Use of the harmonic scalpel for soft palate resection in dogs: a series of three cases

Soft palate resection is performed to resect a redundant or diseased soft palate, often associated with brachycephalic airway obstructive syndrome (BAOS). Resection has been associated with numerous complications, including coughing, bleeding, pharyngeal oedema, respiratory obstruction and death. Traditionally, the surgery is performed by sharp dissection and suturing, but other reported techniques include the use of an electrothermal sealing device or a laser. Operative time for sharp dissection is approximately 12 min, but is shortened to around 5 min when using a laser, as the haemostatic properties of the instrument negates the need for post-resection oversewing. The successful use of a harmonic scalpel to resect redundant soft palates in three dogs is described. The resected soft palates were not oversewn and the surgical time was comparable with that for laser surgery. The first dog had a minor bleed 6 h postoperatively, possibly associated with suboptimal placement of the harmonic scalpel cutting jaws. The following two patients had no postoperative complications. The harmonic scalpel laparoscopic handpiece allowed excellent visualisation of the surgical field and rapid performance of the procedure. All three patients had markedly improved postoperative respiratory function. Cleaning and resterilisation permitted multiple reuse of the handpiece, making it cost-competitive with other surgical techniques.     

Effects of non-invasive positive pressure ventilation on respiratory mechanics and central drive in sleeping patients with chronic obstructive pulmonary disease

AIM: To evaluate the effects of non-invasive positive pressure ventilation (NIPPV) on respiratory mechanics and central drive in sleeping patients with chronic obstructive pulmonary disease (COPD). METHODS: Sixteen moderate-to-severe COPD patients in the acute exacerbation period, admitted to Zhujiang Hospital from October 2010 to October 2011, were chosen in the study. The routine pulmonary function test was performed, and all patients under relatively stable conditions after NIPPV treatment were monitored by respiratory mechanics, diaphragm electromyogram and polysomnography in waking and sleeping states when they were spontaneously breathing or receiving NIPPV. Other physiological parameters were recorded and calculated on a continuous basis in time sequence for 30 min. RESULTS: When COPD patients were spontaneously breathing in sleeping state as compared with waking state, there was no significant difference in respiratory rate (RR) and the ratio of inspiratory time to total respiratory cycle time (T_i/T_tot), but there were significant decreases in tidal volume (V_T), minute ventilation(V_E), mean inspiratory flow (V_T/T_i), dynamic lung compliance (C_Ldyn), root mean square (RMS) of diaphragm myoelectrical voltage and pulse blood oxygen saturation (SpO₂). Meanwhile, there were significant increases in airway resistance (R_aw), pressure-time product (PTP) and end tidal carbon dioxide pressure (P_ETCO₂). When COPD patients received NIPPV as compared with spontaneous breathing in waking state, there was no significant difference in RR, V_T and V_E, but there were significant increases in V_T/T_i, C_Ldyn and SpO₂.Meanwhile, the reductions of T_i/T_tot, R_aw, PTP, RMS and P_ETCO₂ were also significant. When COPD patients received NIPPV as compared with spontaneous breathing in sleeping state, there was no significant difference in RR and RMS, but there were significant increases in V_T, V_E, V_T/T_i, C_Ldyn and SpO₂.Meanwhile, the reductions of T_i/T_tot, R_aw, PTP, and P_ETCO₂ were significant. CONCLUSION: The abnormal changes of respiratory mechanics and the reduction of central drive were the main reasons for hypopnea and hypoxemia in sleeping COPD patients. On the one hand, NIPPV can significantly improve respiratory mechanics of COPD patients in waking and sleeping states by reducing airway resistance and work of breathing, which resulting in better respiratory response and ventilation output. On the other hand, NIPPV can significantly reduce the central drive of COPD patients in waking state, which can not do the same in sleeping state.     

16层螺旋CT对阻塞性睡眠呼吸暂停综合征上气道成像的研究

目的：应用多层螺旋CT（MSCT）对确诊阻塞性睡眠呼吸暂停综合征（OSAS）患者进行上气道成像,分析其形态特点,为临床综合诊断OSAS及选择治疗提供依据。方法：OSAS患者28例,正常对照组14例,于深吸气末、深呼气末、平静呼吸、闭口堵鼻深吸气（Muller）动作时行上气道MSCT扫描,测量各咽部水平的截面积及相应的矢、横径,软腭的长度及厚度．判断上气道的阻塞情况．计算气道塌陷度。结果：（1）OSAS组腭后区及舌后区截面积比对照组明显狭窄、且多发生在吸气时相（P均〈0．01）;（2）OSAS组腭后区、舌后区及喉咽部的气道塌陷度较对照组高（P〈0．01）;（3）OSAS组软腭厚度较对照组厚（P〈0．01）。结论：腭后区及舌后区气道明显狭窄伴气道塌陷度的增加可能是OSAS发病的主要原因。     

Obstructive nephropathy induced with DL-potassium hydrogen tartrate in F344 rats

We experienced obstructive nephropathy in F344 rats treated with DL-potassium hydrogen tartrate (PHT) in a 13-week oral repeated dose toxicity study. Six-week-old male and female F344/DuCrj rats were fed a diet containing up to 2.0% PHT for 13 weeks. Microscopical findings including irregular dilation of the distal tubule lumen, foreign body giant cells, inflammatory cell infiltration, and regeneration of renal tubules were observed focally or multifocally in the renal cortex and/or medulla in the 0.5% and higher dosage groups of both sexes. The severity of these lesions increased in a dose-dependent manner. In the urinalysis, an increase in protein and white blood cells or the concentration of tartaric acid was detected in the 0.5% PHT and higher dosage groups of both sexes or males, respectively, though conventional blood biochemical analysis did not indicate failure of renal function. These results indicate that the PHT induces obstructive nephropathy in rats. There were no other treatment-related changes in other organs.     

加味大柴胡汤联合L-精氨酸对阻塞性黄疸大鼠肾功能的影响

目的研究阻塞性黄疸时,加味大柴胡汤联合L-精氨酸（L—Arg）对肾功能的保护作用。方法SD大鼠40只随机分为假手术组、单纯胆总管结扎组、胆总管结扎＋L-Arg组（L-Arg组）和胆总管结扎＋大柴胡汤＋L-Arg组（中西医结合组）,每组10只。造模成功后第2天起,假手术组及单纯胆总管结扎组每天分别腹腔注射生理盐水,L-Arg组腹腔注射L—Arg,中西医结合组既注射L—Arg又喂加味大柴胡汤,连用9d,观察各组肾功能的变化,同时测定血和肾组织内皮素（ET）、一氧化氮（NO）水平。结果中西医结合组肾功能明显得到改善,且血和肾组织ET下降,NO升高。结论精氨酸和加味大柴胡汤联合使用较单用精氨酸更能减轻阻塞性黄疸时的肾功能损伤,其机制可能与降低体内ET水平、升高NO水平有关。     

慢性阻塞性肺疾病患者血浆B型钠尿肽浓度表达研究

目的探讨慢性阻塞性肺疾病(COPD)患者血浆B型钠尿肽(BNP)浓度表达情况。方法选择COPD急性加重期患者96例为观察组,100例同期健康查体者为对照组,测定两组血浆BNP浓度,并进行BODE评分。结果观察组血浆BNP浓度为(683.7±56.3)pg·mL-1,对照组血浆BNP浓度为(91.7±21.4)pg·mL-1,观察组血浆BNP浓度明显高于对照组(P0.01)。观察组96例中伴有心衰者29例,BNP浓度为(1975.4±431.4)pg·mL-1,67例非心衰者BNP浓度为(327.1±37.3)pg·mL-1,伴心衰患者血浆BNP浓度明显高于非心衰患者(P0.05)。观察组患者BODE分值为(5.61±0.79)分,血浆BNP浓度与其明显正相关(r=2.72,P0.05)。结论BNP和BODE均与COPD危险事件(包括死亡、再住院、转入ICU)有关。COPD患者血浆BNP浓度明显升高,与合并心力衰竭有密切关系,可以对患者预后进行评估。     

加味大柴胡汤对阻塞性黄疸大鼠血浆内毒素的影响

目的：研究加味大柴胡汤保护阻塞性黄疸大鼠的肝功能、抑制脂质过氧化损伤及缓解内毒素血症的作用。方法：制作急性阻塞性黄疸大鼠模型，分为7，14及21d三个时段，每个时段分为3组，即：（1）假手术组（SO组）；（2）胆总管结扎＋生理盐水组（BDL＋NS组）；（3）胆总管结扎＋大柴胡汤（BDL＋中药组）。在各时相点，剖杀大鼠取肝组织及门静脉血，作病理检查；检测肝组织丙二醛（MDA）和门静脉内毒的含量。结果：（1）胆管结扎7、14、21d,BDL 中药组肝组织MDA含量显著高于SO组（P＜0．01），但低于BDL＋NS组（P＜0．01）；（2）胆管结扎7、14、21d后，门静脉血浆内毒素BDL＋NS组明显高于其它组（P＜0．01）。结论：大柴胡汤在提高机体抗病的能力、保护肝功能及减轻内毒素血症方面作用明显。