冬虫夏草对马兜铃酸肾病保护作用的研究

目的：观察冬虫夏草对马兜铃酸肾病大鼠的保护作用。方法：利用关木通制备马兜铃酸肾病大鼠模型，冬虫夏草（1g／d）干预8周，设对照组，于实验第1、4、8周末收集各组大鼠血、尿及肾组织标本，检测血尿素氮（尿素酶法）、血肌酐（苦味酸法）、尿NAG（比色法）、24h尿蛋白定量和β2-微球蛋白（放免法）、体重，尿渗量（冰点渗量计法）以及光镜HE、PAS染色和透射电镜观察，并应用免疫组化技术测定肾组织中Ⅲ型胶原、α-平滑肌肌动蛋白（α—SMA）、角蛋白（Keratin）和转化生长因子-β1（TGF-β1）的表达。结果：模型组大鼠BUN、Scr、尿NAG、β2-MG及白蛋白水平明显高于同期治疗组（P〈0．05）和正常对照组（P〈0.01）；与同期治疗组和正常对照组相比，模型组大鼠肾组织Ⅲ型胶原、α—SMA和TGF-β1表达增强，角蛋白表达减弱，体重及尿渗量进行性降低（P〈0．05）；模型组大鼠肾组织肾小管-间质病变明显重于治疗组。结论：冬虫夏草能在马兜铃酸肾病防治中发挥肾脏保护作用。     

人工虫草菌丝粉防治慢性马兜铃酸肾病的研究

目的探讨人工虫草菌丝粉对慢性马兜铃酸肾病的防治作用。方法将40只大鼠随机分为4组：正常组、木通组（关木通煎剂10g·kg^-1·d^-1灌胃）、治疗组（关木通煎剂10g·kg^-1·d^-1与人工虫草菌丝粉混悬液5g·kg^-1·d^-1灌胃）、马兜铃酸（AA）组（皮下注射AA10mg·kg^-1·d^-1）各10只，给药8w。结果8w后木通组、治疗组、AA组与正常组相比，24h尿蛋白定量、尿NAG酶、尿β2-微球蛋白（β2-MG）增加（P〈0．05，P〈0．01）。治疗组与木通组相比，24h尿蛋白定量及尿β2-MG定量无统计学差别（P〉0．05），治疗组尿NAG酶明显低于木通组（P〈0．01）。3组肾小管间质病理积分显著高于正常组（P〈0．01），治疗组与木通组积分无统计学差异（P〉0．05）。3组转化生长因子β1（TGF-β1），金属蛋白酶抑制剂1（TIMP-1），基质金属蛋白酶9（MMP-9）表达较正常组明显上调（P〈0．01）。治疗组TGF-β1，TIMP-1表达较木通组下调（P〈0．05），MMP-9表达较木通组上调（P〈0．01）。结论人工虫草菌丝粉可降低尿NAG酶和TGF-β1，TIMP-1的表达，但其缓解慢性马兜铃酸肾病所引起的肾损害的作用还未全部达到统计学意义。     

温阳活血方对慢性马兜铃酸肾病大鼠肾损害的干预作用

目的：观察温阳活血方对慢性马兜铃酸肾病肾损害的干预作用。方法：将48只雄性SD大鼠随机分为5组：（1）正常对照组（n=8）：予生理盐水灌胃;（2）模型组（n=10）：按关木通水煎液10ml·kg^-1·d^-1（相当于关木通40g·kg^-1·d^-1,马兜铃酸A2．6mg·kg^-1·d^-1）给大鼠灌胃;（3）中药组（n=10）：在模型组基础上,再予温阳活血方30g·kg^-1·d^-1灌胃;（4）西药组（n=10）：在模型组基础上,再予科素亚33．3mg·kg^-1·d^-1灌胃;（5）中西药结合组（n=10）：在模型组基础上,再予温阳活血方＋科素亚灌胃。20周末,收集大鼠尿液测定24h尿蛋白、NAG、β2-MG,腹主动脉取血用于测定Scr、BUN、RBC、Hb。结果：与正常对照组比较,模型组大鼠24h尿蛋白、NAG、β2-MG、Scr、BUN均明显升高（P〈0．01,P〈0．05）,而血Hb、RBC均明显下降（P〈0．01）;与模型组比较,治疗组大鼠24h尿蛋白、NAG、β2-MG、Scr、BUN均明显下降（P〈0．01,P〈0．05）,而血RBC、Hb均明显升高（P〈0．01,P〈0．05）。结论：温阳活血方对慢性马兜铃酸肾病大鼠肾损害有一定的保护作用,能降低尿蛋白和尿NAG、β2-MG的排泄,改善肾功能和贫血。     

缬沙坦联合大黄治疗糖尿病肾病的临床研究

目的探讨缬沙坦联合大黄治疗糖尿病肾病的疗效。方法将128例糖尿病肾病（DN）患者随机分为缬沙坦对照组和缬沙坦联合大黄治疗组，疗程均为6个月。结果①与治疗前比较，治疗组治疗后血清总胆固醇（TC）、血清甘油三酯（TG）明显下降（P〈0．05，P〈0．01），血清高密度脂蛋白（HDL-C）明显上升（P〈0．05），对照组上述指标变化不明显（P〉0．05）；②治疗组与对照组均能显著改善早期DN患者尿白蛋白（MA）、尿α1微球蛋白（α1，MG）、尿β2微球蛋白（β2-MG）（P〈0．05），而治疗组较对照组疗效显著（P〈0．05）。③对临床DN患者的尿蛋白定量、尿α1-MG、尿β2-MG、血白蛋白（ALB）、血尿素氮（BUN）、血肌酐（Scr），治疗组均改善显著，而对照组除尿蛋白定量、尿α1，MG、尿β2-MG改善显著外，其余指标改善均不明显。结论缬沙坦联合大黄治疗糖尿病肾病疗效确切。     

慢性肾脏病患者血脂变化相关因素分析

目的通过分析慢性肾脏病非透析患者不同分期及原发病脂质代谢紊乱特点及其变化相关因素,为临床调脂治疗提供依据。方法对618例慢性肾脏病非透析患者进行回顾性研究,分析血脂特点及其变化相关因素。结果总胆固醇在前4期均高于对照组（P〈0．01）,三酰甘油在前4期高于对照组（P〈0.01）,高密度脂蛋白在各期均与对照组无差异。相关分析显示患者血总胆固醇与血红蛋白、红细胞压积等呈正相关（P〈0.01）,与白蛋白、尿素氮、血肌酐等呈负相关（P〈0．05）。三酰甘油与血红蛋白、红细胞压积等呈正相关（P〈0.01）,与年龄、白蛋白、尿素氮、血肌酐等呈负相关（P〈0．05）。高密度脂蛋白与血红蛋白、红细胞压积等呈正相关（P〈0．05）,与体质量、尿素氮、血肌酐呈负相关（P〈0．05）。结论慢性肾脏病不同分期患者血脂水平异常与患者年龄、血红蛋白、白蛋白、肾功能等多种因素相关。     

氯沙坦和百令胶囊对马兜铃酸肾病小鼠肾间质纤维化过程的干预研究

目的：研究血管紧张素Ⅱ1型受体拮抗剂（氯沙坦）及虫草制剂（百令胶囊）对慢性马兜铃酸肾病（CAAN）小鼠模型肾间质纤维化的进程的作用。方法：昆明小鼠予关木通浸膏水溶液灌胃致成CAAN模型，并分为对照组、模型组、氯沙坦组（30mg·kg^-1.d^-1灌胃）及氯沙坦和百令胶囊（2g·kg^-1·d^-1）治疗组。对照组予自来水灌胃。于第4、8、12周检测小鼠血清肌酐（Scr）及尿素氮（BUN），后分批处死小鼠，取肾组织切片行Masson染色，用RT—PCR方法检测肾组织中转化生长因子-β1（TGF-β1）及结缔组织生长因子（CTGF）mRNA的表达。结果：与对照组相比，实验后期CAAN模型组小鼠Scr及BUN均显著上升（P〈0．05或P〈0.01）；肾间质纤维化面积显著性扩大（P〈0．01）；肾组织TGF-β1、CTGF的mRNA表达均显著上调（P〈0.01）。在氯沙坦及氯沙坦和百令胶囊干预组，肾组织TGF-β1、CTGF较模型组被显著抑制（P〈0．05或P〈0.01），而两干预组间无明显差异（P〉0．05）。结论：氯沙坦能抑制CAAN小鼠肾间质纤维化进程，延缓肾损害进展；氯沙坦和百令胶囊在抑制CAAN小鼠肾间质纤维化进程中没有协同作用。     

复方丹参联合阿司匹林对大鼠糖尿病肾脏病的作用

目的研究复方丹参联合阿司匹林对大鼠糖尿病肾脏病的治疗作用及其机制。方法采用链脲佐菌素（streptozocin,STZ）诱导大鼠糖尿病肾脏病模型,模型成功后随机分为糖尿病肾脏病（diabetic kidney disease,DKD）对照组、阿司匹林（A）治疗组、复方丹参（s）治疗组、复方丹参联合阿司匹林（A＋S）治疗组。给药4周后检测各组大鼠空腹血糖（fasting blood glucose,FBG）、血尿素氮（blood urea nitrogen,BUN）、血肌酐（serum creatinine,SCr）、尿24h微量白蛋白（microalbumin,mAlb）、丙二醛（malondialdehyde,MDA）、血栓素（thromboxane,TX）B2、转化生长因子（transforming growth factor,TGF）β1mRNA,并观察各组动物肾组织形态学。结果与DKD对照组相比,（A＋S）组FBG、BUN、SCr、尿24hmAlb、MDA、TXB2、TGF-β1mRNA均明显降低（P〈0．05）,肾组织纤维化也明显减轻。结论复方丹参联合阿司匹林对大鼠糖尿病。肾脏病有治疗作用,其改善作用与降低血糖、抗氧化席激损伤和改善肾脏微循环等有关。     

金蝉补肾汤治疗慢性间质性肾炎的临床观察

目的：观察中药金蝉补肾汤治疗慢性间质性肾炎患者在生化及免疫指标方面的变化,探讨其临床疗效和作用机制。方法：选择临床慢性间质性肾炎病例72例,中医辨证分型为脾肾两虚型、气滞血瘀型。随机分为两组,即治疗组与对照组。两组患者均治疗前2周开始低蛋白饮食,治疗组服用中药金蝉补肾汤,对照组服用西药科素亚与中药保肾康。观察治疗3个月后两组临床症状、生化及免疫指标方面的变化。结果：金蝉补肾汤治疗组用药前后比较,患者24h尿蛋白定量下降（P〈0.05）,肌酐和尿素氮明显下降（P〈0.01）,尿渗透压明显提高（P〈0.05）,血红蛋白和红细胞明显升高（P〈0.01）;对照组用药前后比较,24h尿蛋白定量显示下降明显（P〈0.05）,而血常规指标无差异。治疗组以尿β2-M降低及6-K-PGF1α升高尤其显著（P〈0.05）。对照组以血、尿β2-M降低及tpA/PAI升高尤其显著（P〈0.01,P〈0.001）。结论：金蝉补肾汤通过保护肾间质微血管而减少肾小管间质慢性损伤,是延缓肾间质纤维化、治疗慢性间质性肾炎的有效方剂。     

早期痛风肾病的临床干预研究

目的：观察补肾痛风颗粒剂治疗早期痛风肾病的疗效。方法：60例早期痛风肾病患者按简单随机法分为补肾痛风颗粒剂治疗组和别嘌醇对照组。结果：治疗组总有效率为90．0％，对照组为56．6％，两组比较有统计学差异（P〈0，01）。两组均能降低血尿酸（UA）、24h尿尿酸，但组间比较无统计学差异（P〉0．05）；在降低尿＆微球蛋白（β2-MG）、视黄醇结合蛋白（RgP）、尿微量白蛋白（U-Alb）方面治疗组前后比较有统计学差异（P〈0．01），而对照组前后比较无统计学差异（P〉0．05）。结论：补。肾痛风颗粒剂治疗早期痛风。肾病疗效较好，值得进一步研究。     

中药高位结肠透析治疗慢性肾衰竭——附36例疗效分析

目的观察结肠途径治疗机高位结肠透析治疗慢性肾衰竭（CRF）的疗效。方法72例CRF患者随机分为治疗组和对照组各36例，治疗组运用结肠途径治疗机，专门设计的探头可深达肠腔50cm，使用自行研制的透析方法给予高位结肠透析，然后中药保留灌肠，每周2次，4周为1疗程；对照组使用常规中药保留灌肠，4周为1疗程。结果治疗组总有效率为86．11％，对照组总有效率为58．33％，两组比较有统计学差异（P〈0．05），治疗组治疗后SCr、BUN明显下降、Ccr升高，与治疗前比较有统计学差异（P〈0．05），对照组治疗后，SCr、BUN下降、Ccr升高，但与治疗前相比无统计学差异（P〉0．05）。结论结肠途径治疗机高位结肠透析治疗CRF的疗效较好。     

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.     

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.     

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.     

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.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.