有移位跟骨关节内骨折的手术治疗

目的 评价切开复位内固定对有移位跟骨关节内骨折的治疗效果。方法 骨折类型采用Sanders骨折分型法，62例有移位跟骨关节内骨折均采用切开复位内固定治疗方法。62例患者中，57例获得随访(91．9％)，平均随访时间23个月。结果 根据Maryland足部评分系统评价术后功能，本组中优16例(28．1％)，良21例(36．8％)，一般13例(22．8％)，差7例(12．3％)，优良率64．9％。结论 有移位跟骨关节内骨折应考虑切开复位内固定治疗，尽量恢复关节面的平整和跟骨的外形与力线。     

延长的外侧入路治疗跟骨关节内骨折

目的：评估延长的外侧入路治疗有移位的跟骨关节内骨折的临床疗效。方法：对34例跟骨关节内骨折,按Sanders分类法进行骨折分类。采用延长的外侧入路进行切开复位内固定。随访时间6－28个月,平均12．5个月。结果：按“跟骨关节内骨折评分标准”对患足功能进行评分。本组优17侧,良19侧,可2侧,差1侧。优良率为92．3％。结论：采用延长的外侧入路治疗有移位的跟骨关节内骨折能获得满意的临床疗效。     

重建钢板治疗跟骨关节内骨折

目的探讨切开复位跟骨重建钢板内固定治疗跟骨关节内骨折疗效。方法跟骨关节内骨折21例（23足）,采用跟骨外侧可延伸的L形切口入路,切开复位重建钢板内固定。结果所有患者均获4-25个月随访。根据M aryland足部评分系统,优13足,良8足,中2足。结论跟骨关节内移位骨折采用切开复位重建钢板内固定治疗,能早期功能锻炼,减少并发症,降低病残率。     

手术治疗移位的跟骨关节内骨折

目的评价手术治疗移位的跟骨关节内骨折的临床疗效。方法对28例(32足)移位的跟骨关节内骨折行跟骨外侧入路切开复位内固定，其中26例予以植骨。结果26例获得随访，随访时间8～20个门，平均13个月，骨折均完全愈合，参照跟骨关节内骨折评分标准：优15例，良9例，可2例。术后创口局部渗液5例，皮缘局限性坏死1例，经换药后治愈。结论跟骨外侧入路切开复位内固定并植骨术是治疗移位的跟骨关节内骨折的有效方法。     

手术治疗跟骨关节内骨折62例

目的探讨切开复位内固定治疗跟骨关节内移位骨折的临床效果。方法对62例(70足)跟骨关节内移位骨折进行切开复位内固定治疗,内固定采用克氏针、螺钉、重建钢板及钛板,疗效评定标准按Kerr跟骨骨折评分标准。结果62例(70足)术后随访3～24个月,优44足,良19足,差6足,极差1足,优良率91.4%。结论对跟骨关节内移位骨折应充分考虑切开复位内固定治疗。     

跟骨关节内骨折的手术治疗

目的 评估跟骨关节内骨折手术治疗的效果。方法 对56例66足跟骨关节内骨折按Sander’s分型，分别对Ⅱ型20足，Ⅲ型34足，Ⅳ型12足骨折采用切开复位钢板内固定并部分植骨治疗。结果 56例66足获平均23个月的随访，术后按Maryland评分系统进行评估，总体优良率为84．8％。结论 对移位的跟骨关节内骨折手术解剖复位内固定能取得好的效果．     

手术治疗有移位的跟骨关节内骨折

目的评价手术开放复位、钢板和螺钉内固定治疗跟骨关节内骨折的疗效.方法63例71侧有移位的跟骨关节内骨折,其中SandersⅡ型18侧(25.4%),Ⅲ型26侧(36.6%),Ⅳ型27侧(38.0%).采用外侧可延伸的"L"型切口入路,开放复位、钢板和螺钉内固定.部分Ⅳ型骨折采用骨移植且术后予以石膏短期外固定.结果63例均获随访,时间6～26个月,平均15.9个月.按AOFAS标准评价功能,优29侧,良26侧,可11侧,差5侧,优良率77.6%.结论有移位的跟骨关节内骨折,切开复位,钢板、螺钉内固定治疗可获得满意的效果,但Ⅳ型跟骨关节内骨折的治疗效果较Ⅱ、Ⅲ型差.     

内固定治疗跟骨关节内骨折

目的探讨跟骨关节内骨折手术治疗的临床效果。方法采用切开复位、坚强内固定和早期功能锻炼治疗32例跟骨关节内骨折。结果随访21例，随访时间平均22个月，切口感染1例，腓肠神经损伤1例，关节功能受限2例，其余均恢复良好。结论采用切开复位、坚强内固定和早期功能锻炼是治疗跟骨关节内骨折的有效方法。     

地震病人跟骨骨折的手术治疗

[目的] 探讨地震伤员跟骨骨折的特点及切开复位内固定治疗临床效果.[方法] 骨折采用Sanders分型,15例24侧采用切开复位内固定治疗,有13例21侧获得4～4.5个月随访,平均随访时间4.2个月.[结果] 所有骨折均愈合.按Maryland足部评分系统评价,本组优9侧(42.9%),良10侧(47.6%),可2侧(9.5%),优良率90.5%.伤口感染2侧经皮瓣转移后治愈.[结论] 切开复位内固定是治疗跟骨关节内移位骨折的有效方法.地震伤员不宜过早手术,应待病人身体各项指标基本正常、心理情况稳定后手术.     

切开复位内固定治疗跟骨关节内骨折

目的 探讨切开复位内固定治疗跟骨关节内骨折的临床疗效。方法 跟骨外侧L形切口显露跟骨，按后关节面和距下关节→Boehler角和Gissane角→跟骨的长度，宽度和高度的顺序整复跟骨关节内骨折和邻近关节；并用可塑型跟骨钛钢板内固定治疗跟骨关节内骨折共35例，38例，其中Sander'sⅡ型8侧，Ⅲ型14侧，Ⅳ型16侧。结果 术后X线片显示骨折愈合时间为5-12周（平均7.1周）；33侧术后获6-22个月（平均12.3个月）随访，按Maryland足部评分系统评价术后功能，其中优18侧，良13侧，可2侧，优良率为93.9%。结论 切开复位和可塑型跟骨钛钢板内固定治疗跟骨关节内骨折可获得满意的临床疗效。     

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.     

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.     

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.     

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.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.