电子线对瘢痕疙瘩成纤维细胞生物学作用的影响

目的研究电子线治疗瘢痕疙瘩的机制及其有效的安全剂量.方法分别用5,10,15,20Gy的电子线照射体外培养的瘢痕疙瘩成纤维细胞,然后观测其生物学效应.结果 5Gy以上的放射剂量即能抑制成纤维细胞增殖及胶原合成,但剂量超过20Gy,成纤维细胞即被杀死.剂量在10～15Gy之间,成纤维细胞Ⅲ型胶原的合成明显增加.结论 10～15Gy的电子线应是安全有效的放射剂量.     

电子线对瘢痕疙瘩成纤维细胞生物学作用的影响

目的 研究电子线治疗瘢痕疙瘩的机制及其有效的安全剂量。方法 分别用5，10，15，20Gy的电子线照射体外培养的瘢痕疙瘩成纤维细胞，然后观测其生物学效应。结果 5Gy以上的放射剂量即能抑制成纤维细胞增殖及胶原合成，但剂量超过20Gy，成纤维细胞即被杀死。剂量在10～15Gy之间，成纤维细胞Ⅲ型胶原的合成明显增加。结论 10～15Gy的电子线应是安全有效的放射剂量。     

浅层电子线放射治疗背部瘢痕疙瘩的体外实验与临床疗效观察

目的:探讨瘢痕疙瘩成纤维细胞(Keloid Fibroblast,KFs)对不同剂量浅层电子线照射的生物学反应及术后即时浅层电子线放射治疗瘢痕疙瘩的最佳剂量。方法:以人KFs为研究对象,MTT法观察不同剂量浅层电子线照射对KFs增殖的影响,显微镜观察其形态变化。将120例瘢痕疙瘩患者随机分为四组,术后24h内浅层电子线照射剂量分别为2Gy、2.5Gy、3Gy、4Gy,每日照射1次,共照射6次,总剂量为12~24Gy,随访观察其疗效及不良反应。结果:KFs增殖与浅层电子线照射剂量有关,且照射剂量越大,成纤维细胞活力越低;3Gy连续照射6d(总剂量18Gy)对临床瘢痕疙瘩术后疗效最好。结论:术后联合合适剂量的浅层电子线照射治疗是防治瘢痕疙瘩的可靠方法。     

瘢痕疙瘩术后电子线放射治疗48例

目的　探讨电子线放射治疗术后瘢痕疙瘩的效果。方法　随访 1994～ 2 0 0 2年间 4 8例(6 5处 )术后瘢痕疙瘩接受电子线放射治疗的患者 ,总照射剂量 2 5Gy ,随访时间均在 18个月以上 ,对治疗结果进行统计学分析和评估。结果　疗效分析表明 ,总复发率为 2 6 1% ,由感染所致瘢痕疙瘩和有家族史的患者复发率偏高 ,分别为 4 7 8%和 5 3 3% (P <0 0 5 )。患者的年龄、性别、病灶大小及解剖位置分布与复发率高低无直接关系。结论　术后电子线放射治疗对于防治瘢痕疙瘩的复发效果较好 ,是一种治疗瘢痕疙瘩安全有效的方法。     

瘢痕疙瘩成纤维细胞对肿瘤坏死因子α调节胶原合成作用的反应

目的 探讨瘢痕疙瘩的发病机理及其成纤维细胞生物学特性。方法 用肿瘤坏死因子α（TNF-α）分别处理体外培养正常皮肤与瘢痕疙瘩成纤维细胞,采用^3H－脯氨酸掺入、胃蛋白酶消化法检测成纤维细胞胶原合成量。结果 10^3U/ml的TNF－α能显著减少瘢痕疙瘩成纤维细胞的胶原合成量,且与正常皮肤成纤维细胞的反应不同,当TNF－α浓度增至10^4U/ml,瘢痕疙瘩成纤维细胞的胶原合成量却未进一步减少。结论 瘢痕疙瘩成纤维细胞对TNF－α下向调节胶原合成作用的反应敏感性在一定程度上有所降低。     

姜黄素对瘢痕疙瘩成纤维细胞增殖和胶原合成的影响

目的:观察姜黄素对体外培养的人瘢痕疙瘩成纤维细胞增殖及胶原合成的作用,以寻找治疗人瘢痕疙瘩的有效药物。方法:体外培养人瘢痕疙瘩成纤维细胞,分别应用MTT比色法和羟脯氨酸比色法检测姜黄素作用后细胞增殖及胶原合成的变化。结果:和对照组相比,姜黄素能够显著抑制瘢痕疙瘩成纤维细胞的增殖及胶原合成(P<0.01)。结论:姜黄素具有体外抗瘢痕疙瘩的作用,可能成为治疗瘢痕疙瘩的有效药物。     

瘢痕疙瘩术后辅助电子线照射的临床研究

目的 探讨瘢痕疙瘩手术切除后辅助电子线照射预防复发的临床疗效.方法 回顾性分析2004年2月至2009年12月收治的92例患者(120个瘢痕疙瘩)术后电子线照射的临床资料,照射中位总剂量15.0Gy(10.0～30.0Gy),分2～10次照射.RTOG评分标准记录照射反应.Kaplan-Meier法计算局部控制率.结果 照射结束时,10例患者出现1级急性皮肤反应.1例患者治疗期间出现伤口裂开,致伤口延期数天愈合.所有患者中位随访56个月(24～95个月),全组5年局部控制率78.6%,耳垂局部控制率95.7%.均无晚期并发症发生.结论 瘢痕疙瘩术后电子线照射可有效预防复发,尤其是耳垂瘢痕疙瘩.     

瘢痕疙瘩术后电子线治疗效果分析

目的：观察瘢痕疙瘩术后电子线照射在预防手术部位瘢痕疙瘩复发的效果。方法：瘢痕疙瘩术后第1天起手术部位给予电子线照射1～2周，剂量150～300cGY／次，2～5次／周，总剂量1050～2500cGY。结果：瘢痕疙瘩术后电子线照射的伤口无明显缝线反应，愈合良好，无裂开，瘢痕呈细线状，随访病例手术部位未见瘢痕疙瘩复发。结论：瘢痕疙瘩术后电子线治疗是预防瘢痕疙瘩复发的有效方法之一。     

40例瘢痕疙瘩放射治疗的疗效分析

目的探讨利用电子线治疗瘢痕疙瘩的术后效果。方法选取笔者所在科室2007年1月～2011年1月诊治的瘢痕疙瘩患者,均经手术切除,术后运用6MeV电子线照射病变部位,10d为1个疗程,每日1次,每次每个部位照射2Gy。结果运用手术结合6MeV电子线治疗瘢痕疙瘩有效率达90%,且不易复发,不良反应少。结论电子线能有效治愈皮肤瘢痕疙瘩,手术结合放射治疗是治愈瘢痕疙瘩的有效手段。     

消瘢醑对瘢痕疙瘩成纤维细胞Ⅰ、Ⅲ型胶原蛋白的影响

目的　研究复方中药制剂消瘢醑对体外培养的瘢痕疙瘩成纤维细胞 (Keloidfibroblast,KFB)I、III型胶原蛋白的影响。　方法　 6例瘢痕疙瘩成纤维细胞为实验组 ,6例正常皮肤成纤维细胞 (Normalfibroblast,NFB)为对照组 ,采用成纤维细胞体外培养、ABC免疫细胞化学染色技术及积分光密度 (IOD)分析 ,观察在 10 μg ml消瘢醑浓度作用下 ,瘢痕疙瘩和正常皮肤成纤维细胞I、III型胶原蛋白的表达。　结果　瘢痕疙瘩成纤维细胞I、III型胶原阳性染色表达强度均显著高于正常皮肤成纤维细胞 (11113 1± 130 4 9vs 35 19 6± 2 36 0与 1115 7 7± 130 0 3vs 2 6 2 6 5± 4 2 6 3,t值分别为 14 4 2和 13 4 7,P值分别为 0 0 0 0 0 3和 0 0 0 0 0 4 )。 10 μg ml浓度的消瘢醑作用 4 8小时后 :1.瘢痕疙瘩成纤维细胞I、III型胶原阳性染色表达强度均显著高于正常皮肤成纤维细胞 (76 75 4± 82 5 5vs 2 30 5 2± 32 0 4与 10 5 95 2± 1311 5vs 2 4 34 8± 35 6 9,t值分别为 13 37和 12 6 6 ,P值分别为0 0 0 0 0 4和 0 0 0 0 0 5 ) ;2 .瘢痕疙瘩和正常皮肤成纤维细胞呈阳性表达的I、III型胶原染色强度明显下降 ,与未经药物处理的相应空白对照相比具有显著性差异 (76 75 4± 82 5 5vs 11113 1± 130 4 9与     

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.     

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.     

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.     

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.