膀胱颈部肿瘤经皮腔内钬激光治疗

目的 探讨膀胱镜盲区膀胱颈部肿瘤的腔内治疗方法。方法 对32例膀胱镜盲区肿瘤经皮膀胱穿刺引入膀胱镜或输尿管镜及钬激光光纤切除肿瘤。结果 肿瘤显露满意，切除顺利，术后恢复时间与经尿道膀胱肿瘤钬激光切除无明显差异。结论 经皮腔内钬激光治疗膀胱颈部肿瘤，可减小手术创伤，操作简便，效果好。     

经peel-away鞘输尿管镜下钬激光整块切除合并尿道狭窄的膀胱肿瘤临床分析

目的:探讨经peel-away鞘输尿管镜下钬激光整块切除合并尿道狭窄的膀胱肿瘤的手术技巧与疗效。方法:回顾性分析8例非肌层浸润性膀胱肿瘤合并尿道狭窄男性患者的临床资料。患者术前无明显排尿困难症状,术中F26.5电切镜在除去外鞘后仍无法置入膀胱,改用peel-away鞘辅助下输尿管镜联合钬激光整块切除膀胱肿瘤。结果:所有患者手术均顺利完成,手术时间15～45 min,术中出血量2～20 mL,未出现闭孔反射及膀胱穿孔等并发症。随访6～30个月,患者均未出现排尿困难症状,膀胱镜检尿道狭窄无加重,肿瘤复发2例。结论:经peel-away鞘输尿管镜钬激光整块切除合并尿道狭窄的膀胱肿瘤是一种安全有效的方式。     

经尿道双极电切术治疗浅表膀胱肿瘤

目的　探讨经尿道双极电切术治疗浅表膀胱肿瘤 (双极TURBt)的安全性与有效性。方法　用英国Gyrus公司的经尿道双极电切系统行浅表膀胱肿瘤切除术 2 6例。多发肿瘤 8例 ,单发肿瘤 18例 ,膀胱侧壁有肿瘤分布者 13例。结果　经尿道膀胱肿瘤双极电切术手术时间 (19±10 )min(8～ 3 5min) ,无TUR综合征 ,无一例膀胱穿孔 ;13例侧壁肿瘤切除均无明显闭孔神经反射 ,随访 1～ 6个月无复发。结论　用双极电切进行TURBt是一种安全、有效的手术方式     

经尿道输尿管口及周围膀胱壁袖套状切除治疗肾盂移行细胞癌方法探讨

目的探讨治疗肾盂移行细胞癌的新方法及疗效。方法总结2009年1月至2010年12月收治的38例患者资料,所有患者经病理证实为肾盂移行细胞癌Ⅰ～Ⅲ级,均采用经尿道输尿管口及周围膀胱壁袖套状切除加腰部斜切口肾输尿管全切术。合并膀胱肿瘤及腺性膀胱炎者同期行汽化电切处理。术后1周拔除导尿管开始膀胱灌注化疗,每半年行膀胱镜检。结果本组术后均一期愈合,无出血、感染、漏尿等并发症发生。3例术后10个月膀胱肿瘤复发,行汽化电切。现患者均存活。结论腔镜下经尿道输尿管口及周围膀胱壁袖套状切除加腰部斜切口肾输尿管全切术操作简单,疗效好,创伤小,并发症少,恢复快,也可同时查看并处理膀胱其他疾患,是治疗肾盂移行细胞癌的最佳术式。     

上尿路上皮癌手术中输尿管膀胱壁内段3种切除方法的疗效比较

目的比较开放式袖套状切除、经尿道电切以及经尿道铥激光切除输尿管膀胱壁内段治疗上尿路上皮癌的疗效。方法回顾性分析上海交通大学附属第一人民医院2004年5月至2009年5月利用3种不同方法切除输尿管膀胱壁内段治疗上尿路上皮癌的病例共49例。其中开放性输尿管膀胱壁内段袖套状切除术22例（A组）,经尿道电切镜切除输尿管膀胱壁内段15例（B组）,经尿道铥激光输尿管膀胱壁内段切除12例（C组）。比较3种方法的手术时间、术中失血量、导尿管留置时间、腹膜后引流管留置时间、术后住院时间以及肿瘤复发率。结果B、c两组与A组相比,手术时间明显缩短（平均分别为198、183、262rain,P〈0．05）;术中失血量明显减少（平均分别为140、135、363mL,P〈O．05）;术后住院时间明显缩短（平均10、8、12d,P〈o．05）;而B、C两组之间比较差异无统计学意义（P〉O．05）。3组术后腹膜后引流管与导尿管平均留置时间无明显差异（P〉O．05）。中位随访时间49个月（12～72个月）,其中A组术后膀胱肿瘤复发5例（2互7％）,腹膜后肿瘤复发1例（6．7％）;B组术后膀胱肿瘤复发4例（26．7％）;C组术后膀胱肿瘤复发2例（16．7％）。对比3组术后膀胱肿瘤复发率,差异无统计学意义（P=0．91）。结论与传统开放手术行输尿管膀胱壁内段袖套状切除术相比较,经尿道输尿管膀胱壁内段电切除术或激光切除术手术时间短、术后出血少、恢复快、不增加术后肿瘤种植及复发率。其中经尿道铥激光输尿管膀胱壁内段切除术更具有切割精确、手术安全性高等特点,有较好的临床应用前景。     

经尿道2 μm激光膀胱部分切除术治疗膀胱肿瘤的初步探讨

目的 分析应用经尿道2μm激光行膀胱部分切除术治疗膀胱肿瘤的临床特点.方法 采用骶管麻醉,经尿道膀胱镜2μm激光行膀胱部分切除术治疗18例膀胱肿瘤患者,共切除肿瘤21个,肿瘤直径大小1～3 cm.术中用2μm激光沿肿瘤周围全层切开膀胱壁,在肌层与外层结缔组织之间剥离整块膀胱壁,完整切除肿瘤及其基底部膀胱全肌层标本送病理检查.观察手术时间,术中出血情况,术中及术后并发症,肿瘤病理分期以及术后随访.结果 18例患者均可耐受手术,本组患者手术时间5～12 min,平均(7.4±3.3)min;术中出血量极少或几乎不出血,无闭孔神经反射,术后亦无继发出血,1例术后出现尿外渗,给予置管引流;术后肿瘤病理分期:T1期15例患者,共18个肿瘤,T2期:3例患者,共3个肿瘤;术后随访3～6个月,平均4.5个月,无原位复发.结论 2μm激光能对膀胱壁全层进行精确的汽化切割,并且可以在肌层与疏松结缔组织之间进行剥离,在膀胱肿瘤治疗中达到膀胱部分切除的目的 .     

经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效比较

目的　比较经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效及安全性。方法　随机选取 32例膀胱肿瘤患者行经尿道钬激光切除 ,另 2 7例行经尿道电切 ,总结两组患者临床资料 ,并对手术时间、导尿管留置时间、术后膀胱冲洗例数、肿瘤复发情况、肿瘤分期、膀胱穿孔例数、尿道外口狭窄发生率等指标进行比较。　结果　钬激光组手术时间 15～ 5 0min ,平均 2 5min ,膀胱穿孔 1例 ;术后无需膀胱冲洗 ;导尿管留置时间 1～ 4d ,所有患者均获得肿瘤分期 ;随访 1年 ,无尿道狭窄 ,复发 7例。电切组手术时间 10～ 5 5min ,平均 2 8min ,膀胱穿孔 6例 ,术后 5例需膀胱冲洗 ,导尿管留置时间 1～ 6d ,7例获得肿瘤分期 ;随访 1年 ,尿道狭窄 3例 ,复发 8例。两组平均手术时间、导尿管留置时间、术后肿瘤复发、尿道狭窄发生率均无明显差异 (P >0 .0 5 ) ,钬激光组获得准确肿瘤分期例数明显多于电切组 ,而膀胱穿孔及术后膀胱冲洗例数明显少于电切组 (P <0 .0 5 )。　结论　钬激光是一种治疗膀胱肿瘤高效、安全的方法 ,在准确判断肿瘤分期、减少膀胱穿孔及减少出血方面比电切更优越。     

针状电极经尿道切除直径大于3cm膀胱肿瘤的临床观察

目的经尿道切除直径3cm的膀胱肿瘤是电切手术的难点之一。本研究目的是探讨经尿道切除膀胱内大体积肿瘤的新方法。方法采用精准经尿道膀胱肿瘤切除技术,对26例膀胱肿瘤患者(肿瘤最大直径3cm)进行经尿道切除,均未行闭孔神经阻滞。首先以针状电极在距肿瘤基底周边0.5～1cm处正常膀胱黏膜电灼作为标志,然后将针尖插入膀胱肌层,向远离膀胱壁方向牵拉、切断。完整剥离肿瘤后,自电切镜电极通道置入胃镜下息肉切除器的钢丝圈,将肿瘤套住后,保留镜鞘,连同镜体向外牵拉,完整取出肿瘤。如果肿瘤直径过大不能拉出,则继续用力牵拉、收紧钢丝圈,将瘤体切割为2～4份,再分别取出。记录手术时间、有无闭孔神经反射、肿瘤病理分期及有无复发等。结果所有患者均顺利完成精准经尿道膀胱肿瘤切除,肿瘤位于膀胱侧壁未进行闭孔神经阻滞。肿瘤最大直径3.0～6.0cm,单枚肿瘤切除时间20～75min,平均(42.4±20.3)min。术中均未发生闭孔神经反射,无膀胱穿孔等并发症,切除的肿瘤均获得完整病理分期。结论精准经尿道膀胱肿瘤切除是膀胱肿瘤切除手术的全新方法,在切除膀胱内较大肿瘤时具有独特的优势。     

腔内钬激光手术治疗多种复合膀胱病变--507例报告

目的 探讨经尿道钬激光切除膀胱多种复合病变的效果。方法 回顾分析我院2001年8月～2005年9月在镜下经尿道钬激光切除膀胱多种复合病变的临床资料，共507例17种膀胱病变，其中111例同时患2种以上膀胱病变，36例患3种膀胱病变。结果 一期手术505例，二期手术2例。手术时间5～35min，平均20min。无闭孔神经反射，无手术并发症。放置心脏起搏器3例和冠脉支架3例均顺利完成手术。507例随访12～24个月，平均18个月，症状消失，膀胱镜检查无复发。结论 经尿道钬激光切除膀胱多种复合病变安全可靠，可精确控制切除膀胱壁的深度，可作为微创腔内切除膀胱多种复合病变的首选方法。     

经尿道腔内手术治疗女性膀胱颈梗阻（附33例报告）

目的：提高经尿道腔内手术治疗膀胱颈部梗阻的诊治水平。方法：对33例保守治疗无效的膀胱颈部梗阻女性患者行经尿道膀胱颈部电切术。结果：28例患者（84．8％）术后排尿症状明显改善,在手术后6～12周梗阻症状消失。最大尿流率和剩余尿量明显改善,手术前后平均尿流率分别为（6±4）ml／s、（28±10）ml／s（P〈0．05）。切除的膀胱颈部组织病理报告为纤维平滑肌组织增生伴或不伴慢性炎细胞浸润。随访6～58个月,平均18个月,5例在术后2～4年膀胱颈部梗阻症状复发,3例行再次电切后症状改善,2例再次电切,随访3个月无效后行膀胱造瘘术。均未发生尿失禁和尿瘘等并发症。结论：经尿道电切术治疗女性膀胱颈部梗阻手术操作简单、创伤小、出血少,疗效肯定。     

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.