Persistent sepsis-induced hypotension without hyperlactatemia: is it really septic shock?

Purpose

The prognostic value of hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including hyperlactatemia as an obligatory diagnostic criterion.

Methods

We performed retrospective analyses on a cohort of 302 septic shock patients.

Results

When we divided patients according to the presence of hyperlactatemia, 34% evolved without hyperlactatemia and exhibited a very low mortality risk (7.7% compared with 42.9% of those with hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O₂ saturation values, and required lower norepinephrine doses. The potential inclusion of hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%.

Conclusions

Persistent sepsis-induced hypotension without hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.     

股骨头钻孔减压联合持续药物灌注治疗FicatⅡB期股骨头坏死疗效观察

目的探讨股骨头钻孑L减压联合丹香冠心注射液持续灌注治疗FicatⅡB期股骨头坏死的疗效。方法对股骨头缺血性坏死（FicatⅡB期）患者26例（29髋）采用股骨头钻孔减压联合置管持续丹香冠心注射液灌注10d。结果本组获随访3月～3年,根据全国首届骨坏死学术交流会拟订的100分标准,优良率达68．9％（26／29髋）。结论股骨头钻孔减压联合持续药物灌注治疗FicatⅡB期股骨头坏死能明显缓解患者疼痛,病情评分改善,并具有手术操作简单、创伤小、无不良反应、疗效好等优点。     

Intraparenchymal schwannomas: report of two new cases studied with MRI and review of the literature

Intraparenchymal schwannomas are very rare tumours. We present two young adult patients operated for this type of lesion who show no signs of recurrence 2 years after surgery. These tumours have a bimodal peak of presentation: most occur in young patients under 25 years, and the rest present in the elderly. Characteristically they show both Antoni A and Antoni B areas, intense inmunoreactivity to S-100 and Vimentin protein, and none to EMA or CD34. Electron microscopy is diagnostic when basal membrane is found around the cytoplasmatic processes. MRI spectroscopy depicts increased myoinositol, choline and lipids, and perfusion MR demonstrates high rCBV with a characteristic curve due to the total absence of blood brain barrier. An origin in the Schwann cells of the perivascular nervous plexus in the subarachnoid space is the most accepted theory for the histogenesis of these tumours. We propose to perform the characterization of a series of markers such as SOX-10 in every new case in order to prove that theory.     

盆腔灌注治疗配合健康教育在盆腔炎性疾病治疗中的应用

目的探讨盆腔灌注疗法配合健康教育在盆腔炎性疾病中的治疗效果。方法对120例盆腔炎患者进行随机分组,观察组行盆腔灌注治疗,向盆腔内灌注抗生素等药物,7d/次,共2次,期间对患者进行健康教育。对照组为静脉注射抗感染治疗,治疗14d后对两组疗效进行比较。结果观察组盆腔灌注治疗盆腔炎的有效率（96.67%）明显高于对照组的有效率（78.33%）,治疗费用明显降低,两组相比较差异有统计学意义（P〈0.05）。结论盆腔灌注疗法配合健康教育为盆腔炎患者提供了一种高效、经济、简便的治疗方法。     

糖皮质激素鼓室内灌注治疗突发性耳聋的研究进展

突发性耳聋是耳鼻喉科常见疾病,起病急,听力下降程度和并发症可随病程增加而加重。发病率呈上升趋势,听力下降及耳鸣、眩晕等严重影响了人们的正常生活和工作。本病病因不全明确,可作为很多疾病的并发症出现,治疗难度大。如今临床上治疗方法众多,主要为病因治疗或经验性治疗,但大多临床疗效不理想。目前糖皮质激素鼓室内灌注治疗方法报道增多,并一直被作为突发性耳聋的挽救性治疗方法,有待成为解决上述问题的有效方法。     

What predicts cognitive decline in de novo Parkinson's disease?

Subtle cognitive impairment can be detected in early Parkinson's disease (PD). In a consecutive series of de novo, drug-naive PD patients, we applied stepwise regression analysis to assess which clinical, neuropsychological, and functional neuroimaging (dopamine transporter [DAT] and perfusion single photon emission computed tomography [SPECT]) characteristics at baseline was predictive of cognitive decline during an average follow-up time of about 4 years. Decline both in executive (R(2) = 0.54; p = 0.0001) and visuospatial (R(2) = 0.56; p = 0.0001) functions was predicted by the couple of Unified Parkinson's Disease Rating Scale (UPDRS)-III score and caudate dopamine transporter (DAT) uptake in the less affected hemisphere (LAH). Verbal memory and language decline was predicted instead by caudate DAT uptake and brain perfusion in a posterior parieto-temporal area of the less affected hemisphere (R(2) = 0.42; p = 0.0005). No significant effect was shown for age, baseline neuropsychological scores, and levodopa equivalent dose at follow-up. The combined use of clinical structured examination and brain functional assessment by means of dual single photon emission computed tomography imaging appears as a powerful approach to predict cognitive decline in de novo PD patients.     

Positron emission tomography to assess hypoxia and perfusion in lung cancer

In lung cancer, tumor hypoxia is a characteristic feature, which is associated with a poor prognosis and resistance to both radiation therapy and chemotherapy. As the development of tumor hypoxia is associated with decreased perfusion, perfusion measurements provide more insight into the relation between hypoxia and perfusion in malignant tumors. Positron emission tomography (PET) is a highly sensitive nuclear imaging technique that is suited for non-invasive in vivo monitoring of dynamic processes including hypoxia and its associated parameter perfusion. The PET technique enables quantitative assessment of hypoxia and perfusion in tumors. To this end, consecutive PET scans can be performed in one scan session. Using different hypoxia tracers, PET imaging may provide insight into the prognostic significance of hypoxia and perfusion in lung cancer. In addition, PET studies may play an important role in various stages of personalized medicine, as these may help to select patients for specific treatments including radiation therapy, hypoxia modifying therapies, and antiangiogenic strategies. In addition, specific PET tracers can be applied for monitoring therapy. The present review provides an overview of the clinical applications of PET to measure hypoxia and perfusion in lung cancer. Available PET tracers and their characteristics as well as the applications of combined hypoxia and perfusion PET imaging are discussed.     

供肝获取术中供肝质量和灌注情况的快速判断

目的探讨在供肝获取术中快速判断供肝质量和灌注情况的方法。方法对83例供肝获取术中供肝质量和灌注情况的快速判断进行总结。结果83例供体中,有16例在获取术中发现供肝质量有异常(其中7例放弃获取,9例用于移植),有1例在获取术中判断供肝质量为正常,移植术前肝组织活检病理发现血吸虫虫卵。在76例获取的供肝中．有3例术中发现灌注不足。所有用于受体的供肝均在门静脉开放后3—15分钟内可见金黄色胆汁分泌。结论在现阶段我国多为无心跳供体和快速多器官联合获取法广泛使用的情况下。供肝获取术中供肝质量和灌注情况的快速判断尤为重要。     

Diffusion and perfusion of the kidney

MRI of the kidney currently makes the transition from depiction of morphology to assessment of function. Functional renal imaging methods provide information on diffusion and perfusion on a microstructural level. This review article presents the current status of functional renal imaging with focus on DWI (diffusion-weighted imaging) and DCE-MRI (dynamic contrast-enhanced MRI), as well as BOLD (blood-oxygenation level dependent) MRI, DTI (diffusion tensor imaging) and arterial spin labeling (ASL). Technical background of these techniques is explained and clinical assessment of renal function, parenchymal disease, transplant function and solid masses is discussed.