应用多个扩张器修复大面积皮肤缺损

目的寻求在面颈部或全上肢大面积皮肤缺损的修复中，优于传统手术疗效的方法。方法同时采用多个扩张器置入与缺损区皮肤颜色、质地相近的不同部位进行扩张，扩张结束后，只经一次手术完成修复治疗。结果共治疗６例，经随访１～１．５年，外观及功能均较满意。结论在充分做好术前设计及严防扩张器并发症发生的情况下，对于面颈部及上肢大面积皮肤缺损的修复，本方法能取得更较满意的效果。     

应用多个扩张器修复大面积皮肤缺损

寻求在面颈部或全上肢大面积皮肤缺损的修复中，优于传统手术疗效的方法。方法 同时采用多个扩张器置入与缺损区皮肤颜色，质地相近的不同部位进行扩张，扩张结束后，史经一次手术完成修复治疗。结果 共治疗６例，经随访１－１．５年，外观及功能均较满意。     

侧腹部扩张任意型皮瓣修复上肢皮肤软组织缺损

目的 提高上肢大面积皮肤软组织缺损的外科治疗效果。减少供皮区畸形,方法 于侧腹部埋置扩张器,经充分扩张后,取出扩张器,形成蒂在腹部的扩张皮瓣。修复扩张器取出创面后,将“额外”皮瓣远位直接移转至上肢修复皮肤软组织缺损。结果 1997年以来,应用该方法为6例患者修复上肢皮肤软组织缺损,移转扩张皮瓣全部成活,无血运障碍、皮瓣坏死等并发症发生。获得满意效果。结论 在上肢局部无可利用的正常皮肤软组织修复缺损时,远位扩张皮瓣带蒂直接移转是一种值得考虑且安全可靠的手术方法。     

扩张皮瓣在头面颈部皮肤缺损修复中的应用

目的:探讨皮肤扩张皮瓣在头面、颈部皮肤各类缺损修复中的手术方法及临床疗效。方法:总结自2004年以来,应用扩张皮瓣修复头面、颈部皮肤缺损患者23例,根据缺损不同部位情况设计扩张器的大小、形状及埋置方式,二期以旋转,推进,轴形皮瓣方式转移扩张皮瓣修复缺损区。结果:所有23例患者的共使用扩张器36只,一次修复缺损面积最大16.0cm×12.0cm,出现扩张器渗漏1例及扩张器外露1例则选择二期扩张器置入,并发血肿、感染1例,发生率约13%。术后皮瓣均成活,修复后形态自然。随访3个月至5年,疗效满意。结论:充分做好术前设计,提高手术技巧的前提下应用扩张皮瓣是修复头面、颈部皮肤缺损的理想选择。     

扩张的锁骨前胸轴型皮瓣跨区修复面颌部大面积软组织缺损

目的　寻找一种修复面颌部大面积软组织缺损且不破坏颈部自然轮廓的的手术方法。方法　在锁骨下前胸部皮下植入 1～ 2个扩张器 ,经扩张后 ,提供与面部皮肤肤色、质地、厚度相近的组织瓣 :锁骨前胸皮瓣 ,跨过颈部 ,修复面颌部软组织缺损。结果　自 1998年 4月～ 2 0 0 0年 12月共治疗 10例面颌部烧伤后瘢痕挛缩病人。瘢痕切除后皮肤缺损面积为 14cm× 7cm～ 2 8cm× 9cm ;皮瓣形成面积为 17cm× 6cm～ 30cm× 9cm。随访 1～ 2年 ,外观及效果均满意。结论　应用扩张后的锁骨前胸皮瓣 ,跨区修复面部大面积软组织缺损 ,不仅能使面部外观和功能得到改善 ,而且不破坏颈部的自然轮廓 ,供区可直接缝合 ,是一种用于修复面颌部软组织缺损的理想手术方法。     

扩张后超薄皮瓣在面颈部软组织缺损中的应用

探讨面颈部软组织缺损修复后不再发生挛缩，减少臃肿，保持色泽和谐。利用扩张器置于颈、上胸部真皮下血管网下进行皮肤扩张后修复面颈部缺损。结果临床完成９例，效果满意。用扩张后超薄皮瓣修复面颈部软组织缺损是较好的方法之一。     

扩张器重叠连续扩张技术修复体表大面积皮肤缺损

目的提供一种修复体表大面积皮肤缺损的方法.方法Ⅰ期手术埋置扩张器时,在同一个组织腔隙内同时埋置两个扩张器.Ⅱ期手术取出扩张器,进行扩张皮瓣转移的同时,在皮瓣下再次重叠埋置扩张器.如此循环往复,直至大面积皮肤缺损被全部修复.结果共修复各种原因所导致的体表大面积皮肤缺损患者18例,连续扩张次数最少2次,最多9次,每例患者使用的扩张器最少8个,最多42个.除1例患者术后出现1组(2个)扩张器感染外,其余病例术后无血肿、感染、皮瓣坏死等并发症发生.随访时间为6～18个月,远期效果满意.结论扩张器重叠、连续扩张技术在保证扩张过程顺利进行的同时,可以最大限度地对皮肤进行扩张,缩短治疗时间,是一种较好的修复体表大面积皮肤缺损的方法.     

扩张后超薄皮瓣在面颈部软组织缺损中的应用

探讨面颈部软组织缺损修复后不再发生挛缩,减少臃肿,保持色泽和谐。利用扩张器置于颈、上胸部真皮下血管网下进行皮肤扩张后修复面颈部缺损。结果临床完成９例,效果满意。用扩张后超薄攴昨面颈部软组织缺损是较好的方法之一。     

扩张的锁骨前胸轴型皮瓣跨区修复面颌部大面积软组织缺损

目的　寻找一种修复面颌部大面积软组织缺损又不破坏颈部自然轮廓的的手术方法。方法　在锁骨下前胸部皮下植入 1～ 2个扩张器 ,经扩张后 ,提供与面部皮肤肤色、质地、厚度相近的组织瓣———锁骨前胸皮瓣 ,跨过颈部 ,修复面颌部软组织缺损。结果　自1998年 4月～ 2 0 0 0年 12月共治疗 10例面颌部烧伤后瘢痕挛缩病人。瘢痕切除后皮肤缺损面积为 14cm× 7cm～ 32cm× 9cm ;皮瓣形成面积为 17cm× 6cm～ 30cm× 9cm。随访 1～ 2年 ,外观及效果均满意。结论　应用扩张后的锁骨前胸皮瓣 ,跨区修复面部大面积软组织缺损 ,不仅能使面部外观和功能得到改善 ,而且不破坏颈部的自然轮廓 ,供区可直接缝合 ,是一种用于修复面颌部软组织缺损的理想手术方法且供区不需植皮。     

扩张器重叠连续扩张技术修复体表大面积皮肤缺损

目的提供一种修复体表大面积皮肤缺损的方法。方法Ⅰ期手术埋置扩张器时，在同一个组织腔隙内同时埋置两个扩张器。Ⅱ期手术取出扩张器，进行扩张皮瓣转移的同时，在皮瓣下再次重叠埋置扩张器。如此循环往复，直至大面积皮肤缺损被全部修复。结果共修复各种原因所导致的体表大面积皮肤缺损患者18例，连续扩张次数最少2次，最多9次，每例患者使用的扩张器最少8个，最多42个。除1例患者术后出现1组(2个)扩张器感染外。其余病例术后无血肿、感染、皮瓣坏死等并发症发生。随访时间为6～18个月，远期效果满意。结论扩张器重叠、连续扩张技术在保证扩张过程顺利进行的同时，可以最大限度地对皮肤进行扩张，缩短治疗时间，是一种较好的修复体表大面积皮肤缺损的方法。     

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.     

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.     

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.