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Objective To investigate the effect of dexmedetomidine on renal function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass.Methods Fifty patients with rheumatic heart disease were randomly divided into the dexmedetomidine group (group D,n=25) and control group (group C,n=25).Arterial blood samples were collected before operation (T0),at postoperative 24 h (T1),48 h (T2),72 h (T3) and 96 h (T4) respectively.Serum Crea,blood urea nitrogen,cystatin C(Cys-C) and glomerular filtration rate(GFR) were detected by the Hitachi7600 automatic biochemical analyzer.Results Compared with T0,the levels of BUN and Cys-C at postoperative various time points were significant increased,while GFR was decreased,the differences were statistically significant (P0.05).Serum Crea level at T2-T4 in the group D was significantly lower than that at T0,the difference was statistically significant (P0.05).Conclusion Dexmedetomidine can promote the recovery of postoperative renal function in the patients with cardiac valve replacement under cardiopulmonary bypass and has a certain protective effect on kidney.
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Background:Conventional gastrointestinal endoscopy is incapable of determining the deriving layers,size and nature of submucosal lesions,however,mini probe ultrasonography(MPS)is effective for mural stratification and determining the deriving layers and nature of lesions within gastrointestinal wall,and is considered to be an optimal examination for suspected submucosal tumors before endoscopic or surgical operation. Aims:To assess the diagnostic value of MPS for gastrointestinal submucosal lesions and the significance of MPS-assisted endoscopic therapy. Methods:A total of 69 patients with presumed gastrointestinal submucosal protruded lesions were retrospectively enrolled. All of them underwent MPS and then endoscopic therapy,such as cyst incision,high frequency electric snare resection,endoscopic mucosal resection and endoscopic submucosal dissection were performed according to the deriving layers,size and nature determined by MPS. The ultimate diagnosis was confirmed by histopathological examination. Results:In the 69 cases of lesions,MPS showed that 15 were derived from muscularis mucosa,40 from submucosa,and 14 from muscularis propria;10 of them were considered as cyst,18 were stromal tumor,8 were leiomyoma,6 were ectopic pancreas,15 were neuroendocrine tumor,and 12 were lipoma. Compared with pathological diagnosis,an overall coincidence rate of 91. 3%(63 / 69)was achieved by MPS. Conclusions:The accuracy rate of MPS is high for determining the deriving layers and nature of gastrointestinal submucosal protruded lesions prior to the attempting of endoscopic removal. It might be helpful for selecting treatment modalities for this kind of lesions.
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Objective To compare the efficacy and safety of 7.2%hypertonic saline hydroxyethyl starch 200/0.5(HES) and 15% mannitol in the treatment of increased intracranial pressure( ICP) .Methods 112 neurosurgical patients at risk of increased ICP were randomized divided into 2 group to receive either HES or 15% mannitol at a defined infusion rate, which was stopped when ICP was<15 mmHg.Results Of the 112 patients, 58 patients received HES and 54 received mannitol 15%.In eight patients, ICP did not exceed 20 mmHg in treatment was not necessary.Both drugs decreased ICP below 15 mmHg (P<0.0001);HES within 6.0(1.2~15.0) min(all results are presented as median (minimum-maximum range) and mannitol within 8.7(4.2~19.9) min(P<0.0002).HES caused a greater decrease in ICP than mannitol (57% vs 48%; P<0.01).The cerebral perfusion pressure was increased from 60 (39~78) mmHg to 72 (54 ~85) mmHg by infusion with HES (P<0.0001) and from 61(47 ~71) mmHg to 70(50 ~79) mmHg with mannitol ( P <0.0001 ).The mean arterial pressure was increased by 3.7% during the infusion of HES but was not altered by mannitol.There were no clinically relevant effects on electrolyte concentrations and osmolarity in the blood.The mean effective dose to achieve an ICP below 15 mmHg was 1.4 (0.3~3.1) mL/kg for HES and 1.8(0.45~6.5) mL/kg for mannitol (P<0.05).Conclusion HES is more effective than mannitol 15% in the treatment of increased ICP.A dose of 1.4 mL/kg of HES can be recommended as effective and safe.The advantage of HES might be explained by local osmotic effects, because there are no clinically relevant differences in hemodynamic clinical chemistry parameters;efficacy.
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Objective: To determine the predictive value of excision repair cross complement 1 (ERCC1) expression in non-small cell lung cancer (NSCLC) and the sensitivity of NSCLC to non-cisplatin based chemo-therapy and cisplatin based chemotherapy. Methods: The expression of ERCC1 was examined by immunohis-tochemical technique in 130 patients with advanced NSCLC seen in our hospital between February 1st 2006 and October 30th 2007. These 130 patients were divied into three groups. Patients in group A (n=68) had neg-ative ERCC1 expression and received cisplatin based chemotherapy. Patients in group B (n=31) had positive expression of ERCC1 and received non-cisplatin based chemotherapy. Patients in group C (n=31) had posi-tive expression of ERCC1 and received cisplatin based chemotherapy. Results: The expression rate of ER-CC1 was 62 of 130 (47.8%). The rate of ERCC1 in pulmonary adenocarcinoma was higher than that in squa-mous carcinoma. The response rates of chemotherapy in group A, B, and C group were 58.8 %, 51.6%, and 41.5%, respecitvely. There was no significant difference in the response rate between group A and group B (X~2=0.451, P=0.502). There was a significant difference in the response rate between group A and group C (X~2= 6.011, P=0.014). The response rate in group B was higher than that in group C (X~2=2.384, P=1.123). The average survival time in group A, group B, and group C were 12.0 months, 11.0 months, and 7.8 months, respecit-vely. There was no significant difference in patient survival between group A and group B (X~2=3.809, P=0.051). There was significant difference in patient survival between group A and group C (X~2=46.368, P=0.000). Con-clusion: ERCC1 may be an important indicator of the sensitivity of advanced NSCLC to cisplatin or non-cisplat-in based chemotherapy.