处女膜修补手术及麻醉方法的改进

目的；增大处女膜粘膜瓣的接触面，减少因麻醉造成的处女膜粘膜水肿，提高修复手术的成功率。方法：手术全部采用1％的卡因行粘膜表面麻醉。53例采用瓦合粘膜瓣法，3例用瓦合粘膜瓣联合阴道粘膜瓣修复法。结果：56例术后一月随访，53例处女膜孔径为一指，成功率94．64％。结论：采用1％的卡因粘膜表面麻醉，瓦合粘膜瓣法及瓦合粘膜联合阴道粘膜瓣修复法对处女膜修复是行之有效的。     

裂隙劈开错位缝合法处女膜修补术

目的：介绍一种新的处女膜修补术的手术方法。方法：回顾性分析59例患者121个裂口,应用裂隙劈开错位缝合法行处女膜修补术,术毕处女膜孔径恢复至仅容一小指尖,约8mm,术后1月随访。结果：121个裂口中有5个游离缘有少许裂开,其余均完全愈合。结论：裂隙劈开错位缝合法处女膜修补术,增加了组织接触面积,并使内外两层切口自然错开,避免了内外两层的缝合切口位于一条直线上,提高了愈合率,为处女膜修补提供了一种新方法。     

应用瓦合粘膜瓣及荷包减张缝合处女膜修补术

目的：探索一种有效的处女膜修补术。方法：修剪处女膜裂隙两侧粘膜,形成前后交错、宽约4mm的两个瓦合粘膜瓣,拉拢后间断缝合,最后于处女膜中段行荷包减张缝合,然后根据切口愈合情况评价手术疗效。结果：本组173例,其中143例术后3个月至半年获得随访,伤口一期愈合者115例,占80.42%;伤口80%以上愈合者14例,占9.79%;切口愈合低于80%者14例,占9.79%。结论：瓦合粘膜瓣及荷包减张缝合的处女膜修补术是一种有效的手术方式,值得推广。     

纵形劈开双层横行褥式缝合处女膜修补术

目的：改进传统处女膜修复的方法，以进一步提高处女膜修补术的成功率。方法：采用纵形劈开不去粘膜的分离方法以及双层横形褥式缝合和贯穿减张缝合的缝合方式修补处女膜，以增加创面接触面，减少裂口张力。治疗患者48例，于术后7或14天随访观察裂口修复后愈合情况。结果：术后观察48例患者中43例完全愈合，完全治愈率89．5％；80个裂口75个愈合，裂口愈合率93．7％。结论：该种纵形劈开不去粘膜、双层横行褥式缝合的处女膜修补术术式较传统手术方法成功率高，值得推广应用。     

荷包减张缝合在处女膜修补术中的应用

目的：为进一步提高处女膜修补的成功率,对传统的手术方法进行改进,以防止以往修补术后处女膜裂口不能很好地愈合而达不到修复的目的。方法：在传统的处女膜裂口分层缝合的基础上,行荷包缝合进行加强,并在术后5～7天拆线时随防,记录伤口愈合情况。结果：术后5～7天,30例患者中24例完全愈合,完全治愈率80.0%;57个伤口50个愈合,伤口愈合率87.7%。结论：荷包缝合可以促进处女膜裂口修补后的愈合,可以常规用于处女膜修补术。     

H形切开的尿道口成形术治疗尿道处女膜融合症（附52例报告）

为探讨尿道处女膜融合症的治疗方法，采用Ｈ形切开的尿道口成形术治疗尿道处女膜融合症５２例。手术的关键是将尿道远端及尿道口从处女膜组织中松解并予扩张，切除阻碍物，以使尿道口平滑和尿道远端粘膜平坦光滑，增加尿道口与阴道口间距。４９例（９４．２％）随访５～４８个月，４５例（９１．８％）无复发，２例（４．１％）又行尿道口绒毛状增生物电灼后治愈，２例（４．１％）无效。认为本术式治疗尿道处女膜融合症简便有效。     

尿道口处女膜伞的手术治疗

对67例尿道口处女膜伞患行尿道口成形术,基本步骤：横行切口,纵行缝合,切除尿道口梗阻组织,松解处女膜对尿道粘膜的牵拉,潜行游离尿道口后唇粘膜,楔形切除过多的尿道粘膜,延长尿道阴道口间距,54例（占80.6%)随访1个月-3年,症状完全消失48例（88.9%)且无复发,好转3例（5.6%)。2-3年后复发2例（3.7%),无效1例（1.9%)。2例复发再次手术。治愈1例,好转1例。本术式治疗尿道口处女膜伞简便有效。     

阴道粘膜减张缝合在缺损严重的处女膜修复术中的应用

目的：探讨如何提高处女膜修复的成功率。方法：将处女膜缺损严重的妇女分成两组,一组在行处女膜修补前先行阴道外口粘膜减张缝合,一组仅作处女膜修补。比较两组手术有效率。结果：减张缝合组手术有效率为94.6%,显著高于对照组61.5%（P〈0.05）。结论：阴道粘膜减张缝合是修复缺损严重处女膜的有效方法。     

M-Y及M-V成形术在处女膜修补中的应用

目的：探讨不同处女膜修复术式的选择及应用。方法：选择月经结束后10天内患者60例，根据破裂程度和部位，对于以12点为中心的患者，笔者进行了M—Y成形术，对于以6点为中心的患者，笔者采用W—V成形术，对于以3点或9点为中心的，笔者采用直接缝合或瓦合瓣法。术后随访2周，观察处女膜外观及处女膜口径。结果：有2例因术后分泌物较多致使手术失败，1例患者因术后骑车致修补处撕裂，均进行第二次手术。其他患者术后2周随访发现恢复良好，处女膜口约纳小指尖。结论：根据不同患者采用相应的手术方法进行处女膜修补，不仅可以修复裂口，还可以同时起到缩小处女膜内口的作用，确保了手术的成功率。     

三层缝合法处女膜修补术

目的：介绍一种新的处女膜修补的手术方法。方法：回顾性分析110例患者,应用三层缝合法行处女膜修补术,术毕处女膜孔径恢复至仅容一眼科镊柄大小,约5-6mm,嘱术后1月复诊。结果：57例（52％）患者术后1月来院复查,其中52例完全愈合,愈合率约为91％,剩余5例中4例裂口裂开但未至基底部,不影响效果,有效率为98％。1例切口完全裂开,应用环形缝线法二次修补,效果基本满意。结论：应用三层缝合法处女膜修补术,切口愈合率较高,同时有微型阴道紧缩的作用,更能模拟处女的正常生理状态,值得推广。     

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.