股后皮神经营养血管皮瓣在瘢痕性肛门狭窄整形中的应用

瘢痕性肛门真性狭窄患者常合并臀部、会阴严重瘢痕畸形，手术治疗时邻近皮瓣转移修复受到条件限制，常采用单纯瘢痕松解皮片移植的方法修复，难免术后继发挛缩，肛门狭窄再次发生。我科自1998年以来，应用双侧股后皮神经营养血管蒂岛状皮瓣修复烧伤、创伤后肛门瘢痕性狭窄患者9例，取得满意效果。     

创伤性软组织缺损或疤痕挛缩的修复

任何原因造成的四肢大面积软组织缺损或损伤后的瘢痕挛缩,都会发生功能障碍,故常须组织修复或功能重建,对毁损的外形须修复及塑造,作者对24例病人选择了不同的手术方法,效果满意。中厚皮片2例,全厚皮片11例治疗大关节瘢痕挛缩6例,虎口挛缩2例,面部瘢痕挛缩2例。手术后外形明显改善,色泽如常,关节功能恢复。6种带血管蒂     

全面部深度烧伤及瘢痕畸形的整复

１９７９年以来，作者共治疗３７例全颜面部浓度烧伤及烧伤后瘢痕挛缩畸形。其中施行整张全厚皮移植整复３例，整张带真皮下血管网的全厚皮移植１例，改良的全厚皮移植２６例，大张中厚皮片分区移植修复７例，术后３－１５年的随访观察显示整张全厚皮移植者，面部皮肤光洁红润，表情自然；大张中厚皮片分区移植者，皮片拼接外有瘢痕，皮肤弹性差，有色素沉着。改良的整张全厚皮移植，较好地解决了眼睑及下唇继发挛缩外翻问题，是一值     

手瘢痕挛缩畸形整形疗效分析

目的:探讨手瘢痕挛缩畸形手术整形临床效果。方法:2012年3月-2015年10月收治47例(73手)手部瘢痕挛缩畸形患者。手术切除部分或全部瘢痕组织,松解瘢痕挛缩,自体全厚皮移植修复创面。条索状瘢痕、指蹼及虎口处松解瘢痕挛缩后,用V-Y、Z形皮瓣、五瓣等局部皮瓣开大虎口、加深指蹼。结果:7只手因小指或示指指间关节瘢痕挛缩重,无法完全矫正,余手部畸形完全矫正。随访2~24个月,5只手因皮片挛缩,再次出现手瘢痕挛缩畸形。余手部功能恢复良好,皮瓣及皮片质地软,弹性良好。结论:局部皮瓣及全厚皮移植修复手瘢痕挛缩畸形临床效果好;为防止瘢痕挛缩重致畸形难以完全矫正,需早期手术。     

人工真皮复合自体刃厚皮片移植治疗烧伤后关节瘢痕挛缩

目的观察人工真皮复合自体刃厚皮片移植治疗烧伤后关节部位瘢痕挛缩的疗效。方法选择深度烧伤后期瘢痕严重增生挛缩造成关节畸形的患者40例,共46个关节部位。在全身麻醉下切除挛缩瘢痕,彻底松解,矫正关节畸形,先用人工真皮覆盖创面,后移植自体刃厚皮片。嘱患者早期行功能锻炼。术后随访6个月,对术后局部外形、弹性、硬度、关节功能等进行效果评价。结果所有患者利用人工真皮复合自体刃厚皮片移植后皮瓣全部成活,外形、质地及关节功能明显改善。结论人工真皮复合自体刃厚皮片移植术可用于治疗深度烧伤患者关节部位的瘢痕挛缩。     

102例颈部瘢痕挛缩的手术治疗

目的 探讨102例颈部瘢痕挛缩患者手术治疗效果.方法 根据102例颈部瘢痕挛缩患者的瘢痕大小、形态及挛缩程度等选用不同的手术方法,观察其治疗效果.结果 颈部局部整形术46例,采用瘢痕切除加局部皮瓣整形术,彻底松解颈部瘢痕挛缩状态;全厚皮及真皮下血管网皮片移植术24例,5例患者因血供障碍致皮肤部分边缘坏死,经换药后痊愈;皮肤扩张皮瓣21例,手术效果满意,外形达到预期效果;人工真皮加自体表皮移植术11例痊愈,无色素沉着.结论 颈部瘢痕挛缩的治疗仍然比较棘手,本文就颈部瘢痕挛缩的不同程度,选用不同的手术方法,希望达到理想的治疗效果.     

肩肱皮瓣修复颈部瘢痕挛缩畸形疗效分析

目的:探讨颈部瘢痕挛缩畸形的有效外科治疗手段。方法:采用瘢痕广泛松解、双侧或单侧肩肱皮瓣转移,同时用全厚皮片移植修复供瓣区创面。结果:本组21例中,17例手术一次性完成,4例分两次完成。不但改善了患者的上肢功能,还可进一步改善患者颈部的活动度。结论:瘢痕广泛松解、双侧或单侧肩肱皮瓣转移,同时用全厚皮片移植修复供瓣区创面是颈部瘢痕挛缩畸形的有效外科治疗手段。     

轴型皮瓣在真性肛门瘢痕狭窄畸形治疗中的应用

目的:介绍应用邻位轴型皮瓣治疗真性肛门瘢痕狭窄畸形的方法和经验.方法:在15例真性肛门瘢痕狭窄畸形患者手术过程中,设计以直肠下动脉皮支或阴囊(唇)后动脉为轴心血管的轴型皮瓣,环形覆盖切除瘢痕后形成的肛周创面.结果:15例患者术后肛周皮瓣完全成活,肛门狭窄解除,肛周局部外观满意,排便及活动功能基本恢复正常.结论:使用邻位轴型皮瓣治疗真性肛门瘢痕狭窄畸形有手术损伤范围小,皮瓣成活率高,功能外形恢复好等优点,是治疗肛门瘢痕狭窄畸形的一种较好的手术方法.     

脱细胞异体真皮在烧伤后瘢痕修复中的应用

目的：探讨脱细胞异体真皮在烧伤后期瘢痕修复中的应用价值。方法：2006年2月-2007年2月入院治疗的21例烧伤后遗留瘢痕患者（A组）,采用切开并充分松解挛缩的瘢痕组织,利用脱细胞异体真皮加自体刃厚皮移植于继发创面的方法治疗。随机抽取同期21例采用瘢痕松解切除后进行中厚皮移植的患者（B组）及21例进行次全厚皮移植的患者（C组）作对照,比较3组患者的皮片成活情况以及术后1年的随访情况。结果：A组中皮片坏死率较其余两组略高;1年后随访发现,A组在受皮区皮片挛缩程度,外观平整度、色素改变及供皮区瘢痕形成方面均明显优于B组,与C组相当;C组仅适用于较小瘢痕的修复。结论：脱细胞异体真皮加自体皮复合移植是烧伤后期瘢痕修复的有效手段。     

全厚皮片移植修复手部瘢痕挛缩畸形

目的:探讨采用全厚皮片移植修复手部瘢痕挛缩畸形的临床疗效。方法:2008年10月-2012年10月,收治50例5~58岁手部瘢痕挛缩畸形患者,均行手部瘢痕松解、切除,继发创面采用全厚皮片移植修复。供皮区直接拉拢缝合或取刃厚头皮覆盖。结果:手部移植皮肤色泽红润,质地柔软,手可做精细活动。随访患者2个月至4年,未见挛缩复发。结论:全厚皮片移植修复手部瘢痕挛缩畸形操作简便,成活率高,能使手部外观、功能得到较为满意的恢复。     

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.     

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.