大鼠肠缺血再灌注时肺组织β-防御素-2 mRNA表达的变化

目的 观察大鼠肠缺血再灌注时肺组织β-防御素-2(BD-2)mRNA表达的变化.方法 72只雄性SD大鼠随机分为2组(n=36):假手术组(S组)和肠缺血再灌注组(II/R组).采用夹闭肠系膜上动脉(SMA)的方法制备肠缺血再灌注模型.II/R组阻断SMA 1 h后再灌注,S组仅分离SMA.分别于再灌注即刻(T0),再灌注15(T1)、30(T2)、60 min(T3)、3 h(T4)和6 h(T5)时处死6只大鼠,取肺组织,光镜下观察肺组织病理学结果,计算肺通透性指数(PPI),检测肺组织肿瘤坏死因子-α(TNF-α)含量和BD-2 mRNA表达水平.结果 S组肺组织结构未见异常,II/R组出现肺水肿和中性粒细胞浸润.与S组比较,II/R组再灌注各时点PPI升高,BD-2 mRNA表达上调,T0-3时TNF-a含量升高(P＜0.05或0.01).II/R组BD-2 mRNA表达水平与TNF-a含量及PPI的相关系数分别为0.823和-0.615(P＜0.01).结论 大鼠肠缺血再灌注时肺组织BD-2基因表达上调.     

丙泊酚对大鼠肺缺血-再灌注损伤的影响

目的 探讨丙泊酚对大鼠肺缺血-再灌注(I-R)损伤的作用及其机制.方法 钳闭大鼠左肺门45 min,再灌注2 h,建立在体肺I-R模型.动物随机分为四组:假手术组、缺血组(夹闭45min,但不再灌注)、I-R组和丙泊酚组(I R并使用丙泊酚麻醉).监测动脉氧分压(PaO2),测定左肺湿干比(W/D)和左肺支气管肺泡灌洗液(BALF)中丙二醛(MDA)、总蛋白及磷脂浓度.用流式细胞仪测定全血中性粒细胞CD18的表达和呼吸爆发.结果 再灌注2 h各组PaO2差异无统计学意义.与假手术组比较,I-R组BALF中的MDA、总蛋白浓度和W/D均升高(P＜0.05),磷脂含量降低(P＜0.01),以上指标丙泊酚组与假手术组比较差异无统计学意义.I-R组中性粒细胞CD18的表达和呼吸爆发均高于丙泊酚组(P＜0.05).结论 丙泊酚对大鼠在体肺I R损伤具有保护作用,其机制可能与其抗氧化作用和抑制中性粒细胞作用有关.     

缺血预处理和缺血后处理对大鼠心肌缺血再灌注时炎性反应影响的比较

目的 比较缺血预处理和缺血后处理对大鼠心肌缺血再灌注时炎性反应的影响.方法 雄性SD大鼠40只,体重290～320 g,随机分为4组(n=10),缺血再灌注组(I/R组)、缺血预处理组(IPC组)和缺血后处理组(IPOC组)采用结扎左冠状动脉前降支30 min进行再灌注的方法制备心肌缺血再灌注模型,假手术组(S组)仅在左冠状动脉前降支下穿线.监测再灌注期间HR和MAP,并计算HR和MAP的乘积(心肌氧耗指数,RPP).分别于再灌注30和180 min时采集静脉血样,测定血清TNF-α、IL-6、高迁移率组蛋白1(HMGB1)和心肌肌钙蛋白I(cTnI)的浓度.采集完血样,取心肌组织,测定心肌梗死体积.结果 与S组比较,I/R组MAP和RPP降低,血清cTnI和炎性细胞因子浓度升高,心肌梗死体积增大(P＜0.05);与I/R组比较,IPC组MAP升高,IPOC组MAP和RPP均升高,两组血清cTnI和炎性细胞因子浓度降低,心肌梗死体积缩小(P＜0.05);与IPC组比较,IPOC组血清炎性细胞因子浓度升高,心肌梗死体积增大(P＜0.05).结论缺血预处理减轻大鼠心肌缺血再灌注时炎性反应的作用强于缺血后处理,从而使心肌保护效应较好.     

人参皂甙Rb1在核因子NF-E2相关因子2/血红素氧合酶-1通路减轻肠缺血再灌注致急性肺损伤中的分子机制

目的 探讨人参皂甙Rb1对肠缺血/再灌注致急性肺损伤的保护效应及核因子NF-E2相关因子2(Nrf2)/血红素氧合酶-1(HO-1)通路参与该效应的分子机制.方法 成年雄性C57BL/6J小鼠随机分为5组:假手术组(S组);肠缺血/再灌注组(I/R组);再灌注+Rb1组(I/R +Rb1组);全反式维甲酸(ATRA)+再灌注组(ATRA+ I/R组);ATRA+再灌注+Rb1组(ATRA+ I/R+Rb1组).采用肠缺血/再灌注模型,Western blot检测肺组织Nrf2、HO-1表达变化;酶联免疫吸附试验(ELISA)法检测肺组织肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-10水平;检测超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量;检测肺湿/干比及肺组织病理损伤评分.结果 与S组比较,其他4组Nrf2、HO-1蛋白表达,TNF-α、IL-6、MDA含量,肺组织湿/干重比及肺组织病理评分增高(P＜0.05);与1/R组比较,1/R+ Rb1组Nrf2,HO-1蛋白表达,TNF-α,IL-6,MDA含量,肺组织湿/干重比及肺组织病理评分降低(P＜0.05);与I/R+ Rb1组比较,ATRA+ I/R组,ATRA+ I/R+ Rb1组Nrf2、HO-1蛋白表达,NF-α、IL-6、MDA含量,肺组织湿/干重比及肺组织病理评分增高(P＜0.05).SOD活性、IL-10水平与上述变化相反.结论 肠缺血/再灌注可引起急性肺损伤,人参皂甙Rb1后处理能通过激活Nrf2/HO-1通路减轻肠缺血/再灌注所致肺损伤.     

肠腔灌注高氧液对缺血-再灌注后肠黏膜屏障损伤的保护作用

目的探讨缺血期经肠腔灌注高氧液对家兔肠缺血-再灌注后肠黏膜屏障损伤的保护作用。方法健康家兔24只,随机均分成三组:缺血-再灌注组(I/R组)、高氧液处理组(HOS组)、假手术对照组(Sham组)。Sham组只开腹游离但不夹闭肠系膜上动脉(SMA),另两组用无损伤动脉夹夹闭SMA1h。HOS组于缺血期以20ml.kg-1.h-1恒速向肠腔灌注高氧液1h,I/R组则以相同的方式灌注等量的生理盐水,松开动脉夹再灌注2h后取标本。光镜下观察各组肠黏膜组织形态学改变,测定肠黏膜组织ATP含量和肠道的氧摄取率(ERO2);定量分析门静脉血中细菌内毒素(ET)含量;检测血清中肿瘤坏死因子α(TNF-α)、乳酸(Lac)水平;观察细菌移位率。结果与Sham组相比,I/R组光镜下肠黏膜损伤严重,肠黏膜组织ATP含量及肠道的ERO2均明显下降,血液中ET含量、Lac和TNF-α水平明显升高(P<0.05或P<0.01),同时出现了广泛的细菌移位;经肠腔灌注高氧液(HOS组)能够明显改善小肠黏膜损伤及上皮细胞形态学改变,显著提高肠黏膜组织ATP含量及ERO2;明显降低血液中ET、Lac和TNF-α水平(P<0.05或P<0.01),同时显著减少肠道细菌移位率(P<0.05)。结论肠腔灌注高氧液能够显著减轻肠缺血-再灌注引起的小肠黏膜屏障功能障碍,是一种安全有效的小肠保护方法。     

细胞穿透肽PEP-1介导的血红素加氧酶-1对大鼠肠缺血再灌注诱发肝损伤的影响

目的 评价细胞穿透肽PEP-1介导的血红素加氧酶-1(HO-1)对大鼠肠缺血再灌注诱发肝损伤的影响.方法 雄性SD大鼠24只,7～9周龄,体重210～260 g,采用随机数字表法,将其分为3组(n=8):假手术组(S组)、肠缺血再灌注组(I/R组)和融合蛋白PEP-1/HO-1组(HO组).采用夹闭肠系膜上动脉45 min,恢复灌注120 min的方法制备大鼠肠缺血再灌注模型.HO组于缺血前30 min经左侧髂静脉注射融合蛋白PEP-1/HO-1 0.5 mg,S组仅分离闭肠系膜上动脉,但不夹闭.于再灌注120 min时,右侧颈总动脉取血样,测定血清AST和ALT的活性;然后处死大鼠,取肝组织,光镜下观察病理学结果,测定MDA含量和SOD活性.结果 与S组比较,I/R组和HO组血清AST和ALT的活性升高,肝组织MDA含量升高,SOD活性降低(P＜0.05);与I/R组比较,HO组血清AST和ALT的活性降低,肝组织MDA含量降低,SOD活性升高(P＜0.05),肝损伤减轻.结论 细胞穿透肽PEP-1介导的HO-1可减轻大鼠肠缺血再灌注诱发的肝损伤.     

舒芬太尼预处理对大鼠心肌缺血再灌注时心肌Toll样受体4表达的影响

目的 探讨舒芬太尼预处理对大鼠心肌缺血再灌注时心肌Toll样受体4(TLR4)表达的影响.方法 雄性SD大鼠36只,体重250～ 300 g,采用随机数字表法,将大鼠分为3组(n=12):假手术组(S组)、缺血再灌注组(I/R组)和舒芬太尼预处理组(SPC组).采用结扎冠状动脉左前降支的方法建立心肌缺血再灌注模型.SPC组于心肌缺血前经股静脉输注舒芬太尼0.2 μg·kg-1·min-1,输注5min,停止5 min,重复3次进行预处理;S组和I/R组输注等容量生理盐水.于心肌缺血前30 min(T0)、缺血前即刻(T1)、缺血30 min(T2)、再灌注30 min(T3)和再灌注120 min(T4)时记录HR及MAP.再灌注120 min时,取血样,测定血清TNF-α浓度;然后处死大鼠,测定心肌梗死体积以及心肌TLR4和NF-κB p65的表达.结果 3组间不同时点HR比较差异无统计学意义(P＞0.05).与S组比较,I/R组和SPC组T2-4时MAP降低,血清TNF-α浓度升高,心肌TLR4和NF-KB p65表达上调(P＜0.01);与I/R组比较,SPC组MAP各时点差异无统计学意义(P＞0.05),心肌梗死体积减少,血清TNF-α浓度降低,心肌TLR4和NF-κB p65表达下调(P＜0.01).结论 舒芬太尼预处理减轻大鼠心肌缺血再灌注损伤的机制可能与下调心肌TLR4的表达有关.     

肠缺血再灌注对大鼠脑组织小胶质细胞活化的影响

目的 探讨肠缺血再灌注对大鼠脑组织小胶质细胞活化的影响.方法 清洁级健康成年雄性SD大鼠128只,体重250-300 g,采用随机数字表法,将其随机分为2组(n=64):假手术组(S组)和肠缺血再灌注组(I/R组).I/R组采用夹闭肠系膜上动脉90 min后再灌注的方法制备肠缺血再灌注损伤模型.于再灌注2、6、24、48 h时观察肠粘膜病理学结果,并行Chiu评分;取脑组织,计数活化的小胶质细胞,计算小胶质细胞活化率,测定脑组织活性氧(ROS)、MDA含量及SOD活性、NO含量、一氧化氮合酶(NOS)及诱导型一氧化氮合酶(iNOS)活性.结果 与S组比较,I/R组肠组织Chiu评分、脑组织活化的小胶质细胞数、小胶质细胞活化率、ROS、NOS和iNOS活性、MDA和NO含量升高,SOD活性降低(P＜0.05或0.01);I/R组再灌注6-48 h脑组织ROS、NOS和iNOS活性、MDA和NO含量依次升高,脑组织SOD活性及肠组织Chiu评分依次降低,脑组织活化的小胶质细胞和小胶质细胞活化率于再灌注24h时达峰值(P＜0.05或0.01).结论 肠缺血再灌注可通过激活脑组织小胶质细胞,激活NOS和促进ROS生成,从而诱发脂质过氧化反应,该作用作为肠缺血再灌注诱发大鼠脑损伤的机制.     

舒芬太尼后处理对大鼠心肌缺血再灌注时细胞凋亡的影响

目的 探讨舒芬太尼后处理对大鼠缺血再灌注时心肌细胞凋亡的影响.方法 健康雄性SD大鼠36只,体重250 ～ 280 g,采用随机数字表法,将大鼠随机分为3组(n=12):假手术组(S组)、缺血再灌注组(I/R组)和舒芬太尼后处理组(SP组).采用结扎左冠状动脉30 min,再灌注120min的方法制备心肌缺血再灌注模型.S组只挂线不结扎左冠状动脉;SP组于再灌注即刻静脉注射舒芬太尼3.0 μg/kg.于缺血再灌注期间记录HR和MAP.于再灌注120 min时,处死大鼠,取心脏,测定心肌梗死面积,采用RT-PCR测定心肌Bax mRNA和Bcl-2 mRNA的表达,采用TUNEL法检测心肌凋亡细胞,计算凋亡指数.结果 三大鼠各时点HR比较差异无统计学意义(P＞0.05);与S组比较,I/R组心肌缺血再灌注期间MAP降低(P＜0.05),SP组差异无统计学意义(P＞0.05),I/R组和SP组凋亡指数和Bax mRNA表达水平升高,I/R组Bcl-2 mRNA表达水平降低,SP组Bcl-2 mRNA表达水平升高(P＜0.05);与I/R组比较,SP组心肌梗死面积、凋亡指数和Bax mRNA表达水平降低,Bcl-2 n.RNA表达水平升高(P＜0.05).结论 舒芬太尼后处理可能通过上调Bcl-2表达,下调Bax表达,抑制细胞凋亡,从而减轻大鼠心肌缺血再灌注损伤.     

ATP敏感性钾通道在硫化氢减轻大鼠肝缺血再灌注损伤中的作用

目的 评价ATP敏感性钾(KATP)通道在硫化氢减轻大鼠肝缺血再灌注损伤中的作用.方法 健康雄性SD大鼠30只,体重220～250 g,采用阻断左叶和中叶肝脏血流的方法制备肝缺血再灌注损伤模型.采用随机数字表法,将大鼠随机分为5组(n=6):假手术组(S组)仅开腹分离肝蒂,不进行肝门阻断及再灌注;缺血再灌注组(I/R组)制备肝缺血再灌注模型;硫氢化钠组(NaHS组)于再灌注前5 min时腹腔注射NaHS 28 μmol/kg,余同I/R组;格列本脲组(G组)于NaHS给药前5 min时腹腔注射非选择性KATP通道阻断剂格列本脲6 mg/kg,余同NaHS组;5-羟基葵酸组(5-HD组)于NaHS给药前5 min时腹腔注射选择性KATP通道阻断剂5-HD 10 mg/kg,余同NaHS组.于再灌注6h时,采集下腔静脉血样,测定血清ALT和AST的活性;然后处死大鼠,取肝组织,测定TNF-α含量和MPO活性,并观察病理学结果.结果 与S组比较,I/R组、NaHS组、G组和5-HD组血清ALT和AST活性升高,I/R组、G组和5-HD组肝组织TNF-α含量和MPO活性升高,NaHS组肝组织TNF-α含量升高(P＜0.01);与I/R组比较,NaHS组血清ALT、AST活性和肝组织TNF-α含量、MPO活性降低(P＜0.01),病理学损伤减轻;与NaHS组比较,G组和5-HD组血清ALT、AST活性和肝组织TNF-α含量、MPO活性升高(P＜0.01).结论 KATP通道的开放参与了硫化氢减轻大鼠肝缺血再灌注损伤.     

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 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.     

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.