直肠癌Miles术后会阴部肿块56例分析

为了探讨直肠癌Ｍｉｌｅｓ术后会阴部肿块的诊断和治疗，作者回顾性分析了１９８６～１９９４年间住院治疗的５６例直肠癌Ｍｉｌｅｓ术后会阴部肿块病人。结果显示：①病因有慢性炎性肉芽组织增生４３例（７６．８％），局部肿瘤复发１３例（２３．２％）；②ＣＴ、穿刺细胞学检查、ＣＥＡ检测和放免显像技术对该病有诊断价值；③５６例中完整切除会阴肿块５１例，姑息性切除３例，未能切除２例，手术切除率９１．１％（５１／５６）。作者认为：直肠癌Ｍｉｌｅｓ术后会阴部肿块最常见的原因是慢性肉芽组织增生；对会阴部肿块性质的诊断要结合临床及检查结果综合分析，治疗要慎重，且勿盲目手术；加强围手术期管理，术中规范操作以及保证会阴部的切除范围是预防直肠癌术后会阴部肿块及肿瘤局部复发的关键     

^99mTc标记物对阴茎海绵体的血液动力学研究

用~（９９ｍ）Ｔｃ标记物对６名性功能正常男子和２４例阳萎病人阴茎海绵体血液动力学状况进行动态显像研究。６名正常男性，其阴茎动脉系统显像指数（ＰＩＡ）为９０．２０±３８．５３；盐酸罂粟碱负荷后达曲线１／２高峰值所需时间（１／２Ｐ）１．８４±０．５０分；阴茎静脉系统显像指数（ＰＩＶ）为－２１．０４±６．２７：ＰＩＡ＞６０和ＰＩＶ＞－４５被视为有关勃起动、静脉系统正常指标。本研究认为用~（９９ｍ）Ｔｃ标记物进行动态显像检测对于血管性阳萎患者病因鉴别是一种安全，无创，客观和准确的诊断方法。     

选择性腰骶神经后根切断术的电生理研究

探讨采用选择性腰骶神经后根切断术（ｌｕｍｂａｒ－ｓａｃｒａｌｓｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙ,Ｌ－ＳＳＰＲ）治疗脑瘫下肢痉挛时,部分患者出现上肢痉挛缓解,斜视,流涎好转及发音变清晰等现象发生的机制。方法,采用体感诱发电位（ｓｏｍａｔｏｓｅｎｓｏｒｙｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ,ＳＳＥＰ）,感觉神经传导速度（ｓｅｎｓｏｒｙｃｏｎｄｕｃｔｉｏｎｖｅｌｏｃｉｔｙ,ＳＣＶ）及运动神     

结直肠癌术后局部复发因素分析33例报告

目的探讨导致结直肠癌术后局部复发的可能因素。方法将结直肠癌术后局部复发３３例与无复发３１例的临床及病理资料进行对比分析。结果直肠癌局部复发２２例,占６７％（Ｐ＜００５）。Ｍｉｌｅｓ术后局部复发６例,占２７％,Ｄｉｘｏｎ术后复发１６例占７３％（Ｐ＜００１）。术后正规化学药物治疗或放射治疗与非治疗者比较差异有显著意义。结论结直肠癌发生的部位、手术方式、淋巴结清扫程度及术后正规化学药物治疗或放射治疗是影响其术后局部复发的因素。     

Miles手术后并发症的防治

Ｍｉｌｅｓ手术后并发症的防治王正康腹会阴式直肠切除术（ａｂｄｏｍｉｎｏ－ｐｅｒｉｎｅａｌｒｅｓｅｃｔｉｏｎｏｆｔｈｅｒｅｃｔｏｍ）又称为Ｍｉｌｅｓ手术，是下部直肠癌和肛管癌的标准术式，已有８０多年的历史。随着手术技巧的日趋完善，Ｍｉｌｅｓ手术的手术死...     

双功能彩色多普勒超声对静脉性阳萎血流动力学研究

１６例静脉性阳萎在海绵体血管活性药物注射后，采用双功能彩色多普勒超声（ＤＣＤＳ）来监测血流动力学变化，并用３２例功能性阳萎作对照组，背深动脉监测指标，１．舒张期内径（ＡＤ）２．最大收缩期流速（ＰＳＶ），３舒张末期流速（ＥＤＶ）４．阻力指数（ＲＩ）５．血流加速度（ＡＣＣ）。背深静脉监测指标，１．静脉内径（ＶＤ），２．血液流速（ＶＶ）。研究结果提示静脉阳萎ＥＤＶ〉Ｏｃｍ／ｓｅｃ，ＲＩ〈１，均Ｐ〈０．０     

直肠癌血供研究的现状

研究直肠癌血供的方法主要为大体血管解剖和微血管解剖两方面。利用免疫组化技术对直肠癌微血管的研究 ,发现直肠癌微血管密度 (ｍｉｃｒｏｖｅｓｓｅｌｄｅｎｓｉｔｙ ,ＭＶＤ)与其组织分化程度、临床病理分期、转移及术后复发存在明显的相关性。彩色多普勒超声 (ｃｏｌｏｒＤｏｐｐｌｅｒｕｌｔｒａｓｏｎｏｇｒａｐｈｙ ,ＣＤＵ)及磁共振成像 (ｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅｉｍａｇｅ ,ＭＲＩ)对直肠癌的血供研究尚处于初期阶段。一、直肠癌血供研究的意义直肠血供十分复杂 ,血管变异较大 ,各段直肠癌的血供可能不完全相同。对直…     

心脏瓣膜置换术期间血液稀释及其对血流动力学的影响

采用Ｓｗａｎ－Ｇａｎｚ导管监测及动脉血血球压积（Ｈｃｔ）检测方法对２４例心脏瓣膜疾病病人在施行瓣膜置换术期间的血液稀释（ＨＤ）情况及其对血流动力学的影响进行了研究。结果显示，ＣＰＢ开始前由于失血和输入晶体液，Ｈｃｔ有所降低。并因血容量不足ＣＩ下降。ＣＰＢ期间Ｈｃｔ降至２５％左右，ＭＡＰ和ＳＶＲＩ也明显下降，３０ｍｉｎ后逐渐回升。ＣＰＢ结束后ＣＩ明显增高，Ｈｃｔ呈逐渐回增，术毕时达到麻醉前值的７８．６％。ＳＶＲＩ和ＭＡＰ于停机早期较低，后逐渐增高至接近正常值。ＣＰＢ前Ｈｃｔ与ＭＡＰ、ＭＰＡＰ、ＰＣＷＰ、ＰＶＲＩ、ＳＶＲＩ正相关，与ＣＩ负相关。ＣＰＢ中Ｈｃｔ与ＭＡＰ正相关。ＣＰＢ后Ｈｃｔ与ＭＡＰ、ＰＶＲＩ、ＳＶＲＩ、ＲＶＷＩ及ＬＶＷＩ正相关，与ＲＡＰ负相关。结果表明，心瓣置换木期间ＨＤ可通过多种机制影响血流动力学，尤对ＭＡＰ、ＳＶＲＩ及左、右心作功有重要影响。调整恰当的Ｈｃｔ是稳定循环的重要措施．     

修补术加PGV与修补术加奥美拉唑方案治疗十二指肠溃疡穿孔的疗效对比

目的研究十二指肠溃疡穿孔的两种不同疗法——穿孔修补术加近侧胃迷走神经切断术（ＰＧＶ）与穿孔修补术加奥美拉唑方案的临床疗效。方法将１９９４年１月－１９９６年１２月相继入院的４８例十二指肠溃疡穿孔患者随机分为Ａ、Ｂ两组。Ａ组（２１例）在穿孔修补术的基础上，加行ＰＧＶ。Ｂ组（２７例）仅作穿孔修补术，术后辅予奥美拉唑方案（即口服奥美拉唑加羟氨苄青霉素加灭滴灵）。术后定期随访。随访结果按Ｖｉｓｉｃｋ标准分级。结果Ａ组术后半年和２年疗效优良者（ＶｉｓｉｃｋⅠ加Ⅱ级）分别为１８例（８５．７％）和１７例（８１．０％），溃疡复发者（ＶｉｓｉｃｋⅣ级）分别为１例（４．８％半年）和２例（９．５％２年）。Ｂ组术后半年和２年疗效优良者分别为１９例（６６．７％）和１０例（３７．０％），溃疡复发者分别为５例（１８．５％）和１２例（４４．５％）。Ａ组疗效优于Ｂ组（Ｐ＜０．０１）。Ｈｐ检测，Ａ组术后半年和两年的Ｈｐ阳性率分别为８１．０％和８５．７％（Ｐ＞０．０５）；Ｂ组分别为１８．５％和５１．９％（Ｐ＜０．０１）。结论十二指肠溃疡穿孔在施行修补术后，应同时加行ＰＧＶ，以提高对溃疡病的根治效果     

双功能彩色多普勒超声对静脉性阳萎血流动力学研究

１６例静脉性阳萎在海绵体血管活性药物注射后，采用双功能彩色多普勒超声（ＤＣＤＳ）来监测血流动力学变化，并用３２例功能性阳萎作对照组。背深动脉监测指标：１．舒张期内径（ＡＤ），２．最大收缩期流速（ＰＳＶ），３．舒张末期流速（ＥＤＶ），４．阻力指数（ＲＩ），５．血流加速度（ＡＣＣ）。背深静脉监测指标：１．静脉内径（ＶＤ），２．血液流速（ＶＶ）。研究结果提示静脉性阳萎ＥＤＶ＞Ｏｃｍ／ｓｅｃ，ＲＩ＜１，均Ｐ＜０．０１。背深静脉显示持续性、高流速血液回流。我们认为采用ＤＣＤＳ监测对客观评估静脉性阳萎血流动力学变化和静脉性阳萎的诊断均有一定价值。     

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.