膀胱憩室癌5例报告

目的：探讨膀胱憩室癌的临床特征，提高其诊治水平。方法：对5例膀胱憩室癌患者均行CT和膀胱镜检查确诊。3例行根治性膀胱全切、尿流改道手术．2例行膀胱部分切除术。结果：病理诊断移行细胞癌2例，鳞状细胞癌2例，恶性神经鞘瘤1例。3例于术后2个月内死亡，均为非移行性细胞癌；另外2例术后随访10个月，无局部复发和远处转移。结论：CT和膀胱镜检查是确诊膀胱憩室癌的重要方法；膀胱憩室癌的临床分期不同，预后明显不同，非移行细胞癌病理类型有早期浸润行为．预后差。     

膀胱移行细胞癌阴茎转移一例报告

膀胱移行细胞癌阴茎转移罕见,我院2009年12月收治1例,现报告如下.患者,75岁.主因"全膀胱切除术后21个月,阴茎肿痛1个月"于2009年12月25日入院.患者于2004年12月在外院因膀胱肿瘤行TURBt,术后病理示膀胱移行细胞癌Ⅲ级,行羟基喜树碱膀胱灌注化疗.2006年4月因膀胱肿瘤复发再次行TURBt,术中发现膀胱前壁、膀胱左侧壁和前壁交界处、左输尿管口后方大片苔藓样肿瘤,术后病理为膀胱移行细胞癌Ⅲ级,术后行吡柔比星膀胱灌注化疗8个月.2008年3月因"无痛性肉眼血尿4个月"入院,膀胱镜检示膀胱左侧壁地毯样隆起,范围3 cm×3 cm.活检病理示膀胱移行细胞癌Ⅲ级,灶性呈腺癌分化.遂行根治性膀胱全切术+回肠膀胱术.术后病理示膀胱移行细胞癌Ⅲ级,灶性呈腺癌分化,侵及膀胱壁全层.双侧输尿管切端,尿道切端,左右精囊未见癌侵及,左右髂血管旁淋巴结未见转移癌.     

膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的　提高膀胱移行细胞癌伴前列腺癌的诊治水平。　方法　对 8例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。　结果　 8例术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌。 7例经直肠前列腺穿刺活检确诊前列腺癌 ,1例为前列腺增生症 ,行膀胱前列腺全切术后病理证实为前列腺癌。 4例行经尿道膀胱肿瘤电切及双侧睾丸切除术 ,术后使用丝裂霉素或BCG等膀胱灌注及氟他胺内分泌治疗。 1例行膀胱前列腺全切加回肠膀胱术。 8例中 2例失访 ,3例因多发性转移 ,术后存活 <1年 ,3例行根治性膀胱前列腺全切术 ,术后随访 1.5～ 4.0年 ,经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。　结论　血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法 ,根治性膀胱前列腺切除是影响预后的重要因素     

T1G3膀胱移行细胞癌的临床治疗

目的　探讨T1G3 膀胱移行细胞癌的治疗方法。　方法　T1G3 膀胱移行细胞癌患者6 7例 ,平均年龄 6 3岁。均行TURBt,术后BCG膀胱灌注 5 9例 ,丝裂霉素膀胱灌注 8例。　结果　6 7例患者经 1～ 5次治疗 ,随访 12～ 78个月 ,中位时间 4 7个月 ,有 2 8例出现 1次或 1次以上的复发。最终有 2 0例进展为T2 及以上分期肿瘤 ,16例施行膀胱全切 ,4例发生远处转移。 9例患者死于膀胱肿瘤。　结论　初发的T1G3 膀胱移行细胞癌患者可施行TURBt加术后膀胱内药物灌注治疗 ,术后严密随访 ;对肿瘤复发进展者应尽早施行根治性膀胱全切术。     

膀胱小细胞癌诊治体会(附六例报告)

目的　提高对膀胱小细胞癌的认识。　方法　回顾性分析 6例膀胱小细胞癌患者的病理及临床资料。男 4例 ,女 2例 ,平均年龄 5 1岁。其中 2例膀胱小细胞癌含有移行细胞癌和 (或 )腺癌成分。行膀胱部分切除术 2例 ,行膀胱全切术 4例。 5例患者接受 2～ 6疗程化疗。　结果　 6例患者随访 12～ 6 0个月 ,均因肿瘤复发死亡。平均生存时间 2 8个月。　结论　膀胱小细胞癌占原发膀胱恶性肿瘤的 0 .4 4 % ,恶性程度高 ,易发生淋巴结、肝、骨等转移 ,预后差 ,根治性膀胱全切加联合化疗可获得较好疗效。     

膀胱移行细胞癌伴前列腺癌的诊断与治疗(附5例报告)

目的:提高膀胱移行细胞癌伴前列腺癌的诊治水平。方法:对5例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。结果:5例患者平均年龄66.2岁,术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌(均为II至III级)。1例术前既往诊断为前列腺癌,4例术后病理证实为前列腺癌,前列腺癌Gleason分级4级至6级;2例行膀胱全切,输尿管皮肤造口术。1例行膀胱前列腺全切加回肠膀胱术。1例行径尿道膀胱肿瘤切除术,1例因身体原因仅行姑息性输尿管皮肤造口术。术后随访8个月至26个月。1例术后20个月后死于全身广泛转移;1例随访14个月带瘤存活;余3例经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。结论:膀胱癌患者,如合并的前列腺癌,如果重视不够容易被漏诊。血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法,当诊断膀胱癌同时存在局限性前列腺癌时,治疗方案应根据膀胱癌和前列腺癌的分期、分级综合而定。膀胱移行细胞癌伴前列腺癌并不提示预后不良。     

男性尿道癌3例报告

目的探讨男性尿道癌临床特点和诊治措施。方法总结本院2000~2008年诊治的3例男性尿道癌的临床资料,并结合文献讨论。结果男性尿道鳞癌2例,移行细胞癌1例。1例尿道鳞癌行膀胱、前列腺、精囊、阴茎全切和盆腔淋巴结清扫术及回肠膀胱术,术后2年死于心肌梗死。1例尿道鳞癌行膀胱、前列腺、精囊、阴茎全切、耻骨部分切除和盆腔淋巴结清扫术以及回肠膀胱术,存活至今。1例尿道移行细胞癌行姑息性经尿道后尿道肿瘤电切和前列腺部分电切,术后半年患者死于心肺疾病。结论男性尿道癌以手术治疗为主,辅助化疗和放疗,其预后与肿瘤部位、临床分级和病理分级有关。远端尿道癌预后优于球膜部尿道癌。     

原发性膀胱小细胞癌(附4例报告)

目的 提高对膀胱小细胞癌的认识水平。方法 对4例膀胱小细胞癌的病理及临床资料进行回顾性分析。结果 4例患者中男3例，女1例，平均年龄69．5。其中3例行根治性膀胱全切加化疗，1例行姑息性膀胱全切。3例死于肿瘤复发，平均生存20个月，1例存活7年。结论原发性膀胱细胞癌恶性程度高、预后差，根治性膀胱全切加联合化疗可获得较好的疗效。     

膀胱癌术后腹壁切口种植转移的治疗与预后

目的　总结膀胱部分切除术后腹壁切口种植转移患者的诊治效果。　方法　 1985～1999年共收治膀胱癌术后腹壁切口种植转移患者 10例。男 9例 ,女 1例。年龄 39～ 6 8岁。移行细胞癌 6例 ,均为低分化G3 肿瘤 ;移行细胞癌合并鳞癌和腺癌各 1例 ,鳞癌和粘液腺癌各 1例。腹壁转移灶 1.0～ 6 .9cm× 1.4～ 11.5cm。　结果　采用膀胱全切加腹壁转移灶切除 2例 ,经尿道膀胱肿瘤电切术 (TURBT)加腹壁转移灶切除 1例 ,尿流改道加放疗和 (或 )化疗 2例 ,腹壁转移灶切除加放疗和 (或 )化疗 3例 ,单纯放疗和 (或 )化疗 2例。 10例中死亡 7例 ,其中 6例生存 4～ 14个月 ,1例生存4 1个月 ;3例存活者随访 5～ 9个月 ,未见复发。　结论　膀胱癌术后腹壁切口种植转移癌一般分化差 ,或合并其他癌。膀胱全切加肿物切除 ,辅助放化疗虽然能延长患者生存期 ,但预后很差     

膀胱全切原位W形回肠代膀胱术120例临床分析

目的 探讨膀胱全切原位W形回肠代膀胱术优缺点。方法120例男性膀胱癌患者,其中浸润性膀胱移行细胞癌99例,移行细胞癌伴部分鳞化8例,移行细胞癌伴腺癌及鳞癌3例,腺癌6例,鳞癌4例,均行膀胱全切原位W形回肠代膀胱术。膀胱全切采用顺行、逆行相结合的方法。截取末段回肠,排列成W形,褥式缝合制作储尿袋。输尿管以乳头法包埋术种植。结果手术时间,前50例为210-300mim,平均270min;后70例为110-205min,平均143min。术后9l例获得随访,随访2—88个月,平均30个月,85例白天可控制排尿,其中71例夜间可控制排尿。9例术后发生输尿管扩张,7例合并轻度肾积水,2例合并中度肾积水,2例肾功能轻度异常。45例行膀胱造影仅1例发生右侧输尿管返流。术后3个月复查出现低血钾者6例,余85例血电解质均在正常范围。20例患者行尿动力检查,尿流曲线呈持续型12例,间歇型8例;膀胱尿道造影显示尿流持续型代膀胱颈口呈漏斗形,排尿时开放良好,而尿流间歇形代膀胱颈口不呈漏斗形或排尿时颈口开放欠佳。结论膀胱全切原位W形回肠代膀胱术手术时间短,操作简单,出血少,并发症少,原位W形回肠代膀胱有较好的储尿和排尿功能,电解质紊乱发生率低。     

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.