Extracorporeal blood oxygenation and ozonation (EBOO) in man. preliminary report

Autohemotherapy with ozone has been used for four decades with encouraging results but, owing to the lack of clinical studies, it has never been adopted by orthodox medicine. Confident of the valid principles of ozone therapy, we have endeavoured to increase its therapeutic efficacy. Over a ten-year period we have developed an apparatus that makes it possible to treat large quantities of blood with ozone in extracorporeal circulation (extracorporeal blood oxygenation and ozonation EBOO). One of us volunteered to test the system and after six treatments noted the disappearance of two lipomas. This prompted us to treat a patient with Madelung disease and several patients with atherosclerotic vasculopathy. Besides showing therapeutic effects, the preliminary results indicate that EBOO is clinically valid, without side-effects and worthy of testing in various diseases.     

Necrotizing fasciitis successfully treated with extracorporeal blood oxygenation and ozonization (EBOO)

A case of necrotizing fasciitis in a dialysis patient is described. Since traditional therapies were unsuccessful, extracorporeal blood oxygenation and ozonation (EBOO) was tried. This technique is no longer in the experimental stage and is used routinely in our hospital. Patient condition improved radically after EBOO.     

Changes of blood magnesium concentration in patients undergoing surgical myocardial revascularisation.

BACKGROUND: Magnesium (Mg) is the second most relevant intracellular element, which plays an important role in many physiological processes. Magnesium disorders are particularly important in haemodynamically unstable patients, such as patients after extracorporeal circulation. The aim of this study was to analyze the changes in blood Mg levels in patients undergoing coronary artery bypass procedures with extracorporeal circulation. PATIENTS AND METHODS: Twenty male patients, aged 50-69, undergoing CABG with ECC under general anaesthesia, were included in the study. All of them were operated on due to Io and IIo degree coronary disease (according to CCS). The blood concentrations of Mg were examined in five stages: 1) before the induction of anaesthesia; 2) during extracorporeal circulation; 3) after surgery; 4) in the morning of the first postoperative day; 5) in the morning of the second postoperative day. The blood Mg concentrations were determined by spectrophotometric methods. RESULTS: The blood concentration of Mg decreased during extracorporeal circulation and immediately after surgery and increased in the morning of the first and second postoperative days. CONCLUSION: The CABG with extracorporeal circulation resulted in a significant decrease in blood Mg concentration.     

Toxicity of plasma from hemodialysis patients treated with heparin or prostacyclin

Hemodialysis was performed in 6 uremic patients with either a bolus dose of 5 000 IU heparin or prostacyclin at a constant infusion rate of 5 ng/kg/min. Clinical data, plasma triglycerides (TG), free fatty acids (FFA), platelet aggregation, white blood cell count and plasma toxicity were measured prior to and during both procedures. No serious side-effects were recorded. Heparin induced a fall in plasma TG, a rise in FFA and increased plasma toxicity. Prostacyclin infusion had no effect on these parameters. During both tests a marked drop in white blood cell count was found 15 min after the start of hemodialysis. During heparin dialysis no clotting was observed in the extracorporeal circuit. During prostacyclin dialysis clotting was observed at the venous line in three cases.     

Do miniaturized extracorporeal circuits confer significant clinical benefit without compromising safety? A meta-analysis of randomized controlled trials

Miniaturized extracorporeal circulation (mECC) attempts to reduce the adverse effects of conventional extracorporeal circulation (CECC) bypass. However, the potential benefits remain unclear and safety concerns persist. A systematic literature review identified 29 studies incorporating 2,355 patients: 1,181 (50.1%) who underwent cardiac surgery with CECC and 1,174 (49.9%) with mECC. These were meta-analyzed using random effects modeling. Heterogeneity, subgroup analysis, and risk of bias were assessed. Primary endpoints were 30-day mortality, neurovascular compromise, and end organ dysfunction. Secondary endpoints were length of stay and transfusion burden. Miniaturized extracorporeal circulation significantly reduced postoperative arrhythmias (p = 0.03), but no significant difference in 30-day mortality, neurocognitive disturbance, cerebrovascular events, renal failure, or myocardial infarction was identified. Miniaturized extracorporeal circulation also significantly reduced mean blood loss (p < 0.00001) and number of patients transfused (p < 0.00001); however, duration of hospitalization, units transfused per patient, chest tube drainage, and revision for rebleeding remained unchanged. Subgroup analysis of larger studies (10 studies, n ≥ 31) showed mECC to significantly reduce ventilation period, hospital stay, and intensive care unit (ICU) stay. Similarly, a significant reduction in neurocognitive disturbance was seen in studies with closely matched demographic groups. Miniaturized extracorporeal circulation is not associated with increased cerebrovascular injury and may confer an advantage, reducing postoperative arrhythmia, blood loss, and transfusion burden.     

Effect of Surgical Treatment on Lipid Peroxidation Parameters and Antioxidant Status in the Serum of Patients with Peripheral Arterial Disease

The various risk factors for peripheral arterial disease (PAD) are almost identical to those for atherosclerosis and include abnormal levels of lipids or lipoproteins. Lipid peroxidation parameters and total antioxidant capacity in the serum of male patients with PAD before surgery as well as 3–5 days and 7–10 days after surgery were measured. We also compared these parameters with those in a group of patients receiving simvastatin therapy. Concentrations of lipid hydroperoxides (LOOHs) and malondialdehyde, the total antioxidant capacity (assessed by ferric reducing antioxidant power assay), concentration of thiol (-SH) groups, and ceruloplasmin activity were determined spectrophotometrically in PAD patients treated surgically (Group I) or pharmacologically (Group II). The patients before surgical treatment had significantly higher concentrations of malondialdehyde but lower ceruloplasmin activity than those observed in Group II, treated with simvastatin. No significant differences before surgery in ferric reducing antioxidant power or thiol concentrations were found between the two groups. However, in Group I, both ferric reducing antioxidant power and thiol group concentrations decreased 3–5 days postoperatively, and ceruloplasmin activity increased 7–10 days after surgical treatment. The presented results demonstrate diverse oxidative stress responses to surgical treatment and confirm the beneficial effects of statin therapy in PAD.     

Aetiology and pathogenesis of paraneoplastic autoimmune disorders

Paraneoplastic autoimmune disorders (PAD) represent a group of autoimmune diseases associated with neoplasms. As a consequence of a remote autoimmunity-mediated effect, PAD are found in multiple organs or tissues, including the skin, blood and nervous system. Compared with non-paraneoplastic autoimmune diseases, PAD have different aetiologies, pathologies, disease symptoms and treatment responses. There are two main origins of autoimmunity in PAD: neoplasm-mediated dysregulated homeostasis in immune cells/organs and in autoantigens. Pathologically, PAD are mediated predominantly by either autoantibodies or autoreactive T-cells. In the past decade, significant progress has been achieved in increasing our understanding of the aetiology and pathology of PAD. In this review article, we aim to provide a comprehensive overview of the recent advances in this field.     

The relationship between magnesium, epinephrine and norepinephrine blood concentrations during CABG with normovolemic hemodilution.

The effects of procedures with extracorporeal circulation on the disturbance of relationships between blood magnesium (Mg), epinephrine, and norepinephrine levels have not been explicitly explained. It is assumed that both hypomagnesemia and increased concentration of the above mentioned hormones exert adverse effects on the myocardium often causing life threatening disorders. This problem is particularly important in cases of stunned myocardium, observed after extracorporeal circulation procedures. The complex nature of the procedures and the intraoperative normovolemic hemodilution (NH) employed are likely to alter Mg, epinephrine, and norepinephrine concentrations, as well as the above mentioned relations. The aim of the study was to evaluate the changes in blood Mg, epinephrine and norepinephrine concentrations in patients undergoing extracorporeal circulation and normovolemic hemodilution. The study encompassed 16 men operated on for stable coronary disease (I or II degrees according to the Canadian Scale). The patients were divided into two groups according to body weight: A) patients weighing less than 75 kg and B) patients weighing more than 75 kg. The degree of NH caused by constant volume of priming (1800 mL) was determined on the basis of hematocrit measurements and in relation to body weight. The examinations were conducted in 5 stages: 1) after radial artery cannulation before anaesthesia and surgery, 2) during hemodilution and deepest hypothermia, 3) after surgery before sending the patient to Intensive Postoperative care Unit, 4) in the first postoperative day, 5) in the second postoperative day. The observations showed an increase in epinephrine levels in group A in the second stage and of norepinephrine levels in stage 4. Decreased blood Mg levels were noted in all the patients in the second stage, however in group A significantly lower values were also observed in stage 3. Moreover, the correlation between Mg level changes and blood epinephrine and norepinephrine levels were observed. The study revealed significant effects of extracorporeal circulation procedures on adrenergic reactions as well as blood magnesium concentrations. It seems that the degree of NH is the main factor determining blood levels of Mg, epinephrine and norepinephrine during the use of a heart-lung apparatus, which may be particularly relevant in patients with impaired heart function and low body weight.     

The degree of lymphocytic mitochondrial transmembrane potential and blood magnesium concentrations during coronary artery bypass grafting.

Magnesium (Mg) plays an important role in lymphocyte function. Low blood concentration of Mg may result in intralymphocyte imbalance and in turn may be associated with intensified apoptosis of peripheral blood lymphocytes. Due to its multistage character; extracorporeal circulation (ECC) may augment Mg disorders adding to the above mentioned pathology. The aim of this study was to assess the correlation between lymphocyte apoptosis and Mg concentration in the blood during the course of coronary artery bypass grafting (CABG) and in the early postoperative period. METHOD: Twenty male patients undergoing CABG with ECC under general anaesthesia were included in the study. For detection of apoptotic lymphocytes in the circulation, inner mitochondrial transmembrane potential (deltapsim) was measured with the use of chloromethyl-X-rosamine (CMXRos) and flow cytometry. Spectrophotometry was used for Mg blood concentration measurements. Peripheral blood samples were obtained in seven stages: 1) just before anaesthesia, 2) 2 hours after the beginning of surgery, 3) immediately after surgery, 4) 12 hours after the beginning of surgery, 5) 24 hours after the beginning of surgery, 6) 36 hours after the beginning of surgery, 7) 54 hours after the beginning of surgery. RESULTS: The statistically significant increases of lymphocyte apoptosis were noted in stages from 2 to 7. Blood Mg concentrations decreased in stages 2 and 3. There was negative correlation between Mg blood concentration in stages 2 and 3 and the intensity of lymphocyte apoptosis in the stage 5. CONCLUSIONS: 1) CABG with extracorporeal circulation was associated with a decrease of magnesium concentration in the blood and an increase of lymphocyte apoptosis intensity. 2) The decrease of magnesium blood concentration may increase the degree of lymphocyte apoptosis. 3) Lymphocyte apoptosis after extracorporeal circulation has a two-phase course.     

Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation

Prone ventilation is an effective method for improving oxygenation in patients with acute respiratory failure. However, in extracorporeal circulation, there is a risk of cannula-related complications when changing the position. In this study, we investigated cannula-related complications when changing position for prone ventilation and the effect of prone ventilation on impaired oxygenation in patients who underwent extracorporeal membrane oxygenation (ECMO). The study subjects were patients who underwent prone ventilation during ECMO in the period from 2004 to 2011. Indication for prone ventilation was the presence of dorsal infiltration shown by lung computed tomography. Factors investigated were cannula insertion site, dislodgement or obstruction of the cannula, malfunction of vascular access and unplanned dislodgement of the catheters when changing position. Mean arterial pressure, PaO₂/FiO₂, PEEP level, blood flow and rotation speed of the pump were also determined before and after position change. Five patients were selected as study subjects. The mean duration of prone positioning was 15.3 ± 0.5 h. Strict management during position changes prevented cannula-related complications in the patients who underwent extracorporeal circulation. There were no significant changes in mean arterial pressure, PEEP level, blood flow and rotation speed of the pump when changing position. Low PaO₂/FiO₂ prior to prone ventilation was significantly increased after supine to prone and then prone to supine position. Prone positioning to improve impaired oxygenation is a safe procedure and not a contraindication in patients receiving extracorporeal circulation.     

小型幼猪体外循环模型灌注流量对脑血流灌注的影响

目的建立幼猪体外循环(cardiopulmonary bypass,CPB)模型,观察CPB灌注流量发生改变期间,脑灌注流量和局部脑氧饱和度(regional cerebral oxygen saturation,rSO_2)的变化,从而探索CPB灌注流量对脑血流量自我调节的影响,以期为婴幼儿CPB合理的灌注管理、预防脑缺血提供理论依据。方法 12只幼猪按照随机表分为3组,对照组、高流量组(H组)、低流量组(L组)。建立单泵双管CPB灌注模型,用血流检测仪直接检测灌注管路流量反映不同流量下脑动脉内血液灌注的变化,并采用近红外分光广度检测技术(near infrared reflectance spectroscopy,NIRS)监测幼猪CPB模型中rSO_2的变化。在CPB开始前10 min、CPB开始后10 min、升主动脉阻断后30 min和升主动脉开放后10 min 4个时间点检测血清S100钙结合蛋白B(S100 B)浓度。分别进行苏木精-伊红(HE)染色、尼氏染色观察海马CA区组织学变化。结果在主动脉阻断期间,H组脑灌注流量[(30.8±9.9)mL/(kg·min)]较L组[(19.0±7.4)mL/(kg·min)]有增高趋势但无统计学差异(P=0.072),且该时间点H组rSO_2值(52.65%±3.1%)显著高于L组(47.3%±3.3%)(P0.05)。海马组织学变化及血清S100 B蛋白水平无组间差异。结论在小型猪体外循环灌注模型中,脑动脉内流量及局部脑氧饱和度监测提示脑血流压力/血流自我调节减弱,高流量组脑灌注效果优于低流量灌注。     

Effect of maximal arm exercise on skin blood flux in the paralyzed lower limbs in persons with spinal cord injury

 The purpose of the present study was to examine the effect of maximal arm exercise on the skin blood circulation of the paralyzed lower limbs in persons with spinal cord injury (PSCI). Eight male PSCI with complete lesions located between T3 and L1 performed graded maximal arm-cranking exercise (MACE) to exhaustion. The skin blood flux at the thigh (SBFT) and that at the calf (SBFC) were monitored using laser-Doppler flowmeter at rest and for 15 s immediately after the MACE. The subject's mean peak oxygen uptake and peak heart rate was 1.41 ± 0.22 l · min^–1 and 171.6 ± 19.2 beats · min^–1, respectively. No PSCI showed any increase in either SBFT or SBFC after the MACE, when compared with the values at rest. These results suggest that the blood circulation of the skin in the paralyzed lower limbs in PSCI is unaffected by the MACE. Accepted: 12 September 1996     

湿性敷料治疗皮肤Ⅱ度烧伤的比较

背景：已有基础实验证明,伤口在湿性环境下的愈合效果优于干性环境,湿性敷料的研究是皮肤创面愈合研究的重点。 目的：观察湿性敷料对皮肤Ⅱ度烧伤创面的治疗效果。 方法：选取在海南省人民医院门诊接受治疗的38例Ⅱ度烧伤患者,采用自身对照法将创面分为治疗组和对照组,治疗组采用湿性敷料覆盖治疗烧伤创面,对照组采用碘伏纱布或凡士林纱布覆盖,治疗后分别观察两种不同处理方法对创面的愈合效果及对疼痛程度的影响。 结果与结论：所有患者均纳入结果分析,治疗组患者烧伤创面的平均愈合时间为(9.8±3.1) d,对照组创面平均愈合时间为(13.1±2.2) d,两者比较差异有显著性意义(P < 0.01)。治疗组创面疼痛程度明显低于对照组(P < 0.01)。使用湿性敷料(美皮贴或美皮康)治疗Ⅱ度烧伤,可以使创面愈合时间缩短,创面疼痛程度明显降低。     

Reduced dermal infiltration of cytokine-expressing inflammatory cells in atopic dermatitis after short-term topical tacrolimus treatment

BACKGROUND: In several clinical studies, topical calcineurin inhibitors have been shown to be effective in the treatment of atopic dermatitis (AD). They target signaling pathways that control gene expression, particularly the expression of cytokines. OBJECTIVE: We examined the cellular infiltrate in skin lesions of 10 patients with AD and characterized the cytokine pattern expressed by the infiltrating cells before and after short-term topical therapy with tacrolimus 1% ointment. METHODS: Skin biopsies were examined for histologic alterations (hematoxylin and eosin staining), composition of the cellular inflammatory infiltrate (immunofluorescence), and cytokine expression (ribonuclease protection assay, ELISA, immunofluorescence) before as well as 1 and 3 weeks after initiation of tacrolimus therapy. For comparison, biopsies from nonlesional AD and normal skin were analyzed. Systemic immunologic effects were assessed by analyzing peripheral blood leukocytes (immunofluorescence) as well as in vitro stimulated pan-T-cell cytokine production (ELISA). RESULTS: All patients showed a significant improvement of their skin lesions associated with a marked regression of spongiosis, acanthosis, and density of the cellular infiltrate in the dermis. The last was a result of reduced infiltration of T cells, B cells, and eosinophils. In contrast, the numbers of mast cells did not change. Moreover, the expression of the T H 2 cytokines IL-5, IL-10, and IL-13 in CD4 + T cells was reduced after therapy. Interestingly, tacrolimus therapy was also associated with a reduction of CD8 + T cells expressing the T H 1 cytokine IFN-gamma. Furthermore, the numbers of epidermal CD1a + dendritic cells increased after treatment. In the peripheral blood, a decrease of granulocytes (eosinophils and neutrophils) but no changes in the distribution of lymphocyte subpopulations were noticed. CONCLUSION: Topical tacrolimus treatment has anti-inflammatory effects on AD skin as indicated by reduced infiltration of cytokine expressing inflammatory cells. No evidence for drug-induced systemic immunosuppression was obtained.     

关节松动术及超短波联合体外冲击波治疗肩周炎的 疗效观察

目的 观察关节松动术及超短波联合体外冲击波治疗肩周炎的临床效果,为临床治疗肩周炎患者的方法选择提供参考依据。方法 选取2016年1月~2018年1月我院康复科门诊收治的肩周炎患者62例,随机分为观察组和对照组,每组31例。对照组采用关节松动及超短波治疗,观察组在对照组基础上加用体外冲击波治疗。比较两组患者治疗前后肩关节活动度（ROM）、患者的疼痛程度视觉模拟评分（VAS）及临床疗效。结果 治疗后观察组ROM改善程度高于对照组,差异有统计学意义（P＜0.05）。治疗后观察组疼痛程度VAS评分低于对照组[（2.03±1.47）分 vs （3.26±2.51）分],差异有统计学意义（P＜0.05）。治疗后观察组患者的治疗有效率高于对照组（93.54% vs 80.65%）,差异有统计学意义（P＜0.05）。结论 采用关节松动术及超短波联合体外冲击波治疗肩周炎,能明显扩大肩关节活动度,减轻肩关节疼痛,取得了明显的临床疗效。     

低能量体外冲击波治疗ⅢB型慢性前列腺炎的临床疗效观察

目的 探讨低能量体外冲击波在ⅢB型慢性前列腺炎患者中的临床治疗效果。方法 选择2017年2月~2018年10月我院收治的ⅢB型慢性前列腺炎患者45例作为研究对象,采用随机数字表法分为对照组15例和观察组30例。对照组给予盐酸坦洛新缓释片口服治疗,观察组采用低能量体外冲击波治疗,比较两组国际前列腺症状评分及VAS疼痛评分。结果 观察组治疗后疼痛症状（2.36±1.23）分、排尿症状（1.36±1.24）分、生活质量（3.08±1.21）分、总分（7.03±1.85）分及VAS评分（2.67±1.12）分,均低于对照组疼痛症状（4.26±1.89）分、排尿症状（2.35±1.70）分、生活质量（4.35±1.76）分、总分（11.01±4.63）分及VAS评分（3.92±1.01）分,差异具有统计学意义（P＜0.05）。结论 低能量体外冲击波能改善ⅢB型慢性前列腺炎患者症状,有助于减轻患者疼痛,能为ⅢB型慢性前列腺炎治疗提供方法。     

12例中国汉族人艾滋病相关型皮肤Kaposi肉瘤临床病理特征及治疗分析

 目的： 观察12例汉族人艾滋病（AIDS）相关型皮肤Kaposi肉瘤患者的临床、病理学特点及免疫学表型,探讨其有效治理的方法及预后因素。方法：回顾分析12例汉族人AIDS相关型皮肤Kaposi肉瘤患者临床、病理学特征及免疫学表型。结果：12例汉族人AIDS相关型皮肤Kaposi肉瘤患者HIV均阳性;12例患者的皮损主要表现为暗红或紫黑色的丘疹、斑块;病理表现为真皮内见片状或弥漫分布的棱形细胞浸润,增生活跃的血管多呈裂隙状,组织间隙见红细胞渗出,含铁血黄素沉积,有炎症细胞浸润;免疫组化结果如下：T细胞UCHL1(+),局部CD31(+),增生的血管内皮细胞factor Ⅷ(+),血管壁HHF-35(+), vimentin (+++), S-100蛋白(-),6例梭形细胞CD34 (+++),1例梭形细胞CD34（-）。12例患者均使用高效抗反转录病毒治疗（HAART）,4例皮损局限者手术切除,局部辅以微波,预后良好; 另2例皮损局限者辅以微波治疗,皮损消退;6例全身泛发皮损者,其中5例辅以微波、1例联合化疗,5例患者的皮损缓解,1例死亡。结论：12例汉族人AIDS相关型皮肤Kaposi肉瘤患者与其他人群的AIDS相关型皮肤Kaposi肉瘤患者的临床、组织病理学及免疫学表现无明显差异。HAART是治疗AIDS相关型皮肤Kaposi肉瘤的必要手段。早期患者肉瘤直径小于2 cm,可给予手术切除肿物,微波治疗;肿物直径大于2 cm,可给予化疗和微波治疗。     

Neurologische und psychiatrische Komplikationen nach Herzoperationen

Summary In 63 patients undergoing heart operations with extracorporeal circulation (47 males, 16 females, mean age 54 years; coronary artery bypass in 38 cases, valvular surgery in the rest) postoperative neurological and psychiatric complications were evaluated. 18 patients (29%) had no complications, whereas 35 patients (56%) showed minor or transient neurological symptoms, and 9 patients (14%) exhibited severe symptoms. Nine of the patients had slight psychiatric disturbances (affective disturbances, desorientation). No correlation was found between risk factors (age, nicotine abuse, hypertension, hypercholesteremia, neurologic and cardiac history), intraoperative parameters (duration of extracorporeal bypass, aortic clamp time, deviation of mean arterial pressure), postoperative parameters (internal complications) and the complication rate. Therefore no predisposing factors could be identified.

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Treatment of skin swellings with C1-inhibitor concentrate in patients with hereditary angio-oedema

Background:  Skin swellings are the most frequent symptoms in hereditary angio-oedema (HAE) arising out of C1-inhibitor (C1-INH) deficiency. They may be painful and impact daily activities of patients. Detailed clinical data concerning the treatment of skin swellings by C1-INH concentrate have not been reported yet.
Methods:  From 1976 through 2007, a total of 2104 skin-swelling attacks in 47 patients with HAE were treated with the C1-INH concentrate. Time to relief and duration of the swellings were documented during personal interviews using standardized questionnaires. The results were compared with 9046 untreated skin swellings in the same patients.
Results:  The first clinical sign of efficacy was a slowdown of progress of symptoms accompanied by a decreased feeling of tension and pain in the swollen area. The mean time to the first relief of symptoms was 1.1 ± 1.4 h in treated skin swellings and 50.4 ± 33 h in untreated skin swellings. Improvement of facial skin swellings took longer than swellings of the extremities, genitals or trunk. The duration of treated skin swellings was 1.7 day in treated and 3.2 day in untreated ones. In treated swellings, there was long-lasting control and no rebound within the 48 h following the drug administration and no laryngeal oedema following facial oedema were observed. No severe side-effects occurred.
Conclusions:  The C1-INH concentrate has proven to be highly effective and safe for treating skin swellings in patients with HAE arising out of C1-INH deficiency.