Upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation: A case report.

BACKGROUND: In recent years, it has been recognized that transesophageal echocardiography (TEE) is of great value in resuscitation of cardiac arrest. However, its safety has rarely been reported. CASE SUMMARY: We present a 59-year-old male patient scheduled to undergo cardiac surgery for rheumatic heart disease. Upper gastrointestinal bleeding from a Mallory-Weiss tear appeared following cardiopulmonary resuscitation, TEE, and percutaneous cardiopulmonary bypass resuscitation when he suffered from aesthesia-related cardiac arrest. Gastrointestinal injury was diagnosed promptly and treated effectively. However, the exact etiology of gastrointestinal injury was unclear; the interaction of closed-chest cardiac massage and the application of TEE may be involved as a most possible mechanism of injury. CONCLUSION: Serious complications should be considered when TEE is used in patients with special pathophysiological conditions.

[The Role of Bone Morphogenic Protein-4 in the Progression of Vein Graft Hyperplastic Remodeling under Hyperglycemic Condition].

OBJECTIVE: This study was designed to assess the vessel wall characteristics and the expression levels of bone morphogenic protein4(BMP4) and proliferating cell antigen Ki67 in vein grafts harvested from diabetic rats,and to investigate the role of BMP4 in progression of vein graft hyperplastic remodeling under hyperglycemic condition. METHODS: 48 male SpragueDawky rats [body mass (194±16) g] aged 8 weeks were randomly divided into diabetes mellitus (DM) group ( n=24) and nondiabetes mellitus (NDM) group ( n=24). The DM rats were induced by streptozotocin in combination with highsugar and highfat diet. The unilateral external jugular vein was interposition grafted into the common carotid arteries in the two groups. The vein grafts were harvested at preoperatively and 1,2 and 4 weeks postoperatively ( n=6) in each group. The morphological characteristics of the venous graft wall were evaluated by hematoxylineosin staining,and the expression levels and the distribution of Ki67 and BMP4 were assessed by immunohistochemistry analysis,then the expression of BMP4 gene and protein was measured by realtime polymerase chain reaction (RTPCR) and Western blot assay respectively. RESULTS: In the progression of rats vein grafts hyperplastic remodeling,the venous wall thickness of rats thickened with time increasing,and the intimal and medial thickness of the vein grafts harvested from DM rats were significantly higher than those from NDM rats at the same time postoperatively ( P<0.05). Ki-67 was highly xpressed in smooth muscle cells nucleus located in the rats vein grafts,and its expression level was up-regulated gradually in the progression of vein graft failure,and the Ki 67 positive cells of vein grafts from DM rats were significantly higher than those from NDM controls at the same period ( P<0.05). Immunohistochemistry analysis showed that BMP4 was expressed in smooth muscle cells cytoplasmof the rats vein grafts,combined with the results of RT-PCR and Western blot assay,there was a little BMP4 expression could be seen in venous wall of NDM rats,while BMP4 positive cells and the expression level of BMP4 gene and protein from DM rats vein grafts was increasing with obvious time dependence and significantly higher than the NDM rats ( P<0.05). CONCLUSION: The morphological and pathological changes within the venous wall were significantly correlated with the high expression levels of BMP4 in vein grafts harvested from diabetic rats,implying a potential role of BMP4 in the progression of accelerated vein graft failure under hyperglycemic condition.

Preliminary report on use of 3-dimensional computed tomographic images in a disease-based transesophageal echocardiographic simulation system.

We used 3-dimensional computed tomographic images to create a disease-based transesophageal echocardiographic simulation system for complex congenital heart defects. We enrolled 7 pediatric patients with complex congenital heart defects in this proof-of-concept study. Preoperative computed tomographic images and intraoperative transesophageal echocardiographic images were acquired for all patients. Two- and 3-dimensional computed tomographic cross-sectional images were created to simulate the process of transesophageal echocardiographic image acquisition. Computed tomographic images simulating the midesophageal 4- and 5-chamber views, aortic valve short-axis views, long-axis views, and ascending aortic short-axis views were created to correspond with the actual transesophageal echocardiographic images from each patient. Four reviewers then evaluated the image quality of the computed tomographic images, the agreement between the echocardiographic and tomographic images, and the ability of the 3-dimensional computed tomographic full-volume and cross-sectional images to yield the spatial and temporal congruence of transesophageal echocardiograms. In most of the patients, computed tomography yielded images of good-to-excellent quality. Strong agreement was noted between the computed tomographic and transesophageal echocardiographic images acquired in the same patients. The ability of 3-dimensional computed tomography to yield the spatial and temporal congruence of transesophageal echocardiography in selected planes was also good to excellent. We found that 3-dimensional computed tomographic images can simulate the process of transesophageal echocardiography in acquiring the echocardiographic image clearly. This imaging method has the potential to be applied successfully to a disease-based transesophageal echocardiographic simulation system.

[The effects of prolonged sevoflurane anesthesia on renal function in liver fibrosis rabbits].

OBJECTIVE: To determine the effects of prolonged sevoflurane anesthesia on renal function in liver fibrosis rabbits. METHODS: Fifty male new zealand rabbits were randomly divided into two groups: fibrosis group (n = 40) and normal control group (Group N, n = 10). In the fibrosis group, experimental liver fibrosis was induced by subcutaneous injection of carbon tetrachloride (CCl4 soluted in oil with the concentration of 500 mL/L). Twelve weeks later, 24 rabbits survived in fibrosis group were randomly allocated to control group (Group F, n = 12) or treating with sevoflurane (Group S, n = 12). Both group S and group N received 1.0 minimum alveolar concentration (MAC) sevoflurane for 8 h with a fresh gas flow rate of 1 L/min. Group F was just given fluid infusion. After 8 h of 1.0 MAC anesthesia, sevoflurane was discontinued. Blood samples were collected before (T0) and 8 h (T8), 24 h (T24), 72 h (T72), and 120 h (T120) after anesthesia. The renal function was assessed by blood urea nitrogen (BUN) and creatinine (Cr). The serum inorganic fluoride was measured by ion-selective electrode. The pathological consequences of the livers were obtained after 5 days or when the rabbits died. RESULTS: All the rabbits in group S and group F developed liver fibrosis. The hepatic function was significantly abnormal in group S and group F. Aminotransferase (AST), glutamic-pyruvic transaminase (ALT), lactate dehydrogenase (LDH) and total bile acid (TBA) were significantly higher in the fibrosis group (group S and group F) than those in group N. Alkaline phosphatase (ALP) in the fibrosis group was lower than that in group N. There were no significant differences of hepatic function between group S and group F. There were no significant differences in renal function and serum inorganic fluoride before and after anesthesia among the three groups. In group N and S, BUN and serum inorganic fluoride increased slightly at T8, and serum Cr was highest at T72. All of them returned to basic line at T120. In group F, BUN increased slightly at T8, and serum Cr was highest at T72. Serum inorganic fluoride was highest at T120. BUN and serum Cr returned to basic line at T120. CONCLUSION: Prolonged sevoflurane anesthesia has no significant influences on renal function in normal and liver fibrosis rabbits.