内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈4例报告

目的探讨内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈的方法和疗效。方法2005年1~8月,我院应用内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈4例,年龄5~11岁,平均8.5岁。患侧腋窝前缘置入10 mm trocar,在颈阔肌筋膜下、胸锁乳突肌胸骨头与锁骨头浅面钝性分离,注入CO2气体(压力6 mm Hg),建立颈前皮下间隙,置入30°内镜。分别在患侧颈后近锁骨上缘处及对侧胸壁近锁骨下缘处置入5 mm trocar至颈前皮下间隙,置入分离钳与电凝钩,距胸锁骨附着处1 cm电凝横断胸锁乳突肌胸骨头与锁骨头的肌纤维束,并松解胸锁乳突肌周围紧张的纤维组织。结果4例手术均获成功,手术时间分别为90、75、70、45 m in。术中出血均<1 m l。术后第1天开始功能锻炼,第2天出院。第1例颈部皮肤轻微电灼伤,2周后痊愈。1例术后出现面部皮下气肿,次日自行吸收。随访2、4、6、10个月,斜颈均矫正,切口小且隐蔽,瘢痕不明显,颈部皮肤弹性良好,对面部表情活动无影响。结论内镜下胸锁乳突肌切断松解术疗效确切,且具有微创的特点,值得临床推广。     

年龄大于5岁儿童先天性肌性斜颈的手术治疗

目的观察大年龄儿童（年龄大于5岁）先天性肌性斜颈的手术治疗效果。方法手术治疗大年龄肌性斜颈患儿37例,切断胸锁乳突肌锁骨头、胸骨头,于乳突处切断胸锁乳突肌止点腱,并充分松解挛缩组织,术后均作枕颌牵引。结果所有病例均获随访,随访时间2～5年,平均随访2．6年,所有患儿的功能和外观均有改善,其中优28例（75．7％）,良9例（24．3％）。结论胸锁乳突肌上、下端切断术加术后牵引是治疗大龄儿童先天性肌性斜颈的首选手术治疗方式。     

内镜下胸锁乳突肌切断治疗肌性斜颈的疗效观察

目的探讨内镜下离断胸锁乳突肌治疗肌性斜颈的效果。方法23例肌性斜颈患儿,年龄1个月～12岁,中位数2岁6个月。右侧腋窝皮纹线内置入5mm trocar,手持镜头将胸锁乳突肌下端胸骨头和锁骨头表面的肌膜钝性分离,充入CO2气体加压至6mmHg,形成皮下空间。在外侧颈下横纹内和前胸横纹处切开3mm分别置入3mm弯钳和电刀尖。电凝或电切横断胸锁乳突肌纤维束,松解胸锁乳突肌周围的纤维组织。结果23例均在内镜下完成手术。平均手术时间51．2min（35～135min）,术中出血量均〈1ml。无损伤周围大血管和神经。1例颈部切口处皮肤轻微电灼伤,2周后自愈。术后行颈部舒展活动训练,术后第1天出院。23例随访3个月～4年,中位时间6个月,斜颈均矫正,疗效优18例,良5例,切口瘢痕不明显,皮肤弹性好,随表情无异常活动现象,无复发。结论内镜下胸锁乳突肌切断治疗肌性斜颈具有微创、恢复快、效果好的优点,瘢痕不明显,美观且不损伤颈阔肌,对表情活动无影响。     

锁骨下小切口经胸锁乳突肌颈前肌间隙腔镜辅助甲状腺部分切除术15例报告

目的探讨锁骨下小切口经胸锁乳突肌颈前肌间隙入路腔镜辅助甲状腺部分切除的方法和效果。方法15例单侧甲状腺良性结节，锁骨下小切口2-3cm，经胸锁乳突肌颈前肌间隙入路，腔镜辅助下行甲状腺部分切除。结果15例均获成功，手术时间40—80min，平均50min。术中出血10～50ml，平均20ml，无并发症。术后3-4d出院。15例随访1～12个月，平均7个月，无复发。结论经锁骨下小切口胸锁乳突肌颈前肌间隙入路腔镜辅助甲状腺部分切除手术损伤小，出血少，并发症发生率低，安全，术后恢复快。     

胸锁乳突肌成形术治疗先天性肌性斜颈

我院自 1996年 6月～ 2 0 0 1年 7月 ,采用分别切断胸锁乳突肌胸、锁骨头 ,并将胸骨头近断端与锁骨头远断端吻合延长的胸锁乳突肌成形术治疗先天性肌性斜颈患儿 42例 ,取得了满意的疗效。临床资料一、一般资料　本组 42例 ,男 2 5例 ,女 17例 ;年龄 1～18岁 ,平均 4.6岁 ;左侧斜颈 2 7例 ,右侧斜颈 15例 ;1～ 4岁2 4例 ,5～ 12岁 14例 ,12岁以上 4例。二、手术方法　术前拍摄颈椎正位片 ,分别测量双侧乳突至胸锁关节的长度 ,粗略估计患侧胸锁乳突肌需延长长度。年龄较小 ,不合作患儿采用氯氨酮基础麻醉加局麻 ;年龄较大 ,配合较好患儿采用局…     

29例先天性肌性斜颈的手术治疗

[目的]探讨先天性肌性斜颈的手术治疗方法。[方法]对29例患者采用胸锁乳突肌切断松解术，使胸锁乳突肌充分回缩，术后采用包扎、固定及侧卧式训练方法。[结果]29例经2～5a随访，效果较好，优19例（65．51％）；良9例（31．03％）；劣1例（3．45％）。[结论]2～5岁为先天性肌性斜颈最佳手术年龄，胸锁乳突肌切断松解术可作为首选术式。     

胸锁乳突肌多头切断术治疗成人先天性肌性斜颈

目的探讨胸锁乳突肌多头切断术治疗成人先天性肌性斜颈的方法及效果。方法 2009年3月—2011年2月,收治19例成人先天性肌性斜颈患者。男13例,女6例;年龄16～32岁,平均23.5岁。X线片检查示,12例伴不同程度颈椎侧弯及楔形改变。10例伴患侧面部发育迟缓。4例既往曾行胸锁乳突肌单侧头切断术。患者均采用胸锁乳突肌多头切断术,联合术后石膏托及颈托外固定3～6个月。结果术后患者切口均Ⅰ期愈合,无感染及血肿发生。16例患者获随访,随访时间5个月～2年,平均8个月。患者头颈部畸形均较术前明显改善。术后2周疗效评定:7例无颈椎畸形患者为优;12例伴颈椎畸形患者优1例,良7例,一般4例。术后2周测量患侧胸锁乳突肌乳突尖至胸锁关节距离,无颈椎畸形患者较术前延长(1.88±0.30)cm,手术前后差异有统计学意义(t=6.24,P=0.00),且术后测量值与正常值比较差异无统计学意义(t=1.87,P=0.11);伴颈椎畸形患者术后较术前延长(3.38±0.30)cm,差异有统计学意义(t=11.37,P=0.00),但术后测量值仍低于正常值(t=12.19,P=0.00)。结论采用胸锁乳突肌多头切断术治疗成人先天性肌性斜颈,能明显改善症状,恢复颈部活动功能。     

腋下切口提吊建腔内镜辅助治疗肌性斜颈

目的 探讨经腋窝皮肤入路提吊建腔,于内镜下切断胸锁乳突肌治疗肌性斜颈的手术方法.方法 对2008年5月至2014年3月收治的25例肌性斜颈,通过患侧腋窝入路,应用头颈部内镜手术建腔器建立非气腔提吊手术通道,充分切断短缩纤维化的胸锁乳突肌的胸骨头、锁骨头及其周围挛缩的纤维条索.结果 25例患者切口均一期愈合,无重要神经血管损伤,术后随访6个月,斜颈改善良好,瘢痕隐蔽,患者满意.结论 腋部入路提吊建腔内镜下斜颈整复术是治疗肌性斜颈的一种有效且兼顾外形的方法.     

肌延长术治疗先天性肌性斜颈

先天性肌性斜颈是小儿常见疾病,文献报道的手术方法多采用胸锁乳突肌切断松解术式。Ferkel首先报道了胸锁乳突肌延长成形的改良术式,我院自1992年6月～1996年4月有用该术式治疗28例患儿,获得良好的效果,现报告如下: 临床资料 一、一般资料:本组28例患儿,男17例,女11例,年龄4～13岁,平均7.4岁。随诊时间1～5年,平均2.4年。9例以胸骨头紧张为主,5例以锁骨头紧张为主,14     

"Z"字成形术治疗先天性肌性斜颈

我们从 1989年 5月～ 1999年 6月 ,采用切断胸锁乳突肌锁骨头 ,“Ｚ”字延长胸骨头的术式治疗 31例肌性斜颈患儿 ,取得满意疗效。1　临床资料1.1　一般资料　本组 31例 ,男 19例 ,女 12例 ;年龄 1～ 16岁 ,平均 4.2岁 ;左侧斜颈 2 1例 ,右侧 10例。我们按年龄将患儿划分 :1～ 4岁 19例 ,5～ 12岁 9例 ,12岁以上 3例。1.2　手术方法　年龄较小 ,不合作患儿采用氯胺酮基础麻醉加局麻 ;年龄较大 ,配合较好的患儿采用局麻。在锁骨上 1ｃｍ处 ,由患侧胸锁关节向外作一横切口 ,长约 3～ 4ｃｍ ,切开皮肤 ,皮下组织 ,横断颈阔肌 ,暴露胸锁乳突肌起…     

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.