偶发性肾癌(附42例报告)

自１９８０～１９９６年间手术治疗肾癌２２５例，根据诊断符合偶发肾癌标准者４２例，有症状者１８３例。对两组肿瘤的分期、分级和预后等作比较。结果：两组间Ｔ２、Ｔ３ｂ及ＴＮ＋肿瘤构成比差异有显著性（Ｐ＜０．０５），而胞核分级和组织类型构成无显著性差异。５年肾癌生存率在偶发癌组为８２．８％，有症状组为６０．４％，两组生存率有显著性差异（Ｐ＜０．０５），但仅比较两组的肾内局限肿瘤者其生存率无显著性差异。两组死于肾癌患者的平均术后生存时间分别为３６．９个月和２９．４个月，有显著性差异（Ｐ＜０．０１）。本组偶发肾癌较有症状肾癌组织分化和病理分型情况相似，但较多为早期肿瘤。早期诊治是偶发肾癌预后较好的主要原因。     

扩大根治术治疗偶发和非偶发肾癌的比较

扩大根治术治疗无症状偶然发现（偶发）肾癌共１８例，非偶发肾癌２３例。偶发组均为Ⅰ～Ⅱ期肿瘤，与非偶发组相比，病理分期较低（Ｐ＜０．０５）；平均肿瘤最大径更小（Ｐ＜０．０１）；偶发组５年生存率为９４．４％，非偶发组的Ⅰ～Ⅱ期肿瘤是７０．６％，表明前者远期生存更好（Ｐ＜０．０５）。肾癌扩大根治术对Ⅰ～Ⅱ期偶发肾癌的疗效更佳。     

58例偶发性肾癌的临床分析

目的探讨偶发性肾癌的临床特征、诊治方法和影响预后的因素。方法回顾性分析偶发性肾癌58例，非偶发性肾癌146例，对两组肿瘤的分期、分级与预后进行比较。结果偶发性肾癌的病理分期明显低于非偶发组（P〈0.01）；而肿瘤病理分级及组织类型无显著性差异（P〈0.05）；术后3年、5年、10年的生存率分别为92．4％、83．6％和72．4％，明显高于非偶发性肾癌组（P〈0.05）。结论B超、CT的广泛应用提高了偶发性肾癌的检出率；病理分期低、肿瘤小、早期发现和及早的根治性切除是偶发性肾癌预后好的主要原因。     

偶发肾癌的临床探讨(附96例报告)

目的提高偶发肾癌的诊治水平。方法对９６例偶发肾癌进行回顾性总结并与２０２例非偶发肾癌进行对比分析。结果与非偶发肾癌相比,偶发肾癌均为Ｉ～Ｉ期肿瘤,病理分期低（Ｐ＜００１）;平均肿瘤体积小（４４ｃｍ,Ｐ＜００１）;术后５年生存率（８９．８％）高于非偶发组（４５６％）（Ｐ＜００１）。结论偶发肾癌病理分期低,肿瘤体积小,术后远期生存率高;偶发肾癌概念的提出,对肾癌的早期诊治及良好的预后有重要意义。     

微小肾癌(附31例报告)

目的：提高偶发小肾癌的诊治效果，提出微小肾癌的概念。方法：采用回顾性研究对偶发小肾癌不同肿瘤直径与预后因素进行相关分析。结果：肿瘤直径2．0－3．0cm者15例（Ⅰ组），1．5－2．0cm者9例（Ⅱ组），≤1．5cm者7例（Ⅲ组）。3组肿瘤呈浸润性生长者分别为3、1、0例，肿瘤静脉内浸润者分别为2、1、0例，同侧肾内多发病者分别为3、1、0例，Ⅲ级病理分级低，与Ⅱ组、Ⅰ组相比较判别有显著性意义（P＜0．05）。Ⅲ组病理分别低，与Ⅱ组相比较差别无显著性意义（P＞0．05）。与Ⅰ组相比较差别有显著性意义（P＜0．05）。肿瘤直径≤1．5cm者无远隔转移和相后复发死亡。结论偶发肾癌肿瘤直径≤1．5cm者预后良好,可称为微小肾癌。     

偶发肾癌的预后分析

目的探讨和分析偶发肾癌的临床特点、生存率。方法对346例肾癌的临床资料进行回顾性分析并进行生存情况的随访；分为2组，偶发肾癌153例，非偶发肾癌193例，按Robson分期统计各组的病例数，用SPSS11．5统计软件处理。结果偶发性肾癌与非偶发肾癌Robson分期的构成比不同，偶发癌分期较低（x^2=31．741，P〈0．01）。偶发癌3、5、10年生存率为84．20％、72．86％、67．15％，非偶发癌为67．78％、60．54％、47．37％，两组相比差异显著（x^2=8．53，P〈0．05），Kaplan-meier分析显示相同分期偶发癌与非偶发癌生存率差别无统计学意义，COX风险比例模型显示肾癌是否偶发不是影响愈后的因素（β=1．367，P=0．179），分期是影响愈后的独立因素（β=2．44，P〈0．01）。结论偶发肾癌多低分期，术后生存率较非偶发肾癌高，但同一分期内偶发肾癌与非偶发肾癌生存率差别无统计学的意义，偶发不是影响愈后的独立因素。     

偶发肾癌的临床探讨

目的 提高偶发肾癌的诊治水平。方法 对９６例偶发肾癌进行回顾性总结并与２０２例非偶发肾癌进行对比分析。结果 与非偶发肾癌相比,偶发肾癌均为Ⅰ～Ⅱ期肿瘤,病理分期低（Ｐ〈０．０１）;平均肿瘤体积小（４．４ｃｍ,Ｐ〈０．０１）;术后５年生存率（８９．８％）高于非偶发组（４５．６％）（Ｐ〈０．０１）。结论 偶发肾癌病理分期低,肿瘤体积小,术后远期生存率高,偶发肾癌概念的提出,对肾癌的早期诊治及良好的预后     

偶发性肾癌

自１９８０－１９９６年间手术治疗肾癌２２５例，根据诊断符合偶发肾癌标准者４２例，有症状者１８３例。对两组肿瘤的分期，分级和预衙等作比较。结果：两组间Ｔ２，Ｔ３ｂ及ＴＮ＋肿瘤构成比差异有显著性，而胞核分级和组织类型构成无显著性差异。５年肾癌生存率在偶发癌组８２．８％，有症状组为６０．４％，两组生存率有显著性差异，但仅比较两组的肾内避限肿瘤者其生存率无显著性差异。     

小肾癌的临床特征

目的：探讨小肾癌的临床特征。方法：对我院收治的43例小肾癌(直径≤3cm)患者(小肾癌组)和153例肾癌(直径＞3cm)患者(大肾癌组)的临床资料进行对比。结果：小肾癌临床分期低，两组差异显著(P＜0．01)，两组病理分类无统计学意义(P＞0．05)。两组3年生存率分别为96．3％和69．8％(P＜0．01)，5年生存率分别为93．8％和63．6％(P＜0．05)。结论：小肾癌比大肾癌临床分期低，预后较好，生存率高。保留肾单位的手术为小肾癌治疗的较好选择。     

单中心偶发肾癌与症状肾癌的临床诊疗分析

目的分析并比较偶发肾癌与症状肾癌的临床诊疗特点,探讨两者预后有无差异,阐述早期检出肾癌的重要意义。方法回顾性分析2007年1月1日至2016年2月29日收治于我科的354例肾癌患者的临床资料,根据发现肾肿瘤的方式分为偶发肾癌组(n=217)和症状肾癌组(n=137),统计两组患者的病历资料,比较两组在临床特点、诊断方法、治疗方式及生存率上的差异。结果本组病例中偶发肾癌占全部肾癌的61.30%,健康体检是发现偶发肾癌的主要原因,而B超是发现肾占位的主要检查手段;两组患者在性别、年龄、糖尿病病史、吸烟史、身体质量指数(BMI)、肿瘤病理类型、肿瘤侧别和位置上差异无统计学意义(P0.05);而在住院天数、高血压病史、肿瘤大小、肿瘤病理分期、分级、手术切除率、手术方式及范围上差异有统计学意义(P0.05)。偶发肾癌组患者术后3年、5年、7年生存率分别为87.62%、77.78%及66.67%,均高于同期症状肾癌组,差异有统计学意义(P0.05)。结论与症状肾癌相比,偶发肾癌具有肿瘤体积小、临床分期低、手术切除率高及预后好等特点,且检出率呈逐年增加趋势,因此早期发现肾癌对提高患者生活质量及生存率十分重要,B超作为一种无创、经济的筛查方法发挥了重要作用,健康查体有助于肾癌的筛查。     

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.