Effect of continuous blood purification in treatment of patients with severe acute pancreatitis and multiple organ dysfunction syndrome / 临床肝胆病杂志

ObjectiveTo observe the effect of continuous blood purification (CBP) on serum inflammatory mediators in patients with severe acute pancreatitis (SAP) and multiple organ dysfunction syndrome (MODS). MethodsSixty-five SAP patients with MODS who were treated in General Hospital of Chengdu Command Area of Chinese PLA from April 2008 to December 2013 were enrolled and divided into two groups. The 33 patients in the control group received comprehensive internal medicine treatment, and the 32 patients in the treatment group received comprehensive internal medicine treatment and CBP. Changes in APACHE II score, MODS score, and the serum levels of tumor necrosis factor α (TNFα), C-reactive protein (CRP), interleukin 6 (IL-6), IL-18, platelet-activating factor (PAF), and nitric oxide (NO) after treatment were observed. Independent-samples t test was applied for comparison of continuous data between the two groups, and paired t test was applied for before-after comparison within the same group; chi-squared test was applied for comparison of categorical data between the two groups. ResultsIn both groups, APACHE II score, MODS score, and the serum levels of TNFα, CRP, IL-6, IL-18, PAF, and NO decreased significantly after treatment (all P＜0.05), and the treatment group had significantly greater decreases in these values than the control group (all P＜0.001); the survival rates in the treatment group and the control group were 90.6% (29/32) and 78.8% (26/33), respectively, with no significant difference between the two groups (χ2=1.749, P=0.186). ConclusionIn SAP patients with MODS, CBP can effectively clear the serum inflammatory mediators to block systemic inflammatory response and improve organ function, and, therefore, it is an effective method to treat SAP.

Effects of Highly Concentrated Potassium Chloride via Central Venous Catheterization on Severe Hypokalemia / 昆明医科大学学报

Objective To investigate the clinical effects and feasibility of highly concentrated Potassium Chloride via central venous catheterization by micro pump on severe hypokalemia patients in EICU.Methods A totlal of 120 severe hypokalemia patients in our department were randomly divided into experimental group (treated with highly concentrated Potassium Chloride) and control group (normal treatment group) respectively,and treated with Potassium Chloride liquid of different concentration.Potassium levels in blood were checked every hour and the time for reaching standard potassium level (4.0mmol/L) and the total volumes of infusion fluid within 24 hours in the two groups was compared.Results The mean time for reaching standard potassium level and the total volumes of infusion fluid within 24 hours in the experimental group,(12.83 ± 3.57) h and (402.56 ± 54.61) ml respectively,were significantly less than those in the control group (P ＜0.01),(23.18 ±4.98) h and (2875.2 ± 206.26) ml respectively.Conclusion Highly-concentrated potassium chloride injection via central venous catheterization by micro-pump is a safe,effective and feasible treatment on the patients with severe hypokalemia,especially on the patients with volume-overloaded heart and severe hypokalemia,which is worthy of further clinical research.

Diagnosis and treatment of inflammatory myofibroblastic tumor of the chest / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the causes, clinic diagnosis, treatment and prognosis of inflammatory myofibroblastic tumor (IMT) of the chest.</p><p><b>METHODS</b>The clinical data of 12 patients with IMT were retrospectively analyzed including 9 male and 3 female patients aged 36 to 81 years (mean 60.08 years). Five patients underwent pulmonary lobectomy and mediastinal lymph node dissection, 1 had partial lobectomy, 1 had mediastinal tumor resection and costectomy, and 2 received conservative treatment.</p><p><b>RESULTS</b>All the surgical patients recovered after surgery without lymph node metastasis detected by pathological examinations. In the follow-up lasting for 2 months to 5 years, no recurrence or metastasis occurred in these cases. In the 2 cases having conservative treatment, the tumor remained unchanged in one case at 3 month of follow-up and disappeared in the other case.</p><p><b>CONCLUSION</b>IMT in the chest is a rare benign tumor with a low incidence rate and malignancy. Pathological examination is reliable for definite diagnosis. Surgical operation is the primary therapeutic approach. All IMT patients should be closely followed up after the treatment.</p>

Diagnosis, treatment and prognosis of thymoma: an analysis of 116 cases / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of thymoma and to assess its prognostic factors.</p><p><b>METHODS</b>The clinical data of 116 patients with thymoma were collected. A retrospective analysis was performed, by comparing the survival rate calculated by the Kaplan-Meier method with the rate of recurrence or metastasis.</p><p><b>RESULTS</b>The standard posteroanterior and lateral chest radiographs were reliable means of detection of most thymomas. Myasthenia gravis was the most commonly paraneoplastic disease (25.0%, 29/116). The extensive radical resection was beneficial for reducing the rate of recurrence of stage I or stage II thymomas (chi(2) = 4.941, P = 0.0219). The survival time could be prolonged by postoperative radiotherapy and chemotherapy. There was a strong correlation between the clinical stage and the histological classification (according to MH classification), through which the invasive behavior of thymoma could be predicted (chi(2) = 19.76, P = 0.007, RR = 1.47). The 3- 5- and 10-year survival rates were 81.2%, 67.9%, and 40.5%, respectively. Statistical analysis showed a significant negative correlation between the stage and the survival rate (chi(2) = 29.73, P = 0.0000, RR = 0.15).</p><p><b>CONCLUSION</b>The prognosis of thymoma depends mainly on the histological classification, clinical stage and multimodality treatment rather than on the paraneoplastic diseases.</p>

Diagnosis, treatment and prognosis of thymoma: analysis of 116 cases / 中华外科杂志

<p><b>OBJECTIVES</b>To study the diagnosis and treatment of thymoma and to assess prognosis factors.</p><p><b>METHODS</b>The clinical data on 116 patients with thymoma were collected. A retrospective analysis was performed by comparison of their survival rates computed by the actuarial method and rate of recurrence and metastasis.</p><p><b>RESULTS</b>Chest radiograph was used chiefly for the preoperative diagnosis of thymoma; myasthenia gravis (MG) (25.0%, 29/116) was the most common paraneoplastic disease. An extensive and radical resection was carried out to reduce the recurrence rate of thymoma with stage I and stage II (chi(2) = 4.941 P = 0.0219). The survival time was prolonged by postoperative radiotherapy and chemotherapy. A strong correlation was noted between the clinical stage and histologic subtype of M-H classification, by which the invasive behavior of thymoma was predicted (r = 0.385, P = 0.007). The 3-, 5-, and 10-year survival rates were 81.2%, 67.9% and 40.5%, respectively. Statistical analysis showed a significant negative correlation between stage and survival rate (r = -0.897, P = 0.0000).</p><p><b>CONCLUSION</b>The prognosis of thymoma depends mainly on the histologic subtype, clinical stage and multimodality treatment rather than paraneoplastic diseases.</p>