前臂交锁髓内钉治疗尺桡骨多段骨折

目的探讨交锁髓内钉治疗前臂多段骨折效果。方法对11例尺桡骨多段骨折采用闭合复位交锁髓内钉固定。结果术后随访6~15个月。骨折愈合时间为12~22周,术后1例延迟愈合,无感染及骨不连。按Anderson评分:优8例,良2例,可1例。结论交锁髓内钉固定是治疗前臂多段骨折的良好方法。     

弹性髓内钉治疗大龄儿童尺桡骨双骨折

目的应用弹性髓内钉治疗大龄儿童（〉9岁）尺桡骨双骨折,观察临床疗效、放射学结果及前臂功能恢复情况。方法采用弹性髓内钉经皮插入技术治疗尺桡骨双骨折13例,年龄9～15岁,平均11.3岁,随访4～14个月,平均随访9个月。结果随访病例全部骨性愈合,愈合时间为2～5个月,平均3.5个月,前臂活动功能优良,无术中及术后并发症发生。结论应用弹性髓内钉内固定治疗大龄儿童尺桡骨双骨折,安全、微创、方便可行,骨折愈合快,并发症少,可尽早恢复前臂活动功能。     

Acumed前臂髓内钉治疗尺桡骨骨折的临床研究

目的观察Acumed前臂髓内钉治疗尺桡骨骨折的临床疗效。方法采用Aeumed前臂髓内钉治疗尺桡骨骨折33例,其中男23例,女10例;年龄21～65岁,平均37．5岁。桡骨干单骨折13例,尺骨干单骨折18例,前臂双骨折2例。结果30例患者得到随访,随访8～16个月,平均13．4个月,29例顺利愈合,平均愈合时间为14周,1例桡骨干骨折出现不愈合,后给予更换内固定后愈合。根据Anderson评分,优21例,良7例,可1例,差1例,本组优良率,93．3％。结论．．Acumed前臂髓内钉具有手术简单、微创等优点,对骨折愈合及伤肢功能恢复有较好的临床疗效。     

影响经皮髓内钉内固定术治疗前臂骨干骨折疗效的危险因素分析

目的 分析影响经皮髓内钉内固定术治疗成人尺桡骨骨干骨折疗效的危险因素,为其临床应用提供参考.方法 对自1995年5月～2008年11月采用经皮髓内钉内固定术治疗的前臂尺桡骨骨干骨折63例进行临床分析,分别观察骨延迟愈合、骨不连率,Anderson功能评分差率和并发症发生等情况.结果 分类观察中,尺骨和桡骨的骨干两端比骨干中部、严重骨折比轻度骨折、开放复位比手法复位以及细钉比粗钉,骨延迟愈合、骨不连率和Anderson功能评分差率明显高,差异均有统计学意义(P＜0.05).用二元Logistic回归分析发现对尺骨和桡骨骨折部位、骨折程度、复位方式和髓内钉选择均是影响骨折愈合和功能评分疗效的重要危险因素.结论 经皮髓内钉内固定术用于治疗成人前臂骨干骨折时,如骨折位于骨干中部、骨折程度不重、实现手法复位和选择合适粗钉,可获得良好的疗效.这种方法创伤小、并发症少,如使用恰当仍不失为治疗成人前臂骨干骨折的很好选择.     

交锁髓内钉固定治疗尺、桡骨粉碎性骨折

目的介绍应用交锁髓内钉固定治疗前臂尺桡骨粉碎性骨折的经验。方法对2 1例尺桡骨骨折,按AO分型[1] B3 型8例、C1型10例、C2 型3例,采用骨折复位、Smith Nephew交锁髓内钉固定术。结果术后随访6～3 6个月,骨折愈合时间8～2 0周,平均16.2周。术后1例骨折延迟愈合,1例锁钉钉道感染,拔钉后愈合,无1例发生骨不连。按Anderson评分标准评定优10例,良7例,可4例。肘关节伸屈活动功能丧失10°～3 5°,平均18.5°,前臂旋前功能丧失15°～5 5°,平均2 5 .0°,旋后功能丧失15°～45°,平均3 3 .5°。结论应用交锁髓内钉固定方法是治疗前臂软组织损伤同时伴有尺桡骨粉碎性骨折的良好手术选择。     

小切口弹性髓内钉内固定治疗儿童尺桡骨骨折

目的探讨小切口弹性髓内钉内固定治疗儿童尺桡骨骨折的疗效。方法应用双根弹性髓内钉治疗22例尺桡骨闭合骨折患儿。结果患儿均获得随访,时间12～24个月。患儿均达到骨性愈合,无神经损伤、骨折畸形愈合及延迟愈合、骨骺损伤等并发症发生。1例术中闭合复位不佳,1例术后前臂活动受限,2例钉尾皮肤激惹反应形成假性囊肿,1例拇长伸肌腱断裂,均经对症治疗后症状消失。结论选择合适直径的弹性髓内钉,采用小切口闭合复位内固定治疗儿童尺桡骨骨折,是一种比较理想的治疗方法。     

应用前臂带锁髓内钉治疗尺桡骨骨折初步疗效分析

目的 探讨髓内钉固定系统治疗尺、桡骨骨折的临床疗效. 方法自2003年lO月至2007年3月收治并获得随访的尺、桡骨骨折患者共94例,其中尺骨骨折35例,桡骨骨折38例,尺、桡骨双骨折21例,均为闭合性骨折.所有患者均采用闭合复位或小切口有限切开复位髓内钉内固定术,术前若伴有上、下尺桡关节脱位的病例则行石膏单托前臂旋后位固定3周,否则术后早期功能锻炼.结果 所有患者随访9～26个月,平均13.5个月,术后骨折全部愈合,愈合时间8～14周,平均10.2周.并发症:术中骨质劈裂2例,桡神经浅支挫伤1例,骨桥连接1例,无血管、肌腱损伤、骨髓炎、不愈合、内固定失败病例,并发症发生率4.2%.术后半年Anderson功能评价:优68例,良22例,可4例,总优良率95.7%.肘关节屈伸丧失0.150,平均5.5°,前臂旋前丧失0～35°,平均14.2°,旋后丧失0～50°,平均18°. 结论髓内钉用于尺、桡骨骨折的治疗有其独特的优势,特别是对于骨质疏松、多段、粉碎骨折,具有疗效满意、创伤小、并发症少的特点,但在l临床应用中需要掌握一定的熟练技术及指征.     

闭合复位带锁髓内钉与切开复位钢板内固定治疗尺桡骨双骨折的比较

目的 探讨尺桡骨双骨折闭合复位髓内钉内固定与切开复位钢板内固定疗效比较.方法 手术治疗30例尺桡骨双骨折,其中11例行闭合复位带锁髓内钉固定19例行切开复位钢板螺钉内固定.结果 闭合复位带锁髓内钉固定术与切开复位钢板螺钉内固定术对骨折的愈合及旋转功能恢复影响无显著性差异(P=0.3931)结论闭合复位带锁髓内钉固定操作简便、创伤小、不剥离骨膜、不植骨、容易拔除、无再骨折,更适宜治疗尺桡骨双骨折.     

髓内钉内固定治疗尺桡骨骨干骨折的并发症分析

目的观察髓内钉内固定治疗尺桡骨骨干骨折的疗效,并分析术中及术后并发症情况。方法回顾性分析自2009-05—2015-12采用髓内钉内固定治疗的97例闭合性尺桡骨骨干骨折。记录术中与术后并发症情况,并分析发生原因。骨折完全愈合时采用Anderson评分标准评定疗效。结果 97例均获得随访,随访时间平均10.2(8～24)个月。术中6例发生并发症,2例医源性骨折,1例进钉点劈裂,2例髓内钉置入困难,1例锁定螺钉置入困难。术后6例发生并发症,1例术后感染,3例桡骨髓内钉退钉,1例尺桡骨间骨桥连接,1例尺骨骨折不愈合。96例骨折一期愈合,骨折完全愈合时间平均3.6(2～9)个月。末次随访时疗效采用Anderson评分标准评定:优69例,良24例,可4例。结论髓内钉内固定手术治疗尺桡骨骨干骨折具有创伤小、骨折愈合好、术后恢复快等优点,而术前详尽的治疗方案制定、细致的术中操作及合理的术后个体化功能锻炼是避免术中、术后并发症发生的关键。     

Sanatmetal前臂髓内钉微创治疗尺桡骨骨干骨折

目的探讨应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折的手术疗效。方法2005年7月~2007年3月,应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折32例;其中男18例,女14例;年龄26~71岁,平均42岁。前臂尺、桡骨双骨折17例,尺骨骨折7例,桡骨骨折8例。32例中多段骨折7例,陈旧性骨折骨不连2例。结果术后随访3~21个月,平均7个月。术后无一例发生伤口感染及髓内钉断裂或松动。32例均完全骨性愈合,愈合时间平均为4个月。按Anderson评分标准评定:优28例,良4例。肘关节伸屈活动功能丧失5~30°,平均17.5°,前臂旋前功能丧失10~35°,平均21.6°,旋后功能丧失10~40°,平均27.5°。结论应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折,具有手术损伤小,固定牢固等优点,是治疗前臂骨折较理想的手术方法。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.