改进的内眦赘皮矫治术联合重睑成形术Ⅰ期成形

目的探讨改进的内眦赘皮矫治术联合切开法重睑成形术的方法及临床效果。方法根据内眦赘皮的轻重程度及方向,采用改良的"Z"成形术,切除或切断内眦部形成赘皮的异位眼轮匝肌及皮下筋膜组织,联合切开法重睑成形术行Ⅰ期成形。结果本组68例患者,术后赘皮消失,泪阜显露适中,内眦间距缩短,重睑外形美观自然。其中,36例随访3个月至3年,术后皮肤切口无可见瘢痕,形态稳定,内眦赘皮无复发,效果满意。结论该手术方法能够充分矫正内眦赘皮的异常结构,而与重睑成形术同期施术效果稳定,具有一定的临床应用价值。     

内眦赘皮应用切开重睑成形术联合Park-Z成形术效果观察

目的观察内眦赘皮应用切开重睑成形术联合Park-Z成形术的效果。方法 2016-01—2018-02间,濮阳市油田总医院对60例内眦赘皮者应用切开重睑成形术联合Park-Z成形术。回顾性分析受术者的临床资料。结果本组手术过程顺利,术后随访6～12个月,其间8例出现内眦部轻度瘢痕增生,予以皮下注射得宝松后瘢痕增生改善明显。内眦赘皮消失、泪阜显露良好、内眦间距缩短、重睑形态自然且效果满意者44例,感宽度轻微不对称、效果尚可16例。随访期间无内眦赘皮复发。结论应用切开重睑成形术联合Park-Z成形术矫正内眦赘皮,术后内眦处瘢痕不明显,重睑弧度自然,美容效果满意。     

改良Y-V成形内眦赘皮矫治术联合切开法重睑术的临床应用

目的:探讨改良Y-V成形内眦赘皮矫治同期行切开法重睑成形术在临床中的应用效果。方法:以2011年12月~2013年7月共136例内眦赘皮并单睑病例为研究对象,根据典型Y-V成形原理,对Y的长臂及两短臂的形态、位置及短臂与长臂的夹角进行改良,个性化设计成形切口线,并同期行切开法重睑术。结果:采用改良Y-V成形内眦赘皮矫治术联合切开法重睑术,术后内眦部位切口隐蔽,无明显瘢痕,重睑皱襞弧度流畅自然,与内眦部延续自然,符合美学标准。随访3~15个月,手术效果稳定,无复发。结论:改良Y-V成形内眦赘皮矫治同期行切开重睑成形术,是矫治单睑伴内眦赘皮的一种操作简单、实用的方法,值得在临床推广应用。     

横一字切开法内眦赘皮矫正术同期行重睑术的疗效观察

目的：采用横一字切开法内眦赘皮矫正术同期联合切开法重睑术,观察重睑及内眦形态变化以及瘢痕情况,结合患者满意度对临床效果进行综合评价。方法：先按常规方法施行切开法重睑术,然后采用横切法切开内眦角赘皮,并将切口沿下睑缘下2mm向外延伸,分离皮下粘连,切除部分错构的眼轮匝肌、内眦韧带及增厚的筋膜组织,使泪阜充分显露,形成新的内眦角及重睑皱襞线。结果：本组96例患者,术后赘皮消失,泪阜显露适中,内眦间距缩短,重睑外形美观自然。其中,36例随访3个月～3年,切口瘢痕不明显,形态稳定,效果满意。结论：采用横一字切开法内眦赘皮矫正术联合切开法重睑术,能够充分矫正内眦赘皮,内眦部皮肤基本是无痕愈合,重睑形态自然,手术效果满意。     

改良横切法内眦赘皮矫正联合重睑成形术

目的:探求采用改良横切法内眦赘皮矫正同期联合重睑成形术观察重睑形态及内眦赘皮矫正后瘢痕增生情况。方法:内眦赘皮用改良横切法矫正,皮下分离并去除错位异构的眼轮匝肌,折叠缝合内眦韧带;同时常规行切开法重睑术,但重睑切口与内眦切口不相连,呈皮下隧道相通。结果:采用本法192例,术后1个月7例出现内眦部增生发红,3个月后逐渐软化消退,187例随访3～18个月,获得满意的效果。结论:该改良横切法内眦赘皮矫正同时行切开法重睑术,术后重睑形态自然、内眦赘皮矫正充分、操作容易、瘢痕不明显。     

旋转V形瓣内眦赘皮矫正联合切开重睑成形术

目的探讨旋转V形瓣内眦赘皮矫正联合切开重睑成形术的临床效果。方法对103例内眦赘皮患者,设计一尖端向下的V形瓣,向外旋转至内眦上方,矫正内眦赘皮,同时联合切开重睑成形术。结果所有患者术后获随访3~12个月,均未见内眦部明显瘢痕,内眦及重睑形态均良好,效果满意。结论采用旋转V形瓣内眦赘皮矫正联合切开重睑成形术,可获得较好的术后效果,值得临床推广应用。     

改良Z形内眦开大术联合重睑成形术矫正内眦赘皮

目的 探索改良Z形内眦开大术联合重睑成形术矫正内眦赘皮的效果.方法 在内眦部应用改良Z成形术, 将内眦赘皮与下睑交界的内侧及外侧皮肤对应切开后,修剪错位的眼轮匝肌并缩短内眦韧带,沿新内眦点向内侧切开,将内眦赘皮水平移位,松解内侧睑缘处皮肤张力,显露内眦.在上睑中外侧行重睑切开线,保留与内眦开大术切口之间的部分皮肤.结果 自2008年2月至2010年12月,临床治疗21例(42只眼)上睑型内眦赘皮求美者.术后随访3～14个月,赘皮消失, 内眦完全敞开, 内眦处无明显瘢痕,重睑线流畅,效果满意.结论 本方法易于掌握,可有效松解上睑内侧皮肤张力,充分显露内眦形态,瘢痕不明显.     

改良的Z成形术联合重睑成形术矫正内眦赘皮

目的 探讨改良的"Z"成形术联合重睑成形术矫正内眦赘皮的方法,以达到内眦部瘢痕不明显的效果.方法 自2007年9月至2008年10月,对55例伴内眦赘皮的单睑患者,通过设计无张力皮瓣转移缝合及内眦角固定在鼻侧腱膜或骨膜上矫正内眦赘皮.并联合切开法重睑成形术.结果 本组55例患者,术后经1～12个月随访,10例患者术后2个月内瘢痕明显,内眦切口处微红,有硬结形成,约4个月时逐渐恢复,1年后内眦处瘢痕变软,不明显.结论 改良的"Z"瓣转移联合重睑成形术矫正内眦赘皮的方法,能达到无张力缝合,减轻瘢痕的发生,适合于内眦赘皮明显的单睑患者.     

改良新月形去皮法矫正内眦赘皮

目的探索一种简便有效的内眦赘皮矫正方法及同时行切开法重睑成形术的重睑线的设计方法。方法采用改良新月形去皮法矫正内眦赘皮，设计重睑线的内侧与内眦设计线不相连。两者间距保留2～3mm。结果本组患者共120例，其中40例同时完成隆鼻及重睑成形术，5例同时行上睑下垂矫正，其余患者均同时行重睑成形术。112例患者术后随访1周至12个月，除3例内眦赘皮效果欠佳外，其余手术效果满意。结论该方法设计简单，操作容易，术后瘢痕不明显、重睑形态自然，是矫正内眦赘皮较理想的方法。     

切开法重睑成形术联合改良Park Z内眦赘皮矫正术

目的探讨切开法重睑成形术联合改良Park Z内眦赘皮矫正术的临床疗效。方法回顾自2010-2015年,采用切开法重睑成形术联合改良Park Z内眦赘皮矫正术治疗的672例患者,对其治疗前后照片进行对比,并对治疗结果进行总结分析。结果所有患者术后内眦形态自然,泪阜显现理想,重睑线弧度高低适当,自然流畅。术后1~3个月,手术部位隐约可见切口痕迹;术后6个月,内眦部无明显手术痕迹,无内眦赘皮复发。其中,5例患者术后6个月仍有较明显的瘢痕,经给予药物和激光治疗后好转。结论采用切开法重睑成形术联合改良Park Z内眦赘皮矫正术,对伴有内眦赘皮的单睑患者具有较好的临床疗效。     

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 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.     

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.