there are different effects of erythromycin
on the GI motility. The aim of our study was to examine postprandially the propulsive effects of different doses of erythromycin
on the movement of intraluminal contents in the upper GI tract of the rat. The animals were fasted for 24 h before the experiments
but water was given freely. The rats received 1.5 ml 1.5% methylcellulose painted with 0.05% phenol-red intragastrically (test
solution). Erythromycin(E. lactobionate) was given intravenously at doses of 0.05, 0.1, 0.25, 0.5, 1.0 and 5.0 mg/kg 15 min before the administration of a test solution.
The animals were sacrificed 20,60 and 120 min after administration of methylcellulose, when the distance between the front
of the painted intraluminal contents and the pylorus was measured and expressed as a percentage of the total length of small
intestine. The phenol-red content in the stomach and small intestine was measured spectrophotometrically and the gastric emptying
was calculated from the ratio of the measured total and intestinal phenol-red content. Our results showed that the small doses
of erythromycin (0.1 and 0.25 mg/kg) accelerated gastric emptying after 20 min but did not change significantly the propulsive
motility of upper small intestine; however, large doses of erythromycin (1.0 and 5.0 mg/kg) decreased gastric emptying and
upper GI motility after 20 and 60 min. In summary, the prokinetic action of small doses of erythromycin was demonstrated,
but its effecttime on GI motility is short and the ratio of the stimulating and inhibitory doses is 1:10.
This paper was presented at the Section of IUPHAR GI Pharmacology Symposium on ’Biochemical pharmacology as an approach to
gastrointestinal disorders (basic science to clinical perspectives)‘, October 12-14, 1995, Pécs, Hungary. 相似文献
67.
目的:为改革和完善上海市农村合作医疗的政策,制度,规划,计划,措施提供科学依据。方法:使用调查研究,比较研究,描述性统计及SAS统计分析等方法。结果:调查分析了上海市1997-1999年8区(县)合作医疗资金来源,数量,比例,补偿等。结论:1997年以来,上海市农村合作医疗得到了快速发展,仍存在保障水平,补偿比例,投保率低下及发展不平衡,资金使用不合理等问题。 相似文献
68.
棕榈油对成人血脂和血小板功能的影响 总被引:3,自引:0,他引:3
报道了棕榈油(PA),花生油(PE)对血清总胆固醇水平(TC)在5.5~7.0mmol/L的受试者血脂和血小板功能的影响。51名受试者(男31人,女20人,年龄30~66岁之间)分为两组,一组男15人,女11人,称PE组;另一组男16人女9人,称PA组,预备期3周,膳食以当地日常食用的花生油烹调,实验期6周。PA组受试者食用以棕榈油烹调的实验膳;PE组受试者仍食花生油烹调的膳食。脂肪约占膳食能量的30%,其中60%~65%来自实验油。实验结果表明:与起始值相比,6周末PA组受试者血清TC,低密度脂蛋白胆固醇(LDL-C)和总胆固醇与高密度脂蛋白胆固醇比值(TC/HDL-C)显著下降,血浆血栓素B2(TXB2)/6-酮前列环素F1α、(6-keto-PGF1α)比值显著下降,全血血小板聚集率未见显著变化。PE组受试者的血脂、血浆TXB2、6-keto-PGF1α及全血血小板聚集率等指标均未出现显著变化。提示,棕榈油作为我国居民家庭烹调用油并不会增加发生心血管疾病的危险。 相似文献
69.
Effects of the MAO-A-inhibitor brofaromine (BRO), 10 mg/kg po after repeated (twice daily for 14 days) administration on the spontaneous behavior (exploratory and basal locomotor activities) and the exploratory activity modified by methoxamine, clonidine and d-amphetamine in male Wistar rats were studied in both light and dark phases of a diurnal cycle (L: 0700-1900 h). After single administration BRO in the light phase had no effects. In the dark phase BRO decreased the exploration (62% of control, p less than 0.01), increased the clonidine-evoked hypoactivity and amphetamine-evoked hyperactivity. The L-D differences occurred also after repeated administration. BRO in the light phase did not influence the exploration, decreased basal locomotor activity, did not change methoxamine and clonidine action and potentiated the action of amphetamine. In the dark phase, however, it did not influence the exploration and basal locomotor activity, intensified the methoxamine effect, and did not change the clonidine and amphetamine actions. The results demonstrate that the effects of BRO on behavior in rats: 1) differ from the effects caused by other antidepressants which are not MAO inhibitors; 2) are phase-dependent after both single and repeated administration. 相似文献
70.
A clinical trial on the prevention of catheter-related sepsis using a new hub model. 总被引:8,自引:0,他引:8 下载免费PDF全文
M Segura F Alvarez-Lerma J M Tellado J Jiménez-Ferreres L Oms J Rello T Baró R Sánchez A Morera D Mariscal J Marrugat A Sitges-Serra 《Annals of surgery》1996,223(4):363-369
BACKGROUND: Catheter hub contamination is being increasingly recognized as a source of catheter-related sepsis. The authors have investigated the efficacy of a new hub design in preventing endoluminal catheter contamination and catheter-related sepsis arising at the hub. METHODS: Adult surgical and intensive care patients requiring a subclavian catheter for at least 1 week were randomly assigned to receive catheters with standard connectors (control group, n=73) or equipped with a new hub model (new hub group, n=78). Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or because of suspicion of sepsis, in which case peripheral blood cultures were taken. RESULTS: Of the 151 patients included, 15 (10%) developed catheter-related sepsis. Catheters were more often withdrawn because suspicion of infection in the control group (42 vs. 19%, p<0.005). Catheter sepsis rate was higher in the control group (16 vs. 4%, p<0.01) because of the low rate of catheter sepsis arising at the hub observed in the new hub group (1 vs. 11%, p<0.01). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (18 vs. 5%, P<0.03). CONCLUSIONS: A new catheter hub has proved to be useful in preventing endoluminal bacterial colonization and catheter-related sepsis in subclavian lines inserted for a mean of 2 weeks. 相似文献