端侧胰管空肠黏膜-黏膜吻合术后胰瘘的危险因素分析

目的 分析胰十二指肠切除术中应用端侧胰管空肠黏膜-黏膜吻合法术后胰瘘的危险因素.方法 回顾性分析我院1994年1月至2008年1月问101例胰十二指肠切除术病例,分析影响胰瘘的术前及术中危险因素. 结果本组胰瘘发生率为9.9%(10/101),单变量分析结果表明术前黄疸程度(χ2=5.814,P=0.016)、黄疸持续时间(χ2=4.17,P=0.041)、胰腺质地(χ2=5.286,P=0.021)、胰管直径(χ2=4.165,P=0.041)、手术失血量(χ2=5.273,P=0.022)是胰瘘发生的危险因素,多因素Logistic回归分析结果表明,胰腺质地(OR=13.355,P=0.023)、术前黄疸程度(OR=12.126,P=0.006)、手术失血量(OR=5.92,P=0.032)是胰瘘发生的独立危险因素.Logistic回归预测方程:P=1/[<1+e-(-6.378+2.592胰腺质地+2.495术前黄疽程度+1.778手术失血量)],此方程预测发生胰瘘的正确性为92.1%.结论 胰腺质地、术前黄疸程度、手术失血最是端侧胰管空肠黏膜-黏膜吻合法术后胰瘘发生的独立危险因素,手术技术提高,减少术中失血量,可降低胰瘘的发生率.     

胰腺残端捆绑结扎对胰腺远端切除术后胰瘘的影响

目的探讨胰腺残端捆绑结扎对胰腺远端切除术后胰瘘的影响。方法采用回顾性病例对照研究方法。收集2011年1月至2018年8月内蒙古医科大学附属医院收治的60例胰体尾部病变行胰腺远端切除术病人的临床资料;男24例,女36例;中位年龄为45岁,年龄范围为19~68岁。60例病人中,36例离断胰腺仅采用直线切割闭合器,设为未捆绑组;24例离断胰腺前在距离胰腺离断处近端>1 cm用10号或7号丝线予以捆绑结扎,设为捆绑组。观察指标:(1)术后恢复情况。(2)影响胰腺远端切除术后胰瘘的危险因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验或ANOVA检验;偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ²检验。单因素分析采用χ²检验,多因素分析采用Logistic回归模型。结果(1)术后恢复情况:未捆绑组病人术后淀粉酶、生化漏、B级胰瘘、并发症、拔除引流管时间、术后住院时间、总住院费用分别为(2629±592)U/L、14例、5例、7例、(11.9±0.7)d、(13.6±0.7)d、(49430±1626)元,捆绑组病人上述指标分别为(683±312)U/L、3例、1例、2例、(9.7±0.6)d、(11.3±0.5)d、(44767±1163)元,两组病人术后淀粉酶、生化漏、拔除引流管时间、术后住院时间、总住院费用比较,差异均有统计学意义(t=2.528,χ²=1.512,t=2.341、2.311、2.111,P<0.05);两组病人B级胰瘘、并发症比较,差异均无统计学意义(χ²=1.512、1.394,P>0.05)。(2)影响胰腺远端切除术后胰瘘的危险因素分析:单因素分析结果显示肿瘤长径和胰腺残端捆绑结扎是影响胰腺远端切除术后胰瘘的相关因素(χ²=4.462,5.061,P<0.05)。多因素分析结果显示胰腺残端捆绑结扎是胰腺远端切除术后胰瘘的独立影响因素(优势比=0.187,95%可信区间为0.037~0.954,P<0.05)。结论胰腺残端捆绑结扎是胰腺远端切除术后胰瘘的独立影响因素,该方式可有效降低胰腺远端切除术后胰瘘特别是生化漏发生率,缩短引流管留置时间和术后住院时间,促进病人恢复并降低总住院费用。     

腹腔镜胰十二指肠切除术后胰漏的相关因素分析

目的探讨腹腔镜胰十二指肠切除术后B、C级胰漏发生的预后因素。方法回顾性分析2016年12月～2018年6月83例腹腔镜胰十二指肠切除术的临床资料,对可能与B、C级胰漏有关的围手术期因素进行分析。单因素分析采用χ~2检验,有统计学意义的因素采用非条件logistic回归分析进行多因素分析。结果 83例中11例(13.3%)发生术后B、C级胰漏,其中B级9例(10.8%),C级2例(2.4%)。logistic回归多因素分析显示,术前总胆红素≥171μmol/L (OR=4.636,95%CI:1.080～19.894,P=0.039)、胰腺质地柔软(OR=0.202,95%CI:0.047～0.866,P=0.031)与B、C级胰漏的发生密切相关。BMI≥25(OR=22.347,95%CI:1.462～341.501,P=0.026)、术后未应用生长抑素(OR=0.071,95%CI:0.006～0.799,P=0.032)是胰腺质地柔软患者术后B、C级胰漏发生的相关因素。BMI≥25 (OR=13.474,95%CI:1.258～144.322,P=0.032)、术前采取减黄措施(OR=0.057,95%CI:0.005～0.638,P=0.020)是术前总胆红素≥171μmol/L患者术后B、C级胰漏发生的影响因素。结论胰腺质地柔软及术前总胆红素≥171μmol/L与腹腔镜胰十二指肠切除术后B、C级胰漏发生密切相关。BMI≥25时,此类患者B、C级胰漏发生风险明显增加。当术前总胆红素≥171μmol/L时,宜术前采取减黄措施。对于胰腺质软者,预防性应用生长抑素可在一定程度上降低腹腔镜胰十二指肠切除术后B、C级胰漏发生风险。     

胰十二指肠切除术后胰瘘发生的相关因素分析

目的 探讨胰十二指肠切除术后胰瘘发生的危险因素.方法 回顾性分析2000年5月至2010年5月昆明医学院第二附属医院收治的186例行胰十二指肠切除术患者的临床资料,根据术后是否发生胰瘘将患者分成胰瘘组(39例)和非胰瘘组(147例)进行队列研究.对围手术期可能与胰瘘发生相关的多种因素进行分析,筛选胰十二指肠切除术后胰瘘发生的危险因素.单因素分析采用x2检验或Fisher确切概率法,多因素分析采用Logistic回归模型.结果 186例患者中39例发生胰瘘,其中A级26例、B级10例、C级3例.单因素分析结果显示:术前黄疸时间、术前6个月体质量下降、术前TBil、术前纠正后Alb、术后第3天Alb、胰腺残端游离长度、胰管直径、胰腺质地、腹腔引流管拔出时间是发生胰瘘的影响因素(x2=34.990,20.480,8.212,10.890,13.561,11.505,13.820,4.539,36.590,P＜0.05).多因素分析结果显示:术前黄疸时间＞8周、术前6个月体质量下降≥10％、胰管直径＜3 mm、胰腺质地柔软、腹腔引流管拔出时间＞5d是发生胰瘘的独立危险因素(OR=2.229,3.383,1.437,1.273,11.939,P＜0.05).结论 术前黄疸时间＞8周、术前6个月内体质量下降≥10％、胰管直径＜3 mm、胰腺质地柔软和腹腔引流管拔出时间＞5d将增加患者胰十二指肠切除术后胰瘘的发生率.     

胰腺残端胰腺腺泡细胞数量在PD术后胰瘘的应用价值研究

目的评估术后胰瘘与胰腺残端腺泡细胞数量的相关性,并评估其是否可以作为胰瘘的危险因素。方法回顾性分析2015年4月～2018年4月期间我院69例行PD手术的患者。根据术后有无发生胰瘘分为胰瘘组和非胰瘘组,对比分析两组患者的临床数据以及实验室参数,运用Spearman相关性检验分析胰腺残端腺泡细胞数量和引流液淀粉酶含量之间的相关性,使用logistical回归分析确定术后胰瘘的独立危险因素,单变量分析中P0.05的变量纳入到多变量分析中。结果最终胰瘘组20例,无胰瘘组49例。胰瘘组的软胰腺的比例较非胰瘘组显著升高(45.0%和10.2%,P0.001),并且术后第3天引流液中淀粉酶含量和住院时间均显著高于非胰瘘组(P0.001)。此外,胰瘘组的胰腺残端腺泡细胞计数显著高于非胰瘘组(898.9±161.8和443.1±127.6,P0.001)。胰腺残端胰腺腺泡细胞的数量与引流液中淀粉酶含量呈正相关性(r=0.991,P0.001)。多因素分析结果显示显示胰腺质地软(OR:5.060,95%Cl:1.252～7.798,P0.001),较高的胰腺残端胰腺腺泡细胞计数(OR:2.662,95%Cl:1.132～3.947,P0.001)是PD后发生胰瘘的独立危险因素。结论胰腺质地和胰腺残端的腺泡细胞计数是PD术后出现胰瘘的独立危险因素。     

远端胰腺切除术后胰瘘的危险因素分析

目的分析远端胰腺切除术(DP)术后胰瘘(POPF)发生的相关危险因素,探讨预测DP后POPF的有效因素。方法回顾性分析2010年1月至2017年11月期间于徐州医科大学附属医院肿瘤外科接受DP的120例胰腺疾病患者的临床资料,采用非条件logistic回归探索DP后POPF发生的影响因素。结果 120例患者中,有15例(12.5%)发生有临床意义的POPF,其中B级胰瘘13例,C级胰瘘2例。非条件logistic回归结果显示,胰腺质地软及术前胰腺CT值小于40 Hu为DP后发生POPF的独立危险因素(P0.05)。结论胰腺质地及术前胰腺CT值是DP后POPF发生的重要影响因素,术前对患者的胰腺CT值及术中胰腺质地进行评估,可有效预测DP后POPF的风险。     

糖尿病对胰腺癌胰十二指肠切除术后并发症的影响

目的 探讨糖尿病对胰腺癌患者行胰十二指肠切除术后并发症的影响.方法 回顾性研究2005年1月至2012年8月302例行胰十二指肠切除术的胰腺癌患者的临床资料. 结果 302例患者中113例(37.4％)合并糖尿病.术后总的严重并发症发生率为20.0％,胰瘘发生率为13.2％,胃排空延迟发生率为25.8％,各种感染发生率为36.8％,肾功能不全发生率为3.0％,死亡率为3.3％.糖尿病组胰腺质地硬的比例较高(x2=15.175,P＜0.01),胰瘘率较低(x2=7.811,P=0.005);两组间的胃排空延迟、感染、肾功能不全、出血、肺部并发症、心脏并发症和神经系统并发症发生率,以及住院时间和死亡率的差异均无统计学意义(均P ＞0.05).Logistic回归分析显示糖尿病(OR=0.358,P=0.035)和胰腺质地硬度(OR=0.395,P=0.032)是胰瘘发生的保护因素,黄疸(OR =3.819,P=0.010)和术中输血(OR=1.268,P=0.001)是胰瘘发生的危险因素.结论 围手术期血糖控制良好的糖尿病不增加胰腺癌行胰十二指肠切除的手术风险.     

胰十二指肠切除术后胰瘘危险因素的荟萃分析

目的运用荟萃分析评估胰十二指肠切除术后胰瘘的相关危险因素,以指导临床诊治。方法使用Rev Man5.2对2005年1月至2014年9月间国内发表的关于胰十二指肠切除术后胰瘘的危险因素分析的12篇文献进行Meta分析。结果性别、年龄、糖尿病、冠心病、高血压、手术时间、术前总胆红素以及术后是否使用生长抑素与术后胰瘘的发生无统计学意义(P0.05);而术前白蛋白低于30 g/L(OR=0.52,95%CI:0.33~0.80,P0.01)、胰腺质地柔软(OR=0.20,95%CI:0.14~0.29,P0.01)、胰管直径小于3 mm(OR=0.26,95%CI:0.17~0.42,P0.01)、胰管未放置支撑管(OR=0.52,95%CI:0.31~0.88,P0.05)以及胰肠套入式吻合(OR=0.60,95%CI:0.38~0.95,P0.05)与术后胰瘘的发生关系密切。结论胰十二指肠切除术后胰瘘与患者性别、年龄、糖尿病、冠心病、高血压、手术时间、术前总胆红素以及术后是否使用生长抑素;而术前低蛋白血症、质软的胰腺质地、细小的胰管、胰管支撑管是否放置以及胰肠吻合方式的选择等因素影响着术后胰瘘的发生。     

同一术者169例胰十二指肠切除手术并发症分析

目的 分析胰十二指肠切除术手术并发症及影响胰瘘的危险因素.方法 回顾性研究该院2000年1月至2009年12月同一术者施行的169例胰十二指肠切除术患者资料,分析影响胰瘘的危险因素,比较前5年与后5年间的并发症差异.结果 死亡率2.4％,并发症发生率为34.9％,胰瘘发生率为7.7％;多变量Logistic回归分析提示手术出血量大于400ml(OR=2.87;95％可信区间:1.17～8.19;P=0.048)、胰腺质软(OR=1.95;95％可信区间:0.87～6.19;P=0.032)和胰管直径小于3 mm(OR=3.78;95％可信区间:1.01～10.63;P=0.019)是影响术后发生胰瘘与否的危险因素;前5年与后5年患者临床资料在死亡率、并发症以及主要并发症发生率差异无统计学意义,后5年的再手术率较前5年高、术后住院天数显著延长.结论 手术出血量、胰腺质地和胰管直径是影响术后发生胰瘘与否的危险因素;为减少术后胰瘘的发生,应选用术者熟悉的吻合方式进行胰肠吻合.     

胰十二指肠切除术后胃排空功能障碍的危险因素分析

目的:探讨胰十二指肠切除术后胃排空功能障碍的危险因素。方法:将2008年9月—2016年3月行胰十二指肠切除术后发生胃排空功能障碍者52例纳入病例组,选取同期未发生胃排空功能障碍者61作为对照组。分析胰十二指肠切除术后胃排空功能障碍的危险因素。结果:113例行胰十二指肠切除术的患者中,胃排空功能障碍的发生率为46.0%,A级17.6%、B级19.5%、C级8.9%。多因素分析显示,吸烟(OR=1.65,95%CI:1.75~8.96,P=0.037)、2型糖尿病(OR=2.13,95%CI:2.15~25.23,P=0.027)以及胰瘘(OR=5.35,95%CI:1.71~10.42,P=0.001)、胆瘘(OR=1.87,95%CI:2.37~13.28,P=0.035)、腹腔积液(OR=3.75,95%CI:2.35~18.38,P=0.015)、腹腔感染(OR=2.47,95%CI:1.35~11.26,P=0.026)是胰十二指肠切除术后胃排空功能障碍的独立危险因素。结论:吸烟史、合并2型糖尿病、术后并发症(胰瘘、胆瘘、腹腔积液、腹腔感染)与胰十二指肠切除术后胃排空功能障碍具有显著的相关性。     

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 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.     

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.