重复经颅磁刺激对脊髓损伤患者康复治疗的作用

目的探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)对脊髓损伤患者康复治疗的作用。方法纳入2014年12月~2018年1月于本院康复治疗的136例不完全脊髓损伤患者,随机均分为两组,对照组给予常规康复治疗,观察组在此基础上给予r TMS治疗,连续治疗6周。比较治疗前后的美国脊髓损伤协会(ASIA)分级、脊髓损伤步行指数Ⅱ(WISCIⅡ)、脊髓功能独立性评分(SCIM)、改良Ashworth量表(MAS),并进行右侧大脑半球运动诱发电位(MEP)、静息运动阈值(RMT)的测定。结果两组治疗后MAS评分显著降低,WISCIⅡ指数、SCIM评分显著增加,且治疗后观察组均优于对照组,差异有统计学意义(P0. 05);两组治疗后MEP波幅显著上升,RMT显著下降,且治疗后观察组均优于对照组,差异有统计学意义(P0. 05);两组治疗后ASIA分级均显著改善,且治疗后观察组优于对照组,差异有统计学意义(P0. 05)。结论 r TMS治疗不完全脊髓损伤有助于提升患者步行能力、神经功能以及功能独立性,可能与r TMS提高大脑皮质兴奋性与脊髓神经系统可塑性以及促进神经细胞轴突再生有关。     

经颅磁刺激同步踏车训练在胸腰段脊髓损伤治疗中的应用

目的:探讨经颅磁刺激同步踏车训练对胸腰段脊髓损伤患者功能恢复的影响。方法:30例不完全性T10～T12脊髓损伤患者,ASIA脊髓神经功能分级均为C级,病程3～4个月,随机分为训练组和对照组。两组均接受常规康复治疗(包括物理治疗、作业治疗、理疗和梯度气压助动等),训练组比对照组仅增加经颅磁刺激同步踏车训练1个项目。治疗时间6周,比较两组治疗前后ASIA运动评分、ASIA感觉评分、脊髓损伤步行指数Ⅱ(WISCIⅡ)和功能独立性评定(FIM)情况。结果:两组患者治疗前各临床评价指标间比较均无显著性差异(P0.05)。治疗6周后,训练组ASIA运动评分、WISCIⅡ、FIM评分较治疗前均有提高,差异有显著性(P0.05);对照组FIM评分较治疗前提高,差异有显著性(P0.05),余评价指标与治疗前比较差异无显著性(P0.05)。治疗后两组间比较,经颅磁刺激同步踏车训练组ASIA运动评分、WISCIⅡ均高于对照组,差异有显著性(P0.05),ASIA感觉评分、FIM评分两组间差异无显著性(P0.05)。结论:经颅磁刺激同步踏车训练对不完全性胸腰段脊髓损伤患者运动功能恢复有一定程度的促进作用。     

重复经颅磁刺激在不完全性脊髓损伤患者康复中的应用价值

【摘要】 目的：探讨重复经颅磁刺激（repetitive transcranial magnetic stimulation,rTMS）治疗不完全性脊髓损伤的疗效。方法：前瞻性纳入2015年3月~2021年3月我院诊治的美国脊髓损伤协会（American Spinal Injury Association,ASIA）分级为C~D级、病程＜6个月且认知功能无异常的178例不完全性脊髓损伤患者。采用随机数字表法,将患者分为观察组和对照组各89例。两组年龄、性别、病程、ASIA分级、损伤平面等均无统计学差异（P＞0.05）。对照组给予常规康复干预,观察组在对照组基础上进行rTMS干预（每日治疗1次,每周5次,连续治疗10周）。分别于干预前和干预6、10周时,采用简化的McGill疼痛问卷（short-form of McGill pain questionnaire,SF-MPQ）测定疼痛评级指数（pain rating index,PRI）、视觉模拟评分（visual analogue scale,VAS）、现实疼痛指数（present pain index,PPI）,其中PRI包含感觉类（PRI-sensory,PRI-S）和情感类（PRI-affective,PRI-A）;采用改良Ashworth量表（modified Ashworth scale,MAS）、脊髓损伤步行指数Ⅱ（walking index for spinal cord injury Ⅱ,WISCI Ⅱ）、脊髓功能独立性评分（spinal cord independence measure,SCIM）评定肌张力和下肢功能;采用汉密尔顿焦虑量表（Hamilton anxiety scale,HAMA）、汉密尔顿抑郁量表（Hamilton depression scale,HAMD）评定焦虑、抑郁;采用简明健康状况量表（36-item short-form health survey,SF-36）评定生活质量;采用磁刺激仪测定运动诱发电位（motor evoked potential,MEP）波幅、静息运动阈值（resting motor threshold,RMT）。结果：两组干预前PRI-S、PRI-A、VAS、PPI评分无显著性差异（P＞0.05）,两组干预6、10周时均低于干预前（P＜0.05）,且观察组低于对照组（P＜0.05）。两组干预前MAS、WISCI Ⅱ、SCIM评分无显著性差异（P＞0.05）,两组干预6、10周时MAS评分均低于干预前（P＜0.05）,WISCI Ⅱ、SCIM评分高于干预前（P＜0.05）,且观察组干预6、10周时MAS评分均低于对照组,WISCI Ⅱ、SCIM评分高于对照组（P＜0.05）。两组干预前HAMA、HAMD、SF-36评分均无显著性差异（P＞0.05）,两组干预6、10周时HAMA、HAMD评分均低于干预前（P＜0.05）,SF-36评分高于干预前（P＜0.05）,且观察组6、10周时HAMA、HAMD评分均低于对照组,SF-36评分高于对照组（P＜0.05）。两组干预前MEP波幅、RMT无显著性差异（P＞0.05）,观察组干预6、10周时MEP波幅高于对照组（P＜0.05）,RMT低于对照组（P＜0.05）。结论：rTMS可减轻不完全性脊髓损伤患者神经病理性疼痛,提高大脑皮质兴奋性、下肢运动功能和生活质量,减轻焦虑和抑郁,有助于患者康复。     

ASIA脊髓损伤分类标准在颈髓损伤患者神经功能评定中的应用

目的：探讨ASIA标准在颈髓损伤患者神经功能评估中的意义。方法：应用ASIA标准对139例急性颈髓损伤患者的神经功能情况进行回顾性评估。结果：82例完全性脊髓损伤患者中5例逆转为不完全性损伤，77例无逆转者随访时ASIA感觉、运动评分有明显增加。57例不完全性颈髓损伤患者感觉、运动功能改善明显优于完全性损伤患者。结论：完全性颈髓损伤患者可能逆转为不完全性颈髓损伤，并且可有明显节段性神经功能恢复。在脊髓损伤神经功能评定中，ASIA感觉、运动评分具有重要意义。     

综合性康复方案治疗对胸腰段脊髓损伤患者体感诱发电位和功能恢复的影响

目的探讨综合性康复方案治疗对胸腰段脊髓损伤患者体感诱发电位(somatosensory evoked potentials,SEPs)和功能恢复的影响。方法纳入2016年1月~2018年1月就诊的94例胸腰段脊髓损伤患者,根据随机数字表法随机分为观察组(n=47)和对照组(n=47),对照组给予常规康复治疗,观察组给予综合性康复方案治疗。比较两组治疗疗效,治疗前后综合功能、下肢运动功能、日常生活活动能力变化以及SEPs潜伏期变化。结果观察组治疗总有效率为91.49%,高于对照组的74.47%,差异有统计学意义(P0.05);治疗后,观察组综合功能评定量表(FCA)评分、下肢ASIA评分、日常生活活动(ADL)评分均显著高于对照组,差异有统计学意义(P0.05);治疗后,观察组下肢SEPs检测的N波和P波潜伏期均显著短于对照组,差异有统计学意义(P0.05)。结论综合性康复方案治疗胸腰段脊髓损伤患者效果显著,能有效促进患者综合功能、下肢运动功能的恢复,提高日常生活活动能力,并能缩短SEPs潜伏期,有效改善脊髓神经功能。     

颈部脊髓损伤患者神经丝蛋白与ASIA功能分级的关系

【摘要】目的 探讨颈部脊髓损伤患者神经丝蛋白与美国脊髓损伤学会(ASIA)功能分级的关系。方法 选取2016年2月至2019年3月本院收治234例颈部脊髓损伤患者作为本文研究对象,根据颈髓损伤ASIA分级标准,将患者分成五组,即A组(完全性损伤,n=33),B组(不完全性损伤,n=31),C组(不完全性损伤,n=28),D组(不完全性损伤,n=53)和E组(正常,n=89)。比较不同ASIA功能分级患者血清神经丝蛋白水平,并应用Pearson法分析血清神经丝蛋白与ASIA功能分级的相关性。结果 五组患者血清神经丝蛋白水平差异有统计学意义(P<0.05);A组患者血清神经丝蛋白水平明显高于B组、C组、D组和E组,B组患者血清神经丝蛋白水平明显高于C组、D组和E组(P<0.05),C组患者神经丝蛋白水平明显高于D组和E组,且D组患者血清神经丝蛋白水平明显高于E组(P<0.05);血清神经丝蛋白与脊髓损伤ASIA功能分级呈负相关(r=-0.927, P<0.001)。结论 血清神经丝蛋白水平与ASIA功能分级呈负相关,颈部脊髓损伤的严重程度与血清神经丝蛋白水平的提高有关。     

中上胸椎骨折的手术治疗

目的 分析中上胸椎骨折的损伤特点、手术时机与手术方法。方法 对一组35例手术治疗的中上胸椎骨折(T1-10)进行回顾性总结，其中脊髓完全性损伤25例，不完全性损伤10例。比较不同手术时间的出血量、手术前后ASIA分级及感觉运动评分变化。结果 骨折合并脊髓不完全损伤10例，随访ASIA分级提高1～2级；骨折合并脊髓完全性损伤，不能改善ASIA分级，但能提高运动感觉评分平均20分。结论 中上胸椎骨折具有损伤累及节段多、脊髓损伤严重、功能恢复差的特点。脊髓不完全性损伤应尽早手术，完全性损伤宜在伤后2周手术。后路减压、融合、内固定术治疗中上胸椎骨折可以取得较好疗效。     

急性脊髓损伤外科干预时机对神经功能恢复影响的系统评价

目的 :系统评价不同手术时机对急性脊髓损伤患者神经功能恢复的影响。方法 :计算机检索Pub Med、EMBASE、Cochrane Library、ISI Web of knowledge、中国生物医学文献数据库、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)及万方数据库中不同手术时机干预治疗急性脊髓损伤的随机对照试验(RCT),检索时间均从建库至2017年2月。结果:纳入4个RCT,共156例急性脊髓损伤的患者。在不完全性脊髓损伤患者当中早期手术可以改善患者ASIA运动功能评分[MD=3.29,95%CI(-7.90,14.49),P=0.56],Frankel评分总体改善率[OR=7.65,95%CI(2.69,21.74),P=0.000 1];在完全性脊髓损伤患者当中早期手术与晚期手术对患者Frankel评分总体改善率影响不明显[OR=4.88,95%CI(0.74,32.09),P=0.10];早期手术与晚期手术对住院时间[MD=-3.4,95%CI(-8.12,1.32),P=0.16],死亡率[OR=1.07,95%CI(0.21,5.56),P=0.93],褥疮发生率[OR=1.07,95%CI(0.17,6.69),P=0.94]差异无统计学意义。结论 :早期手术在一定程度上能促进患者脊髓功能恢复,也并没有带来更多的并发症,未来仍需要进行高质量的随机对照研究来验证这个结论。     

颈脊髓中央管综合征手术治疗预后影响因素分析

目的分析颈脊髓中央管综合征手术治疗的预后影响因素。方法回顾性分析自2010-06—2014-06行手术治疗并获得随访的52例颈脊髓中央管综合征的临床及影像学资料。采用多元回归分析评估年龄、病变节段数、是否存在椎前高信号、脊髓内高信号的范围、椎管最狭窄处百分比(MCC)、脊髓最大受压缩程度(MSCC)、入院ASIA评分、受伤至手术时间及手术入路对术后神经功能恢复情况的影响。结果 52例均获得随访(25.6±13.4)个月,未出现脊髓损伤、内固定失败等影响预后的并发症。末次随访时52例神经功能均得到一定恢复,ASIA运动功能评分为(89.4±11.7)分,其中上肢(42.4±7.6)分,下肢(47.0±4.7)分。年龄(P=0.019)及入院时ASIA评分(P0.001)是影响预后的主要因素,而受伤至手术时间(P=0.162)、手术入路(P=0.773)、髓内有无高信号(P=0.647)、椎前有无高信号(P=0.106)、MCC(P=0.254)、MSCC(P=0.397)、病变节段数(P=0.806)与预后无明显相关性(P0.05)。结论颈脊髓中央管综合征采用手术治疗安全有效,高龄及入院时ASIA评分较低患者神经功能恢复较差。MRI T2像脊髓内高信号的范围越广提示受伤越严重。     

前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤的疗效对比

目的对比分析前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤的疗效。方法回顾性分析2015年1月—2016年1月,重庆医科大学附属第二医院秀山分院骨科和第二军医大学附属长征医院闸北分院骨科收治的76例重度颈椎脊髓损伤患者临床资料。术前所有患者均出现完全性或不完全性瘫痪症状,美国脊髓损伤协会(ASIA)分级A级(完全性瘫痪,48例)或B级(不完全性瘫痪,28例),其中34例行前路椎体次全切除减压内固定术(前路组),42例行后路全椎板切除减压内固定术(后路组)。记录所有患者呼吸机使用时间,气管插管时间,术前、术后ASIA运动及感觉评分,术后并发症发生情况。结果所有手术顺利完成,患者随访(12.0±0.7)个月。后路组呼吸机使用时间、气管插管时间均少于前路组,差异有统计学意义(P0.05);术后12个月,两组患者ASIA运动及感觉评分均较术前及术后2周显著改善,差异有统计学意义(P0.05),两组间比较差异无统计学意义(P0.05)。术后12个月,前路和后路组患者ASIA分级A级(12 vs.19)、B级(15 vs.16)例数差异无统计学意义(P0.05)。前路组术后发生血肿1例,感染1例,脑脊液漏3例;后路组出现脑脊液漏1例,深静脉血栓1例。结论前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤同样可恢复患者神经功能,后路全椎板切除可缩短呼吸机使用时间及气管插管时间。     

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.