改良Hotz法治疗伴有眼睑松弛的瘢痕性上睑内翻临床观察

目的:探讨改良Hotz法治疗伴有眼睑松弛的瘢痕性上睑内翻的手术效果.方法:20人35例伴有眼睑松弛的瘢痕性睑内翻患者,用改良Hotz法矫正倒睫及眼睑松弛.结果:随访3个月,所有患者上睑内翻矫正,眼睑松弛改善,外观美观自然.结论:改良Hotz法治疗伴有眼睑松弛的瘢痕性上睑内翻效果良好,自然美观.     

改良重睑成形治疗老年性上睑皮肤松弛伴睑内翻倒睫

目的：探讨改良重睑成形术治疗老年性上睑皮肤松弛伴上睑内翻倒睫的临床疗效。方法：62例124眼上睑内翻倒睫患者行改良重睑成形术,上睑采用不等边梯形设计去除多余的皮肤,用5-0丝线在眼睑中、外、内分别作3根固定缝线,悬挂睑板上;伴睑板瘢痕性增厚者联合HOTZ法,在上睑缘内唇上约3mm处做与睑缘平行的宽约2～3mm楔形条状睑板部分切除。结果：随访0.5～1年,最长观察两年,重睑形态自然,未见倒睫复发。结论：这种改良的联合术式达到了较好的美容效果,解决了倒睫带来的不适。     

个体化术式治疗老年性下睑内翻倒睫的临床效果

目的 探讨在老年性下睑内翻倒睫患者治疗中应用个体化术式治疗的临床效果。方法 选取承 德县医院2021年11月-2022年11月收治的78例老年性下睑内翻倒睫患者为研究对象，以随机数字表法分 为对照组和观察组，每组39例。对照组给予单纯眼睑皮肤轮匝肌切除缝合术治疗，观察组给予个体化术 式治疗，比较两组临床疗效及手术满意度。结果 观察组治疗总有效率为94.87%，高于对照组的74.36% （P ＜0.05）；观察组对外形美观、瘢痕外观、双眼对称、倒睫矫正、舒适度的满意度评分均高于对照组 （P ＜0.05）。结论 个体化术式治疗老年性下睑内翻倒睫的临床效果良好，可有效改善患者的临床症状， 且患者对手术的满意度较高，值得临床应用。     

个体化术式治疗老年性下睑内翻倒睫的临床效果观察

目的:观察老年性下睑内翻倒睫采用个体化术式治疗的临床疗效。方法:选取2014年11月-2016年5月间我院收治的老年性下睑内翻倒睫患者56例(98眼),随机分为观察组和对照组。观察组采用单纯眼睑皮肤轮匝肌切除缝合术治疗,对照组采用个体化术式治疗。根据睑缘形态及睫毛是否接触角、结膜判断疗效。对比两组总治愈率。结果:所有56例(98眼)均1期愈合。术后随访6~24个月,观察组8例(11眼)复发,治愈率77.55%。对照度1例(2眼)复发,治愈率95.92%。两组治愈率差异具有统计学意义。结论:对老年性下睑内翻倒睫采用个体化术式治疗临床疗效显著,复发率低,是治疗老年性睑内翻伴倒睫的理想方法。     

四步法治疗伴眼睑松弛的退行性下睑倒睫

目的观察四步法(下睑缩肌转位+睑板固定+外侧睑板悬吊+皮肤轮匝肌切除)治疗伴眼睑松弛的退行性下睑倒睫的疗效。方法选取自2017年3月至2018年1月就诊于武汉爱尔眼科医院汉口医院的77例(109只眼)退行性下睑倒睫、合并下睑内翻、眼睑松弛患者为研究对象。沿平行睑缘做皮肤切口,分离下睑缩肌,将下睑缩肌断端褥式缝合于睑板上方,睑缘侧切口下轮匝肌缝合固定于睑板下缘,外侧睑板固定于颞侧眶缘骨膜,去除皮肤及轮匝肌后缝合皮肤切口。观察患者术后倒睫矫正情况、倒睫复发率及睑外翻发生率。结果 76例于术后1周拆线时下睑局部轻度肿胀,切口恢复良好,眼睑贴附眼球;1例因外侧缝线松脱出现睑球分离,行再次缝线固定后好转。随访1～2年,患者倒睫均矫正良好,未出现外翻及睑球分离的情况,倒睫无复发。结论下睑缩肌转位+睑板固定+外侧睑板悬吊+皮肤轮匝肌切除术式对伴眼睑松弛的退行性下睑倒睫起到了多重保障作用,且疗效确切,并发症较少。     

眼轮匝肌缩短转位术治疗老年性下睑内翻

目的：观察眼轮匝肌缩短转位术治疗老年性下睑内翻的临床疗效。方法：本组70例80眼老年性下睑内翻均施行下睑板前眼轮匝肌缩短转位术,其中15例曾行下睑穹窿皮肤缝线术后复发。结果：本组70例80眼1次矫正成功。术后下睑缘位置恢复正常,无过矫、欠矫现象。9例角膜上皮部分脱落者l～2天上皮完全恢复,随访3个月～6年,手术成功率达100%,无任何并发症。结论：眼轮匝肌缩短转位术是治疗老年性下睑内翻的一种新的有效术式,适用于多种致病原因的老年性下睑内翻,手术操作简单易行。     

老年性下睑内翻的手术治疗及疗效观察

目的:探讨老年性睑内翻手术治疗的方法及疗效。方法:76例(98眼)老年性睑内翻患者随机分成A、B、C组,分别予缝线矫正法、改良皮肤轮匝肌切除术、眼轮匝肌缩短术进行矫正,并术后随访1～2年,观察不同术式的疗效并进行比较。结果:所有病例术后拆线时均获良好矫正,随访1～2年,A组病例有7例(10眼)复发,B组病例有1例(2眼)复发,C组病例无1例复发。结论:改良皮肤眼轮匝肌切除术和眼轮匝肌缩短术操作可行、疗效确切、复发率低,值得临床推广。     

基于park法理论的下睑内翻手术与眼轮匝肌缩短术治疗老年性下睑内翻倒睫的效果比较

目的 比较老年性下睑内翻倒睫分别应用基于park法理论的下睑内翻手术与眼轮匝肌缩短术治疗 的效果。方法 选取我院2021年12月-2022年12月收治的100例（169眼）老年性下睑内翻倒睫患者为研究对 象，随机分对照组（84眼）和观察组（85眼），每组50例。对照组应用眼轮匝肌缩短术治疗，观察组应用 基于park法理论的下睑内翻手术治疗，比较两组矫正效果及眼部症状评分。结果 两组矫正效果比较，差 异无统计学意义（P＞0.05）；两组术后1周及术后1、3个月的OSDI评分均低于术前，差异有统计学意义 （P＜0.05）；但两组术后1周及术后1个月的OSDI评分比较，差异无统计学意义（P＞0.05）；观察组术后3个 月的OSDI评分低于对照组，差异有统计学意义（P＜0.05）。结论 两种方法治疗老年性下睑内翻倒睫的效果 均良好，但相比于眼轮匝肌缩短术，基于park法理论的下睑内翻手术对患者眼部症状的远期改善效果更为理想。     

不同术式治疗老年性下睑内翻效果观察

目的分析比较改良式眼轮匝肌缩短术联合下睑缩肌腱膜缝合术和眼睑皮肤轮匝肌切除术治疗老年性下睑内翻的效果。方法选取2006-03—2014-03间收治的186例(232眼)老年性下睑内翻患者为观察对象。根据住院时间和手术方式的不同分为2组:对照组90例(112眼),采用眼睑皮肤轮匝肌切除术矫正。观察组96例(120眼),采用改良式眼轮匝肌缩短术联合下睑缩肌腱膜缝合术矫正。比较2组患者术后1个月和术后1 a的疗效。结果术后1个月,2组治愈率比较,差异无统计学意义(P0.05)。术后1 a,观察组治愈率(93.7%)高于对照组(63.3%),2组比较,差异有统计学意义(P0.05)。结论改良式眼轮匝肌缩短术联合下睑缩肌腱膜缝合术治疗老年性下睑内翻患者远期疗效优于眼睑皮肤轮匝肌切除术。     

两种手术方法治疗老年性下睑内翻临床对比观察

目的:对比分析眼睑轮匝肌折叠术和眼睑皮肤轮匝肌切除术治疗老年性下睑内翻的临床效果。方法:回顾分析我院就诊的老年性下睑内翻患者,按手术方法不同分为A组采用眼睑轮匝肌折叠术,99例117只眼,B组采用眼睑皮肤轮匝肌切除术,87例102只眼。术后随访6～24个月,术后随访根据睑缘形态判断治疗效果。结果:A组99例117只眼均治愈,未见复发;B组复发21眼,复发率20.59%,两组手术后复发率的差异具有统计学意义。结论:与眼睑皮肤轮匝肌切除术相比,眼睑轮匝肌折叠术治疗老年性下睑内翻术后疗效满意、复发率低,是老年性下睑内翻较理想的手术方法。     

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.