双功彩超、静脉穿刺造影、光电容积描记检查下肢静脉倒流的比较

目的 了解双功彩超、经皮Ｇｅ静脉穿刺造影、光电容积描记（ＰＰＧ）在检测下肢静脉倒流中的优缺点及相对适应证。方法 对４０例下肢慢性静脉疾病的患者,术前应用双功彩超、经皮Ｇｅ静脉穿刺造和ＰＰＧ的方法进行检测,并对检测的结果进行比较分析。结果 双功彩超与经皮Ｇｅ静脉穿刺造影探测股－Ｇｅ静脉段静脉倒流性疾病的结果差异无显著性意义。与双功能超相比性 ＰＰＧ探测下肢静脉倒流性疾病的精度度６７％。结论 ＰＰＧ可     

双功彩超定量评判下肢静脉瓣膜的倒流

目的:确定双功彩超检测下肢静脉瓣膜倒流严重程度的参数。方法:对40例准备行股浅静脉第一对瓣膜重建的病人,术前应用双功彩超检测股浅静脉第一对瓣膜的倒流指数,将检测结果与术中探查的静脉瓣膜倒流程度相比较。结果:双功彩超探测的静脉倒流指数与术中探查的静脉倒流严重程度呈上相关(r=0.8747,P=0.000),静脉倒流指数可以区分轻中度与重度静脉倒流(P=0.000)。结论:双功彩超探测静脉倒流指数可定量地用来评价静脉倒流的严重程度。     

下肢慢性静脉功能不全术后复发60例诊治分析

目的分析和总结下肢慢性静脉功能不全(CVI)术后复发原因及诊治经验。方法对1995年8月至2005年11月上海交通大学医学院附属仁济医院血管外科收治的60例(66侧)CVI术后复发病人行下肢静脉顺行造影、双功多普勒彩超检查,明确复发原因,针对深、浅、交通静脉功能不全施行相应手术。结果复发原因中交通静脉功能不全占95.45%(63/66),隐静脉主干及部分属支残留占72.72%(48/66),深静脉瓣膜功能不全占43.94%(29/66)。下肢静脉顺行造影在静脉通畅性诊断准确率为100%;下肢静脉顺行造影和双功彩超在深静脉瓣膜功能检测及隐静脉主干、属支残留的诊断符合率为87.5%、79.16%;双功彩超对交通静脉的漏诊率(5.11%)明显低于静脉造影(28.31%)。再次手术术后按临床表现严重程度评分(VCSS)为(1.9±1.3)分,明显低于术前(7.0±4.2)分,P<0.01。结论交通静脉功能不全、浅静脉主干及属支残留是CVI术后复发的重要原因,再次手术应全面纠正深、浅、交通静脉功能不全,双功彩超对CVI术后复发病例的病因及定位诊断,尤其是隐-股静脉交界处的病因分析和交通静脉精确定位,具有不可替代的优势。     

光电容积描记检测对下肢静脉瓣膜功能不全的诊断价值

下肢静脉疾病常见，其中血液倒流性疾病占81%。应用无创性检测能客观地评价静脉瓣膜功能以及病变部位。1978年Barnes首先采用光电容积描记(Photople thysmography，PPG)检测静脉炎后综合征的皮肤微循环改变，发现静脉瓣膜可发生功能不全。1979年Abramowitz提出了PPG诊断下肢静脉疾病     

腘静脉外袢成形术治疗下肢静脉倒流性疾病的疗效再评价

目的再评估静脉外袢成形术治疗下肢静脉倒流性疾病的疗效。方法将重度下肢深静脉功能不全 (deepvenousinsufficiency ,DVI)患者分为肌袢组 :行静脉外袢成形术加浅静脉手术 (2 8例 2 9条肢体 ) ,浅静脉组 :仅行浅静脉手术 (46例 5 0条肢体 ) ,比较手术效果。结果肌袢组与浅静脉组在手术前后的下肢胀痛、静脉曲张均由 10 0 0 %降至 9 0 %左右 ;小腿肿胀分别由10 0 0 %和 92 0 %下降为 2 0 7%和 2 2 0 % ;术后难愈合的溃疡分别为 6 9%和 0 0 % ;3年内小腿浅静脉曲张复发率分别为 13 8%与 8 0 %。但 2组之间比较 ,差异无显著意义 (均P >0 0 5 )。结论静脉外袢成形术治疗DVI的疗效尚需进一步评价。     

腘静脉环缩术治疗严重下肢深静脉倒流性疾病

目的　研究和评价应用静脉环缩术治疗严重下肢深静脉倒流性疾病的机理和疗效。　方法　对 78例下肢深静脉瓣膜功能不全 (Ⅲ ,Ⅳ级 )、2例深静脉血栓形成后再通及 2例深静脉无瓣症患者 ,用人造血管环缩静脉管径 1/ 3。并在手术前、后及术中 ,在环缩处近、远侧分别于静息和屏气状态下检测静脉压。　结果　手术前静脉压为 ( 94 7± 8 4 )mmHg ,手术后为 ( 87 9± 7 9)mmHg差异有显著性意义 (P <0 0 1)。术中测压发现静脉环缩处近、远侧存在压力差 ,静息状态下近侧压为( 9 4± 4 5 )mmHg( 1mmHg=0 13 3kPa)、远侧压为 ( 16 5± 8 2 )mmHg ;屏气状态下近侧压为 ( 3 2 4±16 2 )mmHg、远侧压为 ( 4 1 2± 2 8 1)mmHg ,两侧压力差异均有极显著意义 (P <0 0 1)。术后患者症状完全消失或明显减轻 ,溃疡愈合。静脉压下降 60 %以上 ,压力恢复时间大于 2 2s。彩超复查和深静脉造影观察环缩以下无倒流 ,显现瓣膜样作用。　结论　静脉环缩术是治疗严重下肢深静脉倒流性疾病的有效方法。     

股深静脉的形态学和血流动力学分析

目的 初步阐明股深静脉在下肢慢性静脉疾病程中的作用。方法 应用顺行静脉造影、双功彩超对104条慢性静脉疾病的患肢进行股深静脉形态学和血流动力学分析。结果 其中19条肢体深静脉顺行造影股深静脉全程显影，13条肢体股深静脉主干与腘静脉或股浅静脉远端直接相交通，5条肢体股深静脉通过数条细小分支与腘静脉或股浅静脉远端直接相交通。双功彩超检查显示：下肢深静脉顺行造影股深静脉全程显影者均有明显的股深和腘静脉倒流，股深静脉全程显影者其近端股深静脉管径明显大于股深静脉未全程显影者。结论 根据本组资料所示：股深静脉在形态学上可分为5型，股深静脉显影与股深静脉倒流密切相关，Ⅱ型和Ⅲ型股深静脉倒流影响下肢腓肠肌泵功能，这类思考，静脉瓣膜重建应选择在股浅与股深静脉远端相交通的部位之下即腘静脉或同时行股浅与股深静脉瓣膜重建术。     

动脉旁路术前自体大隐静脉移植物的评估

目的　研究动脉旁路术前自体大隐静脉移植物的评估方法。方法　应用静脉造影和双功彩超对动脉旁路术前的自体大隐静脉移植物进行评估 ,并与术中测量结果进行比较。应用双功彩超对年轻对照组、老龄对照组及动脉粥样硬化组的自体大隐静脉进行检测 ,并计算它们的管径和弹性顺应性。结果　大隐静脉造影测定的管径低于术中直接测定的管径值 (P <0 .0 5 )。双功彩超评估大隐静脉 ,在平卧时测得的管径最小 ,站立时静脉明显扩张 ,充血试验时测得的管径最大 ,以年轻对照组最为明显。动脉硬化组在站立位和充血试验时超声测得的大隐静脉管径与术中探查测得的管径无明显差别 (P >0 .0 5 )。年轻对照组弹性顺应性最好 ,老年对照组和动脉硬化组的弹性顺应性无明显差别 ( P >0 .0 5 )。结论　双功彩超采用合适的体位与方法可正确地评估大隐静脉的管径 ,通过测定大隐静脉的弹性顺应性可对其质量进行评估。     

静脉顺行造影在下肢慢性静脉疾病诊断中的再认识

目的分析下肢静脉曲张患者静脉顺行造影表现,总结其对诊断下肢慢性静脉疾病尤其是髂静脉压迫综合征的临床意义。方法 282例下肢静脉曲张患者(329条下肢),左下肢185例,右下肢50例,双下肢47例,术前常规行下肢静脉顺行造影,分析其下肢及髂静脉影像学表现。结果 329条下肢静脉造影成功率100%,下肢深静脉血栓后遗症21例(6.38%),单纯性大隐静脉瓣膜功能不全57例(17.33%),下肢深静脉瓣膜功能不全182例(55.32%),交通支瓣膜功能不全66例(20.06%),先天静脉畸形3例(0.91%);同时发现有髂静脉狭窄大于50%者19例(5.78%),髂静脉狭窄小于50%者57例(17.33%)。结论下肢慢性静脉疾病患者术前静脉造影检查,能够明确原发病因尤其是髂静脉压迫综合征,对于选择个体化的治疗方案具有重要的临床意义和实用价值。     

微波腔内闭合交通支静脉术治疗下肢慢性静脉功能不全

目的：评价经皮穿刺微波腔内闭合交通支静脉术治疗下肢慢性静脉功能不全合并交通支静脉功能不全的临床疗效。方法：全组213例（278条肢体）下肢浅静脉曲张伴交通支静脉功能不全病人均行大隐静脉高位结扎加下肢浅表曲张静脉穿刺微波凝固闭合,同时在超声引导下经皮穿刺微波腔内闭合病变交通支静脉;对部分下肢静脉性溃疡病人配合中西医结合方法局部换药治疗。结果：全组213例（278条肢体）术前检查有632支病变交通支静脉,术中微波闭合629支（3支交通支术中未能明确）;术后1周至3个月内彩超（或静脉造影）证实624支交通支静脉闭合或不显影,另5例共5支交通支静脉未完全闭合。109条肢体（C6）小腿溃疡愈合时间为9-101[平均（31．25±8．28）]d,169条肢体（C4、C5）皮肤营养障碍情况及症状得到不同程度的改善。201例（94．4％）随访3～42个月,小腿溃疡复发6例（5．50％）。全组D-二聚体检查术前与术后比较无统计学差异。结论：经皮穿刺微波腔内闭合交通支静脉术是治疗下肢慢性静脉功能不全合并交通支静脉病变的微创治疗方法,具有疗效显著、安全、创伤小、易康复的特点,尤其适用于患有小腿溃疡的病人．无明显并发症。     

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.