Paget-Schroetter 综合征1例

<正>患者男,22岁,无明显诱因右上肢至右肩部肿胀7天,门诊彩色超声示右侧腋静脉及肱静脉血流速度缓慢。查体:右上肢明显肿胀,累及右肩,皮肤发绀,张力稍高,按压无凹陷,无压痛,皮温较左侧稍低。右上肢周径:肘上5cm处约33cm,肘下5cm约31cm;左上肢周径:肘上5cm约26cm,肘下5cm约25cm。实验室检查:D-二聚体2812ng/ml,白细胞13.39×109/L。MRI:右腋静脉近端至右锁骨下静脉血栓形成(图1A),静脉造影:右腋静脉近端至锁骨下静脉闭塞,周围大量侧支循     

臀部肌肉内肿瘤样钙盐沉着症1例

患者　女 ,2 7岁。因右臀部肿胀、疼痛 3个月入院。无明确外伤史。体查 :右臀部偏外侧略肿胀、压痛 ,局部可触及类椭圆形质硬包块 ,大小约为 7.0cm× 5 .0cm× 4.5cm ,边界清晰 ,表面光滑 ,与局部皮肤软组织无明显粘连 ,可随臀部肌肉活动。CT检查示 :局部臀大肌和臀中肌肌间隙内可见大小约 6.0cm× 4.0cm× 4.0cm团块状不规则高密度钙化影 ,周围可见散在小斑片状病灶 ,CT值 2 10～45 5HU。诊断 :右臀部肌肉肿瘤伴钙化。手术中见 :臀部外上方臀大肌和臀中肌肌腹、肌腱内有椭圆形肿块 ,约6.0cm× 4.0cm× 3 .5cm大小 ,与周围组织粘连明显 ,…     

颈丛神经根部神经鞘膜瘤1例

患者,女,65岁,因左颈部肿物伴左颈、上肢疼痛1年多,于2006-02-07入院。1年多前患者无明显原因出现左上肢疼痛、左颈部肿块,肿块质软,光滑,可活动,轻压痛,疼痛呈隐痛,非持续性,无声斯,无头痛、头晕。曾于当地医院治疗,予保守治疗后无效。查体:吐词清楚,左颈5、6位置可触及约3cm×3cm×4cm大小肿物,质软,轻压痛,伴向左侧上肢放射痛,光滑,活动好,左上臂牵拉试验阳性。颈部MRI:左颈5、6位置大小3cm×2.5cm×3.5cm肿物,突入神经根管,进入椎管,压迫周围经丛,诊断为神经纤维瘤。2月20日在全麻下行颈部肿瘤摘除术,采取左颈外侧入路,于胸锁乳突肌后…     

坐骨结节囊肿误诊1例

正1临床资料患者女性,75岁。因"右侧臀部肿物伴疼痛20 d"就诊。患者20 d前无明显诱因出现右侧臀部肿物,伴肿胀感及触痛,逐渐加重。外院诊断"右臀部皮脂腺囊肿",经抗生素治疗后症状缓解不明显。超声检查示右臀部囊性肿物。无发热及其他不适,既往有高血压病史。查体见右臀部肿物约8 cm×8 cm,无红肿破溃,质地中等,压痛不明显,轻微波动感,基底活动度较近皮肤处差。盆     

关节镜下治疗距下关节绒毛结节性滑膜炎1例

正患者,男,39岁,因左足跟部疼痛、肿胀、包块形成3年入院。3年前发现左足跟部包块形成,局部疼痛伴肿胀。活动及长时间行走后加重,休息后缓解。于外院诊断为滑膜炎,行活血化瘀、消肿止痛等非手术治疗后症状缓解不明显,来我院就诊。查体:左足跟部肿胀明显,可触及一约3 cm×4 cm的包块,边界不清,质软,有压痛,移动性差,局部皮温正     

腋窝逆向淋巴示踪预防乳腺癌术后上肢水肿

1病例资料 患者,45岁,女性,因"右乳肿块2个月"入院.查体:双侧乳房对称,双侧乳头无内陷、无溢液,右乳房10点触及约1 cm×1 cm大小包块,质韧,边界欠清,活动度差,左侧乳房未触及包块.右侧腋窝及锁骨上未触及明显肿大淋巴结.乳腺彩超示:"右乳外上10点可及约1 cm×1 cm大小低回声包块,边界不清,周围呈毛刺状,内伴沙砾样钙化,彩色多普勒血流成像(Color doppler flow imaging,CDFI)示内部血流信号较丰富."乳腺钼靶示:"右乳外上象限密度增高影,大小约为1 cm×1 cm,密度不均匀,内见密集不规则多形态钙化,乳腺影像报告和数据系统(Breast imaging reporting and data system,BI-RADS):5级(考虑乳腺癌)."     

原发性乳腺非霍奇金淋巴瘤一例

正病人,女,71岁。因发现左乳肿物半年于2018年3月3日入院。病人于半年前无意中发现左乳肿块,约2 cm×1cm×1 cm大小,无疼痛、发热及乳头溢液,未予治疗。近期肿物逐渐增大。体格检查:左侧乳腺外上象限触及一肿物,约4 cm×3 cm×3 cm大小,质中偏硬,形态不规则,边界欠清晰,活动度尚可,不伴压痛。左侧乳头无内陷,无溢液及溢血,无表皮破溃及橘皮样外观。左侧腋窝、锁骨上下未触及明显肿大淋巴结。     

黄色肉芽肿肾盂肾炎一例

<正>临床资料患者女性,32岁,因"右侧腰背部阵发性疼痛伴发热2年,加重1周",于2015年6月23日入院,无腰背部外伤史。查体:双肾区对称、无隆起,双肾未触及,右肾区及右侧输尿管叩击痛,左侧无阳性体征;超声:右肾体积增大,大小12.7 cm×7.4 cm,右侧肾窦回声分离,肾盂肾盏内探及多个强回声团,大者约2.0 cm×0.9 cm,后方伴声影;CT尿路成像(CT urography,CTU)+双肾CT血管造影(computerized tomography angiography,CTA)示:右肾体积明显增大,肾皮     

骨化性肌炎一例

<正>病人,女,35岁。左大腿肿块伴疼痛40余天,加重10天入院。否认任何外伤史。左大腿后外侧明显肿胀,可触及一大小约8 cm×6 cm的肿物,质地较硬,活动度差,与周围组织分界不清楚,触痛及压痛明显。周围皮肤红肿,皮温略高。超声检查提示左大腿后外侧肌层内距体表约2.1 cm处,可见范围约为3.4 cm×3.6 cm的不规则低回声区,边界不清晰,     

成人附睾腺泡性横纹肌肉瘤1例

<正>患者,男,22岁,于2015年11月因"检查发现右侧阴囊包块9月余"入院,无阴囊坠胀不适,无局部红肿及压痛,无发热,未作特殊处理,近2个月来发现右侧阴囊包块明显增大,伴局部压痛。入院后查体:右侧阴囊实性肿块,大小约3cm×2cm×2cm,质稍硬,伴明显压痛,睾丸附睾分界不清,包块与阴囊皮肤无粘连,腹股沟未触及肿大淋巴结,     

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.