PLIF围手术期隐性失血相关影响因素初步分析

目的初步探讨分析腰椎后路椎体间植骨融合术(posterior lumbar interbody fusion,PLIF)围手术期患者一般情况与隐性失血间的相关性。方法回顾2012年8月至2014年12月在我院接受PLIF手术且临床资料完整的42例病例,统计分析患者性别、年龄、BMI、ASA分级、手术节段、手术时间以及术中、术后失血情况,计算隐性失血量。通过单因素方差及多元线性回归模型分析患者围手术期一般情况对于隐性失血的影响。结果单因素分析显示手术节段组与手术时间组内隐性出血量均存在统计学差异(P0.05)。多变量线性回归模型提示手术节段是影响隐性出血的独立危险因素。单节段手术组隐性出血量明显少于双节段及多节段手术组(P0.05),但三者隐性失血量占总失血量比例无明显差别。结论 PLIF手术时间延长可能会增加围手术期隐性失血量,手术节段是影响围手术期隐性出血的危险因素之一。     

PVP治疗骨质疏松性椎体压缩性骨折过程中隐性失血及其危险因素分析

目的：探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗过程中出现隐性失血（hidden blood loss,HBL）的影响因素。方法：对2016年3月至2017年12月接受经皮椎体成形术治疗的125例（男55例,女70例）骨质疏松性椎体压缩性骨折的（osteoporotic vertebral compression fractures,OVCFs）临床资料进行回顾性分析。术前均行腰椎正侧位、双斜位及动力位X线片,腰椎CT、MRI及双能X射线骨密度仪（DXA）检查明确诊断。其中胸椎10例,胸腰椎89例,腰椎26例。单节段87例,双节段29例,3节段9例。67例患者椎体压缩高度比例<1/3,41例在1/3~2/3,17例>2/3。术前与术后3 d行血常规检查,分析HBL情况并探索其危险因素。结果：125例患者隐性失血为（317±156）ml。经过多重线性回归分析发现糖尿病病史（P=0.011）、手术节段（P=0.036）、节段数量（P<0.001）、椎体高度丢失率（P=0.002）、椎体高度恢复率（P<0.001）和骨水泥渗漏率（P=0.003）与隐性失血呈正相关。同时,发现椎体高度丢失率高者失血量较椎体高度丢失率低者多,椎体高度恢复良好者失血量较椎体高度恢复不良者多,水泥泄漏也是增加隐性失血的重要因素。然而,骨密度（P=0.814）,高血压病史（P=0.055）与隐性失血无显著相关性。结论：OVCFs患者经过PVP治疗后隐性失血量较大,需要引起关注;同时糖尿病病史、手术节段、节段数量、骨水泥渗漏率、椎体高度丢失率和椎体高度恢复率是增加隐性失血量的危险因素。     

骨质疏松性椎体压缩性骨折椎体后凸成形术后隐性失血及其影响

目的：探讨骨质疏松性椎体压缩性骨折在椎体后凸成形术后隐性失血及相关危险因素。方法：对2015年3月至2017年12月收治的153例骨质疏松性椎体压缩性骨折并接受椎体后凸成形术患者的临床资料进行回顾性分析,其中男55例,女98例;年龄68~87（78.6±11.4）岁。收集患者手术前后红细胞比容用于计算隐性失血量,通过多元线性回归模型分析患者的性别、年龄、体重指数、骨密度、是否合并糖尿病和高血压、手术方式（单侧或双侧）、手术时间、手术节段及数量、椎体丢失高度及恢复高度比因素对于隐性失血的影响。结果：术后隐性失血量为（287.7±68.5）ml。多元线性回归分析显示糖尿病病史（β=2.405,P=0.012）,手术方式（β=3.042,P<0.001）,手术时间（β=2.043,P=0.038）,手术节段（β=1.993,P=0.043）及数量（β=0.374,P<0.001）,椎体高度丢失（β=2.785,P=0.003）及恢复比例（β=7.301,P<0.001）与隐性失血相关。结论：骨质疏松性椎体压缩性骨折椎体后凸成形术存在一定程度的隐性失血,糖尿病病史、手术方式、手术时间、手术节段及数量、椎体高度丢失及恢复比例为隐性失血的危险因素。     

骨质疏松性椎体压缩骨折病人经皮椎体后凸成形术后隐性失血情况及其影响因素

目的 观察骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures, OVCFs）病人行经皮椎体后凸成形术（percutaneous kyphoplasty, PKP）的隐性失血情况,并分析其影响因素。方法 选取2016年9月至2018年5月行PKP手术的100例OVCFs病人进行回顾性分析。根据病人的身高、体重、术前和术后红细胞比容（Hct）、血红蛋白水平计算失血量。收集病人的性别、年龄、身体质量指数（body mass index, BMI）、椎体高度压缩率、椎体高度恢复率、骨折节段数、骨密度、骨水泥渗漏、高血压、糖尿病、手术时间,并分析其与隐性失血量的相关性。结果 本组病人PKP术后的隐性失血量为（293±101） ml,术后血红蛋白丢失量是（8.1±3.5） g/L。单因素分析结果显示手术时间、手术节段、椎体高度恢复率、椎体高度压缩率、骨水泥渗漏、骨密度T值、合并高血压是影响隐性失血量的相关因素。多元线性回归分析结果显示,手术节段数（P=0.008）、椎体高度压缩率（P=0.005）、椎体高度恢复率（P=0.016）、骨水泥渗透（P=0.038）与隐性失血量呈正相关性。结论 PKP术前,应重点关注手术节段数多、椎体高度压缩率高的病人,提高手术评估能力,保障病人的临床安全。     

ASA 评分在肝癌患者外科治疗风险评估中的作用

目的：探讨ASA评分对肝癌患者外科治疗风险评估的价值。 方法：回顾2006年1月—2010年12月419例原发性肝癌肝切除患者围手术期临床资料,分析患者ASA评分与临床因素的关系,并对可能的相关因素作单因素筛选后行多因素回归分析,分析肝癌术后并发症及术中输血有关的影响因素。 结果：统计分析显示,肝癌患者术前并发症及术前血红蛋白影响ASA评分;随着ASA评分上升,患者术中失血量、输血量、术后并发症及住院天数明显高增加（均P<0.05）。多因素回归分析结果显示,ASA评分、失血量、肝硬化、年龄、丙氨酸转氨酶（ALT）水平是术后并发症发生的独立影响因素（均P<0.05）;ASA评分、手术时间、肿瘤直径是术中输血的独立影响因素（均P<0.05）。 结论：ASA评分是肝癌患者围手术期风险较好的早期预测指标。     

PLIF手术隐性失血危险因素分析

目的初步探讨经后路腰椎椎体间植骨融合术(posterior lumbar interbody fusion,PLIF)隐性失血与患者一般情况间的相关性。方法回顾性研究2016年10月至2017年10月在我院脊柱外科进行PLIF手术且临床资料完整的94例病例,其中男49例,女45例,年龄40~80岁,平均60.8岁。老年患者54例,超重42例。36例腰椎间盘突出症,46例腰椎椎管狭窄症,12例腰椎滑脱,其中单节段手术61例,双节段手术33例。统计患者年龄、性别、身体质量指数、手术时间、手术节段,统计术中失血量和术后引流量,评估隐性失血情况。分析患者的一般情况与围手术期隐性失血的相关性。结果手术时间(137.92±43.85)min,59例手术时间≥120min。围手术期总失血量(1 274.65±318.43)mL,显性失血量(746.44±118.62)mL,隐性失血量(529.47±189.53)mL,占总失血量的41.38%。单因素分析结果提示手术节段组内及手术时间组内隐性失血量差异均有统计学意义(P0.01)。多元线性回归分析结果提示手术节段是隐性出血的独立危险因素之一。单节段手术组隐性、显性及总失血量均显著低于双节段组(P0.01),但二者隐性失血量在总失血量中的比例差异无统计学意义(P0.05)。结论 PLIF手术节段数量是隐性出血的独立危险因素之一。     

口服和静脉注射氨甲环酸对于腰椎椎管减压融合术的围手术期失血量影响

目的：探讨氨甲环酸（tranexamic acid,TXA）不同给药方式对腰椎椎管减压融合术围手术期失血量、隐性出血量、输血率,以及不良反应等各方面的影响。方法：对2019年7月至2020年7月接受腰椎椎管减压融合术的60例患者进行回顾性分析,根据TXA不同给药方式分为观察组和对照组,每组30例。观察组术前2 h口服2 g TXA;对照组在切皮前5~10 min予以1 g TXA静脉输注,术后6 h予以1 g TXA静脉输注1次。分别记录两组患者术中出血量、术后引流量、总失血量、隐性失血量、引流管拔除时间、输血率、静脉血栓形成率、不良事件发生率,观察术前和术后1、3 d血红蛋白（hemoglobin,Hb）,红细胞比容（hematocrit,HCT）的变化情况。结果：术后1、3 d的Hb及HCT均较术前有明显改善（P<0.01）,但组间比较差异无统计学意义（P>0.05）。两组术中出血量、术后引流量、总失血量、术中失血量、隐性失血量、拔管时间、输血率比较差异无统计学意义（P>0.05）。两组患者均未见静脉血栓形成和不良事件发生。结论：在腰椎椎管减压融合术围手术期口服TXA与静脉注射TXA在减少围手术期失血量的效果是相当的,且是安全可靠的,从节约医疗成本和使用便利性方面建议口服TXA。     

老年骨科手术患者术前衰弱与术后1年内死亡的相关性

目的 探讨老年患者择期骨科手术后1年内死亡的危险因素,探究衰弱与术后1年内死亡的相关性。
方法 选择2018年12月至2019年6月接受择期骨科手术老年患者313例,男94例,女219例,年龄≥65岁,ASA Ⅰ—Ⅳ级。收集并记录性别、年龄、BMI、ASA分级、受教育年限以及术前、术中指标,采用埃德蒙顿衰弱量表（EFS）评估患者术前衰弱程度,术后1年通过电话进行随访。根据术后1年内是否死亡将患者分为两组：生存组和死亡组。采用单因素分析和多因素Logistic回归分析筛选术后1年内死亡的独立危险因素,通过受试者工作特征（ROC）曲线分析EFS对术后1年内死亡的预测效能。
结果 24例（7.7%）患者在术后1年内死亡。死亡组年龄、ASA分级、EFS、查尔森合并症指数（CCI）、卡茨指数（Katz ADL）、功能活动问卷（FAQ）评分、血糖、C反应蛋白、白细胞介素-6和术中失血量均明显高于生存组（P<0.05）,BMI、简易精神状态评价量表（MMSE）和白蛋白均明显低于生存组（P<0.05）。多因素Logistic回归分析显示,EFS（每增加1分,OR=1.404, 95%CI 1.169~1.685）是术后1年内死亡的独立危险因素之一。EFS预测术后1年内死亡的ROC曲线下面积（AUC）为0.826（95%CI 0.744~0.908,P<0.001）。
结论 衰弱评分增加与老年患者骨科术后1年内死亡呈正相关,为老年衰弱患者提供围术期干预指导,有利于改善患者预后。     

经后路腰椎椎体间融合术围手术期隐性失血量的相关因素分析

目的探讨后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)围手术期中,与隐性失血量相关的影响因素。方法自2015-10-2018-10行PLIF手术治疗81例腰椎退行性疾病患者,统计所有患者的性别、年龄、体重指数(body massindex,BMI)以及手术时间、手术节段数等数据,将其作为因变量;计算上述患者的隐性失血量,并作为自变量。通过单因素分析和多重线性回归分析,探讨与隐性失血量相关的影响因素。结果 81例的围手术期隐性失血量为(316.2±170.9)ml,占总失血量的35.7%。单因素分析显示,隐性失血量在年龄、性别、BMI等因素的不同分组中,均无统计学差异(P0.05);而在手术时间、手术节段的不同分组中,隐性失血量差异有统计学意义(P0.05)。多重线性回归分析显示,手术节段(B=148.52,t=6.85,P0.05)、手术时间(B=-16.78,t=-9.52,P0.05)均是PLIF术中隐性失血增多的独立影响因素之一。结论 PLIF手术围术期的隐性失血量较多,手术时间较长、手术节段数增多均是导致隐性失血增多的独立危险因素。     

心脏外科术后肺部并发症的危险因素

目的 分析心脏外科术后肺部并发症（PPCs）的危险因素。
方法 回顾性分析2017年1月至2020年12月行心脏外科手术患者的病历资料,根据患者是否发生PPCs分为两组：并发症组（n=271）和无并发症组（n=331）。提取性别、年龄、ASA分级、高血压病史、糖尿病病史、慢性阻塞性肺疾病（COPD）病史、脑血管病史、手术史、术前房颤、肺动脉高压、心功能指标、凝血功能指标、肝肾功能指标、乳酸脱氢酶、血糖、手术时间、心肺转流（CPB）时间、术中药物使用情况、术中输血量、术中液体输注量、术中尿量、术后肝肾功能指标、心电图等临床指标,采用单因素分析评估上述指标与PPCs的相关性。将组间差异有统计学意义的单因素纳入Logistic回归模型,分析心脏外科PPCs的独立危险因素。
结果 与无并发症组比较,并发症组年龄、左心房直径明显增大,ASA分级、糖尿病和术前房颤比例、肺动脉高压分级、淋巴细胞含量、尿素氮、球蛋白、总蛋白、乳酸脱氢酶、AST浓度明显升高（P＜0.05）;手术时间和CPB时间明显延长,术中输注血小板比例明显升高,晶体液输注量明显增多（P＜0.05）;术后尿素氮、肌酐浓度明显升高,引流量明显增多（P<0.05）。多因素Logistic回归分析结果显示,ASA Ⅳ级（OR=1.886,95%CI 1.030～3.456,P=0.040）、术前房颤（OR=1.526,95%CI 1.031～2.257,P=0.034）、CPB时间≥2 h（OR=2.418,95%CI 1.692～3.456,P＜0.001）是心脏外科PPCs的独立危险因素。
结论 术前房颤、ASA Ⅳ级、CPB时间≥2 h是心脏外科PPCs发生的独立危险因素。     

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.     

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.