胃肠道间质瘤26例临床分析

目的探讨胃肠道间质瘤的临床特点及其诊断和治疗方法。方法回顾性分析我院2000年-2006年收治的26例胃肠道间质瘤的临床和病理资料。结果免疫组织化学检测结果：CD117的阳性率为96．1％,CD34的阳性率为80．7％。全组均行手术治疗,手术切除率100％。未发生手术并发症,无手术死亡病例。结论CD117和CD34标记阳性是诊断胃肠道间质瘤最有价值的血清学指标;肿瘤大小和核分裂象是判断胃肠道间质瘤良、恶性的重要指标;手术是其主要的治疗方法。     

胃肠道间质瘤的免疫组化分析及临床诊治

目的 探讨胃肠道间质瘤的诊治、临床病理学及免疫组化特征。方法 收集1998～2005年收治的41例胃肠道间质瘤的临床病理学资料，进行免疫组织化学染色，标记抗体为CD117、CD34、SMA和S-100蛋白。结果 危险程度极低2例，低度危险8例，中度危险19例，高度危险12例。肿瘤是否浸润黏膜肌层或浆膜层与危险程度相关（χ^2=4．85，P＜0．05）CD117、CD34、SMA和S-100蛋白阳性表达分别为90％、83％、37％和25％，其阳性表达率与肿瘤危险程度无关（χ^2=0．34、0．04、0．01、0．02，P＞0．05）。结论 Fletcher的危险程度分类符合临床治疗与预后的需要。肿瘤浸润黏膜肌层或浆膜层是危险性的重要指标，而免疫表型与危险程度无关。肿瘤完全切除联合使用伊马替尼是改善预后的关键。     

胃肠道间质瘤的诊治——附18例报告

目的 探讨胃肠道间质瘤的诊断与治疗。方法 回顾分析1998—2003年外科收治并经病理证实的18例胃肠道间质瘤(GIST)的临床资料。结果 本组患者平均年龄51．2岁，男女比为2：1。部位以胃及小肠最多见。免疫组化表型CD117阳性率77％，CD34阳性率76％，SMA阳性率44％，S—100蛋白阳性率24％，Desrnin阳性率22％。病理诊断GIST良性9例，交界性1例，恶性8例。18例均行根治手术或局部切除。结论 GIST的诊断有赖于纤维光镜及钡剂肠道造影与免疫组化的结合，手术切除是最有效的治疗手段。     

胃肠道间质细胞瘤临床病理与免疫组化研究

目的 探讨胃肠间质瘤(CISTs)的临床病理和免疫组化特征，为其诊断提供参考指标。方法 对35例(CISTs进行病理形态学观察，并采用免疫组化染色检测其CD117、CD34、vimentin、SMA和S-100蛋白表达检测。结果 35例GISTs中，良性16例，恶性17例，潜在恶性2例，主要由梭形细胞和上皮样细胞构成：免疫组化vimentin、CD34、CD117肿瘤细胞显示明显阳性，阳性率分别为100％、88。6％、60．0％，SMA和S-100蛋白呈散在细胞阳性，阳性率分别为34．3％和6．1％。结论 GISTs是胃肠道最常见的问质肿瘤，HE染色下形态与平滑肌肿瘤和神经源性肿瘤较相似，免疫组化染色对其诊断和鉴别诊断具有重要作用，CD117特异性较高，CD34敏感性较高。     

42例胃间质瘤的临床及内镜分析

目的探讨胃间质瘤的临床及内镜特征。方法回顾性分析42例经病理证实的胃肠道间质瘤的临床和内镜资料,所有病例的组织均经免疫组织化学染色观察CD117、CD34、Vimentin、Actin和S-100的表达情况。结果本组42例胃间质瘤主要临床表现上消化道出血(占76%)。胃镜下表现:发生于胃底21例、胃体14例、胃窦7例;呈半球形隆起23例,息肉样隆起19例(45%),其中仅有3例内镜下活检证实为胃间质瘤。手术标本病理诊断为良性胃间质瘤17例、交界性14例,恶性11例。免疫组织化学检查CD117和CD34表达的阳性率分别为93%及79%,CD117、CD34在良性、交界性、恶性间质瘤中的表达均无显著性差异(P>0.05)。结论胃间质瘤临床表现无特异性,内镜下活检阳性率低,确诊多依靠手术病理及CD117、CD34的联合检测。     

腹腔镜微创外科治疗胃肠间质瘤43例分析

目的 评价胃肠间质瘤的临床诊断及行腹腔镜手术治疗的可行性与安全性.方法 回顾性分析2006年8月-2009年6月43例超声内镜拟诊胃肠道间质瘤的临床诊断与治疗资料.结果 腹腔镜手术成功36例,成功率为83.7%.超声内镜诊断率为69.O%.术后诊断胃肠道间质瘤免疫组化CD117、CD34标记阳性率为100%.术后患者平均住院时间为5 d,术后疼痛轻微.结论 超声内镜及CD117、CD34标记可以作为胃肠道间质瘤临床影像学诊断及免疫学诊断的重要手段,腹腔镜手术切除胃肠间质瘤是安全可行的.     

15例胃肠道间质瘤的临床病理分析

目的：探讨胃肠道问质瘤(GISTs)的组织学起源与病理特点。方法：对15例GISTs标本进行形态学观察和免疫组织化学染色及对比分析。结果：本组病例多以腹部包块、疼痛及消化道出血为首发症状，以梭形细胞型为主(93.3％)，CD117阳性率为100％，CD34阳性率为73．3％。结论：GISTs符合卡哈尔问质细胞来源。CD117及CD34对GISTs的诊断和治疗具有重要意义。     

胃肠道间质瘤196例临床分析

目的 探讨胃肠道间质瘤的诊断和治疗方法.方法 回顾性分析我院2001年11月～2006年10月收治的胃肠道间质瘤196例的临床资料.本组病人均行手术治疗.结果 免疫组织化学项目CD117、CD34、SMA、S-100、Desmin的阳性率分别为100%、54.6%、52.6%、15.3%、0.术后死于初次复发7例,死于再次手术后3例.本组5年生存率为94.8%.接受格列卫治疗者共38例,完全缓解3例,部分缓解31例,疾病稳定4例.结论 组织形态及免疫组织化学染色是诊断GIST的必要手段.加强对胃肠道间质瘤的认识,规范手术及合理的靶向药物治疗是GIST治疗的关键.     

胃肠道间质瘤28例临床和病理分析

目的探讨胃肠道间质瘤(GISTs)的临床表现、组织学和免疫组化特点及治疗方法。方法对1998~2003年收治的28例GISTs病人的临床和组织学资料进行回顾性分析,应用免疫组织组化染色检测CD117、CD34、SMA、S100的表达。结果GIST主要发生在胃(60.7%)和小肠(25.0%),结直肠(10.7%)和肠系膜(1.25%)较少;本组中良性9例,交界性5例,恶性14例;免疫组织化学染色显示CD117、CD34、SMA、S100表达的阳性率分别是100%、71.4%、28.6%和10.7%。结论GISTs是胃肠道常见的间质性肿瘤,手术前诊断困难,CD117和CD34标记阳性是确诊GISTs最有价值的诊断依据,手术仍是主要治疗手段。     

胃肠道间质瘤的临床分析

目的探讨胃肠道间质瘤的临床诊断与治疗。方法回顾性分析95例胃肠道恶性间质瘤病人的临床资料。结果发生于胃、小肠、结直肠、肠系膜、大网膜的病例分别为65、25、2、2、1例；肿瘤直径1～10cm；其中恶性者47例，良性者48例；行根治性切除62例，行切除术31例，2例广泛转移者行肝结节活检。17例术后发生伤口感染，免疫组化指标：CD117、CD34、CK、EMA、S-100及Desmin阳性率分别为89．5％、86．3％、5．3％、0、9．5％及8．4％。随访80例，2例胃间质瘤广泛转移者分别于术后4月、6月死亡，17例术后5～25月死于其他疾病，余者均无瘤生存，5年生存率43．7％。结论提高对胃肠道间质瘤的认识，强化术中病理学检查及免疫组化检查，确定良恶性及恶性程度，采取合理规范的手术方式，对预后及防止复发有一定意义。     

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.     

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.     

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.