颞浅动静脉岛状瓣修复副鼻窦开放性缺损

目的：探讨应用颞浅动静脉双蒂岛状组织瓣修复副鼻窦开放性损伤的方法。方法：对上颌窦、额窦开放性缺损12例患者,利用同侧颞浅动脉、静脉作为供养血管,形成颞浅动脉顶支颞筋膜岛状组织瓣和额支额部岛状皮瓣,通过皮下组织隧道将组织块移植到缺损的副鼻窦区,进行副鼻窦窦腔的充填和皮肤缺损的修复。结果：12例患者,颞浅动脉顶支颞筋膜岛状组织瓣及额支额部岛状皮瓣全部成活,切口愈合良好。随访观察9例,随访时间为6个月至3年,凹陷区填充效果满意,两侧对称性好。3例患者失访。结论：利用颞浅动脉顶支颞筋膜岛状组织瓣和额支额部岛状皮瓣修复副鼻窦开放性损伤,不需吻合血管,操作较简单,易于成活,术后外观满意,是较好的修复方法。     

岛状皮瓣在整形外科的临床应用

作者自1980年以来应用12种不同岛状皮瓣(或筋膜瓣)修复全身各种皮肤及软组织缺损共18例。如应用颞浅动脉岛状皮瓣修复面部缺损,前额疤痕;颞浅动脉岛状筋膜瓣充填面部凹陷;枕后动脉头皮瓣修复头皮缺损;背阔肌岛状皮瓣修复上臂、腋前胸壁缺损;前     

岛状臀大肌肌皮瓣在臀部软组织缺损修复中的应用

目的：探讨岛状臀大肌肌皮瓣在臀部软组织缺损尤其是骶尾部褥疮修复中的应用。方法：以臀大肌臀上动脉穿出点为旋转轴,利用臀上动脉和臀下动脉交通支所在的臀大肌外缘肌为蒂,以旋转点至缺损区最近点为肌皮瓣蒂长度,根据缺损部位及大小进行肌皮瓣设计,形成岛状肌皮瓣,肌皮瓣面积稍大于缺损区创面。蒂部仅含臀大肌外缘肌肉,宽度1.5～2.0cm。沿设计线切开皮肤找到臀大肌臀上动脉穿出点及臀大肌外缘,向远端解剖,在臀大肌下形成的岛状皮瓣,通过皮下隧道将肌皮瓣转移到缺损区,逐层缝合切口。供区视大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复。结果：应用岛状臀大肌肌皮瓣修复臀部软组织缺损7例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均满意。结论：岛状臀大肌肌皮瓣血供丰富,血管恒定,抗感染能力强,切取及转移方便,是修复臀部软组织缺损尤其是骶尾部褥疮的理想肌皮瓣。     

颞筋膜蒂乳突发际皮瓣修复前额发际皮肤缺损

目的 探讨额颞部发际内外皮肤缺损的修复方法.方法 近十年间,应用耳后发际颞筋膜蒂岛状皮瓣转移修复前额颞部发际皮肤缺损5例.结果 皮瓣全部成活,5～7 d可见头发生长,发际内外界限清楚,额颞部形态佳.结论 应用耳后发际颞筋膜蒂岛状皮瓣转移修复颞额部发际皮肤缺损是一种可行的方法.     

超长蒂颞浅筋膜岛状皮瓣修复鼻部缺损

目的介绍超长蒂颞浅动脉筋膜岛状皮瓣修复鼻翼缺损的手术方式.方法 29例外伤性鼻缺损,其中采用颞浅动脉额支筋膜岛状皮瓣修复12例,颞浅动脉顶支筋膜岛状耳后皮瓣修复14例,预制颞浅动脉顶支筋膜耳后皮瓣3例.结果 27例皮瓣的颜色、质地和形态良好,疗效满意;2例出现皮瓣部分坏死,需再次修复手术.结论超长蒂颞浅动脉筋膜岛状皮瓣治疗鼻尖、鼻小柱及鼻翼缺损,供区损伤小,受区颜色形状好;并且预制的超长蒂颞浅动脉筋膜岛状耳后皮瓣血运可靠,可一次解决衬里问题,此皮瓣是修复鼻尖、鼻翼缺损的好方法.     

颞浅动静脉岛状瓣修复副鼻开放性缺损

目的:探讨应用颞浅动静脉双蒂岛状组织瓣修复副鼻窦开放性损伤的方法.方法:对上颌窦、额窦开放性缺损12例患者,利用同侧颞浅动脉、静脉作为供养血管,形成颞浅动脉顶支颞筋膜岛状组织瓣和额支额部岛状皮瓣,通过皮下组织隧道将组织块移植到缺损的副鼻窦区,进行副鼻窦窦腔的充填和皮肤缺损的修复. 结果:12例患者,颞浅动脉顶支颞筋膜岛状组织瓣及额支额部岛状皮瓣全部成活,切口愈合良好.随访观察9例,随访时间为6个月至3年,凹陷区填充效果满意,两侧对称性好.3例患者失访.结论:利用颞浅动脉顶支颞筋膜岛状组织瓣和额支额部岛状皮瓣修复副鼻窦开放性损伤,不需吻合血管,操作较简单,易于成活,术后外观满意,是较好的修复方法.     

超长蒂颞浅筋膜岛状皮瓣修复鼻部缺损

目的介绍超长蒂颞浅动脉筋膜岛状皮瓣修复鼻翼缺损的手术方式。方法29例外伤性鼻缺损，其中采用颞浅动脉额支筋膜岛状皮瓣修复12例，颞浅动脉顶支筋膜岛状耳后皮瓣修复14例。预制颞浅动脉顶支筋膜耳后皮瓣3例。结果27例皮瓣的颜色、质地和形态良好。疗效满意；2例出现皮瓣部分坏死，需再次修复手术。结论超长蒂颞浅动脉筋膜岛状皮瓣治疗鼻尖、鼻小柱及鼻翼缺损，供区损伤小，受区颜色形状好；并且预制的超长蒂颞浅动脉筋膜岛状耳后皮瓣血运可靠，可一次解决衬里问题，此皮瓣是修复鼻尖、鼻翼缺损的好方法。     

带蒂组织瓣转移手术修复肢体软组织缺损35例分析

目的　分析带蒂组织瓣转移手术修复肢体软组织缺损创面的疗效。方法　选择肌瓣、岛状皮瓣、岛状肌皮瓣转移 ,直接修复缺损或转移肌瓣表面植皮覆盖。结果　 2 9例慢性骨髓炎和 6例外伤后软组织缺损创面 ,肌瓣、岛状皮瓣、岛状肌皮瓣转移修复疗效满意。结论　带有营养血管的肌瓣、皮瓣肌皮瓣转移手术 ,一期修复肢体创伤、骨髓炎等所致的骨缺损腔及软组织缺损创面 ,效果好 ,因不需吻合血管 ,手术相对简单 ,临床使用安全。     

岛状额瓣加胸锁乳突肌皮瓣一期修复颊癌术后大面积洞穿性缺损一例

目的探讨颊部大面积洞穿性缺损的修复方法和胸锁乳突肌皮瓣、额瓣联合修复的优缺点。方法2003年7月行颊癌扩大切除,功能性颈淋巴清扫术患者1例,遗留组织缺损范围皮面9 cm×7 cm,黏膜面4.5 cm×3.0 cm。以甲状腺上血管、枕动脉和颈外静脉胸锁乳突肌肌支为血管蒂的胸锁乳突肌皮瓣修复颊黏膜面,以颞浅血管为血管蒂的岛状额瓣修复颊部皮面,皮瓣大小分别为5 cm×3 cm和10 cm×6 cm。结果患者术后皮瓣、皮片均全部成活,创面Ⅰ期愈合。2周痊愈出院,颊部皮色、质地好。随访1年,肿瘤无复发,生活自理,语言、饮食正常。结论胸锁乳突肌皮瓣和额部岛状瓣可作为颊癌术后颊部大面积洞穿性缺损的一期修复的方法,操作简便、易行,且经济。     

背阔肌岛状皮瓣修复上臂软组织缺损

目的 观察背阔肌岛状皮瓣修复上臂软组织缺损的临床效果。方法 应用背阔肌岛状皮瓣修复１４例上臂软组织缺损。结果 １例皮瓣远端皮肤部分坏死,１３例完成成活。随访４０－６年,受区外形及功能恢复基本满意,供区愈合良好。结论 背阔肌皮瓣由胸背动脉供给血运,该岛状皮瓣具有血供丰富,血管解剖恒定和血管蒂长以及切取容易等优点,带蒂移植适宜修复上臂软组织缺损。     

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.     

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.     

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.