医用胶标记在肺部小结节胸腔镜手术前定位的应用

目的探讨CT引导下肺穿刺注射医用胶在肺部小结节(small pulmonary nodule,SPN)胸腔镜手术前定位的可行性和临床价值。方法 21例21个肺内孤立性结节病灶,术前均行CT引导下经皮肺穿刺注射医用胶定位标记,术中先行肺楔形切除术切除病灶并根据病理结果决定进一步手术方案。结果术前CT引导下经皮肺穿刺注射医用胶定位成功率100%(21/21)。穿刺定位后出现刺激性咳嗽6例(28.6%),无症状气胸5例(23.8%),无出血、血胸。术中均能准确定位后行肺楔形切除术,病理证实为肺癌15例,良性病变6例。结论胸腔镜术前CT引导下经皮肺穿刺注射医用胶定位SPN快速、安全,值得临床推广使用。     

CT引导下快速医用胶定位在肺结节手术中的应用

目的探讨CT引导下快速医用胶定位在肺结节手术中的应用。方法 2015年9月～2018年4月对111例126个肺小结节术前72 h内在CT引导下经皮穿刺定位,将快速医用胶注射到肺结节周边形成硬结,随后行电视胸腔镜下亚肺叶切除术。结果 111例术前在CT引导下注入快速医用胶均形成硬结,定位成功率100%。结节在定位后共发生气胸15例,肺内出血5例,但均无明显不适,未特殊处理。单操作孔胸腔镜手术顺利完成,术中均探查到胶水结节,无中转开胸,无明显并发症。结论术前CT引导下快速医用胶定位肺结节方法可靠,实用性强,值得推广。     

CT引导下用Hook针定位肺部小结节在胸腔镜术前的应用价值

目的探讨肺部小结节胸腔镜术前通过CT引导用Hook针进行定位的意义。方法对2015年1月至2016年8月本院的63例肺部小结节拟行胸腔镜下肺楔形切除术,并且术前均行Hook针CT引导下定位的临床资料进行回顾性分析,总结临床应用中操作要点和经验,探讨Hook针CT引导下定位术的指征和规范。结果本组46位患者共63枚肺部小结节均顺利定位,1位患者出现定位针脱落,但仍依据穿刺后肺内灶状出血完成肺楔形切除术。46例患者中19例出现不同程度气胸,但均无须处理。术后病理结果显示恶性结节49枚,良性结节14枚(其中错构瘤1枚,炎性病变13枚)。腺癌49枚(其中原位癌8枚,微浸润性腺癌16枚,浸润性腺癌25枚)。结论肺部小结节经CT引导下用Hook针定位后行胸腔镜下肺楔形切除术,具有准确、安全、有效等优点,显著提高了早期肺癌的检出率,为患者的早期手术切除提供了保障。     

术前CT定位在电视胸腔镜手术治疗肺部小结节中的应用

目的探讨术前CT定位、术中染料结扎夹标记肺结节表面胸膜的方法在电视胸腔镜下肺小结节切除术中的应用价值。方法选取2015年8月至2018年5月在本院胸外科治疗的89例患者,98枚肺小结节,术前CT在体表定位肺部小结节,术中在胸腔镜辅助下,以亚甲蓝结扎夹标记肺结节表面胸膜,完成镜下楔形切除术。结果 98枚结节按此方法成功定位85枚(87%),13枚结节因其位于纵隔面无法按此方法完成定位,术中无并发症发生,定位成功后行VATS肺楔形切除术,无中转开胸手术,术中均取得明确病理诊断。结论术前CT定位,染料结扎夹标记肺结节表面胸膜的定位方法,简单有效,准确率高,安全性好,是肺部小结节微创术前理想的定位方法。     

术前CT引导下亚甲蓝与Hookwire联合定位肺小结节临床应用价值

目的 探讨CT引导下亚甲蓝与Hookwire联合定位在胸腔镜下孤立性肺小结节(SPN)切除术中的临床应用价值.方法 对56例患者的60枚SPN术前行CT引导下亚甲蓝与Hookwire联合定位后行胸腔镜(VATS)肺楔形切除术.全组患者男19例,女37例;年龄35～81岁,平均(61.1±8.9)岁.结果 56例60枚SPN直径为(6.80±4.12) mm,距壁层胸膜(15.38±4.63) mm.CT引导下定位成功率100％,定位时间(10.76±8.17) min.定位后5例(8.9％)发生局部少量气胸,4例(7.1％)发生肺出血,均无需治疗.60枚肺小结节病灶均准确定位,VATS楔形切除术成功率100％.术后病理显示,肺泡细胞癌(BAC)33枚(55.0％),肺泡细胞癌伴腺癌(BAC+ AC) 11枚(18.3％),肺泡细胞不典型增生(AAH)7枚(ll.8％),炎性肉芽肿4枚(6.7％),错构瘤3枚(5.0％),结核性肉芽肿2枚(3.3％).结论 胸腔镜术前CT引导下亚甲蓝与Hookwire联合定位准确率高,对胸腔镜手术(VATS)楔形切除病灶有极大的帮助作用,具有良好的临床应用价值.     

医用胶在肺微小结节术前定位中的应用

目的探讨医用胶用于肺微小结节术前定位的临床价值。方法 2013年3月至2015年3月兰州大学第二医院胸外科25例患者的28处肺内微小结节病灶经术前定位后行胸腔镜手术切除,其中男18例、女7例,年龄23~67(43.00±3.54)岁。所有患者均在CT引导、局部麻醉下用23G穿刺针行经皮肺穿刺注射医用胶进行肺结节定位。定位当日或次日行胸腔镜手术切除。结果全组2 8处肺内微小结节病灶直径0.42~1.34(0.82±0.12)cm,距离脏层胸膜1.51~3.26(2.31±0.42)cm,均成功实施经皮肺穿刺并于结节周围注射医用胶,定位成功率100.0%。定位并发症包括无症状气胸5例,疼痛2例,均不需特殊处理。术前定位后,肺内微小结节的切除成功率为100.0%,其中2例因结节同肺内动脉、支气管毗邻而直接行肺叶切除术。术后病理提示原发性肺癌12例,结核瘤8例,机化性肺炎2例,转移癌、错构瘤、肺内淋巴结各1例。结论医用胶术前定位肺内微小结节是一种安全、有效、简单的方法,定位后可提高胸腔镜下肺内微小结节的手术切除率。     

对比医用胶与Hook-wire在肺小结节胸腔镜下肺组织切除术前定位中的应用

目的对比医用胶与Hook-wire在肺小结节(最大径≤30mm)胸腔镜下肺组织切除术前定位中的应用价值。方法回顾性分析107例接受胸腔镜下肺楔形切除、肺段或肺叶切除术的肺小结节患者的资料。按术前定位方法分为医用胶组(88例,共90个结节)及Hook-wire组(19例,共19个结节),比较2组病灶位置、结节大小、结节与胸膜的距离、结节良恶性、胸腔镜手术方式及并发症(包括气胸、肺出血、局部疼痛、咳嗽)的差异,并对并发症的相关危险因素进行二元Logistic回归分析。结果 2组病灶位置、结节大小、结节与胸膜的距离、结节良恶性及胸腔镜手术方式差异均无统计学意义(P均0.05),术前定位成功率均为100%。医用胶组总体并发症发生率及肺出血发生率均明显低于Hook-wire组(P均0.01)。定位方法为总体并发症、肺出血、局部疼痛的独立危险因子,结节到胸膜的距离为肺出血的独立危险因子。结论医用胶可用于肺小结节胸腔镜下肺组织切除术前定位,且相对于Hook-wire定位并发症发生率更低。     

孤立性肺小结节在CT引导下带钩钢丝术前定位

电视胸腔镜下(VATS)楔形切除术能完整地切除孤立性肺小结节(solitary pulmonary nodule,SPN),病灶的术中准确定位是手术成功的关键.CT引导下的带钩钢丝(hookwire)术前定位,操作简单,定位准确率高,是一种安全、有效的方法.临床资料2008年4月至2010年6月,我们为100例计110枚SPN(既往或同期有恶性病变病史者37例),经术前CT引导下Hookwire定位后行VATS楔形切除术,其中男48例,女52例;平均年龄(54.2±10.4)岁.单发结节90例,多发结节10例;病灶直径(11.44±4.17)mm,距壁层胸膜(11.49±7.18)mm.病灶分布在右上叶31枚,右中叶9枚,右下叶20枚,左上叶33枚,左下叶17枚.     

对比CT引导肺结节定位针与弹簧圈定位针术前定位亚厘米肺结节效果

目的 对比术前于CT引导下以肺结节定位针与弹簧圈定位针定位亚厘米肺结节的效果。方法 55例亚厘米肺结节(孤立性肺结节,最大径4～10 mm,距胸膜<50 mm)患者于电视辅助胸腔镜手术(VATS)前48 h内接受CT引导下定位病灶,其中30例采用肺结节定位针(定位针组)、25例采用弹簧圈定位针(弹簧圈组),对比2种方法定位时间、CT扫描次数、定位成功率、病灶楔形切除时间、手术成功率及并发症。结果 55例均顺利完成术前定位且VATS均成功切除病灶。2种定位方法之间,CT扫描次数、病灶楔形切除时间及气胸、肺内出血发生率差异均无统计学意义(P均>0.05)。以定位针定位时间长于弹簧圈(P=0.001)。结论 术前于CT引导下以肺结节定位针与弹簧圈定位针定位亚厘米肺结节的安全性和有效性相当,后者操作时间更短。     

微弹簧圈定位在胸腔镜肺小结节切除术中的应用

目的探讨术前CT引导下微弹簧圈定位在胸腔镜孤立性肺小结节切除术中的应用价值。方法 2014年5月~2016年4月,对21例单发肺部小结节病灶经术前定位后行胸腔镜手术切除。结节直径7~21(10.3±8.0)mm,距离脏层胸膜深度5~23(10.2±4.3)mm。术前1日在CT引导下行"拖尾法"微弹簧圈术前定位,胸腔镜下行病灶楔形切除术,送冰冻病理,如为恶性继续行胸腔镜下肺叶切除加纵隔淋巴结清扫术。结果全组21例肺小结节均成功经皮肺穿刺置入微弹簧圈。定位并发症为无症状气胸3例,均无需处理。胸腔镜术中发现微弹簧圈脱位3例,定位成功率85.7%(18/21)。21例均行胸腔镜手术切除。病理确诊原位癌5例,腺癌11例,非典型腺瘤样增生1例,炎症2例,炎性假瘤1例,肺内转移瘤1例。结论 CT引导下微弹簧圈定位用于肺内小结节术前定位是一种简单、直观、有效、精确的方法,值得推广。     

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.