关节镜治疗膝关节早中期类风湿性关节炎

目的探讨膝关节类风湿性关节炎关节镜下滑膜切除术的治疗方法以及疗效评价。方法在关节镜下对33例（39个关节）膝关节类风湿性关节炎患者进行滑膜切除术,其中早期类风湿性关节炎7例,8个关节;中期类风湿性关节炎26例,31个关节。术后给予正规严格的抗类风湿药物治疗。术后随访分别按照Lysholm评分、ESR、CRP以及Ishikawa疗效评定标准进行评价。结果 33例患者平均随访时间为5.77年。采用Lysholm评分、ESR、CRP差异均具有统计学意义（P〈0.05）。Ishikawa评分：39个关节优良率为76.9%（30/39）,早期8个关节的优良率为87.5%（7/8）,中期31个关节的优良率为74.2%（23/31）,二者差异不具有统计学意义（P〉0.05）。结论膝关节早、中期类风湿性关节炎关节镜下滑膜切除术联合术后正规的抗类风湿药物治疗,均可以获得较满意的疗效。     

关节镜下滑膜切除术治疗膝类风湿性关节炎

[目的]探讨关节镜下滑膜切除术在治疗膝类风湿性关节炎中的价值.[方法]在关节镜下对32例43膝类风湿性关节炎患者行关节镜下滑膜切除术,术后给予正规内科治疗3个月.所有患者得到了6个月以上的随访.随访内容包括关节功能的评定和红细胞沉降率( ESR)、C反应蛋白(CRP)和类风湿因子(RF)的测定.[结果]术后6个月关节功能的优良率为90.7％上(43/39个). 术后3个月,ESR、CRP和RF较术前明显下降(P＜0.05). [结论]关节镜下滑膜切除术联合术后正规内科用药治疗膝类风湿性关节炎,对膝关节局部及全身症状均有明显改善作用.     

关节镜下滑膜切除术治疗早、中期类风湿性关节炎的疗效

目的探讨关节镜下滑膜切除术治疗早期和中期类风湿性关节炎(类风关)的疗效. 方法对34例早中期的类风关42个膝关节(早期类风关组22例,24个关节;中期类风关组12例,18个关节),在关节镜下施行以滑膜切除术为主处理,其中32个膝关节辅助使用双极射频进行滑膜的清除和止血.术后给予正规抗类风湿药物治疗,对早、中期两组进行随访(平均25月),包括关节功能的评定,检测血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C reaction protein)和类风湿因子(rheumatoid factor,RF ). 结果早期类风关组24个膝关节术后优良率为91.7%(22/24),中期类风关组18个膝关节优良率为66.7%(12/18),二者优良率差异无显著性(χ2=2.705,P=0.100). 结论早期和中期类风关关节镜下滑膜切除术治疗,均可以取得较满意的疗效,二者疗效无差别.双极射频有助于彻底清除病变滑膜、减少关节血肿、利于关节功能康复.     

膝关节十分区法关节镜下滑膜切除术治疗类风湿性关节炎

目的评估膝关节十分区法关节镜下滑膜切除术治疗类风湿性关节炎的疗效。方法自2010-05—2014-01对16例类风湿性关节炎根据赵立恒等提出的膝关节十分区法行关节镜下膝关节滑膜组织切除术,并与2005-01—2009-12关节镜下行膝关节常规滑膜切除的19例进行比较。比较2组手术前后血沉(ESR)、C-反应蛋白(CRP)、膝关节功能Lysholm评分及复发率。结果常规组19例术后随访10~72个月,平均41.6个月;十分区组术后随访10~48个月,平均34.6个月。2组术后ESR、CRP值及Lysholm评分均较术前明显改善,差异有统计学意义(P0.05)。与常规组比较,十分区组Lysholm优良率更高(χ2=3.96,P0.05)和复发率更低(χ2=3.88,P0.05)。结论采用膝关节十分区法行关节镜下滑膜切除术治疗类风湿性关节炎疗效更确切,降低了复发率,关节功能改善更明显,预后良好。     

膝类风湿性关节炎MRI早期诊断价值与关节镜下全滑膜切除术治疗

目的探讨膝类风湿性关节炎(RA)MRI检查的早期诊断价值,观察膝关节镜下全滑膜切除术的临床疗效。方法回顾性分析2008年1月至2012年12月梅州市人民医院收治的68例行膝关节镜下全滑膜切除术RA患者的临床资料,术前行X线片和注射钆对比剂MRI检查,术后常规病理检查。观察X线片、MRI检查诊断早期RA的准确性,记录患者术前,术后3、6、12个月Lysholm评分及类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)等实验室检查结果的变化。结果根据病理学检查结果,X线片、MRI检查诊断早期RA的准确率分别为66%(29/44)和97%(29/30),两者比较,差异有统计学意义(P0.05)。所有患者获得随访,随访时间12~38个月,平均随访时间18.6个月。术后3、6、12个月Lysholm评分及RF、ESR、CRP等指标明显优于术前,差异有统计学意义(P0.05)。结论 MRI检查诊断早期膝RA较X线片检查准确;全滑膜切除术是治疗膝RA较好的术式选择,术后患者关节功能恢复明显,RF、ESR和CRP等临床指标显著改善,近期效果满意。     

关节镜下滑膜切除术治疗类风湿腕关节炎

目的总结类风湿腕关节炎行关节镜下滑膜切除术的疗效。方法对35例类风湿腕关节炎患者行关节镜下滑膜切除术治疗。术前1周及术后1年采用VAS评分对腕关节疼痛进行评价,测量患者腕关节屈伸活动度,检测患者类风湿因子(RF)、C-反应蛋白(CRP)、红细胞沉降率(ESR)水平。结果患者均获得随访,时间12~20个月。VAS评分术前(8.5±2.7)分,术后1年(3.5±1.3)分;腕关节屈伸活动度术前77.0°±17.0°,术后1年117.0°±19.0°;RF术前(58.1±12.2)U/ml,术后1年(23.1±8.6)U/ml;CRP术前(31.3±4.0)mg/L,术后1年(13.1±3.0)mg/L;ESR术前(52.4±4.5)mm/1h,术后1年(22.5±3.6)mm/1h。术后1年各项指标与术前比较差异均有统计学意义(P0.01)。术后1年疗效评价:优15例,良11例,可7例,差2例,优良率74.29%。结论类风湿腕关节炎患者实施关节镜下滑膜切除术治疗,可减轻患者疼痛,提升关节活动度,效果显著。     

关节镜下滑膜切除治疗类风湿性肘关节炎的疗效评价

常规关节入路行滑膜切除术治疗类风湿性关节炎为一广泛接受的方案,具有较肯定的疗效,但患者术后可能出现术区疼痛,甚至因此影响康复训练,导致关节功能障碍,以及软组织损伤导致关节不稳。在治疗类风湿性膝关节炎方面,已有越来越多的外科医生选择关节镜下滑膜切除术,而对于类风湿性肘关节炎,关节镜下手术有相同的优点。该组病例共21侧肘关节,按Larsen分级分为四组。随访42个月以上(平均97个月)。关节镜入口有四种:正中偏外侧(肘外侧三角的中心点)、后外侧、前外侧与前内侧,术前与术     

关节镜治疗急性化脓性踝关节炎

[目的]探讨关节镜治疗化脓性踝关节炎的临床疗效。[方法]15例患者，通过关节液生化和常规诊断，在关节镜下清理并滑膜切除，术后持续对冲引流3周。ESR、CRP和功能随访1～4a。[结果]术后11．2 d ESR正常，术后9．1 d CRP正常，5例术后1个月功能完全恢复正常，7例术后2个月功能完全恢复，3例术3个月后功能完全恢复，1例功能恢复正常3个月后再发急性化脓性炎。[结论]关节镜下清理并滑膜切除治疗急性化脓性踝关节炎是一种很好的方法，具有创伤小、并发症少、关节功能恢复好等优点。     

膝关节滑膜切除术与关节腔灌洗术在治疗类风湿性关节炎中的疗效分析

[目的]探讨膝关节滑膜切除术与关节腔灌洗术2种不同方法治疗类风湿性关节炎（RA）的疗效。[方法]对32例RA患者（36个膝关节）根据美国风湿病学会（ARA）进行分期，分别采用膝关节滑膜切除术与关节腔灌洗术2种不同方法进行治疗，对其中20例（22个膝关节，以Ⅰ期为主）行关节腔灌洗术配合注射透明质酸钠治疗，对12例（14个膝关节，以Ⅱ期为主）行膝关节滑膜切除术，所有患者术前、术后均给予正规抗类风湿治疗，术后随访6个月，按Lysholm标准评分，判断手术疗效。[结果]术后早期症状均改善，灌洗组优良率为86．4％；滑切组优良率为85．7％。[结论]对于早期RA患者，经系统的抗类风湿治疗后，病变局限于单侧或双侧膝关节时，行关节腔灌洗术配合注射透明质酸钠治疗，可以取得比较满意疗效，对于中期以上滑膜重度增生，关节软骨部分破坏的患者，为抢救关节功能，宜尽早施行开放滑膜切除手术。     

类风湿关节炎关节镜下滑膜切除术（附119例随访分析）

作者分析了自１９８２～１９９４年间在本院行滑膜切除术后２年以上的类风湿关节炎病人６６例１３２个关节。其中关节镜下滑膜切除术１１９个关节，开放滑膜切除术１３个关节。平均随访７．３年，优良率为７４．２％。关节软骨无破坏组与有破坏组的优良率分别为９２．８％及１４．３％。作者认为保守治疗半年而效果不佳者应尽早行滑膜切除术。     

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.     

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.