乳晕周围环状切口垂乳和巨乳整形术

目的 探求一种对乳房松垂和轻中度乳房肥大切口瘢痕不明显,术后塑形良好的手术方式。方法 应用乳晕环状切口去皮,游离皮瓣,“Ｖ”形切除多余腺体,悬吊乳腺于第三 骨膜上,荷包缝合收紧外环切口。结果：１０例受术者随访３～１２月,切口外周“百页裙”状皮肤皱折术后３个月消失,获得了满意的临床效果。结论 此术式设计简单,血供及乳腺悬吊固定良好切口隐蔽,瘢痕不显,乳头乳晕感觉正常,乳房塑形佳。     

乳腺瓣悬吊加假体置入矫正中重度乳房萎缩下垂

目的:介绍采用乳腺瓣悬吊,并在胸大肌后间隙置入硅凝胶假体矫正中重度乳房萎缩下垂的方法和经验。方法:经乳晕周缘"双环形"切口,去除内外环之间的表皮。在皮下脂肪组织与腺体之间广泛分离。在乳腺上部形成4～5cm宽的纵向乳腺瓣,横向切断乳腺瓣,上提缝合固定以悬吊乳房。胸大肌后间隙置入硅凝胶假体。将去表皮的真皮帽边缘与乳腺基部缝合,并固定在胸壁上,重塑乳房外形。结果:2005年1月～2009年6月采用该方法共治疗28例中重度乳房萎缩下垂的患者,无血肿、感染、乳头乳晕坏死等并发症发生。术后随访1～4年,乳房丰满挺拔,萎缩下垂得到矫正,切口瘢痕呈环线状,乳头乳晕感觉功能正常。结论:该术式在增大乳房体积的同时提升下垂的乳房,对中重度乳房萎缩下垂患者可作为一种理想的整形方法。     

双环法旋转圆锥状腺体蒂乳房缩吊术

目的改进传统的双环法在乳房缩小术、乳房悬吊术术后外形扁平，凸度不足，上极瘪陷，提升不够等缺点。方法采用双环切口。“扇”形分离、切除皮下部分脂肪，“楔”形切除适量的外上象限腺体，螺旋状旋转剩余腺体成圆锥状，将其固定在第2肋软骨膜上，矫正轻中度乳房肥大和下垂。结果术后随访20例患者1～3个月，乳房上极较丰满，形态好，乳头乳晕功能正常，切口瘢痕轻，乳房肥大和下垂的矫正获得了满意的效果。结论双环切口，螺旋状旋转剩余腺体成圆锥状，并固定于第2肋软骨膜上，可较好地塑形并悬吊乳房，其切口相对隐蔽，术后乳房高凸，上极略饱满，乳头微上翘，乳晕形态合适，是矫正轻中度乳房肥大下垂的一种较理想的术式。     

环乳晕切口下蒂瓣法矫治巨大乳房

目的:探讨环乳晕切口下蒂瓣矫正特别巨大乳房的临床效果。方法:采取环乳晕切口,以部分去表皮的下蒂瓣为基础,切除乳头乳晕上方、外侧大部分腺体皮肤及内侧部分腺体皮肤组织,上提下蒂瓣,固定重塑乳房腺体形态,再将下蒂两侧的皮肤均匀拉拢,覆盖下蒂瓣,切除多余皮肤,使之形成不超过乳房下皱襞的斜形短切口,乳晕及周围的皮肤真皮层辐射状环缩缝合,缝合皮肤。结果:10例20只乳房,单侧乳房组织平均切除量为1 050g,最大2 200g。随访6~12个月,无乳头坏死、感觉良好,外形饱满。患者对乳房形态、对称性、乳晕大小形状、乳头乳晕感觉及切口瘢痕的满意率分别为100%。结论:环乳晕切口下蒂瓣的巨大乳房缩小整形术,组织切除量大,瘢痕短,并发症少,是一种较好的巨大乳房缩小术式。     

多重悬吊双环法矫正乳房下垂的临床应用

目的 探讨多重悬吊双环法矫正乳房下垂及轻中度乳房肥大的方法及临床效果.方法 采用传统的双环法手术切口,在内、外环切口之间去除表皮,形成真皮帽,并在外环切口周围皮下组织与乳腺腺体表面进行广泛分离直至乳房基底部,然后将乳腺组织在中部环形折叠塑形,再行真皮帽悬吊和乳腺上极边缘多点缝合悬吊,荷包缝合内外环皮肤,术后乳房塑形包扎.结果 16例(32侧)患者均Ⅰ期愈合,无乳头、乳晕坏死.随访6～12个月,乳晕周围皮肤皱褶基本消失,瘢痕细小,乳头、乳晕感觉良好,乳房外形美观.结论 多重悬吊双环法矫正乳房下垂可避免对乳房局部过度分离和牵拉,乳房外形美观,悬吊确切、持久,是矫正乳房下垂伴轻、中度乳房肥大的一种比较理想的方法.     

应用乳腺旋转瓣固定矫正轻中度乳房下垂

目的:介绍采用乳房外下象限乳腺旋转瓣固定矫正轻中度乳房下垂的方法和经验。方法:经乳晕周缘"双环形"切口,去除内外环之间的表皮。在皮下脂肪组织与腺体之间广泛分离。在乳房下方正中垂直剖开乳腺,并向外侧分离,形成乳房外下象限乳腺瓣,并向内上方旋转固定,缩小乳房基底,重塑乳房外形,并上提下垂的乳头乳晕复合体。伴有明显乳腺萎缩者,同期或Ⅱ期行胸大肌下假体隆乳术。结果:2011年2月~2013年12月采用该方法共治疗轻中度乳房下垂19例,无血肿、感染、乳头乳晕坏死等并发症发生,术后随访1~2年,无乳房下垂复发,乳房下垂明显矫正,双乳对称,外形良好。切口瘢痕呈环线状,乳头乳晕感觉功能正常。结论:乳腺旋转瓣固定法结合了"双环法"和"垂直法"两种技术的优势,对轻中度乳房下垂的治疗,提供了一种新的思路和方法。     

腺体外侧蒂皮肤双环切口乳房塑形悬吊术

目的探讨腺体外侧蒂皮肤双环切口乳房塑形悬吊术,在矫正乳房下垂中的应用。方法自2003年以来,应用外侧蒂双环切口乳房塑形悬吊术,矫正乳房下垂患者30例,“楔”型切除乳房下极部分腺体组织,腺体瓣相对旋转缝合固定于胸肌筋膜,保留部分腺体于内上方皮瓣,乳房上极悬吊至第2、3肋软骨膜。结果术后随访患者1~3个月,均获得满意效果。结论外侧蒂双环切口乳房塑形悬吊术,可以有效地塑形悬吊乳房,术后切口隐蔽,乳房上极饱满,是矫正乳房下垂的一种理想选择。     

改良双环法乳房下垂矫正术

目的:介绍改良双环法行乳房悬吊术的方法和经验。方法:采用传统的双环法环乳晕切口,切除双环间表皮,在皮肤与上半乳腺的腺体表面之间剥离,去除上半腺体后松弛的浅筋膜深层,上提腺体至正常位置并固定于深筋膜,同时进行腺体的适当折叠塑形或置入乳房假体增加丰满程度。结果:共行轻、中度下垂28例(4例为单侧下垂),其中悬吊加假体隆乳9例;腺体瓣交叉缝合悬吊塑形19例。术后乳房外形改善满意,乳头、乳晕感觉良好,效果持久。结论:本手术方法安全易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法。     

双环复合组织筋膜瓣法矫正乳房下垂的临床应用

目的 探讨应用双环复合组织筋膜瓣法行乳房悬吊术矫治乳房轻、中度下垂的方法及临床效果.方法 在传统的双环形切口乳房缩小整形术的基础上,在皮肤与乳腺的腺体表面间行广泛剥离后,应用蒂在乳腺上半象限的筋膜瓣垂直下拉,缝合固定于下半象限的乳腺与胸大肌之间,并将乳晕内外环的真皮行荷包缝合,术后将乳房塑形包扎.结果 应用双环复合组织筋膜瓣行乳房悬吊术的方法矫治乳房下垂20例,患者均Ⅰ期愈合,无乳头、乳晕坏死.所有患者术后随访6~12个月,乳晕周围皮肤皱褶基本消失,乳房外形美观持久,乳头、乳晕感觉良好,效果满意.结论 改良手术方法技术简便易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法,值得推广应用.     

改良双环法乳房悬吊术

目的 介绍改良双环法行乳房悬吊术的方法和经验。方法 采用传统的双环法乳房悬吊术切口，在皮肤与乳腺的腺体表面之间行广泛剥离后。在乳腺的下半象限正中将腺体垂直切开，将形成的两部分乳腺复合组织瓣向内上及外上方向旋转后互相交叉重叠缝合固定成形。并将乳晕内外环的真皮行荷包缝合。术后将乳房塑形包扎。结果 采用本方法矫治轻、中度乳房下垂者共8例16侧。术后乳房外形美观持久，乳头、乳晕感觉良好，效果满意。结论 本手术方法简便易行．组织损伤小．瘢痕不明显．是矫治轻、中度乳房下垂的一种比较理想的方法。     

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.     

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.