LC-ⅢB型电脑肛肠治疗仪治疗痔的临床观察

目的:为观察用LC-ⅢB型电脑肛肠治疗仪与传统手术方式治疗痔的疗效及并发症出现状况.方法:将300例痔病患者随机均分为仪器组与手术组进行治疗,分别观察术后72 h内疼痛程度、尿潴留、创面水肿、术后出血及创面平均愈合天数.结果:仪器组在术后疼痛程度及尿潴留方面优于手术组(P＜0.05),创面出血、水肿方面无明显差异(P＞0.05),创面愈合天数大于手术组(P＜0.01).结论:用LC-ⅢB型电脑肛肠治疗仪治疗痔疗效肯定,治疗时痛苦小,并发症少,操作简便,有推广使用价值,但不能完全代替传统手术方式.     

LC—IIIB型电脑肛肠治疗仪治疗痔的临床观察

目的:为观察用LC-ⅢB型电脑肛肠治疗仪与传统手术方式治疗痔的疗效及并发症出现状况.方法:将300例痔病患者随机均分为仪器组与手术组进行治疗,分别观察术后72 h内疼痛程度、尿潴留、创面水肿、术后出血及创面平均愈合天数.结果:仪器组在术后疼痛程度及尿潴留方面优于手术组(P＜0.05),创面出血、水肿方面无明显差异(P＞0.05),创面愈合天数大于手术组(P＜0.01).结论:用LC-ⅢB型电脑肛肠治疗仪治疗痔疗效肯定,治疗时痛苦小,并发症少,操作简便,有推广使用价值,但不能完全代替传统手术方式.     

消痔汤在环状混合痔术后的应用

为探讨消痔汤在环状混合痔术后的应用价值,将780例环状混合痔术后患者分为两组,一组口服中药消痔汤（治疗组）,另一组应用西药治疗（对照组）,观察术后疼痛、创缘水肿、尿潴留、粪嵌塞、痔体脱落期出血、创口愈合情况。结果显示,治疗组显效258例,有效148例,无效14例,总有效率96．7％;对照组显效118例,有效128例,无效114例,总有效率68．3％;治疗组总有效率明显高于对照组,P〈0．05。治疗组疼痛消失时间、创缘水肿消退时间、创面愈合时间明显少于对照组,P〈0．01。治疗组术后尿潴留、粪嵌塞、痔体脱落期出血等并发症发生率明显低于对照组,P〈0．01。结果表明,环状混合痔患者术后口服消痔汤,可有效缓解术后疼痛,减轻术后创缘水肿,预防尿潴留、粪嵌塞及痔体脱落期出血,促进创口愈合。     

LG2000型肛肠病治疗仪治疗肛肠病100例临床观察

为探讨LG2000型肛肠病治疗仪治疗肛肠病的临床疗效,本研究对比分析采用LG2000型肛肠病治疗仪治疗（治疗组）和常规手术治疗（对照组）的肛肠病患者疗效。结果显示,与对照组相比,治疗组手术时间短,创面愈合快,术中出血少,术后尿潴留、创缘水肿、假性愈合等并发症发生率低,且差异均有统计学意义,P〈0．01。术中及术后Ⅱ、Ⅲ级疼痛、复发以及术后疗效方面,两组差异均无统计学意义,P〉0．05。结果表明,LG2000型肛肠病治疗仪治疗肛肠病总疗效优于常规手术治疗,值得临床推广应用。     

高频电容场技术联合内痔分段结扎术治疗重度混合痔的临床研究

为探讨高频电容场技术（HcPT）联合内痔分段结扎术治疗重度混合痔的临床疗效,将100例重度混合痔患者随机分为治疗组和对照组,各50例。治疗组采用HCPT联合内痔分段结扎术治疗,对照组仅采用HCPT治疗,对比两组患者术中出血量、手术时间、总体疗效、术后痔核脱落时间、创面愈合时间,以及术后疼痛、出血、渗液及肛缘水肿情况。结果显示,两组患者总体疗效差异无统计学意义,P〉0．05;但治疗组在术中出血量、手术时间、术后痔核脱落时间、创面愈合时间及术后疼痛、出血、渗液、肛缘水肿方面均明显优于对照组,P〈0．05或P〈0．01。结果表明,HCPT联合内痔分段结扎术治疗重度混合痔疗效确切、安全可靠,而且创面愈合快,术后并发症少,值得临床推广应用。     

电脑肛肠治疗仪治疗中、重度痔71例疗效观察

将140例中、重度痔患者分成两组,71例（电脑组）采用电脑肛肠治疗仪治疗,69例（传统组）采用传统外剥内扎术治疗,并对两组疗效进行对比观察。结果表明,电脑肛肠治疗仪治疗中、重度痔比传统外剥内扎术手术时间短,术中出血少,术后大出血发生率低,术后患者疼痛轻,尿潴留少,医疗费用低,适合基层医院开展。     

PPH在痔合并肛瘘、肛裂患者中应用的可行性研究

为探讨吻合器痔上黏膜环切钉合术（PPH）在痔合并肛瘘、肛裂患者中应用的可行性,将152例痔合并肛瘘、肛裂者随机分为观察组和对照组,各76例,观察组行PPH治疗痔,对照组行外剥内扎术治疗痔,两组均在处理痔的同时手术治疗肛裂、肛瘘。对比两组患者总体疗效、术后并发症及创面愈合时间。结果显示,两组患者均治愈;但观察组术后出血、肛门胀痛、尿潴留、肛缘水肿发生率均低于对照组,且创面愈合时间明显短于对照组,P〈0．05。结果表明,对于痔合并肛瘘、肛裂者,行PPH治疗安全可行,同时配合手术治疗合并的肛瘘、肛裂,疗效肯定。     

早期手术并中药坐浴治疗急性嵌顿痔70例

目的：评价早期手术并中药坐浴治疗急性嵌顿痔的临床疗效。方法：将140例嵌顿痔患者随机分为两组,治疗组采用早期手术并中药坐浴治疗,对照组采用先药物后手术的传统方法治疗。结果：两组治愈率、术后出血及术后并发症差异无统计学意义（P〉0.05）,治疗组平均住院时间、切口愈合时间、术后创面水肿以及术后第4d疼痛减轻优于对照组（P〈0.05）。结论：早期手术并中药坐浴治疗嵌顿痔,疗程短,疼痛轻,不增加术后并发症,是治疗嵌顿痔的首选方法。     

两种术式治疗混合痔的疗效比较

为探讨自动痔疮套扎术（RPH）联合外痔切除术与外剥内扎术治疗Ⅱ、Ⅲ期内痔为主的混合痔的临床疗效,采用RPH联合外痔切除术治疗该类混合痔65例（观察组）,与同期单纯采用外剥内扎术治疗55例（对照组）进行比较,在平均单个痔手术时间、住院时间、创口愈合时间、水肿发生例数、术后出血评分、术后尿潴留例数、疼痛评分、术后1年复发例数方面评价两组的治疗效果。结果显示,观察组可缩短单个痔手术时间、住院时间及创口愈合时间,且可明显减轻术后疼痛、创缘水肿及术后出血,优于对照组（P〈0．05）。而术后1年复发率、术后尿潴留情况两组比较无统计学意义（P〉0．05）。结果表明,在治疗Ⅱ、Ⅲ期内痔为主的混合痔时可优先选择RPH联合外痔切除术,以加快患者术后恢复,减轻术后并发症。     

急性环状嵌顿痔早期手术治疗360例临床观察

为探讨急性环状嵌顿痔早期手术的疗效,对早期手术组360例急性环状嵌顿痔患者采用外剥内扎齿状线保留术,疼痛缓解期为1d,平均住院天数为7d,术后效果理想;疼痛程度、尿潴留、恢复时间与传统择期手术无明显差异;先保守治疗后手术组60例,疼痛缓解期为6．5d,平均住院天数为15d。结果表明,急性环状嵌顿痔早期手术治疗具有痛苦小、疗程短、并发症少等优点。     

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.