成人先天性巨输尿管症（附15例报告）

报告１５例共１９侧成人先天性巨输尿管，其中左侧９例，右侧２例，双侧４例。９例有腰痛，合并血尿５例；有尿路感染症状５例。手术治疗１１例１４例，其中输尿管成形再植１２例，肾、输尿管切除２例。输尿管梗阻段经组织病理检查１２侧有胶原纤维组织增生，纵肌减少，环肌肥厚或慢性炎症等改变。     

继发于后尿道瓣膜的膀胱输尿管返流

报告９例因排尿困难、反复泌尿系感染等症状，经排尿性膀胱尿道造影（ＭＣＵ）检查发现有后尿道瓣膜（ＰＵＶ）及继发性膀胱输尿管返流（ＶＵＲ）患儿，共１５侧。２例经后尿道切开电灼尿道瓣膜，术后留置尿管分别治疗２５和２８个月，现排尿通畅；７例经尿道内窥镜电灼尿道瓣膜，术后排尿均明显改善。术后１３～２８个月（平均１８个月），８例经ＭＣＵ复查，发现只有３侧较轻的返流消失、２侧减轻。认为继发于后尿道瓣膜的膀胱输尿管返流在瓣膜切除后返流仍难自愈，建议在瓣膜切除后尽早做抗返流处理。     

重复肾,重复输尿管畸形的诊断与治疗（附20例报告）

报告重复肾，重复输尿管畸形２０例，其中单侧畸形１５例，双侧畸形５例，并发输尿管异位开口８例，输尿管囊肿４例，重复肾上肾积水７例，重复肾上肾发育不良伴下肾积水，输尿管末端狭窄１例，结合文献分析了ＩＶＵ，Ｂ超和ＣＴ的诊断价值，提出了ＣＴ对双侧重复畸形伴一侧输尿管异位开口具有定侧诊断价值，指出可针对不同情况采取相应的治疗方法及手术方式。     

经膀胱输尿管末端切除治疗双侧巨输尿管症

经膀胱输尿管末端切除治疗双侧巨输尿管症经膀胱输尿管末端切除治疗双侧巨输尿管症...     

先天性巨输尿管症的诊治(附17例报告)

目的 探讨先天性巨输尿管症的诊治方法.方法 回顾性分析17例共20侧先天性巨输尿管症患者的临床资料,其中左侧9例,右侧5例,双侧3例.手术治疗14例17侧,其中输尿管裁剪输尿管膀胱吻合术10例13侧,肾输尿管切除2例2侧,输尿管折叠输尿管膀胱吻合术2例2侧,3例3侧行内镜扩张术.结果 随访1-5年(平均3年),经内镜扩张3例,其中1例患者术后临床症状缓解,输尿管扩张有减轻,2例患者症状改善不明显,肾积水、输尿管扩张无明显减轻;14例手术患者中10例获随访,输尿管裁剪、输尿管膀胱吻合术患者中7例示手术侧输尿管扩张明显减轻,1例肾积水无明显减轻.但症状明显改善,2例肾输尿管切除者行B超检查,显示对侧肾脏代偿性增大;全部患者肾功能检查均正常;输尿管功能性梗阻段经病理检查提示环肌肥厚、纵肌减少9侧,其中3侧伴管壁全层炎症改变,管壁胶原组织增生7侧,纵肌增生1侧.结论 MRU检查在先天性巨输尿管症的诊断中有重要意义;输尿管裁剪整形加抗逆流的输尿管膀胱吻合术是治疗先天性巨输尿管症的首选手术方式.     

小儿重复肾合并其他尿路畸形（附60例报告）

６０例重复肾中，４８例合并输尿管口异位，７例合并输尿管囊肿，４例伴巨大输尿管积水，５例合并肾发育不良，１例为肾积水。年龄４个月～１３岁。临床表现：滴沥性尿失禁４８例，尿路感染１０例，腹部包块６例，排尿困难５例，尿道口有肿物脱出４例。诊断主要依靠ＩＶＵ。５８例经手术治疗，其中５１例作患侧上肾部及输尿管切除，７例行患侧肾切除。术后除１例尿内仍有异常外，均恢复满意。     

腹腔镜下巨输尿管成型2种手术方法的疗效比较

目的:研究腹腔镜下巨输尿管裁剪或折叠后膀胱再植治疗梗阻性巨输尿管症的效果。方法:纳入18例梗阻性巨输尿管症患儿,年龄12～21岁,采用腹腔镜下巨输尿管成型后膀胱再植。巨输尿管成型采用2种不同手术方法,一组采用裁剪法,一组采用折叠法。术后随访尿常规、B超、CT、排尿期尿路造影、肾动态显像。比较两组患者术前的基线特征,围手术期各项指标和术后随访的结果。结果:18例患者手术均获成功,平均手术时间(175±26.3) min,平均失血量(39.7±15.6) mL,术后18例患者下腹疼痛症状消失,泌尿系感染纠正,患侧肾脏排泄梗阻率由轻度或中度排泄受阻恢复为正常。两组患者的年龄、男女性别比、BMI、确诊年龄比较差异无统计学意义。两组的手术成功率比较差异亦无统计学意义。结论:腹腔镜下巨输尿管成型后再植是治疗原发梗阻性巨输尿管症的一种有效的微创治疗手段。体外巨输尿管成型效果好,手术时间短。裁剪法和折叠法在术后输尿管狭窄和膀胱输尿管反流方面无显著差异。     

小儿巨输尿管症的诊断和治疗（附41例报告）

目的探讨小儿巨输尿管症（MU）的诊断和治疗。方法回顾性分析原发性MU29例（先天性9例,原发反流性12例,原发梗阻性8例）和继发性MU12例的临床资料。结杲先天性MU及原发反流性MU21例行输尿管裁剪整形及膀胱再植,随访1～2年未见异常。原发梗阻性MU中2例肾发育不良并输尿管闭锁行肾及输尿管切除,6例输尿管末端狭窄行狭窄段切除,随访2～6年,除2例术后发生输尿管残端综合症二次手术外其余未见异常。继发性MU12例在解除原发病后行输尿管裁剪整形及膀胱再植,随访3年未见异常。结论小儿MU诊断主要依据病史及影像学检查,输尿管裁剪整形膀胱再植术为有效方法;继发性MU在原发病解除后,MU无改善,应及时行MU根治术,改良膀胱外隧道式输尿管膀胱吻合术简单、效果好。     

手术治疗晚期埃及血吸虫病性肾积水

在桑给巴尔的Ｍｎａｚｉ ＭＭｏｊａ医院工作期间，手术治疗晚期埃及血吸虫病性肾积水７例。其中双侧输尿管病变６例，另１例的对侧肾脏情况不详。除１例狭窄位于输尿管上１／３段外，其余病例均位于下１／３段，尤以末端多见。２例有我发性狭窄病变，处理输尿管末端狭窄的方法以再植为主，但应了解末端狭窄上方输尿管的蠕动和排尿功能是否正常。单侧回肠代输尿管应考虑回肠膀胱吻合可能发生的返流并发症。     

成人输尿管囊肿11例报告

目的：总结成人输尿管囊肿的诊治经验。方法；对住院手术治疗的１１例本病虱临床资料进行分析。结果：均经Ｂ超，ＩＶＵ及膀胱镜检查确诊。开放手术２例，经尿道输尿管囊肿电切开术９例。１０例获术后随访，疗效确切。结论：对囊肿直径≤３．０ｃｍ者宜行经尿道电切开术，面对直径〉３．０ｃｍ及合并严重的重复肾重复输尿管畸形者应采取开放性手术，并行输尿管再植抗反流。     

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.