Lung contusion after extracorporeal shock wave lithotripsy for pancreatic stones: A case report

Background:Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is recommended as the first-line treatment for large pancreatic stones. While complications such as post-P-ESWL pancreatitis, bleeding, infection, steinstrasse, and perforation have been reported in the past 30 years, lung contusion has never been reported. The present case demonstrates lung contusion as a complication after P-ESWL.Methods:A 48-year-old man was admitted to our department due to painful chronic pancreatitis with pancreatic duct stones. Computed tomography revealed normal lungs. P-ESWL was performed. The shock wave head contacted with right upper quadrant and the path of shock wave was at a 45° angle to the ventral midline. After P-ESWL, multiple patchy high-density shadows in the lower lobe of right lung were found, which was normal before P-ESWL. The patient had no symptoms of lung injury.Results and Conclusion:Laboratory studies revealed elevated D-dimer from 0.33 to 0.74 ug/mL, which was consistent with abnormal clotting of lung contusion. Chest computed tomography showed slight pleural effusion. Considering the interval between 2 X-rays was only 3 hours, we inferred that lung contusion was related to P-ESWL. The patient displayed stable vital signs, therefore, no specific interventions were conducted. Three days after P-ESWL, endoscopic retrograde cholangiopancreatography was performed and the lung shadows were partially absorbed. Considering the location of shock wave head, it was possible to cause lung contusion in lower lobe of right lung. More than 10,000 P-ESWL therapeutic sessions had been performed in our center since 2010, and it is the first case about lung contusion as a complication. It is also the first report to describe lung contusion after P-ESWL. Although the patient was asymptomatic, it should raise awareness of clinicians.     

Maternal mortality in the United States

Despite a significant improvement in the US maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that - essentially - no progress has been made in most US States since 1982. Additionally, the US Centers for Disease Control and Prevention has stated that most cases are probably preventable. Two disheartening issues within this topic include a gross underestimation of the magnitude of maternal mortality - particularly before 1987, but which likely persists to a lesser degree today - and the continued significant racial disparity in maternal mortality. Explanations for the plateau in maternal mortality include the recent trend of delayed childbearing, with the potential accompanying complications associated with older reproductive age (particularly over 35 years) and multiparity. The impressive increase in multifetal pregnancies related to delayed childbearing and assisted reproductive technology also plays a role. Finally, peripartum cardiomyopathy has become an increasingly recognized source of maternal mortality. Pregnancy-related mortality is largely accounted for by thromboembolic disease, hemorrhage, hypertension and its associated complications, and infection. However, since the inclusion of maternal deaths occurring after 42 days post-delivery as pregnancy related, traumatic injuries - including homicides and suicides - are an alarming source of maternal mortality. An especially important contemporary issue to consider within this topic is cesarean delivery "on maternal request", opponents of which cite concerns not only for immediate morbidity and mortality increased over that associated with a vaginal birth, but also for potential morbidity and mortality associated with future pregnancies. One particularly appealing opportunity to reduce maternal mortality is to recognize, examine, and learn from so-called "near-miss" cases.     

限制性输液复苏法对失血性休克孕兔血流动力学变化的影响

目的 探讨限制性输液复苏法对失血性休克孕兔血流动力学变化及血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)含量变化的影响.方法 将20只妊娠中晚期新西兰大白兔分为2组,分别采用生理盐水传统输液复苏法(PNL组)及限制性输液复苏法(PLH组),每组10只.建立非控制性失血性休克模型,实验设计分为休克期(0～30 min),院前复苏期(30～90 min)及院内复苏期(90～180 min).休克期:两组孕兔均接受颈动脉放血至平均动脉压(MAP)为40～45 mm Hg(1 mm Hg=0.133 kPa).院前复苏期:剪开两组孕兔孕囊血管放血,复制活动性出血模型,然后PNL组和PLH组孕兔分别接受生理盐水及自身血复苏至MAP为80、60 mm Hg.院内复苏期:两组孕兔均接受手术止血及输血、输液治疗.比较两组孕兔各时间点血流动力学、TNF-α及IL-6含量的变化,记录输血、输液量及生存率.结果 (1)120 min时,PLH组孕兔呼吸、心率分别为(66±16)、(235±41)次,PNL组分别为(78±16)、(291±37)次,两组分别比较,差异有统计学意义(P＜0.01);PLH组孕兔MAP和中心静脉压(CVP)分别为(80.4±7.2)mm Hg、(8.0±4.4)cm H2O,PNL组孕兔分别为(72.5±8.2)mm Hg、(5.8±3.1)cm H2O,两组分别比较,差异也有统计学意义(P＜0.01);(2)两组孕兔血清TNF-α、IL-6含量休克后均升高,且在240 min时达高峰,PLH组孕兔血清TNF-α、IL-6含量分别为(105±67)、(118±51)ng/L,PNL组分别为(280±160)、(311±240)ng/L,两组比较,差异有统计学意义(P＜0.01),且PLH组孕兔血清TNF-α、IL-6含量在480 min时已降至正常;(3)PLH组输血、输液量在院前复苏期分别为(16.0±2.2)、(39.0±5.5)ml,在院内复苏期分别为(28.0±6.7)、(90.0±7.1)ml,PNL组在院前复苏期分别为(31.0±8.2)、(85.0±7.9)ml,在院内复苏期分别为(37.5±9.4)、(140.0±24.8)ml,两组比较,差异也有统计学意义(P＜0.05);(4)PLH组孕兔24、72 h的生存率分别为100%、90%;PNL组为80%、60%,两组比较,差异有统计学意义(P＜0.01).结论 限制性输液有利于失血性休克孕兔血流动力学指标的恢复,缓解血清TNF-α、IL-6含量升高的程度,从而提高了动物生存率.     

Prepregnancy body mass index and adverse pregnancy outcomes

OBJECTIVE: The aim of this study was to evaluate the association between prepregnancy BMI, and adverse maternal and neonatal outcomes. METHOD: In this retrospective cohort study 916 consecutive singleton gestations were included who gave birth between 1 January 2006 and 31 August 2006 at the Department of Obstetrics and Gynecology, University of Udine, Italy. Statistical analysis was performed using univaried logistic regression and measured by odds ratio. RESULTS: The obese patients had a statistically, significantly increased incidence of Caesarean section (OR = 2.17, p = 0.009). Women with overweight (OR = 2.43, p = 0.002) and obese weight (OR = 4.86, p < 0.0001) were at increased risk for preterm deliveries. The pre-eclampsia and the fetal macrosomia (> or =4,000 g) were increased in obese women (OR = 5.68, p < 0.0001; OR = 2.58, p = 0.033, respectively). CONCLUSION: Maternal prepregnancy obesity is significantly associated with increased risk of Caesarean section, preterm delivery, pre-eclampsia and macrosomia.     

法洛四联症的围术期处理

目的: 总结法洛四联症矫正手术围术期主要并发症的发生率及处理经验。方法: 对17例法洛四联症患者的一般临床资料、术前心功能状态和手术结果进行分析。结果: 无手术死亡。术后并发低心排出量综合征3例,呼吸衰竭2例,灌注肺及心包内出血各1例。随访3~6个月,无晚期死亡及并发症发生。结论: 熟练掌握法洛四联症矫正手术技术,合理选择适应证,及早发现和正确处理并发症是提高疗效、降低围术期死亡率的关键。     

结直肠肿瘤患者术后焦虑评分同术后并发症的相关性

目的 了解结直肠肿瘤患者术后焦虑评分对术后并发症的影响.方法 前瞻性纳入2010年2月至5月四川大学华西医院胃肠外科中心结直肠外科专业组126名结直肠癌确诊患者,并根据焦虑评分分为3组,组间比较术后并发症发生率;评估分析患者术后焦虑的相关因素;探索术后焦虑评分同患者术后并发症发生率的临界评分值.结果 3组间术后并发症发生率有着明显不同(χ2＝17.904,P＜0.001),同时可能焦虑组(焦虑评分＜7～13分)术后并发症发生率低于无焦虑组(焦虑评分＜7分)(χ2＝11.027,P＝0.002)及焦虑组(焦虑评分>14)(χ2＝20.677,P＜0.001),无焦虑组及焦虑组差异无统计学意义(χ2＝1.636,P＝0.274);术后焦虑的主要危险因子有费用类型(P＝0.053),居住地(P＝0.018),内科合并症(P＝0.014),新辅助化疗(P＝0.053),DUKES分期(P＝0.009),术后普食天数(P＝0.001);而分析得术后焦虑评分的临界值为17分,术后焦虑评分>17分时患者术后并发症发病率较高(χ2＝12.538,P＝0.004).结论 结直肠癌患者术后焦虑评分同术后并发症的发生有着一定的相关性,焦虑评分高者更易发生术后并发症,但适度的焦虑患者术后并发症的发生率相对较低.     

心脏死亡供体原位肝移植术后胆道并发症的原因探讨和诊疗经验

目的: 探讨心脏死亡供体（donation after cardiac death,DCD）原位肝移植术后胆道并发症的发生因素、诊断要点和治疗方法。方法: 对2015年1月—2016年8月于南京医科大学第一附属医院肝移植中心实施的87例DCD供肝肝移植患者临床资料进行回顾性分析。87例中29例行经典原位肝移植,58例行改良背驮式肝移植,胆管重建方式均为胆总管端端吻合,无1例放置T管。结果: 87例肝移植患者中9例通过胆道造影确诊为肝移植术后胆道并发症, 8例治愈, 1例好转, 无死亡。胆道并发症发生率10.1%(9/87)。结论: DCD供体原位肝移植术后胆道并发症的发生与供肝缺血时间、DCD供肝质量、胆管吻合技术及供肝修剪技术等因素有关,术后胆道造影有助于及时诊断胆道并发症。介入技术是胆道并发症的主要治疗手段。     

Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值

目的探讨Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值。方法回顾性选取2016年2月至2021年2月北京中医医院怀柔医院中重度高脂血症性急性胰腺炎患者100例,依据病情严重程度分为中度组(全身或局部并发症2 d以上无持续性器官衰竭或短暂性器官衰竭2 d内消退,n=40)、重度组(2 d以上持续性器官衰竭可能对肾脏、心血管、呼吸等系统至少一个器官造成累及,n=60)两组。统计分析两组患者的临床资料、Ranson评分,并统计分析不同Ranson评分患者的多脏器功能衰竭综合征、感染、局部并发症发生情况、死亡情况。结果两组患者的性别构成比、年龄、血脂最高水平之间的差异均无统计学意义(P> 0.05),重度组患者血糖> 11 mmol/L、血钙≤2 mmol/L、LDH> 350 U/L、白细胞数计数> 16×10⁹/L、Hct降低> 16×10⁹/L、碱缺乏> 6 mmol/L、液体需要量> 6 L的患者比率、Ranson评分均高于中度组,差异均有统计学意义(P <0.05)。重度组...