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Hypertonicity:Clinical entities,manifestations and treatment

World Journal of Nephrology 2017年第1期6卷 1-13页

作者： helbert Rondon-Berrios Christos Argyropoulos Todd S Ing Dominic S Raj Deepak Malhotra Emmanuel I Agaba Mark Rohrscheib Zeid J Khitan Glen H Murata Joseph I Shapiro Antonios H Tzamaloukas Renal-Electrolyte Division Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA 15260United States Division of Nephrology Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States Department of Medicine Strich School of MedicineLoyola University ChicagoMaywoodIL 60153United States Division of Nephrology Department of MedicineGeorge Washington UniversityWashingtonDC 20037United States Division of Nephrology Department of MedicineSchool of MedicineUniversity of ToledoToledoOH 43614-5809United States Division of Nephrology Department of MedicineJos University Teaching HospitalJosPlateau State 930001Nigeria Division of Nephrology Department of MedicineSchool of MedicineMarshall University Joan C.EdwardsHuntingtonWV 25701United States Informatics Section Medicine ServiceRaymond G.Murphy Veterans Affairs Medical CenterAlbuquerqueNM 78108United States Department of Medicine University of New Mexico School of MedicineAlbuquerqueNM 78108United States Marshall University Joan C.Edwards School of Medicine HuntingtonWV 25701United States Section of Nephrology Medicine Service(111C)Raymond G.Murphy Veterans Affairs Medical CenterAlbuquerqueNM 78108United States

Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and longterm neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and *** results from relative excess of body sodium over body water. Loss of water in excess of intake,gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of *** can be hypervolemic,euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and,if present,sodium deficit,and correction of the underlying pathophysiologic process that led to *** in hyperglycemia has two components,solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration,which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level.

关键词：渗血症高血糖治疗方法临床分析

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使组织结构增强的色素内镜能否提高结肠镜下腺瘤的检出率

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世界核心医学期刊文摘（胃肠病学分册） 2006年第10期2卷 19-20页

作者： Lapalus M.-G. helbert T. Napoleon B. 周智勇 Lapalus Fédération des Spécialités DigestiveHpital E.Herriot5 Place d'Arsonval69437 LyonFrance.Dr

Background and Study Aims: Colonoscopy is still considered the standard investigation for the detection of colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. Chromoscopy has been shown to increase the yield for lesion detection in inflammatory bowel disease. The aim of this randomized prospective study was to determine whether a combination of chromoscopy and structure enhancement could increase the adenoma detection rate in high-risk patients. Patients and Methods: All patients included in the trial had a personal history of colorectal adenomas and/or a family history of colorectal cancer (but excluding genetic syndromes). They were randomized to one of two tandem colonoscopy groups, with the first pass consisting of conventional colonoscopy for both groups, followed by either chromoscopy and structure enhancement (the “study" group) or a second conventional colonoscopy (the control group) for the second-pass colonoscopy. All detected lesions was examined histopathologically after endoscopic resection or biopsy. The principal outcome parameter was the adenoma detection rate; the number, histopathology, and location of lesions was also recorded. Results: A total of 292 patients were included in the study (146 patients in each group). The patients’demographic characteristics, the indications for colonoscopy, and the quality of bowel preparation were similar in the two groups. There was a significant difference between the two groups with respect to the median duration of the examination (18.9 minutes in the control group vs. 27.1 minutes for the study group, P < 0.001). Although more hyperplastic lesions were detected throughout the colon in the study group (P = 0.033), there was no difference between the two groups in either the proportion of patients with at least one adenoma or in the total number of adenomas detected. Chromoscopy and structure enhancement diagnosed significantly more diminutive adenomas (< 5m

关键词：色素内镜结肠镜检常规结肠镜检查组织结构病变检出率结肠直肠癌近端结肠染色检查遗传性综合

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Fluid balance concepts in medicine:Principles and practice

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World Journal of Nephrology 2018年第1期7卷 1-28页

作者： Maria-Eleni Roumelioti Robert H Glew Zeid J Khitan helbert Rondon-Berrios Christos P Argyropoulos Deepak Malhotra Dominic S Raj Emmanuel I Agaba Mark Rohrscheib Glen H Murata Joseph I Shapiro Antonios H Tzamaloukas Division of Nephrology Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87131United States Division of Nephrology Department of MedicineJoan Edwards School of MedicineMarshall UniversityHuntingtonWV 25701United States Division of Renal and Electrolyte Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA 15260United States Division of Nephrology Department of MedicineUniversity of Toledo School of MedicineToledoOH 43614-5809United States Division of Renal Disease and Hypertension Department of MedicineGeorge Washington UniversityWashingtonDC 20037United States Division of Nephology Department of MedicineJos University Medical CenterJosPlateau State 930001Nigeria Research Service Raymond G Murphy VA Medical Center and University of New Mexico School of MedicineAlbuquerqueNM 87108United States 不详

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water(TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment(mainly sodium salts) and in the intracellular compartment(mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume(EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illne

关键词： Body fluids Body water Extracellular volume Hypertonicity Hypotonicity Congestive heart failure Hepatic cirrhosis Sepsis Nephrotic syndrome

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