国产网状支架治疗前列腺增生的疗效观察

目的　观察网状支架治疗前列腺增生 (BPH)的临床效果。方法　对 42例BPH患者放置网状支架治疗 ,术后6个月进行随访。结果　 42例均一次性置管成功。 3 9例植入支架后立即自行排尿 ,2例前列腺增生过大 ,前列腺部尿道弯曲延长 ,植入 1个支架排尿仍困难 ,再次植入第 2个支架后自行排尿。 1例支架植入后向下移位 ,发生尿失禁 ,经尿道注入 4℃以下冷水 3 0 0ml,在X线引导下 ,经尿道插入活检钳 ,夹住支架远端向上调整后 ,排尿恢复正常。 3 8例生活质量评分 0～ 3级。 2 8例术后随访 ,国际前列腺症状评分 (IPSS)术前 2 8.6± 6.2分减少至 3 .2分 (P <0 .0 0 1) ,平均尿流率 (AFR)术前 ( 6.8± 3 .2 )ml/s增加至 ( 13 .6± 4.8)ml/s(P <0 .0 0 1) ,剩余尿量 (RUV )术前 ( 15 6± 2 3 .4)ml减少至 ( 60 .3± 2 6.5 )ml(P <0 .0 0 1)。结论　网状支架治疗高危BPH患者是一种安全有效的治疗方法     

盲置网状支架治疗前列腺增生症

目的　探讨盲置网状支架治疗前列腺增生症的临床效果。　方法　B超测定前列腺尿道长度 ,插入网状支架置放器 ,利用定位结构确定网状支架在前列腺尿道部的位置 ,退出外管释放网状支架。　结果　全组网状支架均一次置放成功。全组病例随访 4月～ 13月 ,平均 6 2月 ,IPSS由术前 ( 2 5 9± 3 1)分下降至术后 ( 6 3± 1 6)分 (t =45 14 ,P <0 0 1) ,Qmax由术前 ( 5 3± 0 9)ml s升高至术后 ( 14 5± 1 8)ml s(t =2 6 3 7,P <0 0 1) ,残余尿 (Residualurine ,RU)由术前 ( 178 3± 94 1)ml降至术后 ( 8 8± 13 0 )ml(t =63 0 3 ,P <0 0 1)。　结论　盲置网状支架治疗前列腺增生症 ,操作简便 ,能迅速将支架置入预定部位 ,特别适用于不能耐受或不愿意接受手术的病人     

经尿道双极等离子电切术治疗良性前列腺增生疗效观察

目的 :探讨经尿道双极等离子电切术 (TUPKP)治疗良性前列腺增生 (BPH)的疗效。　方法 :采用TUPKP治疗BPH 313例 ,记录手术时间 ,监测术中出血量 ,记录术后膀胱冲洗时间、留置尿管时间及术后住院时间 ;监测围术期血液指标 ;术后 1个月 2 90例获随访 ,术后 3个月 2 88例获随访 ,术后 1年 14 2例获随访 ,随访前后检查最大尿流率 (Qmax)、国际前列腺症状评分 (IPSS)、生活质量评分 (QOL)并进行疗效分析。　结果 :本组手术时间 (5 1± 2 2 )min ,术中出血量 (6 6± 6 0 )ml,无电切综合征发生 ,术后膀胱冲洗时间 (11± 10 )h ,术后留置尿管时间 (2 .0± 1.8)d ,术后住院时间 (3.6± 1.3)d。Qmax由术前的 (9.0± 4 .4 )ml/s上升至术后 1个月的 (2 0 .5± 7.1)ml/s、术后 3个月的(2 1.8± 5 .4 )ml/s和术后 1年的 (2 1.4± 6 .6 )ml/s(P <0 .0 1) ,IPSS由术前 (2 6 .2± 5 .1)分下降至术后 1个月的 (6 .0± 9.0 )分、术后 3个月的 (5 .6± 0 .8)分和术后 1年的 (4 .4± 2 .7)分 (P <0 .0 1) ,QOL亦有显著改善 (P <0 .0 1)。　结论 :TUPKP治疗BPH安全、疗效好、并发症少 ,有良好的应用前景。     

网状镍钛合金内支架植入治疗高危前列腺增生症尿潴留

目的初步探讨尿道金属内支架植入术治疗高危前列腺增生症（BPH）尿潴留的疗效。方法对56例高危BPH尿潴留患者采用网状镍钛合金支架进行尿道内支架植入术进行治疗。术后随访6～30个月。结果56例患者全部一次植入成功；54例立即自行排尿，另2例留置导尿管3天后自行排尿。术前测定IPSS平均为（26±4．2）分，RUV为（148±13．5）ml；术后随访期间IPSS平均（7．3±2．7）分，RUV为（58．4±16．7）ml（P〈0．01）。结论网状镍钛合金内支架植入术是高危前列腺增生症（BPH）尿潴留的有效治疗方法。     

高危前列腺增生症的经尿道前列腺电切术

目的　探讨经尿道前列腺电切术对高危前列腺增生症 (Benignprostatichyperplasca ,BPH)的价值。　方法　对 2 3 9例高危BPH行部分性经尿道前列腺电切术 (part-TURP )。　结果　行一次电切 2 3 5例 ,二次电切 4例。国际前列腺症状评分(IPSS)由术前 ( 2 7 0± 3 9)分降至术后 ( 8 3± 3 3 )分 (t =49 58,P =0 0 0 0 ) ;生活质量指数 (Qualityoflifeindex ,QOL)由术前( 4 8± 0 9)分降至术后 ( 1 5± 0 6)分 (t =2 8 3 5,P =0 0 0 0 ) ;最大尿流率 (Maximumflowrate ,MFR)由术前 ( 5 8± 3 7)ml s升至术后 ( 18 6± 4 7)ml s(t=-13 0 2 ,P =0 0 0 0 ) ;平均尿流率 (Averageflowrate ,AFR)由术前 ( 1 2± 0 8)ml s升至术后 ( 11 3± 2 3 )ml s(t=-2 1 44,P =0 0 0 0 ) ;剩余尿量 (Residualurine ,RU)由术前 ( 2 73± 71 1)ml降至术后 ( 2 5 6± 12 2 )ml(t =3 3 96,P =0 0 0 0 )。随访 2 3 7例 ,时间 3月～ 48月 ,平均 18月 ,排尿通畅。　结论　高危BPH患者并不是TURP的绝对禁忌证 ,part -TURP对这类患者可行。     

经膀胱尿道支架置入术治疗前列腺增生症(附42例报告)

为探讨前列腺增生症病危患者的最佳治疗方法,采用经膀胱置入镍钛记忆合金网状支架治疗前列腺增生症42例,均一次成功.前列腺症状积分从术前27.8±8减少至6.11±3.29(P<0.001),最大尿流率从术前5.56±3.82ml/s增加至18.52±3.26ml/s(P<0.001).其中26例(61.9％)获得随访,平均随访时间16个月,均排尿通畅。认为该疗法具有简单、损伤小、出血少、置管位置准确、疗效可靠等优点.尤其适合于同时存在膀胱内病变的前列腺增生症高危患者。     

网状支架治疗前列腺增生症121例的远期疗效

目的 评价应用记忆合金网状支架治疗前列腺增生症(BPH)合并膀胱出口梗阻(BOO)的远期临床疗效。方法 1995.3～1999.5月应用国产镍钛合金网状支架治疗前列腺增生症患者121例,术后1年分别进行随访;重新评定疗效。结果 术后1、2、4年有效率分别为91.5％、80.9％、64.3％,IPSS由术前25.4减少至8.5,MFR从术前2.5ml/s增加至13.4ml/s,RUV由术前119.3ml减少至52.8ml。结论 前列腺尿道测量的准确性及支架安放的准确性影响手术的远期疗效。网状支架仍然适用于前列腺增生症的高危患者。     

经尿道等离子体双极电切治疗前列腺增生

目的 :探讨经尿道等离子体双极电切治疗良性前列腺增生 (BPH)的安全性与有效性。方法 :采用经尿道等离子体双极电切行前列腺切除术 (PKVP)治疗BPH患者 10 0例。结果 :10 0例术中出血少 ,无前列腺电切综合征和闭孔神经反射的发生。术后随访 1～ 6个月 ,最大尿流率 (Qmax)由术前的 (7.8± 4 .2 )ml/s升高到术后的 (2 2 .4± 4 .7)ml/s;国际前列腺症状评分 (IPSS)由 (2 7.6± 4 .7)分降低至 (7.2± 2 .8)分 ;生活质量评分由 (4 .5±0 .5 )分降低至 (2 .5± 0 .5 )分 ;剩余尿量由 (76± 80 )ml减少至 (35± 4 5 )ml。结论 :PKVP具有安全性高、并发症少、前列腺切尽率高、疗效确切等优点。     

镍钛记忆合金网状支架在BPH患者的应用及远期疗效观察

目的观察镍钛记忆合金网状支架治疗良性前列腺增生症(BPH)的疗效及安全性。方法38例患者使用镍钛记忆合金网状支架治疗,除了5例患者失访,其余33例患者都得到观察或随访。结果除了2例患者因膀胱逼尿肌功能丧失而治疗失败,其他患者都可自行排尿,2例患者因支架移位而取出,3例患者在2年后恢复留置导尿,15例患者在31～48个月后得到随访,其IPSS评分为21.2±4.3分。结论镍钛记忆合金网状支架对治疗BPH是一种有效的措施,特别适用于不能耐受手术或预期寿命不长的尿潴留患者。     

组织内消融术治疗前列腺增生疗效观察

目的 :探讨组织内消融术治疗前列腺增生的效果。方法 :经尿道消融治疗良性前列腺增生 (BPH) 80例。结果 :随访 1～ 12个月 ,术后 12个月IPSS评分为 9.83± 1.6 5分 ,生活质量评分为 2 .4 6± 0 .2 0分 ,最大尿流率18.98± 1.4 5ml s,剩余尿 4 0 .6 5± 13.4 3ml,前列腺重量 31.2 8± 2 .4 1g ,前列腺体积明显缩小。结论 :本治疗方法操作简便、并发症少 ,特别适用于Ⅰ～Ⅱ度及高危BPH患者 ,是一种新的治疗BPH的良好方法。     

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.