Vasomotion in rat diaphragm microcirculation at rest and during stepwise arterial pressure reduction

The effect of haemorrhagic hypotension on the incidence, frequency and relative amplitude of vasomotion in rat diaphragm microcirculation was assessed by laser Doppler flowmetry (LDF). Graded bleeding to four hypotension levels (80, 60, 40 and 30% of the control state) were performed in 24 Sprague–Dawley rats. The incidence of vasomotion was 83% in the control state, 96% at the 80% level, 100% at the 60% level, 96% at the 40% level, and 46% at the 30% level. The median fundamental frequency of vasomotion determined manually during the control state and at the hypotension levels (in descending order) was 4.11 (range, 3.29–5.58) cycles min^?1 (cpm), 4.48 (3.21–5.92) cpm, 4.20 (3.5–5.56) cpm, 4.01 (3.33–5.36) cpm, 3.71 (3.25–4.49) cpm (P < 0.01 from the fundamental frequency at 80 and 60% hypotension levels). The median relative amplitudes determined manually during the control state and descending hypotension levels were 44.5% (range, 24.9–135.9%), 69.4% (26.6–147.2%), 84.0% (40.3–177.1%) (P < 0.01 from resting and last stage of bleeding), 90.40% (26.2–189.6%) (P < 0.01 from resting and last stage of bleeding), 69.2% (35.6–93.2%). We concluded first that during the resting condition, vasomotion was frequently present in diaphragm microcirculation, which is distinct from other vascular beds of skeletal muscles. Second, the relative amplitude of vasomotion during haemorrhagic hypotension plotted against decreasing blood pressure exhibited a reverse U-shaped curve with a maximum at 40–60% of the control blood pressure, while the frequency of vasomotion remained relatively constant until the last stage of haemorrhage and centred around 3–5 cpm.     

Retrograde endoscopic laser therapy for transitional cell carcinoma of the upper urinary tract

AIM: The aim of the present study was to investigate the safety and efficacy of endoscopic laser therapy for transitional cell carcinoma (TCC) of the upper urinary tract. METHODS: Tumors of the renal pelvis and ureteropelvic junction were detected by ureteroscopy. The tumors were subjected to biopsy, and after TCC was diagnosed, endoscopic laser therapy (Neodymium-YAG and Holmium-YAG) was conducted using a 6.9 Fr. flexible ureterorenoscope. RESULTS: From January 1997 to April 2002, six patients underwent ureteroscopic treatment. Tumor grade was 1 in four patients and 2 in two patients. Average tumor size was 1.45 cm. Endoscopic treatment was chosen for two patients because of the high medical risk associated with open surgery. Another patient underwent diagnostic ureteroscopy, followed immediately by endoscopic treatment. A further three patients elected to undergo ureteroscopic treatment. One patient with large (3 cm), multifocal and incompletely treated tumors died of metastatic disease 22 months after the initial operation. One patient requested nephroureterectomy one month after endoscopic treatment, and pathological examination of the resected specimen revealed no tumor. The other four patients have been followed up for a mean period of 14 months after initial treatment. Recurrence occurred in one patient, and was successfully treated by repeat endoscopic resection. None of the patients required blood transfusion or emergency open surgery. CONCLUSION: Ureteroscopic treatment of small, localized, low-grade TCC of the upper urinary tract is now a safe and feasible alternative to nephroureterectomy in selected patients.     

Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study

A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to determine the effect of early neuromuscular customized training after LDH surgery. No consensus exists on the type and timing of physical rehabilitation after LDH surgery. Patients aged 15–50 years, disc prolapse at L4–L5 or L5–S1. Before surgery, at 6 weeks, 4, and 12 months postoperatively, the following evaluations were performed: low back pain and leg pain estimated on a visual analog scale, disability according to the Roland–Morris questionnaire (RMQ) and disability rating index (DRI). Clinical examination, including the SLR test, was performed using a single blind method. Consumption of analgesics was registered. Twenty-five patients started neuromuscular customized training 2 weeks after surgery (early training group=ETG). Thirty-one patients formed a control group (CG) and started traditional training after 6 weeks. There was no significant difference in pain and disability between the two training groups before surgery. Median preoperative leg pain was 63 mm in ETG and 70 mm in the CG. Preoperative median disability according to RMQ was 14 in the ETG and 14.5 in the CG. Disability according to DRI (33/56 patients) was 5.3 in the ETG vs. 4.6 in the CG. At 6 weeks, 4 months, and 12 months, pain was significantly reduced in both groups, to the same extent. Disability scores were lower in the ETG at all follow-ups, and after 12 months, the difference was significant (RMQ P=.034, DRI P=.015). The results of the present study show early neuromuscular customized training to have a superior effect on disability, with a significant difference compared to traditional training at a follow-up 12 months after surgery. No adverse effects of the early training were seen. A prospective, randomized study with a larger patient sample is warranted to ultimately demonstrate that early training as described is beneficial for patients undergoing LDH surgery.     

Initial experience with carbon dioxide laser laparoscopy

Adhesions and endometriosis are commonly encountered among patients presenting with pelvic or lower abdominal pain and also in a significant proportion of infertile patients. Laparoscopic investigation is usual in patients with these problems, and it has been possible to perform endoscopic surgery with special scissors and electrodiathermy. These methods can cause troublesome bleeding, and the diathermy produces high temperatures which can be hazardous if used in the vicinity of the bowel. The carbon dioxide laser can be used endoscopically to vaporize deposits of endometriosis and adhesions with great precision and virtually no bleeding. One hundred consecutive patients with endometriosis or adhesions were treated with the CO₂ laser laparoscope and followed up for at least a year. Seventy-five per cent of patients with pain due to endometriosis were cured, and 68% of patients were better after laser laparoscopic adhesiolysis. Pregnancy rate in the previously infertile group with endometriosis was 64%. There were no complications due to the intra-abdominal use of CO₂ laser energy under endoscopic control, although there is a need for a controlled trial. It appears that in the hands of an experienced laparoscopist this technique is safe and effective.     

The arthroscopic monopolar radiofrequency treatment of chronic anterior cruciate ligament instability

The Holmium:YAG (Ho:YAG) laser is the arthroscopic laser of choice. The arthroscopic surgeon can ablate, coagulate, or shrink periarticular soft tissues by manipulating Ho:YAG laser power settings. The ability to ablate soft tissue in a hemostatic fashion greatly facilitates the treatment of labral tear, synovitis, subacromial arch decompression, and distal clavicle arthritis. The nonablative application of Ho:YAG laser energy has been used successfully to treat glenohumeral instability. The laser-assisted capsular shift (LACS) procedure, in conjunction with standard labral repair techniques, successfully treats unidirectional and multidirectional shoulder instability Neuromuscular rehabilitation is accelerated. Excellent clinical results may be achieved with appropriate surgical technique and postoperative rehabilitation.     

视盘血管炎——关于混合型的研讨

对６０例（６３眼）视盘血管炎的临床分型进行了探讨，结果表明，除分为Ⅰ、Ⅱ两型外，尚存在混合型，当视盘睫状血管炎性病变波及中央静脉，或两个血管系统同时受炎症侵犯时，即可再现混合型的临床表现，视盘明显水肿，视网膜静脉迂张，散在渗出，出血，动脉狭细。眼底荧光血管造影可见视盘荧光早期充盈明显迟缓，后期渗漏面积〉２．０ＰＤ，视网膜循环时间延长，混合型兼有Ⅰ，Ⅱ两型的临床特征，应作为一个独立类型存在，同时观察     

颈椎间盘突出的MRI诊断价值(附41例分析)

目的：探讨颈椎间盘突出的ＭＲＩ诊断。方法：对４１例椎间盘突出进行磁共振成像检查。结果：表明本病可分为中央型和侧方型突出。ＭＲＩ可直接显示颈椎间盘突出的部位、类型及颈髓和神经根的受压程度。结论：ＭＲＩ对本病的确诊具有重要价值     

Alteration of pulse configuration affects the pain response during diode laser photocoagulation

Background and Objective: The shape of the treatment pulse of the diode laser (810 nm) can be easily altered electronically in contrast to ion laser photocoagulators. We investigated whether changes in laser pulse shape influenced the subjective pain response in patients undergoing retinal photocoagulation when only topical anesthesia was used. Study Design/Materials and Methods: Twenty consecutive patients required peripheral retinal photocoagulation for proliferative diabetic retinopathy or extensive retinal breaks. Three diode pulse waveforms including a square wave, shaped-wave, and an envelope of micropulses were compared to one another. Power was adjusted so that each waveform delivered the same total energy. The patients subjectively ranked the intensity of any pain they experienced for each group of lesions. Responses were compared to one another using an analysis of variance. Results: 40% of patients found the standard square wave pulse to be significantly more painful (P < 0.05) than the shaped pulse mode and 30% found the square wave significantly more painful (P < 0.05) than the micropulse mode. Conclusion: Modification of the laser pulse waveform may ameliorate pain induced by diode laser photocoagulation of the retinal periphery. © 1995 Wiley-Liss, Inc.     

准分子激光心肌血管重建的实验研究

为研究心肌血管重建的机理,在15只鼠心、12只免心,用308nm的XeCl准分子激光在活体上照射左心室壁,形成边缘清楚而光滑的圆筒状心肌管道。在活体心室壁的激光管道周围,心肌细胞的损伤很轻微,无炭化焦痂层,未见碎片和凝固坏死层,只有薄层嗜伊红性变和肌浆凝聚两个断续的条形变化带。当心室壁由激光穿透时,血液从心腔进入激光管道,并与周围扩张的血管相通。实验结果提示,由于准分子激光不造成明显的热损伤,因而可能适合于心肌血管的重建。     

染料激光虹膜透切术56例疗效分析

用国产ＷＤ－Ｌ９２型染料激光机，对５６例，６１眼施行激光虹膜透切术。其中４０眼行周边虹膜透切术，完全切穿率为９２．５％；９例白内障术后瞳孔上移行光学虹膜切除术疗效满意。对其它一些病例也取得一定疗效。认为染料激光具有输出功率大，能量及光斑可调的优点，易一次击穿虹膜，应用于虹膜透切术疗效肯定。