脊髓栓系综合征误诊为单纯性骶尾部瘘一例

患者男,67岁,以"骶尾部皮脂腺瘤术后感染10个月"于2011年3月6日入院。患者10个月前发现骶尾部一包块,于当地医院诊断为骶尾部皮脂腺瘤进行手术,术后10个月切口仍未完全愈合,且有流脓现象,为求进一步诊治来我院。入院检查:患者一般状态可,心肺部查体未见明显异常。专科查体:患者骶尾部见一手术瘢痕,切口周围隆起,表面红肿,按压有脓液流出。骶尾部彩超示:皮下最浅处约0.4cm处可见无回声,范围约4.8cm×0.9cm,走行迂曲,边缘见少许彩色血流,其上缘近尾骨下方。术前初步诊断为单纯性     

多发性气管狭窄患儿非气道手术麻醉一例

正患儿,女,1岁,65 cm,7 kg,因"发现骶尾部包块1年余"入院,初步诊断为"骶尾部包块,气道狭窄"。胎龄22周时,超声检查发现骶尾部一包块(约2 cm×1 cm)。37周顺产,出生时发现骶尾部有"鹌鹑蛋"大小包块。1月龄时曾就诊外院拟行手术,全麻诱导后可视喉镜发现声门下气道软骨呈"O"型闭合环,尝试插入ID 2.5 mm普通气管导管失败,未行手术,后转入我院。     

阴囊内副脾一例

患者男,21岁.左侧阴囊内包块逐渐增长20余年.体检:左侧睾丸处可触及一4cm×3cm大小肿块,质软,边界清楚,移动度差,有轻压痛,左侧输精管轻度增粗.阴囊彩超:左侧附睾头未显示,左阴囊内相当于附睾尾部见一异常回声包块,约3.5cm×3.0cm×2.3cm,边界清楚,回声较正常睾丸稍强,包块内部可见一0.6cm×0.5cm的无回声区,边界清楚.血流信号显示包块内可见较丰富血流信号.超声提示:左侧附睾囊肿.     

藏毛窦伴肛瘘1例

患者男25岁,长途客车司机,“反复肛周疼痛6个月,加重1周”入院。专科检查：肛门截石位肛缘6点处可见2．0cm×3．0cm红肿包块,波动（＋）。肛门指诊：齿状线截石位6点处可触及内瘘口,骶尾部皮肤未见异常。骶麻下,以美蓝引导,顺利找到齿状线6点处的内瘘口。行脓肿及瘘一期切开。术中见美蓝向6点骶尾方向伸展,用探针引导,发现此窦道长约3．5cm,根部有大小约0．5cm×1．0cm感染性病灶,内有数根卷曲的毛发及坏死物质,并伴发炎性肉芽组织增生。     

胎儿骶尾部寄生胎合并畸胎瘤1例

正孕妇,23岁,孕1产0,孕20+6周,因唐氏筛查结果为唐氏高风险而需羊水穿刺检查,穿刺前接受产前常规超声检查。二维超声发现胎儿骶尾部囊实性占位,12.1cm×8.7cm×11.8cm,以实性成分为主,团块内见多个点状强回声,后方伴声影,团块明显凸向羊膜腔(图1);CDFI示团块内较丰富血流信号(图1C),羊水量未见异常。超声诊断:胎儿骶尾部畸胎瘤可能性大。孕22+3周超声复查示胎儿骶尾部团块大小为     

骶尾直肠间隙脂肪肉瘤1例报告

骶尾直肠间隙脂肪肉瘤１例报告彭茂辉患者，男，５８岁。因骶尾部包块进行性长大１年余，以“血管瘤”收入院。患者于入院前１年余发现骶尾部有一红枣大小无痛性包块，近来包块逐渐增大约鸡蛋大小，同时伴低热和局部胀痛，经抗感染治疗包块无明显缩小。查体：于骶尾部可见...     

产前超声诊断泄殖腔外翻综合征2例

正病例1,孕妇26岁,孕23周,孕1产0。超声发现胎儿下腹壁宽2.05 cm回声连续性中断,下腹部至会阴部见3.86 cm×2.75 cm包块向外突起(图1A),内见肠管、肝脏、胆囊回声,膀胱未显示;右侧脐动脉可显示,左侧脐动脉未显示;左足姿势异常,呈马蹄内翻状;脊柱骶尾段表面皮肤完整,骶尾段椎体横切面呈"V"字形,并见1.08 cm×0.91 cm无回声包块稍向外突起,骶尾段椎体骨化中心显示欠清晰;外生殖器显示不清。超声诊断:宫内单活胎     

食管、肺间质细胞瘤各一例

患者男,32岁。因间歇性吞咽有异物感5个月入院。查体未见明显的阳性体征,食管X线钡餐片未见明显异常,胃镜提示距门齿34cm处食管黏膜隆起,表面光滑,超声胃镜提示距门齿34cm处食管壁有占位性病变,直径0.5cm。经左侧开胸探查下段食管未扪及包块,术中于胃镜引导下切开食管肌层,见包     

左臀部巨大侵袭性纤维瘤1例

1病例资料患者,男,53岁。2005年10月22日因左臀部包块3年、明显增大6个月入院。患者左臀部发现板栗大小包块,无任何不适症状,双下肢肌力、感觉正常,弯腰轻度受限。查体:一般情况好,弯腰时包块胀感,无压痛及叩击痛,双下肢肌力感觉正常,生理反射存在,病理反射阴性。细胞学及彩超检查均提示为血管瘤。于2005年10月25日行包块切除术。术中见包块位于皮肤与骶棘肌之间,约15cm×12cm×6cm,与骶棘肌粘连紧密,质韧、边界清楚、包膜厚欠完整,与周围组织亦有粘连,未见大的供血动脉。从骶棘肌剥离后剖开包块,呈实质性,剖面灰白略带暗红色。见图1。病理…     

腹股沟多形性平滑肌肉瘤1例

<正>1病例介绍患者男,49岁,因"发现左侧腹股沟条索样肿物伴疼痛1周"于2012年1月30日入院。无外伤史,无发热寒战。当地医院超声检查示:左腹股沟囊实性包块,约3.3 cm×2.8 cm,内可见液性暗区,距体表0.9 cm,考虑脓肿。予以穿刺抽出血性液10 m L后肿     

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 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.     

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.