良性前列腺增生合并前列腺炎患者的临床特点分析

目的 探讨合并前列腺炎的良性前列腺增生(BPH)患者的临床特点. 方法 BPH患者100例.按是否合并前列腺炎分为单纯组(34例)和合并组(66例).比较2组患者年龄、前列腺体积、PSA与前列腺特异性抗原密度(PSAD)、国际前列腺症状评分(IPSS)的差异,同时分析B超检查对BPH合并前列腺炎的检出情况. 结果单纯组患者年龄为(66.5±6.4)、合并组为(69.9±7.2)岁;单纯组平均前列腺体积为(47.5±26.7)、合并组为(71.4±39.3)ml.单纯组患者PSA和PS-AD中位数分别为3.40和0.08 ng/ml,合并组分别为8.07和0.12 ng/ml;平均IPSS分别为19.9和22.2.2组患者平均年龄、前列腺体积、PSA与PSAD值及IPSS评分比较,差异均有统计学意义(P<0.05).合并前列腺炎患者前列腺体积与炎症浸润程度及腺体破坏程度具有相关性(r分别为0.29,0.25,P<0.01).PSA与前列腺炎浸润分级和破坏分级均具有相关性(r分别为0.319和0.214,P值均<0.05).PSAD与浸润分级具有相关性(r=0.212,P<0.05).B超诊断BPH合并前列腺炎的敏感性为21.2%,特异性82.4%. 结论 BPH患者多伴前列腺炎,且以慢性炎性细胞浸润为主;合并前列腺炎的患者临床检测指标明显高于单纯BPH患者.B超对BPH合并前列腺炎的检出能力不令人满意.     

BPH患者组织学前列腺炎与PSA、前列腺体积、PSAD、IPSS、Qmax及PVR的相关性研究

目的:探讨BPH患者组织学前列腺炎与PSA、前列腺体积、PSA密度(PSAD)、IPSS、最大尿流率(Qmax)及残余尿量(PVR)的相关性。方法:手术切除或经尿道前列腺电切术(TURP)治疗的BPH患者673例。按照是否伴有组织学前列腺炎将患者分为两组:A组:BPH伴组织学前列腺炎;B组:BPH不伴有组织学前列腺炎。比较两组患者PSA、前列腺体积、PSAD、IPSS、Qmax及PVR。结果:A组PSA水平为(5.64±2.48)μg/L,前列腺体积(43.66±13.11)ml,PSAD 0.129±0.048,IPSS(24.72±5.39)分,Qmax(6.94±3.23)ml/s,PVR(124.90±49.80)ml;B组PSA水平为(4.97±1.99)μg/L,前列腺体积(40.41±11.44)ml,PSAD 0.123±0.034,IPSS(23.40±6.21)分,Qmax(7.75±3.52)ml/s,PVR(112.73±50.03)ml。A组PSA水平、前列腺体积、IPSS和PVR均明显高于B组(P<0.05);A组Qmax明显低于B组(P<0.05);PSAD两组间差异无统计学意义(P>0.05)。结论:组织学前列腺炎能明显增加患者的PSA水平、前列腺体积、IPSS和PVR,降低患者Qmax。但是组织学前列腺炎与PSAD无关;组织学前列腺炎是影响BPH临床进展的重要因素。     

膀胱出口梗阻指数在良性前列腺增生诊断中的临床价值

目的:评估膀胱出口梗阻指数(BOOI)在BPH诊断中的临床应用价值。方法:回顾性收集分析2016年7月至2018年9月收治并诊断为BPH的199例患者的尿动力学检查结果并计算BOOI,根据BOOI结果分为BOO组、可疑BOO组以及无BOO组,比较3组患者前列腺体积(PV)、国际前列腺症状评分(IPSS)、排尿期IPSS(IPSS-VS)、生活质量(QOL)评分、最大尿流率(Qmax)以及残余尿量(PVR)。使用Pearson直线相关性分析判断BOOI与PV、IPSS、IPSS-VS、QOL、Qmax、PVR之间的相关性。结果:3组之间年龄(P=0.195)、PSA(P=0.380)、IPSS(P=0.380)、IPSS-VS(P=0.380)、QOL(P=0.380)、Qmax(P=0.380)、PVR(P=0.912)均无统计学差异,但BOO组PV[(58.8±30.0)ml]明显大于可疑BOO组[(49.8±33.9)ml]和无BOO组[(45.5±26.0)ml](P=0.031)。Pearson直线相关性分析发现BOOI与IPSS(r=-0.020,P=0.778)、IPSS-VS(r=-0.013,P=0.853)、QOL(r=-0.107,P=0.132)、Qmax(r=-0.130,P=0.066)、PVR(r=-0.056,P=0.433)均无显著相关性,而对于PV,尽管P=0.012,但|r|=0.178<0.4,因此认为BOOI与PV亦无明显相关性。结论:BOOI与PV、IPSS、IPSS-VS、QOL、Qmax以及PVR均无显著相关,单以BOOI结果诊断BOO并不可靠,BOO的诊断需要同时结合临床实际才能做出。     

中老年男性代谢综合征和前列腺增生关系的研究

目的 探讨中老年男性人群中代谢综合征和BPH的关系. 方法 分层随机选择北京市某社区的中老年男性作为研究对象.调查一般情况,包括年龄、身高、体质量、血压、既往史、IPSS 等;抽取空腹静脉血检测血糖、三酰甘油、高密度脂蛋白、PSA;腹部超声测量前列腺体积;测量Qmax.比较代谢综合征组和非代谢综合征组BPH患病率及严重程度;同时比较代谢综合征组内各亚组的差异. 结果 共调查中老年男性440人.代谢综合征组105人,合并BPH者35人(33.3％);非代谢综合征组335人,合并BPH者40人(11.9％).代谢综合征、肥胖和高脂血症组的BPH患病率较高,分别为33.3％、20.4％和25.0％.与非代谢综合征组相比,代谢综合征组中重度LUTS患病率较高(P＜0.05),IPSS、前列腺体积和血清PSA差异有统计学意义(P＜0.05),Qmax差异无统计学意义(P=0.069).肥胖、高血脂症和糖尿病是BPH的危险因素(OR值分别为1.75、3.36和2.08,P值分别为0.041、0.037和0.045). 结论 代谢综合征患者的BPH患病率较高,代谢综合征影响BPH患者的IPSS、前列腺体积和PSA.肥胖、高血脂症、糖尿病是BPH的危险因素;BPH患者诊疗的同时还需考虑是否合并代谢综合征.     

膀胱内前列腺突入度对BPH患者TURP手术效果的预测评估作用

目的探讨超声测定膀胱内前列腺突入度(IPP)对前列腺增生(BPH)患者行前列腺电切(TURP)手术效果的预测评估作用。方法 136例患者因BPH入院行TURP,经腹超声测量IPP,根据IPP程度将患者分为突入组(IPP10mm)66例,对照组(IPP≤10mm)70例,比较2组术前前列腺体积(PV)、前列腺特异性抗原(PSA)差异,统计、分析2组术前和TURP术后6个月国际前列腺症状评分(IPSS)、生活质量评分(Qo L)、最大尿流率(Qmax)、残余尿量(PVR)变化;多因素分析IPP与手术效果的相关性。结果两组年龄、术前IPSS、Qo L相比无差异(P0.05),但突入组PV、PSA、Qmax、PVR与对照组相比有统计学差异(P0.05),两组TURP术后随访6个月,突入组IPSS下降、PVR减少和Qmax提高与对照组相比有统计学差异(P0.05);多因素分析显示IPP程度与TURP术后IPSS下降(OR=2.98,95%=1.05~6.89)、Qmax提高(OR=5.96,95%=2.85~9.55)相关。结论IPP程度可影响BPH患者PVR和Qmax,相对于IPP≤10mm,IPP10mm的BPH患者TURP术后IPSS下降、PVR减少和Qmax提高更加明显,IPP程度可预测BPH患者TURP术后IPSS下降、Qmax提高。     

前列腺增生症相关下尿路症状与各临床影响因素关系的研究

目的 探讨不同的临床因素与前列腺增生症(BPH)相关下尿路症状(LUTS)之间的关系,了解影响BPH有关LUTS的危险因素.方法 对2003年7月至2009年10月收治的548例前列腺增生症患者的资料进行回顾性研究.分析不同年龄、病史、最大尿流率(Qmx)、前列腺总体积、移行区体积、移行区指数、总PSA、游总比(f/tPSA)、组织炎症对IPSS值的影响,并进行多元线性回归分析.结果 年龄、移行带体积、Qmax、PSA及前列腺组织炎症对IPSS评分影响显著.随着年龄增大和移行带体积的增加,IPSS值变大;随着最大尿流率的减少,IPSS值显著增加(P＜0.05).当PSA ≥4 ng/mL时,IPSS值要显著大于＜4 ng/mL组(P＜0.05),但是介于4～10 ng/mL组和≥10 ng/mL组的IPSS评分并无差异(P＞0.05).合并前列腺组织炎症患者的IPSS值要显著高于非炎症组(P＜0.05).进一步通过多元线性回归分析,发现所有可能影响IPSS评分的因素中,Qmax和前列腺组织炎症与IPSS评分密切相关(β=-0.807,5.736;P＜0.001).结论 前列腺组织炎症和Qmax对下尿路症状的影响最显著.其他的临床因素如患者年龄、移行带体积和PSA值对BPH患者的下尿路症状影响有限,经过多因素回归分析发现并无显著性.     

前列腺增生症患者压力-流率测定的诊断价值评估

目的评估压力-流率测定在前列腺增生症(BPH)患者诊断中的价值。方法对280名伴有下尿路症状的BPH患者进行尿动力学检查和IPSS评分。结果根据膀胱出口梗阻指数(BOOI)将患者分为3组,分别为BOO组156例,轻度BOO组61例,无BOO组63例,其最大尿流率(Qmax)分别为(6．44±1．44)ml／s,(7．49±1．76) ml／s,(8．11±1．97)ml／s,BOO组与另二组统计学分析有显著性差异;最大尿流率时的逼尿肌压力(Pdet-Qmax)分别为(73．49±15．91)cmH2O,(49．90±6．82)cmH2O,(30．70±6．04)cmH2O,3组之间统计学分析有显著性差异;术前IPSS评分分别为(20．55±5．09),(17．51±4．46),(17．54±4．96),BOO组与另两组之间统计学分析有显著性差异;术前剩余尿量(PVR)分别为(104．53±37．14)ml,(106．66±41．70)ml,(104．29±40．75)ml, 3组之间差异无显著性意义。结论压力-流率测定可了解BPH患者BOO严重程度,对BPH治疗的选择和判断预后具有指导意义。     

血清PSA、IPSS评分及前列腺体积与勃起功能障碍的关系

目的 探讨老年前列腺增生患者血清PSA、IPSS症状评分和前列腺体积与勃起功能障碍之间的关系.方法 应用IIEF-5国际勃起功能指数问卷表对入选的BPH患者进行阴茎勃起功能障碍评估,以13分为临床诊断分界线,分为A组(≤12分的为性功能较差的BPH组)和B组(≥13分的为性功能较好的BPH组);两组病例均分别进行IPSS评分、经直肠B超前列腺体积和血清PSA值测定.结果 本研究共收集病例108例,年龄59～89岁,平均年龄(73.67±5.41),BPH伴发ED的发生率为49.07%.A、B两组之间IPSS评分值分别为(23.23±6.05)、(19.98±7.16),两组比较,差异有统计学意义P<0.05,同时对两组IPSS评分和IIEF评分之间行相关分析得出r=0.115,有一定的相关性.A、B两组前列腺体积测定值分别为(63.19±35.38)ml、(58.91±34.99)ml,两组比较差异无统计学意义(P>0.05).A、B两组PSA值分别为(5.25±4.48)ng/dl、(4.48±4.46)ng/dl,两组比较差异无统计学意义(P>0.05);同时对IPSS评分与IIEF-5评分行相关分析,r=0.24,显示一定的相关性.结论 BPH患者有很高的ED发生率.血清PSA与前列腺体积测定值和IPSS评分值有明显的相关性,下尿路症状明显的患者ED发生的风险率更高.     

B超测定BPH体积参数评价膀胱出口梗阻的意义

目的 :探讨经直肠超声 (TRUS)测定良性前列腺增生 (BPH)各项体积参数对诊断膀胱出口梗阻 (BOO)的意义。　方法 :BPH病人 116例 ,年龄 5 9～ 75 (6 8.6± 5 .1)岁。应用TRUS测定前列腺各径数值 ,应用公式V =0 .5 2R1R2 R3 计算出前列腺体积各项参数 ,同时行尿动力学检查 ,并计算AG值。将前列腺体积 (PV)、移行带体积 (TZV)、移行带指数(TZI)与病人年龄、国际前列腺症状评分 (IPSS)、前列腺特异性抗原 (PSA)及AG值进行相关性分析。　结果 :PV、TZV及TZI分别为 (6 9.7± 4 5 .9)ml、(43.5± 2 5 .6 )ml和 0 .5 7± 0 .14。最大尿流率 (Qmax)、最大尿流率时逼尿肌压力 (Pdet.Qmax)及AG值分别为 (8.31± 5 .12 )ml/s、(82 .34± 33.4 7)cmH2 O和 6 6 .72± 30 .4 6。IPSS为 2 5 .3± 4 .7,PSA为 (4.12±3.6 4 )ng/ml。相关分析提示TZI(r=0 .74 2 ,P =0 .0 17)、TZV(r =0 .6 74 ,P =0 .0 31)与AG值有显著的相关性。IPSS与TZI、TZV呈正相关 ,PSA浓度与PV、TZV、TZI呈正相关。　结论 :通过TRUS测定BPH的各项体积参数和尿动力学检查一样 ,能够作为判断BOO的参考指标     

逼尿肌收缩压测定在BPH患者术后疗效评估中的意义

目的 探讨逼尿肌收缩压测定在BPH患者术后疗效评估中的应用价值.方法 BPH患者109例.年龄62～83岁,平均71岁.均行尿动力学检查,明确诊断BOO,排除神经、内分泌以及其他系统疾病因素.根据逼尿肌收缩情况分为2组:Ⅰ组为逼尿肌亢进型61例,逼尿肌收缩压≥40 cm H2O(1 cm H2O=0.098 kPa),单纯行TURP或开放手术;Ⅱ组为逼尿肌无力型48例,逼尿肌收缩压≤20 cm H2O,同期行TURP和膀胱造瘘术,术后持续开放造瘘管至少2周.统计学比较2组患者术后1、3个月逼尿肌收缩压、Qmax和残余尿等参数.结果 2组患者术前最大逼尿肌收缩压分别为(78.4±37.0)、(19.2±5.4)cm H2O,Qmax分别为(7.6±2.2)、(2.5±1.1)ml/s,组间差异均有统计学意义(P＜0.05);术后1个月Qmax分别为(17.4±2.9)、(12.5±2.0)ml/s,组间差异有统计学意义(P＜0.05);术后3个月Qmax分别为(18.3±2.8)、(15.2±1.8)ml/s,组间差异无统计学意义(P＞0.05).结论 BPH患者BOO解除后,收缩乏力状况可以逐渐恢复,Qmax能获得改善,对合并逼尿肌收缩无力患者积极手术解除梗阻,可促进逼尿肌功能恢复.

Abstract：

Objective To study the value of the preoperative detrusor contractility to the outcome assessment of prostatectomy for benign prostatic hyperplasia (BPH).Methods A total of 109 patients with BPH were analyzed.Their ages ranged from 62 to 83 years with a mean of 71 years.All patients underwent urodynamic study to confirm a diagnosis of BOO preoperatively.Further more, their BOO was not caused by nervous, endocrine or other diseases.Pateints were divided into two groups based on maximum detrusor contractility.Group Ⅰ (n =61, BPH with maximum detrusor contractility ≥ 40 cm H2O, 1cm H2O =0.098 kPa) underwent TURP or open surgery, respectively.Group Ⅱ (n =48, BPH with maximum detrusor contractility ≤ 20 cm H2O ) underwent TURP and suprapubic punctural cystostomy simultaneously,the bladder fistula was kept open continuously for at least two weeks postoperatively.The difference in outcome between the two grous was assessed by using urodynamic parameters including maximum detrusor contractility, Qmax and residual urine at one and three months postoperatively respectively.Student's t-test was used to compare the result for normally distributed data and Wilcoxon's signed-ranks test for skewed data in this study.Results There was significant difference in preoperative maximum contractility, Qmax between group Ⅰand groupⅡ (78.4 ±37.0 cm H2O) vs (19.2 ±5.4 cm H2O)(P＜0.01), (7.6±2.2 ml/s) vs (2.5 ± 1.1 ) ml/s (P ＜ 0.05) respectively.Although there was significant difference at one month postoperatively in Qmax (17.4 ±2.9)ml/s vs (12.5 ±2.0)ml/s (P＜0.05), no significant difference was found in Qmax between the two groups after three months ( 18.3 ±2.8 ml/s) vs ( 15.2 ± 1.8)ml/s (P ＞ 0.05).Conclusions The Qmax may improve and the impaired detrusor recovered gradually after the BOO was removed.Performing an operation on patients with BOO accompanied with detrusor underactivity may be useful to recover detrusor contractility.     

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.