儿童陈旧性孟氏骨折合并桡神经深支损伤

儿童陈旧性孟氏骨折合并桡神经深支损伤并不多见。我们自1985～1995年间共收治此类损伤12例,报告如下。1　临床资料本组男9例,女3例;年龄5～14岁;跌伤8例,车祸3例,砸伤1例。就诊时间伤后3～18周,其中伤后4～6周占8例。骨折类型:全部病例均为伸直型闭合性损伤。神经损伤情况:12例均为完全性桡神经深支损伤,其中2例合并桡神经浅支损伤。2　治疗方法及结果所有病人均行手术治疗。对骨折脱位的处理:行开放整复,环状韧带修复或重建4例,未行环状韧带修复或重建,仅用克氏针固定者8例。12例中仅3例作了桡神经深支探查松解。术后3周拔除固定桡骨头克…     

尺骨截骨治疗儿童陈旧性孟氏骨折

目的探讨尺骨截骨手术治疗陈旧性儿童孟氏骨折的疗效。方法对28例患儿采取尺骨截骨固定桡骨小头复位，同时行环状韧带重建，其中3例行桡骨中段缩短截骨固定。结果28例均得到随访，时间6个月～8年。肘关节功能：优20例，良8例。4例合并桡神经损伤患儿完全得到恢复。结论尺骨截骨手术是治疗儿童陈旧性孟氏骨折良好术式。     

儿童孟氏骨折伴桡神经深支损伤23例临床分析

目的：增强对儿童孟氏骨折伴桡神经深支抽伤疾病的认识，观察治疗效果。方法：对23例儿童孟氏骨折伴桡神经深支损伤的临床资料进行分析。结果：30d以内就诊者8例桡神经功能完全恢复，1个月-1年者9例桡神经功能完全恢复，1例肌力恢复至4级。1年以上者3例中仅1例桡神经功能完全恢复，余2例肌力分别恢复至4级和2级。结论：儿童孟氏骨折伴桡神经深支损伤早期诊断及时治疗效果良好。     

陈旧性孟氏骨折并桡神经深支损伤

本文报告22例陈旧性孟氏骨拆并桡神经深支损伤病人的诊治过程及随访结果.桡神经深支损伤多发生在神经在桡骨小头前外方经Frohse弓进入旋后肌处,为疤痕粘连或压迫造成.早期诊治可获满意疗效,对于陈旧性损伤者应手术矫正尺骨畸形,复位桡骨小头,探查桡神经予松解治疗.作者观察桡神经深支伤的主要体征为伸拇、伸指及拇指外展功能障碍,只个别病人有伸腕障碍.     

尺骨成角延长截骨治疗儿童陈旧性孟氏骨折

目的探讨应用尺骨截骨后成角延长钢板内固定术治疗儿童陈旧性孟氏骨折的疗效。方法对12例陈旧性孟氏骨折患儿(病程45 d~18个月)行手术截骨矫正内固定治疗。结果患儿均获随访,时间10~18个月。根据Mackay疗效评定标准:优11例,良1例。结论尺骨截骨成角延长治疗儿童陈旧性孟氏骨折,通过手术矫正尺骨畸形无需重建环状韧带,能够恢复正常的肱桡关节关系,改善关节功能。     

儿童孟氏骨折并桡神经损伤治疗方式的选择

目的探讨儿童闭合性孟氏骨折并桡神经损伤的治疗方式。方法回顾性分析自2012-06—2014-08诊治的74例儿童闭合性孟氏骨折并桡神经损伤,32例新鲜骨折采用手法复位加石膏外固定(A组),22例新鲜骨折手法复位失败后行切开复位钢板内固定(B组),20例陈旧性骨折行尺骨畸形矫正联合神经探查术(C组)。结果 3组骨折均一期愈合,愈合时间3~5个月,平均4.2个月。术后1.5个月桡神经功能恢复有所进展。3组术后9个月肘关节功能优良率差异无统计学意义(χ2=1.068,P=0.213)。3组术后9个月桡神经功能优良率差异无统计学意义(χ2=0.946,P=0.127)。结论手法复位治疗儿童闭合性孟氏骨折并桡神经损伤同样能够正常恢复肘关节和桡神经功能。     

前后联合入路治疗儿童陈旧性孟氏骨折

[目的]探讨前后联合入路行关节切开复位、尺骨截骨术治疗儿童陈旧性孟氏骨折的方法及疗效。[方法]回顾性分析2010年11月~2015年1月收治的22例陈旧性孟氏骨折患儿资料。男15例,女7例,平均年龄7.5岁。伤后至手术时间除2例分别为3年、5年外,其余20例为1~12个月。患者X线片示桡骨头脱位,尺骨桡侧或掌侧弓形弯曲,伤后时间长者见桡骨过度生长。2例伴有桡神经深支损伤症状。所有患儿均采用经肘前Henry入路行肱桡关节切开、瘢痕彻底清除,有桡神经损伤者同时行神经探查松解;肘后沿尺骨嵴做纵切口,在尺骨鹰嘴下4~5 cm横行截骨,矫正尺骨畸形并反向成角、截骨端延长后予钢板固定。所有患儿均不行环状韧带重建。[结果]本组患儿随访12~59个月,平均15.4个月。根据Mackay功能评定标准,优19例,良2例,差1例。X线片示1例再脱位、2例半脱位,余复位稳定。术后肘关节屈伸功能较术前改善,差异具有统计学意义(P<0.05);手术前后前臂旋转功能的差别无统计学意义(P>0.05)。未出现血管神经损伤、异位骨化、尺桡骨骨性连接等并发症。2例桡神经深支损伤患儿3个月内恢复正常。[结论]前后联合入路治疗儿童陈旧性孟氏骨折具有术野显露好、术中操作简便、术后并发症少等优势。前入路允许直视下处理关节内病理改变,同时便于行桡神经探查松解,后入路有利于尺骨截骨矫形术。     

儿童孟氏骨折伴桡神经深支损伤23例临床分析

目的:增强对儿童孟氏骨折伴桡神经深支损伤疾病的认识,观察治疗效果。方法:对23例儿童孟氏骨折伴桡神经深支损伤的临床资料进行分析。结果:30d以内就诊者8例桡神经功能完全恢复,1个月～1年者9例桡神经功能完全恢复,1例肌力恢复至4级。1年以上者3例中仅1例桡神经功能完全恢复,余2例肌力分别恢复至4级和2级。结论:儿童孟氏骨折伴桡神经深支损伤早期诊断及时治疗效果良好。     

儿童孟氏骨折伴桡神经深支损伤23例临床分析

目的:增强对儿童孟氏骨折伴桡神经深支损伤疾病的认识,观察治疗效果.方法:对23例儿童孟氏骨折伴桡神经深支损伤的临床资料进行分析.结果:30d以内就诊者8例桡神经功能完全恢复,1个月～1年者9例桡神经功能完全恢复,1例肌力恢复至4级.1年以上者3例中仅1例桡神经功能完全恢复,余2例肌力分别恢复至4级和2级.结论:儿童孟氏骨折伴桡神经深支损伤早期诊断及时治疗效果良好.     

儿童陈旧性桡骨头脱位合并桡神经损伤的治疗分析(附26例报告)

[目的]评价儿童陈旧性桡骨头脱位合并桡神经深支损伤（Monteggia骨折）手术治疗的中、远期效果。[方法]8例单纯性桡骨头脱位合并桡神经损伤采用切开整复桡骨头脱位重建环状韧带术治疗（5例患者同时施行神经松解术）。18例Monteggia骨折合并桡神经深支损伤采用切开尺骨矫形、桡骨头复位并重建环状韧带术治疗（9例同时施行神经松解术）。[结果]26例患者随访6个月～2a，根据肘功能评价标准（美国特种外科医院，HSS），评定结果：术前优良率88．4％；术后优良率84．6％。桡神经深支功能恢复优良率：松解组71．4％；非松解组91．6％。[结论]手术切开整复桡骨小头脱位重建环状韧带治疗儿童陈旧性桡骨头脱位效果良好；桡神经深支损伤在桡骨头脱位整复后大多能自行恢复，神经松解效果欠佳。     

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.