15例非特异性肉芽肿性前列腺炎临床报告

目的探讨非特异性肉芽肿性前列腺炎的临床和病理学特点。方法回顾分析15例经直肠前列腺活检明确诊断为非特异性肉芽肿性前列腺炎病例，其中15例患者给予抗炎对症治疗，哌拉西林钠舒巴坦钠（邦达）2．4mg／d，疗程3-6周不等，7例伴严重排尿困滩患者加服盐酸坦索罗辛（哈乐）0．2mg／d或者多沙唑嗪释控片（可多华）2mg／d。结果15例患者随诊3-20个月，排尿困难症状明显改善，肛门指诊（DRE）前列腺质地变软、硬结转小，血清前列腺特异抗原（PSA）明显下降。结论非特异性肉芽肿性前列腺炎极易与前列腺癌相混淆，需引起足够重视，确诊必须依靠前列腺活检。     

经尿道前列腺电气化术92例体会

我院自 1 998年 1 0月～ 2 0 0 0年 1月 ,应用经尿道前列腺电气化术 (TVP)治疗前列腺增生症(BPH) 92例 ,取得了满意疗效 ,报告如下。1　资料与方法1 .1　临床资料本组 92例 ,年龄 55～ 83岁 ,平均 72岁。有排尿困难史 1～ 1 0年 ,平均 3年。夜尿次数 4～ 1 0次。直肠指检前列腺最小 4.5cm× 3.6cm,最大 5.5cm× 6.0 cm。B超前列腺测重 40～ 1 2 0 g,平均 60 g。剩余尿量 50～ 2 0 0 ml,平均 82 ml。最大尿流率 5～1 2 ml/s,平均 8ml/s,IPSS评分 1 1～ 32分 ,平均2 4分。因尿潴留就诊入院 42例 (45.7% ) ,并发膀胱结石 6例 (6.5% ) ,并…     

非特异性肉芽肿性前列腺炎的诊治体会(附32例报告)

目的:探讨非特异性肉芽肿性前列腺炎(NSGP)的诊断和治疗方法。方法:2000年9月～2006年5月共诊治NSGP32例,均采用经直肠超声(TRUS)引导下穿刺活检病理确认后,给予抗生素等药物治疗。结果:NSGP的基本病理形态特征是以导管或腺泡为中心的肉芽肿。32例随访6～48个月,平均24个月。排尿刺激症状及梗阻症状好转,Qmax提高至15.0～24.0ml/s,3例尿潴留患者经治疗后,Qmax分别为12.0、14.5和16.5ml/s。直肠指检前列腺硬结缩小至0.5cm×1.0cm左右,质地变软,但恢复较慢,可达12个月。血PSA降至1.3～11.5μg/L,其中17例<4μg/L。4例于治疗后6～12个月症状复发,血PSA上升,经再次抗炎治疗,症状缓解,2例PSA<4μg/L;2例PSA仍>4μg/L,但未发现PCa。结论:TRUS引导下穿刺活检是确诊NSGP的方法;抗生素加用α受体阻断剂可明显缓解症状;对于梗阻症状严重,合并尿潴留患者可行经尿道电切术。     

急诊ESWL治疗后尿道结石并急性尿潴留29例分析

我院自 1 997年 1月～ 1 999年 5月应用国产ZL- 50 3型水囊式碎石机急诊行体外冲击波碎石术 ( ESWL)治疗后尿道结石并急性尿潴留者 2 9例 ,疗效满意 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 2 9例 ,均为男性 ,年龄 2 2～ 60岁 ,平均46.2岁。结石大小为 0 .5cm× 0 .5cm× 0 .8cm～1 .0 cm× 1 .1 cm× 1 .6cm。全部病例均以急性尿潴留就诊。尿潴留时间 4～ 1 2 h。 2 9例中有 5例并发轻度前列腺增生症。1 .2 　 治疗方法尿道粘膜麻醉后 ,由尿道外口注入无菌液体石蜡 5～ 1 0 ml,再用 F18尿道金属探经尿道轻轻将结石推入膀胱 ,然…     

8例直肠巨大腺瘤诊治报告

我院肛肠科 1 992年至 1 999年间共收治直肠巨大腺瘤 8例 ,均经肛门手术治愈。现报告如下。1　临床资料1 .1　一般资料 :本组男 6例 ,女 2例 ;年龄 1 6～ 2 2岁 3例 ,40～ 6 6岁 5例 ;病程 2～ 8年。肿瘤性质 :直肠管状腺瘤 3例 ,绒毛状腺瘤 3例 ,混合腺瘤 2例。其中 2例管状腺瘤瘤体中心癌变 ,但基底部无癌细胞浸润。瘤体下缘距肛门最近者 6 .0 cm,最远者约 1 1 .0cm。管状腺瘤大者 8cm× 8cm× 4cm,混合腺瘤大者 8cm× 6 cm× 4cm,小者 6 cm× 6 cm× 4cm。绒毛状腺瘤呈地毯样者最大 1 0 cm× 5 cm× 2 cm。1 .2　临床表现 :患者一般都有…     

慢性前列腺炎患者前列腺液IL-6和IL-8表达变化及意义

目的　探讨慢性前列腺炎患者前列腺液中IL 6和IL 8的变化与慢性前列腺炎类型、症状和前列腺液白细胞计数的相关关系。　方法　以两杯法尿液细菌培养、前列腺液常规检查和NIH CPSI评分 ,将 10 2例前列腺炎患者分型。放免分析法测定患者和 2 8例正常对照者前列腺液中IL 6和IL 8含量 ,比较结果并进行相关分析。　结果　 90例前列腺炎患者 (Ⅱ、ⅢA、Ⅳ型 )前列腺液IL 6和IL 8水平分别为 ( 0 .5 1± 0 .5 7)ng ml和 ( 10 .75± 7.96 )ng ml,高于正常对照组的 ( 0 .32± 0 .5 1)ng ml和( 4.5 6± 5 .6 8)ng ml(P <0 .0 5和P <0 .0 1)。Ⅱ型前列腺炎患者前列腺液IL 6和IL 8水平与ⅢA型和Ⅳ型者比较差别无显著性意义 (P >0 .0 5 )。前列腺炎患者前列腺液白细胞计数与IL 8水平呈正相关(r=0 .5 2 9,P <0 .0 1)。前列腺液IL 6和IL 8水平与NIH CPSI评分无相关性 (P >0 .0 5 )。　结论　慢性前列腺炎患者前列腺液IL 6和IL 8表达增高 ,并参与前列腺的炎症反应。前列腺液IL 6和IL 8水平可作为慢性前列腺炎的诊断依据之一。     

经腹腔镜脾切除治疗血液病

我院于 1993年 10月至 2 0 0 1年 2月应用腹腔镜脾切除术治疗原发性血小板减少性紫癜 (ITP)及遗传性球形红细胞增多症 (HS)患者 2 0例 ,并与传统手术方法进行比较 ,报告如下。临床资料1.一般资料 :腹腔镜脾切除组中 ,原发性血小板减少性紫癜患者 16例 ,遗传性球形红细胞增多症 4例。男 7例 ,女13例 ,年龄 16～ 6 5岁 ,平均 33岁。脾脏大小 8cm× 5cm×4cm～ 2 2cm× 13cm× 6cm ,平均 12cm× 8cm× 5cm。术中发现副脾 4例 (2 0 % )。 1988年 7月至 1993年 8月间应用传统手术方法脾切除治疗血液病患者 2 2例 ,其中原发性血小板减少性紫癜患…     

5例前列腺增生患者PSA＞60ng/ml的原因分析及治疗选择

目的 探讨前列腺增牛症患者血清前列腺特异性抗原(PSA)>60ng/ml的原因及治疗选择.方法 总结5例血清PSA>60ng/ml前列腺增生患者的临床资料以及手术治疗后PSA的变化,结合文献复习进行分析.结果 5例患者术后PSA水平均明显下降,术后3月PSA由术前平均(72.8±8.3)ng/ml降至平均(16.4±3.2)ng/ml.其中1例前列腺增生伴炎症患者由术前103.5ng/ml降至34.8ng/ml,l例前列腺增生伴部分不典型增生患者由术前84.6ng/ml降低至42.6ng/ml.术后6个月复查,5例PSA平均(11.6±4.8)ng/ml(7.5～18.5 ng/m1).结论 PSA增高除了与前列腺癌相关外,还与年龄、前列腺体积、尿潴留、尿路感染以及前列腺炎症密切有关.对于高水平PSA的前列腺增生患者,建议尽早采取手术治疗.     

腹膜后血管肌脂肪瘤破裂术中休克抢救成功一例

患者女,4 3岁,身高14 8cm ,体重4 5kg ,1d前不慎跌倒致左下腹阵发性绞痛伴胀痛来诊。贫血貌,腹部检查未扪及明显包块,左肾叩痛,移动性浊音(- )。腹部平片:未见异常X光征象,腹部B超:“下腹见一实性占位性病变,大小约8cm×6 5cm×8 4cm”。入院时RBC 3 1×10 12 /L、Hb 88g/L、Hct 0 2 5 ,术前RBC 1 85×10 12 /L、Hb 5 2 9g/L、Hct0 15。腹腔抽出血性液体3ml,拟作急诊剖腹探查。入室后开放静脉通路。以喷他佐辛30mg、丙泊酚10 0mg诱导,罗库溴铵35mg行气管插管,吸入异氟醚及N2 O/O2 维持麻醉。通气参数:潮气量4 0 0～5 0 0ml、呼…     

前列腺脓肿3例报告

例1　38岁。饮酒后第2d出现尿频、尿急、尿痛,排尿不畅,肛门疼痛,会阴部不适,发热(体温38.5～39.5℃),以急性细菌性前列腺炎收住院。直肠指检前列腺度肿大,右侧叶饱满,中央沟变浅,表面光滑有张力,压痛明显,无波动感。血常规检查白细胞16.0×109/L,尿常规检查红细胞+。B超示前列腺6cm×5cm×4cm,右侧叶有一直径约1.5cm液性区,靠近膀胱腔。抗感染治疗5d,尿道排出脓液约15ml,脓液培养为金黄色葡萄球菌。住院15d痊愈出院。半年后B超复查前列腺无异常,自诉性功能正常。例2　65岁。主诉排尿不畅,尿线细,夜尿频2年,以前列腺增生症收住院。直肠指…     

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.