Cimetidine: prophylaxis against upper gastrointestinal haemorrhage after renal transplantation.

The incidence of upper gastrointestinal haemorrhage within four months of renal transplantation was studied in two groups of patients. Thirty patients who received prophylactic cimetidine suffered no episodes of upper gastrointestinal haemorrhage, while six of the 33 patients who did not receive cimetidine suffered haemorrhages and one of them died as a result. The difference between the groups was significant. The results suggest that the prophylactic use of cimetidine in patients receiving renal transplants is worth while.     

Peptic ulceration,gastric secretion,and renal transplantation.

Fifty-four patients on haemodialysis for chronic renal failure underwent renal transplantation. Basal and maximum acid output and the incidence of peptic ulcer before transplantation were not significantly different from those of controls. But after renal transplantation the incidence of symptoms of peptic ulcer was high (22%) and four out of six patients who developed gastrointestinal bleeding died from this complication. In men peak acid output was significantly increased after renal transplantation and was associated with a 30% incidence of symptoms of peptic ulcer compared with 10% in women, who showed no significant change in mean basal or peak acid output. Peptic ulceration after transplantation was not associated with steroid dosage, hyperparathyroidism, or the height of blood urea concentrations. Given criteria of a history of dyspepsia, abnormal barium meal findings, or gastric hypersecretion, it was not possible to identify patients at risk from peptic ulceration or life-threatening complications after renal transplantation. Thus the routine screening of these patients for peptic ulcer has no practical value, and the incidence of fatal complications is not high enough to justify routine prophylactic anti-ulcer surgery aimed at reducing acid secretion before renal transplantation.     

Controlled trial of propranolol to prevent recurrent variceal bleeding in patients with non-cirrhotic portal fibrosis.

Fifty patients with non-cirrhotic portal fibrosis who were admitted to hospital because of upper gastrointestinal bleeding were randomly assigned to treatment with either oral propranolol given in doses that reduced the resting pulse rate by 25% (25 patients) or with a placebo (25 patients). One year after the start of the study 20 patients in the propranolol group and five patients in the placebo group were free from recurrent gastrointestinal bleeding (p less than 0.0001). Giving continuous oral propranolol treatment is therefore effective in preventing recurrent upper gastrointestinal bleeding in patients with non-cirrhotic portal fibrosis.     

心得安预防门脉高压引起初次消化道出血的疗效观察

目的:观察心得安预防门脉高压症消化道出血的疗效、不良反应及临床应用的注意事项。方法选择本院102例肝硬化食道胃底静脉曲张患者,随机分为心得安组(52例)和安慰剂组(25例)。对出血发作的病情、持续的时间、输血量的多少、对止血药物的反应、生存期以及副反应进行观察。结果随访12个月,治疗组出血发生率为19.2%,安慰剂组为28%,两组差异无显著意义。随访20个月,治疗组出血发生率28.8%,安慰剂组48%,两组比较有显著性差异(P<0.05),但生存时间无显著差异。结论心得安对预防门脉高压症消化道初次出血有明显疗效,但不能延长肝硬化病人的生存期。     

Therapeutic effect of cimetidine in patients undergoing haemodialysis.

Blood concentrations of cimetidine were measured and the therapeutic effect of the drug assessed patients undergoing maintenance haemodialysis. Thirteen patients were given a single oral 200-mg dose of cimetidine a mean of 2.7 hours before the start of dialysis. Dialysing for 6--12-6 m2 hours led to a mean fall of 71% in blood cimetidine concentration during haemodialysis. Nine patients with various upper gastrointestinal lesions diagnosed endoscopically were treated for up to six weeks with a reduced cimetidine dose of 200 mg 12-hourly; two patients received two courses of treatment. Repeat endoscopy after treatment disclosed satisfactory healing, and the drug did not accumulate. This lower dose regimen is recommended for patients receiving dialysis who develop upper gastrointestinal lesions for which a histamine H2-receptor antagonist is indicated.     

Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial.

OBJECTIVE--To investigate the possible therapeutic role of omeprazole, a powerful proton pump inhibitor, in unselected patients presenting with upper gastrointestinal bleeding. DESIGN--Double blind placebo controlled parallel group study. Active treatment was omeprazole 80 mg intravenously immediately, then three doses of 40 mg intravenously at eight hourly intervals, then 40 mg orally at 12 hourly intervals. Treatment was started within 12 hours of admission and given for four days or until surgery, discharge, or death. SETTING--The medical wards of University and City Hospitals, Nottingham. SUBJECTS--1147 consecutive patients aged 18 years or more admitted over 40 months with acute upper gastrointestinal bleeding. MAIN OUTCOME MEASURES--Mortality from all causes; rate of rebleeding, transfusion requirements, and operation rate; effect of treatment on endoscopic appearances at initial endoscopy. RESULTS--Of 1147 patients included in the intention to treat analysis, 569 received placebo and 578 omeprazole. No significant differences were found between the placebo and omeprazole groups for rates of transfusion (302 (53%) placebo v 298 (52%) omeprazole), rebleeding (100 (18%) v 85 (15%)), operation (63 (11%) v 62 (11%)), and death (30 (5.3%) v 40 (6.9%)). However, there was an unexpected but significant reduction in endoscopic signs of upper gastrointestinal bleeding in patients treated with omeprazole compared with those treated with placebo (236 (45%) placebo v 176 (33%) omeprazole; p less than 0.0001). CONCLUSIONS--Omeprazole failed to reduce mortality, rebleeding, or transfusion requirements, although the reduction in endoscopic signs of bleeding suggests that inhibition of acid may be capable of influencing intragastric bleeding. Our data do not justify the routine use of acid inhibiting drugs in the management of haematemesis and melaena.     

Prophylactic effect of cimetidine in duodenal ulcer disease.

Fifty-seven symptom-free patients with duodenal ulcer entered a double-blind trial to assess the prophylactic effect of cimetidine. Patients were randomly allocated to receive cimetidine 400 mg twice daily (29 patients) or placebo (28 patients). The trial was designed to imitate daily clinical practice, so duodenal ulcer disease was diagnosed by means of x-ray examination. Three patients from each group withdrew from the trial. All remaining patients continued to receive treatment for 12 months or until symptoms recurred. Three out of 26 patients suffered relapses during cimetidine treatment, compared with 20 out of 25 receiving placebo. No side effects were attributable to cimetidine. Long-term cimetidine treatment had no curative effect as relapses occurred soon after treatment was stopped. The estimated chance (cumulative remission rate +/- 2 SE) of remaining symptom-free 13 weeks after one year''s cimetidine treatment had been completed was 47 +/- 21%. Maintenance treatment with cimetidine is a suitable alternative to elective in surgery in patients with duodenal ulcer subjects frequent relapses. Further study is needed to establish the optimal duration and safety of prolonged cimetidine treatment.     

Hemorrhage During Long-Term Anticoagulant Drug Therapy—Part I: Intracranial Hemorrhage

Intracranial hemorrhage was the most serious hemorrhage as measured by death and disability, occurring during long-term anticoagulant drug therapy of 1,626 patients. Among 95 hemorrhagic episodes considered life-threatening or potentially crippling, 30 were intracranial and 56 were gastrointestinal. Over two-thirds of the patients with intracranial hemorrhage died, as against one-tenth of those with gastrointestinal hemorrhage.The incidence of intracranial hemorrhage is increased among hypertensive patients, but the results of a controlled study indicate that the incidence of intracranial hemorrhage is not affected by whether or not the hypertensive patient is receiving anticoagulant therapy. Hypertension is the important precipitating factor, not the prothrombin level. Even at excessively low prothrombin levels only one intracranial hemorrhage occurred in 337 instances.In this series, reducing coagulability to a desirable range did not increase the probability of intracranial hemorrhage. Once bleeding occurred, however, it increased the risk of death and disability.     

Diabetes mellitus following paediatric renal transplantation: a single centre experience

BACKGROUND/AIMS: Post-transplant diabetes mellitus (PTDM) has a variably reported incidence of 4-41% among adults and children. We describe our recent experience of four children with PTDM in a paediatric renal transplantation centre. METHODS: We undertook a retrospective analysis of the glycaemic status of all paediatric patients undergoing renal transplantation at our centre in the 2-year study period. The clinical features and investigations of those who developed PTDM were further reviewed. RESULTS: Five episodes of PTDM occurred in 4/32 children. There was a variable onset and a wide range of symptoms. Investigations revealed a combination of insulinopenia with peripheral insulin resistance. Insulin therapy was required for variable durations with resolution of PTDM in four episodes. PTDM did not adversely affect the renal graft function. CONCLUSION: PTDM requires increased awareness among paediatric nephrologists and endocrinologists for early recognition and prompt effective intervention.     

肝移植术后急性肾功能衰竭的相关因素的临床分析

目的:探讨肝移植术后并发急性肾功能衰竭(ARF)的相关因素,为肝移植术后ARF的预防和治疗提供参考。方法:回顾性分析了2005年1月~2010年10月在我院行肝移植术的98例患者的临床资料,对术后并发ARF的相关因素进行分析。结果:98例行肝移植术后发生ARF 13例,发生率为13.27%。单因素分析显示术前血尿素氮(BUN)、术前血清肌酐(Scr)、术前血清白蛋白(Alb)、手术时间、失血量与ARF的发生有关(P<0.05)。多因素Logistic回归法分析表明,术前Scr和BUN是肝移植术后并发ARF的危险因素。结论:术前血BUN、血清Scr、血清Alb、手术时间和失血量是肝移植术后并发ARF主要因素,而术前Scr和BUN水平升高是肝移植术后并发ARF的危险因素。对上述因素加以重点评估和合理控制,可以控制肝移植术后ARF的发生。     

High versus "low" dose corticosteroids in recipients of cadaveric kidneys: prospective controlled trial.

Corticosteroids have the major role in the immunosuppressive treatment of patients who have received renal transplants. Despite their extensive use there is still debate about the appropriate dose that will prevent rejection of the renal allograft with the least morbidity. From March 1979 to November 1981 a randomised controlled trial of high (33 patients) v low oral dose (34 patients) of prednisolone along with azathioprine was conducted in recipients of first cadaveric transplants who had received a blood transfusion within six months of transplantation. The main difference in outcome between the two groups was a high incidence of some infections in the high dose group. Patient mortality, graft survival, transplant function, and number of rejection episodes were indistinguishable in the two groups, but rejection episodes tended to occur later in the high dose group. These findings suggest that the use of lower doses of corticosteroids soon after cadaveric renal transplantation does not jeopardise graft survival and results in lower patient morbidity.     

肝移植术后急性肾功能衰竭的相关因素的临床分析

目的：探讨肝移植术后并发急性肾功能衰竭（ARF）的相关因素,为肝移植术后ARF的预防和治疗提供参考。方法：回顾性分析了2005年1月-2010年10月在我院行肝移植术的98例患者的临床资料,对术后并发ARF的相关因素进行分析。结果：98例行肝移植术后发生ARF13例,发生率为13．27％。单因素分析显示术前血尿素氮CBUN）、术前血清肌酐（Scr）、术前血清白蛋白（Alb）、手术时间、失血量与ARF的发生有关（P〈0．05）。多因素Logistic回归法分析表明,术前Ser和BUN是肝移植术后并发ARF的危险因素。结论：术前血BUN、血清Scr、血清Alb、手术时间和失血量是肝移植术后并发ARF主要因素,而术前Scr和BUN水平升高是肝移植术后并发ARF的危险因素。对上述因素加以重点评估和合理控制,可以控制肝移植术后ARF的发生。     

Recurrent Haemorrhage after Acute Gastrointestinal Bleeding

A retrospective survey of 472 consecutive hospital admissions for acute upper gastrointestinal bleeding showed that patients with a large initial bleed are more likely to bleed again than those with a small initial bleed. The incidence of recurrent haemorrhage is also related to the interval since the last bleeding episode, so that patients showing no clinical evidence of haemorrhage for 48 hours are unlikely to bleed again in the near future. Patients admitted after a haematemesis have a higher incidence of recurrent haemorrhage than those admitted after melaena only. Aetiology has been confirmed as an additional important factor, the incidence being highest in those with oesophageal varices or a chronic gastric ulcer. Contrary to widespread belief, age does not appear to affect the incidence of recurrent haemorrhage, nor do other constitutional factors such as sex or the ABO blood group.     

Possible effect of time on renal allograft rejection.

The change in plasma creatinine concentrations from decreasing values after successful renal transplantation to increasing values after the onset of rejection occurs as a sudden event. Twenty-two such episodes in 16 renal allograft recipients were studied by extrapolating sequential measurements of plasma creatinine concentrations to see when the change occurred. Seventeen of the episodes occurred between 2300 and 1100 and the rest at other times. This difference was significant. The results suggest that rejection is more common at night and apparently has a circadian rhythm, being likely to first influence creatinine clearance at around 0600.     

Renal Failure in Cirrhosis of the Liver

The clinical course and autopsy findings of three patients with acute renal failure terminating the course of cirrhosis of the liver are presented. Review of the literature demonstrated that where decompensated cirrhosis is present the renal blood flow is characteristically low, although the total cardiac output is elevated. This circulatory disturbance results in the production of urine low in sodium, although normal in solute content. It also renders the kidney more vulnerable to further, sometimes minor, reductions in renal blood flow. As more patients with hepatic cirrhosis live through episodes of gastrointestinal bleeding and hepatic coma, death in acute renal failure will undoubtedly become more common.     

中国肝细胞癌患者TACE术后死亡原因分析(英文)

目的:通过探讨中国肝细胞癌患者肝动脉化疗栓塞术(TACE)术后并发症及死亡原因,来提高临床治疗效果,并积累治疗经验。方法:通过联合检索CBM及CNKI上从1994年1月到2008年9月的关于中国肝细胞癌患者行TACE术后出现并发症的相关文章,分析总结肝细胞癌患者TACE术后死亡的原因及特点。结果:中国肝细胞癌患者TACE术后并发症较为危重,致死率较高,死亡原因有84%是肝功能衰竭、上消化道出血及肝癌破裂出血,且死亡病例发生在术后1月内的占78.7%,因此大多是早期死亡。结论:中国肝细胞患者TACE术后死亡原因主要是肝功能衰竭、上消化道出血及肝癌破裂出血,且术后死亡常为早期死亡,因此TACE术后严重并发症可直接影响患者的预后情况,我们需要提高对TACE术选择时机的重视程度,规范介入治疗手段和流程,尽量避免和减少严重并发症的发生。     

Serious renal transplant rejection and adrenal hypofunction after gradual withdrawal of prednisolone two years after transplantation.

Ten patients with stable renal function two years after transplantation had their sole immunosuppressive treatment (oral prednisolone 10 mg daily) withdrawn by reducing the daily dose by 1 mg at monthly intervals. Plasma prednisolone concentration, cortisol concentration, creatinine clearance, and serum creatinine concentration were measured in all patients, and the adrenal response to corticotrophin was determined in five by measuring plasma cortisol concentrations before and after tetracosactrin injection. No episodes of rejection occurred in patients taking over 7 mg prednisolone daily. Although three patients apparently required only minimal immunosuppressive treatment (less than 5 mg daily) the remainder suffered episodes of rejection at daily doses below 7 mg. There was a tenuous association between rejection and low plasma cortisol concentration, but neither the pattern of plasma prednisolone concentrations nor the response to tetracosactrin were related to episodes of rejection. Reducing the daily dose of oral prednisolone to under 7 mg should not be attempted in patients with renal transplants unless there are extenuating circumstances.     

内镜止血在急性非静脉曲张性上消化道出血治疗中的临床应用

目的:探讨内镜下金属钛夹止血在急性非静脉曲张性上消化道出血治疗中的应用价值。方法:按照随机数字表法将2014年1月-2014年12月我院收治的40例急性非静脉曲张性上消化道出血患者分为观察组(n=20)及对照组(n=20),观察组行内镜下金属钛夹止血治疗,对照组予以内镜下药物注射,比较两组治疗后的止血效果、临床疗效及并发症情况。结果:观察组患者治疗后的有效止血率、即时止血率为95.00%、100.00%,分别高于对照组的65.00%、75.00%,差异有统计学意义(P0.05)。治疗后观察组临床疗效优于对照组,差异有统计学意义(P0.05)。治疗后两组患者均未出现严重并发症。结论:内镜下金属钛夹止血用于急性非静脉曲张性上消化道出血具有止血效果好、并发症少等特点,临床有重要的参考价值。     

磺达肝癸钠应用于冠心病合并肾功能不全患者的临床研究

目的:观察磺达肝癸钠应用于冠心病急性冠脉综合征合并肾功能不全患者抗凝治疗的疗效及安全性。方法:216例急性冠脉综合征患者分为肾功能正常组及肾功能不全组,皮下注射磺达肝癸钠2.5毫克,一日一次,连用8天,比较两组治疗9天内主要不良心脏事件(MACE)及出血并发症的发生率和30天及180天的随访情况。结果:治疗9天内及随访30天、180天期间,两组患者主要不良心脏事件发生率无统计学差异(P0.05),治疗及随访期间两组均未出现严重出血及中度出血,肾功能不全组轻微出血8例,肾功能正常组轻微出血5例,两组间比较差异无统计学意义(P0.05)。结论:磺达肝癸钠对于冠心病合并肾功能不全患者的抗凝治疗是一种安全有效的药物。     

Hemorrhage During Long-Term Anticoagulant Drug Therapy — Part III: The Relationship of Minor to Serious Bleeding

In a study of reports of 805 instances of spontaneous bleeding occurring among 2,189 patients receiving long-term anticoagulant drug therapy, 124 episodes were considered serious and 681 minor. There was no significant correlation of minor bleeding and serious bleeding.Minor bleeding unassociated with excessive reduction of coagulability or an underlying organic lesion could not be considered, according to this evidence, an indication for discontinuance of anticoagulant drug therapy.In apparently minor internal bleeding, however, hidden underlying organic lesions must be excluded. If gross hematuria occurs, renal lesions must be excluded.Rectal bleeding must not be considered minor until gastrointestinal lesions have been excluded.