平阳霉素及糖皮质激素与激光联合治疗儿童颌面部血管瘤

目的探讨和评价平阳霉素及糖皮质激素与激光联合应用治疗儿童颌面部血管瘤的疗效.方法自2002年3月至2005年2月,采用平阳霉素及糖皮质激素与激光联合治疗儿童颌面部血管瘤78例,瘤体面积0.4 cm×0.8 cm～5.0 cm×8.0 cm.7～10 d注射一次平阳霉素配制液,剂量为0.5 mg/kg,3～5次为一个疗程,一个疗程的总量不超过40 mg;小于6岁的患儿配合口服强地松;最后联合可调脉宽倍频NDYAG激光治疗.结果治疗后经6个月至3年的随访,治愈和基本治愈率88.46%,有效率100%.结论平阳霉素及糖皮质激素与激光联合应用治疗儿童颌面部血管瘤是一种安全、有效、易行的治疗方法.     

平阳霉素加地塞米松局部注射治疗婴幼儿血管瘤

目的探讨平阳霉素+地塞米松局部注射治疗婴幼儿血管瘤的疗效。方法将平阳霉素8 mg+地塞米松5 mg+2%利多卡因1~2 ml+生理盐水3~8 ml稀释后,行血管瘤内注射至肿胀发白为限,1次平阳霉素用量不超过8 mg。观察2周,视瘤体颜色及硬度决定是否继续用药,直至瘤体开始变硬萎缩为止,平阳霉素注射总量不超过40 mg。近两年来,用该方法治疗1~8个月龄婴幼儿体表增生期血管瘤36例,其中颜面部24例,胸部3例,背部2例,上肢5例,足2例;草莓状血管瘤30例,混合型血管瘤6例。血管瘤最小面积0.6 cm×1.2 cm,最大面积23.0 cm×12.0 cm。结果1次注射治愈2例,2~3次注射治愈25例,4~5次治愈9例,其中局部坏死1例(为足背足底大面积草莓状血管瘤),经换药及手术愈合。随访6~19个月,未见复发,除1例遗留瘢痕外,其余全部无瘢痕愈合。有效率达100%。结论平阳霉素+地塞米松局部注射治疗婴幼儿血管瘤,具有疗效显著、简便易行、安全可靠等优点,是治疗增生期血管瘤首选方法之一,值得推广。     

平阳霉素及糖皮质激素与激光联合治疗儿童颌面部血管瘤

目的探讨和评价平阳霉素及糖皮质激素与激光联合应用治疗儿童颌面部血管瘤的疗效。方法自2002年3月至2005年2月,采用平阳霉素及糖皮质激素与激光联合治疗儿童颌面部血管瘤78例,瘤体面积0.4cm×0.8cm~5.0cm×8.0cm。7~10d注射一次平阳霉素配制液,剂量为0.5mg/kg,3~5次为一个疗程,一个疗程的总量不超过40mg;小于6岁的患儿配合口服强地松;最后联合可调脉宽倍频ND:YAG激光治疗。结果治疗后经6个月至3年的随访,治愈和基本治愈率88.46%,有效率100%。结论平阳霉素及糖皮质激素与激光联合应用治疗儿童颌面部血管瘤是一种安全、有效、易行的治疗方法。     

平阳霉素联合地塞米松注射治疗婴幼儿面部血管瘤28例

目的:探索和评价平阳霉素和地塞米松联合注射治疗婴幼儿面部血管瘤的疗效。方法:用平阳霉素8mg 地塞米松5mg 2%利多卡因2ml 生理盐水2ml溶解后行瘤体内注射至肿胀发白为宜,注射剂量以0.2～0.3mg/kg计算。2～3周注射一次,一个疗程3～5次。结果:术后随访12～18个月,有效率100%,治愈和好转率95.65%。结论:平阳霉素联合地塞米松注射治疗婴幼儿面部血管瘤是一种简便易行、安全可靠的治疗方法。     

平阳霉素联合地塞米松局部注射治疗儿童眼睑海绵状血管瘤

目的:观察分析平阳霉素联合地塞米松局部注射治疗儿童眼睑海绵状血管瘤的临床效果。方法:采用平阳霉素8 mg联合地塞米松5mg,用2%利多卡因1ml,生理盐水2ml稀释成4ml,血管瘤瘤体内注射治疗58例儿童眼睑海绵状血管瘤,按每次药量及方法 1周或隔周注射1次,分别为多次注射治疗,每次剂量最多不超过8mg,直致瘤体消失。结果:随访观察6～24个月,55例患儿血管瘤全部消失达到治愈,3例有效,未发生局部感染、组织坏死及瘢痕畸形。结论:应用平阳霉素联合地塞米松局部注射治疗儿童眼睑海绵状血管瘤,具有治愈率高、操作方便、副作用小,有效的恢复了眼睑的正常外形与功能。     

低剂量平阳霉素和得宝松联合注射治疗小儿皮肤血管瘤体会

目的总结低剂量平阳霉素联合得宝松注射液治疗小儿皮肤血管瘤的临床疗效。方法采用低剂量平阳霉素和得宝松联合注射治疗小儿皮肤草莓状血管瘤及海绵状血管瘤83例,一般注射3～5次为1疗程,每3周注射1次。结果 83例97个血管瘤瘤体经1疗程治疗后,经过6～12个月随访,总有效率85.5%,未见明显不良反应。结论低剂量平阳霉素和得宝松联合注射治疗小儿皮肤血管瘤,是一种安全有效、简便的治疗方法。     

平阳霉素加曲安奈德瘤体内注射治疗婴幼儿体表血管瘤

目的：探讨平阳霉素加曲安奈德瘤体局部注射治疗婴幼儿体表血管瘤的疗效。方法：以平阳霉素加曲安奈德瘤体内注射治疗婴幼儿体表血管瘤,皮损最大6cm×6cm,最小1cm×1cm,15天注射1次,3～5次为1个疗程。对2004年3月～2009年3月治疗的150例患儿进行了1～6年的随访观察,将临床资料进行分析。结果：经过1～6年随访,治愈121例,显效29例,无效0例,治愈率80.66%,有效率100%。结论：平阳霉素加曲安奈德局部注射治疗婴幼儿体表血管瘤具有疗效高、疗程短,副作用少等优点,是一种简便、安全有效的方法。     

安全剂量下平阳霉素瘤内注射治疗体表血管瘤和血管畸形

目的探讨平阳霉素瘤内注射治疗体表血管瘤和血管畸形的疗效。方法回顾分析2005年5月～2008年3月应用平阳霉素瘤内注射治疗体表血管瘤和血管畸形42例临床资料,其中男17例,女25例。年龄3个月～51岁。血管瘤18例,静脉血管畸形20例,血管瘤合并血管畸形4例。注射液按照平阳霉素8mg＋2%利多卡因2ml＋生理盐水2ml＋地塞米松2.5mg配制。术前测算瘤体面积,按照平阳霉素0.5mg/cm2多点注射,浅表皮肤及口腔黏膜可酌情减量至0.3mg/cm^2。一次注射未完全消失者可10天～3周或更长时间后重复注射。每次平阳霉素注射量不超过8mg,分次注射总量一般不超过70mg。结果治疗后1年,55个病灶治愈和显效率为85.5%（47/55）,好转12.7%（7/55）,总有效率为98.2%（54/55）。结论平阳霉素瘤内注射治疗血管瘤和小面积、低血流量静脉血管畸形疗效高,疗程短,患者痛苦小,是一种简便、安全的方法。平阳霉素瘤内注射时,0.5mg/cm^2是治疗血管瘤和小面积血管畸形的安全剂量。     

平阳霉素联合地塞米松治疗婴幼儿颌面部静脉畸形疗效观察

目的:观察平阳霉素联合地塞米松注射治疗婴幼儿颌面部静脉畸形的临床效果.方法:随机选取两组不同治疗方法的患儿共204例,分为治疗组(平阳霉素联合地塞米松治疗,191例)和对照组(平阳霉素治疗,113例),均给瘤体内直接注射药物,间隔时间2周,4～6次为1个疗程.结果:治疗组中治愈186例,有效5例,无效0例,有效率97.38%;对照组中治愈103例,有效10例,无效0例,有效率91.15%.经χ2检验,P＜0.05,两组有效率比较差异有统计学意义.结论:平阳霉素联合地塞米松注射治疗婴幼儿颌面部静脉畸形是一种安全、有效、简单的方法.     

平阳霉素治疗婴幼儿颌面部血管瘤的疗效观察

目的:探讨和评价平阳霉素治疗婴幼儿颌面部血管瘤的疗效.方法:采用平阳霉素注射治疗婴幼儿颌面部血管瘤17例.取平阳霉素1mg/cm2,2％利多卡因0.5ml,生理盐水适量配成混合液于瘤体内多点注射,隔用1次,3次为一个疗程.1个疗程不能愈合者,间隔40天后行第2个疗程.记录病变转归进程及不良反应,并追踪随访,评价临床疗效.结果:12例治愈,5例基本治愈,10个月后复诊:局部皮肤略成红色片状.随访2年,无复发病例.结论:平阳霉素治疗耍幼儿颌面部血管瘤疗效确切,不形成明显癜痕,是可取的临床治疗方式,对早期治疗具有积极的意义.     

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.     

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.