超声导向经皮穿刺膀胱颈悬吊术治疗女性压力性尿失禁（附1 …

目的 探讨超声导向经皮穿刺膀胱颈悬吊术治疗女性尿失禁的稞效果。方法 采用超声导向经皮穿刺膀胱颈悬吊术治疗女性压力性尿失标２例，术中超声监视下恢复尿道膀胱后角成９０℃。结果 １２例随访６～４８个月，平均２０．５个月，１１例无尿失禁及排尿困难，１例尿失禁复发。结论 超声导向经皮穿刺膀胱颈悬吊术治疗女性压一尿失禁简便、安全、有效。     

耻骨后经阴道膀胱颈悬吊术治疗女性压力性尿失禁（附15例报告）

目的探讨耻骨后经阴道膀胱颈悬吊术治疗女性压力性尿失禁的疗效。方法应用耻骨后经阴道膀胱颈悬吊术治疗女性压力性尿失禁15例。结果随访6个月～3年，15例中12例治愈，1例Ⅱ型者部分有效，2例Ⅲ型者无效。2例术后发生尿潴留。尿道扩张后治愈。结论耻骨后经阴道膀胱颈悬吊术式是治疗女性压力性尿失禁的一种理想方法。     

女性压力性尿失禁的诊治（附30例报告）

目的：探讨女性压力性尿失禁（SUI）的诊治方法。方法：对30例患者的临床资料进行回顾性分析。其中行改良Stamey术17例次，Gittes术9例次，耻骨阴道吊带术7例次。结果：24例获5个月－3年随访，其中21例参加一般性体力劳动时无尿失禁现象，3例症状复发经再次手术而治愈。结论：对SUI应做尿动力学检查，治疗应根据尿失禁的程度和有无并发症而采取不同的方法，提倡超声导向经皮穿刺膀胱颈悬吊术治疗该病。     

Raz术式治疗女性压力性尿失禁(附13例报告)

目的：探讨Raz术治疗女性压力性尿失禁的疗效。方法：应用经阴道膀胱颈悬吊术的Raz术式治疗女性压力性尿失禁13例。结果：随访6个月－3年，13例中10例治愈，1例Ⅱ型者部分有效，2例Ⅲ型者无效。无明显手术并发症。结论：Raz术式是治疗女性压力性尿失禁的一种理想方法。     

Vesica经皮膀胱颈悬吊治疗女性压力性尿失禁

目的　介绍Ｖｅｓｉｃａ 经皮膀胱颈悬吊术治疗女性压力性尿失禁的手术方法。　方法　应用此术式治疗５ 例患者，通过特制器械将阴道前壁做Ｚ形悬吊，固定于耻骨，使悬吊有一稳定支持，悬吊面积宽阔，悬吊线张力固定。　结果　５ 例患者术后尿垫实验阴性。平均随诊２５ ．２ 个月，５ 例均无尿失禁。　结论　该术式临床效果满意，创伤小，恢复快，悬吊稳定可靠     

经阴道补片吊带术加骨铆钉耻骨固定法治疗压力性尿失禁(附42例报告)

目的：探讨一种治疗妇性压力性尿失禁的新手术方法。方法：采用经阴道补片吊带术加骨铆钉（In-fast）耻骨固定法治疗女性压力性尿失禁患者42例，术中把带有悬吊线的铆钉通过特殊的钻孔器经阴道切口分别置入两侧耻骨上，控制好悬吊张力后固定打结。结果：术后随访5－24个月，平均14.7个月，所有患者尿失禁症状均得到控制，无尿潴留、感染及疼痛发生。结论：经阴道补片吊带术加骨铆钉耻骨固定法简单易行、操作安全，术后效果令人满意。     

注射Macroplastique治疗压力性尿失禁的远期疗效观察

目的：观察注射Macroplastique治疗女性压力性尿失禁的近、远期疗效。方法：12例女性压力性尿失禁患者中2例曾行开放性膀胱颈部悬吊术，1例曾行Sling悬吊术。尿道镜直视下在膀胱颈远端0.5-1.0cm处尿道粘膜下注射Macroplastique，平均4.8ml。术后3、47个月随访其近期、远期疗效，结果：术后初期83.3%完全控尿，16.7%好转；术后3个月，55.6%治愈，22.2%好转，近期有效率为77.8%；随访47个月，33.3％治愈，22.2%好转，远期有效率为55.6％。膀胱颈部活动度小或无者治疗效果较好，膀胱颈部硅胶环绕一圈者治疗效果较好。结论：Macroplastique注射治疗女性压力性尿失禁是一种简单、安全、微创方法，对无明显膀胱颈活动的Ⅰ型和Ⅲ型女性压力性尿失禁患者有较好的近期和远期疗效。     

自体筋膜尿道悬吊治疗女性压力性尿失禁的探讨

目的：探讨自体筋膜尿道悬吊术在女性压力性尿失禁治疗中的效果。方法：采用经耻骨上人路自体筋膜尿道中段悬吊术治疗女性压力性尿失禁,回顾性分析2000年2月～2007年12月采用该手术方式治疗28例女性压力性尿失禁患者的临床资料和治疗效果。结果：所有患者无耻骨后血肿形成,无尿道损伤;膀胱损伤1例,延长导尿管留置时间后治愈;28例患者术后拔除尿管均能自行排尿并满意控尿,6例患者出现不同程度不稳定膀胱症状,经对症处理缓解。随访9～21个月,平均15个月,无压力性尿失禁症状复发及排尿困难。结论：自体筋膜尿道悬吊术治疗女性压力性尿失禁简单易行,操作安全,损伤性较小,费用低廉。     

经耻骨上膀胱尿道悬吊带治疗女性压力性尿失禁(附8例报告)

目的:探讨尿道悬吊带(SPARC)治疗女性压力性尿失禁的疗效.方法:局麻下对8例女性压力性尿失禁患者施行经耻骨上膀胱尿道悬吊带手术治疗.结果:平均手术时间45 min(30～70 min),平均住院2天(1～3天).术后留置导尿管24 h.8例患者术后尿失禁症状均消失,无并发症.结论:SPARC尿道悬吊带治疗女性压力性尿失禁疗效确切,操作简便,对患者损伤少,并发症发生率低,是一种治疗女性压力性尿失禁的有效方法.     

四种吊带手术经腹壁或闭孔固定治疗女性压力性尿失禁的效果比较

目的:探讨四种吊带手术经腹和闭孔途径治疗女性压力性尿失禁的效果.方法:采用人工合成材料的吊带经腹壁固定方式(TVT和IVS技术)治疗女性压力性尿失禁患者23例;用经闭孔固定方式(TOT和TVTO技术)治疗女性真性压力性尿失禁患者16例.并进行疗效比较.结果:绝大多数患者均排尿通畅,无尿失禁复发.但TVT组中有1例排尿不畅,3个月后剪断吊带后变为轻度尿失禁;有1例术中膀胱穿孔,术后停留导尿管1周.结论:用四种吊带手术治疗女性真性压力性尿失禁安全、微创和有效.经闭孔固定技术和用经腹壁固定技术这两种方法各有自己的优缺点.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

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.