第二肝门部肝癌切除合并主肝静脉结扎对门静脉压力的影响

探讨第二肝门部肝癌切除合并主肝静脉结扎对自由门静脉压力（ＦＰＰ）的影响。方法在肝切除术前将埋植式给药装置（ＩＤＤＳ）置入门静脉主干,并通过ＩＤＤＳ对１０例病人之肝切除前后及术后１、３、５、７、１４、２１、２８天的ＦＰＰ进行直接动态测量。结果全组病人肝切除后均发生ＦＰＰ升高,以术后３～７天最为显著,之后逐渐下降;ＦＰＰ升高的幅度与肝硬化程度、肝切除范围、主肝静脉结扎情况之间存在密切联系;３例术后ＦＰＰ≥３５ｃｍＨ２Ｏ病人中,２例并发上消化道出血。结论第二肝门部肝癌切除合并主肝静脉结扎将导致ＦＰＰ的一过性升高,ＦＰＰ的升高是术后消化道出血的重要因素。     

肝切除术后门静脉压力变化的变态观察

观察肝切除术后自由门静脉压力动态变化的规律,方法６３例肝癌病人,术中经胃网膜右静脉插管至门静脉主干,并将埋植式给药装置（ＩＤＤＳ）植于腹壁皮下,经ＩＤＤＳ分别测量肝切除前、切除手及术后１,３,５,７,１４,２１,２８ｄ之自由门静脉压（ＦＰＰ）。结果全组病例肝切除术后ＦＰＰ均出现一过性升高,以术后３－７ｄ升高最为显著,之后逐渐缓慢下降。ＦＰＰ的升高幅度及回落状态与肝切除范围,肝门阻断时间长短,肝硬化     

经肝动脉化疗栓塞治疗肝癌术后并发胆管坏死4例报告

我院从１９９１年３月～１９９６年３月间经皮下植入式输药装置注射碘化油和抗癌药治疗肝癌２６７例，发生胆管坏死４例。现报告如下。１病例摘要例１男，５５岁。因肝左叶癌入院。行左半肝切除，经肝动脉埋置ＤＤＳ并于术中注入４０％碘化油１０ｍｌ，５Ｆｕ５００ｍｇ...     

第二肝门部肝癌切除合并主肝静脉结扎对站静脉压力的影响

探讨第二肝门肝癌切除合并肝静脉结对自由门脉静脉压力的影响。方法在肝切除术前将埋植式给药装置置入门静脉主干，并通过ＩＤＤＳ对１０例病人之肝切除前后及术后１、３、５、７、１４、２１、２８天的ＦＰＰ进行直接动态测量。     

地塞米松用于原发性甲状腺机能亢进症的术前准备

目的 探讨原发性甲状腺机能亢进症（甲亢）新的术前准备方法。方法 术前用复方碘液１０ｄ,５～１０滴／次,３次／ｄ,第７ｄ加用５％～１０％葡萄糖注射液５００ｍｌ加地塞米松２０ｍｇ,静脉滴注１次／ｄ,连用３ｄ后手术。结果 发现１次静脉滴注地塞米松２０ｍｇ后ＦＴ３降为正常,连用３ｄ后ＥＴ４亦降为正常。１０７例术后均无甲状腺危象等并发症的发生。结论 用地塞米松等综合用药对原发甲亢进行术前准备是安全有效的。     

肾移植术后并发高血糖致昏迷一例

患者为男性,４５岁,于１９９５年７月行同种异体肾移植术,术前血糖５．３ｍｍｏｌ／Ｌ。术中及术后３天中每天静脉滴注甲泼尼龙５００ｍｇ。术后第４天改口服泼尼松８０ｍｇ,此后每日递减泼尼松１０ｍｇ,维持量为２０ｍｇ／ｄ。硫唑嘌呤用量为５０ｍｇ／ｄ。术后每天...     

肝移植中肝动脉重建的经验

目的：探讨显微外科技术在肝移植中肝动脉重建的经验。方法：本组肝移植２２例,其中活体肝移植１０例,原位肝移植１２例,再次肝移植２例;均采用显微外科技术行肝动脉吻合。结果：８例肝动脉直径＜２ｍｍ的病例中,重建肝动脉时间为２５～６８ｍｉｎ。一例发生肝动脉血栓形成,一例术后８ｄ死于多器官功能衰竭,一例术后７２ｄ死于排斥反应所致移植物功能丧失。结论：显微外科技术重建肝动脉可降低肝移植术后肝动脉栓塞的发生。     

骨肿瘤的经导管动脉栓塞治疗

研究和评估经导管动脉栓塞术治疗骨肿瘤的价值、作用。对１７例丰富血供性骨肿瘤用明胶海绵进行选择性动脉栓塞，栓塞后３天内进行手术；对７例不宜手术的骨肿瘤用明胶海绵混合抗癌药后进行姑息性栓塞治疗。１６例术前栓塞后１５例肿块被顺利切除，术中出血量大大减少，平均为９４７ｍｌ；７例姑息性栓塞患者疼痛得到了不同程度的缓解，肿块明显缩小。无１例发生严重并发症。经导管动脉栓塞术为某些骨肿瘤十分重要而有效的治疗方法。     

脾肾分流加门奇断流联合术治疗门静脉高压症的远期疗效

目的评价门静脉高压症采用脾肾分流加门奇断流联合术治疗门静脉高压症的长期效果。方法回顾性总结了１９年采用脾肾分流加门奇断流联合术治疗门静脉高压症１４０例，并通过手术前后采用彩色多普勒显像、数字减影血管造影和术中测ＦＰＰ观察门静脉系血流动力学变化。结果临床疗效满意。手术病死率为３６％，术后近期无１例出血，远期再出血率为８３％，术后肝性脑病发生率为５０％，术后５、１０和１５年生存率分别为８３３６％、６４５％和５４５％。术后ＦＰＰ和ＰＶＦ降低有显著意义（Ｐ＜００１）。术后ＦＰＰ平均保持在３２±０４ｋＰａ。结论脾肾分流加门奇断流联合术既保留了分流术和断流术二者的优点，又克服了二者的缺点，是一种合理而可行的术式。     

米非司酮配伍米索前列醇终止8-10周妊娠的疗效探讨与护理

探讨米非司酮配伍米索前列醇终止８～１０周妊娠的疗效。将２４７例孕３５～７０ｄ要求药物终止妊娠的妇女，根据妊娠天数分组。组Ｉ：１４９例，妊娠天数≤７周，米非司酮２５ｍｇ每日２次，连服３ｄ，第４天晨口服米索前列醇０．６ｍｇ；组Ⅱ：９８例，妊娠天数８－１０周，米非司酮２５ｍｇ每日２次，连服２ｄ，第３天米非司酮５０ｍｇ每日２次口服，第４天晨口服米索前列醇０．６ｍｇ，２ｈ后再服０．６ｍｇ，结果两组绒毛平均排     

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.     

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.     

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.     

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.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.