经括约肌或尾骨入路的直肠肿瘤局部切除术

本文报道９例低恶性或良性的直肠肿瘤行局部切除术的结果。其中广基无蒂绒毛状腺瘤６例，距肛缘４～９ｃｍ，肿瘤直径２．０～３．５ｃｍ；类癌２例．肿瘤距肛缘７ｃｍ，直径０．５～０．８ｃｍ；血管瘤１例，肿瘤距肛缘４ｃｍ，大小为２．５ｃｍ×５ｃｍ。经肛门前括约肌局部切除４例，经尾骨局部切除４例，经尾骨及括约肌局部切除１例。术后无肛门失禁及复发。作者认为经肛门括约肌或尾骨入路的肿瘤局部切除术对于距肛缘１０ｃｍ以下的直肠低恶性或良性肿瘤是较理想的手术方式。     

局部切除治疗低位直肠癌32例报告

目的探讨低位直肠癌局部切除的适应证。方法结合文献分析了中国医学科学院肿瘤医院１９７５年１月至１９９７年８月局部切除治疗低位直肠癌病人３２例。结果２６例做了术后放疗,３例做了术前放疗。５年生存率为（８４４±８３）％（寿命表法）。总局部复发率为１８８％,高分化腺癌复发率１２５％（３／２４）,中分化腺癌３７５％（３／８）。Ｔ１期复发率１７９％（５／２８）,Ｔ２期复发率２５％（１／４）。结论低位直肠癌局部切除适应证为：肿瘤局限于粘膜下层,病理为高分化腺癌,肿瘤直径≤４ｃｍ。     

应用双吻合器技术治疗直肠癌120例分析

目的评价双吻合器技术在结直肠吻合术尤其是低位结直肠吻合术中的应用。方法回顾分析自１９９４年以来在四年间治疗直肠癌,应用双吻合器行结直肠吻合术１２０例的经验。结果本组１２０例应用双吻合器的手术中直肠闭合和吻合进程顺利,术后发生吻合口瘘３例（２５％）,吻合口狭窄４例（３３％）,伤口感染２例（１６％）,无手术死亡。结论双吻合器技术能帮助外科医生顺利完成以往手法缝合不易完成或难以完成的低位结直肠吻合术。     

直肠类癌15例的诊断和治疗

胃肠道类癌是少见病，我院１９９０年至２０００年１１月共收治消化道类癌６８例，其中直肠类癌１５例，占２２％，现总结报告如下。 １．临床资料：本组１５例，男９例，女６例，年龄２３～７３（平均４７）岁。７例表现为大便次数增多、黏液血便，其中院外曾被误诊为结肠炎３例；５例伴有肛门疼痛、便秘、里急后重感，３例因便血疑痔疮而就诊。病程６个月～５年，平均２．７年。肿块距肛缘４～６ｃｍ３例，６～８ｃｍ６例，８ｃｍ以上６例。肿块位于直肠前壁１０例，后壁２例，侧壁３例。瘤体直径小于１ｃｍ９例，１～２ｃｍ４例，大于２…     

胸小肌喙突骨瓣移位修复肩锁关节脱位的应用解剖

目的　为胸小肌喙突骨瓣移位修复肩锁关节脱位提供解剖学依据。　方法　３０ 侧经动脉内灌注红色乳胶的成人尸体标本, 对胸小肌的形态、血管、神经及喙突的形态结构进行解剖学观察。　结果　胸小肌中部长（１４９ ±１７）ｃ ｍ ,起始处宽（ ７２ ±１２）ｃ ｍ ,中部厚（５１ ±１９） ｍ ｍ ,附着部宽（１５±０４）ｃ ｍ 。营养动脉主要源于胸肩峰动脉的占８３３ ％ （ ２５ 侧） , 肌门距肌起、止点分别为（ ２２ ±１７）ｃ ｍ 、（５７ ±１４）ｃ ｍ 。胸小肌的神经９３３ ％ （ ２８ 侧） 由胸前内侧神经分支支配, 长（ ２９ ±２４）ｃ ｍ 。喙突长（４ ０ ±０３）ｃ ｍ 、宽（１６ ±０ ２）ｃ ｍ 、厚（０９ ±２ ）ｃ ｍ 。　结论　设计胸小肌喙突骨瓣移位修复肩锁关节脱位具有可行性     

距肛缘5—8cm直肠癌保肛和非保肛术的疗效比较

１９８４年１月～１９９０年１２月对１４５例距肛缘５～８ｃｍ的直肠癌病例做了根治性切除。其中保肛组６９例，非保肛组７６例。两组病理各期之间比较无统计学差别（Ｐ＞０．０５），组织学类型除高分化腺癌保肛组明显高于非保肛组外（Ｐ＜０．０５），其余各类型相比无统计学差别（Ｐ＞０．０５）。局部复发率和远处转移率保肛组为１４５％和１４５％，非保肛组为１７１％和１８４％，两组之间无统计学差别（Ｐ＞００５）。５年生存率保肛组７９％，非保肛组６７％，两组有统计学差别（Ｐ＜００５），以上资料提示，距肛缘５～８ｃｍ的直肠癌选择分化程度较高、体积小、浸润较浅和淋巴结转移少的病例行保留肛门的根治术，可以提高病人的生存质量和生存期。     

低位直肠癌的手术治疗和吻合器的应用体会：附47例病例分析

目的 通过４７例距肛缘５～７ｃｍ低位直肠癌的分析,对距肛缘５～７ｃｍ的你位直肠癌保肛手术的理论依据、术式选择、吻合器应用的优越性和吻合器在保肛手术中的运用体会及主要并发症的防治进行了探讨。１９９４年７月至１９９７年８月作根治性手术的距肛缘５～７ｃｍ的低位直肠癌患者４７例。结果：４０例行Ｄｉｘｏｎ术式,７例行Ｍｉｌｅｓ术式。３８／４０例Ｄｉｘｉｏｎ术式应用管状端端吻合器（ＥＥＡ）,其中发生直肠阴道瘘     

直肠癌术后并发急性坏死性胰腺炎二例

直肠癌术后并发急性坏死性胰腺炎,尚未见文献报道。现将我院直肠癌术后并发急性坏死性胰腺炎２例报告如下。一、临床资料例１　女性,４２岁,以诊断“直肠癌”入院。无胆囊炎胆石症病史。体格检查发现距肛缘８ｃｍ有一菜花样肿物,病理报告为直肠腺癌。Ｂ型超声示：肝脏、肝内外胆管、胆囊及胰腺均未见异常。术前化学药物治疗用０．９％氯化钠１５０ｍｌ加５ＦＵ１０００ｍｇ保留灌肠,１次／日,共１０次;５％葡萄糖５００ｍｌ加５ＦＵ５００ｍｇ和丝裂霉素４ｍｇ,静脉滴注,１次／日,共３次。术前常规肠管准备后,在硬脊膜外麻醉…     

低位直肠癌保肛手术临床分析

目的：分析探讨低位直肠癌保肛手术适应证、术式选择和疗效，方法：根据肛门指诊、直肠腔内超声、ＣＴ，１９９３年８月至１９９４年１２月在１６１例直肠癌中选择９４例实施保肛手术。手术术式分别为低位、超低位结肠－直肠吻合手术。Ｐａｒｋ’ｓ手术、Ｂａｃｏｎ手术、比较分析术工选择原则。手术合并症、排例功能、５年生存率、局部复发率。结果：低位直肠癌保肛率为５８．３９％，其中低位吻合９例，超低位吻合４８例，Ｐａｒｋ’ｓ手术２５例，Ｂａｃｏｎ手术１３例；手术死亡２例（２．１％），吻合口瘘３例（３．１９％，吻合口狭窄１３．８％。术后排便功能优良率；低位吻合为１００％，超低位吻合为９７．７１％，Ｐａｒｋ’ｓ８８％，Ｂａｃｏｎ手术５３．３３％。５年生存率和局部复发率，低位吻合为８２％、０％；超低位吻合７８．９％，４１．６％；Ｐａｒｋ’ｓ     

直肠癌手术治疗180例临床分析

目的 了解近年来直肠癌外科手术处理的变化,及保肛手术开展情况。方法 回顾性分析我院１９９６～１９９８年１８０上肠癌外科治疗情况。结果 全组根治性切除６０％,保肛手术（６９．５％）,Ｍｉｌｓｅ术（３０．５％）,吻合器应用占位直肠癌手术６５．６％,最低吻合距肛缘５ｃｍ。结论 直肠癌手术采用保肛手术已占２／３以上,保肛手术首选低位前切除术,Ｍｉｌｅｓ术已成为最后的选择,为提高５年生存率和减少复发率必须注     

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.