经尿道前列腺汽化术治疗良性前列腺增生症

目的 :探讨良性前列腺增生症 (BPH)的手术新方法。　方法 :采用经尿道前列腺汽化术 (TVP)治疗BPH3 60例。　结果 :TVP平均手术时间 4 0min ,平均出血量 80ml。术后留置导尿管平均 4 .5d ,拔除导尿管后均自行排尿。术后第 3个月和第 6个月随访 ,国际前列腺症状评分 (IPSS)从术前 2 3分分别降至 11分和 7.2分 ,最大尿流率从 7.2ml/s分别上升为 13 .6、15 .8ml/s ,残余尿从 80ml分别降至 2 8.0、12 .0ml。　结论 :TVP是一种安全性高、并发症少、疗效确切的新手术方法     

经尿道钬激光前列腺剜除术治疗良性前列腺增生

目的 :评价经尿道钬激光前列腺剜除和前列腺组织粉碎术治疗良性前列腺增生 (BPH)的临床效果。　方法 :应用 10 0W钬激光器和组织粉碎器对 35例BPH病人实施经尿道钬激光剜除和前列腺组织粉碎术治疗。　结果 :本组 35例手术均获成功。手术时间 30～ 180min ,平均 (6 0 .0± 2 3.2 )min。获得前列腺组织 10～ 5 6g ,平均(31± 9) g ,术后留置导尿管时间 2 0h～ 4d ,平均1.5d。无术中术后输血病例。组织病理学诊断均为BPH。 32例获随访 ,术后 3个月随访国际前列腺症状评分 (IPSS)由 (2 4.0± 6 .2 )分降至 (5 .6± 3.6 )分 (P <0 .0 0 1)。最大尿流率 (Qmax)由 (8.5± 3.9)ml/s上升至 (2 2 .0± 7.2 )ml/s(P <0 .0 0 1) ,残余尿由 (138± 12 5 )ml减少到 (2 1± 15 )ml,未发生严重并发症。　结论 :钬激光前列腺剜除术是治疗BPH的有效微创方法 ,术中术后出血少 ,能够完整剜除增生的前列腺组织。留置导尿管时间短 ,临床症状改善明显。     

TUVP与TURP联合应用治疗良性前列腺增生

目的 :探讨治疗良性前列腺增生 (BPH)的有效方法。　方法 :联合应用经尿道前列腺电汽化术 (TUVP)与经尿道前列腺电切术 (TURP)治疗BPH 179例病人。　结果 :179例病人住院时间 6～ 12d ,平均 5 .5d。术后随访 6～ 36个月。国际前列腺症状评分 (IPSS)由术前的 2 9.0分下降到 7.6分 (P <0 .0 5 ) ;最大尿流率 (Qmax)从术前的 5 .81ml/s上升到 14 .8ml/s(P <0 .0 5 )。　结论 :联合应用TUVP与TURP治疗BPH是安全、有效的方法。     

KTP激光汽化术治疗高龄高危良性前列腺增生的临床观察

目的探讨高能磷酸钛氧钾晶体(KTP)激光前列腺汽化术(PVP)和双极等离子体电切术(PKRP)治疗高龄高危良性前列腺增生(BPH)的有效性及安全性。方法采用80W KTP PVP术治疗高龄高危患者共166例,其中62例行PKRP+PVP术。患者年龄80~95岁,平均83岁;前列腺体积17~278ml,平均74ml,其中80ml以上36例(21.7%)。患者平均国际前列腺症状评分(IPSS)为(28±4)分,平均生活质量评分(QOL)为(5.3±0.7)分;入院时留置导尿者72例(43.4%)。其余患者平均最大尿流率(Qmax)为(6.9±3.2)ml/s。结果本组平均手术时间(92±28)min,平均汽化能量(127±99)kJ;平均术中出血量(121±92)ml,其中9例术中有较明显出血并需要输血,均为术前服用抗凝药物者。术中未出现电切综合征(TURS)迹象。术后1~4d后拔除导尿管,平均(2.9±1.1)d,其中9例因排尿困难、2例因残尿过多而再次留置导尿1~3d拔管排尿通畅,其余患者术后均排尿通畅。出院时IPSS平均(11±2)分,QOL平均(2.0±0.6,Qmax平均(12.6±5.2)ml/s;术后3月和6月的IPSS、QOL分别为(11±4)分,(11±3)分和(1.9±0.4)分,(1.8±0.4)分。结论PVP术或PKRP+PVP术是治疗高龄高危前列腺增生安全而有效的方法,可明显提高患者生活质量。     

经尿道汽化电切加电切术治疗前列腺增生症(附256例报告)

目的　探讨良性前列腺增生症(BPH)的有效治疗方法。方法　采用经尿道前列腺汽化电切(TUEVAP)加经尿道前列腺电切术(TURP)联合治疗BPH患者256例。结果　手术时间20～125min,平均62min。29例(11.3%)术中需输血200～600ml,均为Ⅲ°增生者。切除前列腺组织重量8～120g,平均38g。无电切综合征发生。术后3～5d拔除导尿管,排尿均通畅。180例随访6个月～2年,IPSS由术前28.8±2.0下降至术后7.2±0.3(P<0.01),最大尿流率由术前平均(5.1±0.4)ml/s升至术后(16.7±1.8)ml/s(P<0.01)。B超复查124例,38例(30.7%)仍有剩余尿10～40ml,平均18.2ml。术后继发性出血12例(4.7%),尿道狭窄8例(3.1%),暂时性尿失禁3例(1.2%)。结论　TUEVAP加TURP联合治疗BPH可综合两者的优点,疗效显著,并发症少,安全性高,是治疗BPH的有效方法。     

尿动力学检查及IPSS评分对判断腔内前列腺手术效果的价值

目的:评价尿动力学检查、国际前列腺症状评分(IPSS)对判断BPH患者腔内手术后短期效果的价值.方法:回顾性分析2004年6月～2006年9月住院接受前列腺等离子体前列腺汽化切除及PVP激光汽化的216例BPH患者临床资料.所有患者术前均接受尿动力学检查及IPSS评估,将IPSS评估分为排尿刺激评分(IPSS1)和排尿梗阻评分(IPSS2)两部分记录,术后平均随访8.7个月,术后6个月再次行尿流率检查及IPSS评估.将术前留置导尿者术后最大尿流率超过12 ml/s或手术前后最大尿流率改善超过50%视为疗效显著.结果:216例患者的手术前后最大尿道压力(Pmax)、IPSS、IPSS1、IPSS2的改变均有统计学意义(P＜0.05).137例患者术后6个月疗效满意,比较高低两疗效组间术前各项指标,仅有IPSS2差异存在统计学意义(P=0.039).结论:通过腔内手术可解除BPH患者的梗阻症状,IPSS中关于排尿梗阻的评估可作为判断手术短期疗效的简便指标.在尿动力学检查中,尿道阻力较高者有可能通过腔内手术获得较满意的疗效.     

尿动力学检查术前对BPH患者TVP术后疗效的评价作用

目的：探讨尿动力学检查在术前对前列腺增生（BPH）患者行经尿道前列腺电汽化术（TVP）术后疗效的评价作用。方法：对800例拟行TVP的BPH患者术前行尿动力学检查、国际前列腺症状（IPSS）评分,并于术后随访1年,观察最大尿流率,IPSS评分。结果：800例BPH患者术前最大尿流率均〈15ml／s,IPSS评分平均〉29分。根据术前最大尿道压力、最大尿道压力与充盈时膀胱最大压力的关系、膀胱顺应性及是否存在尿道外括约肌与膀胱逼尿肌压力不协调等指标共分为四组。术后1年最大尿流率平均分别为18．3ml／s、17．9ml／s、9．2ml／s和8．2ml,s,IPSS评分平均分别为12分、11分、23分和26分。其中各组术后最大尿流率〉15ml／s,分别占89．8％、85．5％,29,2％和22．5％。Ⅰ组、Ⅱ组术后各项指标与Ⅲ组,Ⅳ组比较差异均有统计学意义（P〈0．05）。结论：尿动力学榆查对BPH患者行TVP术的疗效有良好的评价作用,可为BPH患者采用何种治疗方法提供重要依据。     

前列腺增生并膀胱结石的腔内激光治疗

目的探讨KTP激光前列腺汽化术结合钬激光碎石术治疗高龄或高危前列腺增生（benign prostatic hyperplasia,BPH）并膀胱结石患者的有效性及安全性。方法 2009年8月-2013年12月采用KTP激光汽化术结合钬激光碎石治疗46例BPH并膀胱结石患者,平均年龄84（79-93）岁。术前国际前列腺症状评分（IPSS）平均（22.1±1.9）分,生活质量评分（QOL）平均（4.8±0.8）分。术前28例患者最大尿流率平均（7.0±1.8）ml/s。结果所有患者均一次处理成功。手术时间平均70（55-95）min,碎石时间平均29（10-40）min。所有患者术中均无明显出血,未出现明显液体吸收现象;术后2-5 d拔除导尿管。46例患者术后均排尿通畅,复查腹部平片均未见明显结石残留。术后3-6个月,复查最大尿流率为15.3-21.4 ml/s。术后IPSS评分平均（4.5±2.7）分,QOL评分平均（1.5±0.6）分,均较术前明显改善,差异有统计学意义（P〈0.05）。结论 PVP结合钬激光碎石术是治疗高龄或高危BPH并膀胱结石的一种安全而有效的方法。     

腔内镜一次性治疗前列腺增生合并膀胱结石

目的探讨腔内镜一次完成治疗前列腺增生(BPH)合并膀胱结石的临床效果。方法采用经尿道前列腺电汽化术(TURVP)及弹道碎石术一次治疗BPH合并膀胱结石42例。结果术后无须冲洗膀胱。3～5天拔除导尿管,5～7天出院,术后3个月国际前列腺症状评分(IPSS)由术前的平均26．5降至4．28分,6个月为3．43分。最大尿流率(MFR)由3．53ml／s升至15．78ml／s,6个月为19．62ml／s。平均尿流率(AFR)由1．6ml／s升至4．8ml／s,6个月为5．2ml／s。结论该方法创伤小,手术安全且治疗确切,术后康复快,无开放手术所致的并发症,是BPH合并膀胱结石的有效治疗方法。     

绿激光前列腺汽化术治疗BPH60例报告

目的:探讨经尿道绿激光前列腺汽化术治疗BPH的手术方法和近期疗效。方法:采用骶管或硬膜外腔阻滞麻醉,应用美国Laserscope公司生产的非接触式绿激光治疗系统,以80 W功率对60例BPH患者进行汽化治疗。结果:本组汽化时间10~250 min,平均(104.21±81.31)min;耗能21.24~531.11 kJ,平均(230.02±150.34)kJ;术后10例未留置导尿管,余50例留置导尿管24~120 h,平均(64.70±25.52)h;膀胱冲洗24~96 h,平均(58.44±20.24)h;术后住院3~9天,平均(4.57±1.83)天。术前平均最大尿流率(Qmax)(7.5±3.12)ml/s,术后平均Qmax(16.78±4.56)ml/s;术前剩余尿量0~800 ml,平均(111.00±177.85)ml;术后剩余尿量0~30ml,平均(12.73±5.91)ml;术前平均IPSS和QOL分别为(26.50±3.18)分和(4.60±0.28)分,术后下降至(6.24±1.86)分和(1.83±0.52)分,与术前比较差异有统计学意义(P<0.05)。术前留置导尿管16例,术中均未输血,术后尿频12例,继发出血2例,术后24天突发尿潴留1例。结论:绿激光前列腺汽化术治疗BPH安全、操作简单、手术时间短、出血少、痛苦小、留置导尿管时间短、康复快,是一种理想的微创手术方法。     

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.     

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.     

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.