螺旋CT三维重建在肱骨近端移位骨折分型及治疗中的应用

目的探讨螺旋CT三维重建对肱骨近端移位骨折分型的影响及在肱骨近端移位骨折中的临床应用价值.方法收集经手术治疗的肱骨近端移位骨折20例,所有患者术前均接受X线片检查,同时行肩部螺旋CT扫描和三维重建.根据Neer分型法对骨折进行分型,比较X线片和螺旋CT三维重建两种方法对肱骨近端移位骨折分型诊断的正确率,并评价螺旋CT三维重建在肱骨近端移位骨折治疗中的作用.结果经手术证实20例中Neer二部分骨折4例、三部分骨折9例、四部分骨折7例,普通X线片对肱骨近端移位骨折分型诊断的正确率为55%(11/22),螺旋CT SSD、MPR结合二维CT横切面图像对肱骨近端移位骨折分型诊断的正确率为90%(18/20),两者比较有显著差异(P＜0.05),所有螺旋CT三维重建资料均对治疗具有指导作用.结论对有手术适应证者,术前行螺旋CT三维重建对肱骨近端移位骨折分型及决定治疗方案有重要的指导价值.     

螺旋CT三维重建在肱骨近端移位骨折分型及治疗中的应用

目的 探讨螺旋CT三维重建对肱骨近端移位骨折分型的影响及在肱骨近端移位骨折中的临床应用价值。方法 收集经手术治疗的肱骨近端移位骨折20例，所有患者术前均接受X线片检查，同时行肩部螺旋CT扫描和三维重建。根据Neer分型法对骨折进行分型，比较X线片和螺旋CT三维重建两种方法对肱骨近端移位骨折分型诊断的正确率，并评价螺旋CT三维重建在肱骨近端移位骨折治疗中的作用。结果 经手术证实：20例中Neer二部分骨折4例、三部分骨折9例、四部分骨折7例，普通X线片对肱骨近端移位骨折分型诊断的正确率为55％(11／22)，螺旋CT SSD、MPR结合二维CT横切面图像对肱骨近端移位骨折分型诊断的正确率为90％(18／20)，两者比较有显著差异(P＜0．05)，所有螺旋CT三维重建资料均对治疗具有指导作用。结论 对有手术适应证者，术前行螺旋CT三维重建对肱骨近端移位骨折分型及决定治疗方案有重要的指导价值。     

多层螺旋CT对胫骨平台骨折分型的诊断价值

目的 探讨多层螺旋CT对胫骨平台骨折(TPF)分型的诊断价值.方法对89例(93侧)TPF的临床资料进行分析.结果93侧中20侧参考CT扫描结果后更改分型,X线片与多层螺旋CT正确率分别为78.49％和100％,差异具有统计学意义(x2=7.854,P＜0.01).28侧胫骨髁间棘骨折及15侧膝骨近端骨折在常规X线片检...     

CT数字化三维重建技术在肱骨近端骨折临床分型中的诊断价值

目的探讨CT数字化三维重建技术在肱骨近端骨折诊断和治疗中的作用。方法收集2009年1月至2011年12月在本院门诊及住院的肱骨近端骨折患者53例，术前进行常规x线平片、CT平扫、利用CT平扫描数据构建三维模型，与传统影像学检查方法在骨折的分型上进行对照分析．以明确骨折的Neer分型分类。根据肱骨近端骨Neer分型分类折选择选择合适的治疗方法，术后12个月采用Con-stant—murley评分标准对肱骨近端骨折患者术后功能进行评价。结果①CT三维重建模型可明确诊断及分型的比例显著高于X线平片（x^2=8．653，P〈0．01）和cT平扫（x^2=6．360，P〈0．05）；②术后平均骨折愈合时间为（5．84±0．57）个月，未发生明显术后并发症，术后12月平均Con—stant—Murlev评分为（87．63±8．64）分。结论利用CT数字化三维重建技术对肱骨近端骨折骨折分型准确，利于临床医生选择适当、合理的治疗方案．有利于提高肱骨近端复杂骨折的诊疗水平。     

多层螺旋CT对胫骨平台骨折分型及治疗的临床价值

[目的]探讨多层螺旋CT(MSCT)容积重组技术(VRT)和多平面重建(MPR)在胫骨平台骨折(TPF)分型及治疗中的临床应用价值.[方法]2005年8月-2009年2月对45例49侧TPF患者的病例资料进行回顾性分析.其中男32例,女13例;年龄20～65岁(平均46岁).4例为双侧TPF.所有患者均行X线检查和64层螺旋CT扫描仪扫描.在轴位CT扫描后行VRT和MPR成像.按照Schatzker分型标准,应用X线片与64层螺旋CT扫描(包括VRT、MPR成像)分别进行分型和制定相应的治疗方案.[结果]参考VRT、MPR成像后,更改X线分型13侧(13/49)、更改治疗方案8侧(8/49)、发现胫骨髁问嵴骨折15侧(漏诊率46.9%)和腓骨近端骨折6例(漏诊率28.6%).[结论]MSCT(VRT+MPR)可以清晰显示TPF塌陷的范围和程度、细节及隐匿骨折,有助于骨折的正确分型、降低漏诊率和选择合理的治疗方案,是X线片和轴位CT扫描有效的补充手段,具有较高临床应用价值.     

螺旋CT三维重建诊断腰椎爆裂骨折的价值

目的探讨螺旋CT多模式三维重建诊断腰椎爆裂骨折(LBF)的价值。方法对54例LBF患者摄腰椎X线片;采用3～5 mm层厚连续螺旋CT扫描,1.5～2.5 mm间距后重建,于AW4.0工作站行SSD、MPR及MIP、仿真椎间盘镜(VMED)三维重建;34例行腰椎MRI检查;采用SSPS 16.0软件分析。结果螺旋CT与平片诊断LBF差异有统计学意义(χ2=4.167,P<0.05);SSD与MIP能取得清晰立体图,MPR能多向观察骨折细节,VMED能模拟MED显示椎管梗阻。MRI能清楚显示椎管受压及脊髓损伤。结论腰椎多模式三维重建对复杂性腰椎骨折诊断、分型与手术模拟等有重要价值。     

螺旋CT重建技术在骨盆环骨折中的诊治价值

目的:探讨螺旋CT二维多平面重建(MPR)、三维重建(3D)对骨盆环骨折的诊断、分型及治疗的临床价值。方法:回顾性分析2004年4月至2009年4月收治的有完整的X线DR(digital radiography)片、螺旋CT片影像资料的57例骨盆环骨折患者,根据Tile分类,本组病例A型38例,B型12例,C型7例。对A型患者采取保守治疗,对B、C型患者全部采取手术治疗,根据骨折移位情况,采用开放复位内固定或经皮行骶髂关节空心螺钉内固定术。术后3d～27个月内进行随访,利用螺旋CT检查进行术后疗效评估,对其术前术后的DR片、螺旋CT的3D、MPR的重建图像进行对照分析。结果:57例骨盆环骨折患者中,5例骨盆后环骨折患者的X线DR片诊断为可疑骨折,9例骨盆后环骨折X线DR片漏诊,3例骨盆前环骨折患者的X线DR片诊断为可疑骨折,3例骨盆前环骨折患者的X线DR片漏诊,后经螺旋CT检查予以修正。术后影像学评价优15例,良3例,差1例;临床评价优16例,良3例。结论:螺旋CT的MPR、3D的重建图像对骨盆环骨折的诊断、分型及临床治疗评估具有重要的临床价值。     

CT三维重建技术在髋臼骨折诊断中的应用价值

目的探讨CT三维重建技术在髋臼骨折诊断中的应用效果。方法将本院收治的46例髋臼骨折患者分为X线片组、CT平扫组和CT三维重建组,对三组髋臼骨折检出率、骨折分型正确率、骨折移位情况判断正确率进行比较。结果 X线片组、CT平扫组、CT三维重建组的髋臼骨折检出率依次为58.70%、80.43%、100%,髋臼骨折分型正确率依次为39.13%、73.91%、100%,对骨折移位情况判断的正确率依次为47.83%、76.09%、100%,即CT三维重建技术对髋臼骨折检出、髋臼骨折分型、髋臼骨折移位情况判断的诊断价值明显优于X线片和CT平扫(P0.05)。结论 CT三维重建技术可以帮助医生直观地观察髋臼骨折情况,对骨折分型及制定手术方案具有较大补益。     

螺旋CT在胫骨平台后侧骨折诊断中的作用

目的:探讨螺旋CT对胫骨平台后侧骨折诊断中的作用.方法:对56例胫骨平台后侧骨折患者行X线片和螺旋CT三维重建,分析CT在胫骨平台后侧骨折诊断和分型中的作用.结果:本组56例,CT分型:Ⅰ型10例(17.8%);Ⅱ型,后外髁劈裂骨折5例(8.9%);Ⅲ型,后外髁塌陷骨折16例(28.6%);Ⅳ型,后外髁劈裂塌陷骨折2例(3.6%);Ⅴ型,后内髁劈裂及后外髁塌陷骨折23例(41.1%).经X线片做出诊断47例,漏诊2例(3.6%),可疑4例(7.1%),3例X线提示裂纹骨折,CT扫描和三维重建显示粉碎骨折(5.4%).结论:螺旋CT检查在胫骨平台后侧骨折诊断、骨折分型、显示骨折移位程度和骨折碎骨片方面,均优于X线检查.     

多层螺旋CT在创伤性关节骨折中的应用

目的　探讨多层螺旋CT在创伤性关节骨折诊断中的应用价值。方法　对 4 5例关节外伤患者进行普通X线片和MSCT检查 ,并通过多平面重建法 (MPR)、三维表面遮盖法 (SSD)及容积重建技术 (VRT)观察骨折细节。结果　 1 2例隐匿骨折和 33例复杂关节骨折通过MSCT检查能清晰地显示骨折线的位置、范围和骨折块的移位。结论　MSCT对关节骨折的诊断具有特殊的诊断价值 ,能提高诊断的准确性 ,为手术方案提供了科学依据     

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.