应用旋转切削技术治疗体表脂肪瘤及局限性脂肪堆积

目的探索一种治疗体表脂肪瘤及局部脂肪堆积的新方法.方法自1998年10月以来笔者对12例患者在局麻下采用耳鼻咽喉科的鼻内窥镜系统及旋转切削刀具治疗体表脂肪瘤及局限性脂肪堆积.结果随访6个月至2年所有病例均取得了满意的效果.结论该手术方法操作简便、安全、疗效可靠,也符合美容外科的原则.是治疗体表脂肪瘤及局限性脂肪堆积值得推广的手术方法之一.     

应用旋转切削技术治疗体表脂肪瘤及局限性脂肪堆积

目的 探索一种治疗体表脂肪瘤及局部脂肪堆积的新方法。方法 自1998年10月以来笔者对12例患者在局麻下采用耳鼻咽喉科的鼻内窥镜系统及旋转切削刀具治疗体表脂肪瘤及局限性脂肪堆积。结果 随访6个月至2年所有病例均取得了满意的效果。结论 该手术方法操作简便，安全，疗效可靠，也符合美容外科的原则，是治疗体表脂肪瘤及局限性脂肪堆积值得推广的手术方法之一。     

体表血管脂肪瘤一例并文献复习

目的:血管脂肪瘤,在临床上其症状及体征多不典型,常易误诊为脂肪瘤、纤维瘤、血管瘤等,而它们的手术原则、治疗方式又不尽相同。本文报道笔者医院收治的1例右腹部体表血管脂肪瘤病例,通过其临床资料结合文献予以分析,探讨体表血管脂肪瘤的影像学诊断及临床治疗。该病例MRI平扫显示梭形异常信号影,T1WI呈等信号,T2WI呈稍高信号,抑脂序列病灶亦呈高信号,手术切除肿瘤,术后病理诊断为血管脂肪瘤,随访3个月,患者症状明显改善。因此,应加强对血管脂肪瘤的认识,获得血管脂肪瘤的最佳的诊断与治疗,诊断主要以磁共振为依据,治疗应以外科手术为主。     

超声吸脂术治疗体表较大脂肪瘤

利用体内超声吸脂术治疗体表多脂症国内外报道较多,但将此法用于治疗体表脂肪瘤则鲜有报道.体表脂肪瘤目前的治疗方法以手术切除为主,但是存在切口长、术后瘢痕明显、甚至切口边缘坏死、切除部位凹陷明显、皮下血肿等诸多不足.我们在2001年9月至2004年3月,应用法国MEDICAMAT公司生产的超声去脂仪治疗皮下较大浅表脂肪瘤18例,取得良好效果,报告如下.     

肿胀吸脂法治疗体表多发性脂肪瘤

多发性脂肪瘤又称痛性脂肪瘤[1 ] ,患者往往因局部胀痛而就诊。我科在 1998年 10月～ 2 0 0 2年 11月 ,应用肿胀吸脂法治疗体表多发性脂肪瘤 11例 ,较传统手术治疗方法有很多优点。1　临床资料本组男 3例 ,女 8例 ,年龄 2 1～ 6 0岁 ,2例曾有脂肪瘤切除史。本组 11例共 15个部位 ,其中手术部位为上肢 6例、下肢 6例、腹部 3例。检查 :四肢和胸腹部皮下可触及多个散在大小不等的圆形或卵圆形结节 ,大小 1cm× 1cm～ 4cm× 3cm不等 ,表面光滑 ,质稍硬 ,压之轻度疼痛。术前用美蓝标记肿瘤位置 ,常规消毒及铺巾 ,采用局部肿胀麻醉。肿瘤所在范围…     

肾上腺髓样脂肪瘤3例报告并文献复习

目的探讨肾上腺髓样脂肪瘤的临床、影像学及病理特点。方法回顾性分析2000年1月～2011年12月3例肾上腺髓样脂肪瘤患者的临床资料并复习相关文献。患者年龄分别为53、67、73岁,平均64岁,男性1例,女性2例,左侧2例,右侧1例,肿瘤直径2.5～11cm。结果 2例患者经后腹腔镜肾上腺肿瘤切除,1例经腹开放手术切除,术后病理检查均证实为肾上腺髓样脂肪瘤。随访6个月至2年未见复发。结论肾上腺髓样脂肪瘤的诊断主要依靠B超、CT和MRI,确诊需经病理学检查证实。手术切除是主要的治疗方法,症状明显或瘤体直径〉4cm者应尽早手术。     

腰椎管内巨大脂肪瘤的外科治疗

目的探讨腰椎管内脂肪瘤的临床特点及手术治疗效果。方法对4例腰椎管内巨大脂肪瘤的临床特点及影像学资料进行分析,经后正中切口入路,行椎板减压手术切除脂肪肿物。结果患者术后肌力均恢复正常。2例发生脑脊液漏。症状完全缓解3例,好转1例。4例均获随访,时间10个月～3年,脂肪瘤未见复发。结论对有椎管压迫症状的腰椎管内脂肪瘤应行手术治疗,行后路椎板减压能取得良好的临床疗效。     

胃肠道脂肪瘤的诊断与治疗

目的总结胃肠道脂肪瘤的诊断与治疗经验。方法回顾性分析1993年至2007年间收治的34例胃肠道脂肪瘤的临床资料。结果胃肠道脂肪瘤的临床表现无特异性,可并发肠套叠或肠梗阻,超声内镜的诊断准确率为93.8%。本组有12例行内镜下脂肪瘤切除术,22例行开腹手术（局部切除术及胃或肠部分切除吻合术）,手术过程顺利,未出现并发症。28例（82.4%）获1-168个月随访,1例胃底多发的脂肪肉瘤于术后2年死于肿瘤转移,其余27例均无复发或转移,存活至今。结论超声内镜是诊断胃肠道脂肪瘤的有效方法,手术是治疗胃肠道脂肪瘤的常规手段,内镜下切除胃肠道脂肪瘤可行。     

肾血管平滑肌脂肪瘤自发破裂出血的急诊处理(附24例报告)

目的 探讨肾血管平滑肌脂肪瘤自发破裂出血的急诊处理.方法 对24例肾血管平滑肌脂肪瘤自发破裂出血患者的临床资料及随访结果进行回顾性分析.术前均行B超和CT检查,22例诊断为肾血管平滑肌脂肪瘤自发破裂出血,2例未能排除肾癌出血.3例保守治疗,4例行选择性肾动脉栓塞术,17例急诊手术.结果 3例保守治疗患者中1例病情稳定,2例改行手术治疗.4例行肾动脉栓塞术患者栓塞成功,出血停止.4例行肾切除术,13例行保留肾单位手术,其中5例行后腹腔镜手术.术后病理诊断为肾血管平滑肌脂肪瘤并出血.随访3个月～6年,肿瘤无复发或转移.结论 B超和CT是诊断肾血管平滑肌脂肪瘤出血的重要手段.治疗可以选择保守治疗、肾动脉栓塞或者急诊手术.     

探讨精索脂肪瘤在双侧腹股沟疝中的临床意义

目的探讨双侧腹股沟疝及其相关临床问题,精索脂肪瘤在双侧腹股沟斜疝中的临床意义。方法总结统计武汉市普仁医院2013年1月至2015年6月,96例双侧腹股沟疝患者临床资料,并分为两组,一组为同期发现双侧腹股沟疝并手术患者82例(85.4%);另一组为行单侧手术后再发另一侧并行手术患者14例(14.6%),术中发现双侧均存在精索脂肪瘤患者62例,常规行双侧腹股沟斜疝无张力修补术(Lichtenstein术),术中重建内环口及切除脂肪瘤。结果术中发现脂肪瘤约(1~4)枚/人,脂肪瘤瘤体直径1~6 cm。术后行病检32例,病理类型:脂肪瘤28例、血管脂肪瘤3例以及脂肪瘤样增生1例。术后随访1~24个月,无疝复发。结论精索脂肪瘤可致内环口扩大,在腹股沟斜疝形成因素中占重要意义。精索脂肪瘤多呈对称性生长,针对BMI偏高、特别站立后下腹部脂肪堆积明显的单侧腹股沟疝患者,术前应尽力发现对侧隐匿性疝的存在;单侧腹股沟疝术中存在精索脂肪瘤的对侧出现腹股沟疝的概率大大增加。     

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.