隐神经营养血管蒂逆行岛状皮瓣修复足踝部软组织缺损

目的应用隐神经营养血管蒂逆行岛状皮瓣修复组织缺损。方法以隐神经相伴行的大隐静脉体表投影为轴线,根据受区大小、部位及旋转点的位置设计逆行岛状皮瓣。结果临床应用6例,修复小腿足踝部创面,皮瓣完全成活。皮瓣面积最大6cm×8cm。经6～20个月随访,效果满意。结论根据皮神经的血管构筑与皮肤血供密切相关的特点,设计隐神经营养血管蒂逆行岛状皮瓣安全可靠,操作简便,为小腿创面修复提供了一种可靠的新方法。     

隐神经营养血管蒂逆行岛状皮瓣的临床应用

[目的]探讨隐神经营养血管蒂逆行岛状皮瓣修复足部、踝部及小腿下1/3软组织缺损的可行性。[方法]自1999年6月~2003年6月,对足部、踝部、小腿下1/3软组织缺损者应用隐神经营养血管蒂逆行岛状皮瓣转移修复6例。面积最大12 cm×7 cm,最小5 cm×3 cm,平均8 cm×5.5 cm。[结果]皮瓣全部成活。随访10个月~3年,皮瓣质地较好。[结论]隐神经营养血管蒂逆行岛状皮瓣是修复足部、踝部及小腿下1/3软组织缺损的良好方法。     

小隐静脉-腓肠神经营养血管岛状皮瓣的应用

目的探讨用小隐静脉-腓肠神经营养血管逆行岛状皮瓣修复下肢远端软组织缺损的效果.方法用小隐静脉-腓肠神经营养血管逆行岛状皮瓣修复踝周、足跟、足底及足背皮肤软组织缺损26 例,皮瓣面积为6 cm×5 cm～22 cm×10 cm,筋膜蒂长6～13 cm.结果随访时间6～46个月,皮瓣全部成活.皮瓣与周围皮肤颜色一致、质地柔软,外观及功能满意.结论小隐静脉-腓肠神经营养血管逆行岛状皮瓣血供可靠,不损伤主干血管,切取容易,是修复踝周、足跟、足底及足背皮肤软组织缺损的理想皮瓣.     

隐神经营养血管蒂逆行岛状皮瓣修复足踝部软组织缺损

目的应用隐神经营养血管蒂逆行岛状皮瓣修复组织缺损。方法以隐神经相伴行的大隐静脉体表投影为轴线，依据受压部位，大小及旋转点的位置设计逆行岛状皮瓣。结果临床应用8例修复小腿足踝部创面，皮瓣完全成活。皮瓣面积最大为6cm×8cm。经8～24个月随诊，效果满意。结论依据皮神经的血管构筑与皮肤血管密切相关的特点，设计隐神经血管蒂逆行岛状皮瓣安全可靠，操作简便，为小腿创面修复提供了一种可靠的新方法。     

隐神经营养血管蒂逆行岛状皮瓣修复小腿远端骨外露的疗效

目的探讨隐神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损的临床效果。方法对9例小腿下1/3踝关节周围皮肤坏死及缺损的患者,行隐神经营养血管蒂逆行岛状皮瓣转移修复术,皮瓣面积最大12cm×8cm,最小6cm×5cm,平均9cm×6.5cm。结果8例全部成活,1例部分坏死,随访6～12个月,皮瓣质地满意,外观佳。结论隐神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损,取材方便,血供可靠,不牺牲主要动脉。     

应用腓肠神经营养血管皮瓣修复踝周软组织缺损

目的 报道应用腓肠神经营养血管逆行岛状筋膜皮瓣修复踝周皮肤软组织缺损的临床效果.方法 应用腓肠神经营养血管逆行岛状筋膜皮瓣修复踝周皮肤软组织缺损13例,创面面积最大20 cm×15 cm,最小10 cm×8 cm,切取皮瓣面积最大22 cm×16 cm,最小11 cm×9 cm,在转移皮瓣时将小隐静脉与创面周围静脉吻合.结果 13例皮瓣术后均无明显肿胀、淤血等现象.其中11例顺利成活,2例出现远端边缘表皮小部分愈合不良,换药后愈合.随访6个月～3年,皮瓣外形、色泽及踝部功能满意.结论 应用腓肠神经营养血管逆行岛状皮瓣修复踝周皮肤软组织缺损,并将远端小隐静脉与创面周围静脉吻合,皮瓣成活率高,临床效果好.     

隐神经营养血管蒂逆行岛状皮瓣修复足踝部软组织缺损

目的应用隐神经营养血管蒂逆行岛状皮瓣修复组织缺损。方法以隐神经相伴行的大隐静脉体表投影为轴线，根据受区大小、部位及旋转点的位置设计逆行岛状皮瓣。结果临床应用６例，修复小腿足踝部创面，皮瓣完全成活。皮瓣面积最大６ｃｍ×８ｃｍ。经６～２０个月随访，效果满意。结论根据皮神经的血管构筑与皮肤血供密切相关的特点，设计隐神经营养血管蒂逆行岛状皮瓣安全可靠，操作简便，为小腿创面修复提供了一种可靠的新方法。     

改良隐神经腓肠神经营养血管逆行皮瓣修复足远端软组织缺损

目的探讨应用改良隐神经、腓肠神经营养血管逆行皮瓣修复足远端软组织缺损的临床效果。方法应用隐神经、腓肠神经营养血管逆行皮瓣，并在其下端再设计一个底边与之相连的辅助皮瓣，用以覆盖较长距离的静脉一神经筋膜蒂转位后外露创面，修复踝足远端软组织缺损14例，皮瓣最大面积30cm×14cm，最小24cm×14cm，皮瓣最上端可切取至胴窝下缘，旋转点在外踝上5-6cm。结果皮瓣全部成活，术后有1例皮瓣远端部分皮肤坏死，经换药后用中厚皮片植皮愈合。所有病例均经6个月至2年以上随访，患肢正常步态行走，皮瓣耐磨，有痛觉。结论改良隐神经、腓肠神经营养血管逆行皮瓣皮肤质量较好，不臃肿，皮瓣切取范围明显大于传统隐神经、腓肠神经皮支营养血管蒂逆行岛状皮瓣，皮瓣上端可达胭窝附近，能很好地修复较长距离的足底、足背及足趾皮肤软组织缺损，且不牺牲主干血管，是修复足远端较大面积皮瓣缺损的理想供区。     

腓肠神经营养血管逆行岛状皮瓣的临床应用

目的　应用腓肠神经营养血管逆行岛状皮瓣修复同侧小腿下段及足踝部软组织损伤的临床效果。方法　应用腓肠神经营养血管逆行岛状皮瓣修复同侧小腿下段及足踝部软组织损伤 19例 ,皮瓣面积最大 15cm× 13cm ,最小 5cm× 4cm。其中将小隐静脉与受区静脉吻合 9例 ,未吻合但在其蒂部结扎 6例 ,未吻合也未结扎 4例。结果　大部皮瓣成活 ,小隐静脉吻合者皮瓣全部成活 ,未吻合但在其蒂部结扎者部分坏死 1例 ,未吻合也未结扎者均短期内间内肿胀淤血且大部分坏死 1例。结论　腓肠神经营养血管逆行岛状皮瓣是修复小腿及足踝部软组织缺损的可靠方法 ,术中若能将小隐静脉与修复区静脉吻合其效果更佳。     

隐神经营养血管蒂逆行岛状皮瓣的临床应用

目的探讨隐神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损的临床应用。方法自1998年6月～2000年12月,对8例小腿下1/3、踝关节周围及足软组织缺损的患者,行隐神经营养血管蒂逆行岛状皮瓣转移修复术,其中3例皮瓣的血管筋膜蒂上保留1.5cm宽的皮桥,作为切开隧道的顶部,这样可避免皮瓣蒂经皮下隧道时血管受压。皮瓣面积最大15cm×9cm,最小6cm×5cm,平均9cm×6.3cm。结果7例全部成活,1例部分坏死,随访6个月～2年,皮瓣质地满意。结论隐神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损,取材方便,血供可靠,不牺牲主要动脉,即使下肢受区皮肤血运条件差的患者也可成活。     

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.