短暂性脑缺血发作与脑动脉狭窄的脑血管造影研究

目的探讨TIA与颅内外血管狭窄的关系,研究DSA对短暂性脑缺血发作(TIA)血管病变的诊断价值。方法选择符合TIA诊断标准的患者54例行颈部血管B超、经颅多普勒(TCD)、心脏超声以及DSA检查,观察TIA患者颈内动脉和椎动脉颅内、外血管有无狭窄及粥样硬化斑块。结果54例患者中发现46例有血管狭窄,其中颈总动脉狭窄2例,颈内动脉狭窄13例,大脑中动脉狭窄5例,锁骨下动脉狭窄3例,椎动脉狭窄18例,基底动脉狭窄5例。狭窄部位斑块31例。其中大动脉狭窄性TIA 36例,栓塞性TIA 13例,腔隙性TIA 3例,血管痉挛性TIA 2例。结论TIA患者大多存在颅内外动脉狭窄及粥样硬化斑块,颅内外动脉狭窄程度及粥样硬化斑块稳定性决定TIA类型。     

肾移植中供受者血管变异的处理

在肾移植中,常会遇到供受者动脉病变及多支血管变异,如处理不当,常导致移植肾失败或肾功能不全.本院共施行肾移植350例,其中受者髂内动脉严重粥样斑块硬化、管腔接近闭塞者30例,供肾多支动脉变异36例,供肾动脉与髂内动脉管径悬殊较大8例,均作了合理的处理.术后移植肾血供良好,1年后随访,吻合血管通畅,肾功能正常,现将其处理经验介绍如下.1 处理方法1.1 髂内动脉严重粥样斑块硬化的处理髂内动脉管腔很小,接近闭塞.这种髂内动脉如与肾动脉吻合,开放血流后移植肾常供血不足,肾色虽鲜艳,但充盈张力差,术后常发生急性肾衰及无尿,导致肾移植失败.对此,我们有沉痛的失败教训.后来我们对25例粥样斑块硬化患者采取髂内动脉斑块切除,然后与肾动脉作端端吻合,开放血流后移植肾充盈张力良好.对5例斑块不能切除者,采取肾动脉与髂外动脉端侧吻合,同样取得良好效果.术后随访1年,肾功能正常,肾动脉无血管杂音,B超、彩色多普勒血流图、肾动脉造影(部分患者)未发现异常变化.     

数字减影血管造影和高频超声诊断颈动脉粥样硬化的对比研究

目的:探讨数字减影血管造影和高频超声诊断颈动脉粥样硬化的优劣.方法:对100例临床怀疑颈动脉硬化的住院患者行数字减影血管造影和颈动脉超声检查,观察颈动脉管腔内径,颈动脉内中膜厚度,有无斑块及其性质、部位,有无狭窄并计算狭窄率.结果:颈动脉斑块发生部位以颈总动脉分叉处最多见.100例患者经高频超声检查有80例患者检出动脉硬化,75例患者检出动脉硬化斑块,其中轻度狭窄45例,中度狭窄26例,重度狭窄4例;100例患者经数字减影血管造影检查有70例患者检出动脉硬化斑块,其中轻度狭窄41例,中度狭窄25例,重度狭窄4例.结论:高频超声诊断颈动脉粥样硬化斑块检出率高于血管造影,联合应用两种技术对颈动脉粥样硬化的病因、诊断、临床治疗及术前评估与术后随访意义重大意义.     

肾旁主动脉粥样硬化的外科治疗经验和结果

作者1976～1983年共收治肾旁主动脉粥样硬化90例。全组进行主动脉肾动脉联合重建手术。术前进行主动脉造影,摄侧位片了解内脏血管情况,下肢缺血病人需检查下肢动脉的输出道。氮血症和难控制的高血压病人要进行肾功能检查。选择部份病人进行排泄性尿路造影,同位素肾扫描和静脉肾素测定。病人分为三组,三组都有肾动脉闭塞。此外,第一组有肾旁主动脉闭塞性疾病47例;第二组肾旁主动脉动脉病30例,第三组内脏动脉闭塞伴肾旁主动脉闭塞或动脉瘤。72例采用标准经腹手术径路,18例经胸后腹膜显露主动脉,其中6例治疗胸腹主动脉瘤,12例有内脏动脉病变。施行最多的是主动脉人造血管重建术计     

腔内覆膜支架植入术治疗穿透性硬化性主动脉溃疡

穿透性粥样硬化性主动脉溃疡（penetratingath-eroscleroticaorticulcer,PAU）指主动脉内膜粥样硬化斑块形成后,在其表面破溃形成溃疡,穿透动脉壁中膜乃至外膜;临床上与主动脉夹层动脉瘤、主动脉壁内血肿等均可表现为急性主动脉综合征。PAU破裂的危险明显高于主动脉夹层,在急诊病例中约409／6患者死亡。本研究采用血管内覆膜支架植入术治疗PAU,效果良好,现报道如下。     

周围血管动脉粥样硬化与冠状动脉粥样硬化相关性的研究

目的应用超声方法检测外周动脉内-中膜厚度（IMT）及斑块情况,探讨外周动脉与冠状动脉粥样硬化的相关性,评价超声检测外周动脉粥样硬化对冠状动脉病变的预测价值及其临床意义。方法对110例天津医科大学第二医院心脏科住院行冠状动脉造影（CAG）的患者术后1—2周内,行外周动脉（包括颈总、颈内、颈外、股总、股浅、股深、胭、足背动脉）粥样硬化情况进行超声检查,以动脉IMT和粥样硬化斑块厚度作为观测指标,对各组病例外周动脉粥样硬化的情况进行比较,进行统计学分析,探讨动脉粥样硬化发生的危险因素,外周动脉与冠状动脉粥样硬化的相关性。结果（1）CCA IMT、颈动脉IMT、CFA IMT、SFA IMT、DFA IMT、下肢动脉IMT在冠脉未见异常组与其余三组任一组均差异有统计学意义（P〈0．05）,冠脉未见异常组IMT值小于其余三组。（2）随着冠状动脉粥样硬化血管的数量增加,颈动脉和下肢动脉动脉粥样硬化情况加重,斑块形成呈明显增加趋势。（3）多因素Logistic回归分析（STEPWISE）,CFAIMT和P下肢与冠状动脉粥样硬化具有显著相关性,有统计学意义（P〈0．05）。结论（1）颈动脉、下肢动脉和冠状动脉粥样硬化的趋势一致。（2）颈部和下肢血管的IMT及斑块对冠状动脉粥样硬化有很好的预测价值;P下肢、CFAIMT可作为预测冠状动脉粥样硬化的重要指标。（3）年龄、吸烟时间、患有高血压及高血压患病时间、甘油三酯、空腹血糖、胰岛素水平是动脉粥样硬化的高危因素。     

胆固醇栓塞:对22例经组织学确诊病例的体会(英)

胆固醇栓子可能为粥样硬化碎屑脱落、斑块溃疡、粥样硬化斑块内组织挤出、或血管内膜损伤使斑块脱落掉入动脉内所造成,从而造成管径为100～200微米的小动脉内的胆固醇晶体栓塞(CE).CE所致病症征象可轻到完全无症状,而重到迅速地进行性多系统     

Ⅲ型前列腺炎患者前列腺液中纳米细菌的培养和形态学鉴定

目的 探索纳米细菌在Ⅲ型前列腺炎(CPPS)患者前列腺液中的分布情况和微生物学特性及其在Ⅲ型前列腺炎发病中的意义. 方法门诊根据病史、尿常规细菌培养、前列腺液常规镜检结果筛选出CPPS患者100例作为试验对象,年龄26～48岁,平均36岁;选择100例健康成年男性作为正常对照组,年龄21～46岁,平均32岁.按照Mearea-Stamey法收集前列腺液,细胞培养方法进行纳米细菌培养,观察其生长情况;单克隆抗体间接免疫荧光染色进行纳米细菌鉴定,并在透射电镜下观察其形态特征.结果 CPPS患者前列腺液标本中发现纳米细菌生长43例,正常对照组仅5例,2组纳米细菌阳性率比较差异有统计学意义(X2=39.58,P＜0.01);透射电镜下观察,纳米细菌呈球状或球棒状,大小100～500 nm,绝大多数聚集成簇,菌体周围有一层黑色物质包绕,并有羟基磷灰石分布.结论 纳米细菌与Ⅲ型前列腺炎发病密切相关.     

主、髂动脉硬化性闭塞症

动脉硬化的病变呈两种趋势,即由动脉壁弹性破坏形成动脉瘤以及由动脉壁增厚,内膜粥样斑块和钙化引起的管腔狭窄甚至闭塞。就临床所见,后者多于前者。周围动脉困硬化引起的狭窄和闭塞称为动脉硬化性闭塞症,常发生于腹主动脉以下的大中型动脉。病     

用抗人膀胱癌单克隆抗体Hb7A对膀胱癌组织中相关抗原的定位检测

用抗人膀胱癌单克隆抗体Hb7A对42例膀胱癌组织标本和人体正常组织应用免疫组织化学技术和免疫荧光技术进行了膀胱癌相关抗原的定位检测,结果42例膀胱癌组织中32例阳性(76.19%),正常人体组织均阴性。Hb7A抗体的相应抗原在膀胱癌组织细胞中的分布与癌细胞所处的增殖周期不同有关。应用免疫组化和免疫荧光技术检测膀胱癌相关抗原具有特异性强、敏感性高的特点,对膀胱癌的诊断及术后随访具有重要的临床意义。     

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.