铒激光治疗脂溢性角化病117例的疗效观察

目的 观察铒激光治疗脂溢性角化病的临床疗效.方法 自2005年3月至2008年6月,采用铒激光治疗脂溢性角化病患者117例,共470个皮损.根据患者的年龄、皮损的性质和部位以及皮肤组织对铒激光的反应,选择能量密度为0.3～0.5j/cm2.治疗1次者102例,治疗2次者15例,每次治疗间隔3～6个月.结果 治疗后随访了所有的患者6个月,痊愈者89例(76.1%),显效者28例(23.9%),总有效率为100%,未出现感染和瘢痕等并发症.结论 铒激光是治疗脂溢性角化病较安全、有效的方法.     

铒玻璃1540nm点阵激光治疗面部瘢痕的疗效观察

目的:评估Lux 1540nm铒玻璃点阵激光治疗面部瘢痕的临床疗效。方法:面部瘢痕患者60例,接受1 540nmnm铒玻璃点阵激光治疗,每隔4周治疗1次,共治疗4次,评估治疗后疗效和不良反应。结果:60例患者中痊愈14例(23.33%),显效27例(45.00%),有效12例(20.00%),无效7例(11.67%),总有效率88.33%。不良反应为治疗即刻疼痛、红斑、水肿、炎症后色素沉着。结论:Lux 1 540nm铒玻璃点阵激光治疗面部瘢痕安全、有效。     

铒激光治疗面部浅表性瘢痕的疗效观察

目的 观察铒激光治疗面部浅表性瘢痕的疗效.方法 应用铒激光先于瘢痕表面行表层汽化扫描,再于首次扫描区域行25%～40%的重叠汽化扫描,使瘢痕底部的深度变浅.对治疗后出现色素沉着的患者采用避光及相应的药物治疗.自2005年4月至2006年10月,对86例面部浅表性瘢痕患者进行了治疗.结果 治疗后随访86例患者12个月,色素沉着发生率为17.5%,经治疗后均消退;浅表性瘢痕治疗的有效率达100%,效果满意;无色素减退、瘢痕面积变大、瘢痕增生等并发症出现.结论 与传统的皮肤磨削术相比,铒激光具有疼痛轻、精确度高、损伤小、操作方便、不易感染、恢复快、治疗后并发症少等优点,是治疗面部表浅性瘢痕安全、有效的优选方法之一.治疗后的护理及药物干预可显著减少色素沉着的发生.     

铒像素激光在瘢痕治疗中的临床应用

目的 探讨铒像素激光在浅表性瘢痕治疗中的临床疗效.方法 对156例浅表性瘢痕患者采用铒像素激光进行治疗,每次治疗间隔1个月,每疗程5次.每次治疗时先划区域,选择治疗参数.治疗区域内定点连续发射5～10个脉冲激光照射.结果 本组患者治疗2～8次.随访3～6个月,瘢痕平复,色素变浅,质地改善.治疗有效率为95.5%.结论 采用像素激光治疗浅表性瘢痕,创伤小,无瘢痕、感染及色素沉着等并发症发生,瘢痕得到有效的修复.随着治疗次数的增加,瘢痕表面上皮修复更完善,效果也更显著.     

超脉冲CO_2激光联合2 940nm铒像素激光治疗重度痤疮凹陷性瘢痕疗效及影响因素分析

目的:探讨2 940nm铒像素激光联合超脉冲CO_2激光治疗重度痤疮凹陷性瘢痕的疗效及影响因素。方法:选取2018年1月-2019年1月在笔者医院就诊的重度痤疮凹陷性瘢痕患者90例,根据随机数字法及患者和家属意愿将其分为采用2 940nm铒像素激光治疗的对照组和采用2 940nm铒像素激光联合超脉冲CO_2激光治疗的观察组,每组45例。比较两组患者的疗效,并记录患者不良反应情况。采用单因素分析和多元Logistic回归模型分析重度痤疮凹陷性瘢痕患者治疗效果的影响因素。结果:治疗后,观察组治疗总有效率(91.11%)高于对照组的总有效率(82.22%)(P0.05);观察组痤疮瘢痕权重评分(ECCA)低于对照组(P0.05);观察组不良反应总发生率(26.67%)低于对照组(44.44%)(P0.05)。单因素分析显示,年龄、性别、BMI、病程、伴发其他皮肤疾病及家族史均与重度痤疮凹陷性瘢痕患者的治疗效果有关(P0.05)。多因素Logistic分析显示,性别、病程、伴发其他皮肤疾病、家族史均是影响重度痤疮凹陷性瘢痕患者治疗效果的危险因素(P0.05)。结论:2 940nm铒像素激光联合超脉冲CO_2激光治疗重度痤疮凹陷性瘢痕可显著提高疗效,减少不良反应的发生。性别、病程、伴发其他皮肤疾病及家族史均可对重度痤疮凹陷性瘢痕患者的疗效造成影响。     

超脉冲CO2激光联合点阵铒激光治疗面部瘢痕的临床研究

目的 观察超脉冲CO2激光联合点阵铒激光治疗面部瘢痕的效果.方法 对70例面部瘢痕患者,采用超脉冲CO2激光和点阵铒激光联合治疗3次;治疗间隔为2～3个月.首先使用超脉冲CO2激光磨削,功率1～2 W,输出时间O.02 s,延迟时间1.12 s.然后使用点阵铒激光治疗,波长为2940 nm,能量500～800 mJ,光斑直径2～7 mm.结果 治疗结束后随访3～6个月,显效者51例,有效者19例.主要并发症为短暂红斑、水肿、色素沉着.结论 超脉冲CO2激光与点阵铒激光联合治疗面部瘢痕,具有疗效好、损伤小、术后恢复快、并发症少等优点.     

点阵铒激光治疗面部各种瘢痕的疗效及影响因素分析

目的:观察应用点阵铒激光治疗面部各种瘢痕的疗效,并对影响疗效的各种因素进行分析。方法:应用点阵铒激光对132例面部瘢痕患者皮损进行磨削、大范围平扫,分析对比依据不同影响因素分组后各组显效率差异,探索对治疗效果有影响的相关因素。结果:所有患者治疗后随访6个月,有效率97.8%,显效率85.7%,无严重不良反应。患者病史长短、皮损的临床分型、病损程度各组显效率差异有统计学意义(P<0.05),性别等其他因素对疗效无影响。结论:点阵铒激光治疗面部瘢痕疗效好,不良反应小,皮损稳定后及早治疗预后较好,皮损程度轻者预后较好,不同临床分型治疗效果不同。     

点阵铒激光治疗面部各种瘢痕的疗效及影响因素分析

目的:观察应用点阵铒激光治疗面部各种瘢痕的疗效,并对影响疗效的各种因素进行分析。方法:应用点阵铒激光对132例面部瘢痕患者皮损进行磨削、大范围平扫,分析对比依据不同影响因素分组后各组显效率差异,探索对治疗效果有影响的相关因素。结果:所有患者治疗后随访6个月,有效率97.8%,显效率85.7%,无严重不良反应。患者病史长短、皮损的临床分型、病损程度各组显效率差异有统计学意义(P<0.05),性别等其他因素对疗效无影响。结论:点阵铒激光治疗面部瘢痕疗效好,不良反应小,皮损稳定后及早治疗预后较好,皮损程度轻者预后较好,不同临床分型治疗效果不同。     

2940nm铒像素激光联合康复新液治疗面部痤疮瘢痕疗效观察

目的:观察评价铒像素激光联合康复新液治疗痤疮瘢痕的疗效。方法:将45例痤疮瘢痕患者随机分为观察组与对照组,两组患者均采用2 940nm铒像素激光进行治疗。观察组进行铒像素激光治疗后给予表皮生长因子外喷及康复新液湿敷,每日3次,每次20min;对照组采用铒像素激光治疗及表皮生长因子外喷。每个月治疗1次,重复治疗3~5次,疗程结束后随访观察3个月。结果:两组患者3次治疗后总有效率均为100%,观察组平均愈合结痂时间为5.1天,对照组平均愈合结痂时间为7.6天,两组平均愈合结痂时间比较有统计学意义(P0.05)。结论:铒像素激光联合康复新液治疗痤疮瘢痕并未提高观察组的有效率,但能降低不良反应,明显缩短脱痂时间。     

脉冲染料激光联合点阵铒激光治疗痤疮后增生性瘢痕的修复效果及对皮肤屏障功能的影响

目的：探讨脉冲染料激光联合点阵铒激光治疗痤疮后增生性瘢痕患者的瘢痕修复效果及对皮肤屏障的影响。方法：选取2019年12月-2020年8月笔者医院收治126例的痤疮后增生性瘢痕患者为研究对象,以随机数字表法分为对照组和观察组,每组63例。对照组实施点阵铒激光治疗,观察组在对照组的基础上实施脉冲染料激光治疗,两组均持续治疗4个月。比较两组治疗4个月后的瘢痕修复效果,治疗期间的临床指标,治疗前、治疗4个月后的皮肤屏障功能及生活质量。结果：治疗4个月后,观察组瘢痕修复总有效率为87.30%,高于对照组的66.67%,差异具有统计学意义（P<0.05）,观察组皮肤红肿、炎性渗出及愈合时间均短于对照组,差异具有统计学意义（P<0.05）;与治疗前比较,治疗4个月后两组皮肤经皮水分丢失量、红斑指数均降低,观察组低于对照组,差异有统计学意义（P<0.05）,而两组角质层含水量、痤疮症状、自我感知、情感功能及社会功能评分均升高,观察组高于对照组,差异具有统计学意义（P<0.05）。结论：脉冲染料激光联合点阵铒激光可明显缩短痤疮后增生性瘢痕患者皮肤红肿、炎性渗出及愈合时间,并可改善...     

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.