骨肿瘤细胞核仁组成区嗜银蛋白的表达

作者研究了７８例骨肿瘤细胞核仁组成区嗜银蛋白（ＡｇＮＯＲ）的表达，对其中３６例比较了ＡｇＮＯＲ计数和ＤＮＡ含量流式细胞分析的结果，对４６例骨肉瘤探讨了ＡｇＮＯＲ数的临床意义。结果表明：（１）良性、低度恶性和高度恶性骨肿瘤ＡｇＮＯＲ数分别为１．７１±０．３６；３．１５±０．６２和３．９９±１．００，其差异有统计学意义；（２）ＡｇＮＯＲ数与ＤＮＡ含量分析提供的ＤＮＡ指数、Ｓ期细胞百分数、Ｇ＿２／Ｍ期细胞百分数及增殖指数的相关关系分别为：０．３０４５、０．５９３７、０．３５０６和０．６２６０，其对应的Ｐ值为：＞０．０５、＜０．０１、＜０．０５和＜０．０１；（３）ＡｇＮＯＲ数一定程度上反映了骨肉瘤的某些临床特点：ＡｇＮＯＲ数高者倾向于有较大的肿瘤体积、较晚的外科分期和较差的预后。     

Ag－NOR对膀胱癌化疗疗效判断的价值

应用Ａｇ－ＮＯＲ染色技术，对１４例处于不同阶段化疗的膀胱移行细胞癌核内ＮＯＲ颗粒进行观察分析。结果表明化疗前、后Ａｇ－ＮＯＲ／核均数有非常显著性差异（Ｐ＜０．０１）．而且Ａｇ－ＮＯＲ／核均数下降的幅度与癌组织退变程度有关。提示Ａｇ－ＮＯＲ技术可作为判断膀胱癌化疗效果的一种新方法。     

Ag—NOR对膀胱癌化疗疗效判断的价值

应用Ａｇ－ＮＯＲ染色技术，对１４例处于不同阶段化疗的膀胱移行细胞癌核内ＮＯＲ颗粒进行观察分析，结果表明化疗前，后Ａｇ－ＮＯＲ／核均数有非常显著性差异（Ｐ〈０．０１）而且Ａｇ－ＮＯＲ／核均数下降的幅度与癌组织变程度有关，提示Ａｇ－ＮＯＲ技术可作为判断膀胱癌化疗效果的一种新方法。     

Ag－NOR对原发性骨肿瘤良恶性鉴别及预后估计的意义

应用银染法测定６３例原发性骨肿瘤（恶性２８例，良性２０例，ＧＣＴ１５例）Ａｇ－ＮＯＲ，结果显示：恶性骨肿瘤Ａｇ－ＮＯＲ计数（８．６１±２．３３／核）明显高于良性骨肿瘤（１．２５±０．２０／核），两者有高度显著性差异（Ｐ值＜０．０１）；两组不同预后的恶性骨肿瘤Ａｇ－ＮＯＲ亦有显著性差异（Ｐ值＜０．０１）；ＧＣＴ与恶性骨肿瘤，及不同Ｊａｆｆｅ分级的两组ＧＣＴ之Ａｇ－ＮＯＲ均无显著性差异（Ｐ值＞０．０５），但ＧＣＴ与良性骨肿瘤之Ａｇ－ＮＯＲ有显著性差异（Ｐ值＜０．０１）．本研究提示：（１）Ａｇ－ＮＯＲ是原发性骨肿瘤良恶性鉴别的一项可靠指标；（２）Ａｇ－ＮＯＲ检测有助于对恶性骨肿瘤的预后估计；（３）对所有ＧＣＴ均应考虑恶性的可能，Ｊａｆｆｅ分级不宜作为反映ＧＣＴ生物学行为的标准．     

骨肉瘤患者预后的单因素分析

本文用单因素分析法探讨了５４例骨肉瘤影响患者预后的因素。结果表明：在考察的１７个因素中，肿瘤细胞核ＤＮＡ含量、Ｓ期细胞百分数、细胞增殖指数、核仁组成区嗜银蛋白表达、细胞核面积、颗粒／核面积比、颗粒／核密度比、肿瘤外科分期、Ｘ线分期、肿瘤部位、最大径对患者预后均有一定影响；而患者年龄、性别、症状时间、肿瘤病理分型、Ｘ线分型、肿瘤细胞核异形因子与患者预后无关。     

Ag—NOR对原发性骨肿瘤良恶性鉴别及预后估计的意义

应用银染法测定６３例原发性骨肿瘤（恶性２８例，良性２０例，ＧＣＴ１５例）Ａｇ－ＮＯＲ，结果显示：恶性骨肿瘤Ａｇ－ＮＯＲ计数（８．６１±２．３３／核）明显高于良性骨肿瘤（１．２５±０．２０／核），两有高度显性差异（Ｐ值〈０．０１）；两组不同预后的恶性骨肿瘤Ａｇ－ＮＯＲ亦有显性差异（Ｐ值〈０．０１）；ＧＣＴ与恶性骨肿瘤，及不同Ｊａｆｆｅ分级的两组ＧＣＴ之Ａｇ－ＮＯＲ均无显性差异（Ｐ值〉０．０５     

结直肠癌核仁组成区嗜银蛋白的预后价值

本作者采用银染技术和流式细胞分析技术分别对８３例结直肠癌细胞的核仁组成区嗜银蛋白（ＡｇＮＯＲ）和ＤＮＡ含量进行测定，并结合临床随访和病理学资料评估其预后价值及相互关系。结果显示：结直肠癌组ＡｇＮＯＲ平均计数（９．７９±３．６７０）明显高于正常结肠粘膜组（２．９３７±０．８１２）。不同组织学分级的ＡｇＮＯＲ有显著性差异（ｐ＝０．０２３），分化好的肿瘤ＡｇＮＯＲ计数低。术后生存≥５年组的ＡｇＮＯＲ数（８．１７７±３．２９６）低于＜５年组（１１．６２２±３．１２３），二组间差异显著（Ｐ＜０．００１）。高ＡｇＮＯＲ（≥１０）组患者的术后生存率亦明显低于ＡｇＮＯＲ＜１０组的患者。结合ＤＮＡ倍体进行分析，ＡｇＮＯＲ＜１０的二倍体肿瘤患者的预后最好，而ＡｇＮＯＲ≥１０的异倍体肿瘤的预后最差，提示ＡｇＮＯＲ是一项预后参考指标，与ＤＮＡ从不同水平影响结直肠癌的恶性潜能，联合检测ＡｇＮＯＲ和ＤＮＡ可较好地反映结直肠癌患者的预后。     

膀胱癌c—erbB—2癌基因蛋白表达与Ag—NORs定量计数的关系

采用免疫组化方法和胶质银染色技术对５６例膀胱移行上皮癌组织的ｃ－ｅｒｂＢ－２癌基因蛋白表达产物进行检测和对嗜银蛋白核仁组成区（Ａｇ－ＮＯＲｓ）进行定量计数，结果显示：ｃ－ｅｒｂＢ－２蛋白产物表达与膀胱癌的分化程度有关，高分级肿瘤的表达水平高于低分级肿瘤。在ｃ－ｅｒｂＢ－２表达阳性的肿瘤标本中的Ａｇ－ＮＯＲｓ计数（５．２３±０．６５）明显高于ｃ－ｅｒｂＢ－２表达阴性的标本（３．３４±０．４２）（Ｐ〈     

崩肉瘤患者预后的单因素分析

本文用单因素分析法探讨了５４例骨肉瘤影响患者预后的因素。结果表明：在考察的１７个因素中，肿瘤细胞核ＤＮＡ含量、Ｓ期细胞百分数、细胞增殖指数、核仁组成区嗜银蛋白表达、细胞核面积、颗粒／核面积比、颗粒／核密度比、肿瘤外科分期、Ｘ线分期、肿瘤部位、最大径对患者预后均有一定影响；而患者年龄、性别、症状时间、肿瘤病理分型、Ｘ线分型、肿瘤细胞核异形因子与患者预后无关。     

骨巨细胞瘤Ag－NORs及PCNA的研究

作者采用改良的Ａｇ－ＮＯＲｓ染色技术和ＰＣＮＡ抗体标记对按Ｊａｆｆｅ分级的４８例骨巨细胞瘤细胞核进行研究，以探求Ｊａｆｅ分级方法是否反映骨巨细胞瘤的增生活性。结果显示随病理分级增高，基质细胞内的Ａｇ－ＮＯＲｓ颗粒数均值增加，病理分级之间，基质细胞内Ａｇ－ＮＯＲｓ颗粒均值除Ⅱ、Ⅲ级之间差别无显著性（Ｐ值＞０．０５）外，其余各级之间差别均有高度显著性（Ｐ值＜０．０１）。随着病理分级的增高，ＰＣＮＡ阳性表达率有增高的趋势，经卡方检验差别有高度显著性（Ｐ值＜０．０１）。基质细胞内Ａｇ－ＮＯＲｓ计数与ＰＣＮＡ阳性表达率之间存在正相关关系。通过此研究说明Ｊａｆｅ三级病理分级方法尽管在临床上有时与骨巨细胞瘤的侵袭性不相一致，但在病理上仍反映了它的细胞增生活性，尤其Ⅱ、Ⅲ级应同样对待。如果结合临床及Ｘ线表现，此分级方法仍不失为一种指导临床治疗和预测预后的有用指标。     

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.     

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.     

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.     

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.