Therapeutic Plasma Exchange for Venom-Induced Thrombotic Microangiopathy Following Hump-Nosed Pit Viper (Genus: Hypnale) Bites: A Prospective Observational Study

Introduction—Thrombotic microangiopathy (TMA), which is the triad of acute kidney injury (AKI), microangiopathic hemolytic anemia (MAHA), and thrombocytopenia, is a rare complication of snakebites, and in Sri Lanka, it is commonly seen with hump-nosed pit viper (HNPV) bites.Methods—We conducted a prospective observational study of patients with AKI caused by HNPV bites in Teaching Hospital, Ratnapura, Sri Lanka for 6 y, commencing in June 2015. Some patients with TMA underwent therapeutic plasma exchange (TPE) and some did not. These 2 groups were compared. Statistical analysis was carried out using Minitab 18.1. Data were presented as median (IQR).Results—There were 52 (8%) patients with TMA, of whom 21 (45%) were in the TPE group and 26 (55%) were in the non-TPE group. TPE improved time to platelet correction (4 d [IQR, 4–5 d] vs 7 d [IQR, 5–9 d]; P=0.009), time to MAHA correction (5 d [IQR, 3–4 d] vs 7 d [IQR, 6–9 d]; P=0.004), time to prothrombin time (PT)/international normalized ratio (INR) correction (1 d [IQR, 1–2 d] vs 3 d [IQR, 3–4 d]; P=0.003), and time to 20 min whole blood clotting test (WBCT20) correction (2 d [IQR, 1–2 d] vs 3 d [1QR 2–3 d]; P=0.020). Renal recovery was predicted by TPE (P=0.048) and highest creatinine level (P=0.001). There was no association between TPE and dialysis dependency at discharge (P=0.597), length of hospital stay (P=0.220), and the number of dialysis cycles prior to discharge (P=0.540). TPE did not improve the number of blood transfusions (5 packs [IQR, 3–8.5 packs] vs 4 packs [IQR, 0–9 packs]; P=0.290).Conclusions—TPE is effective for TMA in the early correction of platelet counts, MAHA, PT/INR, and WBCT20 in HNPV bites.     

刺络拔罐配合静力练习治疗急性踝扭伤临床观察

目的分析通过刺络拔罐配合静力练习治疗急性踝关节扭伤的临床疗效。方法收集2009年-2013年病例共71例,根据治疗方案随机分为观察组36例、对照组35例,观察组采用刺络拔罐配合静力练习治疗,对照组采用单纯刺络拔罐治疗。7 d为1个疗程,1个疗程后观察疗效,2个月后复查或随访患者,评价踝关节Kofoed评分。结果两组治疗后临床疗效比较,差异有统计学意义(P<0.05)。2个月后评价踝关节Kofoed评分,观察组与对照组比较,差异有统计学意义(P<0.05)。结论急性踝关节扭伤通过刺络拔罐配合静力练习治疗效果优于单纯刺络拔罐治疗。     

奶牛子宫内膜炎治疗研究进展

子宫内膜炎是奶牛的常发病,对奶牛养殖业造成的危害巨大.目前,治疗奶牛子宫内膜炎的方法主要有抗生素疗法、中药疗法、中西医结合疗法、微生物疗法、免疫学疗法和激素疗法.主要根据国内最新的研究成果,对奶牛子宫内膜炎的治疗进行综述,并对不同治疗方法的优缺点进行比较,以期为积极探寻该病最为合适的治疗方法提供参考.     

呋塞米冲击疗法在犬急性肾功能衰竭中的应用

呋塞米冲击疗法是指在肾衰治疗过程中采用大剂量的呋塞米进行静脉推注或者加入生理盐水中进行静脉滴注,达到利尿的作用,促进尿液的生成与排出,从而加速肌酐随尿液的排出,达到降低血清肌酐水平,促进肾衰治疗的作用。论文就冲击疗法与常规疗法对急性肾衰治疗效果进行了比较。以临床接诊肾衰治愈病例60例为研究对象,其中30例为对照组使用常规疗法治疗,另外30例为试验组使用常规疗法加冲击疗法治疗。结果表明,呋塞米冲击疗法平均治愈时间比常规疗法治愈时间提前近2 d,证明呋塞米冲击疗法可以有效缩短急性肾衰的治愈时间。     

急性心肌梗死患者冠状动脉支架植入术的近期疗效观察

目的 :观察急性心肌梗死患者冠状动脉支架植入术的近期疗效。方法 :4 8例急性心肌梗死 (AMI)患者 ,胸痛发作至介入治疗时间 (4 .1± 3.1)h,行急诊冠状动脉造影 ,证实冠状动脉闭塞 ,仅对梗死相关血管行支架植入。结果 :全组 4 8例术后即刻血管再通恢复心肌梗死溶栓试验为 3级者 4 3例 (93.7% )、2级者 5例 ,1例术中死于继发性心室颤动。4 8例中在梗死相关血管开通后出现心室颤动 10例 (2 0 .1% ) ,1例术后 2周后因再次心肌梗死死亡。植入术后存活的 4 6例术后随访 (8.2± 3.6 )月 ,无 1例再发生心脏事件。结论 :急性心肌梗死行冠状动脉支架术能成功挽救频死的心肌 ,能有效降低病死率。     

Acute Hepatic Necrosis And Liver Failure Associated With Benzodiazepine Therapy In Six Cats, 1986–1995.

A retrospective analysis was conducted of all feline necropsies performed during a nine year period to identify cases of sever, acute, centrilobular (periacinar), hepatic necrosis (ACHN). After exclusion of cats with anemia, a series of seven cases of ACHN was identified. In addition, two similar cases were identified from tissue submitted for histopathology following, and eight had bile duct hyperplasia. Seven of the nine cats received diazepam prior to dath, and one received zolazepam. Of the seven cats that received diazepam, five were healthy prior to treatment and received oral diazepam for the treatment of inappropriate urination, intercat aggression, or skin disease. Two cats which received diazepam exhibited other clinical signs: one had chronic vomiting, and the other received diazepam after biochemical evidence of hepatocellular necrosis was present. Onset of clinical sings in cats receiving oral diazepam occurred 7–13 days following the initiation of treatment. Clinical signs and clinical biochemical analysis were compatible with severe hepatocellular necrosis and acute liver failure. All cats had lesions in other organs: five had pancreatic disease, five had cardiac disease, and five had renal disease. All cats died, or were euthanized, within 4 dyas of the onset of clinical signs and 2 days after presentation to a veterinarian. Fatal, acute, centrilobular hepatic necrosis appears to be a serious adverse reaction to diazepam therapy in certain cats.