脊柱包虫病的诊断与治疗

目的:探讨脊柱包虫病的诊断及治疗方法。方法:1990年10月～2010年10月手术治疗脊柱包虫病患者9例,病程为3个月～12年。临床表现为午后低热、腰背疼痛和腰背部包块,术前脊髓神经功能Frankel分级A级1例,B级2例,C级2例,D级4例。包虫病8项免疫试验均为阳性。术前均行影像学检查,病变单纯累及胸椎2例(T8、T9 1例,T11、T12 1例),腰椎2例(L3 1例,L1、L2、L3 1例),胸腰段4例(T12、L1 2例,T12、L1、L2 2例),骶椎1例。X线片、CT检查误诊为椎体结核5例、转移瘤2例、脊索瘤1例、腰大肌脓肿1例。MRI检查7例诊断为脊柱包虫病;2例病变单纯累及腰椎者缺乏囊中囊典型信号改变,误诊为脊柱转移瘤。均行椎管减压病灶清除植骨内固定术,其中病变单纯累及胸椎的2例与骶骨1例行后路全椎板切除减压,2例腰椎病变者行椎板间开窗椎管减压,4例胸腰段病变者行脊柱侧前方入路经横突椎管减压。7例术前诊断脊柱包虫病者术前口服抗包虫药阿苯达唑2～3周,所有患者术后继续服用阿苯达唑3个月。结果:手术时间210～330min,平均260min;术中失血量170～470ml,平均300ml。7例术前MRI检查诊断为脊柱包虫病者术后病理诊断为脊柱细粒棘球蚴病,2例术前MRI误诊为脊柱转移瘤者术后病理诊断为腰椎泡状棘球蚴病。随访1～10年,平均4.6年。1例腰椎泡状棘球蚴病患者术后8个月植骨未愈合,经理疗、促骨生长药物治疗,1年后复查X线片显示骨性愈合;其余8例患者植骨区骨性融合,愈合时间为5～8.5个月,平均7个月。末次随访患者脊髓神经功能Frankel分级改善6例,无变化3例。随访期间无复发。结论:MRI检查对脊柱细粒棘球蚴病有诊断价值,对腰椎泡状棘球蚴病易误诊,后者的确诊有赖于病理检查;脊柱包虫病在药物治疗的基础上采用手术治疗可取得较好疗效。     

肝移植治疗终末期肝泡型包虫病

目的 探讨肝移植治疗终末期肝泡型包虫病的临床应用价值.方法 回顾性分析2000年12月至2010年8月新疆医科大学第一附属医院收治的8例行肝移植治疗终末期肝泡型包虫病患者的临床资料,观察患者手术时间、无肝期、术中红细胞悬液输注量、术后并发症等指标.结果 8例患者中位手术时间为635 min(490～760 min),中位无肝期为66 min(44～240 min),术中红细胞悬液输注量中位数为20U(4～40 U).1例行抢救性经典原位肝移植的患者因严重的肝性脑病、肾功能衰竭和凝血功能障碍于术后1 d死亡,其余7例患者手术成功.术后中位随访时间6个月(3～29个月).3例患者分别于术后3、5、6个月因胆源性脓毒血症、胆道铸型、急性排斥反应等并发症死亡.1例患者术后发生胆管吻合口狭窄,行胆肠吻合后痊愈;1例患者左肺转移灶明显缩小和稳定;1例患者术后发生胆管吻合口漏经治疗后痊愈;1例行左半健侧肝脏自体移植的患者,健康生存.结论 终末期肝泡型包虫病是肝移植的适应证.低剂量免疫抑制剂和术后长期服用抗包虫药物是预防术后肝泡型包虫病复发和转移的关键.自体肝移植术后因无需免疫抑制剂治疗,是治疗终末期肝泡型包虫病的理想术式.     

腹腔镜肝包虫外囊摘除术治疗肝囊型包虫病的临床疗效

目的探讨腹腔镜肝包虫外囊摘除术的临床疗效。方法回顾性分析2005年5月至2010年12月新疆医科大学第一附属医院收治的21例肝囊型包虫病患者行腹腔镜肝包虫外囊摘除术的临床资料。所有患者术前1周口服阿苯达唑[10mg／（kg·d）]。术后采用门诊复查、电话等方式进行随访,随访时间截至2012年6月。对中转开腹率、手术时间、术中出血量、术后住院时间、术后并发症和包虫病复发等指标进行分析。结果根据WHO包虫病非正式工作小组包虫病分型,21例肝囊型包虫病患者包虫为CE1型。其中8例患者囊肿位于肝Ⅱ～Ⅲ段,13例患者囊肿位于肝Ⅳ-Ⅵ段。囊肿直径为3～12cm,平均直径为7cm。手术时间为（76±23）min,术中出血量为（110±35）mL,术后住院时间为（4±1）d。术中无输血、中转开腹患者。术后1例患者出现少量胆汁漏并于术后10d自行痊愈。所有患者随访15～60个月,中位随访时间为18个月。无一例患者复发。结论腹腔镜肝包虫外囊摘除术安全、可行,近、远期疗效好。     

肝泡型包虫病根治性切除163例回顾性分析

目的:探讨肝泡型包虫病根治性切除的治疗效果。方法:回顾性分析2013年1月—至2015年6月163例行根治性切除肝泡型包虫病患者的临床资料。结果:根治性手术平均时间(3.1±1.2)h,术中出血量(763±498)m L。术后携带腹腔引流管中位时间6 d,11例携带T管,术后1个月拔除。术后平均肛门排气时间(2.1±0.8)d、经口进食时间(2.7±1.1)d、住院时间(7.9±3.4)d。8例出现术后并发症,其中5例术后胆瘘,1例术区感染,2例术后腹水。术后电话或门诊随访1~6个月无死亡及包虫复发情况。结论:根治性切除是当前肝泡型包虫病患者的首选治疗方案。术前充分评估手术可行性,术中充分掌握肝脏血流控制、肝脏外科解剖、门静脉重建、胆管重建等技术,通过根治性手术切除可明显改善泡型包虫病患者的生存质量,延长患者的生存时间。     

"微创"操作减压术治疗胸椎管狭窄症

目的：探讨后路“微创”操作减压术治疗胸椎管狭窄症的疗效。方法：对68例胸椎管狭窄疗患者采用“削薄”、“打磨”、“漂浮”、“蚕食”等微创操作行后路椎板切除椎管减压术，术后随访1-8年(平均20个月)，根据脊髓功能评分进行疗效综合评价。结果：68例患者中优27例(39．7％)，良24例(35．2％)，可10例(14．7％)，差7例(10．2％)，优良率为75．0％。疗效差的7例患者中2例为脊髓压迫时间过长导致不可逆性脊髓损伤；3例为外院术后疗效不佳于我院行二次手术；2例为胸椎管狭窄合并颈脊髓压迫症患者。结论：后路“微创”操作减压术是治疗胸椎管狭窄症的一种安全、有效、可行的手术方法．     

脑包虫病患者的术后观察与护理

目的探讨脑包虫病患者术后的观察与护理方法。方法对37例脑包虫病患者行手术治疗,术后给予密切病情观察及护理。结果 37例患者手术均成功,无1例出现并发症,均痊愈出院。随访6个月至4年,无复发。结论术后密切观察患者的病情变化,做好伤口与引流管、并发症以及用药观察与护理及出院指导,是减少术后并发症,提高手术成功率,促进患者早日康复的关键。     

Lenke 1C型青少年特发性脊柱侧凸选择性融合术后参数变化

[目的]研究经椎弓根螺钉内固定选择性融合术后Lenke 1C型AIS患者矢状面参数的变化及与冠状面参数或骨盆参数之间的相关关系。[方法]选择41例连续观察的Lenke 1C型特发性脊柱侧凸患者,均行后路椎弓根螺钉固定、选择性融合术。术后随访2年。术前、术后2个月、术后2年均行站立位全脊柱正侧位X线片检查,并行影像学测量与统计。[结果]平背畸形组(胸椎后凸角<20°)患者,术后2个月(19.59±9.59)°、2年(20.45±3.59)°与术前(11.82±3.32)°比较,胸椎后凸角明显增加(P=0.010),术后2个月与2年比较,胸椎后凸角能保持稳定(P=0.998)。胸椎后凸角术后2年变化量与腰椎前凸角2年变化量、术前腰椎前凸角、骨盆投射角呈显著性相关(r值分别为-0.652,0.635,0.805,P值分别为0.041,0.049,0.005)。[结论]椎弓根螺钉内固定系统能改善平背畸形Lenke1C型患者的胸椎后凸。选择性融合术中,胸椎后凸的纠正在维持脊柱矢状位平衡中发挥重要作用。     

脑包虫病患者的术后观察与护理

目的 探讨脑包虫病患者术后的观察与护理方法.方法 对37例脑包虫病患者行手术治疗,术后给予密切病情观察及护理.结果 37例患者手术均成功,无1例出现并发症,均痊愈出院.随访6个月至4年,无复发.结论 术后密切观察患者的病情变化,做好伤口与引流管、并发症以及用药观察与护理及出院指导,是减少术后并发症,提高手术成功率,促进患者早日康复的关键.     

PKP联合针灸治疗骨质疏松性胸椎压缩骨折伴肋间神经痛的疗效分析

目的探讨经皮椎体后凸成形术(PKP)联合针灸治疗骨质疏松性胸椎压缩骨折伴肋间神经痛的疗效。方法纳入自2014-07—2015-01诊治的32例骨质疏松性胸椎压缩骨折伴肋间神经痛,16例采用PKP联合针灸治疗(观察组),16例单纯采用PKP治疗(对照组)。比较2组术后3 d、术后1个月、术后1年的疼痛VAS评分、ODI指数。结果 32例手术均顺利完成并获得12个月随访。观察组术后3 d、1个月VAS评分低于对照组,差异有统计学意义(P0.05);但2组术后12个月VAS评分比较差异无统计学意义(P0.05)。观察组在术后3 d、1个月、1年的ODI指数均低于对照组,差异有统计学意义(P0.05)。结论 PKP联合针灸治疗骨质疏松性胸椎压缩骨折伴肋间神经痛疗效明显,能有效缓解患者疼痛,提高患者的生活质量。     

病灶清除植骨融合术治疗脊柱包虫病的疗效

[目的]观察病灶清除植骨融合术在脊柱包虫病临床治疗中的效果。[方法]回顾性分析2006年1月~2014年12月本院收治的6例脊柱包虫病患者,其中胸椎3例(T8、T10~12、T11~12),胸腰段2例(T10~L1、T12~L1),腰椎1例(L1~L2)。术前行包虫酶联免疫吸附试验,3例阳性。术前ASIA脊髓损伤评分B级1例,C级3例,D级1例,E级1例。术前影像学检查误诊为脊柱结核2例,椎体转移瘤1例。所有病例均行手术治疗,均采用椎体侧后方病灶清除并一期植骨融合椎弓根螺钉内固定术,其中2例复发后采用前路再次病灶清除植骨融合。6例均行病理检查确诊包虫病,其中细粒棘球幼3例,泡性棘球蚴3例,术后均给予阿苯达唑治疗6个月。[结果]所有病例均获随访,随访时间1~7年,平均3.7年,平均手术时间(213.13±47.88)min,平均失血量(913.75±214.67)ml,术后引流量(353.75±90.07)ml,术后完全负重时间(8.50±2.33)周。术后2例出现复发,接受二次手术,其中1例随访5年后病故,1例术后出现切口感染,经二次手术后痊愈。其余植骨病例最终均达到植入骨骨性融合,植骨融合时间(4.50±3.30)个月。末次随访时ASIA脊髓评分与术前相比神经功能改善1~2级。[结论]手术是目前治疗脊柱包虫病的主要方法,病灶清除植骨融合对脊柱包虫病治疗有效,但多节段、混合型脊柱包虫病复发率较高,术中防止囊壁破裂及完整切除病灶对防止复发尤为重要。     

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.