椎板钩加压内固定在寰枢椎融合术中的应用

目的　评价椎板钩加压内固定治疗寰枢椎不稳的临床效果。方法　对寰枢椎不稳者行C1-2 后路自体髂骨植骨、椎板钩(Apofix及Halifix)内固定术。包括齿状突骨折 6例 ,陈旧性齿突骨折伴横韧带断裂 1例 ,齿突骨折骨不连结 1例。术后颈椎X线片检查。结果　随访 3个月～ 5年 ,8例均获得骨性愈合。结论　对寰枢椎不稳可采用寰枢椎后路融合椎板钩内固定术治疗 ,椎板钩内固定术无需椎板下穿越钢丝 ,避免了钢丝断裂及松脱。而术前解剖复位是手术成功的主要措施。     

Apofix椎板钩治疗创伤性寰枢椎不稳

目的 评价Ａｐｏｆｉｘ椎板钩治疗创伤怀寰枢椎不稳的效果。方法 对创伤性寰枢椎不稳患者行Ｃ１－２后路融合、Ａｐｏｆｉｘ椎板钩内固定术。包括齿状突骨折５例,其中１例伴横韧带断裂。结果 术后随访３￣１１个月,颈椎侧位Ｘ线片检查,５例获骨性愈合。结论寰枢椎后路融合,Ａｐｏｆｉｘ椎板钩内固定术适于治疗创伤笥寰枢椎不稳;解剖复侠是手术成功的主要。     

Apofix椎板夹治疗寰枢椎骨折及脱位

目的 探讨Apofix椎板夹治疗寰枢椎骨折及脱位。方法 对14例寰枢椎骨折脱位者行后路Apofix椎板夹加压固定及自体髂骨植骨术。其中资料完整的12例，寰枢椎脱位8例，齿状突骨折4例。结果 12例随访1—2年，全部病例获得骨性愈合。结论 Apofix椎板内固定系统结构简单，稳定性好，术后不需要复杂外固定，可早期下床活动。     

应用APOFIX内固定系统结合后路融合治疗创伤性寰枢椎不稳

目的探讨应用Apofix内固定系统后路植骨融合治疗创伤性寰枢椎不稳的疗效。方法对16例创伤性寰枢椎不稳采用后路Apofix内固定系统植骨融合治疗。结果本组15例获得骨性融合,1例失随访。结论Apofix内固定系统后路植骨融合可为寰枢椎提供可靠的稳定性,是一种治疗创伤性寰枢椎不稳的可靠方法。     

Apofix椎板夹治疗寰枢椎骨折、脱位

目的探讨应用Apofix椎板夹治疗寰枢椎骨折、脱位的方法及疗效。方法对8例寰枢椎骨折、脱位患者采用Apofix椎板夹固定。结果随访5~24个月,脱位纠正,颈部活动基本恢复正常,颈部不稳感消失,按照JOA评分法,术前平均为8.3分,术后平均为14.6分。结论Apofix椎板夹治疗寰枢椎骨折、脱位,术后无需坚强的外固定,具有操作技术难度小、手术风险低、安全、实用的特点。     

双侧经寰枢椎关节螺钉联合寰椎椎板挂钩固定术治疗寰枢椎不稳

目的 探讨寰枢椎不稳的手术治疗方法 .方法 采用双侧经寰枢椎关节螺钉联合寰椎椎板挂钩固定及取自体髂骨植骨融合的方法 治疗寰枢椎不稳患者15例,并进行回顾分析.结果 15例患者均术中顺利,未发生并发症,术后均症状缓解、功能恢复,经6～24个月随访,平均12.3月,均获得骨性愈合,无一例假关节形成,取得满意疗效.结论 双侧经寰枢椎关节螺钉联合寰椎椎板挂钩固定植骨融合术具有安全、术后即刻稳定、植骨融合率高等特点,为寰枢椎不稳后路的理想术式.     

寰枢椎不稳的后路内固定治疗

目的　介绍寰枢椎不稳的后路内固定治疗的新方法。方法　 18例寰枢椎不稳患者经后路治疗 ,其中Apofix9例 ,Apofix +C1,2 经关节螺钉 9例。结果　共放置经关节螺钉 17枚 ,1例因放置过程中引起大出血 ,仅进行了单侧放置。术后并发感染 2例 ,经清创后愈合 ,无内固定失败和椎动脉及脊髓损伤等并发症。随访 5～ 16月 ,植骨全部融合。结论　Apofix和C1,2 经关节螺钉技术是治疗寰枢椎不稳的有效方法 ,可提供有效的固定和提高植骨融合率。     

椎板钩加压内固定在寰枢椎融合术中的应用

评价椎板钩加压内固定治疗寰枢椎不稳的临床效果。方法对寰枢椎不稳者行Ｃ１－２后路自体髂骨植骨、椎板钩内固定术。包括齿状突骨折６例,陈旧性齿突骨折伴横韧带断裂１例,齿突骨折骨不连续１例。术后颈椎Ｘ线片检查。结果随访３个月－５年,８例均获得骨性愈合。     

应用Apofix系统治疗枢椎骨折及创伤性枢椎前滑脱

目的：研究和评估在寰椎骨折及创伤性枢椎前滑脱中应用Apofix系统进行治疗的效果和优缺点及手术关键。方法：16例寰椎骨折及创伤性枢椎前滑脱患者,应用Apofix行颈椎后路内固定加植骨融合术。结果：16例患者全部获得成功,Apofix系统固定牢靠,椎板钩及植骨块无松脱,12例患者随访6－18个月,植骨块融合。结论：Apofix是一种安全、简便有效的颈椎后路内固定系统。手术的成功有赖于术前良好的复位、合理地放置Apofix椎板钩及在夹紧Apofix连接杆前行棘突间植骨。     

新型寰枢椎固定组合的生物力学测试

[目的]采用尸体标本测试枢椎椎板螺钉联合新型寰椎椎板钩内固定系统的生物力学稳定性.[方法]采用6具新鲜尸体颈椎标本(C0-3),分别测试完整标本模型(完整组)、寰枢椎不稳标本模型(失稳组)、双侧寰枢椎经关节螺钉联合Gallie固定植骨模型(bTFS+G组)、双侧寰枢椎经关节螺钉联合新型寰椎椎板钩固定植骨模型(bTFS+...     

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.