直肠癌保肛手术中侧方清扫保留盆腔自主神经124例的疗效评价

目的探讨直肠癌保肛手术中侧方淋巴结清扫和保留盆腔自主神经的临床疗效。方法回顾性分析124例直肠癌保肛手术患者经侧方淋巴结清扫和保留盆腔自主神经后的排便、排尿、性功能及术后生存情况。结果112例患者（90．3％）于术后3d内拔除尿管,平均导尿时间为（58．3±2．1）h。最大尿意尿量为（401．2±23．1）ml,残余尿量为（28．2±2．2）ml。19例术后发生大便失禁,11例经排便训练后基本恢复,2例自行缓解。术后问卷调查98例患者的性功能显示：62．3％的患者可以正常勃起,57．1％的患者有正常的性功能。保留自主神经患者的5年生存率为61．2％。结论直肠癌保肛手术中侧方淋巴结清扫和保留盆腔自主神经能良好保留肛门功能并减少术后排尿及性功能障碍的发生,不影响生存率。     

超声刀联合双吻合器在开放直肠癌低位前切除术中的应用

目的探讨超声刀联合双吻合器在开放直肠癌低位前切除术中的临床应用价值。方法40例拟行直肠癌低位前切除的患者随机分为应用超声刀联合双吻合器20例作为研究组,应用高频电刀联合单吻合器20例作为对照组。比较两组的保肛成功率,同时观察保肛成功病例两组间手术时间、术中出血量、术后第1个24h引流量、术后并发症、肠功能恢复时间及住院时间的差异。结果研究组保肛成功19例（95％）,对照组保肛成功14例（70％）,两组相比P=0．037;33例保肛成功患者中,研究组手术时间（102．5±14．6m）较对照组（114．7±17．5m）明显缩短（P=0．032）;研究组手术出血量（62．5±19．3m1）较对照组（91．3±26．5m1）显著减少（P=0．001）;术后第1个24h引流量研究组和对照组分别为33．6±15．0ml、65．7±25．9ml（P〈0．001）;术后首次排气时间分别为2．4±0．6天、2．9±0．4天（P=0．004）;术后平均住院天数研究组较对照组也显著缩短（P=0．014）;两组术后并发症差异无显著性（P=0．674）。结论开放直肠癌低位前切除术中应用超声刀联合双吻合器是直肠癌手术向微创手术理念和快速康复外科理念发展的尝试．在开放盲肠痛手术领域具有广泛的府用前景。     

腹腔镜下肾切除术转手助腹腔镜与转开放手术的疗效比较

目的对困难腹腔镜下肾切除手术进行探索，并观察转手助腹腔镜与转开放手术的术中与术后临床指标，为临床应用提供参考。方法1999年12月至2006年11月行各类腹腔镜下肾切除手术273例，23例因出血、粘连、肿瘤侵犯周围脏器等原因改变手术方式。其中转手助腹腔镜手术组12例，男8例，女4例，年龄19-73岁，平均52岁，左侧7例，右侧5例；转开放手术组11例，男6例，女5例，年龄32-68岁，平均48岁，左侧5例，右侧6例。观察2组改变手术方式后的手术时间、出血量、切口长度、术后起床活动时间、肛门排气时间、住院时间等指标。结果转开放组1例死亡，其余病例均顺利完成。转手助腹腔镜组改变手术方式后手术时间为（40．1±12．5）min，术中出血量（377±311）ml，切口长度（6．2±2．7）cm，肛门排气时间（2．2±0．6）d，下床活动时间（2．2±1．1）d，术后住院时间（5．4±1．6）d；转开放手术组改变手术方式后手术时间（80．2±37．6）min，术中出血量（854士306）ml，切口长度（19．8士2．5）cm，肛门排气时间（2．5±0．5）d，下床活动时间（4．2±0．8）d，术后住院时间（10．2±2．9）d。与转开放组相比，转手助腹腔镜组在改变手术方式后手术时间、出血量、切口长度、下床活动时间、术后住院时间方面均有明显优势（P〈0.01）。结论腹腔镜下肾切除手术遇到困难时，转手助腹腔镜手术可作为一项安全合理的选择，较转开放手术出血少、创伤小，恢复快。     

腹腔镜全直肠系膜切除治疗低位直肠癌(附198例临床资料报告)

目的探讨腹腔镜全直肠系膜切除治疗低位直肠癌的可行性和安全性。方法回顾分析198例腹腔镜全直肠系膜切除治疗低位直肠癌病例资料。结果全组无手术死亡,无中转开腹。平均手术时间（211.5±69.2）min,中位出血量80（50～200）mL,平均切除淋巴结数为（11.5±6.4）枚,平均肛门排气时间（2.8±1.4）d,平均可下地行走时间（1.6±0.9）d,平均术后住院时间（11.8±6.4）d。术后并发症发生率为20.71%,最常见为肠梗阻（占并发症的24.4%）。中位随访时间为26.1（13.6～45.2）个月,随访率86.9%。33例出现术后复发转移,其中吻合口复发2例,盆腔局部复发3例,腹腔广泛转移4例,远处转移24例。死亡共37例,其中死于肿瘤相关因素28例,死于非肿瘤相关因素9例。5例带瘤生存。结论腹腔镜全直肠系膜切除治疗低位直肠癌不仅具有疼痛轻、恢复快等优点,在技术上也是安全可行的,而最终的结果仍有待于大量的、长期的前瞻性随机对照研究。     

腹腔镜手术治疗老年良性妇科疾病的价值

目的探讨腹腔镜手术在老年妇科良性疾病中的应用价值及安全性。方法比较2001年1月～2006年12月27例腹腔镜手术（腹腔镜组）与25例开腹手术（开腹组）的临床资料。结果腹腔镜组手术时间（20．0±7．9）min明显短于开腹组（44．0±7．2）min（t=-11．419，P：0．000）；腹腔镜组术中出血量（21．9±20．0）m1明显少于开腹组（62．6ml±29．4）（t=-5．875，P：0．000）；腹腔镜组术后病率3例明显少于开腹组12例（，：8．606，P：0．001）；腹腔镜组术后排气时间（13．9±2．9）h明显短于开腹组（23．4±4．3）h（t=-9．404，P=0．000）；腹腔镜组住院时间（7．6±0．9）d明显少于开腹组（10．2±1．2）d（t=-8．882，P=0．000）。结论重视老年患者术前合并症的治疗，术中术后加强监护，腹腔镜是老年妇科疾病手术治疗理想的术式。     

腹腔镜与开放性离断式肾盂成形术的疗效比较

目的比较腹腔镜与开放性离断式肾盂成形术治疗肾盂输尿管连接部梗阻（UPJO）的手术疗效。方法采用经腹腔途径腹腔镜下离断式肾盂成形术38例（A组）。男21例，女17例。年龄8～67岁，平均34岁。病变位于左侧23例，右侧15例。重度肾积水21例，中度17例。经腹膜后开放性离断式肾盂成形术40例（B组）。男18例，女22例。年龄9～63岁，平均32岁。左侧26例，右侧14例。重度肾积水22例，中度18例。对2组的手术时间、术中出血量、术后恢复、临床疗效及并发症进行比较研究。结果A组手术均获成功，无中转开放手术者，手术时间（137．1±30．5）min，术中出血量（143．8±45．2）ml，术后止痛药应用时间（O．8±0．2）d，术后住院时间（7．1±1．2）d，恢复工作时间（24．3±5．6）d。术后发生漏尿1例，经B超引导下肾盂穿刺造瘘3d后痊愈。术后随访6～36个月，吻合口无狭窄，肾积水减轻，中度肾积水12例、轻度积水15例、肾积水消失11例。B组手术时间（135．2±34．6）min，术中出血量（245．3±80．9）ml，术后止痛药应用时间（1．5±0．5）d，术后住院时间（10．3±2．6）d，恢复工作时间为（43．2±11．4）d。发生漏尿2例，分别引流5d和8d治愈；切口感染2例，经换药加抗生素治疗2周后好转；1例腹膜后血肿形成者经再次手术清除腹膜后血肿、止血后于术后第21天出院。术后随访6～36个月，1例吻合口狭窄伴重度积水，其余肾积水减轻（中度肾积水9例、轻度积水16例、肾积水消失14例）。2组手术时间比较差异无统计学意义（P＞0．05），术中出血量、术后止痛药应用时间、术后住院时间、恢复工作时间比较差异均有统计学意义（P＜0．01）。结论腹腔镜与开放性离断式肾盂成形术相比，手术时间相当，前者出血少、创伤小、痛苦轻、并发症少、术后恢复快，术后长期疗效相当。     

3种手术方法治疗肾上腺肿瘤的比较

目的比较小切口腹腔镜与后腹腔镜、开放性手术治疗肾上腺肿瘤的临床价值。方法2003年1月-2006年7月我院对95例肾上腺肿瘤分别采用小切口腹腔镜手术（n=12）,后腹腔镜手术（n=23）,开放性手术（n=60）,比较3组术中、术后情况。结果后腹腔镜手术组手术时间（142.6±41.3）min明显长于小切口腹腔镜组（72.9±13.7）min和开放手术组（96.7±40.9）min（q=7.140,P〈0.05;q=6.827,P〈0.05）;开放手术组术中出血量（232.0±89.2）ml明显多于小切口腹腔镜组（125.0±58.4）ml和后腹腔镜手术组（119.6±63.5）ml（q=5.947,P〈0.05;q=8.055,P〈0.05）;开放手术组术后肠功能恢复时间（4.1±0.8）d明显长于小切口腹腔镜组（2.7±1.2）d和后腹腔镜手术组（2.7±0.9）d（q=7.106,P〈0.05;q=9.163,P〈0.05）;开放手术组术后住院时间（12.6±3.2）d明显长于小切口腹腔镜组（6.7±2.7）d和后腹腔镜手术组（6.3±1.4）d（q=9.383,P〈0.05;q=12.919,P〈0.05）。3组术后复发无统计学意义（χ^2=0.621,P=0.733）。结论与开放手术相比,小切口腹腔镜和后腹腔镜手术具有创伤小、出血少、恢复快等优点;小切口腹腔镜为巨大肾上腺肿瘤切除提供了微创手术的新方式。     

超低位直肠癌腹腔镜辅助下经肛门拖出吻合术（附21例报告）

目的探讨腹腔镜下经肛门拖出式保肛手术在超低位直肠癌治疗中的应用。方法对21例行经肛门拖出式腹腔镜超低位直肠癌保肛手术病人的临床资料进行回顾性分析。结果本组平均手术时间为（200±40）min，平均出血量为（40±10）ml。术中发现吻合口瘘1例；术后发生吻合口瘘2例，吻合口狭窄2例，术后出血4例，盆腔感染4例。术后随访21例，随访时间为5～50月。行超低位吻合的13例6个月内排便正常，行结肠肛管吻合的8例9个月内排便正常。本组无局部复发病例，发生肝转移2例。结论腹腔镜下经肛门拖出式超低位直肠癌保肛手术确实可行，对于中、早期及组织学分型好的超低位直肠癌病人是较好的选择。     

腹腔镜与开腹全子宫切除术的比较

目的 探讨腹腔镜全子宫切除（total laparoscopic hysterrectomy,TLH）的临床价值. 方法回顾分析我院2005年11月～2006年10月38例TLH与40例开腹全子宫切除术的临床资料,比较2种手术方式手术时间、术中出血量、术后病率、肠功能恢复、住院日情况. 结果 腹腔镜组手术时间（85.8±13.8）min明显短于开腹组（99.9±9.3 ）min（t=-5.293,P=0.000）;腹腔镜组出血量（105.8±32.4）ml明显少于开腹组（166.0±67.4）ml （t=-4.930, P=0.000）;腹腔镜组术后病率3例明显少于开腹组15例（χ^2=9.270, P=0.002）;腹腔镜组术后排气时间（26.2±4.2）h明显短于开腹组（40.5±4.9）h （t=-13.601, P=0.000）;腹腔镜组术后住院时间（6.8±0.9）d明显短于开腹组（10.6±0.8）d （t=-19.612, P=0.000）.术后6个月随访开腹组2例切口愈合不良,2例阴道残端肉芽增生,腹腔镜组1例阴道残端肉芽增生,余无并发症. 结论腹腔镜全子宫切除较开腹全子宫切除的优势明显,如果腹腔镜下操作技巧熟练,腹腔镜全子宫切除是一种理想的术式.     

腹腔镜辅助直肠癌保肛手术治疗的临床研究

目的：探讨腹腔镜辅助直肠癌保肛手术治疗方法及效果。 方法：2007年8月—2012年8月入院的90例中低位直肠癌患者,随机分为对照组和观察组。对照组采用常规的套入式吻合保肛术,观察组采用腹腔镜辅助直肠癌保肛术,比较两组临床治疗疗效及不良反应发生率。 结果：观察组手术时间、术中出血量、切口长度、排气时间、拔尿管时间、拆线时间及住院时间分别为（172.23±29.38）min、（64.29±9.27）mL、（4.21±0.38）cm、（4.01±0.33）d、（3.98±0.44）d、 （6.77±0.42）d及（9.39±1.11）d,对照组分别为（205.13±14.40）min、（88.19±11.17）mL、 （6.02±0.79）cm、（5.02±0.59）d、（5.19±0.75）d、（8.03±0.99）d及（8.00±0.89）d,两组上述指标比较,差异均具有统计学意义（P<0.05,）;对照组不良反应发生率为28.89%,明显高于观察组（11.11%）（P<0.01）。 结论：腹腔镜辅助直肠癌保肛手术治疗效果显著,并发症发生率低,值得在基层医院推广并应用。     

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.