Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. The...Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.展开更多
BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)...BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.展开更多
Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Pat...Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Patient’s Concern:A 33-year-old man with confusion and hypotension(blood pressure:70/40 mmHg and pulse rate:140/min)was brought by emergency medical services from home to the emergency department without any companion.The patient was in undifferentiated shock.His hypotension was assessed with inferior vena cava(IVC)size and collapsibility,and rapid ultrasound in shock and hypotension(RUSH)protocol was used to investigate the cause of his shock.Following the RUSH protocol when scanning the IVC,parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid.After seeing these particles,we suspected GI bleeding.Diagnosis:Endoscopy confirmed GI bleeding.Interventions:After placing an orogastric tube and suction,about 2 L of coffee-ground fluid with clots was removed.We started intravenous proton-pump inhibitors 80 mg bolus,followed by a continuous infusion of 8 mg/h.The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension.Outcomes:After being admitted to the GI ward and treated for three days,the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic.Lessons:The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock.The components of the RUSH exam are the heart(H),IVC(I),Morrison’s/FAST abdominal views with the aorta(MA),and pulmonary and pipes scanning(P),and can be memorized with the mnemonic:HI-MAP.We would like to introduce a new mnemonic:Hi-MAPS,adding stomach(S)to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.展开更多
Objective： To investigate the effects of Xuebijing Injection（血必净注射液, XBJ） on survival rate and pulmonary vasopermeability in a rat model of severe scald injury. Methods： Rats were divided into two experiment...Objective： To investigate the effects of Xuebijing Injection（血必净注射液, XBJ） on survival rate and pulmonary vasopermeability in a rat model of severe scald injury. Methods： Rats were divided into two experiments： experiment 1 was monitored for 12 h post-injury for survival analysis after severe burns; in experiment 2, rats were killed for determination of pulmonary vascular permeability and pro-inflammatory mediators. In both experiments, rats were subject to third-degree 50% total body surface area（TBSA） burns or sham injury followed by XBJ or normal saline（NS） treatment. In addition, rat pulmonary microvascular endothelium cells（PMECs） were pretreated with either XBJ or phosphate buffer saline（PBS）, and then subjected to sham serum or scald serum stimulation for 2 or 6 h, followed by transwell examination for the permeability of PMECs. Meanwhile, pro-inflammatory mediators in PMECs culture supernatant were also investigated. Results： The average survival time in the scald＋XBJ group was 582.1±21.2 min, which was significantly longer than that in the scald ＋ NS group（345.8±25.4 min, P〈0.01）. Plasma levels of tumor necrosis factor-alpha（TNF-α）, E-selectin, interleukin-6（IL-6）, vascular permeability and water content of lung tissues were significantly increased in animals after severe burns（P〈0.01）. However, administration of XBJ significantly decreased these levels in plasma and lung tissue. In in vitro cell experiments, XBJ markedly attenuated permeability in PMECs monolayer and reduced the levels of TNF-α, IL-6 and soluble E-selectin after stimulation with scald serum（P〈0.01）. Conclusions： XBJ increases early survival rate by alleviating pulmonary vasopermeability and inhibiting pro-inflammatory mediators in rats subjected to lethal scald injury. XBJ may be a potent drug in treatment of severe burns.展开更多
文摘Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.
文摘BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.
文摘Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Patient’s Concern:A 33-year-old man with confusion and hypotension(blood pressure:70/40 mmHg and pulse rate:140/min)was brought by emergency medical services from home to the emergency department without any companion.The patient was in undifferentiated shock.His hypotension was assessed with inferior vena cava(IVC)size and collapsibility,and rapid ultrasound in shock and hypotension(RUSH)protocol was used to investigate the cause of his shock.Following the RUSH protocol when scanning the IVC,parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid.After seeing these particles,we suspected GI bleeding.Diagnosis:Endoscopy confirmed GI bleeding.Interventions:After placing an orogastric tube and suction,about 2 L of coffee-ground fluid with clots was removed.We started intravenous proton-pump inhibitors 80 mg bolus,followed by a continuous infusion of 8 mg/h.The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension.Outcomes:After being admitted to the GI ward and treated for three days,the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic.Lessons:The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock.The components of the RUSH exam are the heart(H),IVC(I),Morrison’s/FAST abdominal views with the aorta(MA),and pulmonary and pipes scanning(P),and can be memorized with the mnemonic:HI-MAP.We would like to introduce a new mnemonic:Hi-MAPS,adding stomach(S)to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.
基金Supported by the National Natural Science Foundation of China(No.81471872)
文摘Objective： To investigate the effects of Xuebijing Injection（血必净注射液, XBJ） on survival rate and pulmonary vasopermeability in a rat model of severe scald injury. Methods： Rats were divided into two experiments： experiment 1 was monitored for 12 h post-injury for survival analysis after severe burns; in experiment 2, rats were killed for determination of pulmonary vascular permeability and pro-inflammatory mediators. In both experiments, rats were subject to third-degree 50% total body surface area（TBSA） burns or sham injury followed by XBJ or normal saline（NS） treatment. In addition, rat pulmonary microvascular endothelium cells（PMECs） were pretreated with either XBJ or phosphate buffer saline（PBS）, and then subjected to sham serum or scald serum stimulation for 2 or 6 h, followed by transwell examination for the permeability of PMECs. Meanwhile, pro-inflammatory mediators in PMECs culture supernatant were also investigated. Results： The average survival time in the scald＋XBJ group was 582.1±21.2 min, which was significantly longer than that in the scald ＋ NS group（345.8±25.4 min, P〈0.01）. Plasma levels of tumor necrosis factor-alpha（TNF-α）, E-selectin, interleukin-6（IL-6）, vascular permeability and water content of lung tissues were significantly increased in animals after severe burns（P〈0.01）. However, administration of XBJ significantly decreased these levels in plasma and lung tissue. In in vitro cell experiments, XBJ markedly attenuated permeability in PMECs monolayer and reduced the levels of TNF-α, IL-6 and soluble E-selectin after stimulation with scald serum（P〈0.01）. Conclusions： XBJ increases early survival rate by alleviating pulmonary vasopermeability and inhibiting pro-inflammatory mediators in rats subjected to lethal scald injury. XBJ may be a potent drug in treatment of severe burns.
