哑铃状三叉神经鞘瘤的外科治疗

目的 探讨哑铃状三叉神经鞘瘤外科的最佳手术入路。方法 将外科手术的46例哑铃状三叉神经鞘瘤患者按年代分为2组。早期组（1978－1984）患者采用一系列常规硬膜下入路手术,后期组（1985－2000）应用经颅底开颅硬膜外入路手术。回顾性分析其临床资料及治疗经验。结果 早期组肿瘤全除率为42％（5／120,后期组为85％（29／34）,2组差异有显著性意义（χ^2＝8．8,P＜0．01）。2组患者暂时性颅神经障碍发生率分别为63％、47％（χ^2＝3．4,P＞0．05）;永久性颅神经障碍发生率分别为48％、15％（χ^2＝6．1,P＜0．05）。结论 经颅底开颅经硬脑外－经天幕－经硬膜下入路是切除哑铃状三叉神经鞘瘤最好的显微外科入路,不必切除岩骨尖。     

脊椎管内神经鞘瘤的手术治疗

目的：回顾分析了６６例脊椎管内神经鞘瘤的诊断和手术治疗特点。材料与方法：本组包括１９８３－１９９６年收治的６６例脊椎管内神经鞘瘤，其中颈段２７例，胸段１３例和腰骶段２６例，分别叙述临床表现为类型，影像学检查结果，手术治疗。结果：６６例均得到主时、准确的诊断和手术治疗。６０例获全切除，６例大部切除。平均随访２年１１个月，优良率为９０．９％、有效率为９７．０％。结论：（１）椎 神经鞘瘤并不少见，本组４     

后颅凹肿瘤211例

目的:通过手术治疗后颅凹肿瘤。方法:分析总结手术治疗198例后颅凹肿瘤的临床资料。结果:本组211例,198例进行了手术治疗,治愈133例占67.17％;好转30例,占15.15％,致残12例,占6.06％,未愈死亡23例,占11.61％,总有效率82.32％。病理示胶质瘤105例,神经鞘瘤51例,脑膜瘤17例,蛛网膜囊肿10例,胆脂瘤8例,脑囊虫7例,转移瘤4例,脊索瘤3例,血管母细胞瘤3例,脓肿3例,三叉神经鞘瘤2例,毛细血管瘤1例。结论:全麻显微镜下对后颅凹不同部位的肿瘤采用不同的手术入路,根据肿瘤情况进行切除。术中手术技巧及术后必要的监护是提高临床治愈率的关键。     

术中电生理动态监护下显微手术切除椎管神经鞘瘤（附65例报告）

目的 探讨术中电生理监护对椎管神经鞘瘤显微手术中的作用及意义，提高对椎管内神经鞘瘤的治疗水平。方法 回顾性分析65例术中电生理动态监护下，显微手术切除椎管内神经鞘瘤。结果 治愈60例（占92．3％），好转5例（占7．7％），无死亡；肿瘤全切62例，次全切除3例，全切率95．4％。结论 常规动态电生理监测下显微手术切除椎管神经鞘瘤，能保全脊髓神经的功能，减少副损伤，提高手术安全性；显微手术有助于提高肿瘤全切率，可有效减少术后复发。对影响脊柱稳定性的行脊柱融合内固定。     

上肢神经鞘瘤的显微手术治疗

神经鞘瘤可以发生在上肢的任何神经上，常需要手术摘除。临床上常见到手术摘除神经鞘瘤时伤及神经而引起功能障碍。1997年3月至2003年12月，我院在手术显微镜下摘除上肢神经鞘瘤37例，无1例发生严重并发症，效果良好。     

脊椎管内神经鞘瘤的显微外科切除及疗效分析

目的：进一步探讨提高脊椎管内神经鞘瘤的早期诊断率及显微外科手术疗效。方法：回顾1990年5月－2000年5月民治的脊椎管内神经鞘瘤42例,其中颈段8例,胸段21例,腰段13例,全部病例均经X线,脊椎造影、CT或MRI等影像学检查及病理切片诊断。结果：早期确诊率仅36％,术前确诊率为865。36例肿瘤获得全部切除术,6例肿瘤大部分切除,术后经1－10年随访,优良率91．6％,结论,要提高手术治疗效果,关键在于早期诊断,显微外科手术切除脊椎管内神经鞘瘤,能有效地防止肿瘤的复发,提高了治疗的效果。     

小儿原发性椎管内肿瘤(附77例分析)

目的：作者通过对77例小儿原发性椎管内肿瘤进行综合分析。旨在为临床医生提供详尽材料，以关注此病的诊断与治疗，方法：对77例原发性椎管内肿瘤的病理分型，发病率，发病部位进行了回顾性分析。特别是对MRI的影像特点进行了重点论述。结果：77例均行手术治疗，肿瘤全切76例，仅1例室管膜瘤行部分切除治疗，全部病例获得随访，术后症状消失或明显改善76例，脂肪瘤及脂肪纤维瘤占48%，皮样囊肿及畸胎瘤占22%，蛛网膜囊肿占15.6%。神经纤维瘤占4%，80%的病人肿瘤发生在腰骶部，所以常常合并脊髓栓系综合征，结论：（1）小儿原发性椎管内肿瘤以先天性的肿瘤为常见，而成人常见的神经鞘膜瘤和神经胶质瘤不多见。（2）MRI是椎管内肿瘤目前最精确的诊断方法，对肿瘤的治疗和预后价值极大，应广为利用。（3）一旦确诊应尽早手术治疗。     

38例听神经瘤手术护理

听神经瘤是起源于第8颅神经的肿瘤，是颅内常见肿瘤之一，约占颅内肿瘤的8％～10％，后颅窝肿瘤的25％，在小脑桥脑角肿瘤中占90％～95％，属良性，发展缓慢，病程长。临床上主要表现为第8、7、5、9、10、11颅神经障碍，小脑损害，脑干受压、移位等，颅内压增高症状或早或晚亦将发生，但多较晚出现。手术完全切除肿瘤是目前最理想的治疗方法，预后良好。。但术后并发症多，病情变化快，病死率及致残率较高。我科1991年5月至1996年12月收治听神经瘤38例，现将手术护理总结如下。1临床资料本组38例，男21例，女17例，年龄14～65岁，平均43．9…     

胃神经鞘瘤的研究进展

胃神经鞘瘤是起源于间叶组织的肿瘤,临床发病率较为少见,占所有胃间质瘤的6.3%,肿瘤好发于胃体部,通常起源胃粘膜下神经从。大部分胃神经鞘瘤患者没有任何临床症状,影像学检查能起到诊断作用,但确定诊断仍需要病理学检查,其中S-100蛋白是诊断胃神经鞘瘤的"金标准"。胃神经鞘瘤通常需要与胃肠道间质瘤、胃肠自主神经肿瘤等相鉴别。治疗方面,完整的手术切除为首选治疗。     

105例新疆少数民族肺癌临床分析

目的 了解新疆少数民族肺癌发病情况和临床病理特征。方法 回顾性分析了105例少数民族肺癌的性别、民族、分布情况、临床分期和治疗方法。结果 少数民族肺癌占同期住院肺癌病人的8．36％，男：女比约为6：1，男女平均发病年龄具有统计学差异，晚期(Ⅲ期 Ⅳ期)病人占58．1％。结论 少数民族肺癌发病率相对较低，男性明显高于女性，晚期病人多，手术切除率低。     

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.     

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.     

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.