前后路一期病灶清除植骨内固定治疗腰骶脊柱结核

目的探讨采用前后路一期病灶清除植骨内固定治疗腰骶脊柱结核的临床效果。方法采用后路椎弓根内固定加前路病灶清除植骨治疗腰骶椎结核10例,术后抗痨治疗。结果切口均一期愈合,无窦道形成。随访1-4年,植骨块均在4—6个月融合,无植骨块松动移位发生,所有患者腰痛、下肢麻痛症状消失。结论采用后路椎弓根内固定加前路病灶清除植骨是治疗腰骶椎结核的一种稳定可靠的手术方法。     

脊柱结核病灶清除植骨内固定24例报告

目的:总结脊柱结核病灶清除植骨一期内固定的疗效及经验。方法:本组24例,年龄30～61岁,平均病程10.5个月,计中下颈段3例,中胸段7例,胸腰段5例,腰段5例,腰骶段4例。15例术前有不全瘫。均行前路病灶清除,19例同时行前路内固定,4例后路内固定。结果:24例随访8～12个月,术后4～8个月植骨融合,内固定无松动、无复发及感染。结论:脊柱结核前路病灶清除一期植骨内固定可行,应视病灶部位选择前路或后路内固定。     

脊柱结核病灶清除植骨内固定24例报告

目的:总结脊柱结核病灶清除植骨一期内固定的疗效及经验.方法:本组24例,年龄30～61岁,平均病程10.5个月,计中下颈段3例,中胸段7例,胸腰段5例,腰段5例,腰骶段4例.15例术前有不全瘫.均行前路病灶清除,19例同时行前路内固定,4例后路内固定.结果:24例随访8～12个月,术后4～8个月植骨融合,内固定无松动、无复发及感染.结论:脊柱结核前路病灶清除一期植骨内固定可行,应视病灶部位选择前路或后路内固定.     

一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染

目的:探讨一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的临床疗效及意义。方法:回顾性分析2011年3月~2015年1月我院收治并应用一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗的13例L5/S1椎间隙感染患者,其中男8例,女5例;年龄28~60岁(41.6±11.0岁);记录患者术中手术时间、出血量、术后并发症,记录术前、术后腰部疼痛视觉模拟评分(visual analogue scale,VAS)评估临床症状,术前术后腰骶角(lumbosacral angle,LSA)评估腰骶段前凸恢复情况。结果:所有手术均顺利完成,手术后1例出现逆行性射精,1例患者发生单侧下肢肌间静脉血栓,未出现严重并发症;前路手术时间为70~120min(90.0±27.5min),失血量为200~600ml(361.5±150.2ml);后路手术时间为50~70min(57.7±8.3min),失血量为50~200ml(106.9±56.9ml)。术后培养结果其中7例为金黄色葡萄球菌感染,3例为大肠杆菌,1例为铜绿假单胞菌,2例未见细菌生长,但病理检查结果提示感染性病变。病例均获随访,时间6~30个月(16.6±7.8个月)。末次随访时所有患者均达临床愈合,骨融合率100%,随访期内未见复发病例。VAS评分术前平均7.8±0.7分,术后6个月平均1.3±0.5分,与术前比较差异有统计学意义(P0.05);LSA术前4.4°±2.9°,末次随访时17.5°±2.8°,与术前比较有统计学意义(P0.05)。结论:一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的手术创伤小、固定可靠、疗效确切,可以作为治疗L5/S1椎间隙感染的一种手术方法。     

病灶清除联合钉棒固定治疗骶髂关节感染

[目的]探讨病灶清除植骨融合联合钉棒固定治疗骶髂关节感染的临床疗效.[方法]回顾性分析本院2014年6月-2019年6月采用后路病灶清除、植骨融合、钉棒系统内固定术治疗骶髂关节感染患者的临床资料,35例患者符合纳入标准,男13例、女22例,年龄17～73岁,平均(45.74±13.75)岁.其中结核性骶髂关节炎28例、...     

前路病灶清除椎体间植骨结合后路椎弓根内固定治疗腰骶椎结核

目的：探讨前路病灶清除椎体间植骨结合后路椎弓根内固定治疗腰骶段结核的临床疗效.方法：对2005年1月至2012年6月收治的18例腰骶椎结核患者进行回顾性分析,男12例,女6例;年龄35～67岁,平均44岁;病程4～17个月,平均9个月.其中单纯腰痛2例,腰痛伴下肢放射痛3例,下肢肌力感觉减退者13例.神经功能Frankel分级：C级3例,D级10例,E级5例.病灶部位：L4.58例,L54例,LS16例.术前腰骶角15°～27°,血沉45～93 mm/h.均采用前路病灶清除椎体间植骨结合后路椎弓根内固定治疗,应用腰骶角测量、血沉检测和神经功能Frankel分级来评估临床疗效.结果：18例均获随访,时间14 ～22个月,手术时间平均180 min;出血量400～800 ml,术中1例发生髂静脉损伤,术后4例出现不同程度腹胀,无脊髓损伤及其他严重并发症,腰腿痛症状均消失,Frankel分级有不同程度提高,X线、CT检查显示18例患者于术后9～13个月植骨融合,腰骶角和血沉末次随访时与术前比较均显著改善（P＜0.05）.结论：前路病灶清除椎体间植骨结合后路椎弓根内固定是治疗腰骶椎结核的一种有效手术方法.     

脊柱结核病灶清除植骨内固定24例报告

目的：总结脊柱结核病灶清除植骨一期内固定的疗效及经验。方法：本组24例，年龄30～61岁，平均病程10．5个月，计中下颈段3例，中胸段7例，胸腰段5例，腰段5例，腰骶段4例。15例术前有不全瘫。均行前路病灶清除，19例同时行前路内固定，4例后路内固定。结果：24例随访8～12个月，术后4～8个月植骨融合，内固定无松动、无复发及感染。结论：脊柱结核前路病灶清除一期植骨内固定可行，应视病灶部位选择前路或后路内固定。     

手术治疗腰骶椎结核的术式选择

目的:回顾性分析一期后路病灶清除内固定椎体间植骨融合术与一期后路内固定联合前路病灶清除、椎体间植骨融合术治疗成人腰骶椎(L5-S1)结核的临床疗效。方法:2010年1月~2014年11月,我院采用手术治疗腰骶椎结核患者21例,男11例,女10例;年龄17~62岁(38.9±14.3岁);病程10~21个月(16.1±2.7个月)。术前抗结核药物治疗2~4周。8例以椎体破坏为主,无脓肿形成/较小椎旁脓肿或椎管内脓肿;前方存在较高血管损伤风险的患者采用一期后路固定病灶清除椎体间植骨融合术(单纯后路手术组)。13例血管分叉高,具有足够的手术操作空间;有流注脓肿形成;前中柱广泛破坏,后方病灶清除困难者采用一期后路固定联合前路病灶清除、椎体间植骨融合术(后前路联合手术组)。术后均继续抗结核药物治疗12~18个月。记录两组患者手术时间、术中失血量、卧床时间、手术前后疼痛视觉模拟评分(visual analogue scale,VAS)及神经功能改善情况,腰椎正侧位X线片或三维CT评估植骨融合情况,监测血沉、C-反应蛋白评价结核控制情况。结果:单纯后路组手术时间161.2±15.6min,失血量695.2±153.2ml,卧床时间8.5±2.5d;后前路联合入路组手术时间233.6±22.7min,失血量862.0±208.5ml,卧床时间16.9±2.0d。两组患者末次随访时VAS评分、血沉、C-反应蛋白较术前明显改善,差异具有统计学意义(P0.05)。单纯后路组术后窦道形成2例;后前路联合手术组患者前路手术术中髂血管损伤1例,男性患者术后出现逆行性射精1例。末次随访时两组患者均获得骨性融合,未出现内固定失败。结论:单纯后路手术治疗以椎体破坏为主,无脓肿形成或较小椎旁脓肿或椎管内脓肿的腰骶椎结核可以获得满意的疗效;伴有较大骶骨前脓肿、病灶位于前柱的患者应采用后前联合入路手术,且需要髂血管分叉高,具有足够的手术操作空间。     

经前后路联合手术治疗L5S1椎体结核

目的 探讨一期经前路病灶清除后路植骨内固定治疗L5S1椎体结核的临床疗效.方法 对40例L5S1椎体结核患者,采用一期经前路病灶清除椎体间植骨加后路椎弓根螺钉内固定植骨融合治疗.结果 所有患者随访6～24个月,35例植骨融合良好,5例融合欠佳;有1例出现尿路感染.结论 一期经前路病灶清除椎体间植骨加后路椎弓根螺钉内固定椎板植骨治疗L5S1椎体结核能在彻底清除病灶的前提下保证脊柱的稳定性,提高植骨块的融合率和缩短患者卧床时间.     

严重腰骶段结核的手术治疗

目的　探讨严重腰骶段结核手术治疗的方法及疗效。方法　回顾性分析本院 1998年 1月至 2 0 0 3年 1月治疗的严重腰骶段结核 18例。男性 12例 ,女性 6例 ,年龄 2 1～ 6 4岁 ,平均 4 2岁。病变部位 L5～S1 2例 ,L4 ～ S1 6例 ,伴有一侧或双侧腰大肌脓肿。术前抗痨治疗至少 2周以上 ,采用后路椎弓根内固定融合 前路病灶清除植骨融合的方法。结果　平均手术时间 2 6 0 min,平均失血量 12 0 0 m L。创口全部愈合。随访 16例 ,平均随访时间 18个月 ,植骨块无滑脱 ,骨性融合时间 6个月 ,无内固定松动 ,无腰痛及功能受限 ,无病灶复发。 1例因术中植骨块嵌入骶管压迫神经致足下垂 ,随访时未见恢复。结论　严重腰骶段结核应手术治疗 ,采用后路椎弓根内固定融合 前路病灶清除植骨融合的方法疗效确切 ,能达到彻底清除病灶和重建腰骶稳定的目的。     

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.