经皮穿刺病灶清除灌注冲洗局部化疗治疗脊柱结核脓肿

目的:评价CT引导下经皮穿刺微创病灶清除后灌注冲洗局部化疗治疗脊柱结核脓肿的疗效。方法:31例脊柱结核并脓肿患者,其中7例为脊柱结核病灶清除术后复发者,单侧脓肿25例,双侧脓肿6例。7例有神经功能障碍,Frankel分级D级5例,C级2例。所有患者在全身化疗的同时,行CT引导下经皮穿刺微创病灶清除术,术后原结核病灶部位及脓肿部位放置灌注冲洗管进行灌注冲洗和持续局部化疗。结果:全组病灶清除及灌注冲洗管放置顺利,1例因冲洗管脱落改为开放手术治疗;交叉感染1例,经引流及应用敏感抗生素后治愈;1例治疗后1年复发椎弓根结核,给予局部清创,继续局部化疗3个月后痊愈。局部化疗时间53±23d,随访18±6个月,患者的疼痛和脓肿消失,恢复正常工作或生活。结论:经皮穿刺病灶清除灌注冲洗局部化疗治疗不合并严重畸形和严重神经功能障碍的脊柱结核脓肿效果较好。     

经皮穿刺置管药物治疗脊柱结核

目的探讨C型臂引导下经皮穿刺置管局部抗痨药物治疗活动期脊柱结核的临床疗效。方法回顾我院2008年1月至2012年1月收治并获得随访的12例脊柱结核患者的临床资料,其中累及胸腰段2例,腰段8例,腰骶段2例。3例患者术前有不同程度神经受压症状,F ranke l分级C级2例,D级1例。所有患者均在C型臂引导下行经皮穿刺置管,应用改良吴启秋结核临床治愈标准对患者进行疗效评估。结果治疗期间12例患者均获随访,未发生交叉感染及窦道形成,随访2个月～4年,平均3.2年,末次随访时,均达到临床治愈,腰痛症状明显减轻,有神经功能损害者均恢复。结论经皮穿刺置管化疗药物治疗脊柱结核创伤小、费用低、可取得较好疗效,适合治疗早期脊柱结核、身体条件较差或经济条件不允许的患者。     

CT引导下经皮微创治疗脊柱结核的近期疗效

目的总结CT引导下经皮微创治疗脊柱结核的近期临床效果。方法 2005年1月至2012年12月对82例脊柱结核患者采用CT引导下行经皮病灶清除,病灶置管,抗结核药物灌注冲洗引流。记录手术时间、术中出血量、住院时间等指标。术后随访时采用Oswestry功能障碍指数评分并参照张西峰等改良的脊柱结核治愈标准进行疗效评估。结果该组患者均顺利手术。复查均未发现结核复发,术后3个月ESR、CRP恢复至正常。所有患者均达到临床治愈,有神经功能损害者均完全恢复,Oswestry功能障碍指数治疗前后比较差异有统计学意义。治疗前后影像学、症状体征改变终末随访时均有明显改善。结论微创治疗疗效好,具有操作简便、安全、创伤小,治疗费用低等优点,对活动期脊柱结核的临床效果好,是理想的微创手术方法。     

超声引导经皮穿刺置管引流治疗肝脓肿41例临床分析

目的 探讨介入性超声引导经皮穿刺置管持续引流治疗肝脓肿的方法和疗效.方法 本组41 例肝脓肿患者均经临床、影像学(B 超或CT)和细菌培养确诊,行介入性超声引导经皮穿刺置管持续引流治疗.脓肿位于肝左叶9 例,肝右叶24 例,肝2 叶8 例.31 例为单个脓肿,10 例为多发脓肿.结果 41 例均放置引流管并冲洗治愈,平均引流置管时间为(18.5±5.3)d,除5 例患者经二次置管外,余患者均一次置管治疗成功.所有患者随访半年未见复发.2 例患者出现穿刺脓液外漏,经超声引导右膈下置管引流治愈,其余患者未出现明显并发症.结论 介入性超声引导经皮穿刺置管持续引流治疗肝脓肿是有效、安全的方法.     

局部持续化疗和持续引流治疗脊柱结核

目的:观察应用局部持续灌注冲洗引流和局部化疗治疗脊柱结核的临床疗效。方法:对1998年6月～2002年7月应用局部化疗治疗的23例脊柱结核患者进行回顾性分析。所有患者在全身化疗的基础上进行:①持续局部化疗加持续局部引流(15例);②单纯局部化疗(5例);③行手术病灶根治术加局部化疗(3例)。全身化疗时间9~18个月,平均12±2个月。局部化疗灌注冲洗引流的时间为28±10d。观察病变部位影像学改变情况。结果:23例中6例抗酸杆菌染色阳性(占26.1%)。ESR最高平均52.4±28.6m/h,治疗后在1～3个月内ESR均恢复正常。经过8个月~5年随访,所有患者局部无窦道形成,没有发生交叉感染。2～6个月左右X光片见病灶骨桥形成。恢复活动后4例患者出现10°以内的后凸畸形。结论:早中期不合并严重畸形的脊柱结核脓肿、死骨、窦道形成和轻度神经刺激患者,接受脊柱微创持续局部灌注冲洗引流和局部化疗可以治愈,不再需要根治手术治疗。晚期畸形合并神经损伤者进行病灶切除内固定治疗后,局部化疗可以起到防止结核局部复发的作用。     

彩超引导下经皮穿刺置管冲洗引流治疗腹腔脓肿（附124例报道）

目的总结彩超引导下经皮穿刺置管冲洗引流治疗腹腔脓肿的临床疗效。方法回顾性分析我院2003年1月至2013年3月期间对124例腹腔脓肿患者采取彩超引导下经皮穿刺置管冲洗引流治疗的临床资料。结果124例腹腔脓肿患者中治愈118例（95．2％）;6例未治愈（4．8％）,经手术治疗后痊愈。全组置管均顺利,未发生出血、腹腔脏器受损等严重并发症。间隔1～3个月来院复查B超,随访患者106例（85．5％）,随访（7±2．43）个月未见复发。结论选择性采用彩超引导下经皮穿刺置管冲洗引流治疗腹腔脓肿微创、安全及有效。     

脓肿清除术联合置管小剂量灌洗处理胸腰椎结核术后复发的临床疗效

[目的]评价脓肿清除术联合经皮局部置管小剂量异烟肼灌洗治疗胸、腰椎结核经单纯后路一期手术治疗术后复发患者的临床疗效。[方法]回顾分析本科2009年3月~2013年8月收治并获得随访的19例经单纯后路一期病灶清除、植骨融合钉棒内固定术治疗胸腰椎结核的术后复发患者。在全身化疗的同时,行脓肿清除术联合局部置管持续化疗。[结果]随访时间18~48个月,平均36个月,所有患者脓肿清除及局部置管顺利,局部化疗期间患者均未发生交叉感染及窦道形成,没有发生内固定松动断裂等情况。所有患者均达到临床治愈,随访无再次复发。[结论]脓肿清除术联合经皮局部置管化疗创伤小,容易操作,是处理胸腰椎结核经单纯后路一期手术治疗术后复发行之有效的方法。     

经皮置管冲洗引流治疗感染性胰周坏死

目的 探讨感染性胰周坏死采用经皮穿刺置管配合冲洗引流治疗的临床疗效。方法 2018年1月～2022年6月收治的感染性胰周坏死10例，采用穿刺置管冲洗引流治疗，记录病人引流时间、恢复情况及并发症发生情况。结果 9例经穿刺冲洗引流处理后均痊愈，1例穿刺置管冲洗引流治疗失败行开腹清创术后治愈，住院平均冲洗引流时间32天，无并发症发生，治愈后未再复发。结论 经皮穿刺逐级置换冲洗引流具有微创、效果明确等特点，可考虑单独用于部分病人感染性胰周坏死的治疗，值得推广。     

经皮骨髓穿刺减压治疗急性血源性骨髓炎60例

目的 探讨经皮骨髓穿刺减压治疗急性血源性骨髓炎的方法及其疗效。方法 60例急性血源性骨髓炎患者均采用局部骨髓穿刺减压引流，其中39例置橡皮条引流；17例穿刺抽出脓液．在C型臂X线透视下将硅胶管经骨钻孔置入骨髓腔内，持续引流冲洗；4例穿刺阴性者仅行骨穿减压。结果 60例患者，平均用药5～8d体温下降，10d体温正常；17例持续冲洗，平均15d。随诊45例。随诊时间1～5年，治愈率83．3％，复发率6．7％。结论 经皮骨髓穿刺既可实施局部感染病灶的骨髓减压、引流，又可进一步明确诊断，有效提高治愈率。置管冲洗能使骨髓腔内的积血、脓液及坏死组织得到充分引流，控制感染扩散，减少中毒症状。     

CT引导下置管引流局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿

目的：探讨CT引导下置管穿刺引流、局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿的安全性和有效性。方法纳入脊柱结核伴腰大肌脓肿和椎旁脓肿患者35例,进行CT引导下置管穿刺引流、局部强化化疗,同时行口服药物全身化疗18个月,每个月监测肝功、血沉,术后1、3、6、9、12、18、24个月复查,分析治疗前后临床表现、脓肿吸收、病椎愈合情况。结果平均随访时间25个月（18～36个月）,引流时间3周～3个月,35例均获得临床治愈,治疗前疼痛视觉模拟量表（visual analogue scale, VAS）评分平均3．6分（2～7分）,最后一次随访VAS评分平均1．1分（0～3分）,无神经功能障碍及其他并发症。结论 CT引导下置管引流、局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿安全有效,费用低、创伤小,适应证得当可代替病灶清除术。     

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.     

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.     

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.