低能量激光辅助吸脂术的临床应用

目的评价低能量激光辅助吸脂术临床应用的优越性。方法将98例吸脂患者分为治疗组和对照组。治疗组48例患者,192个部位,采用低能量激光照射后行振动吸脂术,对照组50例患者,180个部位,单纯采用振动吸脂术。术后从手术时间、吸脂量、脂肪与血液的比值、皮肤瘀斑和水肿的程度、皮肤平整度以及并发症的发生率等方面,评价低能量激光辅助吸脂术的优越性。结果低能量激光辅助吸脂术较单纯振动吸脂术可以显著缩短手术时间,创伤小,出血少,术后皮肤收缩良好,并发症发生率低。结论低能量激光辅助吸脂是一项新技术,临床初步应用具有较好的效果,但尚需进行深入地研究。     

低能量激光熔脂临床效果观察

目的探索一种辅助吸脂的新技术、新方法，使吸脂术更为省时、省力、安全有效。方法应用低能量激光熔脂技术辅助减肥塑形为402例患者1407个部位行负压或振动吸脂术。结果与振动吸脂组回顾性对比，本组更为省时、省力，损伤小．恢复快，合并症少，安全性高．术后疼痛轻。结论低能量激光熔脂技术是一种安全有效的辅助吸脂的新技术、新方法，值得推广。     

低能量激光熔脂临床效果观察

目的探索一种辅助吸脂的新技术、新方法,使吸脂术更为省时、省力、安全有效.方法应用低能量激光熔脂技术辅助减肥塑形为402例患者1 407个部位行负压或振动吸脂术.结果与振动吸脂组回顾性对比,本组更为省时、省力,损伤小,恢复快,合并症少,安全性高,术后疼痛轻.结论低能量激光熔脂技术是一种安全有效的辅助吸脂的新技术、新方法,值得推广.     

低能量激光熔脂联合负压振动吸脂临床实验效果观察

目的探讨辅助负压振动吸脂术安全有效、创伤小、痛苦少、恢复快的方法,联合低能量激光熔脂技术,使其优点更突出,更省时省力。方法对192例求美者462个部位联合低能量激光熔脂后行负压振动脂肪抽吸术,与169例求美者406个部位行单纯负压振动脂肪抽吸术进行对比,并观察脂肪细胞的扫描电镜、透射电镜和光镜透视下的形态。结果低能量激光熔脂每部位平均用时和单位吸脂量平均用时明显减少,镜下显示大部分脂肪细胞膜多处破裂,脂滴溢出,细胞间质损伤小。结论低能量激光熔脂辅助负压振动吸脂,术后创伤小,疼痛减轻,抽吸部位平整,省时、省力,效果可靠,安全性高。     

低能量激光熔脂联合负压振动吸脂临床实验效果观察

目的探讨辅助负压振动吸脂术安全有效、创伤小、痛苦少、恢复快的方法,联合低能量激光熔脂技术,使其优点更突出,更省时省力.方法对192例求美者462个部位联合低能量激光熔脂后行负压振动脂肪抽吸术,与169例求美者406个部位行单纯负压振动脂肪抽吸术进行对比,并观察脂肪细胞的扫描电镜、透射电镜和光镜透视下的形态.结果低能量激光熔脂每部位平均用时和单位吸脂量平均用时明显减少,镜下显示大部分脂肪细胞膜多处破裂,脂滴溢出,细胞间质损伤小.结论低能量激光熔脂辅助负压振动吸脂,术后创伤小,疼痛减轻,抽吸部位平整,省时、省力,效果可靠,安全性高.     

水射流辅助吸脂临床应用初探

目的 初步探讨水射流辅助吸脂的临床效果和安全性.方法 对121例患者行水射流辅助吸脂,记录手术时间、注入肿胀液量、冲洗液量、吸出总液体量、吸出脂肪量、术后疼痛时间、感觉恢复时间,观察吸出物颜色、术中术后患者的生命体征、皮肤瘀斑和水肿的程度、皮肤平整度以及利多卡因毒性反应等,随访患者手术的满意度.结果 本组患者平均手术时间2.5h,平均吸脂2.4个部位,平均注入肿胀液量1370ml,平均注入冲洗液量8750ml,平均吸出总液体量9240ml,平均吸脂量1720ml,平均疼痛恢复时间为5d,平均感觉恢复时间为23d.所有患者的生命体征平稳,术后第3天时皮肤平整,皮肤瘀斑和水肿程度较轻;术后6个月随访114例,满意率为94.2%,吸脂部位皮肤平坦、无感染、血肿、皮肤坏死、利多卡因中毒等并发症.结论 水射流辅助吸脂对神经、血管的损伤小,组织肿胀轻,可降低药物用量和手术风险,为大容量吸脂术提供了安全保障.     

激光联合泡沫硬化剂治疗下肢静脉曲张体会

目的对比分析激光联合泡沫硬化剂治疗下肢静脉曲张患者临床疗效指标与并发症的影响,以探讨其应用价值和安全性。方法分别采用单纯静脉激光术(对照组,n=150)和激光联合泡沫硬化剂术(观察组,n=150)进行治疗;对比两组患者手术时间、术中出血量、住院时间、住院费用等指标;分析两组患者疗效,疗效评价;记录并发症或不良事件的发生。结果研究组术后恢复时间、住院时间及住院费用均明显短于对照组(P0.05),而两组患者手术时间比较差异无统计学意义(P0.05);两种手术方法均有显著疗效,差异无统计学意义(Z=-0.201,P0.05);研究组局部皮肤感觉异常及局部炎性肿块发生率分别为2例和6例显著少于对照组26例和14例(P0.05);术后回访研究组局部复发5例显著少于对照组18例(P0.05)。结论激光联合泡沫硬化剂治疗下肢静脉曲张疗效显著,术后并发症及不良反应影响较小,更加利于患者术后恢复,值得推广。     

吸脂术在下面部年轻化手术中的应用

目的：探讨一种应用吸脂术的下面部年轻化整形美容手术方法。方法：临床79例患者在下面部年轻化手术中应用吸脂术，其中单纯下面部吸脂术45例，下面部除皱术结合吸脂术34例。结果：79例患者中随访68例，随访时间6个月至3年。单纯下面部吸脂术38例，效果满意32例，改善6例；除皱术结合下面部吸脂术30例，效果满意29例，改善1例；未出现皮肤坏死、面神经损伤等并发症。结论：下面部吸脂术具有面部年轻化的效果，且安全简便、恢复快，无切口瘢痕。在传统的面部除皱术中结合下面部吸脂术，可减少手术并发症，增加面部年轻化效果。吸脂术在下面部年轻化手术中是一种行之有效的方法，可广泛推广。     

浅表吸脂术后并发症的分析:2398例回顾

背景 浅表吸脂术的应用已达到最大化,有提升的效果,能实现较好的美学效果.尽管初始并发症发生率较高,但此类手术和其风险仍能被大众所接受.鉴于人们越来越多的关注浅表吸脂术的安全性和有效性,本文作者总结14年来浅表吸脂术的经验,并分析术后并发症.方法 自1995年3月至2008年12月,行浅表吸脂术共2398例.依据吸脂方法分成3组:电力辅助吸脂(组1)、电力辅助吸脂结合超声(组2)、电力辅助吸脂结合外超声和术后击碎脂肪团(组3).统计分析各组的并发症.结果 平均年龄42.8岁,平均体质量指数27.9 kg/m2,抽吸的平均容量是5045 ml.总体并发症发生率8.6％(206例).包括4例皮肤坏死和2例感染.最常见并发症是术后轮廓不规则.电力辅助吸脂结合外超声伴随/不伴随术后碎脂均可降低总体并发症、轮廓不规则和皮肤坏死的发生率.其他并发症无统计学差异.结论 浅表吸脂术与传统吸入技术相比,并发症发生率较高,特别是术后轮廓不规则,选择适合手术的患者、避免过度抽吸浅表层、联合使用超声技术可降低轮廓不规则的发生率.     

水动力辅助吸脂对自体脂肪移植隆乳患者手术效果和脂肪移植成活率的影响

目的:探讨水动力辅助吸脂对自体脂肪移植隆乳患者手术效果、脂肪移植成活率及并发症的影响。方法:选取2015年8月-2018年8月在笔者医院行自体脂肪移植隆乳术的202例患者为研究对象,其中98例接受常规隆乳患者为对照组,104例接受水动力辅助吸脂进行隆乳患者为研究组,记录患者治疗有效率和并发症发生情况。结果:研究组总有效率为100.00%高于对照组的79.59%,差异有统计学意义(χ^2=22.423,P=0.000)。研究组吸脂时间少于对照组,乳房体积增大量、移植脂肪成活率高于对照组,差异有统计学意义(P<0.05)。研究组术后并发症总发生率为1.92%低于对照组的10.20%,差异有统计学意义(χ^2=26.751,P=0.000)。结论:水动力辅助吸脂可降低自体脂肪移植隆乳患者并发症发生率,提高脂肪移植成活率和治疗效果,可在临床推广应用。     

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.     

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.