透明质酸注射治疗面部静态性皱纹临床观察

目的：观察应用透明质酸注射治疗面部静态性皱纹的临床效果。方法：自2005年10月～2007年5月，对32名患者面部不同部位的皱纹进行透明质酸注射充填治疗，观察注射后的临床效果、疗效时间、不良反应等。结果：所有注射部位均于注射后即得到明显改善。术后随访3、6、12个月分别有88．6％、82．5％、78．5％的注射部位维持了改善的效果。注射治疗中，未出现急慢性过敏反应及感染、肉芽肿、血管栓塞等并发症。结论：透明质酸是一种安全有效、暂时性的面部充填剂，能够有效改善面部静态性皱纹。     

透明质酸注射矫正泪槽畸形

目的 评价应用透明质酸(HA)注射矫正泪槽畸形的临床效果.方法 自2010年6月至2012年6月,对35例矫正泪槽沟畸形患者进行HA注射治疗,注射剂量为0.5～1.5ml.观察注射后的临床效果、疗效时间、不良反应等.结果 所有的注射部位均于注射后即刻得到改善.注射后随访患者,1、3、6个月分别有95.5%、84.7%、52.3%的注射部位维持了改善的效果;6～12个月有43.7%的注射部位维持了改善的效果;12～18个月有15.8%的注射部位维持了改善的效果.注射治疗中,未出现急慢性过敏反应及感染、肉芽肿、血管栓塞等并发症.结论 HA作为暂时性填充剂,治疗泪槽沟畸形安全、可靠.     

透明质酸填充改善面部皱纹的临床疗效

目的评估透明质酸填充改善面部皱纹的临床疗效。方法本组共80例在我院接受透明质酸填充注射治疗面部皱纹的患者,术后患者随访6个月,分析患者术后面部皱纹改善情况、不良反应发生率及患者对治疗效果的满意度。结果 80例患者术后1个月、3个月、6个月面部皱纹改善率分别为93.8%、90.0%和86.3%。所有患者术后出现的局部轻度不良反应均自行消退或在对症治疗后痊愈。所有患者均未出现感染、组织坏死、肉芽肿、血管栓塞等严重不良反应。患者对治疗效果总满意度为93.8%。结论透明质酸填充能明显改善患者面部皱纹,疗效良好,无明显不良反应。     

透明质酸与肉毒毒素联合注射治疗重度眉间纹

目的探讨透明质酸与肉毒毒素联合注射治疗眉间纹的适应证、注射方法和临床效果。方法选择67例严重眉间纹患者,联合应用透明质酸（0．3～0．8m1）和肉毒毒素（9～14U）注射治疗,观察注射后的临床效果、疗效时间和不良反应等。结果透明质酸与肉毒毒素联合注射后,静态眉间纹即刻得到明显改善;注射后2、3d,动态皱眉纹开始逐渐减轻;约1个月时,效果明显改善。随访3～12个月,术后皱纹改善满意,最长可达18个月。结论对重度眉间纹（同时具有静态和动态皱眉纹）的患者,应用透明质酸行皱纹内填充,并结合肉毒毒素对眉间复合体肌肉进行注射,可达到更好的治疗效果。     

医用羟丙基甲基纤维素-透明质酸钠溶液治疗面部皱纹的临床应用

目的 探讨应用羟丙基甲基纤维素-透明质酸钠溶液作为皮肤填充剂治疗面部皱纹的效果.方法 自2006年11月至2008年5月,对60例患者面部共107处皱纹进行羟丙基甲基纤维素-透明质酸钠溶液的注射填充,观察注射后的临床效果、持续时间和不良反应等.依据面部皱纹WSRS分级标准,对比注射前后的照片并将结果分为显效、有效和无效.结果 所有注射部位皱纹在注射后即刻得到明显改善,随访6个月,有效率为100%.最常见的注射后不良反应是局部疼痛、肿胀和皮肤发红,其次为皮下淤血、局部硬结或不平,未出现感染.色素沉着、肉芽肿、血管栓塞等并发症.结论 医用羟丙基甲基纤维素-透明质酸钠溶液作为填充剂治疗面部皱纹具有创伤极小、疗效肯定、安全性高等特点,值得临床推广应用.     

bFGF辅助自体脂肪颗粒注射治疗面部凹陷

目的 观察bFGF辅助自体脂肪颗粒注射面部凹陷的临床效果,寻找治疗面部凹陷的有效方法. 方法 根据入院时间将41例面部凹陷患者随机分为两组,A组2004年4月-2004年12月收治的12例.男5例,女7例;年龄16～49岁.先天性额部凹陷2例,半侧面部萎缩症2例,面部创伤后瘢痕凹陷5例,面部良性肿瘤治愈后凹陷3例.病程2～19年.凹陷部位低于周围正常皮肤(0.52±0.13)cm.凹陷面积(16.0±5.3)cm2.B组2005年1月-2006年5月收治的29例.男14例,女15例;年龄18～52岁.先天性额部凹陷3例,半侧面部萎缩症4例,面部创伤后瘢痕凹陷15例,面部良性肿瘤治愈后凹陷7例.病程2～20年.凹陷部位低于周围正常皮肤(0.58±0.15)cm,凹陷面积(18.0±6.2)cm2.A组采用单纯自体脂肪颗粒注射治疗,B组在A组基础上同时应用bFGF(4 200 IU/10 mL)辅助治疗. 结果 注射后A组获随访6～24个月,平均12.5个月;B组获随访6～24个月,平均13个月.A组1次注射后6例效果满意,～次治疗满意率为50%;余6例于术后6～12个月再次注射,其中2次注射3例,3次注射3例.B组1次注射后24例效果满意,1次治疗满意率为82.8%;5例患者于术后12个月再次注射.两组患者的1次治疗满意率比较,差异有统计学意义(P＜0.05). 结论 面部凹陷是创伤或整形术后常见的并发症,采用bFGF辅助自体脂肪颗粒注射治疗面部凹陷安全有效.     

PPDO线埋置联合透明质酸和A型肉毒毒素注射在面部年轻化中的应用

目的探索PPDO线、透明质酸、A型肉毒毒素联合应用在面部年轻化中的治疗效果。方法根据面部需要提升的部位埋置PPDO线;在面部凹陷区域进行透明质酸注射;在面颈部皱纹处进行A型肉毒毒素注射,3种治疗手段同时应用。结果本组239例患者,术后随访3个月。除11例出现面部轻微不对称外,其余患者均对治疗效果满意。结论 PPDO线联合透明质酸、A型肉毒毒素注射,可使PPDO线作用更强、面部年轻化效果更佳;同时可减少A型肉毒毒素、透明质酸单独应用时的剂量,效果更持久;也可在达到相似治疗效果的情况下减少治疗次数,从而减轻患者的负担,给予其更好的临床体验。     

自体乳化脂肪在面部皱纹中的应用探讨

目的:探讨自体乳化脂肪在面部皱纹中的临床应用。方法:对我科收治的20例面部皮肤软组织老化萎缩凹陷患者,在其腹部或大腿抽吸脂肪颗粒,经离心纯化乳化后,注射移植填充面部皱纹,术后定期观察填充效果。结果:20例(42个部位)中15例接受1次乳化脂肪注射移植,4例接受2次注射移植,1例接受3次注射移植;术后随访6个月,面部皱纹、肤质明显改善,未发现感染、硬结、肉芽肿等并发症。临床疗效患者满意率为75%,术者满意率为80%,不满意率为5%。结论:自体乳化脂肪注射移植填充面部皱纹,效果显著、可靠。     

自体成纤维前体细胞填充凹陷性瘢痕

目的 观察体外培养的自体成纤维前体细胞注射治疗颜面部皱纹和凹陷性瘢痕的临床效果,探讨其在面部抗衰老治疗中的意义.方法 从患者耳后内侧取一块约3 mm×7 mm皮肤,通过体外分离、培养产生自体成纤维前体细胞和自体胶原蛋白,致细胞数量增殖到4×107/ml时再注入到患者治疗部位的真皮层内.结果 本组共780例患者,治疗后随访3～9个月,面部静态皱纹及凹陷性瘢痕均得到明显改善,未出现免疫排斥反应等并发症.结论 应用自体成纤维前体细胞注射治疗颜面部浅表皱纹和凹陷性瘢痕,治疗方法简单、创伤轻微、安全、效果确切,是一种较好的修复真皮组织的技术.     

应用非动物源性稳定性透明质酸凝胶矫正鼻唇沟皱纹的研究

目的 评估非动物源性稳定性透明质酸凝胶(Restylane,瑞典Q-Med公司生产)注射治疗鼻唇沟皱纹的有效性和安全性.方法 鼻唇沟部皱纹严重程度分级在中度以上的患者接受非动物源性稳定性透明质酸凝胶的注射治疗(每侧<1.5 ml).随访时间6个月.分别由医生和患者本人根据皱纹严重程度分级标准进行评分.研究者记录不良事件.治疗前后进行常规实验室检查.结果 共86例患者接受鼻唇沟注射治疗(95%女性,平均年龄43岁).注射治疗6个月后,研究者和受试者分别评估,局部左右两侧鼻唇沟皱纹的评分均较注射前下降;面部整体美容效果的改善程度,均超过90%认为至少有某种程度的改善.在治疗6个月时,左右两侧鼻唇沟的应答率分别是81.4%和84.9%.治疗后6个月,32例(占受试者总数的37.2%)报告不良事件总数为52项,大多数被判断为注射部位反应.大多数不良反应为中度以下,并且可以自愈.没有全身反应.结论 非动物源性稳定性透明质酸凝胶纠正中国人的鼻唇沟皱纹疗效好,并且安全可靠.     

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.     

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.     

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.