Efficacy and safety of azosemide in patients with edema and ascites / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the efficacy and safety of azosemide in patients with edema and ascites.</p><p><b>METHODS</b>A multicentral, randomized, double-blind, controlled clinical trial was applied. All 223 patients (cardiac edema 92, hepatogenic edema 63, renal edema 68) were randomized to azoesmide and furosemide group, and all patients were treated for 2 weeks. Patients with cardiac or renal edema took azosemide (30 mg/d) or furosemide (20 mg/d); patients with hepatogenic edema took azosemide (60 mg/d) or furosemide (40 mg/d). The dosage were adjusted to azosemide 60 mg/d (cardiac, renal edema), 90 mg (hepatogeic edema); or furosemide 40 mg/d (cardiac, renal edema), 60 mg (hepatogeic edema), if diuretic effects were not obtained at the end of third day.</p><p><b>RESULTS</b>At the end of the study, the weight changes were (2.87+/-3.10) kg and (2.81 +/-2.84) kg; the total effective rate of edema lessen was 89.19% and 89.81%; the total effective rate of heart function improvement was 64.44% and 66.66%; the 24 h urine output increased (321.85 +/-669.52) ml and (273.80 +/-645.72) ml for azosemide and furosemide, respectively. The total effective rate of ascites lessen (tested by B-ultrasound) was 89.28% and 86.66%; abdominal girth decreased (5.20 +/-3.58) cm and (5.03 +/-3.74) cm for azosemide and furosemide, respectively. The adverse event rate was 23.01% in azosemide group and 21.01% in furosemide group; the main adverse effects were hypokalemia, hyperuricemia, hypertriglyceridemia and thirsty.</p><p><b>CONCLUSION</b>Azosemide could effectively lessen edema, improve heart function and decrease ascitesûit is well tolerated and is particularly useful for the diuretic treatment.</p>

Diagnosis and therapy of the nutcracker phenomenon: long-term follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis of adult nutcracker phenomenon (NCP) and assess the therapeutic value of endovascular stenting (ES) and superior mesentery artery transposition (SMAT) for the treatment of NCP in long-term follow-up.</p><p><b>METHODS</b>Six patients (6 men) aged 16 and 34 years old (mean age, 22.7 +/- 18.0 years) were diagnosed as having NCP using the examination of the doppler ultrasound and/or magnetic resonance of artery/digital radiography (MRA/DSA). Three patients underwent ES and 3 patients received SMAT for the treatment of the NCP patients associated with recurrent gross hematuria and left flank pain. Doppler ultrasound and urine examination were used at pre- and post-operation.</p><p><b>RESULTS</b>In 3 patients who underwent SMAT, the postoperative complications comprised retroperitoneal hematoma necessitating surgical revision (n = 1). Functional disorder of intestine (n = 1) and paralytic ileus (n = 1) that were resolved by conservative management. In 3 patients who experienced ES, 1 patient received surgical revision because the position of stent was not suitable in left renal vein but no other complication took place. During the follow-up of 6 approximately 50 months (mean 24.7 +/- 18.0 months), except that 1 patient's hematuria disappears at rest and reappears after motion while the other 5 patients remain asymptomatic and free of hematuria. The dopplar ultrasound showed the left renal vein diameters of the angel segment between superior mesentery artery and aorta were (0.18 +/- 0.05) cm preoperation and (0.65 +/- 0.17) cm postoperation, P < 0.001; the left renal vein diameters of the portal segment were (0.89 +/- 0.22) cm preoperation and (0.79 +/- 0.20) cm postoperation, P = 0.003; the left renal vein diameter's ratio between portal and angel segment were (4.99 +/- 0.79) preoperation and (1.23 +/- 0.16) postoperation, P < 0.001.</p><p><b>CONCLUSIONS</b>Dopplar ultrasound plays a very important role in the diagnosis of adult NCP. SMAT is an efficient surgical approach to the treatment of the nutcracker phenomenon and is associated with an acceptable risk of complications. But ES is safer and more efficient than SMAT and may represent a valuable approach to lessening the morbidity of surgical procedures. ES is a new therapeutic method for adult NCP.</p>