287例隐睾诊治分析

目的:总结隐睾及其并发症的诊治经验,提高对隐睾合理治疗年龄的认识。方法:回顾性分析287例362侧隐睾患者诊治资料。就诊时年龄1~45岁,左侧77例,右侧135例,双侧75例,结果:手术治疗362侧,其上行一期下降固定术347例,疑为萎缩或恶变而行手术切除送病理12例,探查缺如3侧。腹外型238侧,腹内型115侧。238例腹外型隐睾B超检查符合率81.9%,体检符合率60.1%。结论:2岁以内最佳手术时机的隐睾患者诊治率明显偏低,应引起重视。B超对隐睾的定位诊断符合率较高。     

超声及腹腔镜探查诊断小儿未触及睾丸

目的探讨超声及腹腔镜探查诊断小儿未触及睾丸的价值。方法对35例未触及睾丸患儿行常规超声检查,对超声于腹腔外未探及患侧睾丸者行腹腔镜探查术。分析检查结果,比较睾丸缺如、睾丸残余与单侧隐睾患儿健侧睾丸体积差异。结果 35例未触及睾丸患儿中,超声探及14例(17个)隐睾(13个腹内型和4个腹外型)、3例腹外型睾丸缺如、2例腹外型睾丸残余及2例异位睾丸,总检出率为60.00%(21/35)。对25例患儿行腹腔镜探查,发现17例(19个)腹内型隐睾、6例睾丸缺如(5例腹内型和1例腹外型)、2例腹内型睾丸残余,腹腔镜探查对腹内型未触及睾丸检出率为100%(24/24)。睾丸缺如、睾丸残余患儿健侧睾丸体积大于单侧隐睾患儿健侧睾丸体积(P均0.05)。结论联合应用超声和腹腔镜对诊断小儿未触及睾丸具有重要应用价值。     

小儿腹股沟不可触及睾丸的隐睾症诊治

目的:总结腹股沟不可触及睾丸的小儿隐睾症诊治经验。方法:回顾性分析收治腹股沟不能触及睾丸的隐睾患儿36例临床诊治资料。分析腹腔镜手术指征,腹股沟探查指征,术前超声检查的作用和术式的选择。结果:腹股沟不能触及的隐睾共36例(41侧),占总数的10.0%(36/361),经腹腔镜和腹股沟探查确定睾丸缺如18例(侧),腹内型隐睾16例(21侧),阴囊内睾丸残余2例(侧)。将腹腔镜下所见分4型,I型9例(侧),II型9例(侧)(其中IA型7例,IB型2例),III型11例(13侧),IV型7例(10侧)[其中IVA型5例(7侧),IVB型2例(3侧)]。分别采用经腹股沟睾丸下降固定,腹腔镜辅助睾丸下降固定术,分期Fowler-Stephen术。术前超声结果阳性诊断率为75%(27/36),睾丸缺如患儿对侧睾丸体积明显大于腹内型隐睾及睾丸残余患儿对侧睾丸体积。术后随访睾丸萎缩1例。结论:对于腹股沟未能查到睾丸的小儿隐睾症应行腹腔镜检查,腹腔镜下II型者,无需再行腹股沟探查,I型需探查腹股沟及阴囊。III型和IVB型可经腹股沟或腹腔镜辅助下行睾丸下降固定术,IVA型隐睾需在腹腔镜辅助下行睾丸下降固定或行分期Fowler-Stephen术。术前超声检查对侧睾丸大小有利于判断是否有睾丸缺如。     

腹腔镜下腹腔内高位隐睾下降固定术的疗效观察

目的：探讨腹腔镜下腹腔内高位隐睾下降固定术的疗效。方法：应用腹腔镜技术进行诊断并行隐睾下降固定术治疗不可触及的高位腹腔内型隐睾患儿21例（24侧）,年龄2～12岁,平均4岁。结果：21例患儿均得到明确诊断。14例（17侧）行一期睾丸下降固定术,3例行Fowler Stephens一期睾丸下降固定术,3例睾丸缺如,1例行睾丸萎缩切除术。随访6～30个月,平均16个月,下降固定的睾丸位置良好,睾丸均无萎缩和回缩。结论：采用腹腔镜技术可以准确诊断高位不可触及的腹腔内型隐睾,并可同时行睾丸下降固定术,安全、有效、微创,值得推广。     

腹腔镜诊治未触及隐睾29例(34侧)

目的探讨腹腔镜技术诊断和治疗未触及隐睾的疗效。方法2002年7月～2005年3月对29例34侧未触及隐睾利用腹腔镜技术进行诊断和治疗。结果29例均得到明确诊断。21侧腹腔内隐睾中16侧行一期睾丸固定术，5侧行分期Fowler-Stephens睾丸固定；13侧为睾丸缺如。29例随访0，5～1年，睾丸无回缩或萎缩。结论腹腔镜对小儿未触及隐睾的诊断和治疗具有创伤小、恢复快、治疗效果好等优点，可作为未触及隐睾患儿的首选诊治方法，如条件许可，一期睾丸固定术也能取得满意的临床疗效。     

腹腔镜手术治疗不可触及睾丸的隐睾患儿体会

目的探讨腹腔镜手术治疗不可触及睾丸的隐睾的价值。方法选取2014-08—2016-01间在郑州儿童医院接受腹腔镜睾丸探查的78例(86侧)不可触及睾丸的隐睾患儿,对其临床资料进行回顾性分析。结果腹腔内睾丸26例(34侧),腹股沟内睾丸2例。其中行Ⅰ期睾丸下降固定术8例(10侧),(F-S)分期睾丸固定术20例(24侧)。睾丸缺如36例,睾丸残余14例。结论腹腔镜手术治疗不可触及睾丸的隐睾,创伤小、术野清晰、能明确睾丸位置及与精索和输精管之间的关系,有助于采取相应的手术方式。     

单侧隐睾患儿术后青春期性发育的研究

目的　观察隐睾患儿术后青春期性发育状况。　方法　随访调查166例隐睾患儿术后青春期阴毛发育程度、阴茎长度和周径、睾丸体积和血清黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)水平。根据术式分为单侧隐睾切除术及固定术组,根据手术年龄将固定术组分为手术年龄<5岁及≥5岁组。比较不同手术年龄、手术方式和隐睾位置对疗效的影响。　结果　单侧隐睾固定术患儿的术侧睾丸体积明显小于下降侧(15. 5±2. 4mlvs8. 1±2. 1ml)、但明显大于未治疗组的隐睾侧(4. 0±2. 0ml)。单侧隐睾固定术、切除术和正常组患儿FSH分别为(4. 5±1. 7、6. 2±1. 8、2. 4±1. 1mIU/ml。手术年龄<5岁患儿的阴毛发育程度、阴茎长度和周径、术侧睾丸体积和T明显大于≥5岁组,后者的FSH水平明显高于前者。高位型患儿术侧睾丸体积明显降低、FSH明显升高。睾丸体积与FSH呈负相关关系(r=-0.291,P<0. 05)。　结论　单侧隐睾患儿术后青春期性征发育可表现为正常,早期手术可防止隐睾和对侧正常下降睾丸生精功能的损害。     

隐睾儿童血清表皮生长因子及其受体表达的临床意义

我们采用放射免疫分析 (RIA)和免疫组织化学方法检测 88例隐睾患儿手术前后血清表皮生长因子 (EGF)浓度和睾丸组织EGF受体 (EGFR)的表达情况 ,探讨EGF在儿童隐睾症中的作用及机理。现报告如下。材料与方法　隐睾患儿 88例 ,年龄2～ 14岁 ,平均 7.1岁。按隐睾位置高低分为外环型 (低位型 ) 2 0例、腹股沟型(中位型 ) 5 1例和腹内型 (高位型 ) 17例 ;按侧别分为单侧型 2 0例 ,双侧型 6 8例。按就诊年龄分为 3组 :2岁～组 2 4例 ,5岁～组 35例 ,>10岁组 2 9例。行睾丸固定术后 6个月患儿 2 6例 ,平均年龄6 .8岁。正常儿童组为随机选取的…     

隐睾儿童手术近期疗效及手术时机的探讨

目的　探讨隐睾儿童年龄因素与睾丸固定术近期疗效的关系及手术时机的选择。　方法　采用放射免疫法 (RIA)和免疫组织化学方法检测 88例隐睾儿童手术前后 6个月血清表皮生长因子 (EGF)、睾酮 (T)、5α 二氢睾酮 (5α DHT)、雌二醇 (E2 )、促黄体生成素 (LH)、卵泡刺激素 (FSH)、催乳素 (PRL)水平和隐睾组织表皮生长因子受体 (EGFR)、雄激素受体 (AR)的表达以及隐睾的组织学变化 ,分析年龄与上述指标及隐睾分型的关系。　结果　 88例隐睾儿童 10 8枚睾丸中 ,高位型隐睾多见于 2～ 4岁组 (9/2 4,3 7.5% ) ,低位型多见于 10～ 14岁组 (2 0 /2 4,81.8% ) ,差异有非常显著性意义 (P<0 .0 1) ,而单、双侧型与年龄无关 (P >0 .0 5)。 5～ 9岁隐睾儿童术前血清EGF ,T ,5α DHT值均显著降低 (P <0 .0 5) ,血清FSH ,LH水平则显著升高 (P <0 .0 5)。≥ 5岁患儿血清EGF、隐睾组织病理及EGFR和AR表达较 2～ 4岁组差。患儿术后血清EGF、T、5α DHT值较术前均有明显增高 (P <0 .0 5) ,而术后血清E2 ,FSH值显著低于术前 (P <0 .0 1)。　结论　睾丸固定术有利于生殖内分泌功能恢复及睾丸组织的生长发育 ,是治疗隐睾症的可靠方法。依据 4岁前隐睾病理学和性激素内分泌改变较轻以及2岁以后睾丸仍有向下迁移趋势的特点 ,主张     

单侧睾丸缺如37例报告

单侧隐睾患儿经查体及手术探查未能发现睾丸称为单睾畸形或单侧睾丸缺如[1] 。我院 1989至 2 0 0 1年手术治疗1172例隐睾患儿 ,发现单侧睾丸缺如 37例 ,发病率占隐睾的 3.17%。现报告如下。材料与方法　本组 37例。年龄 2～ 13岁。右侧 2 2例 ,左侧 15例。术前均经两位医师仔细检查下腹部、会阴部、大腿内侧 ,均未发现异位睾丸。 37例患儿健侧睾丸均较同龄正常儿童有不同程度增大 ,双侧阴囊发育较好者 19例 ,患侧阴囊发育欠佳者 12例 ,患侧阴囊发育较差者 6例。 2 1例行B超检查 ,18例未发现睾丸 ,3例于腹股沟处探及直径约0 .3～ 0 .5cm低回…     

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.