去带盲结肠可控膀胱术

目的　改进膀胱癌患者膀胱全切后贮尿和排尿问题。　方法　对 2 3例全膀胱切除患者行去带盲结肠可控膀胱术。　结果　 2 2例术后随访 3～ 30个月 ,3个月后贮尿囊容量 45 0～ 6 0 0ml,平均 5 5 0ml,平均内压 (14± 8)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　去带盲结肠可控膀胱术是一种较为理想的尿流改道方法 ,具有较好的应用价值。     

正位可控性去带盲结肠膀胱术的疗效观察

目的:探讨正位可控性去带盲结肠膀胱术的临床疗效.方法:对17例膀胱肿瘤患者行膀胱全切除术后,应用末段回肠及盲升结肠作贮尿囊行正位膀胱重建术.结果:17例中15例获随访6～24个月,平均14.5个月.全组无严重并发症,均无瘤生存;术后3周自主可控性排尿,日间排尿可控率为93.3%,1年夜间尿失禁22.2%.术后6个月尿动力学检查,膀胱容量336 ml、最大尿流率13.7 ml/s、剩余尿量42 ml,而充盈期膀胱压力明显低于尿道闭合压.输尿管反流1例,但无尿道、输尿管狭窄,肾功能正常.结论:正位可控性去带盲结肠膀胱术具有膀胱容量大、内压低,正位排尿,可控性好,且手术操作简单、并发症少等优点,患者易于接受,是一种较理想的尿流改道方式.     

去带盲结肠可控性膀胱术18例报告

目的 介绍去带盲结肠可控性膀胱术的临床经验。方法 对18例膀胱癌患根治性全膀胱切除后,施行了去带可控性盲结肠膀胱术。结果 获访17例,平均随访16（6－28）个月。16例能完全控制排尿,1例夜间轻微溢尿。插管均容易。术后12月膀胱容量平均415ml。充盈压力平均22cmH2O。无输尿管狭窄及反应。肾功能、 血生化、尿液化验正常。结论 去带盲结肠可控性膀胱术具有手术简便、容量大、内压低、无反流、可控排尿、并发症少的优点。     

改良可控性盲结肠膀胱术15例报告

目的　提高膀胱肿瘤全膀胱切除的临床疗效。　方法　对 15例膀胱肿瘤患者行可控性盲结肠膀胱术 ,并对术式进行改进。　结果　 15例随访 4～ 2 9个月 ,3个月后贮尿囊容量 45 0～ 6 5 0ml,平均 5 5 0ml,充盈状态下平均囊内压 (11.4± 4.3)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　改良可控性盲结肠膀胱术操作简单 ,贮尿囊容量大、内压低、自控排尿良好 ,并发症少 ,具有良好的临床应用价值。     

正位可控去带盲结肠膀胱加回肠抗反流术

目的：探讨正位可控去带盲结肠膀胱加回肠抗反流术的临床效果。方法：采用膀胱全切正位可控去带盲结肠膀胱加末段回肠抗反流术治疗膀胱癌20例。结果：随访9～42个月，白天均可控制排尿，14例夜间能白控排尿，6例夜间有尿失禁。尿动力学检查：12个月贮尿囊平均最大容量350ml，平均最大囊内压3．16kPa，剩余尿量为16ml，平均最大尿流率19．2ml／s。贮尿囊造影及IVU显示2例有双侧输尿管反流，无输尿管狭窄和肾积水。血电解质及肾功能正常。结论：正位可控去带盲结肠膀胱加末段回肠抗反流术操作简单，并发症少，疗效好，是一种较理想的膀胱替代术。     

去带盲结肠可控膀胱术20例报告

目的简化手术操作,探索去带盲结肠可控膀胱的应用价值。方法１９９５年１０月～１９９７年１２月,采用去带盲结肠可控膀胱术治疗全膀胱切除患者２０例。结果２０例平均随访１７７个月,完全可控１９例,可控率９５％。出院时贮尿囊容量为２５０～３５０ｍｌ,１年后为４００～７００ｍｌ。无输尿管返流,肾功稳定。结论去带盲结肠可控膀胱术操作简单、并发症少、疗效确实,是一种较好的尿流改道方式     

回结肠代膀胱术临床分析(附25例报告)

目的　探讨回结肠代膀胱术的临床疗效。　方法　对 2 5例膀胱肿瘤患者膀胱全切除术后 ,应用末段回肠及盲升结肠作贮尿囊行正位膀胱重建术。　结果　 2 5例中获随访 2 2例 ,随访时间 6～ 3 4个月 ,平均 19.5个月。患者一般于术后 3周自主可控性排尿 ,日间排尿可控率 91% ,1年夜间尿失禁 2 6%。术后 6个月尿动力学检查膀胱容量 (3 86± 75)ml(2 90～ 550ml)、最大尿流率 (12 .5±2 .2 )ml/s、剩余尿量 (2 6± 11)ml ,充盈期膀胱压力明显低于尿道闭合压。输尿管返流 2例 ,无尿道狭窄、输尿管狭窄 ,无高氯性酸中毒 ,肾功能正常。 1例术后 8个月发生肿瘤多处转移 ,余 2 1例无瘤存活。　结论　回结肠代膀胱术具有膀胱容量大、内压低 ,正位排尿 ,可控性好 ,并发症少等优点 ,患者易于接受 ,是一种较理想的尿流改道方式     

去带可控性盲结肠新膀胱术(附七例报告)

目的介绍一种膀胱全切术后尿流改道方法。方法１９９６年１２月～１９９７年１２月对７例全膀胱切除患者行去带可控性盲结肠新膀胱术。结果随访２～１２个月,贮尿囊平均容量４２０ｍｌ,平均内压（１５±９）ｃｍＨ２Ｏ,贮尿囊造影未见输尿管返流,ＩＶＵ上尿路无积水和输尿管狭窄,排尿控制良好,插管容易,尿液中无致病菌生长。结论去带可控性盲结肠新膀胱术具有手术操作简单、容量大、内压低、无返流、能自由控制排尿等优点,明显改善了患者的生活质量,具有较好的应用价值     

原位可控回结肠代膀胱术疗效总结

目的 回顾分析膀胱全切术后原位回结肠代膀胱术的疗效及并发症.方法 对52例膀胱癌患者行膀胱全切,原位回结肠代膀胱术,术后对患者排尿情况、肾功能、术后近期及远期并发症等进行随访.结果 45例患者获随访,随访时间3～146个月,平均42个月.术后6个月白天可控排尿38例,夜间可控排尿35例.3例(6.7%)术后6～15个月死于肿瘤盆腔复发或转移.2例(4.4%)于术后18、22个月尿道肿瘤复发,其中1例半年后死亡.5例(11.1%)术后3年内死于非肿瘤原因.术后近期和远期并发症发生率分别为17.8%(8例)和24.4%(11例).术后12个月2例患者出现肾功能轻度异常,血尿素氮为7.2、11.8 mmol/L,血肌酐为137、168 μmol/L.结论 原位可控回结肠代膀胱术无明显代谢紊乱及肾功能损害,具有良好的排控能力,手术并发症大多可临床治愈,是一种较为理想的尿流改道术式.     

去带盲结肠可控膀胱术3例报告

目的：探讨一种全膀胱切除或全盆腔脏器切除术后尿流改道方法,方法：对２例全盆顺切除和１例全膀胱切除患行去带盲结肠可控膀胱术。结果：随访４～１６个月,贮尿囊平均容量４５０ｍｌ,平均内压为（１．９６±０．４９）ｋＰａ,无输尿管反流,血电解质和肾功能正常,排尿控制良好,结论：去带盲结脾性可控膀胱术具有手术操作简单,贮尿囊容量大、内压低,自控排尿良好,并发症少优点,是目前较为理想的尿流改道方法。     

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 comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.