经甲半月以远弧形切口入路治疗指甲根部甲下血管球瘤

目的探讨应用经甲半月以远弧形切口治疗指甲根部甲下血管球瘤的可行性及疗效。方法 2017年3月—2019年10月收治16例(16指)指甲根部甲下血管球瘤患者。其中男2例,女14例;年龄21～67岁,平均35.3岁。病程5个月～17年,中位病程15个月。拇指6例,示指3例,中指2例,环指4例,小指1例。均表现为典型"三联征";术前冷敏感试验和Love试验均为阳性。患者均行全甲板拔除,经甲半月以远弧形切开甲床暴露瘤体,完整切除瘤体后,原位复位甲床不予以缝合,制作甲模板并原位回植,缝合加压固定。术后随访观察甲床愈合、疼痛、指甲生长等情况。结果术后患者切口均Ⅰ期愈合,术后病理检查均提示为甲下血管球瘤。所有患者均获随访,随访时间3～26个月,平均15个月。患指疼痛症状均消失,冷敏感试验和Love试验均为阴性;换药期间无明显疼痛。新生指甲平整光滑、外观满意,无明显纵嵴畸形等并发症发生;随访期间无1例复发。结论应用甲半月以远弧形切口治疗指甲根部甲下血管球瘤,操作简便、肿瘤切除彻底,术后复发率低,可有效保护甲床,预防术后指甲畸形,是一种有效手术方法。     

带部分甲床的单侧或双侧V-Y推进皮瓣修复手指末节皮肤及甲床缺损

目的总结带部分甲床的单侧或双侧"V-Y"推进皮瓣修复手指末节皮肤及甲床缺损的治疗效果。方法对2014年2月-2016年12月收治的10例12指末节指腹、指端皮肤软组织及残留甲基质的甲床缺损患者,带远端部分甲床的单侧或双侧"V-Y"推进皮瓣修复创面。结果所有患者均获得随访,随访时间6~21个月,平均15个月。术后皮瓣及甲床全部成活,无一例发生感染,创面Ⅰ期愈合;手指指端饱满圆滑、外形良好,无疼痛及瘢痕挛缩;皮瓣质地柔软,指甲光滑平整。术后9个月根据中华医学会手外科学会上肢部分功能评定试用标准评定手功能:优10指,良2指,优良率100%。结论带部分甲床的单侧或双侧"V-Y"推进皮瓣修复手指末节皮肤及残留甲基质的甲床缺损,手术操作简单,皮瓣血供可靠,可保留指体长度,减少二次损伤,术后疗效满意,是修复手指末节皮肤软组织及部分甲床缺损较为理想的手术方法之一。     

指端血管球瘤的诊断与治疗

目的 总结手指末端血管球瘤的诊断及手术治疗效果。方法 2002年3月～2006年5月，收治9例手指末端血管球瘤患者。其中男2例，女7例；年龄20～70岁。病程31个月～37年，平均8年。均行指甲开窗、切开甲床、刮除瘤体以及术后应用活血化瘀中药内服、外洗创口。结果 切口Ⅰ期愈合。术后第1天开始，患指疼痛即明显减轻，术后1周疼痛完全消失。患者均获随访11～28个月，平均19个月。疗效良好，无1例复发，术后无遗留痕迹。结论 根据血管球瘤特征性临床症状及影像检查均可确诊。采用指甲开窗、切开甲床、刮除瘤体能减轻创伤，疗效满意。     

经甲旁切口入路与经甲床切口入路治疗甲下血管球瘤的疗效分析

目的对比分析经甲旁切口入路与经甲床切口入路治疗甲下血管球瘤的临床效果。方法回顾性分析2010年4月-2017年12月收治的26例手指甲下血管球瘤患者,采用两种不同入路方法行血管球瘤切除术的临床资料。随机分两组,A组经甲旁切口入路行血管球瘤切除术11例,B组经甲床切口入路行血管球瘤切除术15例,运用SPSS 19.0统计学软件进行数据处理,并对其手术平均时间、术后渗液、术后甲床不贴附、甲嵴、术后愈合时间及患者重返工作岗位时间进行观察比较。结果经甲旁切口入路行血管球瘤切除术手术时间长,偶有发生感染,但术后愈合时间及患者重返工作岗位时间较短。经甲床切口入路行血管球瘤切除术手术时间短,易发生甲下积血积液、甲床不贴附或甲嵴,因指端无指甲的保护,术后愈合时间及患者重返工作岗位时间较长。结论经甲旁切口入路相比经甲床切口入路行血管球瘤切除术有明显的优势,手术并发症少,术后恢复时间短。     

甲弧影以远弧形切口联合甲模板回植在治疗甲下血管球瘤中的应用

目的探讨采用甲弧影以远弧形切口联合甲模板回植治疗甲下血管球瘤的可行性及疗效。方法回顾性分析2019年3月至2021年6月中国科学技术大学附属第一医院骨科治疗的甲下血管球瘤患者的临床资料。所有患者在拔除指甲后, 采用甲弧影以远弧形切口入路切开甲床, 暴露瘤体后完整切除, 切开的甲床瓣原位复位, 不予缝合, 选择使用5 ml注射器针筒或原甲板制作甲模板, 戳引流孔, 回植覆盖于甲床表面, 三点缝合加压固定, 常规换药, 3周后拆除甲模板。记录患者术前及术后1个月疼痛视觉模拟法(VAS)评分, 并随访观察甲床愈合、疼痛改善、指甲生长及肿瘤复发等情况。手术前后VAS评分以M(Q1, Q3)表示, 采用Mann-WhitneyU检验进行分析, P<0.05为差异有统计学意义。结果共纳入37例患者, 男5例, 女32例;年龄18～67岁, 平均39岁。术后病理均确诊为甲下血管球瘤, 所有患者均获得随访, 随访时间6～36个月, 平均22个月, 术后换药均无明显痛感, 拆除甲模板后见甲床平整干燥, 无明显瘢痕形成, 术后切口均一期愈合, 新生指甲平整光滑、外观满意, 疼痛症状均消失, 随访期间...     

指腹血管球瘤的诊治

目的 探讨手指指腹血管球瘤的诊治及病理观察的重要性以降低术后复发率.方法 2002年2月至2010年12月收治15例指腹血管球瘤患者,临床均有局部疼痛,Love试验、冷敏感试验呈阳性,结合B超和MRI检查,术中完整切除肿瘤和包膜,术后肿瘤组织送病理检查.结果 15例平均随访时间为1年,术后肿瘤无复发,术前阳性体征完全消失.病理结果均证实为血管球瘤.结论 术前临床体征、B超及MRI检查和术中肿瘤完整切除,均有助于指腹血管球瘤的手术预后,降低复发率.     

足趾复合组织瓣瓦合再造拇及手指末节

目的 介绍一种移植足趾复合组织瓣再造拇及手指末节的新术式.方法 自第一足趾腓侧切取部分骨甲皮瓣与第二足趾胫侧切取的趾底皮瓣相瓦合,形成一个血管蒂的复合组织瓣再造拇及手指末节.结果 临床应用7例7指全部成活.受区伤口Ⅰ期愈合.术后随访6～14个月,指腹饱满,两点辨别觉5.0～8.0 mm,外形逼真,指甲生长良好,关节活动度正常.第一足趾供区直接缝合后均Ⅰ期愈合,第二足趾供区植皮处肤色深,关节活动无影响,行走良好,无疼痛及足部肿胀.结论 第一足趾腓侧骨甲皮瓣与第二足趾胫侧的趾底皮瓣相瓦合是再造拇及手指末节的理想方法 .     

手指血管球瘤的诊治分析

[目的]探讨手指血管球瘤的诊断与治疗。[方法]回顾性分析11例血管球瘤的发病过程及治疗结果。[结果]11例均行手术切除，术后随访6～48个月无复发。[结论]手指血管球瘤具有特征性临床表现，甲床外血管球瘤易误诊，结合影像学表现可提高诊断率。手术切除是一种有效治疗方法。     

甲根部血管球瘤的MRI影像学诊断及显微外科治疗

目的探讨在手术显微镜视下治疗甲根部血管球瘤的手术方法及临床效果。方法自2015年12月至2021年11月, 我科共收治甲根部血管球瘤患者14例, 在手术显微镜视下于生发基质部行纵行切口, 必要时辅以远端横行切口, 清晰显露瘤体并切除, 修整甲板和远端甲床后将甲板原位回纳, 保护甲床。术后随访观察患指疼痛及新生甲板的外观等情况。结果术后所有患者均获得随访, 时间为4～48个月, 平均14.3个月。患指疼痛症状均消失, 新生指甲平整光滑, 外观满意, 无明显纵嵴形成, 甲板甲床贴合紧密。参考吕桂欣等制定的标准评价新生指甲:优9例, 良5例。结论采用显微外科技术, 在生发基质上采用纵行切口, 必要时辅以远端横行切口, 彻底显露并切除血管球瘤, 结合修整甲板塑性, 术后复发率低, 新生指甲外观优良, 是治疗甲根部血管球瘤的有效方法。     

指骨下筋膜瓣联合甲模板修复甲床中远端缺损

目的研究应用指骨下筋膜瓣联合甲模板修复甲床缺损的方法可行性及临床疗效。方法自2019年6月至2022年12月我科急诊收治15例甲床缺损患者, 均伴有指骨骨质外露, 甲床缺损为原面积的1/4～2/3, 彻底清创后采用患指远端指骨下筋膜瓣覆盖骨外露创面, 使用5-0可吸收缝线缝合筋膜瓣和残留甲床创缘, 使用莫非氏管修剪制作甲模板覆盖于甲床和筋膜瓣之上, 缝线稍加压固定甲模板, 待自然脱落甲模板。术后随访观察创面愈合情况和指甲生长情况, 按照李宝山等指甲评价标准评价患处恢复情况。结果本组15例15指筋膜瓣全部存活良好, 创口Ⅰ期愈合, 供区无坏死。术后随访2～12个月, 平均5.6个月。指甲生长良好, 平整光滑, 指甲和筋膜瓣贴合完好, 指腹供区无瘢痕, 指腹饱满, 手指活动正常, 无压痛。按照指甲评定标准:优12例, 良2例, 差1例。其中1例差因为随访时间短指甲未能生长良好。结论应用指骨下筋膜瓣联合甲模板修复指骨骨质外露、甲床缺损, 具有操作简便、损伤较小且指甲外形恢复良好等优点, 是急诊处理甲床缺损的较好选择。     

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.