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Objective To investigate the characteristics of the serum creatinine change patterns and its clinical signifi cance in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods Two hundred and ninety-three consecutive ST elevation myocardial infarction(STEMI) patients who underwent emergent PCI were retrospectively grouped into the descending type,increasing type,stable type,U curve type and converse U curve type according to the dynamic changes serum creatinine in within 72h after PCI. The characteristics of diff erent patterns relationship of the respective pattern to the Mehran risk score,the serum creatinine changes between admission to 1 month after PCI,and the incidence of adverse events were analyzed.Results The proportion of the 5 pattern groups was 9.9%(decending type),17.7(increasing type),47.1%(stable type),4.1%(U curve type)and 21.2%(converse U curve type),respectively. The incidence of adverse events was higher in the increasing type,stable type and converse U curve type compared to the other 2 types in 1 month after PCI. Hypotension before admission and volume expansion therapy were more common in the groups of descending type and U curve type while diuretics were more frequently used in converse U curve type than descending type. The decline of creatinine from admission to 1 month after PCI were 57.9% in descending type and 27.3% in U curve type. Conclusions The dynamic change of serum creatinine presents with multiple patterns in patients undergoing emergent PCI. Hypotension before admission,volume expansion therapy,and the use of diuretics may aff ect the value of serum creatinine. The serum creatinine level at admission seems not suitable for baseline assessment to evaluate the risk of contrast-induced acute kidney injury in some patients.
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Objective To study the anatomical features and operative significance of ophthalmic segment of internal carotid artery by the lateral orbital keyhole approach .Methods Selected 15 cases (30 sides) adult cadavers with formalin perfusion including 2 fresh cadavers perfused with red and blue latex and simulated by lateral orbital keyhole craniotomy .Surgical microscope was used to observe the morphologi-cal characteristics ,adjacent relaionship and important perforating vessels of the ophthalmic artery segment of internal carotid artery .The data measured after the brain was removed from the brain .Results The ophthalmic segment of internal carotid artery originated from the distal dura ring of upper cavernous sinus sphenoidalis and ended at the initial side of posterior communicating artery .The anterior half segment was blocked by the anterior process and the optic nerve and sent out fibrous structures to wrap the surrounding tissue .The starting point of oph-thalmic artery located at 5 mm of anterior end of the anterior process in 28 sides (82.4％),5 mm of the medial aspect of the anterior process in 22 sides (64.7％).The superior hypophyseal artery (SHA) could send 2 to 3 grades of perforating vessels to supply the anterior optic nerve,optic chiasma and pituitary stalk .Conclusion When we treat sellar region lesions by the lateral orbital keyhole approach ,especially for clipping the aneurysm at the ophthalmic segment ,we should expertly master the anatomical features of ophthalmic segment of internal ca -rotid artery,focus on protecting these perforating vessels ,and it has important clinical significance for the prognosis of the patients .
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Objective To compare the incidence of contrast-induced acute kidney injury(CI-AKI) following iso-osmolar iodixanol or low-osmolar iohexol administration in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods The study was a prospectiverandomized controlled study.Consecutive patients with AMI were assigned to either the iodixanol group or the iohexol group randomly after they were categorized in different group according to the infarcted walls(inferior and anterior infarction)indicated by electrocardiogram. The primary end point was the incidence of CI-AKI,which is defined as serum creatinine(sCr)increase>25% or>0.5 mg/dl(44 μmol/L)from baseline witin 72 hours. Results Two hundred ninety-seven patients were enrolled and allocated to the iodixanol group(n=149)or the iohexol group(n=148),and CI-AKI occurred in 22.1% of patients in the iodixanol group and 16.9% of patients in the iohexol group (95% confidence interval –14.2% to 3.8%,P for noninferiority<0.002). The incidence of CI-AKI was higher in the anterior infarction group than in the inferior infarction group(21.4% vs. 11.6%,P<0.01). Conclusions In patients with AMI who underwent emergent PCI,iohexol was not inferior to iodixanol on the incidence of CI-AKI,and it is reasonable to avoid selection bias for assigning patients into inferior and anterior infarction group according to the infarcted walls for the future CI-AKI related clinical study.
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Objective To compare the incidence of contrast-induced acute kidney injury(CI-AKI) following iso-osmolar iodixanol or low-osmolar iohexol administration in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods The study was a prospectiverandomized controlled study.Consecutive patients with AMI were assigned to either the iodixanol group or the iohexol group randomly after they were categorized in different group according to the infarcted walls(inferior and anterior infarction)indicated by electrocardiogram. The primary end point was the incidence of CI-AKI,which is defined as serum creatinine(sCr)increase>25% or>0.5 mg/dl(44 μmol/L)from baseline witin 72 hours. Results Two hundred ninety-seven patients were enrolled and allocated to the iodixanol group(n=149)or the iohexol group(n=148),and CI-AKI occurred in 22.1% of patients in the iodixanol group and 16.9% of patients in the iohexol group (95% confidence interval –14.2% to 3.8%,P for noninferiority<0.002). The incidence of CI-AKI was higher in the anterior infarction group than in the inferior infarction group(21.4% vs. 11.6%,P<0.01). Conclusions In patients with AMI who underwent emergent PCI,iohexol was not inferior to iodixanol on the incidence of CI-AKI,and it is reasonable to avoid selection bias for assigning patients into inferior and anterior infarction group according to the infarcted walls for the future CI-AKI related clinical study.