单肺通气期间体位对血液氧合的影响

目的比较单肺通气(OLV)期间不同体位对血液氧合及肺内分流的影响。方法15例择期开胸食管癌根治术病人,ASAⅠ~Ⅱ级,于仰卧位双肺通气(TLV)(T1)、仰卧位OLV 30 min(T2),侧卧位开胸前OLV 30 min(T3)分别进行动静脉血气分析,并计算肺内分流率(Qs/Qt)。结果T2与T1比较,动脉血氧分压(PaO2)、混合静脉血氧分压(P-VO2)、动脉血氧饱和度(SaO2)、混合静脉血氧饱和度(S-VO2)和静脉血氧饱和度(CvO2)明显下降,Qs/Qt明显升高(P<0.01),动脉血氧含量(CaO2)明显下降(P<0.05)。T2与T1相比,PaO2明显下降,Qs/Qt明显升高(P<0.01),SaO2明显下降(P<0.05),P-VO2、S-VO2、CaO2和CvO2无明显变化。T2与T3比较,PaO2和S-VO2明显下降,Qs/Qt明显升高(P<0.01)。P-VO2、SaO2和CvO2明显降低(P<0.05)。结论T3较T2能明显改善血液氧合,减少肺内分流。     

单肺通气期间雷米芬太尼和硬膜外镇痛对血液氧合及肺内分流的影响

目的比较单肺通气（OLV）期间雷米芬太尼和胸段硬膜外镇痛对血液氧合及肺内分流的影响.方法14例择期开胸食管癌根治术患者,ASA Ⅰ～Ⅱ级.于全麻双肺通气（TLV）、雷米芬太尼输注OLV 30 min和停雷米芬太尼胸段硬膜外镇痛OLV 30 min,分别进行动、静脉血气分析,并计算肺内分流率（Qs/Qt）.结果与TLV时比较,OLV时动脉血氧分压（PaO2）明显下降,Qs/Qt明显升高（P＜0.01）,混合静脉血氧分压（PvO2）、动脉血氧饱和度（SaO2）、动脉血氧含量（CaO2）均明显下降（P＜0.05）.但OLV时输注雷米芬太尼与硬膜外镇痛相比,PaO2、Qs/Qt、PvO2、SaO2、CaO2均无显著性差异.结论OLV期间输注雷米芬太尼和硬膜外镇痛对血液氧合和肺内分流无明显影响.     

异丙酚和氯胺酮对单肺通气犬肺内分流的影响

目的 对比观察异丙酚和氯胺酮对单肺通气犬肺内分流的影响,探讨异丙酚对缺氧性肺血管收缩反应(HPV)的影响程度。方法 杂种犬12只,随机分为异丙酚组、氯胺酮组。两组均于单肺通气(OLV)前30 min开始静滴异丙酚或氯胺酮6 mg·kg-1·h-1,后行单肺通气,于双肺通气(TLV)30 min、单肺通气2、10、30、60 min同时采集动脉血及混合静脉血行血气分析,并计算分流率(Qs/Qt)。结果 两组TLV 30 min Qs/Qt差异无显著性(P>0.05),OLV 2 min时Qs/Qt均较TLV时明显增高(P<0.01),但两组间无明显差异(P>0.05)。OLV 10、30及60 min时两组间Qs/Qt差异有显著性(P<0.05),组内不同时间Qs/Qt差异也有显著性(P<0.05)。结论 异丙酚与氯胺酮相比轻度增加单肺通气时肺内分流。     

异丙酚靶控输注对单肺通气肺内分流的影响

目的:研究异丙酚靶控输注(TCI)对单肺通气(OLV)时肺内分流、动脉氧合和肺顺应性(Cdyn)的影响.方法:选择20例ASA I～II级开胸手术患者随机分为两组(每组10例),异丙酚TCI组(P组)设定诱导时靶浓度为4μg/mL,术中维持为3～5μg/mL,对照组用异氟醚0.7～1.3 MAC吸入维持麻醉.在麻醉后双肺通气(TLV)10 min(t1)、单肺通气(OLV)30 min(t2)、OLV 60 min(t3)、OLV 120 min(t4)、恢复TLV 30 min(t5)各时间里抽取动脉血和右心房血行血气分析并计算肺内分流率(Qs/Qt)及肺顺应性(Cdyn).结果:术中两组生命体征维持平稳,OLV后t2、t3、t4与t1相比两组Qs/Qt有明显升高(P＜0.05),而PaO2明显下降(P＜0.05),但两组间比较差异无显著性.Cdyn在C组下降明显(P＜0.05),两组比较差异显著.结论:异丙酚靶控输注与异氟醚比较并不明显增加肺内分流、降低动脉血氧分压及肺顺应性,且术中血流动力学稳定.     

单肺通气前通气侧肺前列腺素E_1超声雾化对气体交换的影响

目的观察单肺通气(OLV)前右侧肺前列腺素E1(PGE1)超声雾化对OLV期间肺内分流率(Qs/Qt)及动脉氧合的影响。方法择期行左胸食管癌根治术患者60例,随机均分为两组:在OLV前对右侧肺雾化吸入PGE10.2μg/kg(P组)和等量生理盐水(C组)。记录雾化吸入前(T1)、OLV 10min(T2)、OLV 15 min(T3)、OLV 30 min(T4)、OLV 60 min(T5)和OLV 120 min(T6)时的氧合指数及血流动力学指标。结果两组患者PaO2在OLV开始后均呈直线下降,其中C组在T4时降至最低点;T2~T4时P组PaO2明显高于C组(P0.05),且PaO2的最低值延迟至T5时出现。T2~T4时P组Qs/Qt明显低于C组(P0.05)。两组不同时点血流动力学差异无统计学意义。结论 OLV前右侧肺雾化吸入0.2μg/kg PGE1能减少肺内分流,改善氧合。     

小剂量乌拉地尔对单肺通气期间动脉氧合及血流动力学的影响

目的 观察小剂量乌拉地尔对单肺通气(OLV)期间动脉氧合及血流动力学的影响.方法 择期行食管癌根治术患者100例,随机均分为两组,分别在OLV期间持续静脉输注乌拉地尔4 μg· kg-1 ·min-1(U组)和等容量生理盐水(C组).记录两组双肺通气20 min(T0)、OLV 20 min (T1)、30 min(T2)、45 min(T3)、60min(T4)时的氧合指标及血流动力学指标.结果 与T0时比较,T1～T4时两组患者PaO2均明显降低,Qs/Qt明显升高(P＜0.01).与T1时比较,T3、T4时U组患者PaO2显著升高,Qs/Qt显著降低(P＜0.05) ;T4时C组患者PaO2明显升高,Qs/Qt明显降低(P＜0.05).与C组比较,T3、T4时U组患者PaO2明显升高,Qs/Qt明显降低(P＜0.05).两组各时点MAP、HR差异无统计学意义.结论 小剂量乌拉地尔可改善OLV期间动脉氧合,减少肺内分流,但对血流动力学无明显影响.     

乌司他丁对术中单肺通气患者术后肺内分流及动脉血氧合的影响

目的观察术中单肺通气患者术中和术后24小时的动脉血氧合以及肺内分流的变化,并研究乌司他丁对单肺通气患者术后保护作用。方法对术中需行单肺通气的肺叶切除术患者60例ASAⅡ～Ⅲ级,随机分为对照组P以及术前使用乌司他丁5000U/kg的实验组W。每组均为30例,手术开始时,手术结束时,术后24h分别进行动脉血及混合静脉血作血气分析,并计算Qs/Qt及PaO2。结果手术结束时,两组Qs/Qt均有增加(P<0.05),然而实验组术后24h在Qs/Qt是低于对照组(P<0.05)。手术结束时两组动脉血氧合与术前无明显差异。在术后24小时,两组的PaO2/FiO2是低于单肺通气前,但术后24小时,实验组在PaO2/FiO2高于对照组(P<0.05)。结论乌司他丁能够有效改善开胸手术术中单肺通气患者术后动脉血氧合状况,减少术后肺内分流。     

硬膜外阻滞复合全麻对单肺通气期间气体交换的影响

目的 观察胸段硬膜外阻滞复合全麻对单肺通气期间气体交换的影响.方法 随机选择ASA Ⅰ～Ⅱ级择期开胸手术病人80例,将病人随机分为两组,全麻复合硬膜外麻醉组(A组)和全麻组(B组),每组40例.两组病人在开胸前双肺通气20 min(T1)时及开胸后单肺通气(OLV)30 min(T2)、60 min(T3)、120 min(T4)时,分别采动脉血及混合静脉血,观察病人动静脉血气情况并计算肺内分流率(Qs/Qt)值、肺泡-动脉血氧分压差(A-aDO2)和无效腔量/潮气量(Vd/Vt)值.结果 与T1相比,两组T2-4时Paw均升高(P<0.01),T2-4时Qs/Qt均增加(P<0.01),A-aDO2增加(P<0.01),PaO2降低(P<0.01),而Vd/Vt,血压、心率变化无统计学差异(P>0.05);与B组相比,A组T2-4时的Qs/Qt增加(P<0.01),A-aDO2增加(P<0.01),PaO2,降低(P<0.01),而Vd/Vt,血压、心率变化无统计学差异(P>0.05).结论 单肺通气期间硬膜外阻滞复合全麻对肺换气功能有影响,使Qs/Qt增加,PaO2下降,A-aDO2增大;对肺泡通气功能指标Vd/Vt影响甚微.     

不同压力的持续气道正压对化疗后病人单肺通气氧合与分流的影响

目的　探讨应用一种新的持续气道正压 (CPAP)系统在肺癌病人化疗后单肺通气(OLV)时对病人氧合和肺内分流的影响。方法　择期手术病人 30例 ,ASAⅠ～Ⅲ级 ,随机分为对照组 (A组 )、CPAP 2组 (B组 )和CPAP 5组 (C组 ) ,每组 1 0例。A组在OLV期间非通气侧肺的支气管导管直接开口于大气中 ;B组OLV期间非通气侧持续给予CPAP(压力 2cmH2 O) ,C组OLV期间非通气侧持续给予CPAP(压力 5cmH2 O) ,并在平卧双肺通气 2 0min ,仰卧OLV 2 0min ,侧卧OLV2 0、4 0min和关胸双肺通气时 ,分别采取动脉血行血气分析并计算肺内分流率 (Qs/Qt)。结果在OLV后 2 0、4 0min时 ,B、C两组氧合明显高于A组 (P <0 .0 1 ) ,B、C两组Qs/Qt明显低于A组 (P<0 .0 5 ) ,B、C两组之间氧合和Qs/Qt仅在OLV后 4 0min时差异显著。结论　化疗后病人非通气侧持续CPAP ,有助于提高氧合 ,减少肺内分流 ,减少低氧血症的发生率 ,且CPAP 2cmH2 O更易为临床所接受     

化疗后病人单肺通气期间氧合及肺内分流的变化

目的探讨肺癌化疗后病人在单肺通气期间氧合和肺内分流的变化。方法ⅢA期非小细胞肺癌病人20例(CT组),盐酸吉西他滨或多西他赛联合卡铂2周期化疗后手术,术前ASAⅡ～Ⅲ级。另选20例术前未化疗肺癌病人为对照组(C组)。麻醉诱导后,插入双腔气管导管,用纤支管镜确保导管到位。桡动脉穿刺置管测压和中心静脉置管(17～18cm)。在双肺通气后20min(S1)、单肺通气后20min(S2)、40min(S3)、80min(S4)、再次双肺通气后30min(S5)时分别采取动脉血和静脉血测血气,记录PaO2、PaCO2、PVO2、pH、Hb等。根据肺内分流标准模型公式计算Qs/Qt。结果与双肺通气相比,两组在单肺通气期间PaO2明显降低(P<0.05),两组在单肺通气期间Qs/Qt均明显增加(P<0.05),两组在单肺通气期间PVO2均明显下降(P<0.05)。与对照组相比,在单肺通气期间,化疗组PaO2明显低于对照组(P<0.05),化疗组Qs/Qt明显高于对照组(P<0.05)。与双肺通气相比,两组在单肺通气期间气道压力(Paw)明显升高(P<0.05)。结论化疗后肺癌病人在手术中进行单肺通气期间,由于化疗药物的肺毒性作用和弥散功能的受损,与未化疗肺癌病人相比,PaO2下降更加显著,肺内分流也相应增多。     

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.     

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.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

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.