无菌尿液引流装置的研制及临床应用

临床常用的引流袋在尿液引流过程中有许多缺点 ,如 :计量不准 ;衔接不良 ;易污染操作者双手 ;逆行感染机会多等。我们研制出一种无菌尿液引流装置 ,克服了以上不足 ,经临床应用 ,效果满意 ,具有推广价值     

外科医源性尿瘘的诊治

为了重视医源性尿瘘的诊治和预防，我们报告了1964～1996年我院收治的24例外科医源性尿瘘．其中与妇产科有关的14例占56．5％，与普外科有关的4例占173％，与泌尿外科有关的6例占26％．包括输尿管阴道瘘、膀胱阴道瘘、膀胱子宫瘘、输尿管宫颈瘘、输尿管回肠瘘、输尿着皮肤瘘、尿道直肠瘘、输尿管腹腔瘘、膀胱腹壁瘘等各种情况。本文对医源性尿瘘的病因、临床症状和治疗进行了讨论．     

Biventricular Physiology of Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve Edge-to-Edge Repair

ObjectivesThe study sought to assess the acute hemodynamic effects of iatrogenic atrial septal defect (iASD) closure following transcatheter mitral valve edge-to-edge repair (TMVR).BackgroundThe potential hemodynamic and clinical consequences of an iASD following TMVR are currently subject to controversial debates.MethodsIn 21 patients with relevant left-to-right shunt flow (50% [IQR: 38% to 60%] of systemic perfusion volume) across an iASD following TMVR, interventional closure was performed with recordings of left ventricular (LV) and right ventricular (RV) pressure-volume loops during iASD occlusion.ResultsiASD occlusion led to a volume shift from the RV (RV end-diastolic volume index: pre 102 [IQR: 80 to 120] ml/m², post 92 [IQR: 70 to 111] ml/m²; p < 0.001) to the LV (LV end-diastolic volume index: pre 91 [IQR: 74 to 124] ml/m², post 97 [IQR: 77 to 127] ml/m²; p < 0.001) with reduced RV (3.49 [IQR: 2.07 to 3.58] l/min/m² vs. 2.68 [IQR: 2.07 to 3.58] l/min/m²; p < 0.001) but increased LV cardiac index (2.25 [IQR: 1.80 to 3.28] l/min/m² vs. 2.77 [IQR: 1.90 to 3.34] l/min/m²; p = 0.039). Although RV end-diastolic pressure decreased (pre 5.0 [IQR: 4.0 to 8.5] mm Hg, post 4.5 [IQR: 3.0 to 8.3] mm Hg; p = 0.024), LV end-diastolic pressure remained unchanged (pre 11.0 [IQR: 9.5 to 14.0] mm Hg, post 13.0 [IQR: 9.0 to 15.5] mm Hg; p = 0.142). LV transmural pressure increased (7.0 [IQR: 4.0 to 11.0] mm Hg vs. 11.0 [IQR: 7.0 to 15.0] mm Hg; p = 0.001) and LV eccentricity index decreased (p < 0.001). The change in LV transmural pressure correlated significantly with the change in LV-to-RV end-diastolic volume ratio (r = 0.674; p = 0.018). Right heart failure symptoms declined at 1-month follow-up (71% vs. 35%; p = 0.003) as did New York Heart Association functional class (≥III: 48% vs. 25%; p < 0.001).ConclusionsiASD closure following TMVR leads to a volume shift from the RV to the LV with reduced pulmonary but increased systemic cardiac index and with favorable biventricular interaction at maintained LV filling pressure, resulting in a decline in heart failure symptoms at 1-month follow-up.     

Right-to-Left Shunt Through Iatrogenic Atrial Septal Defect After MitraClip Procedure

ObjectivesThe aim of this study was to investigate the incidence, characteristics, hemodynamic conditions, and clinical significance of right-to-left (R-L) shunt through an iatrogenic atrial septal defect (iASD) after the MitraClip procedure.BackgroundR-L shunt through an iASD after the MitraClip procedure has not been well investigated.MethodsFrom 2014 to 2017, 385 consecutive patients with mitral regurgitation underwent the MitraClip procedure. iASD was assessed using intraprocedural transesophageal echocardiography. Right and left heart catheterization was used to assess the hemodynamic status of patients. All patients provided written informed consent for the procedure. All data for this study were collected from an established interventional cardiology laboratory database approved by the Cedars-Sinai Medical Center Institutional Review Board.ResultsR-L shunt was observed in 20 patients (5%). In 7 of these patients (35%), R-L shunt was accompanied by acute deoxygenation. Prevalence of severe tricuspid regurgitation (55% vs. 20%; p = 0.001), serum B-type natriuretic peptide (664 pg/ml [434 to 1,169 pg/ml] vs. 400 pg/ml [195 to 699 pg/ml]; p = 0.006), mean pulmonary artery pressure (38 mm Hg [34 to 45 mm Hg] vs. 29 mm Hg [22 to 37 mm Hg]; p < 0.001), and right atrial pressure (19 mm Hg [13 to 20 mm Hg] vs. 10 mm Hg [7 to 14 mm Hg]; p < 0.001) were significantly higher in patients with R-L shunt than in those with left-to-right shunt. Patients with R-L shunt also showed a more prominent reduction in the left atrial V-wave and mean pressure from baseline to post-procedure compared with those with left-to-right shunt (−22.8 ± 2.6 mm Hg vs. −11.8 ± 0.9 mm Hg [p = 0.002] and −7.9 ± 0.8 mm Hg vs. −4.0 ± 0.4 mm Hg [p = 0.003], respectively).ConclusionsR-L shunt through an iASD was observed in 5% of patients who underwent the MitraClip procedure and in one-third of patients with R-L shunt presented acute deoxygenation. Elevated right atrial pressure concomitant with pulmonary hypertension and significant reduction in left atrial pressure after MitraClip deployment were associated with R-L shunt.     

Azathioprine induction of tumors with microsatellite instability: Risk evaluation using a mouse model

Mismatch-repair (MMR)-deficient cells show increased in vitro tolerance to thiopurines because they escape apoptosis resulting from MMR-dependent signaling of drug-induced DNA damage. Prolonged treatment with immunosuppressants including azathioprine (Aza), a thiopurine prodrug, has been suggested as a risk factor for the development of late onset leukemias/lymphomas displaying a microsatellite instability (MSI) phenotype, the hallmark of a defective MMR system. We performed a dose effect study in mice to investigate the development of MSI lymphomas associated with long term Aza treatment. Over two years, Aza was administered to mice that were wild type, null or heterozygous for the MMR gene Msh2. Ciclosporin A, an immunosuppressant with an MMR-independent signaling, was also administered to Msh2^wt mice as controls. Survival, lymphoma incidence and MSI tumor phenotype were investigated. Msh2^+/− mice were found more tolerant than Msh2^wt mice to the cytotoxicity of Aza. In Msh2^+/− mice, Aza induced a high incidence of MSI lymphomas in a dose-dependent manner. In Msh2^wt mice, a substantial lifespan was only observed at the lowest Aza dose. It was associated with the development of lymphomas, one of which displayed the MSI phenotype, unlike the CsA-induced lymphomas. Our findings define Aza as a risk factor for an MSI-driven lymphomagenesis process.     

损伤性高位良性胆管狭窄的外科治疗策略

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term surviv...     

玻璃体切割手术相关医源性视网膜裂孔的临床观察

目的分析玻璃体切割手术过程中医源性视网膜裂孔(iatrogenic retinal breaks,氉IRB)的发生率、危险因素及预防措施。方法回顾分析129例133眼玻璃体手术病例,记录眼别、术前诊断、玻璃体后脱离状态、晶状体状态,分析术中IRB的数目、分布及预防措施。结果 133眼中12眼术中出现13个IRB,总体发生率为9.0%。其中,黄斑裂孔或黄斑前膜33眼中3眼(9.1%)出现IRB,增生性糖尿病视网膜病变52眼中6眼(11.5%)出现IRB,玻璃体积血40眼中3眼(7.5%)出现IRB。8眼(6.0%)出现巩膜切口相关IRB,5眼(3.8%)出现其他区域IRB,其中1眼同时存在巩膜切口相关IRB及其他区域IRB。术中制作玻璃体后脱离组的IRB发生率(12.3%)高于术前存在玻璃体后脱离组(6.6%),但差异无统计学意义(P=0.256);有晶状体组的IRB发生率(10.5%)高于术中联合超声乳化组(4.5%)及人工晶状体或无晶状体组(8.0%),但差异均无统计学意义(均为P>0.05)。术后发生视网膜脱离4眼(3.0%),所有视网膜脱离眼经二次手术后视网膜均达到解剖复位。结论各种疾病行玻璃体切割手术均有发生IRB的可能,没有证据表明术中制作玻璃体后脱离及晶状体状态与IRB的发生具有明显相关性。为避免IRB可能引起的玻璃体术后视网膜脱离,术中仔细排查与处理是非常重要的。     

The Role of Invasive Hemodynamics in Guiding Contemporary Transcatheter Valvular Interventions

Recent advances in transcatheter interventions have refueled the interest in utilizing invasive hemodynamics in the catheterization laboratory. The authors review contemporary invasive techniques used to confirm valve disease and guide transcatheter valve interventions. They also discuss the available data and the remaining questions on the role of invasive hemodynamics in current practice and in the future.     

医源性肾出血的超选择性肾动脉栓塞治疗

目的探讨超选择肾动脉栓塞术治疗医源性肾岀血的临床应用价值,方法2003年9月-2011年2月收治17例严重血尿的医源性肾出血患者,行选择性肾动脉数字减影血管造影(DSA),采用超选择插管后用明胶海绵和弹簧圈栓塞治疗,并平均随访6个月以上。结果16例DSA清晰显示患者病侧肾对比剂外溢,均1次栓塞成功,另1例2次栓塞成功,出血均停止。17例全都保留患肾功能和大部分组织,无严重并发症,随访期间所有患各均无血尿复发。结论超选择肾动脉栓塞治疗医源性肾出血成功率高、见效快、创伤小、并发症少,能最大限度地保护正常肾组织,可作为首选治疗方法,具有较高的临床应用价值。     

Vascular trauma

The incidence and type of vascular injury differs in different geographical locations. Blunt and iatrogenic injuries are the two commonest causes of vascular trauma in most European countries including the UK. However, in the USA, most vascular injuries are the result of stab or gunshot wounds. Vascular injuries are associated with high morbidity and mortality. They require a clear concept of the management and timely intervention in order to avoid early and late complications. This article outlines the basic principles in the management of vascular trauma.