UHS与Lichtenstein无张力疝修补术的对比研究

目的比较腹股沟疝应用UHS装置与Lichtenstein修补术式的优缺点。方法回顾性分析2010-12—2012-12间行UHS疝修补114例与Lichtenstein疝修补88例手术时间、术后住院天数、慢性疼痛、并发症等资料。结果 2种术式在住院时间、复发率等方面差异无统计学意义(P>0.05);Lichtenstein修补术手术时间明显短,手术费用低,但术后慢性疼痛评分较高。结论应用UHS装置与Lichtenstein无张力疝修补术均可以用于腹股沟疝修补,各有优缺点。     

局麻下平片无张力疝修补术治疗腹股沟疝疗效分析

目的观察局麻下平片无张力疝修补术治疗腹股沟疝的效果。方法随机将272例接受腹股沟疝修补术的患者分为2组,观察组(124例)实施局麻下平片无张力疝修补术。对照组(148例)在腰硬联合麻醉下行bassini疝修补术。对比2组治疗效果。结果观察组手术时间、住院时间、切口疼痛时间、下床活动时间、并发症发生率和术后复发率均少于对照组,差异有统计学意义(P0.05)。结论局麻下平片无张力腹股沟疝修补术创伤小、并发症少、恢复快、复发率低。     

局麻下Lichtenstein无张力平片疝修补术治疗腹股沟疝797例分析

目的评估Lichtenstein无张力疝修补术治疗腹股沟疝的结果并总结临床经验。方法回顾分析797例腹股沟疝患者Lichtenstein无张力疝修补术的临床资料。结果平均住院时间65min,术后并发症发生率为24.1%(194例次),复发率0.1%(1例)。结论成人腹股沟疝采用在局麻下Lichtenstein手术恢复快,复发率低并且适合在日间门诊开展。     

开放式腹膜前间隙UHS疝修补术与Lichtenstein修补术后并发症分析

目的对比开放腹膜前间隙超普装置(UHS)腹股沟疝修补术与开放Lichtenstein修补术的临床疗效。方法选择2013年1月至2018年12月间213例分别采用UHS疝修补术与Lichtenstein修补术的腹股沟疝患者临床资料,入组条件为临床和随访资料完整,包括UHS疝修补术101例(UHS组),Lichtenstein疝修补术112例(Lichtenstein组);所有患者均完成为期1年随访,记录和比较两组的手术时间、平均住院时间、术后局部不适、疼痛、复发等临床资料,评价两种手术方式的疗效。结果两组手术时间、术后平均住院时间方面,差异无统计学意义(P0.05),两组术后早期并发症如血肿、阴囊水肿、感染均没有统计学意义。UHS组在腹股沟区不适、慢性疼痛、缺血性睾丸炎明显少于Lichtenstein组,差异有统计学意义(P0.05)。术后随访1年,Lichtenstein组有5例复发,UHS组未发现复发患者。结论本组病例数据显示,采用开放腹股沟疝修补术的术式中,超普装置(UHS)腹股沟疝修补术较Lichtenstein修补术的远期并发症少。     

无张力疝修补术治疗绞窄性腹股沟疝的体会

目的比较无张力疝修补术与传统Bassini手术对绞窄性腹股沟疝的治疗效果。方法回顾性分析2003年1月至2007年12月间急诊行手术治疗的47例绞窄性腹股沟疝。其中,行Li-chtenstein无张力疝修补术21例(A组),行Bassini手术26例(B组)。结果两组术后并发症发生率差异无统计学意义(P0.05)。B组术后住院时间明显长于A组(P0.05)。术后随访6个月~5年,病人复发率差异无统计学意义(P0.05)。结论对绞窄性腹股沟疝的病人应用Lichtenstein无张力疝修补术是安全的。     

Lichtenstein无张力疝修补术治疗腹股沟疝1712例分析

目的 评估Lichtenstein无张力疝修补术治疗腹股沟疝的结果并总结临床经验.方法 回顾性分析1712 例腹股沟疝患者的1847例次(其中双侧疝135例)Lichtenstein无张力疝修补术的临床资料.结果 平均住院3.5 d,术后并发症发生率为2.54%(47例次),复发率0.16%(3例).结论 成人腹股沟疝采用在局麻下Lichtenstein 手术术后恢复快、复发率和并发症发生率低并且适合在日间病房开展.     

腹股沟疝应用UHS腹膜前修补与疝环充填式修补的比较分析

目的探讨应用超普疝修补装置(UHS)行腹膜前无张力疝修补术的优势。方法回顾性分析2010年1月至2014年6月,安徽医科大学第一附属医院收治成人腹股沟疝患者157例的临床资料。其中72例行腹膜前无张力疝修补术(UHS组),85例行疝环充填式无张力疝修补术(疝环充填组),比较二组手术时间、住院时间、术后疼痛发生率及复发率等。结果 UHS组的手术时间和术后住院时间分别为(53±7)min,(3.2±2.2)d,疝环充填组的手术时间和术后住院时间分别为(62±28)min,(4.6±4.1)d;UHS组术后疼痛发生率为2.78%,术后1年无复发,对照组术后疼痛发生率和术后1年复发率分别为15.29%,8.24%。采用SPSS16.0统计学软件分析比较上述数据,UHS组均优于疝环充填组(P0.05)。结论与疝环充填式无张力疝修补术相比,UHS腹膜前无张力疝修补术能明显缩短手术时间和术后住院时间,减低患者术后疼痛发生率及复发率。     

肾移植术后腹股沟疝患者12例临床诊治分析

目的探讨应用不同补片进行无张力修补术治疗肾移植术后腹股沟疝的临床应用体会。方法对温州医科大学附属第一医院2008年7月至2014年7月期间收治的12例肾移植术后腹股沟疝患者临床资料进行回顾性分析。结果 12例患者肾移植术后出现腹股沟疝的中位时间为72个月;腹股沟疝类型包括斜疝9例,直疝2例,斜疝合并直疝1例,均为单侧。患者均在疝确诊后6~12个月内手术治疗,10例使用聚丙烯疝补片行Lichtenstein平片修补术,2例使用超普疝修补装置(UHS)行疝环充填式无张力修补术,平均手术时间(54±26)min。1例UHS修补斜疝合并直疝术中损伤移植输尿管,行移植输尿管膀胱再植。术后切口疼痛3例,阴囊积液1例。截至2014年7月,术后随访12~32个月,肾功能均无明显变化,未观察到切口感染、疝复发、异物不适感、睾丸萎缩、射精痛及慢性疼痛等并发症。结论肾移植术后腹股沟疝患者使用传统聚丙烯疝补片行Lichtenstein平片修补术对移植肾影响较小,应用UHS行疝环充填式无张力修补术中易损伤移植输尿管。     

Lichtenstein无张力疝修补术治疗腹股沟疝4011例

目的：评估Lichtenstein无张力疝修补术治疗腹股沟疝的结果并总结临床经验。方法回顾性分析3 631例腹股沟疝患者的4011例（其中双侧疝380例）Lichtenstein无张力疝修补术的临床资料。结果 经Lichtenstein手术治疗的3 631例腹股沟疝患者平均住院3.8d,术后并发症发病率为2.4％,复发率为0.1％。结论 在局麻下对腹股沟疝患者施行Lichtenstein手术具有术后恢复快、复发率和并发症发病率低的特点。     

开放式腹膜前间隙UHS疝修补术与Lichtenstein修补术后并发症分析

［摘要］ 目的 对比开放腹膜前间隙超普装置（UHS）腹股沟疝修补术与开放Lichtenstein修补术的临床疗效。方法 选择2013年1月至2018年12月间213例分别采用UHS疝修补术与Lichtenstein修补术的腹股沟疝患者临床资料,入组条件为临床和随访资料完整,包括UHS疝修补术101例（UHS组）,Lichtenstein疝修补术112例（Lichtenstein组）;所有患者均完成为期1年随访,记录和比较两组的手术时间、平均住院时间、术后局部不适、疼痛、复发等临床资料,评价两种手术方式的疗效。结果 两组手术时间、术后平均住院时间方面,差异无统计学意义（P>0.05）,两组术后早期并发症如血肿、阴囊水肿、感染均没有统计学意义。UHS组在腹股沟区不适、慢性疼痛、缺血性睾丸炎明显少于Lichtenstein组,差异有统计学意义（P<0.05）。术后随访1年,Lichtenstein组有5例复发,UHS组未发现复发患者。结论 本组病例数据显示,采用开放腹股沟疝修补术的术式中,超普装置（UHS）腹股沟疝修补术较Lichtenstein修补术的远期并发症少。     

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.