腹膜后多形性横纹肌肉瘤1例

正患者男,60岁,因"左腰部肿块进行性增大1个月"入院。查体腰部无压痛,实验室检查无异常。CT:巨大软组织肿块位于左侧腹膜后(12.2cm×11.0cm×12.5cm)及腹腔内(8.2cm×7.4cm×9.8cm);MRI:平扫T1WI肿块呈等-稍低信号(图1A),T2WI呈不均匀明显高信号(图1B),内可见囊变、坏死,未见出血;增强扫描肿块呈持续填充式强化,其内可见无强化区域(图1C)。影像学诊断:腹膜后平滑肌肉瘤。行开     

肝脏孤立性纤维性肿瘤1例

正患者男,41岁,反复上腹胀2个月。CT(图1):平扫显示肝右叶前下段类圆形肿块影,边界清楚,大小约7.54cm×6.91cm,呈不均匀性稍低密度,CT值30 HU,增强扫描动脉期病灶内可见少许明显强化血管影,肿块整体呈不均匀性轻度强化,CT值45HU,静脉期(CT值51HU)及延迟期(CT值68HU)进一步强化,整体呈不均匀性渐进性强化。MRI(图2):肿块T1WI呈稍低信号,其内可见斑片状更低信号,T2WI呈混杂高信号,可见斑片状或条索状低信号,T2WI压脂     

松果体区乳头状肿瘤1例

正患者女,43岁,以"间断头晕1年,加重3天"入院;既往体健。查体未见明显异常。头部MRI:三脑室后份见团块状稍低T1信号,其内见点片状T1高信号(图1A),T2WI呈等信号(图1B),T2-液体衰减反转恢复序列图像呈低信号,弥散加权成像(b=0、1 000s/mm~2)未见弥散受限;四叠体池受压;幕上脑室系统扩张,脑室周围可见条片状T2高信号;增强T1WI见病灶明显强化(图1C),信号稍欠均匀,约22mm×13mm×16mm;诊断:三脑室后份异常信号,考虑富血供占位性病变,生殖细胞瘤?     

盆腔深部侵袭性血管黏液瘤1例

<正>患者女,29岁,因"发现左下腹包块6个月"入院。查体:左下腹可触及约5 cm×10 cm包块,质硬,活动度可,局部无压痛;肛门指诊胸膝位进指6 cm,未触及肿物,退指后未见指套染血、带脓。CT:盆腔及右侧盆底可见不规则团块样稍低密度肿块影(图1A),约6.5 cm×11.0 cm,边界不清,CT值21～25 HU。MRI:平扫示子宫及阴道后方、直肠右前方团块状异常信号,T1WI呈低信号,T2WI呈高信号(图1B),其内可见条束状、结节状     

纤维板层型肝细胞癌1例

患者男, 50岁, 因"体检发现肝占位病变2年余"收住入院。查体:剑突下触及约4 cm包块, 质硬, 边界尚清, 上腹轻度压痛, 无反跳痛及肌紧张。肿瘤标志物:AFP、PIVKA-Ⅱ、CA19-9无升高。影像学检查:超声检查:肝左叶探及一实性不均质回声结节, 大小约5.8 cm×3.3 cm, 形态欠规则, 边界欠清;CT检查:平扫见肝左外叶一片状稍低密度灶, 大小约4.7 cm×4.2 cm×4.0 cm, 与周围肝组织分界欠清。增强扫描动脉期不均匀强化。门静脉期及延迟期进一步强化;MRI检查:T1WI见肝S3团片状稍低信号(图1A), T2WI见肝S3团片状不均匀稍高信号(图1B), DWI见肝S3团片状高信号, ADC见肝S3团片状低信号, 边界清, 内部见轮辐状T1、T2双低信号。增强扫描动脉期肝S3团片状不均匀强化, 其内轮辐状信号无强化(图1C), 门静脉期及延迟期进一步强化, 其内轮辐状信号无强化。全麻下行"腹腔镜下左半肝切除术+胆囊切除术"。术后病理标本见6.5 cm×6.0 cm×5.5 cm类圆形肿瘤, 质地硬, 边界尚清, 呈灰白色, 中央可见到界限不清的星状纤维...     

颅内恶性副神经节瘤MRI表现1例

<正>患者男,53岁,因"头痛、头晕伴行走不稳20余天,加重1天"入院。查体:血压201 mmHg/115 mmHg,神志清,精神可,自主体位。实验室检查未见明显异常。MRI:右侧额颞叶交界区见约2.8 cm×3.5 cm×3.4 cm团块状T1WI混杂等、高信号(图1A),T2WI呈稍高信号(图1B),Flair序列呈高信号,高b值(b=1 000 s/mm2)DWI呈高信号,病灶内见点线状血管流空信号;增强后病灶呈明显不均匀强化,邻近硬脑     

脑膜血管瘤病1例

<正>患者女,61岁,1年前无明显诱因双眼视力下降,3个月前症状加重,并伴四肢无力及右侧肢体间歇性不自主抖动。查体:嗅觉丧失,双眼周边视野缺损、对光反射迟钝。颅脑CT:右侧额叶团片状高密度影,约2.4 cm×5.2 cm,CT值约937 HU(图1A)。颅脑MRI:右侧额叶不规则肿块,T1WI呈低信号、T2WI呈混杂信号,边界清晰,内见斑片及条索状T2WI高信号,其周边可见T2WI稍高信号(图1B);增强扫描病灶呈斑片状及条索样强化(图1C)     

鞍区节细胞胶质瘤1例

正患者女,50岁,因"2年前无明显诱因出现双眼视力下降,近3个月头晕"入院。查体:神清语明,双侧瞳孔等大、等圆,直径约3.0mm,对光反射灵敏;术前视力右眼0.8、左眼0.6;右眼视野下方及上方暗点,左眼配合不佳。垂体MR平扫及增强(图1):蝶鞍扩大,鞍底下陷,鞍区见类圆形异常信号,约1.8cm×1.4cm×2.0cm,T1WI呈稍低信号,T2WI呈稍高及等信号,增强扫描呈不均匀强化,程度低于正常垂体,垂体柄右     

枕大孔区椎动脉相关血管外皮细胞瘤1例

<正>患者女,58岁,因"后枕部麻木2年余,加重伴疼痛1月余"入院。MR检查:平扫示枕大孔区延髓左后方见不规则团块状稍长T1混杂短T2信号(图1A、1B),约2.6cm×2.8cm×2.6cm,肿块内可见数个小圆形血管流空信号,边界尚清,延髓受压向右前方移位,病变向下略超出枕骨大孔水平。液体衰减反转恢复序列呈混杂稍低信号,DWI呈混杂等低信号,未见明     

腋下罕见毛细血管瘤一例

病例 患者男,26岁,因"左侧腋下外生肿物逐渐增大2年"入院.患者2年前无意中发现左侧腋下有一外生肿物,肿物初起时约成人拇指肚大小,表面皮肤颜色无异常,无疼痛及瘙痒,表面光滑,质地坚韧,随时间延长肿物逐渐增大,入院治疗.查体:可见左侧腋窝有一体积约6.0 cm×2.5 cm×2.5 cm大小外生肿物(图1),肿物呈类圆柱形,蒂部宽大,与周围组织无明显粘连,肿物末端可见皮肤分岔呈两瓣样结构,肿物质地坚韧,有轻度触痛,腋下周围未触及明显淋巴结肿大.磁共振成像(MRI):左侧腋部约平正中线水平见一类圆柱形包块,大小为5.8 cm×2.4 cm,呈长T1、混杂T2信号,T2W1内见线样低信号分隔,肿块边界清晰,上部与皮下脂肪相连,余游离于腋窝(图2).左侧腋窝内还见-1.9 cm×1.1 cm软组织结节影,见分支,边界清晰,所见各骨未见异常信号及骨质破坏.     

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.     

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.     

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.