腺性膀胱炎的诊断与治疗（附116例报告）

目的 探讨腺性膀胱炎的诊断与治疗效果。方法 对116例腺性膀胱炎患者行抗感染、经尿道电切加汽化、膀胱药物灌注等治疗，并对其临床资料进行回顾分析。98例行经尿道电切加电汽化治疗，对其中21例合并膀胱颈肥厚或下唇抬高者同时行膀胱颈部电切；2例疑有恶变者行膀胱切开电切加汽化治疗；16例拒绝手术者和17例症状缓解不明显者，行全身抗炎及膀胱灌注丝裂霉素等治疗。结果 116例患者随访9～54个月。经尿道电切加汽化治疗者98例，膀胱镜检查正常、症状消失者68例，治愈率69％；2例疑有恶变者行膀胱切开电切加汽化治疗者，术后未见复发；行全身抗炎及丝裂霉素等灌注治疗者33例，18例症状消失或缓解，有效率54．5％。结论 下尿路梗阻可能是引起腺性膀胱炎的病因，经尿道电切加汽化治疗是治疗腺性膀胱炎的主要方法。在治疗腺性膀胱炎的同时治疗下尿路梗阻是十分必要的，全身抗炎、膀胱三角区灌注是治疗腺性膀胱炎的有效方法。     

经尿道局部电切术治疗早期腺性膀胱炎疗效观察

目的　探讨经尿道局部病灶电切术治疗早期腺性膀胱炎的疗效。方法　早期腺性膀胱炎 18例 ,膀胱镜下为位于三角区或膀胱颈的单个小滤泡 ,小颗粒状黏膜凹凸不平和充血。存在下尿路感染征象 14例 ,其中 4例有下尿路梗阻表现。活检病理报告囊腺性膀胱炎伴鳞状上皮化生14例 ,腺性膀胱炎 4例。 18例在硬膜外麻醉下行经尿道局部病灶电切电灼术 ,伴后尿道息肉者同时行电灼治疗。定期复查膀胱镜 ,以患者主观症状改善情况和膀胱镜活检病变复发情况作为疗效判断标准。结果　术后随访 5～ 3 4个月 ,自觉症状消失 2例 ,无改变 10例 ,加重 6例 ,膀胱镜活检病变复发 10例。结论　早期腺性膀胱炎单纯行局部电切电灼术不仅不能改善症状 ,部分患者症状反而加重 ,病变复发率高。建议治疗上应同时针对下尿路感染、梗阻及下尿路动力学异常进行处理。     

腺性膀胱炎的诊断和治疗（附90例报告）

目的探讨腺性膀胱炎的临床特征和诊治效果。方法分析腺性膀胱炎90例诊治的经验。结果主要症状为膀胱刺激症状，血尿和排尿困难，病变部位最常见膀胱颈121和膀胱三角区，确诊依赖于膀胱镜下活检。治疗采用经尿道电切，膀胱部分切除。结论腺性膀胱炎有潜在的恶变倾向，需长期复查。     

腺性膀胱炎的诊断和治疗(附150例报告)

目的探讨腺性膀胱炎临床特征和诊治效果。方法报告腺性膀胱炎１５０例的诊治经验。结果主要症状为膀胱刺激症状、血尿和排尿困难。病变最常见部位为膀胱颈口和三角区,确诊依赖于膀胱镜下活检。３１例腺性膀胱炎与膀胱肿瘤有关。治疗采用经尿道电切,膀胱部分切除和膀胱全切。结合文献讨论了腺性膀胱炎的诊断和治疗。结论腺性膀胱炎有潜在的恶变倾向,需长期随访复查。     

腺性膀胱炎的诊断及治疗体会

目的探讨腺性膀胱炎的诊治方法及临床价值。方法回顾分析16例腺性膀胱炎的临床资料。结果16例均采用经尿道电切术加膀胱腔内灌注的治疗方法，无并发症发生。随访6～36个月，其中14例症状消失（有效率87．5％）。1例症状减轻，1例患者在膀胱腔内化疗期间复发。结论膀胱镜检查为诊断腺性膀胱炎的“金指标”，经尿道电切术加膀胱腔内灌注治疗是一种安全有效的治疗方法。     

腺性膀胱炎：附15例报告

报告腺性膀胱炎１５例，主要症状为膀胱刺激症状、血尿及排尿困难。膀胱镜检查示病变部位最常见于膀胱三角区。均经膀胱活检确诊。病理报告伴局部癌变１例，伴不典型增生４例。选择经尿道电灼或是电切、前半膀胱切除术（切除三角区、颈部和双输尿管口）、全膀胱切除术治疗，取得满意疗效。     

经尿道电切联合吡柔比星膀胱灌注治疗腺性膀胱炎（附32例报告）

目的探讨经尿道电切术联合吡柔比星治疗腺性膀胱炎的方法及疗效。方法对32例腺性膀胱炎患者经尿道电切后行吡柔比星(THP)膀胱灌注。结果32例中，临床症状完全消失22例，好转7例，复发3例。结论经尿道电切联合THP膀胱灌注治疗腺性膀胱炎是一种可行有效的方法。     

经尿道汽化电切术治疗膀胱白斑合并腺性膀胱炎

目的探讨经尿道汽化电切术治疗膀胱白斑合并腺性膀胱炎的效果。方法 2006年8月～2010年12月,对29例女性膀胱白斑合并腺性膀胱炎采用经尿道汽化电切术治疗,术后辅以膀胱药物灌注化疗8次。结果手术均获成功,未出现膀胱穿孔、尿失禁、膀胱颈狭窄等严重并发症。8周后症状消失或好转27例,2例症状无明显缓解。25例随访3个月～4年,平均22个月,其中16例〉12个月。1例术后15个月复发,未见恶变病例。结论膀胱镜检查加活组织检查对膀胱白斑合并腺性膀胱炎的早期诊断具有重要意义,经尿道汽化电切术并辅以膀胱药物灌注化疗是治疗膀胱白斑合并腺性膀胱炎的有效方法。较单纯膀胱白斑,合并腺性膀胱炎者复查膀胱镜检查间隔时间要短,并随时注意行可疑组织活检。     

腺性膀胱炎21例诊治体会

目的总结腺性膀胱炎的诊治体会. 方法对21例腺性膀胱炎患者行电汽化治疗.结果 21例均获随访,时间6～36个月.14例症状完全消失;7例症状明显改善,后经膀胱内丝裂霉素灌注治疗,症状完全消失. 结论膀胱镜活检是确诊腺性膀胱炎的主要手段,经尿道电汽化治疗本病是行之有效的方法,症状未完全缓解者辅以膀胱内药物灌注治疗有效.     

腺性膀胱炎伴重度不典型增生13例临床分析

日的分析腺性膀胱炎伴重度不典型增生的临床治疗方法。方法介绍2006年12月∽2009年5月在北京大学首钢医院收治的13例腺性膀胱炎伴重度不典型增生患者的治疗经过并随访其预后。术前膀胱镜检均显示膀胱颈部、三角区或／和相邻的左右侧壁多发滤泡和乳头样病变}三角区单发实性块状隆起;病变活检病理为腺性膀胱炎伴重度不典型增生（肿块）、腺性膀胱炎（滤泡及乳头状突起）。结杲12例行经尿道膀胱肿物电切术,术后盐酸吡柔比星30mg膀胱灌注1次／周,连续8次;3、6、9、12个月复查时累计复发病例数分别为2、7、11、11例,此11例在膀胱灌注化疗1次／月后病变消失,随访至2010年2月无复发。1例患者拒绝肿物电切术而接受盐酸吡柔比星30mg长期膀胱灌注1次／周,肿物体积和性质无变化。砖论腺性膀胱炎伴重度不典型增生的治疗宜首选病变切除;不能耐受或不愿行切除手术者可维持长期膀胱灌注化疗,但是必须严密随访并定期活检;首次治疗后未见复发者可继续观察,对于反复复发者可规律膀胱灌注,多数有效。     

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.     

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.