LaparoEndoscopic Single-site(LESS) renal surgery emerging as a potential alternative to conventional laparoscopy,is technically challenging and the major vascular anomaly may increase the risk of intraoperative haemor...LaparoEndoscopic Single-site(LESS) renal surgery emerging as a potential alternative to conventional laparoscopy,is technically challenging and the major vascular anomaly may increase the risk of intraoperative haemorrhage.Herein,we present a case of right transumbilical LESS radical nephrectomy which was successfully performed in the presence of double inferior vena cava and duplicated the standard laparoscopic techniques.Most importantly,to bring such an aberrant vascular anatomy to the attention of laparoscopic,especially LESS surgeons with high resolution pictorial illustrations.展开更多
We have previously reported that the diameter of the inferior vena cava(IVC) reflects the amount of body fluid in hemodialyzed (HD) patients. The present study was undertaken to depict the criteria of IVC diameters fo...We have previously reported that the diameter of the inferior vena cava(IVC) reflects the amount of body fluid in hemodialyzed (HD) patients. The present study was undertaken to depict the criteria of IVC diameters for determining dry weight (DW) in anuric HD patients. In healthy subjects, the maximal diameters during quiet expiration (IVCe) and the minimal diameters during quiet inspiration (IVCi) were (16.7±3.2) and (5.7±5.4)mm,respectively (mean±SD).The collapsibility index (CI,1-IVCi/IVCe), which inversely correlates with the central venous pressure,was 0.68±0.29. In anuric HD patients,the IVCe/CI values before and after HD were 14.9±3.2/0.68±0.24 and 8.2±2.3/0.94±0.09, respectively. IVCe decreased proportionally to the amount of ultrafiltration. In HD patients with hypervolemic pulmonary edema, the IVCe and CI values were 22.4±2.9 and 0.22±0.11, respectively. We proposed that IVCe/CI after HD is (8±3)mm/0.9 ± 0.1 as the markers of DW in anuric HD patients and that an IVCe value≥22mm together with a CI≤0.22 implies the warning level of body fluid retention.展开更多
We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blo... We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume[1] and proposed using the criteria of IVC diameter to determine dry weight(DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre-and post-HD are (14.9±0.4) and (8.2±0.3) mm, respectively[2]. However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia,both hyper-and hypovolemia can be detected by IVC measurement.……展开更多
The IVC diameters in HD patients
Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC d... The IVC diameters in HD patients
Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC diameters in HD patients. The IVC diameters of stable anuric HD patients are shown in Table 2. In agreement with our previous observation [7-9] ,the reduction of BW from (51.7±12.6) to (49.3±12.6)kg by ultrafiltration during HD resulted in a significant (P<0.0001)reduction of the IVCe and IVCi from (14.9 ± 3.2) to (6.8±1.9)mm and (5.2±4.2) to (0.1±0.3) mm,respectively. Thus,CI values before and at the end of HD were calculated as (0.68±0.24) and (0.98±0. 05), respectively (P<0.0001).
……展开更多
Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carr...Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carry a high risk of injury because of the radiation and contrast agent.Patients with nephrotic syndrome(NS)or some other renal diseases may prone to thrombosis due to the excretion of protein C and protein S overmuch.So,it is necessary to develop a new therapy without contrast agent.Mixed-reality(MR)is a new technology as a guidance of inferior vena cava filter implantation exposed under no X-ray and required no contrast agent.展开更多
This article explains the definition of pulmonary embolism as well as its causes and elaborates on a new type of inferior vena cava filter(VCF)we have developed. Shaped like a waistdrum, the VCF is mainly made of TiNi...This article explains the definition of pulmonary embolism as well as its causes and elaborates on a new type of inferior vena cava filter(VCF)we have developed. Shaped like a waistdrum, the VCF is mainly made of TiNi shape memory alloy-wire. It has a subulate wire frame which can intercept the thrombus on each side. Its medial body is made up of straight shape memory alloy-wire . Every pillar is bound by several shape memory alloy springs. This type of inferior vena cava filter has a good resistance to fatigue and is hard to be broken. Through animal experiments its framework has been proved to be lasting. Neither deformation nor fragmentation happened when the VCF had been kept in the body for a long time. The thrombus interception efficiency of our VCF is higher than imported VCFs. The filter is unfavorable for thrombosis. After implantation, the IVC was completely unimpeded and no displacement occurred. Moreover the VCF did little damage to the Wall of vein. Neither IVC perforation nor haematoma occurred after the operation.展开更多
基金Supported by the Municipal Hospitals' Project for Emerging and Frontier Technology of Shanghai (SHDC12010115)the Chinese Military Major Project for Clinical High-tech and Innovative Technology (2010gxjs057)the Project of Key Discipline of Shanghai
文摘LaparoEndoscopic Single-site(LESS) renal surgery emerging as a potential alternative to conventional laparoscopy,is technically challenging and the major vascular anomaly may increase the risk of intraoperative haemorrhage.Herein,we present a case of right transumbilical LESS radical nephrectomy which was successfully performed in the presence of double inferior vena cava and duplicated the standard laparoscopic techniques.Most importantly,to bring such an aberrant vascular anatomy to the attention of laparoscopic,especially LESS surgeons with high resolution pictorial illustrations.
文摘We have previously reported that the diameter of the inferior vena cava(IVC) reflects the amount of body fluid in hemodialyzed (HD) patients. The present study was undertaken to depict the criteria of IVC diameters for determining dry weight (DW) in anuric HD patients. In healthy subjects, the maximal diameters during quiet expiration (IVCe) and the minimal diameters during quiet inspiration (IVCi) were (16.7±3.2) and (5.7±5.4)mm,respectively (mean±SD).The collapsibility index (CI,1-IVCi/IVCe), which inversely correlates with the central venous pressure,was 0.68±0.29. In anuric HD patients,the IVCe/CI values before and after HD were 14.9±3.2/0.68±0.24 and 8.2±2.3/0.94±0.09, respectively. IVCe decreased proportionally to the amount of ultrafiltration. In HD patients with hypervolemic pulmonary edema, the IVCe and CI values were 22.4±2.9 and 0.22±0.11, respectively. We proposed that IVCe/CI after HD is (8±3)mm/0.9 ± 0.1 as the markers of DW in anuric HD patients and that an IVCe value≥22mm together with a CI≤0.22 implies the warning level of body fluid retention.
文摘 We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume[1] and proposed using the criteria of IVC diameter to determine dry weight(DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre-and post-HD are (14.9±0.4) and (8.2±0.3) mm, respectively[2]. However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia,both hyper-and hypovolemia can be detected by IVC measurement.……
文摘 The IVC diameters in HD patients
Since BW and stature as well as gender and age were not considered to be determinant factors of the IVC diameters, these factors were not accounted for in evaluating the IVC diameters in HD patients. The IVC diameters of stable anuric HD patients are shown in Table 2. In agreement with our previous observation [7-9] ,the reduction of BW from (51.7±12.6) to (49.3±12.6)kg by ultrafiltration during HD resulted in a significant (P<0.0001)reduction of the IVCe and IVCi from (14.9 ± 3.2) to (6.8±1.9)mm and (5.2±4.2) to (0.1±0.3) mm,respectively. Thus,CI values before and at the end of HD were calculated as (0.68±0.24) and (0.98±0. 05), respectively (P<0.0001).
……
基金supported by Capital Clinical Application Research Project(No.Z181100001718042)
文摘Pulmonary embolism(PE)is one of the fatal heart attacks,and lower limbs deep vein thrombosis(DVT)is the most common reason for PE.Inferior vena cava filter(IVCF)implantation is a most prevention for PE.But it may carry a high risk of injury because of the radiation and contrast agent.Patients with nephrotic syndrome(NS)or some other renal diseases may prone to thrombosis due to the excretion of protein C and protein S overmuch.So,it is necessary to develop a new therapy without contrast agent.Mixed-reality(MR)is a new technology as a guidance of inferior vena cava filter implantation exposed under no X-ray and required no contrast agent.
文摘This article explains the definition of pulmonary embolism as well as its causes and elaborates on a new type of inferior vena cava filter(VCF)we have developed. Shaped like a waistdrum, the VCF is mainly made of TiNi shape memory alloy-wire. It has a subulate wire frame which can intercept the thrombus on each side. Its medial body is made up of straight shape memory alloy-wire . Every pillar is bound by several shape memory alloy springs. This type of inferior vena cava filter has a good resistance to fatigue and is hard to be broken. Through animal experiments its framework has been proved to be lasting. Neither deformation nor fragmentation happened when the VCF had been kept in the body for a long time. The thrombus interception efficiency of our VCF is higher than imported VCFs. The filter is unfavorable for thrombosis. After implantation, the IVC was completely unimpeded and no displacement occurred. Moreover the VCF did little damage to the Wall of vein. Neither IVC perforation nor haematoma occurred after the operation.
