Objective To investigate the effects of hypertonic saline (HTS) treatment on the function and susceptibility to sepsis of reticuloendothelial system (RES) in mice with hemorrhagic shock. Methods Forty percent of total blood volume of male Balb/c mice was withdrawn by cardiac puncture. Two hours later, the mice were treated with blood infusion and normal saline (10 ml/kg) or 7.5% NaCl (10 ml/kg).The survival rate of the mice was observed after cecal ligation and puncture (CLP). The phagocytosis function of the RES was measured by carbon clearance rate(α) and carbon amount ingested by the macrophages of liver and spleen. In vitro, the peritoneal phagocyte function in solutions of different osmotic pressor was measured by assaying neutral red amount taken in. Results The survival rate after CLP in HTS treated group was 70%, whereas all the mice in the normal saline group died. At the third hour after hemorrhagic shock, the RES carbon clearance rate(α) and carbon amount ingested by the macrophages of liver in the HTS treated mice were 5.61±0.42 and 0.59±0.19 respectively, significantly higher than those in the normal saline treated mice (4.15±0.62， 0.42±0.16). In vitro, hyperosmolarity below 40 mmol/L had no significant effects on the phagocytosis activity of peritoneal macrophages in mice. Conclusion Treating hemorrhagic shock with HTS can decrease the susceptibility to sepsis and improve the RES phagocytosis function indirectly.
Objective To detect the clinical characters and the classification of the congenital retinal vascular anomalies. Methods Nine cases (12 eyes) of congenital retinal vascular anomalies were examined by ocular examination and fundus fluorescein angiography (FFA), in which 3 cases (4 eyes) were examined by indocyanine green angiography (ICGA) simultaneously. Results The congenital retinal vascular anomalies were located at the posterior pole in 8 cases (10 eyes), and extended to peripheral retina in 1 case (2 eyes). Congenital retinal vascular anomalies were classified as follows: congenital retinal macrovessel (1 case, 1 eye); congenital retinal arteriolar tortuosity (2 cases, 3 eyes); inherited retinal venous beading (1 case, 2 eyes); and congenital prepapillary vascular loops (5 cases, 6 eyes). Four cases (5 eyes) were associated with spontaneous hemor rhage induced by physical exertion (Valsalva maneuver). Conclusion Most of the congenital retinal anomalies are located at the posterior pole, involving arteries and veins, and can be associated with spontaneous hemorrhage induced by Valsalva maneuver. (Chin J Ocul Fundus Dis，2003，19：269-332)
Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
Objective To assess the effectiveness and safety of reptilase in the treatment of bleeding due to internal diseases. Methods The Cochrane Library, MEDLINE, VIP, and CNKI were searched. The quality of included studies was evaluated and meta-analysis was performed for the results of homogeneous studies. Results Forty studies involving 2 879 participants related to a variety of internal diseases were included. All included studies were inadquate in reporting randomization, concealment of allocation and blinding. Meta-analysis based on included studies showed that reptilase could better alleviate bleeding compared with the control group in intrecranial encephalic hemorrhage （RD 0. 24, 95 % CI 0. 01 to 0.48）, hypertension induced intrecranbd hemorrhage （RD -0.20, 95% CI -0. 38 to -0. 03）, in hemostasis rate within 24 hours in hemoptysis （RD 0.41, 95% CI 0.17 to 0. 64）, in upper alimentary tract hemorrhage （ RD 0.39, 95% CI 0.03 to 0. 76 ）, in newborn upper alimentary tract hemorrhage （RD 0.32, 95% CI 0. 23 to 0.41 ）. Only one case of hypersensitivity occured in reptilase group. Conclusions Reptilase is an effective and safe hemostasia remedy for hemorrhage of internal diseases. Due to high risk of selection bias and detection bias of included studies, the evidence is not b enough to judge whether reptilase is better than other hemostatics. Our results suggest that further and larger-scale trials of the use of reptilase in the treatment of hemorrhages of internal diseases are needed.
Objective To explore the prevention and treatment of injury to brangches of the middle hepatic vein in laparoecopic cholecystectomy. Methods The clinical data of 27 hemorrhage cases of injury to brangches of the middle hepatic vein in laparoscopic cholecystectomy from January 2008 to January 2010 were analyzed retrospectively. Results All 27 hemorrhage cases were successfully stopped bleeding under laparoscopy by the way of packing hemostasis （n=17）, clamping hemostasis （n=6）, and suturing hemostasis （n=4）. In the 3 hemostasis methods, the operating time and amout of bleeding in the cases with packing hemostasis was the shortest and the least, respectively, which was （90.26±12.46） min and （240.32±80.15）ml, respectively, but the differences of the 3 methods were not statistical significance （P＞0.05）. Conclusions During laparoscopic cholecystectomy, gallbladder bed should be seperated in the correct plane to avoid injury to brangches of the middle hepatic vein. The most important to ensure surgery safety is applying the right surgical hemostasis method to stop bleeding quickly, and the open surgery will be the first choice in the right time when the difficult hemostasis occurs under laparoscopy.
ObjectiveTo analyze the causes and characteristics of massive hemorrhage secondary to percutaneous nephrolithotomy (PCNL) and assess the value of superselective renal artery embolization in the management of this condition. MethodsThe imaging data and prognosis of 28 patients who developed repeated massive hemorrhage secondary to PCNL and underwent superselective renal artery embolization between April 2005 and June 2013 were reviewed. ResultsFollowing superselective renal artery embolization, hemorrhage was effectively controlled in all the 28 patients. Follow-up lasted from 6 to 62 months, averaging 41.6 months. No hematuria or other complications occurred during the follow-up period. ConclusionSuperselective renal artery embolization is safe and effective in managing massive hemorrhage secondary to PCNL, and it may be used as a preferred treatment for patients who are refractory to expectant treatments.
ObjectiveTo explore the related factors for the influences and outcomes of mothers and infants, and further provide a basic reference for reducing maternal and prenatal mortality caused by central placenta previa, through the analysis of its clinical characteristics. MethodsWe retrospectively analyzed the clinical data of 89 patients with central placenta previa treated from January to August 2012. ResultsThere were 89 patients with central placenta previa, and the average age of these patients was (29.6±11.4) years, and the average number of pregnancy among the patients was 3.17. Nine patients had scar uterus; 8 had pernicious placenta previa (9%); 34 had prenatal anemia symptoms; 44 had prenatal vaginal bleeding with the bleeding volume ranged from 2 to 500 mL; 40 were treated before delivery. The average gestational age was 36 weeks ±4.2 days, and 28 of them were readmitted. The intraoperative bleeding in such patients as had placenta located in the anterior wall, placenta adhesion or implantation, history of uterine cavity operation or multipara was more than other patients. The postpartum hemorrhage of patients with the gestational age of 36 weeks or more was more than that of patients with the gestational age shorter than 36 weeks. The incidence of fetal distress in patients with the gestational age of 36 weeks or more is lower and the neonatal 1-minute Apgar score was higher than that in patients with the gestational age shorter than 36 weeks (P<0.05). ConclusionThe treatment of central type of placenta previa should be more active to prolong the gestational week. Patients with placenta adhesion or implantation, caesarean, multipara and placenta in the anterior wall are susceptible to intraoperative bleeding during the termination of pregnancy. Termination of pregnancy in these patients with central placenta previa should be carried out by cesarean section when gestation is more than 36 weeks to reduce postpartum hemorrhage and complications.
ObjectiveTo explore the diagnostic and therapeutic value of laparoscopy in acute abdomen. MethodsRelated literatures were collected to analyze the advantages, the scope of application, and the effect on the body of laparo-scopy, and to clearly defined the indications of laparoscopy in acute abdomen and related taboos. ResultsMost people could be tolerated for CO2 pneumoperitoneum. Laparoscopic surgery had a certain advantages compared with open surgery in the diagnosis and treatment. It was widely used in the diagnosis and treatment of acute abdomen. ConclusionLaparo-scopic surgery is recommended for acute appendicitis, acute cholecystitis, peptic ulcer perforation, and so on, but it is still controversial in intestinal obstruction, intestinal diverticulum perforation, and the application of abdominal trauma, which need more randomized controlled studies comparing with open operation.
ObjectiveTo systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. MethodsLiterature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04). ConclusionFor patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
ObjectiveTo investigate the anticoagulant drug treatment decision for patients with renal contusion and acute pulmonary embolism, and to enhance the level of treatment for this disease. MethodsA retrospective analysis of the clinical data of a patient with renal contusion and acute pulmonary embolism treated at the West China Hospital of Sichuan University, along with a relevant literature review. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as “Pulmonary embolism” AND “Hemorrhage”from January 1983 to December 2023. ResultThe patient was a 21-year-old male who presented with right kidney contusion for 5 days and dyspnea for 1 day. The abdominal CT scan revealed a ruptured right kidney accompanied by hemorrhage and hematoma in the surrounding tissue. Abdomen ultrasound: a low echogenic area measuring approximately 10.6 cm×2.8 cm is noted around the right kidney. The CT pulmonary angiography (CTPA) demonstrated filling defects at the bifurcation of the pulmonary trunk, as well as within the upper and lower lobes of both lungs and their respective branches. The blood gas analysis of patient indicated (face mask oxygen therapy at 10 L/min, oxygenation index of 120): pH 7.456, PCO2 24.9 mm Hg, PO2 73.2 mm Hg. His myocardial markers were Myoglobin: 79.21 ng/ml, Troponin T: 58.7 ng/L, BNP: 2062 ng/L. The patient was diagnosed with renal contusion and pulmonary embolism, and was treated with subcutaneous heparin（initial dose is given as an 80 IU/kg intravenous bolus, followed by a continuous infusion of 12-18 IU/kg/h） and low-molecular-weight heparin at a dose of 0.8 ml every 12 hours one after another for anticoagulation, along with symptomatic treatment. Following the intervention, the patient's respiratory distress showed significant improvement, and subsequent arterial blood gas analysis indicated enhanced oxygenation. Then, the anticoagulant medication was adjusted to oral rivaroxaban anticoagulation for 6 months, follow-up CTPA scan revealed complete resolution of the pulmonary embolism and the abdominal CT scan indicated a reduction in the extent of patchy low-density shadows surrounding the right kidney, leading to the discontinuation of anticoagulation therapy. After searching the above-mentioned databases, total of 26 articles were identified that reported on 30 patients diagnosed with high-risk bleeding and acute pulmonary embolism; among these, 3 patients succumbed while 27 exhibited clinical improvement. ConclusionsPatients with renal contusion and acute pulmonary embolism can be safely and effectively treated with low-dose heparin anticoagulation under close monitoring. High-risk bleeding patients with acute pulmonary embolism present a significant challenge in clinical practice. After weighing the risks of bleeding disorders and the adverse outcomes of pulmonary embolism, it is necessary to find the optimal balance between anticoagulation and bleeding. Consequently, the formulation of personalized treatment strategies in accordance with established guidelines can enhance patient outcomes.