针刀松解治疗枕大神经痛临床观察

我院2002年元月~2004年12月疼痛门诊对方便随访的86例枕大神经痛患者随机分为针刀松解组和神经阻滞组进行对照观察,现将结果报告如下:1临床资料1.1一般资料:86例枕大神经痛患者,男34例,女52例,年龄27~63岁,平均48.2岁。病程1月~4年。左侧枕大神经痛26例,右侧枕大神经42例,双侧枕大神经痛18例。随机分为针刀松解组和神经阻滞组,每组43例。1.2治疗方法[1]:①神经阻滞:病人骑坐在治疗椅上,双前臂重叠放在椅背上,额部置于前臂上,在枕大神经出筋膜点即枕骨粗隆与乳突连线中点(相当于风池穴)的压痛点为治疗点,用5号齿科针垂直皮面进针,直达枕骨,注…     

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。     

穴位注射治疗枕大神经痛38例

在门诊头痛病人中有部份病人表现枕部和后颈部发作性剧痛,当咳嗽、喷嚏、头部活动时疼痛加重、颈部活动不利、头微前倾或侧倾。查体：在枕外粗隆与乳突连线中点稍内侧（即枕大神经穿出皮下处）有压痛,风池穴有深压痛,压痛点可向枕颈部放射,部分病人在枕大神经出分布区尚有感觉过敏或感觉减退,以上即是枕大神经痛的典型表现。笔者对原发性38例枕大神经痛采用穴位注射治疗,取得了满意疗效,现报告如下：     

桡神经浅支卡压的解剖与临床

目的:了解桡神经浅支卡压的依据并讨论了该征的诊断及治疗原则。方法:解剖观测了20具40侧成人上肢标本桡神经浅支穿出处的局部解剖特点及其距桡骨茎突的距离,随访了12例患者,9例采用局部封闭治疗,3例采用手术神经松解治疗。结果:桡神经浅支穿出部位为腱性组织所包绕。该处筋膜将肱桡肌腱挤在一起,从而易于受压。临床随访6个月至2年,保守及手术治疗患者症状均完全消失无复发。结论:解剖:桡神经浅支在前臂中下段易发生卡压有其解剖学基础。临床上病程短症状轻患者保守治疗往往能有较好疗效,病程长症状重或存在其它病理性压迫患者往往需要手术治疗。     

足底外侧神经第一支卡压所致跟痛症

跟痛症的原因多认为与跟骨内压力增高有关。而常常忽视足底外侧神经第一支卡压的原因。此神经常在拇展肌深筋膜与跖方肌内侧头内下缘之间受到卡压。Baxter等对此神经卡压所致跟痛症患者行手术松解,约89％的跟痛症状缓解、消失。我们对32例跟痛症患者在此神经卡压部位行类固醇激素封闭治疗,效果满意,现报道如下。     

下位斜方肌肌皮瓣修复支气管胸膜瘘三例

我们于 1999～ 2 0 0 0年应用斜方肌下部肌皮瓣移转修复支气管胸膜瘘并残腔 3例 ,全部成功。1　应用解剖　斜方肌上起自枕外隆突至第 12胸椎棘突之间 ,止于锁骨外侧 1/ 3、肩峰及肩胛岗 ,呈三角形。斜方肌血供主要是颈横动脉 ,该动脉在斜方肌深面分为深、浅两支。深支沿肩胛内侧缘深面下行 ,在菱形肌下缘发出一分支穿出深层 ,分布于斜方肌下部外侧及其皮肤。以深支为蒂形成下位斜方肌岛状肌皮瓣 ,其血管蒂较长 ,所带皮肤筋膜组织最远可达肩胛下角以下 10ｃｍ处[1 ] 。2　手术方法　自锁骨上凹找到颈横动脉 ,向后追踪其深支在脊柱与肩胛内侧…     

铍针治疗颈肩部皮神经卡压综合征

目的：探讨皮神经卡压综合征的发病机制和铍针的治疗机制。方法：采用铍针治疗78例颈肩部皮神经卡压综合征的患者，枕大皮神经卡压综合征18例，枕小皮神经卡压综合征5例，肩胛上皮神经卡压综合征27例，颈横皮神经卡压综合征4例．锁骨上皮神经卡压综合征24例。其中男35例，女43例；年龄19～63岁，平均39．8岁。根据治疗前后患者颈肩部疼痛的改变判定疗效。结果：临床痊愈54例；显效16例；有效8例。结论：通过铍针对皮下组织、筋膜和肌肉的切割，使筋膜表面张力降低，松解粘连，消除瘢痕，消除感觉神经末梢所受的刺激和压迫，缓解疼痛。     

肘部尺神经卡压症

目的 :探讨肘部尺神经卡压症的术式及并发症。方法 :8例采用单纯松解术 ,3 0例采用前置术 ,对所有病人从struths弓到屈指深肌腱膜进行探查松解 ,术中保护尺神经血供。结果 :尺神经在肘部多处可受到卡压 (平均 2 4处 )。随访平均 2 2个月 ,按 2 0 0 0年手外科学会周围神经功能评价标准评价 ,优良率 86 8%。神经卡压症状在1年内手术术后疗效好。结论 :手术对尺神经卡压的 5个部位都应进行探查、松解。根据不同的病例选择前置或单纯的松解术。     

显微外科治疗臀上内侧皮神经卡压征

应用显微外科技术治疗臀上内侧皮神经卡压征 2 7例 ,于髂嵴处压痛点纵行切口长 5 cm,深筋膜下寻找该神经 ,镜下仔细用显微剪刀切开神经缩窄处膜性结构 ,充分松解游离神经 ,达到解剖结构清晰、损伤轻微、恢复较快、不留任何后遗症 ,术后获得良好疗效显微外科治疗臀上内侧皮神经卡压征$中国人民解放军第二一一医院骨科@陈庆贺     

颈脊神经后内侧支卡压的解剖及其临床意义

目的为临床诊治颈神经后内侧支卡压提供解剖学基础。方法对10具（20侧）成人尸体头颈标本颈脊神经后内侧支易受卡压的部位进行解剖学观测。结果（1）C2颈脊神经后内侧浅支（枕大神经）易受卡压处分别位于该神经走行于头下斜肌与枢椎椎弓板之间段、穿过头半棘肌段和穿上项线骨纤维孔处。（2）C3-5脊神经后内侧浅支（第三枕神经）易受卡压处分别位于该神经穿行头半棘肌和穿头夹肌段。C3颈脊神经后内侧深支即头夹肌支,该神经穿过头半棘肌处。（3）C3-8后内侧支穿颈脊神经后支骨纤维管。结论颈神经后内侧支穿行的骨纤维管、项部肌肉、项部肌肉的腱性组织是造成颈脊神经后内侧支卡压的解剖学基础。     

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.     

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.     

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.