青少年慢性盆底疼痛综合征临床分析

目的探讨青少年慢性盆底疼痛综合征(CPPS)或慢性非细菌性前列腺炎(CNBP)的临床特点及治疗方法。方法依据美国国立卫生研究院(NIH)前列腺炎的诊断标准,将30例青少年患者分为Ⅲa型8例,Ⅲb型22例;按前列腺炎症状严重程度评分(SSI)进行分组治疗,规律性治疗1~3个月。全部患者均配合精神心理及物理疗法,部分患者服用清热解毒和(或)活血化瘀类中药。Ⅲa型患者以广谱抗生素及α1-受体阻滞剂治疗为主。Ⅲb型则分别给予α1-受体阻滞剂及镇静镇痛肌松治疗。结果治疗后SSI评分降低,显效18例,有效8例,无效4例,总有效率87%。结论青少年CPPS不完全同于成人CPPS,综合性治疗是一种有效的方法。     

特拉唑嗪在正常血压的ⅢB型前列腺炎中的应用研究

ⅢB型前列腺炎是慢性前列腺炎／慢性骨盆疼痛综合征（CP／CPPS）中常见的类型，又称为非炎症性CPPS；α1肾上腺素受体阻滞剂是目前治疗ⅢB型前列腺炎的常用药物，但其效果和对血压的影响报道不多，本研究以特拉唑嗪为例对这两方面进行探讨，为临床用药提供帮助。     

α-受体阻滞剂和抗抑郁药联合治疗Ⅲ型前列腺炎

目的研究α-受体阻滞剂和抗抑郁药联合治疗Ⅲ型前列腺炎的效果。方法本组48例被诊断为Ⅲ型前列腺炎（CP／CPPS）的患者，年龄20-50岁，平均30岁。均有会阴区域疼痛、尿频及紧张、焦虑等症状。病程3月。2年，平均18个月。均有抗生素治疗史，疗效不佳。采用α-受体阻滞剂（多沙唑嗪控释片4mg／d或坦索罗辛2mg／d口服）、抗抑郁药（舍曲林50mg／d或文拉法辛75mg／d口服）联合疗法，3个月为一疗程。在治疗前、治疗后4周、8周和12周对患者进行美国国立卫生研究院慢性前列腺炎症状指数（NIH-CPSI）评分并记录不良反应情况。疗效评定标准为：（1）显效：NIH-CPSI较治疗前下降〉15分：（2）有效：NIH-CPSI较治疗前下降〉5分：（3）无效：NIH-CPSI较治疗前下降〈5分或上升。总有效率为显效率与有效率之和。结果显效16例，有效25例，无效4例，总有效率91％（41／45）。2例患者因药物不良反应退出治疗。结论α-受体阻滞剂和抗抑郁药联合治疗方案安全有效，可以明显缓解Ⅲ型前列腺炎患者的临床症状。     

慢性骨盆疼痛综合征的综合性治疗

目的 :探讨慢性骨盆疼痛综合征 (CPPS)的诊疗方法。　方法 :分析 16 5例CPPS患者的病史和实验室检查结果 ,依据美国国立卫生研究院 (NIH)前列腺炎的诊断标准 ,对患者进行分类。综合性治疗 6～ 8周。ⅢA型患者以广谱抗生素及α1受体阻滞剂治疗为主 ,ⅢB型则分别给予α1受体阻滞剂、镇静剂、镇痛肌松剂治疗 ;全部患者均配合精神心理及物理疗法 ,部分患者加服中成药。根据慢性前列腺炎症状指数 (CPSI)评分判断疗效。　结果 :治疗 6周后显效 12 1例 (73.3% ) ,有效 2 6例 (15 .8% ) ,无效 18例 (10 .9% )。　结论 :综合性治疗是CPPS有效的治疗方法。     

慢性前列腺炎诊治及疗效评价(附600例报告)

目的：探讨慢性前列腺炎的诊断标准。方法：调查600例慢性前列腺炎病例的实验室诊断结果,按照美国国立卫生研究所（NIH）制定的前列腺炎症状评分（CPSI）标准,进行NIH分类和疗效的判定。应用喹酮类抗生素4－12周,根据病情适当应用α受体阻滞剂、热疗或前列腺按摩疗法。结果：按NIH分类,本组Ⅱ型80例（13．3％）,ⅢA型335例（55．8％）,ⅢB型185例（30．9％）。治疗6周前后CPSI症状评分判定：临床治愈138例（23％）,显效（CPSI减少＞15）372例（62％）,有效（CPSI减少＞15）60例（10％）。无效30例（5％）。结论：两杯判定试验（PPMT法）进行前列腺炎的诊断分类简单易行。CPSI是一种较好的疗效评价方法。喹诺酮类抗生素、α受体阻滞剂和止痛剂等药物的联合应用对慢性前列腺炎具有较好疗效。     

α1A受体阻滞剂联合环氧化酶抑制剂对慢性非细菌性前列腺炎的治疗作用

目的：以慢性前列腺炎症状评分（NIH-CPSI）为评价指标.探讨a1-受体阻滞剂联合环氧化酶抑制剂对慢性非细菌性前列腺炎的治疗作用.方法：105例慢性非细菌性前列腺炎患者治疗前后进行前列腺液（EPS）常规检查和细菌培养、慢性前列腺炎症状评分（NIH-CPSI）评价,应用a1A-R阻滞剂坦索罗辛＋环氧化酶（COX-2）抑制剂塞来昔布进行治疗观察.结果：治疗后患者EPS常规检查WBC计数明显减少（P＜0.01）,CPSI评分明显改善（P＜0.01）.结论：a1A-R阻滞剂＋COX-2抑制剂联合用药对慢性非细菌性前列腺炎有较好的治疗作用.     

盐酸坦索罗辛联合前列腺按摩治疗ⅢB型慢性前列腺炎

目的 探讨α-受体阻滞剂盐酸坦索罗辛联合前列腺按摩治疗ⅢB型慢性前列腺炎的疗效.方法 对45例ⅢB型慢性前列腺炎患者采用α-受体阻滞剂+前列腺按摩联合治疗.疗程为8周;对比治疗前后前列腺炎症状评分、尿流率变化.结果 45例患者均完成8周治疗疗程,治疗前后疼痛症状评分为18.1 4±1.2和8.1 4±0.9;排尿症状评分7.9±0.7和3.7 ±0.4;生活质量评分9.2±1.1和3.9±0.3;治疗前后最大尿流率8.2±2.1ml/s和23.1±2.4 ml/s;平均尿流率12.1±1.7ml/s和16.2±1.4ml/s;经统计学检验治疗前后差异有统计学意义(P<0.05).结论 α-受体阻滞剂联合前列腺按摩治疗ⅢB型慢性前列腺炎能缓解患者症状、改善患者生活质量.     

细胞因子及热休克蛋白在慢性前列腺炎患者精浆中的含量及其临床意义

目的:探讨慢性细菌性前列腺炎以及慢性前列腺炎/慢性骨盆疼痛综合症(CP/CPPS)患者精浆中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)以及热休克蛋白70(HSP70)的含量及临床意义。方法:采用酶联免疫吸附测定法(ELISA)对36例慢性细菌性前列腺炎(Ⅱ型)、43例炎症型慢性非细菌性前列腺炎即炎症型慢性骨盆疼痛综合征(ⅢA型)、46例非炎症型慢性非细菌性前列腺炎即非炎症型慢性骨盆疼痛综合征(ⅢB型)患者及25例健康志愿者精浆中TNF-α、IL-1β以及HSP70含量进行测定分析,并将HSP70的表达与慢性前列腺炎症状评分进行相关性分析。结果:慢性细菌性前列腺炎患者精浆中细胞因子(TNF-α、IL-1β)以及HSP70含量明显高于CP/CPPS患者及正常对照组。CP/CPPSⅢA型患者精浆中IL-1β的含量明显高于CP/CPPSⅢB型患者及正常对照组。CP/CPPS患者精浆中HSP70的含量明显低于正常对照组。慢性细菌性前列腺炎患者精浆中HSP70的含量与CPSI评分呈显著负相关。结论:精浆中HSP70的含量能够作为评价慢性细菌性前列腺炎病情程度的分子生物学指标。IL-1β能够作为CP/CPPS分型诊断指标。对于慢性细菌性前列腺炎患者,HSP70具有细胞保护功能。CP/CPPS患者精浆中HSP70表达的抑制可能与T细胞功能受损有关。     

磁疗椅对慢性盆腔疼痛综合征的治疗作用

目的：观察磁疗椅对慢性盆腔疼痛综合征（CPPS）的疗效。方法：2005年6月～2007年4月,我院收治ⅢB型CPPS患者40例,随机分为两组,一组单用α-受体阻滞剂坦索罗辛（O．2mg／d）（单用组）治疗;另一组并用坦索罗辛（0．2mg／d）和磁疗椅（并用组）治疗,磁疗椅每周2次,每次约30min,4周为1个疗程;治疗前后作前列腺炎症状评分（NIH—CPSI）。结果：所有患者均按要求完成治疗。与单用组比较,并用组NIH—CPSI、疼痛评分、排尿评分、严重程度和生活质量评分均有显著下降（P〈0．05）。结论：磁疗椅对CPPS有显著疗效,且操作简单,患者无明显不适,依从性好,值得在临床上推广运用。     

前列舒通胶囊联合α-1A受体阻滞剂治疗湿热瘀阻型Ⅲ型前列腺炎临床观察

目的 前瞻性研究前列舒通胶囊联合α-1A受体阻滞剂治疗湿热瘀阻型Ⅲ型前列腺炎的临床疗效.方法 将121例湿热瘀阻Ⅲ型前列腺炎患者随机分为观察组和对照组,分别给予前列舒通胶囊（3粒,每天3次）＋盐酸坦洛新胶囊（0.2mg,每晚1次）和盐酸坦洛新胶囊（0.2mg,每晚1次）治疗,8周后按照美国国立卫生研究所（NIH）制定的前列腺症状评分标准（CPSI）量化两组患者的症状积分,并观察治疗前后前列腺液中卵磷脂小体、WBC、PH值的变化,比较两组患者的临床疗效及其副作用.结果 经过8周的治疗,观察组和对照组的NIH-CPSI评分、QOL评分及EPS常规中白细胞数目均有显著下降（P＜0.01）,但观察组下降的程度均较对照组明显（P＜0.01）.结论 前列舒通胶囊联合α-1A受体阻滞剂治疗湿热瘀阻型Ⅲ型前列腺炎比单用α-1A受体阻滞剂疗效明显,值得临床推广.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.