提上睑肌缩短术在治疗重度先天性上睑下垂中的应用

目的：为寻求重度先天性上睑下垂的良好的手术治疗效果。方法：对44例重度先天性上睑下垂者采用经皮肤－睑结膜入路提上睑肌缩短术。对可能出现的并发症提出了预防的方法。结果：眼睑高度基本正常，上睑皱襞弧度自然，并发症少。结论：提上睑肌缩技术可适用于重度先天性上睑下垂者，其效果优于额肌筋膜瓣的手术方法，能达到既矫正畸形又改善外观的效果。     

提上睑肌缩短术在治疗重度先天性上睑下垂中的应用

目的　为寻求重度先天性上睑下垂的良好的手术治疗效果。方法　对 44例重度先天性上睑下垂者采用经皮肤睑结膜入路提上睑肌缩短术。对可能出现的并发症提出了预防的方法。结果　眼睑高度基本正常 ,上睑皱襞弧度自然 ,并发症少。结论　提上睑肌缩短术可适用于重度先天性上睑下垂者 ,其效果优于额肌筋膜瓣的手术方法 ,能达到既矫正畸形又改善外观的效果     

提上睑肌缩短术在治疗重度先天性上睑下垂中的应用

目的为寻求重度先天性上睑下垂的良好的手术治疗效果.方法对44例重度先天性上睑下垂者采用经皮肤睑结膜入路提上睑肌缩短术.对可能出现的并发症提出了预防的方法.结果眼睑高度基本正常,上睑皱襞弧度自然,并发症少.结论提上睑肌缩短术可适用于重度先天性上睑下垂者,其效果优于额肌筋膜瓣的手术方法,能达到既矫正畸形又改善外观的效果.     

提上睑肌缩短及前徙术治疗重度先天性上睑下垂的临床分析

目的：分析提上睑肌缩短及前徙术治疗重度先天性上睑下垂的效果。方法：对18例（22眼）重度先天性上睑下垂者采用提上睑肌缩短及前徙术,对术后效果及并发症随访观察1年。结果：2眼欠矫,术后3天再次手术调整后疗效满意;22眼均睑缘弧度自然,睫毛位置正常,无暴露性角膜炎等其它并发症。结论：提上睑肌缩短术治疗重度先天性上睑下垂疗效较满意。     

提上睑肌缩短术矫治先天性上睑下垂临床分析

目的:探索采用提上睑肌缩短术如何提高上睑下垂的治疗效果。方法:对147例(182眼)先天性上睑下垂患者采用经皮肤-睑结膜入路提上睑肌缩短术进行治疗。结果:本组共治147例182眼。其中126例经3月～11年随访,术后满意101例,基本满意19例,矫治不足4例,过矫2例。结论:综合相关因素确定提上睑肌缩短量,术中注意提上睑肌瓣的解剖和处理,掌握手术操作要点,有助于在功能和外形上取得满意效果。     

全麻下提上睑肌缩短术治疗儿童重度上睑下垂

重度上睑下垂，过去多主张采用额悬吊术，认为重度上睑下垂不适于作提上睑肌缩短术。近来有检采用提上睑肌缩短要治疗成人重度上睑下垂获得较好疗效。为了解提上睑肌缩短术在全麻下的缩短量及疗效，本文对２７例３２只眼在全麻下行提上睑肌缩短术的重度上睑下垂患儿作了总缩短量与疗效的关系。全部手术采用经皮肤、结膜内牙切口联合手术方式。结果表明，儿童重度先天性上睑下垂可以采用提上睑客厅主治疗，肌力小于４ｍｍ者，全麻下平     

全麻下提上睑肌缩短术治疗儿童重度上睑下垂

重度上睑下垂，过去多主张采用额肌悬吊术，认为重度上睑下垂不适于作提上睑肌缩短术。近来有人采用提上睑肌缩短术治疗成人重度上睑下垂获得较好疗效。为了解提上睑肌缩短术在全麻下的缩短量及疗效，本文对２７例３２只眼在全麻下行提上睑肌缩短术的重度上睑下垂患儿作了总结，分析了缩短量与疗效的关系。全部手术采用经皮肤、结膜内外切口联合手术方式。结果表明，儿童重度先天性上睑下垂可以采用提上睑肌缩短术治疗，肌力小于４ｍｍ者，全麻下平均缩短提上睑肌２５ｍｍ（２４～２８ｍｍ），９０％获得满意疗效；缩短量为２１～２３ｍｍ时，５７％欠矫，４３％满意；缩短量小于２１ｍｍ，７只眼全部欠矫（１００％）。本文还讨论了手术并发症的预防和处理。     

提上睑肌缩短术治疗重度先天性上睑下垂

目的:观察提上睑肌缩短术治疗肌力＜4 mm的重度先天性上睑下垂的效果.方法:对肌力在4 mm以下的重度先天性上睑下垂71例86眼行提上睑肌缩短术,观察并分析术后上睑的高度,睑裂宽度,上睑的弧度及重睑形态结果:本组患者71例( 86眼)中治愈81只眼,占94.19％;欠矫4只眼,占4.65％;过矫1只眼,占1.16％;结论:提上睑肌缩短术是治疗重度先天性上睑下垂的有效方法.     

改良上睑提肌缩短术治疗中度和重度上睑下垂

目的 探讨应用改良上睑提肌缩短术治疗中、重度先天性上睑下垂的疗效.方法 对30例中、重度先天性上睑下垂患者(包括2例上睑下垂术后欠矫和复发患者),采用联合睑板切除的上睑提肌缩短术.术中睑板切除量根据睑板的宽度设计,上睑提肌切除量＝(上提量-睑板切除宽度)× (4～5) mm.并分离睑结膜和上睑提肌,切除一定量的睑结膜以防止结膜脱垂,对术后效果进行随访观察.结果 30例除3例矫正不足外,余均获得良好上提效果,上睑缘弧度自然,无严重并发症,仅少数患者早期有轻度睑裂闭合不全.结论 改良上睑提肌缩短术适用于中、重度先天性上睑下垂患者及上睑下垂术后欠矫的患者,在矫正畸形和改善外观方面均能达到良好的效果.掌握手术操作要点,有助于在功能和外形上取得满意效果.     

提上睑肌三阶梯手术矫正上睑下垂的临床应用

目的 探讨提上睑肌三阶梯手术矫正上睑下垂的适应范围及效果。方法 根据提上睑肌肌力和上睑下垂的程度，将患者分为三组。A组为提上睑肌肌力好，上睑呈轻度下垂者。单纯采用提上睑肌徙前术矫正。B组为提上睑肌有一定的肌力，上睑呈中度下垂者。在提上睑肌徙前术的基础上。行提上睑肌缩短术矫正。C组为提上睑肌肌力差，上睑呈重度下垂者。在提上睑肌徙前、缩短术的基础上行提上睑肌反折悬吊术矫正。结果 87例患者术后随访6～30个月，上睑缘位于角膜缘下1mm．眼睑弧度自然，两眼对称，眼睑闭合自如，无暴露性角膜炎及结膜脱垂等并发症，效果满意。结论 提上睑肌徙前、缩短、反折悬吊三阶梯手术，可广泛适用于矫正不同程度的上睑下垂。     

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.