心脏死亡器官捐献供肾与传统尸体供肾肾移植的疗效比较

目的 比较心死亡器官捐赠(DCD)供肾与传统尸体供肾肾移植的疗效.方法 回顾性分析单中心2007年2月至2012年6月的69例DCD供肾肾移植受者的资料,并根据受者年龄(相差10岁以内)、移植次数和免疫抑制剂应用情况,按1∶2的比例匹配同期138例传统尸体肾移植受者,进行资料比较.结果 DCD肾移植组术后移植肾功能恢复延迟(DGF)和原发性移植肾无功能(PNF)的发生率为29.0％和2.9％,而传统尸体肾移植组为13.8％和0,差异有统计学意义(P＜0.05).Kaplar-Meier分析结果表明,DCD肾移植组术后6个月、1年和3年的移植肾存活率分别为95.7％、95.7％和93.3％;而传统尸体肾移植组分别为97.8％、97.8％和96.8％,两组的差异无统计学意义(P＞0.05).两组受者存活率的差异也无统计学意义(P＞0.05).术后7和14d,DCD肾移植组的移植肾肾小球滤过率低于传统尸体肾移植组(P＜0.05),但术后1个月至1年,两组移植肾肾小球滤过率的差异无统计学意义(P＞0.05).结论 虽然术后DGF和PNF发生率较高,但DCD肾移植的长期疗效与传统尸体肾移植相当,DCD供肾可以作为替代传统尸体供肾的良好来源.     

持续低效每日透析治疗移植肾功能延迟恢复的临床效果

目的 探讨持续低效每日透析(sustained low-efficiency dai1y dialysis,SLEDD)治疗肾移植术后移植肾功能延迟恢复(delayed graft function,DGF)的疗效.方法 选择2011年6月至2016年3月西安交通大学第一附属医院肾移植科78例同种异体尸体肾移植术后发生DGF且需行肾脏替代治疗的患者.其中采用间断性血液透析(intermittent hemodialysis,IHD)治疗22例,采用SLEDD治疗32例,采用持续静脉-静液滤过(continuous veno-venous hemofiltration,CVVH)治疗24例,三组治疗前临床资料比较差异无统计学意义(P＞0.05).回顾性分析三种血液净化治疗模式对DGF患者尿毒症毒素浓度变化、血流动力学、水-电解质和酸碱平衡、疾病转归指标及所需血液净化时间、费用的影响.结果 三组患者每次治疗后尿毒症毒素平均浓度变化IHD组高于SLEDD及CVVH组(P＜0.01),血流动力学不稳定的发生率IHD组高于SLEDD及CVVH组(P＜0.05),每日液体出入量、超滤量SLEDD及CVVH组均较IHD组增多(P＜0.05),肾功能恢复率SLEDD及CVVH组优于IHD组(P＜0.05),移植肾功能恢复时间SLEDD及CVVH组明显短于IHD组(P＜0.05),SLEDD与CVVH组比较差异无统计学意义(P＞0.05).电解质及酸碱平衡指标三组间差异无统计学意义(P＞0.05);血液净化治疗费用CVVH组明显高于IHD及SLEDD组(P＜0.05),IHD组与SLEDD组无明显差别(P＞0.05).结论 SLEDD在DGF治疗中,与IHD比较,患者血流动力学相对稳定,移植肾功能恢复率高、恢复时间短,并有相对较大的液体摄入空间;与CVVH比较,尿毒症毒素浓度变化、血流动力学、移植肾功能恢复率及恢复时间无明显差异,但血液净化治疗所需时间及费用相对较少.     

体质指数对移植肾功能恢复的影响

目的 探讨体质指数(body mass index,BMI)对肾移植术后移植肾功能恢复的影响.方法 回顾性分析2009年5月至2015年3月在昆明医科大学第一附属医院器官移植中心行活体供肾移植术的104例受者的临床资料,根据《中国成人超重和肥胖症预防控制指南》推荐的标准,将所有符合要求的受者分为消瘦组(BMI＜ 18.5 kg/m2)、正常组(BMI 18.5～23.9 kg,/n2)、肥胖和超重组(BMI＞ 23.9 kg/m2),比较3组移植肾术后1周、2周、3周、1个月、3个月、6个月及1年血肌酐(Cr)变化、移植肾功能延迟恢复(delayed graft function,DGF)、1年内急性排斥反应(acute rejection,AR)发生率.结果 消瘦组与正常组DGF和AR发生率差异无统计学意义(P＞0.05);肥胖和超重组DGF及AR发生率较正常组明显增高,差异有统计学意义(P＜0.05).消瘦组、正常组、肥胖和超重组移植肾术后1周、2周、3周、1个月、3个月、6个月及1年Cr变化均与BMI呈正比例关系,体型肥胖的受者Cr较体型瘦弱或正常者高,肾功能恢复慢.结论 BMI是DGF、AR的独立影响因素,肥胖和超重的受者术后发生DGF和AR风险高,Cr达到正常范围所需时间长,移植肾功能恢复慢.     

两种不同供肾来源肾移植受体疗效的临床随访研究

目的:比较国人活体肾移植与尸体肾移植的疗效并分析相关因素。方法:对同期154例活体肾移植受体(活体供肾组)和包括DCD供体在内的262例尸体肾移植受体(尸体供肾组)随访12~58个月,分析比较两组患者移植肾并发症、肾功能和人肾累积存活率情况。结果:活体供肾组和尸体供肾组分别发生急性排斥反应(AR)18例(11.7%)和59例(22.5%)(P=0.006),移植物功能延迟恢复(DGF)6例(3.9%)和28例(10.7%)(P=0.015)。两组在7天、1、3、6、12、36个月六个随访点的Ccr和Scr结果显示,早期活体供肾组移植肾功能恢复稍快,但在术后12和36个月时,两组Ccr和Scr的差异并无统计学意义。活体供肾组和尸体供肾组在整个随访期内的人肾累积存活率差异也无统计学意义,1年时人累积存活率分别为96.5%和97.9%(P=0.414),移植物累积存活率为96.2%和97.4%(P=0.726);3年时人累积存活率分别为96.2%和95.8%(P=0.846),移植物累积存活率为93.7%和92.8%(P=0.875)。结论:两种供肾方式受体1年和3年人肾累积存活率相似。活体肾移植受体AR、DGF等并发症发生率较低,早期肾功能恢复稍快,但1年及3年时肾功能与尸体肾移植相似,随访期内活体供肾组受体最佳肾功能出现在术后3年时,而尸体供肾组出现在术后3个月时。     

LifePort保存心脏死亡器官捐献供肾的临床研究

目的:探讨采用LifePort保存心脏死亡器官捐献(DCD)供肾对移植肾功能恢复的影响。方法:分析解放军三〇三医院2012年8月~2013年10月期间30个DCD案例肾移植后受者的临床资料。根据同一供体两只供肾采用不同的保存方式,随机分入LifePort组(n=30)和普通冷藏组(n=30例),比较两组受者肾功能恢复延迟(DGF)、急性排斥反应(AR)等并发症的发生率及移植肾功能恢复等情况。结果:LifePort组受者的DGF发生率为20%(6/30),而普通冷藏组的DGF发生率为46.7%(14/30),差异有统计学意义(P0.05)。两组间AR发生率、围手术期移植肾存活率及受者存活率的差异无统计学意义(P0.05)。LifePort组受者术后出院时血清肌酐恢复优于普通冷藏组,且平均住院时间较短,差异有统计学意义(P0.05)。结论:LifePort能有效改善离体DCD供肾的保存质量,降低受者DGF发生率,有利于移植肾功能恢复。     

肾移植中应用IL-2受体拮抗剂与抗胸腺细胞球蛋白行免疫诱导的长期疗效比较

目的 比较肾移植中应用白细胞介素2受体拮抗剂(IL2Ra)与抗胸腺细胞球蛋白(rATG)行免疫诱导的长期疗效.方法 回顾性分析2006年至2010年间的371例肾移植受者,其中使用IL2Ra诱导治疗者261例(IL2Ra组),使用rATG诱导治疗者110例(rATG组).所有受者术后采用钙调磷酸酶抑制剂+吗替麦考酚酯+皮质激素的三联免疫抑制方案,并使用更昔洛韦预防巨细胞病毒感染,使用复方磺胺甲(恶)唑预防卡氏肺孢子虫感染.术后对所有受者随访了1～5年,观察和比较移植肾功能恢复延迟(DGF)、1年内急性排斥反应和感染的发生率,以及受者和移植肾长期存活率等.结果 两组间受者性别、年龄、原发病等资料的差异均无统计学意义(P＞0.05),但与IL2Ra组比较,rATG组受者接受的供肾更多来源于尸体供肾(P＜0.01),且供肾冷缺血时间较长(P＜0.01).IL2Ra组和rATG组术后DGF发生率分别为3.1％和1.8％(P＞0.05),术后1年内急性排斥反应发生率分别为10.7％和2.7％ (P＜0.05),感染发生率分别为14.9％和21.8％ (P＞0.05).术后1、2和3年,IL2Ra组受者存活率分别为98.9％、98.9％和98.5％,rATG组均为98.2％ (P＞0.05);IL2Ra组移植肾存活率分别为98.5％、98.1％和97.7％,rATG组均为97.3％(P＞0.05).结论 在临床肾移植中,经rATG诱导治疗较IL2Ra有更低的急性排斥反应发生率,并且不增加发生感染的风险.     

HLA-G与肾移植术后急性排斥反应和巨细胞病毒活动性感染的相关性研究

目的 探讨HLA-G的表达水平与肾移植术后急性排斥反应(AR)和巨细胞病毒(CMV)活动性感染的相关性.方法 根据术后是否发生AR或CMV活动性感染,将132例初次肾移植受者分为肾功能稳定组、AR组和CMV组.另选择41例健康供者作为对照组.采用流式细胞术、酶联免疫吸附试验、蛋白质印迹法以及实时定量聚合酶链法检测各组HLA-G及其mRNA的表达,并采用免疫组织化学法观察移植肾组织中HLA-G的表达.结果 肾移植前后各组膜结合型HLA-G1 (mHLA-G1)的表达均处于较低水平,仅术后CMV组mHLA-G1+的中性粒细胞出现显著升高(P＜0.05).术前可溶性HLA-G5(sHLA-G5)的表达水平肾功能稳定组显著高于对照组(P＜0.05);术后sHLA-G5的表达水平CMV组显著高于肾功能稳定组(P＜0.05),而肾功能稳定组均高于对照组和AR组(P＜0.05),AR组与对照组的差异无统计学意义(P＞0.05).术后CMV组sHLA-G5 mRNA的表达水平最高(P＜0.05),肾功能稳定组次之,对照组和AR组均较低.21例AR组移植肾组织活检样本中,17例HLA-G表达呈阴性,3例呈阳性,1例呈弱阳性;9例CMV组移植肾组织活检样本的HLA-G表达均为阳性.132例受者中,28例CMV感染者的AR发生率为7.1％(2/28),104例非CMV感染者的AR发生率为25.0％(26/104),二者间AR发生率的差异有统计学意义(P＜0.05).结论 sHLA-G5可作为预测AR和CMV感染的生物标志分子;CMV感染和AR与受者体内的免疫平衡状况相关.     

肾移植术后6个月血清肌酐水平对移植肾长期存活的影响

目的探讨肾移植术后半年肾功能对移植肾长期存活的影响。方法回顾性分析自1992年4月至2001年3月在本中心进行首次单纯尸体肾移植病例794例的临床资料。根据术后6个月时间点血清肌酐(Scr)水平,分为肾功能异常组(Scr>133μmol/L)与肾功能正常组(Scr≤133μmol/L)。通过Kaplan-Meier方法分别计算包括急性排斥(AR)、延迟复功(DGF)和不包括AR、DGF时两组患者带功和排除带功死亡时移植肾短期和长期存活率。结果两组在受体移植时年龄、淋巴毒、冷/热缺血时间及免疫抑制剂方案无显著性差异;而男女性别比例、受体体重、随访时间、术后6个月内AR和DGF发生率、术后6个月或12个月环孢素A(CsA)剂量、随访期间及Scr水平等差异有显著性意义。肾功能异常组与正常组相比有较高的AR和DGF的发生率,但不管是否存在AR和DGF,肾功能异常组带功和排除带功死亡时移植肾的长期存活均明显低于肾功能正常组。结论术后6个月Scr水平影响移植肾的长期存活。     

应用血肌酐下降率预测肾移植患者术后早期肾功能恢复情况

目的 探讨肾移植术后患者SCr下降率(CRRz)与早期移植肾功能恢复情况的相关性,建立早期预测移植.肾功能恢复的标准. 方法同种异体肾移植术后患者80例.分3组:①移植肾功能立即恢复(IGF)组53例,术后5 d SCr＜265.2 gmol/L;②移植肾功能缓慢恢复(SGF)组14例,术后5 d SCr＞265.2gmol/L,但1周内不需要透析治疗;③移植肾功能延迟恢复(DGF)组13例,术后1周内需要透析治疗.比较分析3组患者CRR:值和CRRz的99%可信区间(99%CI).结果 IGF组、SGF组和DGF组患者CRR2值分别为(46.8±14.6)%、(25.6±13.5)%和(0.7±17.7)%,99%C1分别为41%～52%、15%～36%和-14%～16%.3组间CRR2值两两比较,差异有统计学意义(P≤0.01).由3组CRR2的99%CI设定IGF、SGF、DGF的早期预测标准分别为CRR2≥40%、15%＜CRR2＜40%和CRR2≤15%.结论 CRR2与术后早期移植肾功能恢复情况有较好的相关性,可用于早期预测移植术后患者发生明功能延迟恢复的风险.     

术前自体骨髓间充质干细胞输注用于肾移植诱导治疗的临床研究

目的 观察骨髓间充质干细胞( BMSC)输注预防肾移植早期急性排斥反应(AR)的有效性和安全性.方法 88例肾移植受者分为BMSC组(43例)和对照组(45例),BMSC组于肾移植当天和术后2周时分别经外周静脉输注自体BMSC,对照组不进行任何诱导治疗.观察两组AR的发生情况、移植肾功能、并发症发生情况,随访时间为24个月.结果 两组患者基本资料的差异无统计学意义(P＞0.05).BMSC组在术后3、6个月AR的发生率分别为4.7％和9.3％,明显低于对照组的20.0％和26.7％(P＜0.05).BMSC组术后7、14和30d的估算肾小球滤过率(eGFR)分别为(1.28±0.62)、(1.33±0.63)和(1.47±0.49)ml/s,明显高于对照组(P＜0.01,P＜0.01,P＜0.05).BMSC组并发症的发生率为44.2％,低于对照组的66.7％(P＜0.05).两组24个月时AR的发生率和eGFR的差异无统计学意义(P＞0.05).两组移植后感染发生率的差异无统计学意义(P＞0.05).结论 术前自体BMSC输注可降低肾移植后早期AR的发生率,可促进移植肾功能早期恢复,安全性较好.     

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.