针刀松解对颈性眩晕的疗效分析

目的观察小针刀治疗颈性眩晕的临床疗效,探讨其疗效机制。方法将81例颈性眩晕患者随机分为针刀组、针刺组,观察两组临床疗效和经颅多谱勒超声(TCD)检测结果。结果 2个疗程结束后,针刀组在总有效率与TCD检测指标方面,与针刺组比较,差异具有显著性(P<0.05,P<0.05)。结论针刀松解对颈性眩晕疗效确切。     

针刀神经触激治疗腰椎间盘突出症的临床疗效评价

目的观察针刀神经触激治疗腰椎间盘突出症的临床疗效。方法将77例腰椎间盘突出症患者随机分为针刀神经触激组38例和针刺组39例。针刀神经触激组,采用针刀松解配合神经触激,每周1次,4次一疗程;针刺组,采用针刺腧穴,每周2次,8次一疗程。两组治疗前、后(治疗结束时)用VAS评分和症状体征评分进行评分,予以统计分析。结果两组治疗均能减轻疼痛、改善症状体征,针刀神经触激组优于针刺组(P0.05)。结论针刀神经触激疗效显著。     

枕部针刀松解治疗颈源性头痛的临床研究

目的:观察针刀治疗颈源性头痛的效果,探讨皮神经卡压因素在颈源性头痛发病中的作用。方法:自2008年10月至2009年6月,采用针刀松解术治疗颈源性头痛患者82例,治疗部位为枕部,左右两侧共8点:乳突后压痛点;乳突与C2棘突连线中点;枕骨粗隆与乳突连线内1/3交点;C2棘突水平后正中点旁开1.5～2cm处压痛点。男23例,女59例;年龄17～73岁,平均41.57岁;病程0.5～50年,平均10.4年。患者均以头痛为第一主诉,本文以头痛疼痛强度(PPI)评估分级为观察指标。结果:术后1个月总有效率为81.70%(67/82),术后3个月内复发现象明显。但17.07%(14/82)的患者在治疗后6个月未复发。结论:一次针刀松解治疗使17.07%的颈源性头痛患者获得临床痊愈,说明皮神经卡压因素是颈源性头痛的重要病因;针刀治疗后3个月内患者头痛复发现象明显,提示应在此期间增加治疗次数并扩大治疗范围。     

星状神经节阻滞治疗颈源性眩晕的疗效观察与护理

目的:探讨星状神经节阻滞(SGB)治疗颈源性眩晕的临床效果.方法:将68例颈源性眩晕的患者随机分成观察组与对照组各34例,分别使用星状神经节阻滞治疗与传统基础疗法并进行疗效比较.结果:观察组疗效及显效、痊愈时间显著优于对照组(P<0.05,P<0.01).结论:星状神经节阻滞治疗颈源性眩晕具有疗效好,安全性高,元明显副作用等优点,值得推广.     

关节松动术联合星状神经节超激光照射在颈源性眩晕中的临床研究

目的观察关节松动术联合星状神经节超激光照射治疗颈源性眩晕的临床疗效及安全性。方法颈源性眩晕患者120例随机分三组,每组各40例。Ⅰ组(治疗组):关节松动术加星状神经节超激光照射治疗;Ⅱ组(对照组1):关节松动术加星状神经节阻滞治疗;Ⅲ组(对照组2):牵引加星状神经节超激光照射治疗。治疗前后采用颈性眩晕评估量表(Evaluation Scale for Cervical Vertigo,ESCV)及经颅多普勒超声(TCD)测评。结果治疗后三组患者ESCV评分均有显著提高(P0.01),左、右椎动脉和基底动脉的平均血流速度均较治疗前有提高(P0.05);Ⅰ、Ⅱ组优于Ⅲ组(P0.05)。Ⅰ组未出现Ⅱ、Ⅲ组发生的治疗并发症。结论关节松动术联合星状神经节超激光照射是颈源性眩晕一种较有效的治疗方法。     

星状神经节阻滞治疗女性颈源性头痛及椎动脉型颈椎病的疗效观察

目的:探讨星状神经节阻滞治疗女性颈源性头痛及椎动脉型颈椎病的临床治疗效果.方法:选择经我院门诊确诊的颈源性头痛及椎动脉型颈椎病其中主症状为发作性眩晕,并且其眩晕与体位有关.部分患者可伴有头痛,恶心,呕吐甚至摔例等症状的患者40例.均采用星状神经节阻滞(SGB)治疗,SGB法3次/周,左右交替进行,每10次为1疗程,休息5d,行第2疗程治疗,所有患者均治疗2个疗程.根据患者治疗前后发作性眩晕,头痛,恶心,呕吐甚至摔例等症状改善情况评价星状神经节阻滞治疗女性颈源性头痛及推动脉型颈椎病的临床效果.患者治疗前后发作性眩晕,头痛,恶心,呕吐甚至摔例等症状明显改善,其总有效率达90％以上.结论星状神经节阻滞疗法治疗女性颈源性头痛及椎动脉型颈椎病效果确切.     

手法为主综合治疗颈源性眩晕117例

颈源性眩晕是临床常见病症之一，是以眩晕、颈项僵硬疼痛为主的一组综合症状。我们自1999年以来采用手法为主综合治疗颈源性眩晕117例，疗效满意，现总结如下：     

推拿配合旋提整脊法及辩证牵引治疗颈源性眩晕临床观察

目的 观察推拿配合旋提整脊法及辩证牵引治疗颈源性眩晕的临床疗效。方法 选取本院骨科门诊60例颈源性眩晕患者，采用随机数字表法分为观察组和对照组，分别采用推拿配合旋提整脊法及辩证牵引和推拿配合旋提整脊法治疗2周，观察两组患者的临床效果与安全性。结果 治疗后，观察组椎基底动脉血流速度(LVA、RAV、BA)显著高于对照组(P<0.05),眩晕障碍量表(dizziness handicap inventory, DHI)总分和眩晕症状严重程度VAS评分均显著低于对照组(P<0.05);观察组总有效率为96%,显著高于对照组的80%(P<0.05)。结论 推拿配合旋提整脊法及辩证牵引可松解颈部肌肉、增加椎间隙、调节寰枢关节关系、改善颈椎生理曲度、减少颈椎对椎基底动脉及交感神经的压迫刺激，显著缓解颈源性眩晕的临床症状。     

腹针配合治脊疗法治疗颈源性眩晕50例分析

颈源性眩晕是眩晕中最常见的疾病之一。治疗时应与内耳眩晕及内科疾病引起眩晕相鉴别,临床表现较为复杂,颈源性眩晕的持续时间长,治疗困难,远期疗效不巩固。我科采用腹针配合治脊疗法治疗取得满意的疗效。现报告如下。1临床资料1.1对象患者均为康复医学科2000年2月-2004年2月的门诊及住院病人随机抽取100例。治疗组50例。对照组50例。经CT、脑电图检查,排除颅内病变及内耳疾患,排除内科疾病引起的眩晕。其中男40例,女60例,年龄19～60岁,病程3月￣3年。本组患者均有不同程度眩晕,有的患者还有头痛、视物模糊、耳鸣、恶心、心悸、失眠等。体…     

射频针刀治疗血瘀型膝关节骨性关节炎的临床疗效

目的:观察射频针刀治疗血瘀型膝关节骨性关节炎的临床疗效,探讨治疗前后关节痛点红外热像变化规律。方法:选取天津中医药大学第一附属医院骨伤科2016年1月—2018年12月就诊的膝关节骨性关节炎患者98例,随机分为观察组及对照组,每组49例,观察组采用射频针刀治疗,每周1次,共治疗2次,对照组采用常规针刺治疗,1次/d,连续治疗2周。比较两组治疗前后VAS评分、WOMAC评分、Lysholm评分、总有效率以及膝关节周围痛点红外绝对温度及温差值(△T)。结果:观察组治疗后在VAS评分、WOMAC评分、Lysholm评分的改善方面优于对照组,具有统计学差异(P0.05),观察组总有效率89.79%,优于对照组的77.55%,具有统计学差异(P0.05)。观察组治疗后膝关节周围痛点红外热像绝对温度改善程度优于对照组,患侧-健侧温差值(△T)改善程度观察组优于对照组,以上两项均具有统计学差异(P0.05)。结论:射频针刀治疗血瘀型膝骨性关节炎具有较好的临床疗效,关节痛点红外热像绝对温度及温差变化可以作为评价病变改善程度的指标。     

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.     

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.     

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.     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.