圆柱形髂骨块椎间融合与RF固定治疗腰椎滑脱

腰椎滑脱症是一种常见病 ,约占腰腿痛病人总数的 5 %。自 1993年 6月～ 1999年 6月采用圆柱形髂骨块后路椎间融合与ＲＦ系统治疗腰椎滑脱 18例 ,报告如下。1　临床资料1 1　一般资料　本组 18例 ,男 12例 ,女 6例 ,年龄 2 2～6 1岁 ,平均 39 5岁 ,病史最短 3个月 ,最长 2 6年。滑脱类型与平面 :峡部崩裂 10例 ,退行性 4例 ,创伤性 4例 ;滑脱等级Ⅰ°5例 ,Ⅱ°9例 ,Ⅲ°4例 ;滑脱平面Ｌ514例 ,Ｌ4 4例。1 2　临床症状　本组病例术前均有慢性腰痛史 ,程度不一 ,其中单纯腰痛 2例 ,一侧腰腿痛 6例 ,双侧腰腿痛 10例 ;5例合并椎间盘突出 ,其中 4…     

减压植骨脊柱固定器内固定治疗腰椎滑脱

腰椎弓裂致腰椎滑脱为腰腿痛常见的原因之一。腰椎滑脱手术方法较多 ,1999年 4月～ 2 0 0 1年 3月 ,采用椎板间开窗减压、植骨和多爪钳夹式脊柱固定器内固定治疗腰椎滑脱2 1例 ,报告如下。1　临床资料1 1　一般资料　本组男 8例 ,女 13例。年龄 35～ 6 0岁 ,平均 4 5岁。病程 3个月～ 10年。单纯腰痛 5例 ,腰痛伴双下肢痛 9例 ,伴单侧下肢痛 7例。腰椎Ｘ线片和ＣＴ检查示Ｌ4滑脱 10例 ,Ｌ5滑脱 11例 ,腰椎Ⅰ度滑脱 18例 ,Ⅱ度滑脱 3例 ,合并椎间盘突出 8例 ,骨质增生 6例 ,椎管狭窄 6例 ,椎间盘突出位于Ｌ4、5双侧 2例 ,Ｌ4、51例 ,Ｌ5Ｓ15…     

DRFS椎弓根螺钉系统治疗腰椎滑脱症

目的：探讨腰椎整复减压和DRFS固定及植骨治疗腰椎滑脱症的临床疗效。方法：自1998年2月～2002年2月，22例经保守治疗无效的腰椎滑脱患者接受上述方法手术治疗，Ⅰ度滑脱8例，Ⅱ度滑脱12例，Ⅲ度滑脱2例；L4／5 5例，L5／S1 17例。比较手术前后临床症状和X线片滑脱程度。结果：术后平均随访6个月(3～12个月)，20例(90．9％)滑脱完全复位，其余2例滑脱明显改善。17例腰腿痛症状全部消失，4例腰腿痛症状大部分消失，1例腰腿痛症状较前有所减轻。结论：应用DRFS内固定复位效果良好，临床效果满意。     

RF多板手术治疗腰椎滑脱并椎间盘突出30例

近三年来 ,我院在总结别人经验及教训基础上 ,利用ＲＦ钢板进行手术复位 ,充分减压髓核摘除、复位、内固定并植骨融合治疗腰椎滑脱并椎间盘突出30例 ,取得较好的疗效 ,现报告如下 :1　临床资料1 1　一般资料　本组 30例 ,男 12例 ,女 18例 ,年龄 2 2～ 6 9岁 ,病史 6个月～2 0年。按Ｍｅｙｅｒｄｉｎｇ分类 :Ⅰ°6例、Ⅱ°2 0例、Ⅲ°4例 ;按Ｍｅｗｍａｎ分型 :退行性变滑脱 16例 ,峡部裂滑脱 10例 ,创伤后滑脱 4例 ;滑脱平面 :Ｌ58例 ,Ｌ4 12例 ;椎间盘突出 :Ｌ4 ,512例 ,Ｌ5Ｓ118例。1 2　临床表现　 30例均有腰痛伴下肢放射性痛 ,2 3例为…     

短节段Silhouette内固定结合BAK治疗腰椎滑脱症的体会

腰椎滑脱症是引起腰腿痛的原因之一 ,治疗方法很多。我院自 2 0 0 0年 1月～ 2 0 0 1年 9月与上海长海医院合作 ,应用短节段 Silhouette内固定结合 BAK治疗腰椎滑脱症 10例 ,取得了满意的疗效 ,现报告如下。临床资料一、一般资料　本组男 7例 ,女 3例 ;年龄 36～ 6 0岁 ,平均 4 5 .6岁。L4 °滑脱 1例 , °滑脱 3例 ;L5 °滑脱 2例 , °滑脱 4例。均伴有椎弓根崩裂 ,其中 9例有神经根症状。二、内固定装置　 Silhouette内固定系统 (见图示 )由椎弓根螺钉、金属杆、横向连接器组成。术中椎弓根螺钉采用固定轴 ,直径有 3种 (5 .5 mm、6 .5…     

青少年腰椎间盘突出症诊断与治疗

目的 分析青少年腰椎间盘突出症特点，提高诊治水平。方法 12例青少年患者中，2例症状较轻者保守治疗后缓解，6例经2～16个月保守治疗失败，4例未行保守治疗。共9例行后路手术治疗。结果 无严重手术并发症。随访时，2例未手术患者腰腿痛常复发。8例手术患者获1年6个月～9年随访，6例无腰腿痛，神经功能恢复，恢复术前活动度；2例劳累后有轻微腰痛，其中1例5年后复发。结论 神经根张力试验阳性是青少年腰椎间盘突出症临床特点，提高对该病的认识是防止漏诊误诊的关键。     

椎体及横突间植骨治疗腰椎滑脱症15例报告

腰椎椎弓峡部裂导致腰椎滑脱是引起腰腿痛常见原因之一。我院自1996年3月～1998年4月应用后路椎板减压椎体间及横突间双植骨术冶疗腰椎滑脱15例,效果满意,现报告如下。 1 临床资料 1.1 一般资料 本组15例,男4例,女11例。年龄35～58岁,平均43.6岁。病程8个月～10年,平均3年5个月。临床表现:单纯腰痛2例,腰痛合并单侧下肢放射痛3例,腰痛合并双下肢放射痛5例,     

骶孔滑脱钢板治疗L5椎体滑脱

目的：探讨骶孔滑脱钢板对L5椎滑脱的治疗效果。方法：自1998年1月～2000年5月采用骶孔滑脱钢板对16例L5双侧峡部裂性滑脱患者进行治疗，其中Ⅰ^*4例，Ⅱ^*7例，Ⅲ^*4例，Ⅳ^*1例。结果：通过对16例患者术后6～48个月随访，椎间融合率为100％，腰痛改善率为81．2％，腿痛及间歇性跛行改善率为87．5％。结论：骶孔滑脱钢板结构简洁有力、操作方便、保持腰骶功能的优点，效果优良，是治疗L5滑脱的理想器械。     

环锯前路椎体间植骨治疗腰椎滑脱症

腰椎滑脱症,以腰5多见,多数患者随年龄增长出现滑脱进展,出现慢性腰腿疼,需手术治疗,我院自88年以来用环锯作椎体钻孔及髂骨取骨,前路椎体间植骨治疗Ⅰ°、Ⅱ°腰椎骨滑脱16例,经随访疗效满意。 临床资料 本组16例,男14例,女2例,年龄20～54岁,平均42岁。病史最长12年,最短5天。腰部有外伤史8例,6例有严重下腰痛,5例有神经根刺激症状。其中8例有间     

椎弓根内固定器在腰椎滑脱症中的应用

我院自1989年10月～1992年7月对30例有明显腰腿痛或马尾神经症状的腰椎滑脱症患者采取了椎弓根螺钉钢板内固定治疗,取得较满意效果,特报告如下。 一般资料:男3例,女27例;年龄36～52岁,平均48.5岁。病程6个月～15年。峡部崩裂性滑脱6例,退变性滑脱24例。并发椎间盘突出者4例(L4-53例,L5～ S11例)。 临床表现:腰痛30例,单侧下肢痛19例,双侧下肢痛11例。间歇性跛行24例。腰部有压痛25例,无压痛5例。腰部活动受限21例,直腿抬高<60者22例。肌力减退17例,感觉迟钝18例,反射减弱或消失8例。 X钱表现:L。滑脱2例,L.滑脱19例,L。滑脱9例。按Meyer…     

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.