Objective To enhance clinical gastrointestinal physicians’ understanding of ascites resulting from constrictive pericarditis by analyzing clinical features of. Methods A retrospective analysis was carried out in patients with constrictive pericarditis with the major presentation of ascites in our department of gastroenterology from January 1993 to May 2008. Medical records of these patients were reviewed, including data of demographics, course of desease, clinical presentation, relevant imaging studies and so on. Results There were 8 cases of constrictive pericarditis with the major presentation of ascites in our department of gastro-enterology in 15 years. The jugular varicosity was the most common manifestation in the 8 cases, followed by tabdominal distension and oedema. There were some abnormal changes in the electrocard-iography of the 8 cases. In 4 cases, no diagnosis was reached by the echocardiogram. In 8 cases,the definite diagnosis was reached by CT or MRI. Conclusion Cautions should be demanded for the patients with the major presentation of ascites in the department of gastroenterology owing to the possibility of constrictive pericarditis. In these patients, consummate physical examination is demanded such as the jugular varicosity. And the definite reason must be probed in the patients with the abnormal electrocardiographic changes.

Objective To investigate the clinical value of tumour markers and serum-ascites albumin gradient (SAAG) in diagnosis of malignant ascites. Methods One hundred and fourteen patients with ascites, who were admitted to the hospital between Jan. 2005 and Jan. 2008, were retrospectively reviewed. The patients were divided into malignant (n = 39) or benign (12 with tuberculosis and 93 with aseptic liver cirrhosis) ascites groups according to the etiology. The distribution of tumor markers (CEA, CA19-9 and CA125) and SAAG in both groups were analyzed and receiver operating characteristic (ROC) was constructed. Results The tumor markers and SAAG were found both in malignant ascites group and benign ascites group. The concentrations of CEA and CA19-9 in serum and ascites were higher in malignant ascites group than in benign ascites group. The SAAG in malignant ascites group was significantly lower than that in patients with liver cirrhosis (P<0.05), but had no difference in comparison with tuberculosis patients (P>0. 05). There was no difference in level of CA125 in serum or ascites between malignant ascites group and benign ascites group (P>0.05). The area under the curve of ascitic fluid CEA, CA19-9 and SAAG were 0.79, 0.82 and 0.85, respectively. The cutoff values of ascitic fluid CEA, CA19-9 and SAAG were optimally chosen at 1.45 μ/L, 19.50 μ/L and 13. 50 g/L, respectively. The sensitivity and specificity were 66.7% and 78.1% in CEA, 74.4% and 84.8% in CA19-9, as well as 82.9% and 84.6% in SAAG.The combination of ascitic fluid CA19-9 with SAAG could increase the specificity to 97.14%, but decrease the sensitivity to 61.54%. Conclusion It is feasible to achieve optimum combination of biochemical indicators using ROC in differential diagnosis of malignant ascites from benign ascites.

OBJECTIVE:To evaluate the effect of L-carnitine on serum total level of homocysteine (tHcy) in patients undergoing maintenance hemodialysis. METHODS: 60 patients undergoing maintenance hemodialysis were randomly divided into two groups (treatment group and control group): the patients in the treatment group were injected i.v. with 1.0 g of L-carnitine for 12 weeks,and those in the control group were injected i.v. with 5 mL normal saline for 12 weeks. Meanwhile,the healthy people were involved as normal control group(n=20). tHcy was detected by ELISA method;the fasting insulin was detected by radio-immunity method. Fasting blood glucose,total cholesterol,triglyeride,HDL and LDL were detected by routine method. The reciprocal of the multiplication product between fasting blood glucose and insulin concentration were computed as insulin sensitivity index(ISI). RESULTS: After treatment for 12 weeks,the treatment group showed increased ISI but significantly reduced tHcy(P

OBJECTIVE To discuss the liable episodes of the urinary tract infection with relation of catheter and propose the prevention measures.METHODS We radomly selected 536 patients with catheter.The urinary tract infection,as well as related factors were observed in patients with indwelling catheter.RESULTS The catheter replacement time interval as well as indwelling time were the risk factors,when the indwelling catheter time was 1-3 days,the CAUTI rate was 10.3%,if the time was ≥10 day,the CAUTI rate was 97.6%.Additionally the antibiotic use would cause dysbacteriosis which also easily caused the urinary tract road infection.CONCLUSIONS When taking care of the patients who had catheter,we should grasp the indications of catheterization,reduce the indwelling time,apply the effective nursing measures and correct choice of antibiotics,that can evidently control the infection.

Objective To explore the CT characteristics of mucinous cystadenocarcinoma of appendix.Methods The CT findings of 5 patients with mucinous cystadenocarcinoma of appendix proved by surgery and pathology were analyzed retrospectively,and the corresponding literatures were also reviewed.Results All lesions in 5 patients showed cystic changes in the right hypogastrium inclu-ding irregular shape with lobulation in 4 and tubular shape in 1.The maximum traverse diameters ranged from 27 mm to 146 mm. Unclear boundary was showed if the lesion invaded the adjacent gut.The cystic wall was asymmetry and thickened with little nodes and nipple in the inner wall.The thick septa were seen in 3 tumors.Much mucus was seen in tumors with uneven density and average CT value of 1 9.3 HU-34.6 HU.On enhanced CT,obvious enhancement of the cystic wall and septa in 4 and moderate enhance-ment in 1 was showed.The adjacent fatty gap of 3 tumors were clear,however it was vague when accompanied with acute inflamma-tion.Small calcification in 3 and enlarged lymphatic nodes in 3 were also found.Conclusion CT shows some characteristics of mu-cinous cystadenocarcinoma of appendix and plays an important role in the diagnosis of the disease.

Objective To compare the efficacy of different volume of ropivacaine and lidocaine for ultrasound-guided infraclavicular brachial block.Methods Sixty patients scheduled for distal upper limb surgery were divided into group A and group B by random digits table method with 30 cases each.The patients were given ultrasound-guided infraclavicular brachial block,but the patients in group A using 0.3％ ropivacaine mixed with 1％ lidocaine 20 ml,the patients in group B using the same mixture 30 ml.Sensory block was assessed every 5 min after the block.Motor block was evaluated at 30 min after the block.The onset time of anesthesia,surgical success rate,complications and duration of anesthesia were recorded.Results There was no significant difference in the surgical success rate [93.3％(28/30) vs.96.7％(29/30),P＞0.05],onset time of sensory block [10 (5) min vs.5 (5) min,P＞0.05] and degree of motor block between the 2 groups.The duration of anesthesia in group A was shorter than that in group B (P ＜ 0.05).Conclusion The efficacy of ultrasound-guided infraclavicular brachial block with the mixture of 0.3％ ropivacaine and 1％ lidocaine 20 ml and 30 ml is similar in surgical success rate and onset time of anesthesia.

Objective To analyze the CT manifestation and clinical characteristics of appendiceal mucinous tumor for improving the diagnostic and therapeutic level. Methods The CT and clinical data of 7 patients with appendiceal mucinous tumor verified by histopathology were retrospectively analyzed. Results Among the 7 cases, mucinous cystadenomas was in 6 cases, and mucinous cystadenocarcinoma was in 1 case. One case had no obvious discomfort;3 cases visited because of pain on right hypogastrium and fever;3 cases had the medical history ofchronic appendicitis, among whom 2 cases had the mass on right hypogastrium which had existed for 1 day or 2 years. The unenhanced CT showed that all of 7 cases had the cystic tumors on right hypogastrium near the cecum, and the maximum traverse diameter was 25-208 (67 ± 27) mm. The cyst walls of mucinous cystadenoma in 6 cases were flimsy, symmetrical, 2.3-3.5 mm thickness and smooth. Three cases had cyst walls calcification; the cyst wall of mucinous cystadenocarcinoma was thick and asymmetrical, and the thickness of cyst wall was 3.5-5.7 mm. Small nodes could be found inside the walls. 7 cases had much mucilage, with CT value 14.0-33.5 HU. Four cases had slight septa. The enhanced CT showed that the cyst walls of mucinous cystadenoma in 6 cases were mild to moderate continuous enhancement during venous phase; the cyst wall and nodes mucinous cystadenocarcinoma was obvious and continuous enhancement. Four cases showed clear boundary, while 3 cases accompanied with acute inflammation showed dim edge. The enlargement of lymphatic nodes could be seen near mesentery in 1 case. All the 7 cases were treated by surgical treatment. One patient who survived after 26 months showed the metastasis of peritoneal pseudomyxoma after 20 months. The 6 patients with mucinous cystadenoma were followed up for 18 - 36 months, they did not had metastasis or recurrence by CT review. Conclusions Appendiceal mucinous tumor is often short of characteristic in clinical symptom and physical sign, but has favourable prognosis. CT is a vital tool for its diagnosis and identification.

Objective To assess the effectiveness and safety of vitamin D in preventing and treating bone loss in renal transplant patients.Methods Methods recommended by the Cochrane Collaboration were used.MEDLINE,EMBase,Cochrane Library and CNKI were searched from Jan.1990 to Nov.2009 to locate all the randomized controlled trials (RCT) concerning preventing and treating bone loss by vitamin D in renal transplant patients.The qualities of included trials were evaluated by two independent reviewers.Trails consistent with criteria wereanalyzed by Revman 4.2 software.Results Nine RCTs involving 658 post transplant patients were included.The qualities of included trials were graded as grade A in 4,grade B in 2 and grade C in 3.Meta-analysis showed that after being treated with vitamin D for one year,the difference of BMD,Z-score and T-score between the two groups was statistically significant (P＜ 0.05); the difference of PTH concentration was also statistically significant (P＜0.01),but there was no significant difference in concentrations of serum calcium and phosphorus,and the incidence of hypercalcemia (P＞0.05).Conclusion Current available evidence demonstrates that vitamin D is effective and safe in preventing and treating bone loss in renal transplant patients.

OBJECTIVE: To analyze the differences of sleep respiratory parameters recorded by PSG and synchronous blood pressure measured by ambulatory blood pressure monitor between obstructive sleep apnea (OSA) patients with hypertension (HT) and simple OSA and simple HT; To determine the characteristics of sleep respiratory parameters and blood pressure changes in patient with OSA accompanied HT. METHOD: We chose the patients who were diagnosed simple HT (n=45) and simple OSA (n=50) and OSA with HT (n=56), Compared the sleep respiratory parameters and blood pressure changes between the three groups. Meanwhile the correlations about the sleep respiratory parameters and synchronization blood pressure were analyzed. RESULT: Compared with simple HT and simple OSA, OSA with HT has higher apnea hyponea Index (AHI) (P<0. 001), oxygen desaturation index (ODI), awake index (AI), wake after sleep onset (WASO) and the proportion of non-rapid eyemovement sleepl (N1) in total sleep time(TST), has lower mean arterial oxygen saturation (MSaO2), lowest arterial saturation oxygen (LSaO2), the proportion of slow wave sleep (SWS) and rapid eyemovement sleep (REM) in TST (P<0. 05). There were positive correlations between the systolic/diastolic blood pressure (SBP/ DBP) and AHI, ODI, AI, WASO and N1/TST (P<0. 05). Compared with simple OSA, the mean day systolic blood pressure (dMSP), mean night systolic blood pressure (nMSP), mean day diastolic blood pressure (dMDP), mean night diastolic blood pressure (nMDP) and mean night diastolic blood pressure (nMDP) were significantly decre- sed, meanwhile the difference between the average systolic/diastolic blood pressure day and night were significantly increased after continuous positive airway pressure (CPAP) treatment. OSA with HT has higher There were negative correlations between the SBP/DBP and MSaO2, LSaO2 (P<0. 05). Blood pressure mainly changed in the later sleep stage when the REM phase was increased. Blood pressure changes were characteristic of increasing DBP and decreasing SaO2. CONCLUSION There are significant differences between simple OSA and OSA with HT in the sleep respiratory parameters, which are closely related with changes of blood pressure in sleep stage; AHI is the high risk factor of the OSA with HT. PSG is a effective factor in estimating the OSA accompanied HT course of development and prognosis.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Continuous Positive Airway Pressure ; Humans ; Hypertension ; complications ; Polysomnography ; Sleep ; Sleep Apnea, Obstructive ; complications ; diagnosis ; Sleep Stages

Objective To evaluate the therapeutic effects of taurine combined with silybin meglumine in patients with non-alcoholic steatohepatitis (NASH). Methods One hundred patients with NASH were divided into two groups with 50 for each. The patients in the control group received polyene phosphatidyl choline (456 mg) combined with silybin meglumine (100 mg) 3 times daily for 24 weeks. While those in the treatment group received taurine (2 g) combined with silybin meglumine (100 mg) 3 times daily for 24 weeks. All patients were asked to take up basic therapy including drinking without alcohol, restricting sugary and fatty intake, improving food structure, carrying moderate aerobics and lightening body weight. Results At the end of 24 weeks, the clinical symptoms and the liver function ameliorated in two groups. Ultrasonic or CT examination showed that the steatohepatitits was improved significantly in two groups. Additionally, the levels of blood glucose, serum triglyceride and cholesterol as well as BMI decreased simultaneously (all P value <0. 05). Whereas the treatment group was superior to control group in aspect of amelioration of inappetite, nausea and vomiting as well as lever of serum triglyceride (all P value <0. 05). There was no side effect in the treatment group. Conclusion Based on the basic therapy, taurine combined with silybin meglumine can mitigate the degree of NASH, improve the metabolism of blood glucose and lipid with few side-effects.