非那雄胺剂量对减少经尿道前列腺电切术中出血的影响

目的评价术前服用不同剂量的非那雄胺对经尿道前列腺电切除术（TURP）术中出血量的影响及其作用机理。方法90例拟行TURP术的良性前列腺增生患者,随机分为3组：5 mg组（术前2周每天服用非那雄胺5 mg）、10 mg组（术前2周每天服用非那雄胺10 mg）及未服药组,每组30例。记录各组TURP前列腺切除重量、手术时间、计算术中出血量。免疫组织化学SP法检测各组前列腺组织微血管密度（MVD）及血管内皮生长因子（VEGF）蛋白表达,并进行统计学分析。结果5 mg组、10 mg组及未服药组前列腺组织平均手术切除量分别为（22.3±6.2）g、（22.5±6.5）g和（23.2±5.3）g,差异无统计学意义（P〉0.05）。与未服药组比较,服药组的手术时间、术中平均出血量、前列腺组织MVD值、VEGF阳性计数均显著降低,差异有统计学意义（P〈0.05）,但5 mg组与10 mg组差异无显著性意义（P〉0.05）。结论术前2周每天服用非那雄胺5 mg即可有效抑制前列腺组织中VEGF蛋白表达,抑制前列腺组织血管生成,从而缩短TURP手术时间,减少术中失血量。     

术前短期大剂量服用非那雄胺减少TURP术中出血的临床研究

目的 评价术前口服非那雄胺(保列治)在经尿道前列腺电切术中的疗效及机制.方法 观察52例服用非那雄胺的(服药组)和52例未服药的(对照组)前列腺增生患者行前列腺电切术中的出血情况,用免疫组化S-P法对患者前列腺切除组织中CD34、bcl-2、增殖细胞核抗原(PCNA)和血管内皮生长因子(VEGF)的表达进行分析,分析比较二组临床资料及免疫组化指标.结果 服药组前列腺电切术中出血量、每分钟出血量和每克组织出血量均较对照组低,差异有显著性(p＜0.05),免疫组化结果显示前列腺组织中血管密度及血管内面积较对照组明显减少,两组差别有非常显著性意义,前列腺组织MVD值分别为60±2.4和123±3.9(p＜0.01),bcl-2、PCNA及VEGF阳性细胞所占面积较对照组少,差异均有统计学意义(p＜0.01).结论 术前短期大剂量服用非那雄胺可抑制前列腺组织微血管生成,从而有效减少TURP术中出血.     

经尿道前列腺汽化联合电切治疗良性前列腺增生症(附165例报告)

目的　探讨经尿道前列腺汽化电切除术 (Transurethralelectrovaporizationoftheprostate,TUVP)与经尿道前列腺电切术 (Transurethralresectionoftheprostate,TURP)联合治疗良性前列腺增生症 (Benignprostatichyperplasia ,BPH)的疗效。　方法　1999年 10月～ 2 0 0 1年 9月联合TUVP与TURP治疗BPH 16 5例。　结果　手术时间 ( 2 0～ 145 )min ,平均 6 5min。切除前列腺组织重量 8g～ 10 0g ,平均 34g。随访 112例 ,时间 3月～ 18月。IPSS由术前 ( 2 1 0± 3 0 )分下降至术后 ( 7 8± 1 1)分 (t=2 12 ,P <0 0 5 )。残余尿量由术前 ( 6 5 0± 12 6 )ml下降至术后 ( 18 6± 15 0 )ml(t=2 35 ,P <0 0 5 )。　结论　TUVP联合TURP治疗BPH综合两者优点 ,出血少 ,并发症少 ,疗效显著 ,安全性高。     

非那雄胺对良性前列腺增生患者围手术期尿道黏膜下和腺体微血管密度的影响

20 0 1年 9月至 2 0 0 3年 9月 ,我们对5 0例行TURP术的中、重度良性前列腺增生 (BPH)患者围手术期服用非那雄胺 ,观察非那雄胺减少围手术期出血的作用。现报告如下。对象与方法　 5 0例患者随机分为 2组 ,每组 2 5例 ,术前 7d至术后 14d ,分别予非那雄胺 5mg/d和 10mg/d口服。同期 30例行TURP患者作为对照。TURP切取尿道黏膜下和前列腺增生组织 ,免疫组化SP法检测前列腺组织的微血管密度 (MVD)和血管内皮生长因子(VEGF)、转化生长因子 β1(TGF β1)。统计学分析 :应用SPSS 11.5软件进行单因素方差分析和 χ2 检验。结果　 3…     

戈舍瑞林对减少经尿道前列腺切除术中出血的机制研究

目的评价术前应用戈舍瑞林对经尿道前列腺切除术（transurethral resection ofprostate,TuRP）术中出血量的影响及其作用机理。方法将前列腺增生（benign prostatic hyperplasia,BPH）患者随机分为3组。A组：术前28d口服非那雄胺（保列治,5mg／d）,B组：术前22d皮下注射戈舍瑞林3．6mg,C组：空白对照组。每组30例。比较3组前列腺切除重量、术中出血量,免疫组织化学SP法检测前列腺组织微血管密度（micro vessel density,MVD）及血管内皮生长因子（vascular endothelial growthfactor,VEGF）蛋白表达,统计学分析。结果前列腺组织平均手术切除量比较,3组间差别均无统计学意义,术中平均出血量、平均切除1g前列腺组织失血量、前列腺组织MVD值、微血管腔内面积、VEGF平均阳性细胞数比较,A组与B组、C组比较,B组与c组比较,差别均有统计学意义（P〈O．05）。站论术前应用戈舍瑞林可以抑制前列腺组织内VEGF蛋白表达,进而抑制前列腺组织血管生成,从而减少TURP术中出血,效果比术前口服非那雄胺更佳,无明显副作用。     

经尿道电气化术治疗前列腺增生的远期疗效

目的 :评价经尿道电气化术 (TUVP)治疗良性前列腺增生 (BPH)的远期疗效。方法 :BPH患者 80例 ,根据治疗方法分为TUVP组和经尿道前列腺电切术 (TURP)组 ,比较其国际前列腺症状评分 (IPSS)、生活质量评分 (QOL) ,最大尿流率Qmax、膀胱剩余尿量 (PRV)及远期并发症 (尿道狭窄、尿失禁及再次手术 )的发生率等情况。结果 :TUVP与TURP患者的各项指标术前分别为IPSS(2 9.7± 4 .3)和 (2 8.6± 4 .5 )分、QOL(5 .7± 0 .8)和 (5 .3± 0 .7)分、Qmax(8.4± 3.9)和 (8.2± 4 .2 )ml/s、PRV(2 4 3.0± 5 5 .3)和 (2 4 0 .0± 4 7.2 )ml,均P值 >0 .0 5。术后分别为IPSS(8.1± 1.7)和 (10 .7± 2 .6 )分 ,QOL(1.7± 0 .6 )和 (2 .0± 0 .5 )分 ,Qmax(2 1.6± 4 .3)和 (19.1±4 .3)ml/s、PRV(2 8.7± 10 .4 )和 (38.7± 12 .5 )ml,均P值 >0 .0 5。远期并发症的发生率分别为 5 .2 % (TUVP)和7.1% (TURP) ,P值 >0 .0 5。结论 :TUVP与作为金标准的TURP长期疗效是等同的     

再次经尿道前列腺切除患者前列腺组织学特征及其临床意义

目的:探讨再次经尿道前列腺切除术(TURP)患者前列腺组织的病理组织学特征及其临床意义。方法:选取再次TURP手术的50例患者前后两次手术标本(再次TURP组)和50例仅有一次手术患者的标本(对照组)。采用免疫组织化学S-P法检测前列腺组织中CD34、VEGF、AR的表达,计算微血管密度(MVD)值及VEGF、AR指数,并对再次TURP组首次标本和对照组标本、再次TURP组两次手术标本分别进行比较及统计学分析。结果:VEGF、AR在所有标本中均有表达。再次TURP组首次标本中MVD值、VEGF指数、AR指数分别为:35.83±20.92、7.55±2.72、6.17±1.86,再次手术的标本为:32.16±16.65、7.06±2.36、6.99±2.44;对照组为:20.56±6.99、4.28±2.62、4.16±1.34。再次TURP组首次标本MVD值、AR、VEGF指数均高于对照组,两组差异有统计学意义(P<0.05);而再次TURP组前后两次手术标本间各指标差异无统计学意义(P>0.05)。相关分析发现,AR指数和VEGF指数、VEGF指数和MVD值、AR指数和MVD值之间均存在正相关,相关系数(r)分别为:0.650、0.705、0.525(P<0.05)。结论:BPH患者前列腺组织中高MVD值及AR、VEGF的高表达是导致其TURP术后复发及再次手术的重要原因之一,可作为判断术后复发的危险因素及采取针对性预防措施的指标。     

胰腺癌微血管密度及血管内皮生长因子表达

目的　探讨胰腺癌组织中微血管密度 (MVD)和血管内皮生长因子 (VEGF)表达及其与淋巴结转移的关系。方法　采用免疫组织化学法及形态半定量方法对 31例胰腺癌和 7例正常胰腺组织进行MVD记数和VEGF表达检测。结果　胰腺癌组织中MVD记数、VEGF表达率分别为 11.0 5± 4.6 2、83% ,明显高于癌旁组织 5 .40± 1.71、2 0 %和正常胰腺组 6 .19± 1.5 6、14% (P <0 .0 1) ;淋巴结转移组MVD记数 ,VEGF表达分别为 13.0 0± 4.45、2 .0 0± 0 .95 ,明显高于无转移组 9.46±4.15、1.0 5± 0 .17和正常胰腺组 6 .19± 1.5 6、0 .14± 0 .38(P <0 .0 1)。MVD与VEGF表达呈正相关 (r =0 .418,P >0 .0 5 )。结论　MVD、VEGF表达高低可作为判断胰腺癌淋巴结转移、预后的指标。     

经尿道电气化术联合电切术治疗前列腺增生症(附122例报告)

目的 :探讨良性前列腺增生症 (BPH)的有效治疗方法。方法 :联合应用经尿道前列腺电气化术(TUVP)和经尿道前列腺电切术 (TURP)治疗BPH患者 12 2例 ,平均年龄 72 .3岁 ,其中Ⅰ度增生 8例 ,Ⅱ度增生5 1例 ,Ⅲ度增生 37例 ,Ⅳ度增生 2 6例。结果 :手术操作时间 30～ 15 0min ,平均 74.2 9min。 1例 (0 .8% )术中输血40 0ml,2例 (1.6 % )术后输血 2 0 0～ 40 0ml。发生 1例 (0 .8% )电切综合征。术后平均留置导尿管 5d。随访 1～10个月 ,国际前列腺症状评分 (IPSS)由术前 (2 9.8± 1.5 )分降至术后 2个月 (10 .9± 1.0 )分 (P <0 .0 1) ,排尿通畅 ,并发症少。结论 :TUVP与TURP联合应用治疗BPH具有二者的优点 ,出血少 ,能切除更多前列腺组织 ,并发症少 ,疗效显著     

经尿道电切术治疗重度前列腺增生症

目的 :探讨重度前列腺增生症经尿道电切治疗效果。方法 :采用经尿道前列腺电切术 (TURP)治疗重度 BPH 70例 ,随访 3～ 18个月。结果 :切除前列腺重量平均 74.6 g,平均手术时间 70 min。术后平均留置导尿管 3 d,术后平均住院时间 5 d。最大尿流率 (Qmax)由术前的 (6 .3± 1.5 ) ml/ s上升至术后 3个月的 (15 .1± 4.7)m l/ s,前列腺症状评分 (IPSS)术前为 (2 9.7± 1.2 )分 ,术后 3个月降至 (5 .1± 1.0 )分 (P<0 .0 1)。结论 :TURP安全、并发症少、疗效好。重度 BPH不是 TU RP的禁忌证。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

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.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

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.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.     

Artificial organs 2010: a year in review

In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.     

Avaliação do clube de revista de anestesiologia por meio de mudanças semânticas

Background and objectives

The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically.

Methods

This study reports the performance of medical residents in anesthesiology from the Clinics Hospital – University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree–disagree–not sure–agree–totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis – difficulty index and discrimination power.

Results

Residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51), July 2012 (n = 66) and December 2012 (n = 56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating “totally agree” from “agree” increased the difficulty indices, but did not improve the discrimination power.

Conclusions

The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.     

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.