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Objective:To investigate the incidence, drug sensitivity and drug resistance characteristies, and theraputic effect of staphylococcal peritoneal dialysis-associated peritonitis (PDAP), aim to provide clinical evidences for standardizing treatment therapy of staphylococcal PDAP. Methods:Clinical data of PDAP patients admitted to the Second Hospital of Jilin University, the First Hospital of Jilin University-the Eastern Division, Jilin Central Hospital and Jilin First Automobile Work General Hospital during January 1, 2013 and December 31, 2019 were retrospectively collected. The results of etiology, drug sensitivity and drug resistance of staphylococcal PDAP patients were collected. According to the pathogenic bacteria, patients were divided into staphylococcus aureus group ( n=48) and coagulase-negative staphylococcus group ( n=232). According to the results of methicillin resistance, patients were divided into drug-resistant group ( n=71) and drug-sensitive group ( n=30). The prognosis of antibiotic therapy in each group were compared. Poisson regression was used to test the changing trend of the incidence of staphylococcal PDAP. The changes of drug sensitivity and drug resistance of staphylococcus were compared between 2013 and 2019 by linear trend χ2 test. Results:A total of 1 085 cases of PDAP occurred in 625 patients were screened, and 280 cases of staphylococcal PDAP were finally included. The incidences of staphylococcal PDAP, staphylococcus aureus PDAP and coagulase-negative staphylococcal PDAP were 0.063 times per patient year, 0.010 times per patient year and 0.053 times per patient year respectively. In addition, the incidence of PDAP caused by staphylococcus, staphylococcus aureus and coagulase-negative staphylococcus decreased year by year (all P<0.05). With the change of years, the sensitivity rate of staphylococcus to rifampicin increased, while the sensitivity rate of staphylococcus to moxifloxacin decreased (both P<0.05). The drug resistance rate of staphylococcus to levofloxacin increased ( P<0.05). The staphylococcus aureus group was more prone to refractory PDAP and catheter removal than that in coagulase-negative staphylococcus group, and the recurrence rate was higher than that in coagulase-negative staphylococcus group (all P<0.05). The proportion of vancomycin used during the whole course of antibiotic therapy in drug-resistant group was higher than that in drug-sensitive group ( P<0.05). Conclusions:The incidence of staphylococcal PDAP decreases year by year, and the drug sensitivity characteristics of staphylococcus also change. The therapeutic outcomes of staphylococcus aureus PDAP are worse than that of coagulase-negative staphylococcus.
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OBJECTIVE@#To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis.@*METHODS@#The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events.@*RESULTS@#A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (@*CONCLUSIONS@#Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.
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Humans , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To assess the clinical value of volume helical shuttle (VHS) of highdefinition CT (HDCT) in the diagnosis of congenital heart disease (CHD).Methods Forty-three patients suffering from CHD were examined with VHS of HDCT and echocardiography (ECHO).Twenty-four patients (21 children,3 adults) received surgery.Based on surgical data,the diagnostic accuracy of CHD by VHS of HDCT was compared with that by ECHO with respect to the intra-cardiac lesion,extra-cardiac lesion and hemodynamics.The visibility of the origin and proximal course of coronary arteries was also evaluated on VHS.CT effective doses were calculated,using mSv =DLP × K. Results Thirty-six intra-cardiac deformities were found by operation,and the diagnostic accuracy of both VSH and ECHO were 100.0％ (36/36).VHS successfully detected 42 of 44 (95.4％) cardiac-vascular connection and large vascular deformities,whereas ECHO only detected 26 (59.1％ ).The right-to-left shunt and left-to-right shunt of septal defects revealed by VHS were 5 and 6 patients respectively,which all coincided with the results of ECHO.Fourteen bi-directional shunt of septal defects were detected by ECHO,and 13 of them were diagnosed as right-to-left shunt by HDCT except an illegibility in 1 patient.The origin and proximal course of coronary arteries were all visible on VHS.Effective dose for children was (3.38 ± 1.86) mSv,and for adults was ( 10.27 ± 2.59) mSv.Conclusions VHS of HDCT scan is advantageous in the diagnosis of CHD.It can depict the intra- and extra- cardiac structures as well as coronary arteries and provide hemodynamic information.
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Objective To assess the value and feasibility of 64-slice spiral CT in diagnosis of coronary artery aneurysm in the follow-up of young children with previous Kawasaki disease. Methods Twelve boys (mean age 5.1 years) for follow-up (ranged 1.1 to 5.1 years) with known Kawasaki disease and coronary artery aneurysms underwent coronary CT angiography using 64-slice spiral CT.The number,location,shape and size of each coronary artery aneurysm were recorded and compared with those of echocardiography performed simutaneously. Results A total of 30 coronary artery aneurysms were identified with mean diameter of(7.5±3.8) mm,and mean maximum length of (12.4±9.1) mm.10 aneurysms were small in size,7 aneurysms were medium in size and 13 were giant aneurysms.Fourteen aneurysms were saccular,and the remaining 16 were fusiform. Among the aneurysms in left coronary artery,7 of them were located in the main branch,9 were located in the proximal segment of the anterior descending branch,4 were located at the middle segment of the anterior descending branch,and 2 were located in the circumflex branch.Among the aneurysms in right coronary artery,6 of them were located in the proximal segment,9 were located in the middle segment,and 4 were located at the distal segment.Nine of the aneurysms involved 2 segments of the coronary arteries,and one involved 3 segments.Six stenotic segments were found. Calcification was found in 5 aneurysms and 3 of them had thrombosis. Echocardiography failed to detect 8 aneurysms of small size and located in the middle or distal segments of the coronary arterys.Conclusion The 64-slice CT angiography proved valuable for monitoring young children with Kawasakidisease.
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Objective To study the characteristics of satellite nodules of hepatocellular carcinoma (HCC) and the treatment methods by transcatheter hepatic arterial chemoembolization (TACE). Methods Forty one cases of massive HCC and single nodular HCC proved by pathology underwent the examination of spiral CT and angiography for observing the characteristics of satellite nodules. All the patients were treated by TACE and the results were analyzed. Results The satellite nodules were found in 17 out of 41 cases by CT and/or angiology of which 10 were hypervascular and 7 hypovascular. The satellite nodules located within 1 cm from the margin of the main HCC in 11 out of 17 cases. In the treatment of TACE, the tip of catheter was located on the proximal end of feeding artery of tumor so that the embolization area included the area of satellite nodules. After 6-19 months follow up, 5 patients were complete response (CR) and partial response (PR) in 17 cases but no progressive patients were found. Conclusion The satellite nodules extensively exist in HCC and can be effectively treated using reasonable methods.
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<p><b>OBJECTIVE</b>To evaluate the significance of temporary block of gastroduodenal artery in hepatic artery chemotherapy.</p><p><b>METHODS</b>Forty patients were randomized into two groups with 20 in each. In the trial group, when the catheter was introduced into the gastroduodenal artery, pituitrin was infused slowly (2 U/min) till the gastroduodenal artery became blocked, then the catheter was pulled back to the common hepatic artery to start chemotherapy. In the control group, saline (10 ml) was infused slowly (4 ml/min) instead of pituitrin.</p><p><b>RESULTS</b>In the trial group, all patients had temporary increase of blood pressure ranging from 20 to 50 mm Hg, which was tolerated with most recovered in 20 to 30 minutes. Two patients had pain in the upper abdomen and others only had slight gastrointestinal discomfort. In the control group, epigastric upset or pain during operation was present in 5 patients. In 9 patients, upper abdominal pain after the operation was present which was serious in two. One of these two patients was confirmed as having gastric antrum erosion by gastroscopy. There was statistically significant difference in the upper abdomen pain in these two groups by Chi-square test (P < 0.025). The relative and absolute risk reduction were 77.8% and 35.0% and the mean number of patients needed to treat was 2.86. The time of resuming preoperative appetite in the trial and control groups were 7.1 +/- 1.37 and 11.8 +/- 2.56 days, with the difference statistically significant (P < 0.01).</p><p><b>CONCLUSION</b>Temporarily block of the gastroduodenal artery, being simple, safe, and effectively reducing patients' untoward and finacial burden, is advised to be practiced in hepatic artery chemotherapy.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Catheterization , Chemoembolization, Therapeutic , Drug Therapy , Hepatic Artery , Infusions, Intra-Arterial , Liver Neoplasms , TherapeuticsABSTRACT
Objective To study the imaging manifestations and characters of infectious atypical pneumonias.Methods The imaging materials of 80 cases of infectious atypical pneumonias which were proved by clinical were collected, the characters of imaging manifestations were analysed.Results The abnormal appearance of lung appeared after fever occured, the average time was 2.3 days. The most appearance was high density patchy and was found in every lung field. The multiple focuses were 43.8% in all the cases. The focuses changed fast. CT could have some help in early diagnosis and prognosis observation of infectious atypical pneumonias. Conclusion Medical imaging can play important part in the diagnosis and determining the treatment effect of infectious atypical pneumonias.
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Objective To evaluate the diagnostic value of MR I、CT、DSA for cerebral arteriovenous malformation(AVM). Methods A total of 40 case of AVM were examined with imaging methods in which 19 MRI, 30 CT and, 12 DSA. Combination of two or three kinds of eximinations were perfo rmed in 20 and 4, respectively. Results Diagnostic accordance r ate rate of CT was 70%, sensitivity and specificity of MRI were 100% and 84% res pectiv ely, diagnostic accordance rate of DSA was 92%. Conclusion MRI,CT,D SA can play important roles in the diagnosis of AVM. MR and DSA are superior to CT. DSA could reveal the circulation time and the stealing blood situation of AV M and thus suggests the applicability of interventional embolization therapy.
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Objective To investigate methods and feasibility of percutaneous regional isolated hepatic perfusion combined with charcoal hemoperfusion(PRIHP-CHP).Methods Four out of 12 dogs underwent the procedure of routine transhepatic arterial infusion(TAI) as control group, 8 underwent PRIHP-CHP as experimental group. Adriamycin was used in our study, the concentration of plasma in hepatic vein and systemic vein was detected in both groups. Results All the procedures were successful in the PRIHP-CHP group eight, but 1 dog died because of air embolization. The average procedure duration for each was (132.3?15.3) minutes. The peak level of adriamycin concentration in hepatic vein and systemic in TAI were (3709.676?385.723) ng/ml and (1576.140?226.933) ng/ml respectively. In PRIHP-CHP, the peak level were (4653.420?430.204) ng/ml and (433.612?40.501) ng/ml. There were statistically significant differences between TAI and PRIHP-CHP (?