静脉注射利多卡因对老年冠心病非心脏手术围插管期心率变异性的影响

目的：研究静脉注射利多卡因在全麻诱导气管插管期间对老年冠心病自主神经系统功能的影响。方法：选择90例择期腹部手术老年冠心病患者．随机分成利多卡因组（L组n=45）和安慰剂组（P组n=45）．分别于麻醉前（T0）,麻醉诱导后（T1）及气管插管后（T2）用心率变异功率谱分析（HRPSA）技术观察患者的心率变异性（HRV）改变。结果：麻醉诱导后．两组HRV总功率频段（TP）和其中低频段（LF）,高频段（HF）．LF／HF（低频／高频比）均显著降低（P〈0．05）．组间比较L组LF低于C组（P〈0．05）;气管插管后,两组LF、HF、LF／HF及TP均显著升高（P〈0．05）．组间比较L组LF与LF／HF升高程度显著低于P组（P〈0．05）,HF组间差异无统计意义。结论：静注利多卡因能明显抑制插管操作引起植物神经功能的干扰．有利于维护老年冠心病患围插管期心脏自主神经调节功能。     

盐酸右美托咪定对老年冠心患者全麻气管插管期心率变异性的影响

目的：研究盐酸右美托咪定（dexmedetomidine．Dex）在全麻诱导气管插管期间对老年冠心病患者自主神经系统功能的影响。方法：98例择期腹部手术老年冠心病患者．随机分成盐酸右美托咪定（D组n=49,诱导前给予负荷剂量右美托咪定0．7ug,／0g．注射泵缓慢静脉注射．输注时间超过10rain．维持剂量以0．4ug/（kg·h）持续静脉注射）和安慰剂组（P组n=49．诱导前静脉注射等容量氯化钠溶液）．分别于麻醉前（To）．麻醉诱导后（T1）及气管插管后（T2）用心率变异功率谱分析（heart rate Power spectrum analysis．HRPSA）技术观察患者的心率变异性（heart rate variability．HRV）改变。结果：麻醉诱导后．两组HRV总功率频段（TP）和其中低频段（LF）、高频段（HF）．LF／HF（低频／高频比）均显著降低（P〈O．05）．组问比较D组LF低于P组（P〈O．05）;气管插管后,两组LF、HF及TP均显著升高（P〈O．05）,而D组的LF／HF较麻醉前（T0）差异无统计意义,P组的LF／HF较麻醉前（T0）显著升高（P〈O．05）：组间比较D组LF、TP升高程度显著低于P组（P〈0．05）．HF组间差异无统计学意义。结论：盐酸右美托咪定能明显抑制插管操作引起的对植物神经功能的干扰,有利于维护老年冠心病患者围插管期心脏的自主神经调节功能。     

三种麻醉方法对腹腔镜手术二氧化碳气腹期间自主神经活动趋势的影响

目的以心率变异性（heart rate variability，HRV）为观察指标，观察分析不同的麻醉方法对腹腔镜胆囊切除手术（Laparoscopic cholecystectomy，LC）二氧化碳（CO2）气腹期间自主神经活动趋势的影响。方法选择ASAⅠ～Ⅱ级的择期L患者45例，按手术日期分为全身麻醉组（Ⅰ组，对照组）、全身麻醉＋艾司洛尔组（Ⅱ组）和全麻复合硬膜外阻滞组（Ⅲ组），分别在麻醉前，气腹前，气腹后5、10、20及30min观察HRV及血流动力学的变化。结果与气腹前相比，Ⅰ组低频（LF）、低频／高频（LF／HF）在气腹后不同时点均显著升高（P〈0．05）；Ⅱ组LF／HF在气腹后5、10min显著升高（P〈0．05）；Ⅲ组气腹后各时点LF、HF、LF／HF均无显著变化（P〉0．05）。组间比较，Ⅰ组LF、LF／HF在气腹后各时点均显著高于Ⅱ、Ⅲ组（P〈0．05），Ⅱ组LF在气腹后10min显著高于Ⅲ组（P〈0．05），LF／HF在气腹后5、10min显著高于Ⅲ组（P〈0．05）。HF各组间差异无显著性（P〉0．05）。结论艾司洛尔可减轻气腹引起的应激反应，但不能完全阻止其交感活性的增强；全麻复合硬膜外阻滞用于腹腔镜胆囊切除手术，可以抑制气腹引起的交感神经兴奋，维持自主神经的稳定性。     

老年糖尿病患者非心脏手术后心脏自主神经功能的变化

目的 探讨老年糖尿病患者非心脏手术后心脏自主神经功能的变化。方法择期行非心脏手术老年患者30例，分为糖尿病组（DM组，n=15）和非糖尿病组（NDM组，n=15）。用三通道动态心电图监测仪分别于手术前日（术前）、术后第1天和第2天记录当晚23：00至次日早晨7：00总的心率变异性（HRV），包括总功率（TP）、高频功率（HF）、低频功率（LF）、极低频功率（VLF）及LF／HF。结果术前DM组TP、HF低于NDM组（P〈0．05），术后第1天：两组TP、HF、LF、VLF、LF／HF下降，DM组HF低于NDM组而LF／HF高于NDM组（P〈0．05或0．01），术后第2天：DM组TP、HF、LF及VLF较术后第1天进一步降低，亦低于NDM组（P〈0．05或0．01）。结论与非糖尿病患者比较，糖尿病患者非心脏手术后发生心脏自主神经功能紊乱更为严重和持久。     

全身麻醉与硬膜外麻醉对自主神经系统的影响

目的：应用心率变异功能频谱分析（HRV-PSA），观察全身麻醉与硬膜外麻醉对自主神经系统活动的影响。方法：选择32例ASAⅠ-Ⅱ级择期子宫切除术成年女性患者，分为硬膜外组（EA组，n=16）和全麻组（GA组，n=16），观察两组患者在麻醉前（T1）、麻醉诱导后15min（T2）、切皮后1min（T3）、牵拉子宫（T4）、子宫切下后（T5）及术毕时（T6）的HRV、MAP及HR的变化。结果：EA组：与T1比较，LF/HF在T4时显著性升高；低频（LF）和高频（HF）在T5、T6时显著性下降；其余各时点的LF、HF、LF/HF无明显改变。GA组：与T1比较，LF、HF均显著性下降；LF/HF除T6时显著性升高外，其余各时点均显著性下降。结论：硬膜外麻醉和全身麻醉对HRV均产生一定程度的抑制，以硬膜外麻醉的影响较小，其交感/迷走神经张力呈交感占优势的方向转移；全身麻醉对LF、HF的抑制较强，使交感/迷走神经张力呈副交感占优势的方向转移，而术后LF/HF又急剧升高，提示自主神经系统稳定性受到严重影响。     

非透析慢性肾脏病患者心率变异性的特点及其影响因素分析

目的：分析非透析慢性肾脏病（CKD）患者心率变异性（HRV）的特点及相关因素。方法：对263例住院且尚未行肾脏替代治疗CKD患者进行HRV（包括SDNN、RMSSD、pNN50、LF、HF、LF/HF）检测,并分析影响CKD患者HRV的因素。结果：CKD1～5期患者HRV下降的比例为57.79%,在CKD1、2、3、4、5期的比例分别为30.77%、42.00%、52.94%、72.73%和87.27%,各组间差异具有统计学意义（P〈0.05）。CKD患者SDNN均值为（110.8±33.5）ms,除CKD1与2期J间、CKD3与4间差异无统计学意义（P〉0.05）,其他各组间比较差异具有统计学意义（P〈0.05）;RMSSD均值为（30.2±18.7）ms,CKD5期明显低于其他4组,且与其他4组间比较差异具有统计学意义（P〈0.05）,但其他4组间比较差异无统计学意义（P〉0.05）;pNN50均值为9.4±5.3,CKD1、2、3、4、5期患者的pNN50呈递减趋势,且各组间比较差异均具有统计学意义（P〈0.05）;LF均值为（1014.3±609.2）ms,CKD3、4期间比较差异无统计学意义（P〉0.05）,其他各组间比较差异均具有统计学意义（P〈0.05）;HF均值为（806.9±318.3）ms,CKD3、4期间比较差异无统计学意义（P〉0.05）,其他各组间比较差异均具有统计学意义（P〈0.05）;LF/HF均值为2.1±0.9,CKD1、2期间,CKD3、4期间比较差异无统计学意义（P〉0.05）,其他各组间比较差异均具有统计学意义（P〈0.05）。血红蛋白、性别、血钠及血钾水平与HRV显著相关。结论：非透析CKD患者HRV下降的比例较高,且随着CKD分期增加,发生HRV下降的比例增加。     

光棒联合直接喉镜气管插管对心率变异性的影响

目的观察光棒联合直接喉镜气管插管对心率变异性（heart rate variability,HRV）的影响,评价光棒联合喉镜进行气管插管的临床应用安全性和可行性。方法拟行气管插管全身麻醉患者80例,采用随机数字表法分为直接喉镜组（A组）和光棒联合直接喉镜组（B组）,每组40例。应用功谱分析法记录诱导前（TO）、诱导后（T1）、插管即刻（T2）及插管后1min（T3）、5min（T4）的HRV的总频（total frequency,TF）、高频（high frequency,HF）、低频（low frequency,LF）和LF／HF比率（LF／HF ratio,LF／HF）,同时记录各时间点的心率（heart rate,HR）、收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、各组插管时间、插管成功率及出现相关并发症例数。结果与T1时TF、LF[（795±167）、（265±87）ms^2／HZ]比较,A组患者T2、T3时的TF[（1825±207）、（1692±198）ms^2／HZ]、LF[（815±129）、（796±127）ms^2／HZ]和LF／HF（4．6±0．9;412±0．6）明显增加,A组增加程度大于B组（P〈0．05）;A组相应时间点HR、SBP及DBP增加程度也明显大于B组（P〈0．05）;B组插管成功率明显高于A组,而插管时间及并发症显著低于A组（P〈0．05）。结论光棒联合直接喉镜气管插管对HRV影响小、插管时间短、插管成功率高、并发症少,是一种安全有效的插管方法。     

平衡针法治疗膝骨性关节炎的临床疗效观察

目的：观察平衡针法治疗膝骨性关节炎的临床疗效,为临床治疗本病提供更有效的治疗方法。方法：将61例符合纳入标准的观察对象,按首次来诊的先后顺序,用随机数字表法随机分为两组,治疗组31例采用平衡针法针刺,对照组30例采用传统针刺。两组病例均每日治疗1次,6次为1疗程,疗程间间隔3－4d,临床观察2个疗程后进行视觉模拟定级WAS）评定、膝关节症状和体征分级量化,并判定疗效。结果：①在VAS评分方面,两组VAS积分自身前后比较均有显著性差异（P〈0．01）,两组间治疗后比较有显著性差异（P〈0．05）;②在膝关节症状和体征改善方面,两组症状和体征总积分自身前后比较均有显著性差异（P〈0．01）,两组间治疗后比较有显著性差异（P〈0．05）,其中两组间治疗后行走时疼痛、关节肿胀、关节活动度比较有显著性差异（P〈0．05）,晨僵或起床后疼痛、休息时疼痛比较无显著性差异（P〉0．05）;③治疗组总有效率为93．54％,对照组总有效率为83．3％,两组比较有显著性差异（P〈0．05）。结论：①在VAS评分方面,两种疗法均能改善膝关节疼痛,治疗组优于对照组;②在膝关节症状和体征改善方面,两组均能改善膝关节症状和体征,其中治疗组在改善行走时疼痛、关节肿胀、关节活动度方面优于对照组,在晨僵或起床后疼痛、休息时疼痛方面,两组有类似的疗效;③治疗组临床疗效优于对照组,平衡针治疗本病有一定优势。     

高位或低位硬膜外麻醉复合全麻病人围术期心率变异性的变化

目的比较高位或低位硬膜外麻醉复合全麻胸、腹部手术病人围术期心率变异性(HRV)的变化,以探讨其自主神经系统功能的状态。方法择期行胸、腹部手术病人25例,ASAⅠ或Ⅱ级,年龄18-65岁,男女不限。随机分为2组:低位硬膜外麻醉复合全麻组(L组,n=13,行腹部手术,T12-L1或T11,12硬膜外穿刺置管)、高位硬膜外麻醉复合全麻组(H组,n=12,行胸科手术,T6,7或T7,8硬膜外腔穿刺置管)。静脉注射异丙酚、维库溴铵麻醉诱导,术中吸入60％N2O及异氟醚,维持呼气末吸入麻醉药浓度1．0 MAC。术前1 d、入室后、硬膜外麻醉平面稳定后、复合全麻后即刻、拔管后及术后1、2 d观察HRV:高频功率(HF)、低频功率(LF)、低频功率与高频功率比(LF／HF)的变化。结果感觉阻滞平面稳定后,L组阻滞平面上界T8.8±2.0,H组T3.0±0.3。与入室后比较,两组硬膜外麻醉平面稳定后、复合全麻后即刻、拔管后LF、HF及LF／HF差异无统计学意义(P>0．05);H组术后1、2 d LF、HF降低,L组术后1 d LF、术后2 d LF／HF高于H组(P<0．05)。结论高位或低位硬膜外麻醉复合全麻病人围术期HRV无明显改变;术后高位硬膜外麻醉病人自主神经系统张力降低,但自主神经系统功能维持平衡。     

颈康饮治疗神经根型颈椎病的临床研究

[目的]观察颈康饮治疗神经根型颈椎病的临床疗效。[方法]将152例神经根型颈椎病病例，随机分为颈康饮治疗组（87例）和颈复康颗粒对照组（65例），分别观察2组患者治疗前后主要症状疼痛程度（VAS法）、血液流变学指标、血清细胞因子IL-10和血黏附因子的变化，并比较2组疗效。[结果]治疗组和对照组治疗后疼痛积分较治疗前均明显减少（P〈0．01），2组间治疗前后疼痛积分的差值比较，有显著性差异（P〈0．05）；血液流变学指标、血清细胞因子IL-10和血黏附因子，治疗后2组均有显著性差异（P〈0．05）；治疗组的治愈率、有效率与对照组比较有显著性差异（P〈0．05）。[结论]颈康饮治疗神经根型颈椎病有明显的疗效。     

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.     

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.