影响Ⅱ期结直肠癌患者预后的临床病理因素分析

目的 分析影响Ⅱ期结直肠癌患者预后的临床病理因素,进一步探讨Ⅱ期结直肠癌患者进行辅助化疗的必要性.方法 收集2000年1月至2005年12月中山大学附属第一医院(作者原工作单位)收治的符合纳入标准的255例Ⅱ期结直肠癌患者的临床资料.采用Kaplan-Meier法绘制患者的生存曲线,Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单变量和多变量Cox回归分析.结果 随访截至2010年4月23日,平均随访时间为(63±22)个月,中位生存时间为63个月.255例患者5年总生存率和无瘤生存率分别为85.3％和83.7％.术前无肠梗阻或肠穿孔患者的5年总生存率和无瘤生存率分别为86.9％和85.6％,高于术前出现肠梗阻或肠穿孔患者的72.7％和68.4％(x2=4.546,4.573,P＜0.05).手术切缘阴性患者的5年总生存率和无瘤生存率分别为85.5％和83.9％,高于手术切缘阳性患者的75.0％和75.0％(x2=7.020,6.009,P＜O.05).多因素分析结果提示术前肠梗阻或肠穿孔是Ⅱ期结直肠癌患者生存的独立影响因素(Wald=4.477,相对危险度为2.371,95％可信区间为1.066～5.275,P＜0.05);接受辅助化疗和无辅助化疗患者的5年总生存率分别为87.3％和82.2％,无瘤生存率分别为86.0％和80.3％,两者比较,差异无统计学意义(P＞0.05).结论 术前肠梗阻或肠穿孔是影响Ⅱ期结直肠癌患者生存的独立危险因素;术后行辅助化疗并不能改善Ⅱ期结直肠癌患者的预后.     

结直肠癌肝转移预后影响因素的分析

目的 探讨结直肠癌肝转移患者预后的相关影响因素.方法 回顾性分析5年间收治的71例结直肠癌肝转移患者的临床病理资料.选择患者性别、年龄、肝转移部位、肝转移时间、转移灶数目、转移灶大小、原发肿瘤分化程度、有无淋巴转移、有无肝外转移以及肝转移病灶治疗方法等10个因素,用SPSS 17.0软件进行结直肠癌肝转移单因素分析和多因素Cox回归分析,并对有意义的相关因素进行交互作用分析.结果 71例结直肠癌肝转移患者生存时间为(16.5±5.3)个月,3年生存率为12.7％.单因素分析显示肝转移部位、转移灶数目、转移灶大小、肿瘤分化程度、有无淋巴转移、有无肝外转移以及肝转移病灶治疗方法等7个因素与预后有关,它们的组间差异均具有统计学意义(x2 =11.279,9.600,8.076,17.376,19.817,24.310,32.267;P＜0.05).Cox回归模型表明原发肿瘤分化程度(RR=1.671,95％CI 1.236 ～2.345,P=0.026),淋巴转移(RR=1.658,95％ CI1.214 ～2.286,P=0.010),有无肝外转移(RR =2.586,95％ CI 1.758 ～6.326,P=0.000)以及肝转移病灶治疗方法(RR=6.846,95％CI3.624～13.032,P=0.000)与结直肠癌肝转移预后有密切关系.结论 肿瘤分化程度、有无淋巴转移、有无肝外转移以及肝转移病灶治疗方法是结直肠癌肝转移预后的独立危险因素.     

PUMA和BIM表达与结直肠癌浸润转移及预后的关系

目的 研究BH3-only蛋白家族中p53上调凋亡调控因子(PUMA)和与bcl-2相互作用的细胞死亡调解因子(BIM)在结直肠癌组织中的表达及其与结直肠癌侵袭、转移和预后关系.方法 采用免疫组化染色方法(EnVision),检测PUMA和BIM蛋白在30例正常大肠黏膜、30例大肠腺瘤及142例结直肠癌组织中的表达.分析PUMA、BIM蛋白表达与患者临床病理特征、预后及化疗耐药相关蛋白[P-糖蛋白(P-gp)、谷胱甘肽S转移酶-π(GST-π)]的相关性.结果 PUMA蛋白在结直肠癌组织中的阳性表达率为82.4％,低于其在大肠腺瘤和正常大肠黏膜组织中的阳性表达率(均为96.7％)(x2=3.93、3.93,P＜0.05).BIM蛋白在结直肠癌组织中的阳性表达率为62.7％,明显低于其在大肠腺瘤组织中和正常大肠黏膜的阳性表达率(90.0％和96.7％)(x2 =8.42、13.29,P＜0.01).PUMA蛋白与BIM蛋白在结直肠癌组织中的表达呈正相关(r=0.747,P=0.000).PUMA蛋白的表达与肿瘤的分化程度(x2 =11.87)、浸润深度(x2=11.59)、淋巴结转移(x2=12.82)、TNM分期(x2=33.47)以及P-gp表达(x2=18.30)有关(P＜0.05),而与患者的年龄、性别、肿瘤大小、病理组织学类型以及GST-π表达无关(P＞0.05).BIM蛋白的表达与分化程度(x2=16.19)、淋巴结转移(x2=14.95)、TNM分期(x2=52.66)以及P-gp表达(x2 =10.60)有关(P＜0.05),而与患者的年龄、性别、肿瘤大小、浸润深度、病理组织学类型以及GST-π表达无关(P＞0.05).PUMA、BIM阳性表达者的术后1、3、5年生存率明显高于阴性表达者(x2=6.10、27.60,P＜0.05).淋巴结转移(RR=0.238)、TNM分期(RR=7.895)、PUMA(RR=1.691)和BIM蛋白的表达(RR =0.440)可作为结直肠癌独立的预后指标(P＜0.05).结论 PUMA、BIM在结直肠癌中的表达与结直肠癌的侵袭、转移和预后明显相关.PUMA和BIM蛋白表达降低的结直肠癌患者病期晚、预后差.     

肿瘤相关巨噬细胞在晚期胰腺癌组织中的浸润及其与预后的关系

目的 探讨肿瘤相关巨噬细胞(TAM)在胰腺癌组织中的浸润及对胰腺癌患者生存和预后的影响.方法 应用免疫组织化学方法 检测胰腺癌及胰腺良性病变组织中TAM的特异性标志物CD68,了解TAM在胰腺癌组织和胰腺良性病变中的浸润密度,比较TAM高密度组与低密度组胰腺癌患者的生存差异,并对影响预后的多个临床病理因素进行单因素及多因素分析.结果 在200倍高倍光学显微镜下计数,86例胰腺癌组织标本中TAM平均密度为29.6/HP,25例胰腺良性病变组织标本中TAM平均密度为14.2/HP.在胰腺癌组织中TAM浸润密度较良性病变组织中明显为高(P＜0.01).胰腺癌患者中TAM低密度组的中位生存时间为(16.7±3.4)个月,1年累积生存率为73.8%;TAM高密度组的中位生存时间为(9.4±2.6)个月,1年累积生存率为20.1%.TAM低密度浸润胰腺癌患者1年生存率较TAM高密度患者为高(P＜0.01).在胰腺癌患者中,低分化癌TAM浸润较明显.多因素分析显示,组织学分级及TAM浸润的密度是影响晚期胰腺癌生存的独立的预后因子.结论 晚期胰腺癌组织中有明显的TAM浸润,TAM高密度浸润状态提示预后不良.     

结直肠癌肝转移复发再次肝切除术的疗效与预后分析

目的 探讨再次肝切除术在结直肠癌肝转移复发治疗中的应用价值.方法 回顾性分析43例结直肠癌肝转移复发再次肝切除术和67例结直肠癌肝转移复发内科化疗的临床资料.结果 结直肠癌肝转移复发再手术组和化疗组1,3,5年生存率分别为83.7％,51.1％,27.9％和65.7％,20.6％,3.0％(P＜0.05或P＜0.01).再次肝切除组无手术死亡病例,并发症发生率为32.6％.单因素分析显示肝脏复发转移灶个数,切缘情况,CEA,肿瘤大小,肿瘤分化程度与预后有关.多因素回归分析结果表明,仅有肝脏复发转移灶个数和肿瘤大小为影响预后的独立因素.结论 再次肝切除术对于结直肠癌肝转移复发是安全的治疗方案,肿瘤负荷较小(癌直径＜5 cm和转移灶＜3个)的患者预后较好;再次手术可以延长结直肠癌肝转移复发患者的生存时间.     

肝细胞癌大体形态分型的临床意义

目的 探讨肝细胞癌(以下简称肝癌)大体形态分型与患者临床病理特征及预后的关系,以及影响肝癌患者预后的相关因素.方法 回顾性分析2008年1月至2013年12月南京大学医学院附属鼓楼医院收治的119例肝癌患者的临床资料.将手术切除标本沿冠状位切成厚度约1 cm的切片并拍照,记录病理学特点.参照文献,结合临床经验,将肝癌手术切除标本大体形态分为结节型(1型)、结节突起型(2型)、结节融合型(3型)、浸润型(4型).比较4种类型患者的临床病理因素.采用门诊及电话方式进行随访,随访时间截至2014年4月或患者死亡.正态分布的计量资料以x±s表示,多组间比较采用方差分析,两两比较采用LSD-t检验;偏态分布数据以M(P25,P75)表示,多组间比较采用Kruskal-Wallis检验,两两比较采用Mann-Whitney检验.计数资料比较和单因素分析采用x2检验或Fisher确切概率法.采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行生存分析.采用COX逐步回归模型进行多因素分析.结果 119例肝癌患者中,1型占20.17％ (24/119),2型占25.21％ (30/119),3型占21.85％(26/119),4型占32.77％(39/119).4种不同大体形态分型的肝癌患者年龄、HBsAg阳性、术前AFP、手术时间、术中出血量、住院时间、T分期、微血管侵犯比较,差异均有统计学意义(F =4.499,x2=2.944,3.516,F=1.028,2.837,2.419,x2=6.606,12.732,P＜0.05).进一步两两比较:患者术前AFP,4型显著高于3型、2型和1型,差异均有统计学意义(Z=2.183,1.851,2.083,P＜0.05).患者手术时间,4型显著长于3型和1型,差异均有统计学意义(t=1.825,1.758,P＜0.05);4型与2型比较,差异无统计学意义(t=1.521,P＞0.05).患者术中出血量,4型显著多于3型、2型和1型,差异均有统计学意义(t=1.769,1.875,2.205,P＜0.05).患者住院时间,4型显著长于2型和1型,差异均有统计学意义(t=2.159,1.975,P＜0.05);4型与3型比较,差异无统计学意义(t=0.248,P＞0.05).患者微血管侵犯,4型显著多于3型、2型和1型,差异均有统计学意义(x2=5.905,8.291,4.729,P＜0.05).119例肝癌患者中,116例术后获得随访,随访率为97.48％(116/119),中位随访时间为26个月(4～74月).119例患者总体中位生存时间为25个月(1～73个月),1、3、5年总体生存率分别为83.2％、70.7％、63.4％;无瘤中位生存时间为14个月(1～70个月),1、3、5年无瘤生存率分别为73.3％、42.7％、11.4％.1型肝癌患者总体中位生存时间为56个月(51 ～61个月),1、3、5年总体生存率分别为94.1％、82.5％、65.3％,无瘤中位生存时间为48个月(41 ～54个月),1、3、5年无瘤生存率分别为81.3％、66.7％、58.6％;2型肝癌患者总体中位生存时间为56个月(52 ～ 60个月),1、3、5年总体生存率分别为91.6％、82.6％、82.6％,无瘤中位生存时间为46个月(40～51个月),1、3、5年无瘤生存率分别为81.4％、64.1％、64.1％;3型肝癌患者总体中位生存时间为53个月(48 ～58个月),1、3、5年总体生存率分别为91.6％,84.7％,77.8％,无瘤中位生存时间为42个月(36 ～48个月),1、3、5年无瘤生存率分别为80.1％、62.3％、50.0％;4型肝癌患者总体中位生存时间为46个月(40 ～51个月),1、3、5年总体生存率分别为65.7％、51.5％、45.6％,无瘤中位生存时间为29个月(23 ～34个月),1、3、5年无瘤生存率分别为64.3％、31.6％、22.3％.不同大体形态分型肝癌患者预后(总体生存率和无瘤生存率)比较,差异有统计学意义(x2=7.971,7.652,P＜0.05).患者预后(总体生存率和无瘤生存率)4型显著差于3型、2型和1型,差异均有统计学意义(总体生存率:x2=4.823,6.131,5.785,P＜0.05;无瘤生存率:x2=5.184,5.634,9.262,P＜0.05).单因素分析结果显示:术前AFP、T分期、微血管侵犯、肿瘤大体形态分型是影响肝癌患者预后的相关因素(x2=3.516,6.687,6.165,7.974,P＜0.05).多因素分析结果显示:T3 ～T4期、微血管侵犯、肿瘤大体形态分型为4型是影响肝癌患者预后的独立危险因素(RR=3.646,2.397,1.617,95％可信区间:1.042 ～ 12.713,1.063 ～5.403,1.119 ～2.337,P＜0.05).结论 肝癌的大体形态分型可能与患者临床病理因素相关,浸润型肝癌患者术前AFP高、术中出血量大、微血管侵犯发生率高,预后差.T3～T4期、微血管侵犯、肿瘤大体形态分型为浸润型是影响肝癌患者预后的独立危险因素.     

分化抑制因子2和表皮生长因子受体及人类表皮生长因子受体2在结直肠癌组织中的表达及其意义

目的 研究分化抑制因子2(Id2)、表皮生长因子受体(EGFR)及人类表皮生长因子受体2(Her-2)在结直肠癌中的表达以及与患者预后的关系.方法 采用PV6000二步法检测359例结直肠癌及35例癌旁正常组织中Id2、EGFR及Her-2的表达.结果 (1)结直肠癌组织中Id2的阳性率为68.0%,EGFR的阳性率为64.9%,二者在结直肠癌组织中的表达均显著高于癌旁正常组织中的表达(P值均＜0.05).Her-2在结直肠癌组织中的阳性率为1.7%,与癌旁正常组织中的阳性率相比差异无统计学意义(P=0.441).(2)Id2的阳性表达与患者的TNM分期、组织学分级、肿瘤组织的肠壁浸润深度、淋巴结转移情况以及腹腔和远处转移情况等相关(P值均＜0.05).(3)Id2阳性表达组的无瘤生存时间较阴性表达组短(P=0.002),阳性表达组的5年生存率低于阴性组(P=0.001).结论 Id2可能在结直肠癌的发生、发展及转移中发挥重要作用,可以作为评价结直肠肿瘤生物学行为及判断预后的指标之一.     

拓扑异构酶Ⅱα在结直肠癌组织中的表达及其临床意义

目的 探讨拓扑异构酶Ⅱα在结直肠癌组织中的表达水平及其与各临床病理因素、长期预后之间的关系.方法 采用EnVision免疫组化法检测490例结直肠癌患者组织中拓扑异构酶Ⅱα蛋白的表达水平,分析它与各临床病理因素之间的关系,并采用Kaplan- Meier分析和多因素COX回归分析研究其在预后预测中的价值.结果 拓扑异构酶Ⅱα的表达水平与T分期(P=0.042)、N分期(P =0.038)呈负相关;与局部复发率(P=0.053)也呈负相关,差异均有统计学意义.Kaplan- Meier分析显示拓扑异构酶Ⅱα的表达水平与患者的总生存时间(P=0.022)和无瘤生存时间(P=0.036)呈正相关.多因素COX回归分析显示拓扑异构酶Ⅱα的表达水平(P=0.017)、血清CEA(P＜0.001)、CA199(P=0.002)、肿瘤的分化程度(P=0.001)和Dukes分期(P ＜0.001)是结直肠癌患者总生存时间的独立影响因素.结论 拓扑异构酶Ⅱα的表达水平是结直肠癌的独立预后因素,联合检测拓扑异构酶Ⅱα、CEA、CA199和肿瘤的分化程度有助于结直肠癌患者的预后判断和为患者选择个性化的治疗方案,尤其是那些早期的结直肠癌和结肠镜下切除的已癌变的息肉.     

糖尿病与结直肠癌临床病理因素及预后的相关性研究

目的 探讨糖尿病对结直肠癌临床病理因素及预后的影响.方法 采用回顾性研究的方法,将2000年1月至2007年6月收治的共计599例结直肠痛患者分为糖尿病组(DM组)和非糖尿病组(NDM组),比较两组性别、年龄等一般情况及临床病理因素的差异并作Logistic多因素同归分析;并对直接接受根治手术的402例患者进行预后影响凶素的Cox回归分析.结果 本组患者中共58例(9.7%)罹患糖尿病,糖尿病组与非糖尿病组患者在体质量、年龄、是否合并高血压方面差异均有统计学意义(P<0.05);两组在肿瘤组织学分级、浸润、淋巴转移、TNM分期及脉管癌栓方面差异均无统计学意义(P>0.05).Logistic多因素回归分析显示糖尿病与结直肠癌的病理因素无相关性(P>0.05).直接接受根治手术的患者生存分析显示:术后3年的转移复发Kaplan-meier曲线及生存曲线有、无糖尿病的两组间差异均无统计学意义(P=0.521、0.909);多因素Cox回归分析未提示糖尿病与结直肠癌患者预后相关(P=0.991).结论 在接受了外科手术的结直肠癌患者中,糖尿病与结直肠癌的临床病理因素无相关性;罹患糖尿病并不改变结直肠癌患者的预后,糖尿病在结直肠癌发展与转归的作用尚需进一步研究.     

达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌疗效的Meta分析

目的 比较达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌的疗效.方法 检索PubMed、Cochrane Library、EMBASE、Medline、万方、知网、维普、康健等数据库,并检索纳入文献的参考文献.检索时间从建库至2012年2月.收集达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌的随机对照试验(RCT)和非随机对照试验(NRCT).按预设标准进行筛选并进行质量评价,将纳入文献的患者分为机器人组和传统腹腔镜组,提取数据后用RevMan5.1软件进行Meta分析,比较两种手术方式治疗结直肠癌的疗效.二分类变量采用优势比(OR)及95％可信区间(95％ CI)表示,连续性变量采用加权均数差(WMD)及95％ CI表示.结果 共纳入1个RCT及10个NRCT,共计结直肠癌患者974例,其中机器人组426例,传统腹腔镜组548例.Meta分析结果显示:与传统腹腔镜组比较,机器人组手术时间长、中转开腹率低、术后肛门排气时间短(WMD =25.61,OR =0.32,WMD =-0.21,P ＜0.05);两组患者术中出血量、淋巴结检出数目、远切缘距肿瘤距离、并发症发生率及住院时间比较,差异无统计学意义(WMD=-23.14,-0.31,0.14,OR=1.06,WMD =-0.43,P ＞0.05).结论 达芬奇机器人手术系统与传统腹腔镜治疗结直肠癌的肿瘤切除情况无差异,但达芬奇机器人手术系统结直肠癌切除术具有中转开腹率较低、术后肛门排气时间较短等优势.     

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.     

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.     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.