局部或邻位皮瓣修复鼻部软组织缺损的分区应用

目的探讨鼻部软组织缺损的有效方法,以尽可能使修复组织在色泽、质地上与鼻部局部组织相近,且切口瘢痕隐蔽.方法结合Burget鼻部美学分区,将其再分为三个区域,根据分区选用局部或邻位皮瓣修复鼻部各区软组织缺损30例(鼻根部以Rintala鼻额部局部皮瓣推进3例;鼻中段的鼻背部行双侧斧状局部皮瓣旋转3例;鼻侧壁行对侧壁局部皮瓣转移,供区植皮4例;鼻端部以鼻唇沟皮下蒂岛状瓣转移修复鼻尖部7例;鼻唇沟局部皮瓣旋转修复鼻翼部7例;鼻背轴型皮瓣旋转修复鼻小柱6例).结果修复效果满意.结论根据鼻部分区选用局部或邻位皮瓣是修复鼻部软组织缺损的较好方法.     

局部或邻位皮瓣修复鼻部软组织缺损的分区应用

探讨鼻部软组织缺损的有效方法，以尽可能使修复组织在色泽、质地上与鼻部局部组织相近，且切口瘢痕隐蔽。方法 结合Ｂｕｒｇｅｔ鼻部美学分区，将其再分为三个区域，根据区选用局部或邻位皮瓣修复鼻部各区软组织缺损３０例（鼻根部以Ｒｉｎｔａｌａ鼻额部局部皮瓣推进３例；鼻中段的鼻背部行双侧斧状局部皮瓣旋转３例；鼻侧壁行对侧壁局部皮瓣转移，供区植皮４例；鼻端部以鼻唇沟皮下蒂岛状瓣转移修复鼻尖部７例；鼻唇沟局部皮瓣旋     

烧伤后鼻部及邻位组织缺损畸形的修复

目的 了解烧伤后鼻及邻位组织缺损的最佳修复方法 及效果. 方法 1999年1月-2008年12月,笔者单位采用额部扩张皮瓣、上臂带蒂皮瓣、耳后反流轴型岛状皮瓣及鼻唇沟皮瓣,修复烧伤后鼻部及邻位组织缺损畸形患者12例,其中全鼻缺损4例,鼻部分缺损8例.12例患者巾鼻缺损伴面颊部瘢痕3例,伴额部瘢痕5例,伴上唇外翻及上唇大部分缺损共5例.皮瓣面积3.0cm × 1.5 cm～10.0 cm×8.0 cm. 结果 采用额部扩张皮瓣修复5例、上臂带带皮瓣修复3例、耳后反流轴型岛状皮瓣修复1例、鼻唇沟皮瓣修复3例.12例皮瓣全部成活.随访1～7年,患者鼻的功能及外形均明显改善. 结论 额部皮瓣为修复烧伤后鼻缺损的首选皮瓣.面部严重烧伤,瘢痕明显,不能选择局部皮瓣或邻位皮瓣时,可考虑应用上臂带蒂皮瓣、耳后反流轴型岛状皮瓣等修复.     

邻近部位皮瓣转移修复鼻端部软组织缺损

选择不同的邻近部位皮瓣修复鼻端部软组织缺损。方法：根据鼻尖、鼻翼及鼻小柱不同范围的软组织缺损，选用邻近部位皮瓣转移修复22例(鼻唇沟皮瓣9例，反流轴型耳廓复合组织瓣3例，轴型鼻背旋转皮瓣4例，额部皮瓣6例)。结果：皮瓣转移至受区后在色泽、质地上与受区原有组织接近，修复效果满意。结论：邻近部位皮瓣转移是修复鼻端部不同范围的软组织缺损的较好方法。     

鼻部皮肤小肿瘤切除后的缺损修复

目的 回顾和总结鼻部小面积皮肤肿瘤切除后,创面的修复原则和术式选择.方法 选择直径≤2.0 cm,鼻下部1/3皮肤良恶性肿瘤切除后致鼻部组织缺损的73例患者.根据缺损部位、范围、类型和患者的要求,应用局部双叶皮瓣修复鼻尖、鼻翼和鼻侧壁皮肤软组织缺损(n=31);鼻唇沟皮瓣修复鼻翼外侧全层缺损(n=8);鼻唇沟皮下蒂皮瓣修复鼻翼皮肤软组织缺损(n=12);耳郭复合组织瓣游离移植修复鼻翼缘全层缺损(n=22).结果 71例患者手术获得完全成功,对修复术后效果满意.1例鼻唇沟皮瓣远端折叠部分皮肤浅层坏死,换药后愈合,鼻翼、鼻孔轻度变形.1例耳郭复合组织瓣游离移植再造鼻翼术后因感染而失败.结论 应用局部双叶皮瓣、鼻唇沟皮瓣、皮下蒂皮瓣或耳郭复合组织游离移植修复鼻部直径≤2.0 cm的皮肤肿瘤切除后的创面,可获得Ⅰ期修复的满意效果.     

鼻端部软组织缺损修复29例临床报告

目的探讨鼻端部软组织缺损修复的有效方法.方法根据鼻尖、鼻翼及鼻小柱不同范围的软组织缺损,修复方法包括邻近部位皮瓣转移修复19例(鼻唇沟皮瓣9例,额部皮瓣6例,轴型鼻背旋转皮瓣4例),耳郭组织移植10例(复合组织块游离移植7例,反流轴型耳郭复合组织瓣3例).结果 29例患者,随访2周至6个月,修复组织在色泽、质地上与受区接近,修复效果满意.结论耳郭复合组织移植和邻近部位皮瓣转移是修复鼻端部不同范围的软组织缺损的较好方法.     

鼻端部软组织缺损修复29例临床报告

目的探讨鼻端部软组织缺损修复的有效方法。方法根据鼻尖、鼻翼及鼻小柱不同范围的软组织缺损，修复方法包括邻近部位皮瓣转移修复19例(鼻唇沟皮瓣9例，额部皮瓣6例，轴型鼻背旋转皮瓣4例)，耳郭组织移植10例(复合组织块游离移植7例，反流轴型耳郭复合组织瓣3例)。结果29例惠者，随访2周至6个月，修复组织在色泽、质地上与受区接近，修复效果满意。结论耳郭复合组织移植和邻近部位皮瓣转移是修复鼻端部不同范围的软组织缺损的较好方法。     

鼻部不同部位缺损的修复

目的：探讨鼻部分或全部缺损的手术修复。方法：根据鼻部不同范围的缺损选择不同的方式进行修复，包括邻近皮瓣、岛状皮瓣、复合组织游离移植等。结果：31例鼻部缺损组织瓣修复中鼻唇沟皮瓣13例，邻近滑行皮瓣8例，额部岛状皮瓣5例，耳廓复合组织游离移植5例均成活。术后鼻外形均满意。结论：鼻缺损修复方式较多，应根据缺损的部位，范围选择不同的修复方式。     

鼻缺损修复术中美学亚单位原则的应用

目的探讨鼻美学亚单位原则在鼻部缺损修复和再造术中应用的效果和意义。方法鼻部各亚单位缺损患者共27例,根据鼻美学亚单位分区分为5组,为鼻背、鼻尖、鼻翼小叶、软组织三角以及涉及两个或两个以上亚单位组。根据缺损面积占亚单位的比例,对小于50%的缺损作亚单位局部修复,大于50%的则去除残余组织,行全亚单位重建。其中,游离组织移植(如植皮、耳廓复合组织移植)10例,局部皮瓣4例,额部皮瓣13例,术后随访5~37个月,以修复后的鼻外形和色泽来判断修复和再造效果。结果植皮、局部转移皮瓣14例全部存活;耳廓复合组织游离移植2例出现表皮发红发暗,半年后皮肤色泽渐趋正常;额部皮瓣鼻再造13例中,有1例出现鼻小柱伤口愈合不佳,鼻假体外露,鼻小柱瘢痕增生挛缩,二期行上唇黏膜瓣带蒂转移修复治愈。27例全部得到随访,患者和家属对手术结果均表示满意。结论运用鼻亚单位原则进行鼻部缺损修复和再造,与传统方法比较,能够获得更为满意的效果。     

鼻部缺损手术方法的探讨

目的 探讨采用鼻美学亚单位修复鼻部缺损后的美学效果.方法 根据鼻部缺损的部位和范围,按照美学原理进行不同供区的设计以修复缺损.对鼻翼缺损小于1.5 cm鼻亚单位.应用耳郭复合组织瓣修复;鼻缺损大于1.5 cm鼻业单位选择鼻唇沟皮瓣修复;扩张后的额部正中或旁正中皮瓣适宜修复大于一个鼻亚单位的全鼻缺损;对于额部瘢痕者.采用远位上臂内侧皮管分次转移修复鼻缺损.结果 本组23例患者,移植组织瓣均成活,再造鼻及各鼻亚单位逼真.外形良好.结论 鼻缺损的修复应根据缺损部位的大小选择不同部位的皮瓣,而大于50%全鼻或鼻亚单位的缺损,应彻底切除全鼻或鼻亚单位后再进行修复.     

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.