Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracor...Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.展开更多
Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitt...Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from December 2017 to July 2018 were selected. They were all undergoing transperineal 3D volume ultrasound combined with 2D high-frequency ultrasound examination, and the diagnosis results were analyzed. The results of ultrasonography and surgical pathology were compared. Results: Among 52 patients, 3D volume ultrasound combined with 2D high-frequency ultrasound were used to diagnose 32 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 5 cases of supra-sphincter type, and 1 case of extra-sphincter type. T supervisor classification accuracy rate is 90%. The detection rate of branch pipes was 92%, and the compliance rate of internal fistula was 95%. Two-dimensional high-frequency ultrasound was used to diagnose 34 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 4 cases of supra-sphincter type, and 0 cases of extra-sphincter type. The detection rate of branch canals was 42%, and the accuracy of type classification was 90%. The coincidence rate was 95%. There was a statistically significant difference in the detection rate of the anal fistula branch and the coincidence rate of the internal fistula between the two methods (both P Conclusion: 1) The overall coincidence rate of three-dimensional volumetric ultrasound combined with two-dimensional high-frequency ultrasound in the diagnosis of anal fistula is high;2) Three-dimensional volumetric ultrasound technology has great application prospects in infants and anal fistulas.展开更多
文摘Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
文摘Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from December 2017 to July 2018 were selected. They were all undergoing transperineal 3D volume ultrasound combined with 2D high-frequency ultrasound examination, and the diagnosis results were analyzed. The results of ultrasonography and surgical pathology were compared. Results: Among 52 patients, 3D volume ultrasound combined with 2D high-frequency ultrasound were used to diagnose 32 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 5 cases of supra-sphincter type, and 1 case of extra-sphincter type. T supervisor classification accuracy rate is 90%. The detection rate of branch pipes was 92%, and the compliance rate of internal fistula was 95%. Two-dimensional high-frequency ultrasound was used to diagnose 34 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 4 cases of supra-sphincter type, and 0 cases of extra-sphincter type. The detection rate of branch canals was 42%, and the accuracy of type classification was 90%. The coincidence rate was 95%. There was a statistically significant difference in the detection rate of the anal fistula branch and the coincidence rate of the internal fistula between the two methods (both P Conclusion: 1) The overall coincidence rate of three-dimensional volumetric ultrasound combined with two-dimensional high-frequency ultrasound in the diagnosis of anal fistula is high;2) Three-dimensional volumetric ultrasound technology has great application prospects in infants and anal fistulas.
