• 【肾脏能起到肺的作用吗?家兔缺血肾脏逆行灌注过程中的全身氧合和肾脏保存。】 复制标题 收藏 收藏
    DOI:10.1111/j.1464-410X.2006.06257.x 复制DOI
    作者列表:Humphreys MR,Ereth MH,Sebo TJ,Slezak JM,Dong Y,Blute ML,Gettman MT
    BACKGROUND & AIMS: OBJECTIVE:To investigate renal preservation by a novel method of perfusion using an oxygenated perfluorocarbon (PFC) emulsion via retrograde access to the kidney, as preserving renal function during urological surgery has been elusive, and the recognized technique of nephron-sparing surgery has increased its application and practice in modern urology. MATERIALS AND METHODS:After institutional review and approval, 30 New Zealand White rabbits were studied. In a solitary kidney model, each rabbit had the ureter catheterized before 40 min of renal artery occlusion. Each rabbit was randomized to one retrograde perfusion group, i.e. sham, normothermic PFC, chilled PFC, normothermic saline, and chilled saline. The rabbits were maintained for 2 weeks, during which renal function, urine output, systemic blood gases, weight and serum creatinine level were measured. After death, the kidneys were individually examined and graded by one renal pathologist unaware of the treatment. RESULTS:The rabbits treated with retrograde PFC perfusion (normothermic and chilled) had less change in their creatinine clearance, at 3.6 and 4.0 mL/min per kg, than the sham group, at 7.8 mL/min per kg, while also having significantly higher systemic venous oxygenation, at 26.3 and 10.0 mmHg, than the sham group, at 0.2 mmHg. Normothermic and chilled perfusion with PFC was also associated with less histological evidence of ischaemic damage, with mean (sd) scores of 13.0 (13.5) and 8.7 (4.5), respectively, than in the sham group, at 33.3 (16.8), while favourably matching the contralateral control kidney group, at 5.5 (2.3). The rabbits treated with saline retrograde perfusion also had better outcomes than the sham cohort. There were no adverse effects in any of the study arms or with the use of PFC. CONCLUSION:Retrograde oxygen delivery to the kidney through the urinary collecting system was successful in this pilot study. Renal function, laboratory and histological data indicate a trend towards renal preservation and even systemic oxygenation in the experimental groups compared with the sham rabbits, with no adverse effects attributed to this technique.
    背景与目标:
  • 【门静脉和肝动脉多普勒超声参数在肝硬化和门静脉高压症诊断中的价值。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Iwao T,Toyonaga A,Oho K,Tayama C,Masumoto H,Sakai T,Sato M,Tanikawa K
    BACKGROUND & AIMS: OBJECTIVES:This prospective study was designed to assess the sensitivity and specificity of Doppler ultrasound parameters in the diagnosis of cirrhosis and portal hypertension. METHODS:Portal and hepatic arterial Doppler ultrasound was performed on 76 patients with cirrhosis and esophageal varices and on 73 age- and sex-matched controls. The parameters evaluated were portal venous velocity and hepatic arterial pulsatility index. The liver vascular index was calculated as the ratio of portal venous velocity to hepatic arterial pulsatility index. RESULTS:Portal venous velocity was significantly lower (11.0 +/- 2.4 vs 15.9 +/- 2.8 cm/s, p < 0.001) and hepatic arterial pulsatility index was significantly higher (1.28 +/- 0.18 vs 0.95 +/- 0.17,p < 0.001) in patients than in controls. Thus, the liver vascular index was significantly lower in patients than in controls (8.7 +/- 2.1 vs 17.2 +/- 4.3 cm/s, p < 0.001). The sensitivity and specificity of these parameters in the detection of cirrhosis and portal hypertension was then analyzed with the receiver operating characteristic curve. The best cut-off values were considered to be 13 cm/se of portal venous velocity and 1.1 of hepatic arterial pulsatility index, showing a sensitivity and specificity of 83, 85, 84, and 81%, respectively. The best cut-off value of the liver vascular index was 12 cm/s with a sensitivity and specificity of 97 and 93%, respectively. CONCLUSIONS:The liver vascular index is a high sensitive and specific Doppler ultrasound parameter in the diagnosis of cirrhosis and portal hypertension.
    背景与目标:
  • 【硬皮病的P波振幅和肺动脉压。】 复制标题 收藏 收藏
    DOI:10.1016/j.jelectrocard.2006.01.004 复制DOI
    作者列表:Wokhlu N,Hsu VM,Wilson A,Moreyra AE,Shindler D
    BACKGROUND & AIMS: BACKGROUND AND PURPOSE:Scleroderma is an immune-mediated disease characterized by excess deposition of collagen leading to microvascular occlusion. Morbidity and mortality are often secondary to pulmonary hypertension from injury to pulmonary microvasculature and interstitial lung disease. This study correlated P-wave findings on the 12-lead electrocardiogram (ECG) with mean pulmonary artery pressure (mPAP) measured by right heart catheterization in patients with scleroderma. METHODS:A retrospective review of 12-lead ECGs in 23 patients referred to a rheumatology clinic with the diagnosis of scleroderma was performed. Right heart catheterization was performed within 1 month of the resting ECG. RESULTS:Linear regression related P-wave amplitude in lead II with mPAP (r = 0.52, P = .011) This model was 73% sensitive and 67% specific for the presence or absence of elevated mPAP. CONCLUSIONS:P-wave amplitude analysis on the ECG may be helpful in the assessment of pulmonary hypertension in patients with scleroderma.
    背景与目标:
  • 【[胎儿左右肺动脉的多普勒检查。与胎儿位置和胎龄的关系: 方法学研究]。】 复制标题 收藏 收藏
    DOI:10.1055/s-2007-1000509 复制DOI
    作者列表:Taddei F,Chaoui R,Lenz F,Bast C,Kalache K,Heling KS,Bollmann R
    BACKGROUND & AIMS: UNLABELLED:A Methodical Study:

    AIM OF THE STUDY:To analyse the feasibility of colour and spectral Doppler assessment of blood flow in the fetal right (RPA) and left (LPA) main pulmonary arteries in relation to fetal position and to gestational age.

    STUDY DESIGN:The fetal position was a priori divided into 3 types, depending on whether the fetal heart was visualised apically (Type 1), from the right side (Type 2) or from the left side (Type 3). Three groups A (19-25 weeks gestation), B (26-32) and C (33-39) including 33 consecutive pregnancies each, were examined to document the fetal position as well as the rate of the successful Doppler examinations of the RPA and/or LPA.

    RESULTS:The fetal position Type 2 was most common throughout gestation (in group A = 42%, B = 36%, C = 51%) followed by the type 3 and then type 1. The rate of successful Doppler records from the RPA and LPA depended on the fetal position: In Type 2 RPA in 98%; in Type 3, LPA in 100%; but the apical approach was not effective (< 40%). Depending on gestational age, the success rates for a Doppler examination of at least one vessel were high (> 85%), whereas successful examination of both vessels was unlikely (12%).

    CONCLUSIONS:In the second half of pregnancy, independent of fetal position, Doppler examination of at least one pulmonary artery is successful in most cases, whereas the assessment of both vessels is rather difficult.

    背景与目标: 未标记 : 有条不紊的研究:
    研究的目的 : 分析彩色和频谱多普勒评估胎儿右 (RPA) 和左 (LPA) 主肺动脉血流与胎儿位置和胎龄的可行性。
    研究设计 : 根据胎儿心脏是从右侧 (2型) 还是从左侧 (3型) 可视化,先验地将胎儿位置分为3种类型。A组 (妊娠19-25周),B组 (26-32) 和C组 (33-39),每组33次连续怀孕,检查以记录胎儿位置以及RPA和/或LPA的成功多普勒检查率。
    结果 : 2型胎儿位置在整个妊娠期间最常见 (A组 = 42%,B = 36%,C = 51%) 接着是类型3,然后是类型1。来自RPA和LPA的成功多普勒记录的速率取决于胎儿位置: 在2型RPA中98%; 在3型中,在100% 中LPA; 但是根尖方法无效 (< 40%)。根据胎龄的不同,对至少一个血管进行多普勒检查的成功率很高 (> 85%),而对两个血管的成功检查不太可能 (12%)。
    结论 : 在怀孕的后半段,在大多数情况下,独立于胎儿位置,对至少一条肺动脉进行多普勒检查是成功的,而对两条血管的评估相当困难。
  • 【基于人群的样本中肾脏血浆对血管紧张素II的血流反应与血压之间的关系。】 复制标题 收藏 收藏
    DOI:10.1097/00004872-199715050-00004 复制DOI
    作者列表:Turner ST,Kardia SL
    BACKGROUND & AIMS: OBJECTIVE:To assess whether interindividual variation in renal plasma flow or in its response to angiotensin II infusion is associated with interindividual differences in blood pressure in a population-based sample of 287 non-Hispanic whites (143 women and 144 men), aged 20-49.9 years.

    METHODS:After seven days of eating a high-sodium diet (260 mmol/day), the renal plasma flow was determined by measuring the clearance of p-aminohippurate before and after infusion of 3 ng/kg per min angiotensin II. Multiple linear regression methods were used to assess whether measures of the renal plasma flow and of its response to angiotensin II infusion were predictive of systolic or diastolic blood pressures measured prior to administration of the high-sodium diet, on day 6 of the high-sodium diet, or during the renal clearance procedure on day 7 prior to angiotensin II infusion.

    RESULTS:There was some evidence that measures of the renal plasma flow and of its response to angiotensin II infusion during the high-sodium diet were statistically significant predictors of measures of blood pressure in women; there was less evidence for this for blood pressures in men. Interindividual variation in measures of the renal plasma flow and of its response to angiotensin II infusion explained less than 10% of the interindividual variation in any measure of the blood pressure in both sexes.

    CONCLUSION:These results suggest that interindividual variation in renal plasma flow ad in its response to angiotensin II infusion during a high-sodium diet will be of limited utility in elucidating the basis for interindividual differences in blood pressure.

    背景与目标: 目的 : 在基于人群的287非西班牙裔白人 (143名女性和144名男性) 样本中,评估肾血浆流量或对血管紧张素II输注的反应的个体差异是否与血压的个体差异相关,年龄在20-49.9岁之间。
    方法 : 在食用高钠饮食 (260 mmol/天) 7天后,通过在每分钟输注3 ng/kg血管紧张素II之前和之后测量对氨基马尿酸盐的清除率来确定肾血浆流量。使用多元线性回归方法来评估肾血浆流量及其对血管紧张素II输注的反应的测量是否可以预测高钠饮食第6天在给予高钠饮食之前测得的收缩压或舒张压。钠饮食,或在输注血管紧张素II之前第7天的肾脏清除过程中。
    结果 : 有证据表明,高钠饮食期间肾脏血浆流量的测量及其对血管紧张素II输注的反应是女性血压测量的统计学显着预测指标; 男性血压的证据较少。肾血浆流量测量及其对血管紧张素II输注的反应的个体差异解释了男女血压测量中个体间差异的10%。
    结论 : 这些结果表明,在高钠饮食中对血管紧张素II输注的反应中,肾血浆流量ad的个体差异在阐明血压个体差异的基础方面将是有限的。
  • 【肾脏对肾素-血管紧张素系统阻断反应的性别差异。】 复制标题 收藏 收藏
    DOI:10.1681/ASN.2005101095 复制DOI
    作者列表:Miller JA,Cherney DZ,Duncan JA,Lai V,Burns KD,Kennedy CR,Zimpelmann J,Gao W,Cattran DC,Scholey JW
    BACKGROUND & AIMS: :Evidence suggests that gender differences exist in renin-angiotensin system (RAS) function. It was hypothesized that women may differ also in their response to RAS blockade. The renal and peripheral hemodynamic responses to incremental dosages of an angiotensin receptor blocker and the degree of angiotensin II (AngII) insensitivity achieved during 8 wk were examined in men and women. Participants were 30 young healthy men (n = 15; mean age 27 +/- 2) and women (n = 15; mean age 28 +/- 2) who were on a controlled sodium and protein diet for 1 wk before each study. The humoral, renal, and systemic response to incremental dosages of irbesartan (75 mg for 4 wk, then 150 mg for 4 wk) was assessed, as was the pressor response to AngII (3 ng/kg per min), at 2-wk intervals. AngII type 1 receptor expression in skin biopsies was assessed at baseline and after 8 wk by a real-time PCR protocol. Men and women both exhibited significant declines in BP. Women achieved significantly reduced AngII sensitivity compared with men at lower dosages, showing no pressor response at 4 wk of 75 mg/d irbesartan, whereas men continued to exhibit a pressor response at 4 wk of 150 mg/d. Receptor expression at baseline did not differ between men and women but by 8 wk was significantly decreased in women and unchanged in men. Our findings indicate that men may require larger dosages of angiotensin receptor blocker than do women and that the BP response cannot be used as a surrogate marker for adequate RAS blockade of the renal microvasculature.
    背景与目标: : 证据表明,肾素-血管紧张素系统 (RAS) 功能存在性别差异。据推测,女性对RAS封锁的反应也可能有所不同。在男性和女性中检查了对血管紧张素受体阻滞剂增量剂量的肾脏和外周血液动力学反应以及在8周期间实现的血管紧张素II (AngII) 不敏感性程度。参与者是30名年轻的健康男性 (n = 15; 平均年龄27/- 2) 和女性 (n = 15; 平均年龄28/- 2),他们在每次研究前接受钠和蛋白质饮食控制1周。评估了对递增剂量的厄贝沙坦 (75 mg,4 wk,然后150 mg,4 wk) 的体液,肾脏和全身反应,以及对AngII的升压反应 (3 ng/kg/min) 间隔2-wk。通过实时PCR方案在基线和8周后评估皮肤活检中的AngII 1型受体表达。男性和女性的血压都明显下降。与较低剂量的男性相比,女性的AngII敏感性显着降低,在4 wk 75 mg/d厄贝沙坦时没有升压反应,而男性在4 wk 150 mg/d时继续表现出升压反应。基线时,男女之间的受体表达没有差异,但到8周时,女性显着降低,而男性则没有变化。我们的发现表明,男性可能比女性需要更大剂量的血管紧张素受体阻滞剂,并且BP反应不能用作适当的RAS阻断肾微血管的替代指标。
  • 7 The art of assessing aortic stenosis. 复制标题 收藏 收藏

    【评估主动脉瓣狭窄的艺术。】 复制标题 收藏 收藏
    DOI:10.1136/heartjnl-2012-302392 复制DOI
    作者列表:Rajani R,Hancock J,Chambers JB
    BACKGROUND & AIMS: :This review describes the assessment of the aortic valve by echocardiography and also the roles that multidetector CT (MDCT) and cardiac magnetic resonance have to play as complimentary imaging modalities. It describes how to resolve apparent discrepancies in grading aortic stenosis and discusses the management of apparently moderate stenosis associated with cardiac symptoms or left ventricular dysfunction. The role of cardiac imaging including three-dimensional (3D) echocardiography and MDCT scanning in the preparation for transcatheter aortic valve implantation and during and after the procedure are described. While echocardiography remains the mainstay of imaging, 3D modalities, notably MDCT, are increasingly useful and a multimodality approach is likely to become established as routine clinical practice.
    背景与目标: : 这篇综述描述了超声心动图对主动脉瓣的评估,以及多探测器CT (MDCT) 和心脏磁共振作为互补成像方式所发挥的作用。它描述了如何解决主动脉狭窄分级中的明显差异,并讨论了与心脏症状或左心室功能障碍相关的明显中度狭窄的管理。描述了包括三维 (3D) 超声心动图和MDCT扫描在内的心脏成像在经导管主动脉瓣植入准备以及手术期间和之后的作用。尽管超声心动图仍然是成像的主要手段,但3D模式 (尤其是MDCT) 越来越有用,并且多模态方法可能会被确立为常规临床实践。
  • 【舒张期颈动脉纵向壁运动对衰老和冠状动脉疾病状态均敏感,而与动脉僵硬无关。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2017.04.026 复制DOI
    作者列表:Au JS,Valentino SE,McPhee PG,MacDonald MJ
    BACKGROUND & AIMS: :We investigated the ability of systolic and diastolic carotid artery longitudinal wall motion (CALM) to delineate expected differences in arterial health in individuals representing a range of both age and health status. We recruited 161 younger healthy adults (aged 24 ± 5 y), 51 older healthy adults (aged 70 ± 5 y) and 14 adults with coronary artery disease (aged 67 ± 8 y) for resting assessment of CALM and arterial stiffness. All CALM parameters were reduced in the old healthy adults and adults with coronary artery disease compared with the young healthy adults (p < 0.01), with diastolic velocity and maximum diastolic acceleration being further reduced in the adults with coronary artery disease than in the older healthy adults (p < 0.01). Diastolic CALM parameters were more strongly related to age (β range: -0.46 to -0.53) than systolic CALM parameters (β range: -0.24 to -0.44). In contrast to previous examinations of a variety of CALM parameters, diastolic CALM may provide superior promise in terms of characterizing arterial wall properties, with additional sensitivity to cardiovascular disease status.
    背景与目标: : 我们研究了收缩期和舒张期颈动脉纵向壁运动 (CALM) 描绘代表年龄和健康状况范围的个体的动脉健康预期差异的能力。我们招募了161名年轻的健康成年人 (24 ± 5岁),51名老年健康成年人 (70 ± 5岁) 和14名患有冠状动脉疾病的成年人 (67 ± 8岁) 进行静息评估平静和动脉僵硬度。与年轻健康成年人相比,老年健康成年人和患有冠状动脉疾病的成年人的所有CALM参数均降低 (p <0.01),与老年健康成年人相比,患有冠状动脉疾病的成年人的舒张速度和最大舒张加速度进一步降低 (p <0.01)。舒张期平静参数与年龄 (β 范围: -0.46至-0.53) 的相关性高于收缩期平静参数 (β 范围: -0.24至-0.44)。与以前对各种平静参数的检查相比,舒张期平静在表征动脉壁特性方面可能具有出色的前景,并且对心血管疾病状态具有额外的敏感性。
  • 【通过蛋白质组学方法观察到STZ诱导的糖尿病大鼠肾线粒体中alpha-2u球蛋白的下调。】 复制标题 收藏 收藏
    DOI:10.1016/j.ando.2012.09.007 复制DOI
    作者列表:Sun SH,Liu SQ,Cai CP,Cai R,Chen L,Zhang QB
    BACKGROUND & AIMS: AIM:To identify the changes of mitochondrial protein expression in diabetic renal parenchyma and to characterize their molecular functions and biological processes in diabetes. METHODS:Mitochondrial proteins extracted from renal parenchyma mitochondria of streptozotocin-induced diabetic rats and normal rats were separated by two-dimensional polyacrylamide gel electrophoresis and identified by matrix-assisted laser desorption/ionization tandem time-of-flight mass spectrometry. RESULTS:Eleven proteins from 533 visualized protein spots displayed significant different expressions in mitochondria of diabetic kidneys compared with those in normal ones. Among these altered proteins, two proteins with the most obvious changes in protein expression were identified as alpha-2u globulin (mature protein, named A2) and its proteolytically modified form (named A2-fragment) respectively. These proteins were found in mitochondria of male rat renal parenchyma and were proved to be down-regulated in diabetic rats simultaneously. CONCLUSION:Our results suggest that down-regulation of alpha-2u globulin may be associated with an abnormal β-oxidation of long-chain fatty acids during diabetes. The decreased expression of A2-fragment in renal mitochondria of diabetic nephropathy may reduce fatty acid β-oxidation, which leads to a diminished energy supply from mitochondria to kidney tissue and the deposition of a large number of fatty acids in the kidney, ultimately causing and aggravating kidney damage. In conclusion, these findings may be helpful for understanding the molecular mechanism of diabetic nephropathy.
    背景与目标:
  • 【英国肾移植资源评估。】 复制标题 收藏 收藏
    DOI:10.1016/s0140-6736(85)91508-9 复制DOI
    作者列表:Sells RA,Macpherson S,Salaman JR
    BACKGROUND & AIMS: :Statistics on treatment rates for patients with end stage renal disease (ESRD) show that the number of ESRD patients per million population in the United Kingdom has increased slowly in recent years. The British Transplantation Society issued questionnaires in 1983 and 1984 to determine the number of patients transplanted, the number of suitable patients, and the facilities needed to enable all suitable patients to receive treatment. While there is a high transplant rate, the percentage of ESRD patients on dialysis is low, and there is a "socially unacceptable deficit" with respect to treatment of diabetics and the elderly.
    背景与目标: : 有关终末期肾病 (ESRD) 患者治疗率的统计数据表明,英国每百万人口中ESRD患者的数量近年来增长缓慢。英国移植学会1983年和1984发放了问卷,以确定移植的患者人数、合适的患者人数以及使所有合适的患者都能接受治疗所需的设施。尽管移植率很高,但接受透析的ESRD患者的百分比却很低,并且在糖尿病患者和老年人的治疗方面存在 “社会上不可接受的缺陷”。
  • 【在2002 2012年期间接受治疗的瑞典肾细胞癌患者的总体生存率: RENCOMP研究的更新,并对同步转移和老年人群进行亚组分析。】 复制标题 收藏 收藏
    DOI:10.1016/j.urolonc.2017.05.013 复制DOI
    作者列表:Lindskog M,Wahlgren T,Sandin R,Kowalski J,Jakobsson M,Lundstam S,Ljungberg B,Harmenberg U
    BACKGROUND & AIMS: BACKGROUND:This retrospective study investigated overall survival (OS) and factors influencing OS in Swedish patients with metastatic renal cell carcinoma (mRCC) during the pre- (2002-2005), early (2006-2008), and late (2009-2012) targeted therapy (TT) era. METHODS:Three national Swedish registries identified patients with mRCC. Median OS was estimated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. Subgroup analysis was conducted for patients with synchronous metastases (M1) and the elderly (aged≥75y). RESULTS:A total of 4,217 patients with mRCC were identified, including 1,533 patients with M1 and 1,275 elderly patients. For patients with mRCC diagnosed in 2002 to 2005, 2006 to 2008, and 2009 to 2012, median OS was 10.0, 13.0, and 18.0 months. Similarly, median OS improved in the M1 and elderly populations. Elderly patients were less likely to be prescribed TT (≥75 vs.<75y): 18.3 vs. 63.5% (in 2006-2008) and 28.6% vs. 55.9% (in 2009-2012). Diagnosis of mRCC in 2009 to 2012, nephrectomy and TT prescription were associated with improved OS in the total mRCC, M1, and elderly populations. CONCLUSION:This real-world study showed continued significant improvement in mRCC OS during the late TT era, including in M1 and elderly populations. TT should be considered for all patients with mRCC based on tolerability, regardless of age.
    背景与目标:
  • 【巴西圣保罗腹膜透析和血液透析治疗终末期肾脏疾病的成本评估。】 复制标题 收藏 收藏
    DOI:10.3747/pdi.2011.00138 复制DOI
    作者列表:de Abreu MM,Walker DR,Sesso RC,Ferraz MB
    BACKGROUND & AIMS: OBJECTIVE:Conventional hemodialysis (HD) predominates over peritoneal dialysis (PD) around the world. Prospective and comparative studies comparing the costs of these modalities are scarce. In the present prospective assessment, we describe the resources used and total patient costs for both HD and PD. ♢ METHODOLOGY:We assessed 249 patients on HD and 228 on PD. All patients were 18 years of age or older and on stable dialysis. The information was collected at three points over 1 year, using standard questionnaires. The sources for costs were the Brazilian public and private health care systems. Societal perspective was considered. ♢ STATISTICAL ANALYSIS:Core trends and dispersions were measured. Regression models assessed the impact of modality on the average total cost per patient per year. ♢ RESULTS:Of the 249 HD patients and 228 PD dialysis patients, 189 (74%) and 160 (70%) respectively completed follow-up. The mean age for women was 55.8 years; for men, it was 59.8 years (p = 0.001). The average total cost per patient-year was US$28 570 for HD and US$27 158 for PD. By category, the costs consisted of direct medical-hospital costs (82.3% for HD, 86.5% for PD), direct nonmedical costs (5.3% for HD, 3.7% for PD), and indirect costs (12.4% for HD, 9.8% for PD). Overall costs were less for PD patients than for their HD counterparts (p = 0.025). ♢ CONCLUSIONS:Maintenance dialysis represented the most important source of costs for both modalities; loss of productivity incurred significant costs. Future studies should contemplate the social consequences arising from each modality.
    背景与目标:
  • 【患有室间隔缺损和肺动脉狭窄的新生儿的大动脉右旋转位,并伴有动脉导管过早闭合和两种缺陷的可能病理生理。】 复制标题 收藏 收藏
    DOI:10.1007/s00246-012-0557-4 复制DOI
    作者列表:Nakajima J,Kawakami T,Takeuchi K,Tsuchiya K
    BACKGROUND & AIMS: :Premature closure of the ductus arteriosus (PCDA) and transposition of the great arteries (TGA) cause persistent pulmonary hypertension of the newborn (PPHN). We present a case of a newborn who demonstrated d-TGA with ventricular septal defect (VSD) and pulmonary stenosis (PS) complicated by PCDA. The neonate showed severe cyanosis resistant to resuscitation soon after birth, and was diagnosed with d-TGA with VSD by echocardiography. PPHN was also suspected based on physical symptoms and results of echocardiography. The neonate was given inhaled nitric oxide, prostaglandin E1, and catecholamines under sedation, and underwent a balloon atrial septostomy (BAS). His condition gradually improved, and he was extubated on day 7, but his pulmonary subvalvular stenosis gradually worsened and pulmonary blood flow was markedly decreased. A second BAS was performed on day 27 and he showed no improvement. Blalock-Taussig shunt surgery was performed on day 34, which markedly improved his condition. The co-existence of d-TGA and PCDA is generally a lethal state. In our patient, an increase in pulmonary blood flow during the fetal period was restricted because of PS and outlet flow from the left ventricle to the right ventricle via the VSD. This restricted blood flow through the ductus arteriosus, which led to narrowing of the DA. At the same time, damage to and constrictive changes of the pulmonary vessels were prevented. The ductus arteriosus should be carefully evaluated to exclude PCDA in cases of d-TGA. The presence of both VSD and PS may be a prognostic factor in such cases.
    背景与目标: : 动脉导管过早闭合 (PCDA) 和大动脉转位 (TGA) 导致新生儿持续性肺动脉高压 (PPHN)。我们介绍了一例新生儿,该新生儿表现出d-tga伴室间隔缺损 (VSD) 和肺动脉狭窄 (PS) 并发PCDA。新生儿出生后不久就表现出严重的紫绀抵抗复苏,并通过超声心动图诊断为d-TGA和VSD。根据身体症状和超声心动图检查结果,也怀疑PPHN。新生儿在镇静下吸入一氧化氮,前列腺素E1和儿茶酚胺,并接受球囊房间隔造口术 (BAS)。病情逐渐好转,第7天拔管,但肺瓣膜下狭窄逐渐加重,肺血流量明显减少。在第27天进行了第二次BAS,但他没有任何改善。在第34天进行了Blalock-Taussig分流手术,明显改善了他的病情。d-TGA和PCDA的共存一般是致死状态。在我们的患者中,由于PS和通过VSD从左心室到右心室的出口流,限制了胎儿期间肺血流量的增加。这种通过动脉导管的血流受限,导致DA变窄。同时,防止了肺血管的损伤和收缩变化。在d-tga的情况下,应仔细评估动脉导管以排除PCDA。在这种情况下,VSD和PS的存在可能是预后因素。
  • 【在荷兰心胸中心接受孤立冠状动脉旁路移植术的患者中,抗血小板治疗的围手术期管理。】 复制标题 收藏 收藏
    DOI:10.1007/s12471-017-1006-z 复制DOI
    作者列表:Janssen PWA,Claassens DMF,Willemsen LM,Bergmeijer TO,Klein P,Ten Berg JM
    BACKGROUND & AIMS: BACKGROUND:International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). METHODS:A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014. RESULTS:Eleven centres responded to the survey. Acetylsalicylic acid monotherapy was discontinued before surgery in 6 centres. In patients with an acute coronary syndrome receiving dual antiplatelet therapy (DAPT), most centres discontinued the P2Y12 inhibitor preoperatively. DAPT was restarted after surgery in 4 centres. However, 6 centres continued DAPT in patients who had undergone coronary stenting within one month of surgery. In patients with coronary stents, variation in the management of antiplatelet therapy increased in proportion to the interval between stenting and surgery. A total of 70 patients were included in the registry. Acetylsalicylic acid monotherapy was discontinued in 51% of patients and restarted in all patients. P2Y12 inhibitor treatment was discontinued before surgery in 70% of patients and re-initiated after CABG in 29%. CONCLUSIONS:Major differences were observed in the preoperative and postoperative management of antiplatelet treatment between different Dutch cardiothoracic centres and within a single centre. Part of this variation is probably due to lack of evidence and differences between the current guidelines; however, many of the strategies were not in accordance with any of these guidelines.
    背景与目标:
  • 【2岁儿童出现肺动脉吊带和气管支气管。】 复制标题 收藏 收藏
    DOI:10.5761/atcs.cr.12.01971 复制DOI
    作者列表:Lovett M,Entrikin D,Ungerleider R,Ootaki Y
    BACKGROUND & AIMS: :Pulmonary artery sling is an incomplete vascular ring, the result of the left pulmonary artery arising from the right pulmonary artery and effectively constricting the airway, and it usually presents within the first weeks to months of life. We report a surgical correction of tracheal stenosis for a two-year-old patient associated with pulmonary artery sling and tracheal broncus.
    背景与目标: 肺动脉吊带是一种不完整的血管环,是左肺动脉从右肺动脉产生并有效收缩气道的结果,通常在生命的最初几周到几个月内出现。我们报告了一名两岁的肺动脉吊带和气管支气管相关患者的气管狭窄手术矫正。

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