中西医结合综合治疗腰椎间盘突出28例报告

近年来采用中西医结合综合治疗腰椎间盘突出症28例，取得了满意的效果，现介绍如下：临床资料本组28例，男12例．女16例．年龄最小19岁，年龄最大62岁。病程最短的2周．病程最长的6年。干部9例．工人10例．农民4例．家务5例。有明显外伤及腰扭伤史者比例，28例均有明显腰痛和患侧下肢麻木和放射痛。临床检查腰椎侧弯14例．11例有不同程度生理弯曲变直。28例均有患椎棘突旁压痛和沿坐骨神经传导痛．直腿抬高试验阳性，加强试验阳性．屈颈试验阳性，挺腹试验阳性。28例均摄腰椎正倒位片，15例作CT扫描．4例作MRI检查，L（4-5）突出9例，L5…     

双侧开窗法治疗中央型腰椎间盘突出症

我院自1990～1995年采用双侧开窗法治疗中央型腰椎间突出症21例，经临床观察，疗效满意，并发症少，无复发，现报告如下。临床资料门例中，男16例，女5例。年龄28～71岁，平均48岁。病程6个月～15年，其中6～12月8例，1～2年7例，2～3年4例，3年以上2例。病变部位L3～42例，L4～411例，L5～S18例。12例表现为双侧坐骨神经痛及双下肢肌力减弱，9例为单侧坐骨神经痛，其中5例有同侧肌力减弱。3例伴会阴区感觉障碍及大小便失禁。21例均经CT及脊髓造影检查确诊为中央型腰椎间盘突出。手术方法患者俯卧位，局麻下自后正中切口，以病变椎间隙为…     

极外侧型腰椎间盘突出症的诊治特点

目的：探讨极外侧型腰椎间盘突出症的诊治特点。方法：回顾性分析16例病人的症状,体征,影像学表现和手术。结果：坐骨神经痛11例,腰痛3例,股神经牵拉试验阳性9例,直腿抬高试验阳性4例,椎间盘突出L4／5间隙9例,结论：极外侧型腰椎间盘突出症腿痛多较腰痛严重,直腿抬高试验阳性率低,好发于L4／5且压迫同节段的神经根,影像学表现是主要诊断依据。手术入路依突出位置和病理类型而定。     

按摩扳点颤压手法复位治疗腰椎间盘突出症536例

笔者采用按摩扳点颤压手法复位治疗腰椎间盘突出症536例，获得满意疗效，报告如下。临床资料536例中男271例，女265例；年龄14～73岁。病程2日～18年。有腰外伤史492例。腰痛合并两臀、两下肢皆痛者11例，腰痛合并一侧臀部疼痛者525例，腰痛伴放射F肢痛407例。脊椎侧弯伴后凸畸型198例，直腿高抬试验60“以下463例，腰部椎旁压痛伴放射痛51b例，冲击试验向下肢放射痛14例，姆背伸力减弱432例。481例查CT片均有不同程度的腰椎间盘突出或膨出等不同改变，少数伴腰椎管狭窄。治疗方法1．按摩推拿：患者取俯卧位，医者站于患侧。在背腰臀部至…     

耳针手法治疗腰椎间盘突出症的临床观察

自1985年6月～1987年8月间，我们采用耳针、手法治疗腰椎间盘突出症100例，现报告如下。临床资料在100例中，男76例，女24例；年龄20～64岁；病史最短2个月，最长21年，平均3年半；有明显外伤或劳损史78例，无明显诱因22例；主要症状和体征：腰痛以左侧为主67例，右侧对例，两侧均痛2例；患肢放射痛86例，脊柱侧弯73例，椎间区叩痛89例，直腿抬高试验6O”以下94例，腓总神经挤压（＋）67例，患侧小腿皮肤感觉迟钝83例，患侧小腿前群肌肌力减退74例。根据X线片、CT、造影等影像学检查诊断，突出在L3．45例，L4－563例，L55132例。X线片表…     

手术治疗中老年人腰椎间盘突出症252例

1986年1月～1996年4月，手术治疗中、中老年腰椎间盘突出症252例，现结合病理、临床特点报告如下。临床资料一般资料：本组252例中男187例，女65例；年龄46～75岁；病程3月～20年；病变部位：L3－418例，L4-593例，L5—S110例，L4-5、L5—S1双间隙31例；单纯性椎间盘突出症57例，合并中央椎管狭窄123例，伴神经很管及侧隐窝狭窄72例，伴腰椎滑脱12例。临床表现：本组216例既往有腰痛病史，所有病例发病以来均伴有下肢坐骨神经放射痛，其中单侧81例，双侧176例，静止状态下双下肢发麻39例，间歇性歧行148例，剧烈疼痛坐卧不安23例，腰椎生…     

老年性腰椎间盘突出症临床分析

腰椎间盘突出症是骨科常见病和多发病，多见于中青年。我们将60岁以上的腰椎间盘突出症称为老年性腰椎间盘突出症，有其独特的临床特征。本院自1988～1994年共手术治疗老年性腰椎间盘突出症26例。现就临床特征及手术治疗等问题探讨如下。1临床资料1．1一般资料本组26例，男11例，女15例。年龄60～69岁，平均64岁。病程1个月～7年，平均45个月。1．2临床表现所有病例均有腰痛伴坐骨神经放射痛及间歇性破行。静止状态下肢麻木21例，下肢肌肉萎缩19例，剧烈疼痛坐卧不安者13例，直腿抬高试验阳性20例，姆趾背伸肌力减弱22例，下肢皮肤感觉减退2…     

腰椎间孔椎间盘突出症（附4例报告）

腰椎间孔椎间盘突出症以往少见，且多通过手术明确诊断。随着影像学的发展及临床认识的深入，此类型腰椎间盘突出症渐多[1-3]。本文就4例该型椎间盘突出症的病理解剖、诊断和手术特点加以探讨。1资料与方法1.1临床资料1991～1994年12月我院共收治椎间扎型腰椎间盘突出症4例，其中男性3例，女性1例，平均年龄42岁。发病到手术时间较短，腰痛及单侧下肢放射性疼痛持续而严重，夜间加重伴失眠。急性痛苦病容，强制体位，腰椎侧弯，平腰，相应侧椎旁压痛、叩击痛、反射痛，坐骨神经走行压痛，相应神经根感觉运动反射受损明显，Lasegue征阳性，…     

钬激光在治疗输尿管结石中的应用

1．1 临床资料 本组患者189例，男119例，女70例。年龄25—62岁，平均年龄42岁，病史1d-2年，以疼痛伴血尿就诊者110例，无明显阳性体征。B超示患侧积水162例，腹平片可见输尿管上段结石22例，中段结石66例，下段结石105例，静脉肾盂造影示121例患侧肾积水，上段输尿管扩张，75例患侧未显影，阴性结石3例。术前诊断：右侧输尿管结石108例，     

手法加电动牵引治疗腰椎间盘突出症

以柔松手法为主，配合电动牵引治疗腰椎间盘突出症７２例。疗效满意，报告如下。临床资料１．诊断标准：（１）症状：下背痛伴下肢放射痛。（２）强迫体位：破行或不能行走；站立位脊柱侧弯或不能站立；不能自然睡卧。（３）背肌紧张；腰椎生理弧度改变；病变腰椎旁深在压痛并向痛侧下肢后外侧放射。（４）直腿抬高＜６０°，挺腹试验阳性。（５）痛侧坐骨神经分布区感觉异常；膝腱反射及跟腱反射改变；　趾屈伸肌力改变。（６）ＣＴ征：椎间盘纤维环突出伴侧隐窝狭窄。２．病情等级：３级：疼痛严重，不能行走，不能站立，不能安卧；临床检…     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.