综合外鼻美容手术的美学设计与探讨

目的探讨在一次手术中对外鼻进行综合美容整形的方法,以获得符合美学规律的鼻外形.方法针对患者鼻部外观的缺陷,参考额鼻角、鼻唇角、鼻长宽比、鼻尖角和弦等鼻部美学指标,综合的设计手术方案和手术方法.并对行综合外鼻部美容手术的32例患者进行分析.结果经1～6个月的随访,行综合外鼻美容手术的32例患者中28例满意,占87.5%.结论采用综合外鼻美容手术的设计方案和手术方法,能获得较满意的术后效果,综合外鼻美容手术值得推广和应用.     

基于鼻面比例美学标准的鼻综合整形术

目的:探讨应用美学标准中鼻部与面部各角度及相关比例进行鼻综合整形术的效果及其临床应用。方法:自2012年2月至2015年6月,对78例鼻部求美者行基于美学标准的鼻综合整形术。根据鼻面比例美学标准设计手术方案,取自体软骨作鼻中隔的延伸移植、鼻小柱的支撑移植及鼻尖的轮廓移植,鼻背应用肋软骨或膨体假体,骨性轮廓整形采用自体脂肪充填额部、面中部、梨状孔。结果:所有患者术后鼻部外观佳,鼻部与面部各比例均衡,符合美学标准,无明显瘢痕,术后随访患者均满意。结论:本手术设计符合美学标准,操作方便,术后远期效果好,鼻部外形佳,面部轮廓饱满,鼻面各比例及角度协调,可作为鼻综合整形术的可行术式之一。     

联合部分筛骨垂直板在鼻美容整形术中的应用

目的探讨筛骨垂直板应用于鼻美容整形术中的方法、效果及其优缺点。方法对35例鼻部有美学缺陷的求美者,施行常规开放入路鼻美容整形术。术中取部分筛骨垂直板加鼻中隔软骨和耳软骨重建强有力的鼻尖支架,再结合鼻背假体隆鼻。术后随访观察是否出现相关并发症,并对术后鼻部美学效果进行评价。结果术后随访3~9个月,所有求美者均未见其他并发症发生。鼻美学效果评价:32例满意;3例欠满意,其中2例对鼻背高度欠满意,1例出现轻微鼻背假体歪斜,总体对鼻尖形态满意。结论联合应用部分筛骨垂直板在一定程度上解决了鼻美容整形术中材料不足的问题,操作安全可行,美学效果较佳,求美者的满意度较高。     

自体耳软骨移植鼻尖成形术临床效果

随着生活水平的提升．人们对美的追求日益增强,越来越多的美容就医者要求有一个适合自己的鼻形,这也突出了鼻部美学在人体美学上的重要意义,而鼻尖部成形术则占整个鼻部整形的相当部分比例,一个符合美学并有个性的鼻形是爱美之人共同的愿望。我们对86例美容就医者行自体耳软骨移植鼻尖成形术,获得满意效果。     

膨体聚四氟乙烯联合鼻中隔软骨及耳软骨在分段搭建美学亚单位鼻综合整形术中的应用

目的:探讨依据鼻部局部美学亚单位间不同的解剖特点,采用膨体聚四氟乙烯(Expanded polytetrafluoroethylene,e-PTFE)联合鼻中隔软骨及耳软骨在鼻综合整形术中对鼻部进行分段调整的效果。方法:2017年8月至2019年3月,应用该方法进行了32例手术,取鼻正中飞鸟形切口加双侧鼻翼缘切口,利用膨体聚四氟乙烯、鼻中隔软骨、耳软骨,对鼻背、鼻小柱、鼻尖等各个美学分区进行逐一调整,观察其效果。结果:本组29例获得随访,随访时间3~17个月,恢复都较满意,取得了较好效果,无慢性感染、假体歪斜、鼻尖皮肤变薄等并发症发生。结论:根据鼻部的美学分区,通过对鼻部美学亚单位分别修饰处理,可以达到鼻部外观和手感完美统一的效果。     

鼻部综合整形术十年回顾

国内的鼻部再造修复术的报道始于20世纪40年代,鼻部单项美容整形术的报道始于40年代末,鼻部的综合美容整形术在90年代后期开始发展较快. Burget和Menick[1]于1985年提出了鼻部美学亚单位分区的概念,即将鼻部划分为鼻背、鼻尖、鼻小柱、双侧鼻翼、鼻侧壁和软三角区(soft triangles)6个美学亚单位.我们将两个以上亚单位同时予以纠正的鼻部整形界定为鼻部综合整形.目前,国内越来越多的整形医师已经意识到,单纯鼻梁增高对鼻外形的整体改善效果是有限的,要想改善鼻外形,需将多个鼻部亚单位进行综合整形.笔者综合我院十年(1999～2008年)的统计资料(鼻部整形手术为7846例,其中鼻综合整形术1933例,占鼻部手术的25%),将鼻部综合整形阐述如下.     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的应用

的 探讨予以鼻整形手术患者自体肋软骨移植构建鼻尖软骨复合体治疗的临床价值。方法 选 取2021年4月-2022年10月于南昌诺颜医疗美容医院行鼻整形手术的200例患者为研究对象，通过奇偶法 分为试验组和对照组，每组100例。试验组采用自体肋软骨移植构建鼻尖软骨复合体，对照组采用常规 材料复合体，比较两组鼻部美学角度测量值、患者满意度及并发症发生率。结果 试验组鼻唇角、鼻面 角、额鼻角水平均高于对照组（P＜0.05）；两组鼻背高度比较，差异无统计学意义（P＞0.05）；试验组 鼻部外形、鼻部高度及整体满意度评分均高于对照组（P＜0.05）；试验组并发症发生率为3.00%，低于 对照组的13.00%（P＜0.05）。结论 将自体肋软骨移植构建鼻尖软骨复合体用于鼻整形手术中的效果较为 理想，可有效改善鼻部形态，且患者满意度高，不良反应少。     

通过鼻再造术一次性修复鼻及鼻周缺损

目的：探索一次性修复鼻及鼻周缺损的治疗方法。方法：1995年～2008年,收治34例鼻及鼻周缺损的患者,男21例,女13例;年龄17～70岁。先行额部扩张器置入术。二期手术,利用缺损周围的局部翻转皮瓣形成鼻衬里,将缺损纳入鼻前庭;额部扩张皮瓣移位行鼻再造术。三期断蒂。病程6～26月。结果：34例患者,32例疗效满意。结论：将鼻周的缺损视作术后新鼻部解剖区的一部分,再造全鼻并修复缺损,重建面部美学解剖分区。该方法与传统方法相比,能够获得更为满意的效果。     

鼻部美学分区在自体脂肪颗粒注射精细隆鼻术中的应用

目的探讨鼻部美学分区在自体脂肪颗粒注射精细隆鼻术中的应用效果。方法根据美学标准,将鼻部划分为10个美学亚单位,对19例患者按照鼻部美学分区行脂肪颗粒注射隆鼻术。结果本组共19例患者,鼻部肿胀于注射后5～10 d自行消退,无一例发生感染、血肿、血管栓塞等并发症。所有患者经1、2次注射后鼻背挺拔,鼻尖饱满、圆润,鼻部皮肤光泽度增加,鼻根纹减轻或消失,术后经1～20个月的随访,医师和患者均较满意。结论以鼻部美学分区为基础对自体脂肪颗粒注射隆鼻术患者进行的术前评估,有助于获得精细的美容效果。     

3D照相技术辅助精准美学设计在鼻整形术中的应用

目的探讨3D照相技术辅助精准美学设计在鼻整形中的临床应用效果。方法手术前与求美者有效沟通,应用3D照相技术采集求美者全面部形态的原始数据,应用3D模拟软件face sculptor进行三维立体成像及数据分析。与求美者一起确定理想的鼻背长度、高度、弧度、鼻尖突出度,鼻小柱-上唇角,鼻额角等鼻部美学亚单位形态,获得双方认可的、理想的鼻部三维立体效果。医师通过对设计后的效果进行测量,指导术中操作并完成手术。结果本组共102例求美者。其中95例对术后效果满意;4例术后鼻尖突出度降低,鼻尖下旋,行Ⅱ期手术修复后效果满意;2例出现鼻背轻微偏斜,不影响美观;1例术后1个月出现不明原因感染,给予局部清创后好转;无其他术后并发症发生。结论 3D照相技术值得在整形美容领域推广。     

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.