Coronary Disease ; diagnosis ; drug therapy ; Humans ; Nitrates ; adverse effects ; therapeutic use ; Prognosis ; Vasodilator Agents ; adverse effects ; therapeutic use

Atrial Fibrillation ; prevention & control ; Humans ; Primary Prevention

Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Atrial Fibrillation ; prevention & control ; Humans ; Mineralocorticoid Receptor Antagonists ; therapeutic use ; Renin-Angiotensin System

Objective To compare the neuromuscular blocking effects of rocuronium given by intermittent bolus injection, continuous infusion and target-controlled infusion during liver transplantation. Methods Thirty-six patients with hepatic failure of both sexes aged 21-63 yr weighing 48-80 kg undergoing liver transplantation were studied. The donor livers were obtained from living donors. The patients were divided into 3 groups according to the mode of rocuronium administration ( n = 12 each): group Ⅰ intermittent bolus injection (group Ⅳ); group Ⅱ continuous infusion (group CI) and group Ⅲ target-controlled infusion (group TCI). Neuromuscular block was assessed by TOF stimulation of ulnar nerve (TOF-Watch SX). Anesthesia was induced with midazolam 5 mg,fentanyl 4-6 μg/kg and propofol 1.0-1.5 mg/kg, and rocuronium was administered using different modes of administration. A bolus of rocuronium 0.6 mg/kg was given during induction and supplemental rocuronium 0.15 mg/kg was given when T1 was returned to 25% in preanhepatic stage and T4/T1 (TOFR) returned to 25% in anhepatic and neohepatic stages in group Ⅳ. TCI at an initial target effect-site concentration of 3 μg/ml was started during induction, the concentration was adjusted to maintain T1 at 5%-10% , TCI was temporarily suspended at the beginning of anhepatic and neohepatic stages, and then TCI at a target effect-site concentration of 0.1 μg/ml was started again and the concentration was adjusted to maintain T1 at 5%-10% in group TCI. A bolus of rocuronium 0.6 mg/kg was given during induction, the initial infusion rate was set at 30 μg· kg-1 ·min-1 and then adjusted to maintain T1 at 5%-10% in preanhepatic stage, CI was temporarily suspended at the beginning of anhepatic and neohepatic stages, and then it was started again at 1 μg· kg-1 · min-1 in preanhepatic stage and the infusion rate was adjusted to maintain T1 at 5%-10% in group CI. Tracheal intubation was performed when the maximal effect was achieved. The administration was stopped after suture of the peritoneum. The onset time, the maximal depression of T1 , intubation condition, recovery time and the total amount of rocuronium consumed were recorded.Results There was no significant difference in onset time, the maximal depression of T1, intubation condition,ecovery time and the total amount of rocuronium consumed among the 3 groups ( P ＞ 0.05). Conclusion There is no significant difference in the onset and recovery when neuromuscular blocade was induced by rocuronium via Ⅳ, CI and TCI, but neuromuscular blockade induced by rocuronium via TCI and CI is more stable than that induced by rocuronium via Ⅳ during liver transplantation.

Objective To compare the therapeutic effect between routine shunting and selective shunting in patients with moderate and severe carotid artery stenosis undergoing carotid endarterectomy (CEA). Methods One hundred and ninety-two patients with moderate and severe carotid artery stenosis undergoing CEA were selected, and the patients were divided into control group (routine shunting) and observation group (selective shunting) according to the random digits table method with 96 cases each. The intraoperative carotid artery occlusion time and incidences of stroke event 30 d after operation were recorded. Results In the observation group, the rate of carotid artery shunting was 35.4％ (34/96), among which the rate of carotid artery shunting in patients with contralateral severe carotid artery stenosis or occlusion was 8/13, the rate of carotid artery shunting in patients with unilateral carotid stenosis was 31.3％ (26/83), and there was statistical difference (χ2 = 13.006, P<0.01). There was no statistical difference in intraoperative carotid artery occlusion time between control group and observation group ( t=2.091, P>0.05). In the observation group, the intraoperative carotid artery occlusion time in patients with carotid artery shunting was significantly shorter than that in patients without carotid artery shunting:(4.36 ± 0.48) min vs. (10.15 ± 0.91) min, and there was statistical difference (t=7.884, P<0.05). There was no statistical difference in the incidence of stroke event 30 d after operation between control group and observation group (χ2 = 1.189, P>0.05). Conclusions The selective shunting during CEA can reduce the incidence of postoperative stroke event in patients with carotid artery stenosis, and especially it can give a good clinical effect in the patients with contralateral severe carotid artery stenosis or occlusion.

0.05). The onset time of 0.2mg/kg and 0.4mg/kg cisatracurium was significantly shorter than that of 0.1mg/kg cisatracurium and 0.5mg/kg atracurium (P

Objective The study was designed to compare the effects of desflurane and isoflurane on the vecuronium-induced neuromuscular block in the elderly patients. Methods Thirty ASA class I - II elderly patients aged over 70 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups: desflurane group ( I , n = 10) ; isoflurane group ( II , n = 10) and 3 control group ( III , n = 10). Anesthesia was induced with midazolam 0.02-0.05 mg? kg-1 , propofol 0.5-2.0 mg ? kg-1 and fentanyl 2-5?g? kg-1 maintained with inhalation of 6% desflurane(1 MAC) +50% N2O in oxygen (group I ) or 1.15% isoflurane + 50% N2O in oxygen(group II ) or 50% N2O in oxygen (group III ) supplemented with intermittent iv boluses of propofol and fentanyl when necessary. Neuromuscular block was monitored using accelograph (TOF GUARD , Denmark) .A total dose of vecuronium 40 mg ?kg-1 was divided with 4 equal doses of 10?g ? kg-1 , which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak (T1 was no longer depressed in the height of 3 successive stimuli) .The cumulative dose-response curves of the 3 groups were established. The onset time and maximum depression of T1 of the initial dose and 3 incremental doses were recorded. After the last increment of 10 ?g?kg-1, the time for T1 to returned to 25% ,75% ,90% and TOF ratio(T4/T1) to 70% were recorded. The recovery index was also calculated.Results The demographic data were comparable between the 3 groups. The ED50 and ED95 were significantly lower in desflurane and isoflurane groups than those in control group(P 0.05 ) . The time for T1 to return to 25 % , 75 % and 90 % was significantly longer in desflurane and isoflurane group than that in the control group. The recovery from vecuronium-induced neuromuscular block was slower in desflurane group than that in isoflurane group( P

Objective To analyse renal lesions associated with infectious endocarditis (IE). Methods Renal lesions associated with IE were reviewed. One hundred and fifty-five cases of IE were admitted to Peking Union Medical College Hospital from 1983 to 2004. C-square, t-test and Spearman's rank correlation analysis were performed. Results One hundred and thirty-seven(84.4%) cases of renal lesions associated with IE with an average age of 38 were found. The ratio of male to female was 1.4 and the period of pre-renal lesion was 4.8 months. Renal lesions included asymptomatic hematuria and/or proteinuria (71.0%), acute nephritic syndrome (6.5%), nephrotic syndrome (2.6% ), rapid progressive glomerulonephritis (1.3% ), renal embolism (1.3% ), isolated pyuria(3.2%), renal lesion not directly related to IE(2.6%). Acute renal insufficiency in 14 cases were caused by glomerulonephritis (5 cases), acute interstitial nephritis (5 cases), renal embolism(1 case), acute heart failure(5 cases) and the adverse effect of antibiotics (2 cases). Renal biopsy was taken in four patients. One diffuse proliferative glomerulonephritis, one membranous glomerulonephritis, one membrane-proliferative glomerulonephritis and one crescentic glomerulonephritis were found. All patients received antibiotic therapy and three of them stopped taking antibiotics, which was suspected to cause renal lesion. 20.4% cases received surgical therapy. 3.6% were treated with corticosteroid and/or immunoimpressive drugs and two cases of them were treated with intravenous bolus methylprednisolone. One case recieved anticoagulant therapy. 4.5% cases died. 43.8% cases with renal lesions were cured and 85.7% serum creatinine level decreased to normal. Statistical analysis showed that active treatment made no improvement on neither patients with or without renal lesion nor patients with different severity of renal lesion. Conclusions Renal lesions associated with IE are common. Most are asymptomatic hematuria and/or proteinuria. Acute nephritic syndrome, nephrotic syndrome, rapid progressive glomerulonephritis, renal embolism may also occur. It maybe appropriate to treat with corticosteroid, immunopressive drugs or intravenous bolus methylprednisolone for patients with rapid progressive glomerulonephritis under successful management of infective endocarditis.

Objective：To study the mental health status of heroin addicts and their need for psychotherapy after detoxification. Methods：The mental health of 83 heroin addicts and 70 normal subjects were assessed by SCL-90, Social Support Rating Scale , EPQ, SAS and SDS. Results：As compared to normal controls, heroin additions were found to score higher on various mental health measures, including SCL-90 total and factor scores, the N score of EPQ, as well as total scores on SAS and SDS. The social support in heroin addicts scored lower than normal subjects. Conclusion：Heroin addicts have severe psychological problems, which warrant long-term psychological rehabilitation after detoxification.

Objective To evaluate the role of multi-slice computed tomography (MSCT) in the diagnosis of pulmonary sequestration.Methods MSCT scans of 18 cases of pulmonary sequestration proved by surgery and pathology were reviewed.All cases underwent plain and contrast enhanced CT scanning,and retrospective reconstruction was made.Various reconstruction techniques in displaying the pulmonary sequestration and associated malformation were evaluated.Results Anomalous systemic arterial supply was discovered by transverse CT images in 12 cases.The reconstructed images using multiple methods showed the aberrant artery more clearly in all cases,including 6 cases in which the abnormalities were not confirmed by transverse CT.Drainage vein was revealed in 13 cases and lung heteroplasia with other malformation was demonstrated in 14 cases.Volume rendering (VR) reconstruction is the optimal choice for displaying the abnormal vessels and airway.Conclusion Enhanced MSCT with image post-processing can show the abnormal artery and vein of the pulmonary sequestration and the associated malformation,so it is the first choice in diagnosing pulmonary sequestration in pediatric population.