局麻药高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞的临床研究

目的观察利多卡因复合罗哌卡因高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞的临床效果。方法 80例行下肢手术的患者随机均分为高浓度低容量坐骨神经阻滞+低浓度高容量腰丛阻滞组(Ⅰ组)和相同容量浓度阻滞组(Ⅱ组)。Ⅰ组患者坐骨神经给予1.5%利多卡因10 ml+0.75%罗哌卡因10 ml,腰丛给予1%利多卡因15 ml+0.3%罗哌卡因25 ml;Ⅱ组坐骨神经和腰丛均给予0.6%利多卡因+0.3%罗哌卡因混合液25 ml。观察并记录坐骨神经和腰丛神经支配区域针刺感觉消失时间、趾跖曲和背曲运动消失时间、屈膝运动消失时间和抬腿运动消失时间。结果Ⅰ组麻醉成功率明显高于Ⅱ组(P0.05),坐骨神经支配区域感觉阻滞起效时间明显短于Ⅱ组(P0.05),腰丛起效时间与II组差异无统计学意义。Ⅰ组趾跖曲和背曲运动消失时间明显短于Ⅱ组(P0.05),屈膝运动消失时间和抬腿运动消失时间与Ⅱ组差异无统计学意义。结论利多卡因复合罗哌卡因高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞能够获得更高的阻滞成功率及更短的起效时间。     

腰丛神经阻滞与硬膜外阻滞在老年股骨粗隆骨折手术中比较

目的比较老年患者股骨粗隆骨折手术中神经刺激器定位下的腰丛-坐骨神经阻滞与硬膜外麻醉效果。方法 60例ASA2～3级拟行老年股骨粗隆骨折患者,随机分为腰丛-坐骨神经阻滞组（A组,n=30）和硬膜外麻醉组（B组,n=30）。A组采用神经刺激器定位下的腰丛-坐骨神经阻滞。腰丛：0.5%罗哌卡因25ml和1%利多卡因15ml;坐骨神经：0.5%罗哌卡因10ml和1%利多卡因10ml。B组行硬膜外麻醉,给予0.5%罗哌卡因和1%利多卡因混合液10～18ml。观察两组患者血流动力学变化、阻滞起效,持续时间及穿刺操作时间、麻醉费用、效果。结果 A组在手术过程中的收缩压、舒张压、心率较B组平稳,两组感觉阻滞起效有显著差异（P〈0.05）,A组感觉阻滞维持时问明显长于B组（P〈0.05）;两组穿刺时间、麻醉费用、药物剂量有显著差异（P〈0.05）。结论腰丛-坐骨神经阻滞用于老年患者单侧股骨粗隆骨折不仅可满足手术需要,而且对血流动力学影响小,阻滞维持时间长,麻醉费用低。     

腰丛-坐骨神经阻滞在老年合并肺部疾病患者髋部手术中的应用

目的临床研究腰丛-坐骨神经阻滞用于老年合并肺部疾病患者髋部手术的安全有效性。方法患者均在神经刺激器引导下行腰丛-坐骨神经阻滞,麻醉药物采用0.4%盐酸罗哌卡因,手术开始前常规泵注丙泊酚和瑞芬太尼;观察麻醉效果及感觉和运动阻滞起效时间,监测神经阻滞前,手术开始时,手术开始后10、20、30 min时SBP、DBP、HR、SPO2值。结果各时间点BP、HR、SPO2无显著变化,麻醉满意度100%,无一例麻醉意外和并发症。结论腰丛-坐骨神经阻滞有效保证患者围手术期安全,降低麻醉风险,效果肯定。     

不同剂量地塞米松对罗哌卡因神经阻滞作用的影响

目的比较不同剂量地塞米松复合罗哌卡因神经阻滞对罗哌卡因阻滞时效的影响。方法 60例内、外踝关节骨折拟行手术患者随机均分为三组。所有患者均在神经刺激器定位下行腰丛-坐骨神经阻滞麻醉。A组:0.4%罗哌卡因50ml;B组:0.4%罗哌卡因50ml加入地塞米松5mg;C组:0.4%罗哌卡因50ml加入地塞米松10mg。观察并记录腰丛、坐骨神经感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞持续时间、运动阻滞持续时间。观察并记录三组患者术后24、48h镇痛泵的舒芬太尼用量、按压总次数和有效次数,记录三组患者术后12、24、36、48h的数字疼痛分级法(NRS)评分及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生率。结果 A组感觉阻滞持续时间和运动阻滞持续时间明显短于B、C组,且B组明显短于C组(P<0.01)。A组患者术后12、24h的NRS评分[(5.2±1.3)、(3.4±0.5)分]明显高于B组的[(1.1±0.3)、(1.6±0.6)]分和C组的[(0.4±0.1)、(1.0±0.2)]分(P<0.05)。A组患者按压总次数和有效次数、48h舒芬太尼用量明显多于B、C组(P<0.05)。结论 5和10mg地塞米松均能延长0.4%罗哌卡因腰丛-坐骨神经阻滞作用时间,且10mg作用更明显。     

下肢手术病人左旋布比卡因与罗哌卡因腰丛-坐骨神经联合阻滞的效果

目的 下肢手术病人左旋布比卡因与罗哌卡因腰丛-坐骨神经联合阻滞的效果。方法 择期行单侧下肢手术病人50例,随机分为2组,罗哌卡因组(R组)和左旋布比卡因组(L组),每组 25例。坐骨神经穿刺点为髂后上棘与股骨大转子连线中点垂直线和股骨大转子与骶裂孔连线交点; 腰丛穿刺点为髂嵴连线,腰椎棘突旁开4 cm。选用Stimuplex HNS 11刺激器,采用Stimuplex D 22 G 刺激针。刺激起始电流强度1 mA,在观察到下肢肌肉收缩后,逐渐降低刺激电流强度到≤0．3 mA,相 应的肌群仍有收缩。R组:坐骨神经及腰丛分别注入0．5％罗哌卡因20 ml共200 mg;L组:分别注入 0．375％左旋布比卡因20 ml共150 mg。药物注射完毕后每5 min测定感觉和运动神经阻滞程度,并记 录麻醉起效时间。术中观察病人对止血带的耐受程度及神经阻滞程度分级。记录运动、感觉恢复时 间和首次按压镇痛泵时间。术后24 h评估病人对腰丛-坐骨神经联合阻滞的接受程度及麻醉相关并 发症。结果 R组1例病人阻滞失败,7例(R组5例,L组3例)阻滞尚完全。5例病人(R组3例,L 组2例)手术进行至约50 min时(40～70 min)感到止血带不适。两组间感觉和运动功能恢复时间及术 后首次需要镇痛药物时间比较差异无统计学意义(P>0．05)。49例病人对腰丛-坐骨神经联合阻滞 的接受程度评分均为1分,且未见麻醉相关并发症。结论0．375％左旋布比卡因腰丛-坐骨神经联 合阻滞的起效时间、持续时间和麻醉效果方面与0．5％罗哌卡因相似。     

腰丛-坐骨神经联合阻滞用于老年患者下肢手术的临床研究

目的探讨腰丛-坐骨神经联合阻滞在老年患者下肢手术应用的可行性。方法40例60岁以上拟行单侧下肢手术的患者随机均分为两组。A组采用神经刺激器定位技术,正确定位腰丛和坐骨神经后分别给予0.375%罗哌卡因20～25ml和0.5%罗哌卡因15～20ml;B组选择L2～3或L3～4间隙行硬膜外麻醉,给予0.75%罗哌卡因10～15ml。观察两组血流动力学变化、阻滞效果及其不良反应。结果B组麻醉15min后各时点的SBP、DBP均明显低于麻醉前及A组(P<0.05或P<0.01);A组镇痛持续时间长于B组(P<0.05),但运动阻滞持续时间短于B组(P<0.05);B组术中使用麻黄碱的例数及输液量高于A组(P<0.05);B组患者围术期恶心、呕吐、尿潴留等不良反应的发生率明显高于A组(P<0.01)。结论腰丛-坐骨神经联合阻滞对血流动力学影响小,术后镇痛时间长,并发症少,适用于老年患者下肢手术。     

糖尿病患者周围神经松解时腰丛-坐骨神经联合阻滞的效果

本院2005年9月至2006年5月在腰丛-坐骨神经联合阻滞下行周围神经松解术的糖尿病患者53例,男26例,女27例,年龄17～78岁,其中Ⅰ型糖尿病患者5例,Ⅱ型糖尿病患者48例,ASA分级Ⅰ～Ⅲ级,30例合并高血压、冠心病,6例既往有脑梗塞病史,4例近期有急性心肌梗塞发作.在神经刺激器定位下行腰丛-坐骨神经联合阻滞,腰丛阻滞时先注射1%利多卡因10～15 ml,再注射0.5%罗哌卡因10～15 ml;坐骨神经阻滞时先注射1%利多卡因15～20 ml,再注射0.5%罗哌卡因15～20 ml.98%(52/53)的患者阻滞效果完善,1例患者阻滞效果不完善,术中需辅助静脉麻醉.感觉神经和运动神经阻滞起效时间分别为9.2±2.6、(12.4±2.0)min,感觉神经和运动神经阻滞维持时间分别为402±102、(293±103)min.术中所有患者血压、心率平稳.术中、术后未见不良事件发生,术后患者满意率为96.2%(51/53).     

罗哌卡因腰-硬联合麻醉应用于前列腺电切术中的效果分析

目的探讨罗哌卡因腰-硬联合麻醉应用于前列腺电切术中的效果,并与左旋布比卡因的麻醉效果进行比较。方法将入选的66例行前列腺电切术患者随机分为两组各33例,Ⅰ组患者行罗哌卡因腰-硬联合麻醉,Ⅱ组患者行左旋布比卡因腰-硬联合麻醉,比较两组患者的麻醉效果。结果Ⅰ组的麻醉阻滞起效时间快于Ⅱ组,且Ⅰ组最大运动阻滞时间明显长于Ⅱ组,Ⅰ组术后低血压的发生率明显低于Ⅱ组,且术中Ⅰ组膀胱痉挛次数明显少于Ⅱ组（P〈0.05）。Ⅰ组镇痛效果的有效率明显高于Ⅱ组（P〈0.05）。结论罗哌卡因腰-硬联合麻醉应用于前列腺电切术中具有较好的麻醉效果,值得临床推广使用。     

双点腰丛定位联合坐骨神经阻滞在老年患者下肢手术的应用

目的：比较老年患者下肢手术中神经刺激仪定位下双点腰丛定位联合坐骨神经阻滞与硬膜外麻醉的效果比较。方法选择年龄在65岁以上、ASA2~3、行单侧下肢手术病人86例,随机分为腰丛联合坐骨神经阻滞组（A组n=43）和硬膜外麻醉组（B组n=43）。腰丛：每点注入0.5%罗哌卡因0.5%利多卡因混合液（10±2）ml,坐骨神经：注入0.5%罗哌卡因0.5%利多卡因混合液（20±5）ml,B组用0.5%的罗哌卡因1%利多卡因混合液（10±2）ml行硬膜外穿刺麻醉。比较两组麻醉的效果、操作时间、麻醉药总剂量、麻醉费用,观察两组患者神经阻滞的起效、完善时间、持续时间,血液动力学指标变化及不良反应发生率。结果 A组的感觉神经阻滞起效快,痛觉消失快,痛觉恢复持续时间长,运动神经阻滞的起效慢,强度低,持续时间短与B组相比存在显著差异（P〈0.05）。B组患者的SBP,DBP,HR在T3,T4,T5期与麻醉前相比存在显著改变（P〈0.05）,B组患者的SBP,DBP,HR在T2,T3,T4,T5期与A组相比也存在显著改变（P〈0.05）。B组的恶心呕吐,头痛,尿潴留,局部血肿发生率明显高于A组。结论神经刺激仪引导下的双点腰丛定位联合坐骨神经阻滞用于老年患者单下肢手术,不仅麻醉效果相当,而且血液动力学平稳,相对并发症少。     

轻比重罗哌卡因在高龄患者腰-硬联合麻醉髋关节手术的应用

目的 观察高龄患者髋关节手术小剂量罗哌卡因腰-硬联合麻醉的麻醉效果及对循环呼吸功能的影响.方法 ASA Ⅱ或Ⅲ级髋关节手术60例,男18例,女42例,年龄(85.5±10.5)岁,体重(65.35±13.91)kg,随机分为两组,各组30例.A组腰麻用轻比重0.2%罗哌卡因5～7 mg,硬膜外阻滞用0.2%罗哌卡因;B组腰麻用重比重0.5%布比卡因8～10 mg,硬膜外阻滞用0.375%布比卡因硬膜外阻滞.记录两组麻醉效果和术中BP、HR、SpO2变化.结果 A组麻醉平面T8～T10,单侧,术中各时点BP、HR、SpO2平稳,Bromage评分患肢1～2分,健肢0～1分;B组麻醉平面T6～T8,双侧,术中各时点BP明显下降,HR明显减慢(P<0.01),也低于A组(P<0.05),Bromage评分双下肢以3～4分为主.结论 轻比重罗哌卡因腰-硬联合麻醉更适用于高龄髋关节手术患者.     

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.     

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.     

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.     

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.