经阴道前壁尿道悬吊器对经闭孔途径治疗失败的女性压力性尿失禁的疗效

目的探讨经耻骨后经阴道前壁尿道悬吊器(TVT-EXACT)治疗经闭孔途径治疗女性压力性尿失禁(SUI)失败后患者的手术方法、并发症的发生及预防、有效性及其安全性。方法女性SUI患者12例采用耻骨后经阴道前壁尿道悬吊器治疗。于术前及术后2个月进行国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分。结果 12例患者均顺利完成手术,无膀胱穿刺伤、无耻骨后血肿形成。2例发生术后排尿困难、尿潴留:1例经留置尿管2周后缓解;另1例留置尿管4周后缓解,控尿正常,SUI未复发。术后随访12~24个月,平均16.5个月,无SUI复发。完全改善率91.67%(11/12),1例患者明显改善,但有偶尔少量漏尿。术后生活质量评分明显改善,ICI-Q-SF评分术后2个月(0.33±0.33)明显好于术前(15.50±0.94)(P0.01)。结论经耻骨后经阴道前壁尿道悬吊器(TVT-EXACT)治疗经闭孔途径治疗女性SUI失败后患者简单易行,操作安全,并发症发生率低.术后效果满意。     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁

目的探讨经闭孔无张力尿道中段悬吊术(transobturator inside-out tension-free urethral suspension,TVT-O)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的效果。方法2005年8月～2006年2月采用经闭孔无张力尿道中段悬吊术治疗女性SUI18例,螺旋穿刺针自阴道前壁尿道旁间隙经闭孔穿刺至大阴唇外侧皮肤后放置网片,调整张力,关闭切口。结果手术时间10～25min,(15±3)min;术中出血量10～20ml,(15±2)ml。1例术后排尿困难,保留尿管3d后自行排尿。18例治愈,随访6个月均无复发。结论TVT-O操作简单,疗效确切,是治疗女性SUI安全有效的方法之一。     

经闭孔无张力阴道吊带术治疗女性压力性尿失禁(附16例报告)

目的 探讨经闭孔无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的疗效.方法 经临床和尿动力学检查确诊16例女性SUI患者,手术自尿道外口与阴道外口之间的切口向耻骨和耻骨降支的联合处钝性分离间隙并穿过闭孔,将聚丙烯网吊带无张力置于尿道中段.结果 手术时间平均20分钟,术中出血量平均18ml,术后平均留置导尿...     

经闭孔尿道中段悬吊术治疗女性压力性尿失禁效果分析

目的探讨经闭孔尿道中段悬吊术治疗女性压力性尿失禁的临床效果。方法对20例女性压力性尿失禁患者实施经闭孔尿道中段悬吊术。观察手术时间、术中出血量及术后并发症等指标。结果本组20例患者均顺利完成手术,手术时间15~40 min,术中出血量20~30 m L,留置尿管时间2~5 d,住院时间4~8 d。1例术后出现排尿困难,1例出现手术部位疼痛。经休息及对症处理后症状消失。未发生尿急等并发症。术后患者均获6个月随访,以患者主观评价:尿失禁症状消失能完全控尿19例,治愈率95.00%,未见有复发病例。结论闭孔尿道中段悬吊术治疗女性压力性尿失禁,创伤小,术后恢复时间短,治愈率高。     

改良的经闭孔尿道中段悬吊术治疗女性压力性尿失禁的临床研究

目的评价自制聚丙烯网片及穿刺锥经闭孔尿道中段悬吊术治疗女性压力性尿失禁的安全性和治疗效果。方法从2005年3月至2013年12月采用自制聚丙烯网片及穿刺锥对尿失禁门诊检查确诊为压力性尿失禁的230例,行经闭孔尿道中段悬吊术。对术中的情况及治疗后的效果进行分析定期随访。结果全部患者在静脉麻醉或骶麻下完成手术,平均手术时间20 min,术中出血30 ml,200例患者术后24 h去除导尿管后能自行排尿,30例出现残余尿100 ml,经留置导尿48 h后好转。术后随访6~12个月未见复发。结论自制聚丙烯网片及穿刺锥经闭孔尿道中段悬吊术除方法简单易学、操作安全、调节悬带松紧方便、术后恢复时间短效果确切外,且价格低廉易为更多的患者所接受。     

TVT-O治疗压力性尿失禁89例的中期随访报告

目的探讨经闭孔无张力尿道中段悬吊术（transobturator vaginal tape inside-out,TVT-O）治疗压力性尿失禁（stress urinary incontinence,SUI）的疗效。方法 2006年3月～2009年6月对89例轻、中、重度压力性尿失禁行TVT-O。采用特制的穿刺器械由阴道内经闭孔穿出,将吊带平铺于尿道中段形成＂吊床＂达到治疗SUI的目的。结果 89例手术顺利,72例行单纯TVT-O,5例合并子宫脱垂行阴式子宫全切术,6例合并阴道前后壁脱垂行阴道前后壁修补术,6例（合并阴道前壁脱垂1例,阴道后壁脱垂5例）行网片悬吊术。未出现膀胱损伤或穿孔、血管、神经损伤,无血肿、尿瘘,无吊带侵蚀,术后出现排尿困难2例。89例随访36个月,完全治愈85例,显著好转3例,无效1例,完全治愈率95.5%（85/89）,显著好转率3.4%（3/89）,联合手术者未见SUI复发或阴道前后壁脱垂复发,72例单纯行TVT-O者性生活未觉明显异常。结论 TVT-O治疗轻、中、重度压力性尿失禁,安全有效。     

经耻骨后和经闭孔尿道中段无张力悬吊术治疗女性压力性尿失禁的疗效观察

目的:观察经耻骨后和经闭孔尿道无张力悬吊术治疗女性压力性尿失禁(Stress urinary incontinence,SUI)的疗效。方法:选择女性SUI患者198例,病程2~25年,平均7.3年;年龄41~78岁,平均58.3岁。采用经耻骨后无张力阴道吊带术(tension-free vaginal tape,TVT,57例为TVT组)或经闭孔尿道下无张力吊带术(transobturator vaginal tape inside-out,TVT-O,141例为TVT-O组)进行治疗。结果:本文患者随访6~120个月,179例(90.4%)治愈,其中TVT组平均随访86个月,治愈51例(89.5%),改善4例(7%);TVT-O组平均随访38个月,治愈128例(90.7%),改善6例(4.3%);疗效不佳9例(3.5%)。TVT组2例发生膀胱穿孔(3.5%),TVT-O组3例出现腹股沟血肿伴下肢大腿根部疼痛,2例出现短期单下肢活动障碍,但经保守治疗均好转;术后拔除尿管后排尿困难5例,其中TVT组2例,TVT-O组3例,经多次下压式尿道扩张及延长保留尿管后解除梗阻、恢复正常排尿4例;TVT组中1例采用尿道扩张无效而剪断悬吊带。结论:经阴道中段无张力悬吊术(尤其是TVT-O)操作简便,疗效佳,并发症少,是治疗女性SUI的有效方法。     

经闭孔和经耻骨后入路尿道下悬吊术治疗压力性尿失禁的疗效比较:一项前瞻性多中心随机对照研究

作者报道了一项经闭孔和经耻骨后入路于尿道后方行尿道悬吊术治疗女性压力性尿失禁(SUI)的前瞻性随机比较研究结果.从2004年3月～2005年5月,88例经临床和尿流动力学检查诊断的连续病例(年龄>18岁)随机分为经耻骨后入路组(RPR组,42例)和经闭孔入路组(TOR组,46例),行尿道悬吊术.     

经阴道经闭孔无张力尿道中段吊带术治疗压力性尿失禁失败5例临床分析

目的探讨改良的经阴道经闭孔无张力尿道中段吊带术(TVT-A)治疗压力性尿失禁(SUI)失败的原因及处理方法。方法收集解放军926医院、弥勒市中医医院2013年3月至2015年3月收治的88例SUI患者,均行TVT-A治疗,将其中治疗失败的5例患者纳入研究对象,回顾性分析患者的一般资料、第1次手术治疗方案和再次治疗方式。结果 5例患者中,有3例患者于术后24h取出尿管后发现治疗失败,1例患者于术后10d发现治疗失败,另1例患者于术后24d发现。患者治疗失败均表现为尿失禁症状同术前,压力试验阳性。失败原因主要包括吊带过松、吊带位置偏低、术后过早剧烈活动致吊带脱落。3例患者再次行TVT-A手术治疗后治愈,1例改行经阴道经闭孔无张力尿道中段吊带术TVT-O手术治疗后治愈,另1例改行经耻骨后尿道中段无张力悬吊术(TVT-E)手术治疗后治愈。5例患者随访1年均未复发。结论 TVT-A治疗SUI术后失败较为少见,吊带过松、吊带位置偏低、吊带脱落等均有可能造成手术失败。术中严格掌握吊带松紧度的调节和吊带位置的固定,术后早期禁止剧烈活动,并加强术后随访,是减少TVT-A手术失败的关键。     

经闭孔尿道中段无张力悬吊术治疗女性压力性尿失禁护理研究

目的:探讨经闭孔阴道无张力尿道中段悬吊术(TOT)治疗女性压力性尿失禁围手术期的护理.方法:对我科自2007年8月至2010年6月采用TOT术治疗的35例女性压力性尿失禁患者,进行术前心理护理、泌尿系和阴道的准备、术后护理及排尿的观察、随诊.结果:35例女性压力性尿失禁患者术后随访2-24个月,治愈率100%.结论:经闭孔阴道无张力尿道中段悬吊术是治疗女性压力性尿失禁的有效方法,配合积极的护理、有效的膀胱功能锻炼,可提高术后效果及排尿自控力.     

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.     

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.