BACKGROUND Liver cancer is one of the most common malignant tumors with a high incidence and mortality.Hepatitis-liver cirrhosis-liver cancer is known as the trilogy of liver cancer.At present,due to significant devel...BACKGROUND Liver cancer is one of the most common malignant tumors with a high incidence and mortality.Hepatitis-liver cirrhosis-liver cancer is known as the trilogy of liver cancer.At present,due to significant development of imaging interventions,they occupy an irreplaceable position in the field of liver cancer treatment,especially ultrasound-guided ablation.Because patients with liver cancer often present with liver cirrhosis,which leads to morphological deformation of the liver,it is difficult to perform a linear ablation of liver cancer in the areas near the phrenic top and within large blood vessels,among others.The present study reports on two cases of liver cancer that have been subjected to curvilinear ablation.After 1 mo,magnetic resonance imaging showed complete ablation,demonstrating that ultrasound-guided curved ablation is feasible and effective in the treatment of liver cancer.CASE SUMMARY Two patients were treated at the Liver Disease Department of the Xixi Hospital Affiliated to Zhejiang University of Chinese Medicine in 2019.Because the first liver cancer patient’s tumor was located close to the diaphragm,it was difficult to complete a straight needle ablation procedure in one session.In order to achieve accurate and minimally invasive treatment of this tumor,a curved needle ablation procedure was designed.The second patient presented with a hepatic cyst in front of the tumor.In order not to damage the hepatic cyst,a looper needle ablation technique was used.The procedure was successfully completed in both cases.CONCLUSION Curved ablation is a new technique that can be used to treat tumors situated in a variety of locations,providing new ideas for interventional techniques.Its operation difficulty is higher and further animal experiments are necessary to improve the operation procedure.展开更多
Background： It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration （CVVH） with regional citrate anticoagulation （RCA）. This study aimed to assess the determinants ...Background： It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration （CVVH） with regional citrate anticoagulation （RCA）. This study aimed to assess the determinants of calcium infusion rate during CVVH with RCA in critically ill patients with acute kidney injury （AKI）. Methods： A total of 18 patients with AKI requiring CVVH were prospectively analyzed. Postdilution CVVH was performed with a fixed blood flow rate of 150 ml/min and a replacement fluid flow rate of 2000 ml/h for each new circuit. The infusion of 4% trisodium citrate was started at a rate of 29.9 mmol/h prefilter and adjusted according to postfilter ionized calcium. The infusion of 10% calcium gluconate was initiated at a rate of 5.5 mmol/h and adjusted according to systemic ionized calcium. The infusion rate of trisodium citrate and calcium gluconate as well as ultrafiltrate flow rate were recorded at 1, 2, 4, 6, 12, and 24 h after starting CVVH respectively. The calcium loss rate by CVVH was also calculated. Results： Fifty-seven sessions of CVVH were performed in 18 AKI patients. The citrate infusion rate, calcium loss rate by CVVH, and calcium infusion rate were 31.30 （interquartile range： 2.70）, 4.60 ± 0.48, and 5.50 ± 0.35 retool/h, respectively. The calcium infusion rate was significantly higher than that of calcium loss rate by CVVH （P 〈 0.01）. The correlation coefficient between the calcium and citrate infusion rates, and calcium infusion and calcium loss rates by CVVH was -0.031 （P 〉 0.05） and 0.932 （P 〈 0.01）, respectively. In addition, calcium infusion rate （mmol/h） = 1.77 ± 0.8 x （calcium loss rate by CVVH, mmol/h）. Conclusions： The calcium infusion rate correlates significantly with the calcium loss rate by CVVH but not with the citrate infusion rate in a fixed blood flow rate during CVVH with RCA.展开更多
文摘BACKGROUND Liver cancer is one of the most common malignant tumors with a high incidence and mortality.Hepatitis-liver cirrhosis-liver cancer is known as the trilogy of liver cancer.At present,due to significant development of imaging interventions,they occupy an irreplaceable position in the field of liver cancer treatment,especially ultrasound-guided ablation.Because patients with liver cancer often present with liver cirrhosis,which leads to morphological deformation of the liver,it is difficult to perform a linear ablation of liver cancer in the areas near the phrenic top and within large blood vessels,among others.The present study reports on two cases of liver cancer that have been subjected to curvilinear ablation.After 1 mo,magnetic resonance imaging showed complete ablation,demonstrating that ultrasound-guided curved ablation is feasible and effective in the treatment of liver cancer.CASE SUMMARY Two patients were treated at the Liver Disease Department of the Xixi Hospital Affiliated to Zhejiang University of Chinese Medicine in 2019.Because the first liver cancer patient’s tumor was located close to the diaphragm,it was difficult to complete a straight needle ablation procedure in one session.In order to achieve accurate and minimally invasive treatment of this tumor,a curved needle ablation procedure was designed.The second patient presented with a hepatic cyst in front of the tumor.In order not to damage the hepatic cyst,a looper needle ablation technique was used.The procedure was successfully completed in both cases.CONCLUSION Curved ablation is a new technique that can be used to treat tumors situated in a variety of locations,providing new ideas for interventional techniques.Its operation difficulty is higher and further animal experiments are necessary to improve the operation procedure.
文摘Background： It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration （CVVH） with regional citrate anticoagulation （RCA）. This study aimed to assess the determinants of calcium infusion rate during CVVH with RCA in critically ill patients with acute kidney injury （AKI）. Methods： A total of 18 patients with AKI requiring CVVH were prospectively analyzed. Postdilution CVVH was performed with a fixed blood flow rate of 150 ml/min and a replacement fluid flow rate of 2000 ml/h for each new circuit. The infusion of 4% trisodium citrate was started at a rate of 29.9 mmol/h prefilter and adjusted according to postfilter ionized calcium. The infusion of 10% calcium gluconate was initiated at a rate of 5.5 mmol/h and adjusted according to systemic ionized calcium. The infusion rate of trisodium citrate and calcium gluconate as well as ultrafiltrate flow rate were recorded at 1, 2, 4, 6, 12, and 24 h after starting CVVH respectively. The calcium loss rate by CVVH was also calculated. Results： Fifty-seven sessions of CVVH were performed in 18 AKI patients. The citrate infusion rate, calcium loss rate by CVVH, and calcium infusion rate were 31.30 （interquartile range： 2.70）, 4.60 ± 0.48, and 5.50 ± 0.35 retool/h, respectively. The calcium infusion rate was significantly higher than that of calcium loss rate by CVVH （P 〈 0.01）. The correlation coefficient between the calcium and citrate infusion rates, and calcium infusion and calcium loss rates by CVVH was -0.031 （P 〉 0.05） and 0.932 （P 〈 0.01）, respectively. In addition, calcium infusion rate （mmol/h） = 1.77 ± 0.8 x （calcium loss rate by CVVH, mmol/h）. Conclusions： The calcium infusion rate correlates significantly with the calcium loss rate by CVVH but not with the citrate infusion rate in a fixed blood flow rate during CVVH with RCA.
