Evaluation and threshold value of hepatic vein pressure gradient for early postoperative rebleeding after endoscopic esophageal varices ligation / 中国内镜杂志

Objective To assess the value of hepatic venous pressure gradient in the evaluation of early postoper﹣ative hemorrhage after endoscopic esophageal varices ligation (EVL). Methods 120 cases of rebleeding after EVL from January 2014 to January 2015 as subjects. Collect and study clinical indexes such as the venous pressure gra﹣dient, then used logistic regression analysis method to analyze the threshold assessment. Results Drinking, hemor﹣rhage in early stage, bilirubin, heart rate, blood transfusion, child Pugh score and MELD score were significant dif﹣ferences (P< 0.05); HVPG=16.98 mmHg, for the prediction of rebleeding threshold, and in the time of the highest predictive accuracy. Conclusion The hepatic venous pressure gradient has an accurate evaluation value for early postoperative hemorrhage after endoscopic esophageal varices ligation.

Role of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of interstitial cystitis / 中华泌尿外科杂志

ObjectiveTo evaluate the clinical efficacy of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of interstitial cystitis (IC).Methods Twenty-one IC patients received intravesical sodium hyaluronate therapy under combined blockage or intravenous anesthesia.Bladders were perfused with normal saline under 100 cm H2O perfusion pressure and expanded for 10 min,the bladders were then injected through a catheter with 40 mg/50 ml sodium hyaluronate which was released after 1 h.Intravesical perfusion was applied once every week four to six times in a course of treatment.Results The average bladder capacity was extended from 191.6 ± 88.7 ml before expansion to 425.3 ± 79.8 ml after bladder expansion ( P =0.000).The extension was done under anesthesia.There were two suspected bladder ruptures after starting the bladder expansion at 6.5 min and 7.2 min.There was significant gross hematuria in 19 cases,10 min after bladder expansion.After treatment,the catheters were removed 24 h after manipulation in 17 patients; the catheters were removed 72 h after manipulation in two cases with hematuria;the catheters were removed four days after manipulation in the two cases of suspected bladder rupture.Pain was significantly reduced after the catheters were removed and the maximum urinary output increased slightly.The day before the second injection of sodium hyaluronate,the urinary frequency decreased significantly than before start of treatment (32.8 vs 18.5 times/24 h).The maximum urinary output increased significantly compared with the output before treatment (86.7 vs 151.9 ml).Pain was reduced significantly after treatment (8.7 vs 3.0).The O'Leary-Sant IC score and the QOL were significantly improved (30.0 vs 17.0,5.9 vs 2.4,respectively) (P =0.000).After the third treatment,the symptoms continued to improve.The treatment results were best in the fifth week at the time of the sixth injection of sodium hyaluronate.Symptoms rebounded at six months.However compared with that before treatment,the difference was still statistically significant ( P =0.000).ConclusionsBladder hydrodistention under anesthesia for severe intractable IC patients produces immediate effectiveness.Sodium hyaluronic infusion can alleviate urinary frequency and pain,and the effectiveness and duration of treatment are positively correlated.