经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻

目的分析经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻的临床效果。方法自2013年1月至2015年5月采用经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻患者30例33足,其中男2例,女28例;年龄25~73岁,平均(52.6±5.1)岁。术前均拍摄足负重正位X线片并测量足母外翻角(hallux valgus angle,HVA)及第1、2跖骨间夹角(intermetatarsal angle,IMA)的角度,术前参照美国足踝外科协会(American Orthopaedic Footand Ankle Society,AOFAS)前足功能评分系统标准评价患足功能。术后再次测量HVA、IMA及评价AOFAS前足功能变化。所有相关数据使用SPSS 16.0软件进行处理。结果所有病例随访时间6~25个月,平均13.9个月。除1例因出现转移性足底痛二期行第二跖骨远端截骨成形术(Weil截骨术)外,其余患者均对治疗满意。随访期间无患者出现足背麻木、足母内翻或足母外翻复发、转移性跖骨痛、截骨处不愈合等后遗症。HVA由术前(33.5±6.4)°纠正为(11.0±4.5)°,P0.05;跖间角由术前(13.6±2.5)°纠正为(7.4±2.3)°,P0.05;AOFAS前足评分由术前(39±8.5)分纠正为(87±9.3)分,P0.05。结论经内侧切口行外侧软组织松解联合Austin、Akin截骨术治疗中度足母外翻临床效果良好,且具有避免足背侧瘢痕、防止损伤局部皮神经和深部血管的特点。     

采用改良Chevron截骨联合外侧软组织松解治疗重度拇外翻的疗效观察

目的 观察采用改良Chevron截骨联合外侧软组织松解治疗重度拇外翻的临床疗效.方法 回顾分析2018年3月至2019年4月北京积水潭医院院足踝外科应用改良Chevron截骨联合外侧软组织松解的以拇外翻角(HVA)增大为主的重度拇外翻患者22例(27足),对照组患者42例(50足).影像学检查包括HVA、第1、2跖骨轴...     

第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻

目的 :探讨第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻的临床疗效。方法:自2015年6月至2017年6月,采用第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻32例(40足),其中男3例3足,女29例37足;年龄22～80岁,平均57.57岁;病程2～32年,平均14年;轻度9足,中度31足。术前患者合并拇囊炎,伴有第1跖趾关节周围疼痛并存在负重行走时疼痛加重。手术前后拍摄足负重正侧位片,比较拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),并采用美国足踝外科协会拇外翻评分(AOFAS)评价临床疗效。结果:32例患者获得了随访,时间12～24个月,平均15.2个月。术后切口均愈合良好,无感染、跖骨头坏死等并发症发生。术前HVA、IMA分别由(32.08±5.59)°、(11.63±2.24)°减小至术后12个月的(10.31±4.36)°、(5.02±2.34)°,差异有统计学意义(P0.05)。AOFAS评分由术前的56.75±6.42提高至术后12个月的88.80±3.99 (P0.05)。结论:第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻畸形可获得较好的临床效果,为拇外翻治疗提供了更多的选择。     

Akin截骨联合第1跖骨截骨治疗拇外翻的疗效

目的探讨Akin截骨联合第1跖骨截骨治疗拇外翻的疗效。方法采用Akin截骨联合第1跖骨截骨治疗27例拇外翻患者(27足):Akin截骨联合Chevron截骨19例,Akin截骨联合Scarf截骨6例,Akin截骨联合Juvara截骨2例。比较术前及末次随访时的第1、2跖骨间夹角(IMA)与拇外翻角(HVA)的变化。末次随访时采用AOFAS踝-后足评分标准评价疗效。结果患者均获得随访,时间10~16个月。截骨端均骨性愈合,前足疼痛较术前显著减轻,无拇外翻复发、转移性跖骨痛等并发症发生。末次随访时,HVA、IMA较术前显著减小,AOFAS踝-后足评分较术前显著提高,差异均有统计学意义(P<0.001)。结论Akin截骨联合第1跖骨截骨治疗拇外翻,纠正畸形效果满意,可降低拇外翻术后复发率,近期临床效果好。     

内侧单切口撑开器辅助下外侧软组织松解联合Scarf截骨治疗中重度足拇外翻

目的探讨经单一内侧切口撑开器辅助下行外侧软组织松解联合第1跖骨Scarf截骨治疗中重度足拇外翻的手术疗效。方法自2011-12—2012-12诊治22例（25足）中重度足拇外翻,于第1跖骨内侧作单一切口,远端延长至第1跖趾关节,撑开器辅助下行外侧软组织松解及Scarf截骨矫正。结果 20例（23足）获得随访12-24个月,平均14个月。截骨愈合时间10-13周,平均11.5周。术前拇外翻角（HVA）30.3°-51.5°（40.0±5.6）°,第1、2跖骨间夹角（IMA）15.0°-21.4°（18.6±1.8）°,AOFAS评分41.7-67.1（55.9±6.0）分;末次随访时HVA 5.8°-21.4°（13.3±4.0）°,IMA 6.2°-12.9°（10.8±1.8）°,AOFAS评分80.5-96.2（87.3±4.6）分,均较术前明显改善,差异有统计学意义（P〈0.05）。结论撑开器辅助下内侧单切口外侧软组织松解联合Scarf截骨能有效矫正中重度足拇外翻畸形,撑开器辅助下内侧单切口显露清楚、创伤小且外形更加美观。     

改良Silver联合跖骨截骨治疗拇外翻畸形

目的 分析采用改良Silver精准外侧软组织松解及内侧关节囊紧缩联合跖骨截骨术治疗拇外翻，探索改良Silver精准外侧软组织松解及内侧关节囊紧缩联合跖骨截骨对纠正拇外翻畸形的效果。方法 回顾分析2019-10—2021-12收治的20例拇外翻患者，均应用改良Silver联合跖骨截骨术治疗，并采用拇外翻角、跖骨间角评估，比较术前与术后即刻、术后3个月、术后6个月的差异，以及术前及末次随访时第一跖趾关节的AOFAS量表评分。结果 手术后即刻、术后3个月和6个月的HAA、IMA,以及末次随访时的AOFAS评分均较术前显著改善，差异均有统计学意义(P<0.05)。但术后即刻、术后3个月和6个月的HAA、IMA的差异均无统计学意义(P>0.05)。结论 拇外翻采用精准外侧软组织松解及内侧关节囊紧缩的改良Silver联合跖骨截骨术，拇外翻外形明显改善，功能恢复良好，无复发，疗效满意。     

Chevron截骨软组织松解矫正轻中度（足母）外翻

[目的]分析Chevron截骨软组织松解术矫正轻中度(足母)外翻的效果。[方法] 2017年4月—2020年6月,对36例(44足)轻中度(足母)外翻患者实施Chevron截骨术联合远端软组织松解术,比较术前及术后随访时疼痛视觉模拟评分(VAS)、美国足踝骨科协会前足评分(American Orthopaedic Foot and Ankle Society, AOFAS)、(足母)外翻角(hallux valgus angle, HVA)、第1、2跖骨间角(intermetatarsal angle, IMA)。[结果]所有患者均顺利手术,切口愈合良好,无严重并发症。与术前相比,末次随访时,VAS评分由(5.20±1.10)分显著减少至(1.28±0.46)分(P0.05);AOFAS评分由(49.67±3.08)分显著增加至(83.81±6.15)分(P0.05); HVA由(32.33±3.67)°显著减少至(12.47±4.96)°(P0.05),IMA由(14.23±3.37)°显著减少至(9.00±3.78)°(P0.05)。[结论] Chevron截骨软组织松解术治疗轻中度(足母)外翻的临床效果满意。     

跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻

目的探讨跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻的临床效果。方法对32例患者(48足)行Chevron截骨手术治疗,测量手术前后拇趾外翻角(HVA),第1、2跖骨间夹角(IMA)的变化,评估足部疼痛及关节活动恢复情况。结果 29例(44足)获得随访,时间12~16(14.5±4.1)个月;3例(4足)失访。患者对术后临床效果满意,截骨部位愈合时间为4~6周。术前HVA为30°±4.1°、IMA为14°±1.7°;术后3个月HVA为4°±4.2°、IMA为10°±2.4°,术后1年HVA为5°±4.5°、IMA为11°±3.3°,均较术前明显减小,差异有统计学意义(P0.05);术后1年与术后3个月的HVA、IMA比较差异无统计学意义(P0.05)。结论跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻疗效满意。     

改良微创Chevron截骨整形术治疗足拇外翻的疗效分析

目的观察改良微创Chevron截骨整形术治疗足拇外翻的临床疗效。方法自2016年6月至2017年6月,对收治的36例(46足)足拇外翻患者行改良微创Chevron截骨整形术。通过美国足踝评分系统(aofas ankle hindfoot scale, AOFAS)对手术前后的临床效果进行评价,同时对比术前及术后6周足拇外翻角(HVA)与第一、二跖骨间夹角(IMA)的角度,以及术后瘢痕的临床疗效评价。结果本组共36例患者,随访10～17个月。AOFAS术后评分平均为89.16分;术后6周,患者HVA术后平均为12.18°;IMA术后平均为6.74°。通过影像学比较HVA角度,其差异无统计学意义(P0.05)。对切口瘢痕处行临床疗效评估,总有效率为96%。患者未见临床复发。结论采用改良微创Chevron截骨整形术治疗足拇外翻可以获得良好的临床效果,且近期疗效较满意。     

改良Chevron截骨手术治疗中重度足拇外翻的近期疗效

目的探讨采用第1跖骨远端改良Chevron截骨手术治疗中重度足拇外翻的临床效果。方法笔者自2014-05—2015-12采用第1跖骨远端改良Chevron截骨手术治疗20例(22足)中重度足拇外翻,分别对手术前后患者AOFAS评分、VAS评分、拇趾外翻角(HVA)、第1跖骨远端关节角(DMAA)和第1、2跖骨间夹角(IMA)的差异进行统计学分析。结果所有患者获得随访6~48(20±8.5)个月。均获得骨性愈合,无一例发生切口并发症、跖骨头坏死、拇内翻等并发症,末次随访时无足拇外翻复发。2足术后出现拇趾背皮肤麻木;7例末次随访跖趾关节活动范围有所减小,但患者无明显不适。AOFAS评分:术前(58±3.1)分,术后(92.5±5.0)分;VAS评分:术前(6.5±3.1)分,术后(1.6±1.4)分。术后AOFAS评分和VAS评分均较术前有明显改善,差异有统计学意义(t=-11.763,P=0.027;t=3.657,P=0.043)。术后HVA角、IMA角、DMAA角较术前均获较大改善,差异有统计学意义(t=15.032,P=0.006;t=8.588,P=0.037;t=5.038,P=0.026)。结论对于中重度足拇外翻或DMAA增大的足拇外翻,应用改良Chevron截骨手术可获得满意效果。     

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.     

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.     

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.     

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.     

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.     

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.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

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.     

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.