原发性输尿管癌的诊断和治疗

目的提高对原发性输尿管癌的诊断和治疗水平。方法回顾性分析19例确诊为原发性输尿管癌患者的诊断方法和治疗手段。结果19例均为移行细胞癌,术前确诊14例,确诊率为73.7%。全部患者行手术治疗,术后随访1月~7年,3年内死亡4例,存活5年以上3例,3~5年4例,余8例随访1月~3年存活。结论静脉肾盂造影、逆行肾输尿管造影、膀胱镜检查是诊断原发性输尿管癌的基本检查手段,输尿管镜检查配合取活检是原发性输尿管癌术前重要的确诊方法。对于高期、高级别肿瘤,肾、输尿管全长、膀胱袖口状切除仍为最有效和首选的手术方法,对于低期、低级别肿瘤可考虑保留肾脏的手术,包括输尿管肿瘤段部分切除、输尿管端端吻合术,输尿管下端、膀胱部分切除 输尿管膀胱移植术,输尿管镜电切术。     

原发性输尿管癌的诊断与治疗(附28例报告)

目的:提高原发性输尿管癌的诊治水平。方法:回顾性分析2 8例经病理证实的原发性输尿管癌,对其诊断与治疗进行讨论。结果:2 8例证实均为移行细胞癌,主要症状有:肉眼血尿、患侧腰部疼痛和肾积水。经静脉肾盂造影,膀胱镜检查,逆行肾盂造影,CT检查,术前确诊19例,术前确诊率67.8%。2 8例病人均手术治疗,采用三种手术方式,其中2 5例得以随访,死亡18例。结论:肉眼血尿,患侧腰部疼痛和肾积水是原发性输尿管癌的主要临床症状;静脉肾盂造影、膀胱镜检查和逆行肾盂造影是原发性输尿管癌的主要检查方法;患肾、输尿管全长和膀胱袖套状切除术,是原发性输尿管癌的主要术式。     

输尿管肿瘤诊治研究（附27例报告）

目的：提高输尿管肿瘤的诊治水平。方法：回顾性分析27例输尿管下段肿瘤的临床资料,总结诊治经验。结果：通过术中冷冻及术后病理证实,24例为输尿管移行细胞癌,2例息肉,1例为平滑肌瘤。术前经B超、IVP、MRU、输尿管镜检查等确诊16例,行手术治疗。结论：联合应用B超、IVP、MRU、输尿管镜检查可提高输尿管肿瘤的诊断符合率。良性肿瘤采用输尿管镜下钬激光治疗,采用后腹腔镜辅助小切口。肾输尿管及膀胱袖套状切除术治疗输尿管移行细胞癌,该术式安全、有效,可确保完整切除全长输尿管。     

输尿管镜诊治原发性输尿管癌

目的探讨原发性输尿管癌的腔内诊断与治疗方法。方珐回顾性分析11例原发性输尿管癌应用输尿管镜诊断与治疗的诊断符合率和疗效。结果11例均为移行细胞癌，术前确诊11例，确诊率为100％。术后随访3个月-2年，仅2例分别于术后8月和12月原位复发，再次行输尿管镜电切。结论输尿管镜检查配合取活检是原发性输尿管癌术前重要的确诊方法。对于早、中、低期、低级别原发性输尿管肿瘤，应用输尿管镜电切技术治疗完全可以替代传统的肾、输尿管全长、膀胱袖口状切除术。     

原发性输尿管癌的早期诊断与治疗(附26例报告)

目的：提高原发性输尿管癌的诊治水平。方法：回顾性分析26例原发性输尿管癌临床资料，比较各种检查方法，总结诊治经验。结果：26例术后均行病理检查证实为移性细胞癌。术前经B超、IVU、膀胱镜及逆行肾盂输尿管造影、CT、MRU等确诊24例(92．3％)。结论：联合应用B超、IVU、膀胱镜、逆行肾盂输尿管造影和CT、MRU检查方法，可提高原发性输尿管癌的诊断符合率。膀胱镜、逆行肾盂输尿管造影是原发性输尿管癌的最基本的检查手段。治疗以手术为主。     

原发性输尿管癌17例报告

目的 探讨原发性输尿管癌的诊断和治疗方法.方法 总结1998年7月～2008年6月收治的17例原发性输尿管癌患者的临床资料.结果 17例均为移行细胞癌.阳性率较高的检查有逆行尿路造影、64排CT、磁共振水成像、输尿管镜检查、荧光原位杂交技术（FISH）,阳性率分别为70.6%、100.0%,81.8%、85.7%和100.0%.治疗以肾、输尿管、膀胱袖套状手术切除为主,术后辅以膀胱灌注化疗.15例获随访4月～8年,5年生存率为37.5%（3/8）.结论 早期诊断和综合治疗是提高原发性输尿管癌远期疗效的关键.     

原发性输尿管癌的诊断与治疗(附28例报告)

目的：提高原发性输尿管癌的治疗水平。方法：结合有关文献分析了１９８４年１月￣１９９７年７月收治的２８例原发性输尿管癌的临床特点、诊断、治疗及预后并进行讨论。结果：２８例术后均经病理检查证实。首发症状以肉眼血尿最常见,膀胱镜检、逆行输尿管造影和输尿管镜检查是最重要的诊断方法,治疗以手术为主。２８例中１７例获得随访,其中９你无瘤生存,８例死亡。结论：原发性输尿管癌预后与肿瘤的分级、分期密切相关,早期诊     

原发性输尿管癌26例的诊断与治疗

目的：提高原发性输尿管的诊治水平。方法：结合献回顾分析了1986/2001收治的26例原发性输尿管癌的临床特点、诊断、治疗及预后。结果：25例术后病理检查证实为输尿管移行细胞癌，主要症状有肉眼血尿，病变侧肾积水。CT及膀胱镜检查，逆行输尿管造影和输尿管镜检查为主要诊断方法，以手术治疗为主。26例中有19例得以随访，其中13例生存，9例死亡。结论：凡原因不明的血尿患，经B超或静脉尿路造影检查，发现肾积水或肾不显影时，应考虑到原发性输尿管癌的可能，其预后与肿瘤的分级及分期密切相关。早期诊断、正确治疗和预防复发是提高患生存率的关键。     

原发性输尿管癌的诊断与治疗(附14例报告)

目的:提高原发性尿管癌的诊治水平。方法:结合有关文献分析收治的14例原发性输尿管癌的临床特点、诊断和治疗并进行讨论。结果:14例术后均经病理证实。首发症状以血尿常见,逆行输尿管造影检查和输尿管镜检查是最重要的诊断方法,治疗上以手术为主。14例中10例获得随访,2年内死亡5例,存活2～5年者3例。结论:早期诊断、合理的治疗是提高患者生存率的关键。     

原发性输尿管恶性肿瘤24例分析

目的探讨原发性输尿管恶性肿瘤的诊断、治疗和预后。方法对1992年1月～1999年12月经手术及病理证实的24例原发性输尿管癌进行回顾性分析。结果24例病理均为移行细胞癌，组织学分级：移行细胞癌Ⅰ级10例，Ⅱ级9例，Ⅲ级5例；临床分期：T1期10例，T2期9例，T3～T4期5例。后腹膜淋巴结清扫5例中3例发现有淋巴结癌转移。24例中有22例得到随诊，随诊时间2个月～7年，平均4年2个月。生存3年以上18例(75％)，有8例术后2个月～3年膀胱内出现移行细胞癌，其中输尿管移行细胞癌Ⅰ级5例，Ⅱ级3例，6例为输尿管下段肿瘤。1例7年中共复发5次。复发性肿瘤行TUR—BT或激光治疗，膀胱内多发性复发性肿瘤行全膀胱切除2例。T3～T4期5例，有3例获随诊，3年内死于远处肝、肺转移。结论静脉肾盂造影和逆行造影、膀胱镜、输尿管镜检查及尿脱落细胞学检查是诊断本病的重要手段，输尿管镜检查加活检是输尿管肿瘤诊断的最可靠依据。输尿管肿瘤预后、肿瘤的膀胱内复发、全身转移与肿瘤的分级分期及肿瘤部位有关。     

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.     

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.     

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.