植入自体雪旺氏细胞的胚胎神经修复上肢神经缺损

目的 研究修复上肢神经缺损新的手术方法。方法 应用植入自体雪旺氏细胞的胚胎神经复合型神经桥接体，修复上肢神经缺损46例（52条），术后1年进行神经功能评定。结果 本组46例随访40例，随访时间12－36个月，接Seddon的周围神经损伤术后恢复评定标准进行评定，优良率为69．57％。植入自体雪旺氏细胞的胚胎神经复合型神经桥接体移植，是一种修复上肢神经缺损的新方法，具有进一步深入研究和临床应用的前景。     

早期康复治疗在Ⅱ～Ⅴ区指屈肌腱损伤术后的临床应用

目的：报道指屈肌腱修复后早期康复介入的疗效。方法对73例Ⅱ～Ⅴ区指深屈肌腱损伤患者,随机分为观察组37例和对照组36例,两组患者性别、年龄、致伤原因、损伤指别、神经损伤比较,差异均无统计学意义（P＞0.05）,具有可比性。对照组给予临床常规治疗,术后4周再行康复治疗;观察组在急诊修复后第4天即在使用支具情况下开始进行物理治疗及康复训练。两组采用相似康复治疗方法,应用手指总主动活动度（TAM）测定法评定疗效。结果术后3--6个月,按TAM法评定患指功能,观察组优良率明显高于对照组（P〈0.01）,活动度及手指感觉、两点辨别觉均优于对照组,差异有统计学意义（P＜0.05）。结论指屈肌腱修复术后功能锻炼开始的时间愈早,手功能恢复的优良率愈高。     

神经康复支具对桡神经康复的疗效观察

目的评价简易神经康复支具用于桡神经损伤患者术后康复的疗效。方法将25例桡神经损伤的患者随机分为康复支具组（13例）和对照组（12例）,比较两组患者桡神经功能改善情况。结果采用桡神经功能评定试用标准对两组患者桡神经功能进行评估。康复支具组3个月优良率为69．23％,对照组为25％（P〈0．05）。12个月随访时两组优良率分别为84．6％和75％,差异无统计学意义（P〉0．05）。结论采用本康复支具可明显缩短桡神经功能恢复时间,但不影响远期预后。     

上肢神经损伤的急诊显微外科修复

目的：报道１９８１～１９９５年，显微外科急诊择期修复上肢神经损伤１７２例２２２条神经的临床效果。方法：对其中７５例１０４条神经开放性损伤进行急诊清创及显微外科修复。结果：术后有５３例７２条神经得到３个月～８年的随访，按ＢＭＲＣ提出的综合评价肢体神经运动和感觉功能来评定疗效，优良率达８６．１％。结论：应用显微外科技术对上肢神经开放性损伤进行急诊一期修复是提高周围神经损伤修复优良率的有效方法。     

显微外科技术下脱细胞基质周围神经修复膜在上肢周围神经损伤中的应用效果

目的 探讨显微外科技术下脱细胞基质周围神经修复膜在上肢周围神经损伤中的治疗效果。方法 回顾性分析2020年10月至2022年3月我院收治的23例上肢周围神经损伤病人的临床资料,其中男18例,女5例;年龄为10~60岁,平均41.3岁,指神经损伤9例,腕部及前臂远端的正中神经损伤14例。神经损伤予脱细胞基质周围神经修复膜修复,记录病人两点辨别觉,参考英国医学研究院神经外伤学会（MCRR）的评定标准评估指神经恢复情况,手部功能根据中华医学会手外科学会上肢部分功能评定试用标准评估。结果 病人术后随访9~14个月,9例指神经损伤病人的两点辨别觉平均为7 mm,S3级6例,S3+级3例,14例腕部及前臂远端的正中神经损伤拇指对掌功能基本恢复到正常,优7例,良3例,可4例,优良率为71.4%。结论 脱细胞基质周围神经修复膜在人体上肢周围神经损伤中运用安全,能较好地改善神经恢复情况,在促进神经恢复方面有一定的作用。     

化学去细胞同种异体神经移植术后病人的护理

[目的]探讨对化学去细胞同种异体神经修复周围神经损伤的护理及康复。[方法]自2003年4月-2006年4月，应用化学去细胞同种异体神经移植治疗完全断裂周围神经损伤患者39例，术后及出院后进行专项护理及康复，术后6个月以上患者随访共21例，对结果进行统计分析。[结果]21例患者中，16例神经损伤恢复效果达到优良，修复优良率达到71．4％。[结论]对化学去细胞同种异体神经移植术后的患者进行康复及护理，可以获得良好的临床效果。     

上肢神经损伤的显微外科修复与康复

目的探讨开放性上肢神经损伤的显微外科修复及康复的疗效。方法上肢神经损伤31例。应用显微外科技术进行外膜缝合、束膜缝合、外膜束膜缝合分别予以修复，并把康复理念贯穿应用于治疗全过程。结果术后全部病例经1年至6年随访，平均优良率为83．3％。结论显微外科技术和康复理念的结合应用，是上肢神经损伤治疗获得满意效果的重要步骤。     

手部肌腱及神经损伤的显微外科修复

目的 探讨手部肌腱、神经损伤的急诊显微外科修复的的临床疗效及其意义。方法 回顾性分析急诊显微外科修复的261例手部肌腱、神经损伤临床资料。其中，肌腱修复225例，神经修复36例。结果 手部的功能良好，肌腱活动正常，感觉良好。功能评定优良率为88．1％。结论 手部肌腱、神经损伤后早期高质量的显微外科修复，术后早期积极的功能康复治疗，是提高临床疗效的重要保证。     

康复护理在上肢周围神经损伤修复术后的应用

目的探讨上肢周围神经损伤修复术后的康复护理方法，教会患者自我保护及恢复代偿能力。方法回顾分析72例患者的临床资料。结果通过对72例上肢周围神经损伤患者实施康复教育。其中疾病知识知晓度掌握64例占89％，基本了解8例占11％，满意度占99％。72例患者未发生并发症，出院后均掌握康复护理知识。结论针对性的康复护理指导是上肢周围神经损伤功能恢复的重要保证。     

关节镜下半月板部分切除术后患者的早期康复护理

目的探讨关节镜下半月板部分切除术后早期康复护理的效果。方法将116例关节镜下半月板部分切除术后患者随机分为对照组和观察组各58例。对照组术后行常规护理，观察组术后早期实施康复训练，术后2周比较两组患肢膝关节恢复效果。结果观察组患肢膝关节恢复效果优者44例（75．9％），良8例（13．8％）；对照组分别为22例（37．9％）和13例（22．4％），两组优良率比较，差异有显著性意义（P〈0．01）。结论早期实施康复训练，可促进患者早日康复。     

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.