膝关节色素沉着绒毛结节性滑膜炎合并巨大游离体1例

<正>笔者于2011-09诊治膝关节色素沉着绒毛结节性滑膜炎(PVNS)合并巨大游离体1例,报道如下。1病例报道患者,男,64岁,因"右膝关节肿痛6年,发现右膝肿块1年"入院。浮髌试验阴性,抽屉试验阴性,右膝活动度0°~100°。X线片检查:右侧髌骨下方及右侧股骨下段外侧缘见不规则高密度影,其内密度不均,边缘见硬化改变,髌骨下缘见骨质破     

胫骨高位截骨术治疗膝关节内侧间室骨关节炎并内翻畸形一例

<正>患者男性,65岁,农民,因"右膝关节疼痛3年,加重伴活动受限2个月。"入院。体格检查:一般情况良好,右膝关节无红肿,右膝内翻畸形(图1);膝关节内侧压痛;膝关节活动范围:伸0°~屈115°;膝外翻试验阳性,前后抽屉实验阴性;右足背动脉搏动好,末梢血运良好。X线检查示右膝关节内翻畸形(图2),右膝内侧间隙变窄(图3);MRI检查示膝关节前、后交叉韧带完好,内侧副韧带略迂曲(图4,5)。     

髌骨骨巨细胞瘤1例

患儿,女,14岁,摔倒致右膝疼痛剧烈,摔伤后4 h就诊。门诊CT检查显示:右髌骨病理性骨折。骨科门诊遂以“右髌骨病理性骨折”收住入院。膝关节X线检查:右侧髌骨骨质改变,考虑良性肿瘤合并病理性骨折,见图1A。CT检查:右侧髌骨呈膨胀性生长致骨质破坏,其内多发条状高密度影及软组织密度影,考虑良性骨肿瘤致病理性骨折,见图1B。     

右膝关节多灶性Rosai-Dorfman病1例

<正>患者男,37岁,10个月前右膝摔伤,伤后5天左右自觉右膝夜间疼痛剧烈,此后于外院断续接受理疗、针灸等对症处理,疼痛有所缓解,为求进一步诊治来我院就诊。专科查体:右膝关节远端皮温轻度升高,皮肤轻度泛红,无肿胀;右侧股骨远端、胫骨近端及髌骨压痛(+),右膝浮髌试验(+),抽屉试验及侧方应力试验(-)。右膝关节CT:右侧髌骨、股骨远端及胫骨     

膝关节髌下脂肪垫疝1例

患者　女,41岁。因行走时左膝关节反复疼痛1年加重3个月入院。检查:一般情况好,右膝关节无肿胀,关节屈曲时髌韧带外侧有包块突出,伸膝时包块可自行还纳,关节屈伸活动时有明显摩擦感,髌骨外缘压痛。Ｘ线片示右膝关节无明显异常改变。ＣＴ片示:右膝外侧副韧带变薄。入院后考虑:①右膝髌下脂肪疝出;②右膝髌骨软化症;③右膝骨关节炎。在持硬麻下行手术治疗。术中见:右膝髌下脂肪垫肥厚,髌韧带外侧关节囊变薄,使髌下脂垫由此疝出,故手术切除部伤髌下脂肪垫,关节囊薄弱处重叠缝合。术后右膝关节疼痛消失,随访2年右膝关节疼痛未再复发。该类病例临…     

髌骨软骨母细胞瘤1例

患者,男,17岁。1年前无明显诱因出现右膝酸痛,右侧股四头肌萎缩,并伴有行走乏力,曾在当地医院就诊,行右下肢股四头肌肌电图检查,考虑为股神经损害,给予药物"弥可保"营养神经治疗,但症状改善不明显,为求进一步诊治于2011年3月4日就诊并入院。患者无明确外伤史。查体:双下肢等长,右侧股四头肌萎缩,右侧髌骨上10cm处周径较左侧短缩5cm,右膝关节无内、外翻畸形,未见明显肿胀,触之皮温略高,右膝关节浮髌试验阴性,髌骨摩擦试验阴性,髌骨压痛阳性,无半月板及韧带损伤体征。实验室检查结果未见明显异     

髌骨关节面骨折一例报告

1　临床资料　患者男 ,18岁 ,因踢他人时踢空后感右膝关节剧烈疼痛 ,不能站起 ,到当地医院行手法复位后 ,膝关节肿胀疼痛加重 ,遂来我院治疗。检查 :右膝关节肿胀 ,主动屈伸明显受限 ,髌前压痛阳性 ,浮髌试验阳性 ,抽屉试验阴性。右膝关节Ｘ线片 :侧位片见股骨髁前下方有一三角形骨折块 (图 1) ,正位片见胫骨髁间嵴上方有一略呈鞍状骨折块。股骨髁及胫骨上端骨质完整 ,诊断为右髌骨骨折。伤后2ｄ在腰麻下行切开复位内固定手术。术中见右髌骨关节面中下部有一 2 1ｃｍ× 1 6ｃｍ× 0 5ｃｍ完整骨折块。复位后 ,用克氏针于骨折块上、下各钻…     

单纯髌骨软骨骨折一例报告

1 临床资料患者男,31岁,坐位起立时右下肢外旋滑倒,闻及右膝清脆响声,即感右膝疼痛,活动受限.休息后症状不能缓解,关节肿胀、疼痛加重,来我院就诊.检查:右膝皮肤无擦、挫伤,肿胀明显,主动伸屈受限,浮髌试验阳性,麦氏征可疑阳性,轴移及侧方应力试验阴性.右膝关节正侧位X线平片未见骨折及脱位.考虑为半月板撕裂而行急诊关节镜检查,抽出含脂肪滴血液50ml,冲洗后镜检见:距髌骨内缘0.5cm处滑膜有2cm纵形裂伤,支持带无撕裂.髌骨下极中部关节面1.5cm×2.0cm软骨粉碎撕裂,碎裂软骨内上端与髌骨相连,未脱落(见图1).碎裂软骨处软骨下骨无破裂,交叉韧带、内外侧半月板无异常.镜下切除碎裂软骨,冲洗关节腔,大棉垫包扎膝关节,未使用石膏固定.术后第一天下床活动,关节疼痛、活动受限缓解.术后6个月随访,患侧膝关节无不适.     

先天性永久性髌骨脱位1例

1 病例资料 患者,男,17岁,自诉右膝关节畸形14年余,步行时间稍长后即感右膝部疼痛,休息后缓解,为求进一步诊治,遂来本院就诊,否认外伤史及家族遗传史. 体格检查:右股骨髁间窝处空虚凹陷,膝关节轻度外翻,局部无压痛,膝关节可伸屈,伸屈膝关节时右髌骨均位于右股骨外侧髁外侧,位置较固定,人工复位不能,髌股撞击痛阴性、髌骨倾斜试验阴性、"恐惧试验"阴性、Q角(屈膝30°时髂前上棘到髌骨中心连线与胫骨结节到髌骨中心连线间的夹角)约为20°.     

股骨髁下骨坏死1例报告

1病历摘要。患者,男性,20岁.以右侧膝关节酸痛1个月,无创伤史,无服用类固醇激素,亦无酗酒史.临床检查:右膝关节无明显肿胀,右膝关节双侧膝眼处较对侧间隙增宽,右膝关节活动正常.入科后各项实验室检查未见异常,血沉正常.X线检查:右膝关节间隙明显增宽,以内外侧显著,股骨下端关节面骨质破坏,边缘毛糙,可见斑点状小内片影,髁间窝骨质尚光滑,胫骨关节面骨质未见明显异常(图1).     

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.     

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.     

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.     

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.