不同移植体修复晚期颅骨缺损56例的疗效分析

目的　评估不同移植体修复晚期颅骨缺损的疗效。方法　自1991年以来,应用不同移植体修复晚期颅骨缺损56例,其中应用MEDPOR6例、自体肋骨30例、颅骨外板8例、羟基磷灰石8例、固体硅橡胶4例。结果　经6～12个月临床随访,治疗效果明显,成功率达91.1%,除1例假体外露及1例癫痫发作外,其余无严重并发症发生。结论　颅骨缺损的修复,MEDPOR及自体颅骨及肋骨是安全可靠的,羟基磷灰石及硅橡胶须严格掌握适应证,尽量少用。     

不同移植体修复晚期颅骨缺损56例的疗效分析

评估不同移植修复晚期颅骨缺损的疗效。方法 自1991年以来，应用不同移植体修复晚期颅骨缺损56例，其中应用MEDPOR6例、自体肋骨30例、颅骨外板8例、羟基磷灰石8例、固体硅橡胶4例。结果 经6－12个月临床随访，治疗效果明显，成功率达91．1％，除1例假体外露及1例癫痫发作外，其余无严重并发症发生。结论 颅骨缺损的修复，MEDPOR及自体颅骨及肋骨是安全可靠的，羟基磷灰石及硅橡胶须严格掌握适应证，尽量少用。     

自体骨、生物材料在颅颌面骨缺损修复中的应用研究

目的:运用自体骨与生物材料修复颅颌面骨缺损,观察临床效果并术后随访,以比较自体骨移植与生物材料植入的疗效。方法:将2006年以来笔者科室收治的各种颅颌面骨缺损129例患者分为A、B两组。A组:采用自体骨移植修复,共51例,其中带血管蒂的颅骨外板修复6例、颅骨外板修复37例、下颌骨外板修复8例;B组:采用生物材料植入修复,共78例,其中钛板(网)修复17例、Medpor修复46例、羟基磷灰石修复15例。术后随访6~72个月,通过摄相,头颅X线正、侧位片,面部轮廓测量,颌面部CT及三维重建,了解患者满意度,观察临床效果及有无后期并发症发生。结果:129例患者术后伤口均一期愈合,颅颌面轮廓得到了很大改善,同时具有很好的美容效果。自体骨修复患者中1例术后出现了血清肿,通过负压引流和加压包扎清除了血清肿后伤口一期愈合。术后随访1例Medpor修复额骨缺损患者切口边缘增生,1例Medpor修复患者固定的钛钉穿破皮肤,1例Medpor修复面中分患者修复体外露。其他患者术后随访,颅颌面骨轮廓外观正常,双侧对称,无再陷及表面凹凸不平、修复体移位、外露、假体取出等明显的并发症发生,患者对术后效果满意。结论:颅颌面骨缺损的修复首选自体骨,其中自体颅骨外板与下颌骨外板修复效果较好;当缺损面积大自体骨量不足时,考虑生物材料修复,其中Medpor、羟基磷灰石、钛板应用较多,临床效果满意。     

创伤后颅骨缺损EBCT三维测量及数据库的建立

目的探索建立创伤后颅骨缺损数据库,为颅骨缺损的三维测量及个性化设计提供研究的平台。方法对电子束CT扫描颅骨缺损的患者,应用自主开发的骨组织表面绘制软件3DMSR对CT原始数据进行分析处理和三维测量,并转换成适用于快速成型、个性化修复和数据库建立的通用格式。结果1995年至2004年,对84例创伤后颅骨缺损的患者,应用电子束CT和计算机辅助设计技术进行三维测量和个性化手术模拟,根据不同病例的具体情况分别采用自体颅骨外板、自体下颌骨外板、MEDPOR、钛网及钛合金个性化修复体等方法完成治疗,并将相关信息建成颅骨缺损数据库。结论颅骨缺损数据库的建立,对于个性化治疗方案及相关研究,具有积极的意义。     

创伤后颅骨缺损EBCT三维测量及数据库的建立

目的 探索建立创伤后颅骨缺损数据库，为颅骨缺损的三维测量及个性化设计提供研究的平台。方法 对电子束CT扫描颅骨缺损的患者，应用自主开发的骨组织表面绘制软件3DMSR对CT原始数据进行分析处理和三维测量，并转换成适用于快速成型、个性化修复和数据库建立的通用格式。结果 1995年至2004年，对84例创伤后颅骨缺损的患者，应用电子束CT和计算机辅助设计技术进行三维测量和个性化手术模拟，根据不同病例的具体情况分别采用自体颅骨外板、自体下颌骨外板、MEDPOR、钛网及钛合金个性化修复体等方法完成治疗，并将相关信息建成颅骨缺损数据库。结论 颅骨缺损数据库的建立，对于个性化治疗方案及相关研究，具有积极的意义。     

三种材料修补颅骨缺损的疗效分析

颅骨缺损是颅脑外伤手术后常见的后遗症,一般3个月后可行颅骨修补.颅骨修补材料种类繁多,但目前临床使用的材料主要有3种:自体颅骨、金属材料(如钛板、钛网)和非金属材料(硅橡胶涤纶网、羟基磷灰石、珊瑚等).本院1995年1月至2005年4月,采用自体颅骨骨瓣、硅橡胶涤纶网、钛金属网3种材料修补颅骨缺损患者共205例,报告如下.     

游离肋骨-前锯肌-皮肤复合组织瓣修复大面积颅骨缺损

目的:探讨吻合血管的游离肋骨-前锯肌-皮肤复合组织瓣修复大面积颅骨缺损的临床应用价值。方法:设计以胸背血管为营养血供的游离肋骨-前锯肌-皮肤复合组织瓣,用以修复大面积颅骨缺损10例。结果:10例患者,组织瓣完全成活9例,坏死1例。随访1～10年,患者术后外观满意,无感染、皮下积液等并发症发生。结论:游离肋骨-前锯肌-皮肤复合组织瓣可以很好地完成大面积颅骨缺损的修复,是一种理想的自体修复材料。     

非血管化自体骨移植修复下颌骨缺损的临床研究

目的:探讨非血管化自体骨移植修复下颌骨缺损的可行性,并分析其临床疗效。方法:采用非血管化自体骨移植修复下颌骨缺损患者36例,男26例,女10例,年龄18～73岁,平均43.5岁。对36例下颌骨不同范围缺损进行一期修复,其中12例用自体肋骨修复,24例用自体髂骨修复。6个月后行二期手术种植义齿。结果:髂骨移植24例中,除1例因感染部分骨吸收外,均成活,安装义齿有咬合功能。12例肋骨移植,4例骨吸收,8例成活者中,2年后均有不同程度的骨吸收,不能安装义齿,不能承担咀嚼功能,只起到恢复外形的作用。结论:非血管化自体骨移植修复下颌骨缺损是一种较理想的修复方法,可广泛应用于临床。     

颅骨外板游离移植修复颅面骨缺损畸形

因创伤、感染及先天畸形所致的颅骨和面部骨缺损 ,常造成功能障碍或外观畸形而需要手术植骨修复。近年来 ,自体的颅骨外板被认为是较理想的供骨[1] ,在修复颅面骨缺损尤显优越。但因供骨制取较困难 ,临床合用不广泛。自1990年以来 ,以自体颅骨外板游离移植 ,修复了 2 6例颅面骨缺损畸形 ,经 12～ 2 4个月的随访 ,效果满意 ,报告如下。1　临床资料　本组 2 6例 ,男 2 1例 ,女 5例。年龄 6～ 45岁 (仅 1例为6岁 ,其余均在 17岁以上 )。其中外伤性额、眶部颅骨缺损19例 ,感染性眶骨缺损 1例 ,肿瘤术后下颌骨缺损 1例 ,上颌骨先天发育不全 1例 ,…     

颅骨外板游离移植修复颅面骨缺损畸形

因创伤、感染及先天畸形所致的颅骨和面部骨缺损，常造成功能障碍或外观畸形而需要手术植骨修复。近年来，自体的颅骨外板被认为是较理想的供骨［1］，在修复颅面骨缺损尤显优越。但因供骨制取较困难，临床合用不广泛。自1990年以来，以自体颅骨外板游离移植，修复了26例颅面骨缺损畸形，经12～24个月的随访，效果满意，报告如下。 1　临床资料 　　本组26例，男21例，女5例。年龄6～45岁(仅1例为6岁，其余均在17岁以上)。其中外伤性额、眶部颅骨缺损19例，感染性眶骨缺损1例，肿瘤术后下颌骨缺损1例，上颌骨先天发育不全1例，复杂性鞍鼻4例。游离颅骨外板最大面积为6cm×9cm，最小为1.5cm×3cm。     

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.