儿童颈椎椎间盘钙化

目的：对9例儿童颈椎椎间盘钙化病例的临床表现、影像学表现、鉴别诊断及治疗进行讨论；方法：本组9例，男5例，女4例，年龄5—15岁，平均11．2岁。9例均为单发性颈椎椎间盘钙化，起病前1例有发热史，1例有外伤史。除1例无症状者偶然发现，其余患者临床表现均以颈部疼痛活动受限为主，均给予牵引等非手术治疗。结果：9例在治疗后2周--1个月内症状消失。随访2年以上，钙化影在3个月--3年内消失。结论：儿童颈椎椎间盘钙化症属自疗性疾病，预后良好，保守治疗有满意疗效。     

儿童椎间盘钙化症（附8例报告）

[目的]总结儿童椎间盘钙化症的特点和诊断治疗体会。[方法]1998～2003年诊治儿童椎间盘钙化症8例。回顾分析患儿的临床症状、体征以及X线表现。主要诊断依据x线平片发现椎间盘钙化症。。分别经局部镇痛、卧床休息、围领保护以及下颌带牵引等方法治疗。[结果]症状均于四周内缓解，7例椎间盘钙化最快在1．5个月时开始吸收，且均在2年内吸收完全。1例随访3年余，虽无症状，但间盘钙化未吸收。[结论]儿童椎间盘钙化症为一种自限性疾病，以保守治疗的方法治疗，能取得满意疗效，且预后良好。     

超声引导下X线定位穿刺置管在经皮内窥镜下腰椎椎间盘切除术中的应用

腰椎椎间盘突出症(LDH)是骨科常见疾病,也是成年人腰腿痛的主要病因之一.非手术治疗是大多数LDH患者的首选治疗方案,但仍有10％ ～ 20％的患者因非手术治疗达不到理想效果或症状反复发作不得不选择手术摘除突出髓核以解除神经压迫[1].经皮内窥镜下腰椎椎间盘切除术(PELD)是治疗LDH的经典微创术式,在把握适应证的基...     

小儿颈椎椎间盘钙化

小儿颈椎椎间盘钙化非常少见。本文报告１２例，男８例，女４例。年龄５～１３岁。其中３例有发热史，２例有外伤史。除１例无症状者为偶然发现外，其余患者均有以颈部疼痛为主的临床症状，部分同时有全身症状和／或神经压迫症状。Ｘ线平片检查表现为颈椎椎间盘中央部分的钙化阴影，而ＣＴ扫描和ＭＲＩ检查可明确显示椎间盘钙化范围及脊髓和／或神经根受压程度。小儿颈椎椎间盘钙化症属自限性疾病，预后良好。即使存在有神经受压症状，非手术治疗仍可获得满意疗效。     

椎间盘钙化19例报告

目的　对 19例椎间盘钙化的患者 ,通过症状、体征、影像学资料的临床探讨 ,观察其变化规律 ,研究治疗方法。方法　观察患者的临床症状、体征、影像学表现的变化。结果　从影像学看 ,椎间盘钙化可分为 3种类型 :环内钙化、环外钙化、混合钙化 ;本组环内钙化 5例 ;环外钙化 12例 ;混合钙化 2例 ,环内钙化是CT切层呈“铁饼”状 ,形成封闭区的患者 ,病情稳定自限 ,采用保守治疗 ,效果较好。环外钙化 12例 ,8例手术治疗 ,效果满意 ;混合钙化伴有神经症状者 1例手术治疗 ,1例保守治疗 ,均得到较好的治疗效果。结论　纤维环破坏 ,外界物质进入髓核 ,产生反应 ,导致钙化。钙化形成一完整的封闭的与外界隔绝的独立区域时 ,是进入静止期的衡量标准之一 ,椎间盘钙化环内型多采取保守治疗 ,其余可采取手术治疗     

腰椎间盘术后椎间盘炎的诊断与治疗方法探讨

目的探讨腰椎间盘术后椎间盘炎的临床特征,诊断与治疗方法。方法自1994年7月-2004年7月共收治9例腰椎间盘术后椎间盘炎患者,平均年龄48岁,近期内均接受过腰椎间盘手术,其中2例使用椎间盘手术。全组患者血沉均升高（40-110mm/h),均经MRI检查确诊,6例症状典型,疼痛较重的患者行前路病灶清除植骨融合术,3例症状不典型,疼痛较轻患者予非手术治疗。结果 行前路病灶清除植骨融合术患者,疗效较好,症状缓解明显,保守治疗病程较长,病精常有反复,但一般预后良好。结论结合患者的临床特性,经MRI检查可以作出诊断。根据患者病情的具体情况,选择手术治疗或非手术治疗。     

C2/C3颈椎前路椎间盘切除融合术治疗Hangman骨折对下位颈椎椎间盘高度及颈椎曲度的影响

Hangman骨折是高位颈椎最常见的损伤类型之一,占所有轴性骨折损伤的20％ ～ 22％,此类损伤多由车祸或坠落时颈部过伸或轴向负荷加大导致[1].Hangman骨折患者常伴有颈椎不稳和运动障碍,非手术治疗融合率低,预后差[2].对于不稳定的Hangman骨折及非手术治疗效果不佳的患者,一般建议手术治疗.手术治疗可及时缓解患者的神经症状及长期外固定引起的持续性疼痛,还可缩短住院周期.手术入路包括前路和后路.     

椎间盘钙化19例报告

目的 对19例椎间盘钙化的患者，通过症状、体征、影像学资料的临床探讨，观察其变化规律，研究治疗方法。方法 观察患者的临床症状、体征、影像学表现的变化。结果 从影像学看，椎间盘钙化可分为3种类型：环内钙化、环外钙化混合钙化；本组环钙化5例；环外钙化12例；混合钙化2例，环内钙化是CT切层呈“铁饼”状，形成封闭区的患者，病情稳定自限，采用保守治疗，效果较好。环外钙化12例，8例手术治疗，效果满意；混合钙化伴有神经症状者1例手术治疗，1例保守治疗，均得到较好的治疗效果。结论 纤维环破坏，外界物质进入髓核，产生反应，导致钙化。钙化形成一完整的封闭的与外界隔绝的独立区域时，是进入静止期的衡量标准之一，椎间盘钙化环内型多采取保守治疗，其余可采取手术治疗。     

Smiley face rod固定技术治疗青少年腰椎峡部裂研究进展

腰椎峡部裂是指一侧或两侧峡部骨质不连续,在一般人群中发生率为6％,男女比例为2:1[1].腰椎峡部裂是引起青少年腰背痛的常见原因,与腰椎反复过伸及旋转活动密切相关[2-5].有研究[6]表明,青少年腰椎峡部裂有一定遗传倾向.大部分有症状的青少年腰椎峡部裂患者可通过规范的非手术治疗恢复日常生活和运动,尤其对于发现较早的单...     

腰椎椎体后缘骨骺离断症合并腰椎椎间盘突出症椎板开窗减压术后致对侧神经根症状1例报告

椎体后缘骨骺离断症（PRAS）合并腰椎椎间盘突出症（LDH）好发于青少年,如伴有神经根、马尾压迫症状,手术治疗是最主要且最有效的手段。针对术中是否需要完全切除离断的椎体后缘骨块,目前尚存争议。本研究通过1例PRAS合并LDH患者的诊疗经过进行文献回顾,探讨该病的诊疗措施,旨在为临床医师提供参考,现报告如下。     

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.     

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.