Initiating Continuous Renal Replacement Therapy in Patients With Transurethral Resection of Prostate Syndrome: A Case Report.

With advances and developments in hysteroscopy, cystoscopy, transurethral resection of bladder tumor, and arthroscopy, transurethral resection of prostate (TURP) syndrome has been increasingly reported. TURP syndrome is often accompanied by severe hyponatremia, fluid overload, and a plasma hypotonic state, resulting in heart failure and pulmonary and cerebral edema. Conventional treatment methods, such as intravenous infusion of hyperosmotic saline, can rapidly reverse the downward trend of serum sodium levels in efforts to prevent and treat cerebral edema. However, this may not be suitable for patients with cardiac and renal insufficiency and may induce central pontine myelinolysis due to the possibility of worsening volume load and difficulty in controlling the correction rate of serum sodium. The patient described in this report presented with severe hyponatremia (sodium<100 mmol/L) combined with intraoperative pulmonary edema; his cardiac function and oxygenation status deteriorated after an intravenous infusion of 3% hypertonic saline. He underwent continuous renal replacement therapy (CRRT) to prevent the progression of multiple-organ edema and cardiac insufficiency. CRRT has demonstrated efficacy in the treatment of chronic hyponatremia in patients with renal failure, and can slowly and continuously correct water-electrolyte imbalance, acid-base imbalance, and volume overload. TURP syndrome with severe hyponatremia and pulmonary edema was diagnosed; accordingly, the patient was treated with 3% hypertonic saline, furosemide, and CRRT, without the development of overt neurological sequelae.

Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in ischemia-causing coronary stenosis: a meta-analysis.

PURPOSE: Fractional flow reserve based on coronary computed tomographic angiography (CCTA; FFRCT) can evaluate functional severity in coronary artery disease (CAD). This study investigated the diagnostic value of FFRCT for determining CAD severity. MATERIALS AND METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until June 16, 2016 using the following search terms: fractional flow reserve, coronary computed tomography angiography, myocardial ischemia. Randomized controlled trials, two-arm prospective studies, and retrospective studies were included in the analysis. RESULTS: Twenty-one studies were included with a total of 2216 subjects and 2798 vessels. FFRCT, sensitivity per-vessel and per-patient were ≥82% and specificity was ≥73% for diagnosis of ischemia. FFRCT had better diagnostic accuracy and discrimination than CCTA. CONCLUSION: This study indicates that FFRCT may be a good tool for screening and diagnosing of myocardial ischemia in patients with CAD.

The relationship between functional capacity (FC) and cardiac autonomic nervous dysfunction to surgery stress in senile patients.

The aim of the study presented here is to compare the pre- and post-operative cardiac autonomic nervous function of senile patients with different functional capacities (FC). Ninety-two senile patients scheduled for elective non-cardiac surgery were selected, whose FC was evaluated in terms of Duke activity status index (DASI). According to FC, the patients were classified into three groups: Group 1 (poor FC); Group 2 (moderate FC) and Group 3 (excellent FC). Heart rate variability (HRV) was monitored during the night before, on the 1st and the 2nd day after operation respectively. The results demonstrated some indices of pre-operative HRV of patients with poor or moderate FC were significantly lower than those with excellent FC. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) of all patients were significantly decreased. The LF/HF of patients with a poor or moderate FC showed a significant difference compared to patients with excellent FC. In conclusion, we emphasize that surgery induced a cardiac autonomic nervous dysfunction in senile patients not only with low FC but also with high FC; the disturbance of pre- and post-operative cardiac autonomic nervous activity is associated with a diminished FC (<7METs=metabolic equivalents) in senile patients.

The relationship between functional capacity (FC) and cardiovascular risk factors (CVRFs) in senile patients after noncardiac surgery.

The aim of the present study was to investigate the relationship between the number of cardiovascular risk factors (CVRFs) and functional capacity (FC) in the senile patients undergone noncardiac surgery. One hundred and eighty-two senile patients scheduled for elective noncardiac surgery were selected. According to the Duke activity status index (DASI), the FC of each patient was evaluated, and also their CVRFs were recorded. According to the number of CVRFs, the patients were ranked into different groups. The significant differences in FC between the groups(') were identified using the analysis of variance. The examination showed that FC decreased with the increasing number of CVRFs. As a conclusion, we emphasize that with the increasing number of CVRFs, the FC of senile patients, i.e., their metabolic equivalents (METs) decrease. The occurrence of low FC and higher CVRFs is a common phenomenon in senile patients.