梗阻性黄疸胆汁中胆管脱落细胞研究

目的建立梗阻性黄疸患者胆管引流胆汁中脱落细胞收集方法,比较胆管良性病变及恶性肿瘤胆管脱落细胞特征。方法从临床收集64例梗阻性黄疸患者引流胆汁,分离提取有核细胞,比较胆管结石和胆管癌病例胆管脱落细胞数量。涂片或应用瑞-姬双染法染色后观察不同病例胆管脱落细胞形态。结果梗阻性黄疸胆汁引流中可收集到大量胆管脱落细胞。胆管癌病例胆管脱落细胞数量显著多于胆管结石病例,分别为（4.70±0.82）×10^3个/ml和（3.80±0.98）×10^2个/ml（P〈0.01）。胆管癌和胆管结石脱落细胞形态学观察均具有明显特征。结论梗阻性黄疸胆管引流胆汁中存在较大量具有形态学特征的脱落细胞。这些细胞可以作为临床鉴别诊断的重要依据,也是在细胞和分子水平探讨胆管癌发生机制的可靠途径。     

鼻胆管引流胆总管切开一期缝合治疗胆总管结石

目的观察预置鼻胆管引流胆总管切开取石一期缝合胆总管对胆总管结石的治疗价值。方法以2007年1月至2008年6月我院进行的23例预置鼻胆管引流胆总管切开取石一期缝合的胆总管结石患者（观察组）为对象,并选择同期28例胆总管切开取石T管引流的患者为对照（对照组）,对其治疗效果进行对比研究。结果观察组的术后胆汁引流量（2312．6±347．4）ml和住院天数（15．2±6．5天）均低于对照组的（2617．1±401．5）ml和（20．4±3．9）天,差异有显著性,P〈0．05;而手术时间（98．7±10．5分）分和治疗费用（14．0±2．4千元）均高于对照组（91．0±7．4）分和（9．4±2．0）千元,P〈0．05;术后因非并发症引起的不适比率观察组高于对照组（P〈0．05）,而并发症发生率和残余结石发生率二者相比无统计学意义差别。结论鼻胆管引流胆总管切开一期缝合治疗胆总管结石具有痛苦轻、恢复快,且不增加并发症发生率。     

增生性瘢痕中血管内皮细胞生物学功能的研究

目的 探讨增生性瘢痕中血管内皮细胞的生物学功能及其与瘢痕形成的关系。方法 取人增生性瘢痕组织和正常皮肤组织，进行组织学观察。分离和纯化2种标本中的血管内皮细胞，应用酶联免疫吸附测定法分别检测单个血管内皮细胞中转化生长因子β1，（TGF-β1）、成纤维细胞生长因子2（FGF2）、血小板源性生长因子（PDGF）、内皮素1（ET-1）和血管内皮生长因子（VEGF）的水平。结果光学显微镜下可见正常皮肤微血管数目较少；增生性瘢痕微血管数目增多，血管狭长扭曲甚至闭塞。透射电镜可见增生性瘢痕中毛细血管管腔狭窄，有内皮细胞脱落。增生性瘢痕中血管内皮细胞分泌TGF-β1、PDGF、ET-1、VEGF、FGF2的水平分别为（60±8）、（30±4）、（0．12±0．03）、（52±5）、（18．1±1．2）μg／个细胞，明显低于正常皮肤（P〈0．05）。结论 增生性瘢痕中血管内皮细胞生物学功能减退，可能与瘢痕中胶原的大量产生和缺氧有关。     

自体骨髓细胞经门静脉移植治疗肝硬化与肝功能不全的临床研究

目的观察自体骨髓细胞经门静脉移植对肝硬化和肝功能不全的治疗效果。方法2005年2月至2006年6月在我科接受手术治疗的40例肝硬化门静脉高压症患者（脾切除、断流术或内镜食道曲张静脉套扎术）,被随机分为治疗组和对照组,每组20例。两组患者于术中埋置“门静脉导管-皮下药盒”,术后3-4周,治疗组经移植通道输注自体骨髓细胞,而对照组只输注生理盐水。在第1次输注后每隔1个月再重复进行输注,共输注3次。第3次输注后1个月进行疗效评价。结果（1）两组恢复均顺利,未发现与移植操作有关的不良反应或并发症。（2）丙氨酸转氨酶、总胆红素、白蛋白和凝血酶原时间：治疗组分别由（60±52）μmol／L、（26±15）μmol／L、（33±5）μmol／L和（18±2）s变为（26±15）μmol／L、（14±8）μmol／L、（41±3）μmol／L和（12±2）s（P〈0．01）;对照组分别由（47±37）μmol／L、（22±23）μmol／L、（35±4）μmol／L和（18±4）s变为（65±51）μmol／L、（19±42）μmol／L、（35±4）μmol／L和（18±4）s（P〉0．05）;治疗组优于对照组（P〈0．01）。（3）血清透明质酸和前胶原Ⅲ肽：治疗组分别由（188±160）ng／ml和（13±18）ng／ml变为（104±80）ng／ml和（8±9） ng／ml（P〈0．05）;对照组分别由（79±193）ng／ml和（10±16）ng／ml变为（136±187）ng／ml和（9±17）ng／ml（P〉0．05）;治疗组亦优于对照组（P〈0．01）。结论自体骨髓细胞经门静脉移植可改善肝功能和肝纤维化血清学指标。     

恶性梗阻性黄疸经皮肝穿刺胆管内外引流术前后T淋巴细胞亚群、肿瘤坏死因子变化及其意义

目的探讨经皮肝穿刺胭管内外引流术对恶性梗阻性黄疸（MOJ）患者免疫功能的影响。方法将我院2000年11月至2007年3月收治的108例恶性肿瘤致梗阻性黄疸患者按胆汁引流途径分成2组：外引流组52例，内引流组56例。分别于术前1d、术后1周检测肝功能、血清肿瘤坏死因子（TNF-α）及细胞金疫功能指标，观察各指标术前术后的变化，与健康对照组进行比较。结果外、内引流总胆红素（TBIL）分别由术前（344．55±106．57）、（322．20±111．51）／μmolL降为术后1周的（291．57±104．47）、（284．73±105．96）／／L，两组总胆红素均较术前明显下降（P〈0．05），两组间差异无统计学意义（P〉0．05）。TNF-α在外、内引流组分别由术前的（109．59±20．96）、（110．99±17．25）ng／L降为术后的（105．33±20．60）、（84．93±14．44）ng／L，内引流组较术前显著改善（P〈0．01）；内引流组患者术后外周血T淋巴细胞亚群（TLS）CD4^＋、CD3^＋、CD4^＋／CD8^＋值较术前明显增高，术后CD8^＋则明显低于术前（P〈0．05）；而外引流组TNF-α及外周血CD4^＋、CD3^＋、CD8^＋、CD4^＋／CD8^＋与术前比较，差异无统计学意义（P〉0．05），两组问存在明显差异。结论经皮肝穿刺胆道引流术是治疗恶性肿瘤致梗阻性黄疸有效的方法；恶性肿瘤致梗阻性黄疸时全身免疫功能低下，胆道内引流后细胞免疫功能显著改善。     

表现为急性胆囊炎的胆囊癌25例分析

目的：探讨老年人胆囊癌的临床特点，避免表现为急性胆囊炎的老年人胆囊癌行腹腔镜胆囊切除术。方法：回顾分析1995年1月-2005年12月表现为急性胆囊炎的老年患者（≥60岁）109例，其中术中或术后发现胆囊癌25例（均经病理证实），将此组患者与其余非肿瘤患者的术前临床资料包括术前肝功能等进行统计分析。结果：胆囊癌组25例，12例行剖腹探查，13例行腹腔镜手术。14例术中行快速冰冻切片示恶性而扩大手术或中转开腹，其余11例术后病理证实恶性肿瘤。非肿瘤组84例，34例行开腹手术，50例行腹腔镜手术，14例中转开腹。术前肿瘤组与非肿瘤组的肝功能变化有显著差异，主要为总胆红素TBil（83．4±131．2）μmol／L和（20．6±13．9）μmol／L，（P〈0．05）；直接胆红素DBil（55．1±77．4）tunol／L和（7．3±5．2）μmol／L，（P〈0．05）；AST（96．1±89．7）IU／L和（44．3±29．1）IU／L，（P〈0．05）；GGTP（512．1±871．8）IU／L和（99．8±101．3）IU／L，（P〈0．05）；AKP（433．7±272．5）IU／L和（98．7±47．4）IU／L，（P〈0．01）。结论：对于某些肝酶标异常的老年人急性胆囊炎，有胆囊癌可能。应进一步完善影像学检查，手术以直接开腹为宜。     

大鼠肝移植后早期血清一氧化氮的变化及其意义

目的探讨大鼠肝移植后早期血清一氧化氮（NO）的变化情况及其意义。方法将SD大鼠随机分成A、B、C三组，进行肝移植．供、受者均为SD大鼠。A组于移植肝恢复血流2h、B组于移植肝恢复血流4h、C组于移植肝恢复血流6h时采取受者的下腔静脉血和左肝叶组织．测定血清丙氨酸转氨酶（ALT）和NO含量．免疫组化法测定移植肝组织中核因子．κB p65亚单位（NF-κB p65）的表达，并观察肝组织病理学变化；每组均于移植肝恢复血流时收集5min的胆汁，测量5min胆汁分泌量。结果A组的5min胆汁分泌量为（3．73±1．11）μl．明显高于B组的（2．35±0．92）μ和C组的（2．23±0．81）μl（P〈0．05）。A组血清ALT含量为（468±36）IU／L．B组为（619±49）IU／L．C组为（820±65）IU／L，A组明显低于B、C组（P〈0．05），B组明显低于C组（P〈0．05）。A组血清NO含量为（14．2±1．5）μmol／L，明显高于B组的（10．5±1．2）μmol／L和C组的（10．3±1．1）μmol／L（P〈0．05）。A组肝组织中NF-κB p65表达阳性细胞百分率为（23．5±1．9）％．B组为（43．8±3．8）％，C组为（48．6±5．1）％．A组明显低于B、C组（P〈0．05）。病理学观察显示．随着移植肝脏再灌注时间的延长，肝组织损伤呈进行性加重。Pearson相关性分析提示．NO与血清ALT水平及NF-κB p65表达呈明显的负相关（r值分别为-0．74和-0．77，P〈0．01）。结论移植肝脏再灌注早期．血清NO下降，NF-κB的活性逐渐增强．移植肝脏的功能和组织损伤呈加重趋势。     

低温氧合血微流量持续灌注保存大鼠心脏的效果

目的探讨低温氧合血微流量持续灌注保存大鼠心脏的效果。方法切取Wistar大鼠心脏，随机分为3组，实验组的心脏以4℃氧合血微流量（1ml／h）持续灌注低温保存10h；对照组的心脏以4℃St．Thomas液微流量持续灌注低温保存10h；单纯冷保存组的心脏以4℃St．Thomas液单纯浸泡保存10h。保存后的鼠心用Langendorff装置灌注，生物机能实验系统测定血流动力学指标；高效液相色谱仪测定心肌细胞的ATP含量；光镜和电镜观察心肌组织和线粒体的形态学改变。结果在再灌注30min时，实验组的左心室收缩压（LVSP）为（38．25±3．84）mm Hg，左心室发展压（LVDP）为（32．54±4．01）mm Hg，左心室压力微分（±dp／dt）为（1080±123）mm Hg／s；对照组的LVSP为（34．48±4．68）mm Hg，LVDP为（19．27±4．63）mmHg，±dp／dt为（935±196）mmHg／s；单纯冷保存组的LVSP为（32．14±4．95）mmHg，LVDP为（16．99±4．85）mmHg，±dp／dt为（825±302）mmHg／s，实验组的上述血流动力学指标优于对照组和单纯冷保存组（P〈0．05）。实验组心肌细胞的ATP含量为（1．759±0．502）μmol／L，对照组的ATP为（1．453±0．573）μmol／L，单纯保存组的ATP为（1．059±0．463）μmol／L，实验组的ATP含量明显高于对照组和单纯冷保存组（P〈0．05）。实验组的心肌组织和细胞超微结构的变化轻于对照组和单纯冷保存组。结论低温氧合血微流量持续灌注能改善大鼠心脏的保存效果。     

完全腹腔镜肝切除术中顺行胆道镜检查的临床应用

目的介绍完全腹腔镜肝切除术中顺行胆道镜检查治疗肝胆管结石的技术要点，初步探讨其临床应用价值。方法2002年6月至2005年12月，11例左肝内胆管结石患者在我科行腹腔镜肝切除术，术中经左肝管残端置入胆道镜探查胆总管及右肝管，根据结果行取石、胆道冲洗治疗，术后封闭左肝管残端。结果11例均成功行完全腹腔镜肝切除术，其中左外叶切除术6例（联合胆囊切除3例），左半肝切除术5例（联合胆囊切除1例）。术中应用胆道镜行单纯胆道冲洗5例，胆总管取石3例，右肝管取石2例，1例因探查发现右肝管开口狭窄而中转行胆管成形术。手术时间（201．4±57．5）min，出血量（136．4±68．6）ml，其中胆道镜探查时间（42．3±12．1）min。术后住院时间（4．6±1．6）d。术后随访（22．5±11．6）个月，优9例，良2例。结论腹腔镜下顺行胆道镜可以不放置T管，从而缩短恢复时间，减轻患者痛苦，是一项安全、可行的技术。     

低蛋白加α酮酸饮食对5/6肾切除大鼠残肾组织炎症因子表达及病理变化的影响

目的观察低蛋白加α酮酸饮食对5/6肾切除大鼠模型的残余肾功能保护作用及对肾组织炎症反应的影响,并探讨其可能的作用机制。方法30只SD雄性大鼠随机分为3组后行5/6肾切除,术后给予不同的饮食：低蛋白加酮酸组（4％酪蛋白＋2％α酮酸）、低蛋白组（6％酪蛋白）和高蛋白组（20％酪蛋白）,同时设10只SD雄性大鼠为假手术对照组（20％酪蛋白）。检测术前及术后第4、8、12周各组尿蛋白、血白蛋白、Ser、BUN等指标。12周后处死大鼠,观察肾组织病理改变;免疫组化方法检测肾组织单核巨噬细胞抗原（ED-1）、单核细胞化学吸引蛋白质1（MCP-1）及RANTES的表达情况。结果（1）术后4周起,3个切除组Scr、BUN及尿蛋白均持续升高,其中以高蛋白组最显著（P＜0．01）,而低蛋白加酮酸组升高最为缓慢;第12周时,低蛋白加酮酸组显著低于其余2组[Scr为（125．44±5．50）比（172．00±9．54）、（135．22±5．78）μmol/L;尿蛋白量（24h）为（28．36±3．69）比（92．32±34．06）、（46．62±6．19）mg,P＜0．01。（2）与高蛋白组和低蛋白组相比,低蛋白加酮酸组肾组织损害明显减轻,肾小球病理积分为0．38±0．13比0．84±0．28、0．49±0．11,P＜0．01。（3）低蛋白加酮酸组肾小管间质内MCP-1、RANTES的表达比高蛋白组及低蛋白组显著减少,同时ED-1的阳性细胞数也明显减少[肾小管间质ED-1阳性细胞为（3．59±0．78）个比（13．33±1．20）、（6．50±0．99）个,P＜0．05。结论低蛋白加酮酸饮食可改善5/6肾切除大鼠的血脂及肾功能,并可能通过抑制肾组织的慢性炎症反应,减轻残肾组织肾小球硬化和肾间质的病变程度,减少尿蛋白的排泄,从而延缓大鼠慢性肾衰的进展。     

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.