实时三维超声心动图评价心肌致密化不全患儿左心室收缩功能

目的探讨实时三维超声心动图(RT-3DE)评价心肌致密化不全患儿左心室整体及局部收缩功能的价值。方法依据常规超声左心室射血分数(LVEF)将34例LVNC患儿分为LVEF正常组(A组,LVEF≥50%,25例)及LVEF减低组(B组,LVEF50%,9例),选取同期20名健康儿童作为正常对照组(C组),行RT-3DE检查,测量左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)及LVEF,计算收缩末期左心室最厚处非致密心肌/致密心肌比值(NC/C)并观察左心室17节段心肌受累情况,通过左心室容积-时间曲线分析获得节段舒张末期容积(rEDV)、节段收缩末期容积(rESV)及节段射血分数(rEF),并进行统计分析。结果与C组比较,A组LVEDV(t=-0.17,P=0.87)、LVESV(t=0.79,P=0.44)及LVEF(t=-1.72,P=0.10)差异均无统计学意义;B组LVEDV(t=1.62,P=0.15)差异亦无统计学意义,但LVESV明显增大(t=2.85,P=0.03),且LVEF明显减低(t=-6.15,P0.01)。A组NC/C与B组间差异无统计学意义(t=-1.15,P=0.27),但左心室心肌受累节段数更少(t=-4.59,P=0.03)。A组与C组间左心室17节段rEDV及rESV差异均无统计学意义(P均0.05),左心室中部后间隔、后壁及后侧壁、心尖部间隔、下壁及侧壁rEF差异均有统计学意义(P均0.05)。B组均与C组间左心室17节段rEDV差异无统计学意义(P均0.05),基底部后侧壁及前侧壁、中部前壁、前间隔、后壁、后侧壁及前侧壁、心尖部前壁、间隔及侧壁rESV、左心室17节段rEF差异均有统计学意义(P均0.05)。结论应用RT-3DE技术评估LVNC患儿整体和局部收缩功能有利于早期诊断、治疗和改善预后。     

三维造影超声心动图评估左心室功能

目的探讨三维造影超声心动图(C3DE)评估左心室功能的价值。方法对27例心肌梗死患者、17例肥厚型心肌病患者及19名健康志愿者行SPECT、三维超声心动图(3DE)及C3DE检查,对比3种方法测得的左心室舒张期末容积(LVEDV)、左心室收缩期末容积(LVESV)、每搏输出量(SV)及左心室射血分数(LVEF)的差异及其相关性。结果心肌梗死和肥厚型心肌病患者3DE所测LVEDV和LVESV均小于C3DE、SPECT测值(P均0.05),C3DE与SPECT间LVEDV和LVESV测值差异无统计学意义(P均0.05);心肌梗死患者3DE所测LVEF高于C3DE和SPECT测值(P均0.05),C3DE与SPECT间LVEF测值差异无统计学意义(P0.05)。健康志愿者中,3种方法所测LVEDV、LVESV、SV及LVEF差异均无统计学意义(P均0.05)。C3DE所测LVEDV、LVESV及LVEF与SPECT测值均呈正相关(r_s=0.95、0.97、0.95,P均0.01)。结论 C3DE可用于评估左心室功能,尤其适用于心肌梗死、肥厚型心肌病等存在心室重塑的患者。     

经皮冠状动脉腔内成形术治疗急性心肌梗死的效果及对内皮功能和心功能的影响

目的探讨经皮冠状动脉腔内成形术(PTCA)治疗急性心肌梗死(AMI)的效果及对内皮功能和心功能的影响。方法选取2020年5月至2022年9月黄淮学院附属驻马店市中心医院收治的98例急性心肌梗死患者作为研究对象, 采用随机数字表法将患者分为对照组和PTCA组, 每组患者各49例。PTCA组患者实施PTCA进行治疗, 对照组患者则给予常规静脉溶栓治疗。比较两组患者治疗后的临床疗效及不良事件发生。采用超声心动图检测两组患者左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)水平;采用一氧化氮(NO)、内皮素-1(ET-1)、血管性假血友病因子(vWF)检测试剂盒检测两组患者血清NO、ET-1、vWF水平。组间计量数据比较采用t检验。结果 PTCA组患者的临床治疗总有效率[46例(93.88%)]明显高于对照组患者[38例(77.55%)], 差异有统计学意义(t=5.333, P<0.05)。PTCA组患者LVEDV[(136.01±4.46) ml]、LVESV[(69.68±2.06) ml]水平明显低于对照组患者LVEDV[(155.24±4...     

次全结扎冠状动脉法构建巴马小型猪心肌缺血模型

目的采用次全结扎巴马猪冠状动脉法建立心肌缺血模型。方法对10只巴马小型猪术前行冠状动脉CTA(CCTA)及心脏MR(CMR)检查。开胸后次全结扎冠状动脉左前降支建立模型,并于术后2、12、24、48、72h及1、2、3、4周复查CTCA及CMR,测心功能指标,包括左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)及射血分数(LVEF)。术后4周处死实验动物行病理检查。结果7只巴马小型猪顺利完成手术,建模成功率70.00%。建模后CTCA示结扎处狭窄程度约80%～100%;与术前比较,术后24h后不同时间点LVEF下降(P0.05)、LVESV增加(P0.05),术后2周后不同时间点LVEDV增加(P0.05)。CMR检测梗死节段与病理结果的一致性较好(Kappa=0.888)。结论次全结扎冠状动脉左前降支可建立良好的心肌缺血动物模型。     

心血管磁共振特征追踪技术诊断早期高血压性心脏病

目的探讨心血管磁共振特征追踪(CMR-FT)技术对早期高血压性心脏病(HHD)的诊断价值。方法选取54例HHD患者,其中26例左心室射血分数(LVEF)≤50%(LVEF≤50%组),28例LVEF>50%(LVEF>50%组);另选40名健康志愿者作为对照组。行心血管磁共振(CMR)检查,检测各项心功能参数及整体纵向应变(GLS)。结果3组间左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每搏输出量(SV)、LVEF、心输出量(CO)、心指数(CI)、心率(HR)、左心室收缩期质量及舒张期质量、GLS差异均有统计学意义(P均<0.05)。GLS与LVEDV、LVESV、HR、左心室收缩期质量及舒张期质量均呈正相关(r=0.340、0.460、0.284、0.640、0.570,P均<0.01),与SV、LVEF、CO、CI均呈负相关(r=-0.223、-0.516、-0.052、-0.260,P均<0.05)。结论CMR-FT可用于评估左心室功能,有助于早期诊断HHD。     

三维斑点追踪成像评估2型糖尿病伴腹型肥胖患者左心室心肌收缩功能

目的探讨三维斑点追踪成像(3D-STI)评估2型糖尿病(T2DM)伴腹型肥胖患者左心室心肌收缩功能的价值。方法收集56例T2DM患者,其中腹型肥胖组26例、无腹型肥胖组30例,以30名健康体检者为对照组。比较3组常规超声参数左心室舒张末期内径(LVDd)、二维射血分数(2D-EF)、相对室壁厚度(RWT)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、三维射血分数(3D-EF)以及应变参数左心室整体纵向应变(LVGLS)、左心室整体圆周应变(LVGCS)、左心室整体面积应变(LVGAS)、左心室整体径向应变(LVGRS)。结果常规超声参数及应变参数比较,腹型肥胖组LVDd、RWT、LVEDV、LVESV均较对照组、无腹型肥胖组升高(P均0.05),2D-EF、3D-EF均低于对照组(P均0.05)。腹型肥胖组、无腹型肥胖组LVGLS、LVGCS、LVGAS、LVGRS均较对照组减低(P均0.05),且腹型肥胖组均低于无腹型肥胖组(P均0.05)。结论 3D-STI可用于评估T2DM伴腹型肥胖患者左心室心肌收缩功能。     

重组人促红细胞生成素预先给药对心肌缺血再灌注损伤大鼠心肌炎性反应的影响

目的探讨重组人促红细胞生成素（rhEPO）预先给药对心肌缺血再灌注损伤大鼠心肌炎性反应的影响及其机制。方法健康雄性SD大鼠138只,体重350～450g,随机分为3组：假手术组（Sham组,n=42）、缺血再灌注组（I/R组,n=48）和rhEPO预先给药组（n=48）。缺血前24h,Sham组和I/R组腹腔注射0．9%NaCl溶液4ml/kg,rhEPO预先给药组腹腔注射rhEPO 5 000IU/kg（溶于0．9% NaCl溶液4ml/kg）。采用阻断左前降支冠状动脉30min、再灌注180min制备心肌缺血再灌注损伤模型,分别于结扎冠状动脉前即刻、缺血即刻、再灌注30、60、120、180min 3组各随机处死6只大鼠,取左心室心肌组织,测定肿瘤坏死因子-α（TNF-α）、自细胞介素（IL）-6和IL-10的含量,检测心肌细胞核NF-kB和活化蛋白-1（AP-1）的表达；3组随机另取6只大鼠,再灌注结束时观察心肌中性粒细胞浸润情况。I/R组和rhEPO预先给药组再随机取6只大鼠,再灌注结束时测定心肌梗死面积。结果与Sham组比较,I/R组和rhEPO预先给药组NF-kB、AP-1表达及TNF-α、IL-6、IL-10含量升高（P＜0．01）；与I/R组比较,rhEPO预先给药组NF-kB和AP-1表达及TNF-α、IL-6含量降低,IL-10含量升高（P＜0．05或0．01）；rhEPO预先给药组较I/R组心肌梗死面积减小,中性粒细胞浸润程度减轻。结论预先腹腔注射rhEPO 5 000 IU/kg可减轻大鼠心肌缺血再灌注损伤,其机制与下调NF-kB和AP-1表达,抑制心肌炎性反应有关。     

实时三维超声心动图评价择期PCI对急性心肌梗死左心室重构的价值

目的应用实时三维超声心动图(RT-3DE)评价择期经皮冠状动脉介入治疗术(PCI)对急性心肌梗死患者心室重构的影响。方法收集初次急性心肌梗死患者90例,根据治疗方法不同,分为择期PCI组(44例)和药物治疗组(46例)。于入院时和3个月时应用RT-3DE测量两组患者左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、射血分数(LVEF)。结果择期PCI组患者的LVEDV、LVESV各测值明显小于药物治疗组(P0.01),而LVEF明显大于药物治疗组(P0.01);LVEF的减小与LVEDV的增大呈负相关(r=-0.653)。结论择期PCI治疗能显著减轻急性心肌梗死患者的心室重构并改善患者的心脏功能。应用RT-3DE能够更清晰地显示心腔的立体结构,更好地测定LVEDV、LVESV。     

实时三维超声检测心肌节段参数评价风湿性二尖瓣狭窄的左心室运动

目的应用实时三维超声心动图(RT-3DE)检测左心室心肌节段参数,评估风湿性二尖瓣狭窄患者左心室心肌各节段运动功能。方法回顾性分析2014年10~11月我院14例风湿性二尖瓣狭窄(RMS)患者的临床资料(试验组),其中男4例、女10例,年龄34~64(50.9±9.0)岁;另选择健康人员11名作为对照组,其中男7名、女4名,年龄32~67(49.5±9.7)岁。2组患者均行常规二维超声(2DE)及实时三维超声(RT-3DE)检查,记录左心室射血分数(LVEF)、左心室舒张期末容积(LVEDV)、左心室收缩期末容积(LVESV)、左心室心肌各节段的纵向应变值、圆周应变值、面积应变值、横向应变值。结果两组RT-3DE检测的LVEF、LVEDV、LVESV试验组较对照组明显减小(P0.05),左心室心肌纵向应变试验组较对照组大部分节段有明显减小(P0.05)。结论通过RT-3DE可准确评价风湿性二尖瓣患者心肌运动及功能的变化。     

帕瑞昔布钠对急性心肌梗死大鼠心功能的影响

目的 评价帕瑞昔布钠对急性心肌梗死大鼠心功能的影响.方法 成年雄性SD大鼠24只,体重230～250 g,随机分为3组(n=8):假手术组(S组)、急性心肌梗死组(AMI组)和帕瑞昔布钠组(P组).AMI组和P组采用结扎左冠状动脉前降支的方法制备大鼠急性心肌梗死模型,S组冠状动脉穿线但不结扎;24 h后P组腹腔注射帕瑞昔布钠8 mg/kg,1次/d,连续3 d,AMI组用生理盐水替代.术后第4天测定并记录左心室收缩压(LVSP)、左心室舒张末期压(LVEDP)、左心室收缩压最大上升速率(+dp/dtmax)和左心室收缩压最大下降速率(-dp/dtmax);采集颈总动脉血样3 ml,采用放射免疫法测定血浆血栓素A2(TXA2)和前列腺素I2(PGI2)的浓度,并计算PGI2/TXA2;采血后取左心室心肌组织,测定梗死面积,计算心肌梗死体积.结果 与S组比较,AMI组和P组LVSP、±dp/dtmax、血浆PGI2浓度和PGI2/TXA2降低,LVEDP和血浆TXA2浓度升高(P＜0.05).与AMI组比较,P组LVSP、±dp/dtmax、血浆PGI2浓度和PGI2/TXA2升高,LVEDP和血浆TXA2浓度降低(P＜0.05).AMI组和P组心肌梗死体积比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠可改善急性心肌梗死大鼠左心室功能,其机制与调节PGI2/TXA2相对平衡有关.     

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.