改良脾腔分流联合断流术在门静脉高压症治疗中的作用

目的 探讨改良脾腔分流联合断流术治疗门静脉高压症的安全性及疗效. 方法 回顾性分析135例接受脾切除、贲门周围血管离断联合脾腔静脉分流术的肝硬化门静脉高压症患者的临床资料. 结果 135患者手术全部成功,围术期死亡率2.2％( 3/135).110例获得随访,时间9月～12年,再出血率5.5％ (6/110),肝性脑病发生率6.4％(7/110),自由门静脉压力由术前的(36.9±3.2)cmH2O,下降至(32.0±1.5) cmH2O,差异显著(P＜0.01). 结论 脾腔分流联合断流术安全有效,是外科治疗门静脉高压症的优先选择之一.     

不同肠内营养液与生长激素联合应用对烫伤大鼠炎性反应的影响

目的 了解标准肠内营养(EN)、肠内免疫营养(EIN)液与重组人生长激素(rhGH)联合应用对烫伤大鼠炎性反应的影响. 方法 将128只SD大鼠按随机数字表法分为EN、EIN、EN+rhGH、EIN+rhGH组,每组32只.将大鼠制成总面积30%TBSA的Ⅲ度烫伤模型,分别于伤后1、4、7、10 d抽取各组大鼠静脉血,检测血清内毒素、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平;切取大鼠肝组织检测其CD14 mRNA、TNF-α mRNA的表达.另取8只SD大鼠作为对照组,检测上述指标. 结果 伤后各组各时相点大鼠血清内毒素、IL-6、TNF-α水平以及肝组织中的CD14 mRNA、TNF-α mRNA表达均高于对照组(P＜0.01).伤后4、7、10 d,EIN组和EN+rhGH组血清内毒素、IL-6、TNF-α水平以及肝组织CD14 mRNA、TNF-α mRNA表达均低于EN组(P＜0.05或P＜0.01);伤后10 d,EIN+rhGH组血清内毒素[(0.37±0.07)EU/mL]、IL-6[(289±49)ng/L]、TNF-d[(1.87±0.32)μg/L]水平以及肝组织CD14 mRNA(0.39±0.05)、TNF-α mRNA(0.47±0.03)表达均低于EIN组[(0.48±0.08)EU/mL、(364±53)ng/L、(2.50±0.48)μg/L、0.67±0.06、0.66±0.05,P＜0.05或P＜0.01]. 结论 EN、EIN液与rhGH联合应用可减轻大鼠烫伤后的炎性反应,且rhGH具有明显的协同作用.     

肝后型门静脉高压症患者血浆前列环素含量及其影响因素分析

目的观察布-加综合征(B-CS)患者血浆中前列环素(PGI2)含量,探讨PGI2在肝后型门静脉高压症患者发病中的作用。方法采用放免法检测19例B-CS患者分流减压手术前后、21例B-CS患者口服肠道抗菌药物前后静脉血PGI2含量,光电比色法检测患者口服肠道抗菌药物前后静脉血内毒素含量。结果对照组患者血浆PGI2含量为(9.46±3.74)ng/L。分流减压手术前后,B-CS患者门静脉压力由(37.2±4.5)cmH2O下降至(25.8±4.2)cmH2O(P<0.01);血浆中PGI2含量由(17.71±6.93)ng/L下降至(12.43±3.54)ng/L(P<0.01),且其含量下降与门静脉压力下降呈正相关(r=0.54,P<0.05)。口服肠道抗菌药物前、后,B-CS患者血浆内毒素含量由(0.328±0.188)Eu/ml下降至(0.226±0.147)Eu/ml(P<0.01);而血浆PGI2含量分别为(14.08±5.54)ng/L和(14.21±4.98)ng/L,差异无统计学意义(P>0.05),但高于对照组(P<0.01)。结论布-加综合征患者血浆PGI2含量增高,且参与了门静脉的高压状态的维持。PGI2含量增高之原因部分地由于机体合成PGI2增多所致。增高的门静脉压力是刺激机体合成PGI2增多的原因之一,内毒素水平可能与机体合成PGI2增多无关。     

静脉注射异丙酚对内毒素血症大鼠心功能的影响

目的 评价静脉注射异丙酚对内毒素血症大鼠心功能的影响.方法 健康雄性Wistar大鼠32只,体重250～300g,随机分为4组(n=8):对照组(C组)、内毒素组(L组)、内毒素+异丙酚组(L+P组)及异丙酚组(P组).L组、L+P组静脉注射内毒素10g/kg,C组和P组注射等量生理盐水,注射后60min,L+P组和P组静脉注射异丙酚10mg/kg,C组和L组给予等量生理盐水,30min后下腔静脉取血并处死大鼠.于注射内毒素前、注射内毒素后30、60、61、62、63、65、70、80及90min时记录心率(HR)、左室收缩压(LVSP)及左室内压力变化最大速率(±dp/dtmax);并计算L+P组和P组心功能指标变化幅度,测定血清肿瘤坏死因子-α(TNF-α)浓度.结果 与注射内毒素前比较,L组注射内毒素后心功能指标均降低,L+P组注射异丙酚后HR、LVSP、±dp/dtmax降低,P组注射异丙酚后HR、LVSP、±dp/dtmax降低(P＜0.05);与注射内毒素后60min时比较,L+P组注射异丙酚后HR、LVSP、-dp/dtmax降低,+dp/dtmax升高(P＜0.05).与L组比较,L+P组注射异丙酚后HR、LVSP、-dp/dtmax降低(P＜0.05).与P组比较,L+P组注射异丙酚后HR、LVSP、±dp/dtmax变化幅度减小(P＜0.05).与C组比较,L组、L+P组TNF-α浓度升高(P＜0.05);L+P组低于L组(P＜0.05).结论 静脉注射异丙酚不加重内毒血症大鼠心功能的抑制.     

不同病理模型大鼠脾切除后感染致多器官功能不全综合征

目的观察不同病因脾切除后感染致多器官功能障碍综合征(MODS).方法 75只Wistar大白鼠建立5组动物模型,其中4组行脾切除,所有大鼠通过盲肠结扎加穿刺(CLP)方法形成腹腔感染,24 h后处死并测定MODS的指标.结果正常对照+CLP组无明显脏器受损.正常脾切除+CLP组心、肺、肝、肾有轻度病理改变,谷丙转氨酶(ALT)88.18 U/L,谷草转氨酶(AST)75.77U/L,尿素氮(UREA)10.44mmol/L,肌酐(CRE)138.86μmol/L(P＜0.05).三组病理性脾切除+CLP大多出现MODS表现,死亡率增加,ALT＞132.09U/L,AST＞164.29U/L,UREA＞13.36 mmol/L,CRE＞159.44μmol/L(P＜0.01).结论术后腹腔感染时,脾切除为MODS提供了条件,而不同术前病理状态促进了MODS的发生.     

茯苓多糖对肝叶部分切除老年大鼠术后认知功能障碍的影响

目的 探讨茯苓多糖对肝叶部分切除老年大鼠术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响. 方法 将30只老年SD大鼠按照随机数字表法分成假手术组、模型对照组和茯苓多糖组,每组10只.建立肝叶部分切除老年大鼠POCD模型,采用Morris水迷宫实验评价肝叶部分切除老年大鼠的学习记忆能力,ELISA检测大鼠血清中TNF-α和IL-6水平. 结果 与模型对照组比较,术后第1、3、7天茯苓多糖组逃避潜伏期相对缩短、穿越平台次数相对增多;与模型对照组比较,术后第1、3、7天茯苓多糖组血清中TNF-α和IL-6水平分别为(18.9±3.9) ng/L和(14.7±3.8) ng/L,(8.9±2.2)ng/L和(9.9±2.6) ng/L,(6.6±1.8) ng/L和(9.6±2.7) ng/L,差异有统计学意义(P＜0.05);与模型对照组比较,茯苓多糖组脾脏系数和胸腺系数分别为(2.59±0.92) mg/g和(1.60±0.40) mg/g,差异有统计学意义(P＜0.05). 结论 茯苓多糖能够改善肝叶部分切除老年大鼠POCD的症状,其机制可能是抑制炎症反应和提高机体免疫力等综合方面.     

ω-3不饱和脂肪酸对大鼠肝切除术后肠屏障的影响

目的 观察ω-3不饱和脂肪酸(ω-3PUFA)对大鼠肝切除术后肠屏障的影响.方法 雄性SD大鼠96只随机分为假手术组(S)、生理盐水组(NS+PH)和大(H+PH)、小剂量(L+PH)ω-3PUFA治疗组(2ml/kg、1 ml/kgω-3PUFA静脉注射+大鼠70%肝切除组).检测肝切除术后1、2、3、5 d谷丙转氨酶(ALT)、谷草转氨酶(AST)、门静脉血中自细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、内毒素(ET)水平的变化以及小肠黏膜的病理形态学改变.结果ω-3PUFA治疗组术后1、2、3 d ALT、AST较生理盐水组有显著下降(P<0.05).术后1、2、3、5 d,ω-3PUFA治疗组门静脉血中TNF-α、IL-6有显著降低,内毒素水平也有显著下降[H+PH组分别为:(69.61±15.65)、(53.20±6.26)、(35.90±9.76)、(31.81±8.96)ng/L,L+PH组分别为:(79.99±8.73)、(56.11±5.69)、(43.46±14.39)、(34.40±4.88)ng/L,P<0.05].病理学检查可见生理盐水组肠上皮黏膜组织形态受损明显,ω-3PUFA治疗组肠上皮黏膜受损较小.结论 围手术期应用ω-3PUFA可能通过减少炎症因子的释放达到保护肠屏障的效果.     

CD4+CD25+调节性T细胞/辅助性T细胞17在脓毒症大鼠中的作用

目的 观察CD4+ CD25+调节T细胞(Treg)/辅助性T细胞17(Th17)细胞在脓毒症大鼠炎性免疫反应中的作用.方法 110只雄性SD大鼠随机分为正常对照组、假手术组、脓毒症(CLP)组,采用改良的盲肠结扎穿孔术(CLP)制作大鼠脓毒症模型.采用流式细胞术检测CD14+单核细胞表面人类白细胞抗原-DR基因(HLA-DR)表达率、Treg细胞及TH17细胞比例;酶联免疫吸附试验(ELISA)检测白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α、转化生长因子(TGF)-β、白细胞介素(IL)-17炎性因子蛋白表达.结果 与假手术组比较:(1)伴随着脓毒症病情的发展,大鼠出现明显的免疫抑制,CD14+单核细胞HLA-DR表达率＜30％,IL-10/TNF-α比值(27.41 ±7.04比6.63 ±2.60)明显增高(P＜0.01).(2)术后96 h脓毒症大鼠Treg细胞[(11.91±3.88)％比(6.57±2.60)％,P＜0.01]和Th17细胞[(5.14±0.29)％比(2.85±0.07)％,P＜0.01]表达明显增高.(3)术后96 h脓毒症组前炎性细胞因子IL-6[(42.31±15.89) ng/L比(6.32 ±3.18) ng/L,P＜0.01]、IL-10[(69.89 ±20.78) ng/L比(13.58±5.37) ng/L,P＜0.01]、TNF-α[(5.03±3.10) ng/L比(2.77±1.10) ng/L,P＜0.01]、TGF-β[(4.99±2.01) ng/L比(1.88±1.07) ng/L,P＜0.01]、IL-17[(92.77±11.64) ng/L比(7.58±2.30) ng/L,P＜0.01]表达明显增高.结论 伴随着脓毒症病情的发展,大鼠出现明显的免疫抑制;在大鼠脓毒症的发生发展中,Treg细胞介导的免疫抑制及Th17细胞介导免疫激活反应同时存在;脓毒症细胞因子微环境变化可能是导致Treg细胞/Th17细胞失衡的原因之一.     

泡状棘球蚴感染诱导免疫耐受的研究

目的 观察泡状棘球蚴感染对纯系大鼠异位移植心脏存活时间的影响并探讨发生机制.方法 建立Brwon norway(BN)大鼠到Lewis (LEW)大鼠的颈部异位心脏移植模型.对照组(n=12)以健康的LEW大鼠为受者;实验组(n=12)以感染泡状棘球蚴的LEW大鼠为受者.术后观察移植心的存活时间、组织病理学变化,测定血清内白细胞介素-4(IL-4)和y-干扰素(IFN-γ)水平.FACS 流式检测实验组和对照组大鼠脾内CD4+ CD25+调节性T细胞(CD4+ CD25+ Treg细胞)的数量水平.结果 实验组与对照组移植心的存活时间分别为(16.17±3.19)d及(7.92±1.93)d,两组差异有统计学意义(P＜0.05).实验组移植心的组织病理学分级(平均分级为3.38级)与对照组(平均分级为3.79级)比较,差异无统计学意义(P＞0.05).发生排斥反应后,实验组血清内IL-4水平为(152.21 ±45.62) ng/L高于对照组(50.85±22.15) ng/L,而实验组血清内IFN-γ水平为(12.35±1.02) ng/L水平低于对照组(42.63±4.15) ng/L,两组差异均有统计学意义(P ＜0.05);FACS流式检测结果提示实验组大鼠脾内CD4+ CD25+ Treg细胞数量为10.8％,高于对照组的6.1％,两组差异有统计学意义(P＜0.01).结论 泡状棘球蚴感染造成Th1/Th2向Th2类细胞因子偏移,通过介导CD4+ CD25+ Treg细胞数量增加而导致大鼠异位移植心脏存活时间延长,它可能是诱导移植免疫耐受的原因之一.     

脾切除对大鼠小体积肝脏模型的小肝综合征的预防作用

目的 探讨脾切除对大鼠小体积肝脏模型的小肝综合征(SFSS)的预防作用及其可能机制.方法 建立大鼠小体积肝脏模型,切除80%肝组织,即规则切除左外叶、左内叶、中叶和乳头叶,保留肝右叶和锥体叶,脾切除组在切除80%肝组织的同时行脾切除,对照组仅切除80%肝组织,另设仅游离肝脏而不行肝切除的假手术组.各组分别于术后0、3、6、12、24和72 h等6个时点各处死大鼠6只,取血清和肝组织,检测肝功能指标、肝组织中核因子Κb(NF-Κb)p65含量以及肝组织中肿瘤坏死冈子α(TNF-α)、细胞间黏附分子-1(ICAM-1)、增殖细胞核抗原(PCNA)Mrna和蛋白表达、髓过氧化物酶(MPO)活性,测量门静脉压力,计算SFSS发生率及动物术后1周存活率.结果 对照组术后门静脉压力明显升高,为(12.14±0.90)cm H2O,明显高于假手术组(P＜0.05),而脾切除组门静脉压力为(11.11±0.80)cm H2O,明显低于对照组(P＜0.05).对照组术后血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氧酶(LDH)和胆红素总量(Tbil)明显升高,血清白蛋白(Alb)和胆碱酯酶(CHE)明显下降,脾切除组的ALT、AST、LDH和Tbil水平明显低于对照组,差异均有统计学意义(P＜0.05).对照组术后NF-Κb p65含量升高,TNF-α和ICAM-1 Mrna及其蛋白表达增加,MPO活性亦增高,PCNA Mrna及其蛋白表达亦增强,与对照组比较,脾切除组的NF-κBp65含量明显减少,TNF-α和ICAM-1 Mrna及其蛋白表达显著降低,MPO活性减弱,但PCNAmRNA和蛋白的表达更明显(P＜0.05).假手术组、对照组与脾切除组术后1周内的SFSS发生率分别为0、75%和25%,术后1周存活率分别为100%、50%和83.3%,后二者比较,差异均有统计学意义(P＜0.05).结论 脾切除能降低大鼠小体积肝脏模型的SFSS发生率,可能与脾切除后减少门静脉灌流、抑制NF-Κb活化、减轻细胞损害和促进肝细胞再生有关.     

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.