经尿道前列腺切除及去势术联合89Sr和药物治疗晚期前列腺癌

目的 评价姑息性经尿道前列腺切除及去势术联合~(89)Sr和药物治疗晚期前列腺癌(PCa)的疗效。方法 对8例晚期PCa患者行姑息性经尿道前列腺电气化切除(TUEVP)及睾丸切除术后,给予~(89)Sr锶(~(89) ~(Sr))和服用缓退瘤或磷酸雌二醇氮芥治疗,随访了2—4年。结果 病人前列腺症状评分(IPSS)平均下降50％,平均最大尿流率(Qmax)由(5.4±2.1)ml/s增加到(15.3±3.0)ml/s。血清PSA由治疗前的平均53.4μg/L降至~(89) ~(Sr)治疗后第3个月末的平均3.6μg/L。随访8例中,生存6例,死亡2例。转移性骨痛缓减率达100％,6例生存者的原发灶和转移灶明显缩小或消失,5例中存已超过3.5年,1例超过3年。结论 该方法可明显提高晚期PCa患者的生活质量并延长生存期,是治疗晚期PCa较有效的方法。     

睾丸实质切除联合缓退瘤治疗前列腺癌

目的 :观察睾丸实质切除联合缓退瘤治疗晚期前列腺癌的疗效。　方法 :对 12例病人行双侧睾丸实质切除术 ,术后服用缓退瘤 3个月。　结果 :所有病人自觉睾丸与术前一样 ,无心理异常。 11例病人带瘤生存 ,1例死于多器官功能衰竭 (MSOF)。　结论 :本方法疗效确切 ,病人无心理创伤。     

晚期前列腺癌综合治疗的初步疗效分析

目的 :探讨晚期前列腺癌综合治疗的方法。　方法 :对 1991年 5月～ 1997年 7月收治的 6 2例晚期前列腺癌 (C期和D期 )病人的治疗结果进行分析。 33例前列腺症状评分 (IPSS) <15的前列腺癌病人 (I组 )行去势术 +缓退瘤。 2 9例IPSS≥ 15的病人 (Ⅱ组 )行经尿道前列腺电切 (TURP) +去势术 +缓退瘤。内分泌治疗期间梗阻症状明显加重者再次行TURP。　结果 :治疗后所有病人的主观症状均较治疗前明显改善 ,最大尿流率 (MFR)增加、剩余尿减少、PSA值明显下降。 34例病人在治疗期间 (治疗 16～ 39个月后 )转变为激素非依赖性前列腺癌 ,经停用缓退瘤 ,改用癌腺治或酮康唑治疗 ,17例 (5 0 % )病人得到不同程度的缓解。　结论 :对IPSS≥ 15的晚期前列腺癌病人 ,TURP可有效地减少尿道梗阻所致的并发症 ,配合内分泌治疗效果良好 ,无严重并发症 ;对激素非依赖性前列腺癌 ,停用缓退瘤 ,改用酮康唑或癌腺治治疗 ,可取得一定疗效。     

特异性抗原密度联合前列腺穿刺活检诊断前列腺癌的价值

目的 :评价前列腺移行带特异性抗原密度 (PSAT)与前列腺穿刺活检联合检测在前列腺癌 (PCa)诊断中的价值。方法 :对 4 9例血清PSA >10 μg/L患者行前列腺穿刺活检后 ,部分给予重复穿刺及手术治疗 ,综合比较PSAT。结果 :4 9例中 ,前列腺活检病理检查诊断为PCa 2 4例 (4 8.98% ) ,良性前列腺增生 (BPH) 2 5例 (5 1.0 2 % ) ,其PSAT平均值分别为 (0 .6 1± 0 .11)、(0 .38± 0 .13) μg/L ,两者相比差别有统计学意义 (P <0 .0 1) ;后者行手术治疗后病理检查诊断为PCa 6例 (2 4 % ) ,BPH 19例 (76 % ) ,其PSAT平均值分别为 (0 .4 0± 0 .11)、(0 .32± 0 .0 7) μg/L ,两者相比差别有统计学意义 (P <0 .0 5 )。结论 :PSAT对PCa ,特别是早中期PCa的诊断 ,比前列腺穿刺活检更为敏感 ,二者联合检测对临床诊治有重要的价值和意义。     

前列腺特异抗原对诊断前列腺癌的价值

目的 :联合检测血清中总 PSA(t- PSA)、游离 PSA(f- PSA)以及 f- PSA/ t- PSA比值 ,探讨其对前列腺癌 (PCa)的诊断价值。方法 :采用微粒子酶免疫法 (MEIA)检测 6 2例正常人、78例前列腺增生症 (BPH)和 2 4例PCa患者血清中 t- PSA、f- PSA,并得出 f- PAS/ t- PSA比值。计算资料以 x± s表示 ,两组均数比较经 t检验。结果 :单独以 t- PSA >4.2μg/ L或 f- PSA >0 .93μg/ L作为对 PCa的诊断指标 ,其特异性分别为 6 1.5 %、42 .3% ,阳性检出率分别为 6 4.5 %、42 .9% ,而以 f- PSA/ t- PSA比值 <0 .11作为对 PCa的诊断指标 ,其特异性和阳性检出率分别为 87.2 % ,83.4% ,显著高于 t- PSA和 f- PSA(P <0 .0 0 1)。结论 :当血清 t- PSA超过正常时 ,f- PSA/ t- PSA的比值对 PCa和 BPH的鉴别诊断具有非常重要的临床应用价值     

经直肠高强度聚焦超声系统治疗前列腺癌57例疗效分析

目的:探讨经直肠高强度聚焦超声系统(HIFU)治疗PCa的疗效。方法:使用Sonablate500型经直肠HIFU治疗系统,对57例PCa患者进行HIFU治疗,其中局限性PCa27例,晚期PCa30例。在确定生化复发之前,对局限性PCa仅行经直肠HIFU治疗;对于晚期PCa,在行经直肠HIFU治疗的同时,联合应用内分泌治疗。结果:HIFU治疗平均手术操作时间为111(86～153)min,平均术后住院时间为3.2(2～18)d。平均随访时间18(6～30)个月。局限性PCaHIFU治疗后,生化检查阴性率(PSA(4.0μg/L)在治疗后的1、2、3年分别为86%、81%和79%。30例晚期PCa治疗平均8个月(3～24个月)后,26例血清PSA<4.0μg/L(其中20例血清PSA<0.5μg/L)、21例患者前列腺体积缩小>50%。治疗后6个月时与治疗前相比,前列腺体积缩小、PSA水平降低、Qmax增加及IPSS改善差异均有显著性(P<0.05)。HIFU治疗后无严重尿道直肠瘘、尿失禁等并发症发生。结论:经直肠HIFU治疗PCa,安全、有效,并发症少,近期疗效较好,是一种可选择的PCa微创治疗方法。     

大体积良性前列腺增生患者高值PSA临床分析

目的　探讨大体积良性前列腺增生 (BPH)患者高值血清前列腺特异抗原 (PSA)的来源。　方法　对 2 7例术前PSA值 8.1～ 75 .1ng/ml,直肠指诊前列腺≥Ⅲ° ,超声测量前列腺体积 >5 0ml,无前列腺癌 (PCa)迹象的排尿困难患者 ,采用耻骨上前列腺切除术及术后PSA追踪检测方法 ,分析术后PSA值变化的原因以及术前高值PSA的来源。　结果　 2 7例切除腺体 4 0～ 1 85g ,平均 82 .7g。病理检查 2例发现PCa灶 ,2 5例未发现PCa灶。术后 1个月内 1例有PCa灶者PSA上升 ,2 6例迅速下降至正常范围。 2 4例获随访 1 7～ 5 7个月 ,PSA 0 .0 8～ 2 .39ng/ml,平均 1 .1 6ng/ml。　结论　大体积BPH患者的高值PSA多源于前列腺移行区增生腺体 ,而非源于外周区     

双睾丸切除和药物治疗后前列腺切除治疗晚期前列腺癌(附7例报告)

目的：探讨双睾丸切除和内分泌药物治疗后行根治性或姑息性前列腺切除术治疗晚期前列腺癌的临床效果。方法：对７例晚期前列腺癌患者行双睾丸切除术后服用缓退瘤和乙烯雌酚３￣６个月再行根治性（２例）或姑息性（５例）前列腺切除术。结果：解除了患者下尿道梗阻,提高了生存质量,延长了生存期,４例患者生存超过３．５年,３例超过３年。结论：该方法是治疗晚期前列腺癌的有效方法。     

前列腺移行带特异抗原密度检测前列腺癌的临床观察

目的　评价前列腺移行带特异抗原密度 (PSAT)检测前列腺癌 (PCa)的临床价值。　方法　用酶免法测定 30例PCa及 88例良性前列腺增生症 (BPH)患者血清PSA水平 ,用经直肠前列腺B超测定患者总前列腺体积及移行带体积 ,并计算PSA密度 (PSAD)及PSAT值。　结果　PSA在 4～ 10ng/ml时 ,PCa和BPH患者PSAD值分别为 0 .2 6± 0 .11、0 .13± 0 .0 6 ,两组间相比差别具有显著性意义 (P <0 .0 1) ;PSAT值则分别为 1.0 4± 0 .70、0 .2 1± 0 .13 ,两组间相比差别具有显著性意义 (P <0 .0 1)。若选择PSAD =0 .15作为判断患者是否需穿刺活检的标准 ,将有 2 7%的PCa漏诊 ,而若选择PSAT =0 .35作为判断患者是否需穿刺活检的标准 ,只有 9%的PCa漏诊 (P <0 .0 1)。　结论　PSAT是一种新的有效的检测PCa的方法 ,PSA在 4～ 10ng/ml范围时 ,用PSAT检测PCa较用PSAD更精确。     

良性前列腺增生与前列腺癌患者血清总PSA水平与游离PSA比值的比较

目的　探讨血清总前列腺特异性抗原 (T PSA)水平及游离PSA比值 (F/T)在良性前列腺增生 (BPH)与前列腺癌 (PCa)鉴别诊断中的作用。　方法　对 10 3例PCa患者及 810例BPH患者T PSA及F/T值的差异进行分析比较。　结果　BPH患者血清T PSA <4、4～及 >10ng/ml者分别占 71.7%、2 2 .1%、6 .2 % ,PCa患者分别为 10 .7%、17.5 %和 71.8% ,两组间差别有极显著性意义 (P<0 .0 0 5 )。当F/T值 <0 .16时 ,两组患者血清T PSA <4及 4～ 10ng/ml的例数差别有极显著性意义 (P <0 .0 0 5 ) ;但T PSA >10ng/ml的患者 ,两组间差别无显著性意义 (0 .1

10ng/ml时 ,F/T值则无明显鉴别意义     

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.     

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.     

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.