经脐单孔腹腔镜阑尾切除术治疗慢性阑尾炎58例

目的 探讨单孔腹腔镜阑尾切除术治疗慢性阑尾炎的安全性和可行性.方法 回顾性分析北京中日友好医院2010年1月至2012年11月同一术者行腹腔镜阑尾切除术治疗慢性阑尾炎共计121例,其中单孔腹腔镜阑尾切除术58例,三孔腹腔镜阑尾切除术63例,比较分析两组的临床资料.结果 与三孔腹腔镜组比较,单孔腹腔镜组切口满意度得分较高,(4.5±0.7)比(3.0±0.6),f=13.50,P=0.00;术后对止痛药的需求次数较少,(1.2±0.5)次比(2.1±0.7)次,t=-8.25,P=0.00;手术时间未增加,(40±10) min比(37 ±9) min,t=1.94,P=0.055;失血量未增多,(12±6) ml比(13 ±6) ml,t=-1.50,P=0.137;术后住院时间无差异,(1.4±0.6)d比(1.6±0.7)d,t=-1.82,P=0.072.全组在围手术期均无手术并发症发生.结论 单孔腹腔镜阑尾切除术安全可行,与常规三孔腹腔镜手术有相似的临床效果.     

肥胖患者行腹腔镜与开腹阑尾切除术疗效的对比研究

目的 对比分析肥胖患者行腹腔镜与开腹阑尾切除术的临床效果.方法 回顾性分析2008-2010年因急性阑尾炎在中国医科大学附属盛京医院行阑尾切除术的肥胖患者153例的临床资料.153例中,腹腔镜阑尾切除术92例(其中4例转为开腹),开腹阑尾切除术61例,对两种术式的手术时间、术中出血量、术后排气时间、术后止痛药使用频率、术后主要并发症的发生率、住院时间和住院费用进行比较.计数资料比较采用x2检验,计量资料采用t检验.结果 腹腔镜阑尾切除术组在手术时间、术中出血量、术后排气时间、术后止痛药使用频率、术后主要并发症的发生率、住院时间方面均短于或少于开腹阑尾切除术组,差异有统计学意义(手术时间:t=14.0,P＜0.01;术中出血量:t =19.7,P＜0.01;术后排气时间:t=12.3,P＜0.01;术后止痛药使用频率:t=21.01,P＜0.01;术后主要并发症的发生率:x2=40.138,P＜0.01;住院时间:t=17.3,P＜0.01).两者在住院总花费上的差异无统计学意义(=1.434,P =0.154).结论 肥胖患者行腹腔镜阑尾切除术治疗阑尾炎与开腹阑尾切除术相比具有创伤小、恢复快、并发症少和平均住院时间短等优点,是治疗肥胖阑尾炎患者理想的手术方式.     

手助腹腔镜脾切除与开腹脾切除治疗巨脾效果比较

比较手助腹腔镜脾切除与开腹脾切除治疗巨脾的效果。回顾性分析41例因巨脾行脾脏切除术的临床资料。手助腹腔镜脾切除术患者23例,开腹脾切除术患者18例。比较两组患者手术时间、术中出血量、术后平均住院时间、术后并发症发生率。结果显示,与开腹脾切除术相比,手助腹腔镜脾切除的手术时间长[(313+41.8)min vs(209+19.9)min,P=0.01]、术中出血量少[(324±54.8)ml vs(539±154.8)mL,P=0.01]、术后并发症少(P=0.004)、术后平均住院时间短[(6±1.2)d vs(9±1.4)d,P=0.01]。结果表明,与开腹脾切除术相比,手助腹腔镜脾切除的手术出血量少,术后并发症发生率低,术后住院时间更短,但手术时间长。     

腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究

目的 回顾性分析比较腹腔镜结直肠癌根治术与同期开腹手术患者的临床资料,探讨应用腹腔镜技术行结直肠癌根治术的可行性.方法 2001年8月至2008年6月期间我科行腹腔镜结直肠癌根治术患者62例(腹腔镜组),其中右半结肠癌根治术17例,横结肠癌根治术2例,左半结肠癌根治术10例,直肠癌Dixon手术23例、Miles手术9例、Hartmann手术1例;开腹结直肠癌根治术患者78例(开腹组),其中右半结肠癌根治术17例,横结肠癌根治术4例,左半结肠癌根治术11例,直肠癌Dixon手术27例、Miles手术18例、Hartmann手术1例,对照比较2组患者的手术及术后情况.结果 2组均无术中、术后严重并发症和手术死亡病例,腹腔镜组有4例中转开腹手术.腹腔镜组与开腹组的平均手术时间分别为(230.6±23.5) min和(145.5±17.6) min,差异有统计学意义(P＜0.01).腹腔镜组术中失血量明显少于开腹组[(135.5±22.5) ml 比(300.6±34.5) ml,P＜0.01].清除的淋巴结数量2组间差异无统计学意义[(11.8±1.5)枚比(13.3±1.7)枚,P>0.05].直肠前切除远端切缘长度腹腔镜组明显长于开腹组[(3.1±0.4) cm 比(2.6±0.3) cm,P＜0.01].腹腔镜组术后胃肠功能和排尿功能恢复时间明显早于开腹组[进流质饮食时间: (2.3±0.7) d比(3.6±0.9) d,P＜0.05;进固体饮食时间: (3.5±1.1) d比(4.7±1.2) d,P＜0.05;留置导尿管时间: (2.3±0.4) d比(4.4±1.2) d,P＜0.01].腹腔镜组住院时间明显短于开腹组[(8.5±0.7) d比(12.8±0.9) d,P＜0.01],但住院费用仍明显高于开腹组[(3.14±0.25)×104元比(2.02±0.75)×104元,P＜0.05].2组的3年生存率差异无统计学意义(89.5%比89.1%,P>0.05).结论 腹腔镜结直肠癌切除术安全、有效,具有可行性.     

经脐单切口与传统三孔腹腔镜阑尾切除术的回顾性对比研究

目的探讨经脐单切口腹腔镜阑尾切除术的安全性、可行性。方法回顾性分析2009年6月~2014年12月我科经脐单切口(189例)和三孔(123例)腹腔镜阑尾切除术的临床资料,均经临床表现、彩超或CT诊断为阑尾炎,排除病例资料不全、联合其他手术、妊娠期阑尾炎、急性阑尾炎发病超过72小时者。比较2组术中、术后资料。结果 2组均无中转开腹,经脐组与三孔组手术时间、术后排气时间、术后住院日差异无显著性[(45.5±12.7)min vs.(46.3±17.8)min,t=-0.461,P=0.650;(1.4±0.5)d vs.(1.5±0.6)d,t=-1.588,P=0.112;(3.8±1.6)d vs.(4.1±1.9)d,t=-1.554,P=0.121],经脐组术后3个月美容评分高[(4.5±0.6)分vs.(4.2±0.5)分,t=4.585,P=0.000],2组并发症发生率、病理类型等无统计学差异,其中经脐组切口感染3例,三孔组4例。结论经脐单切口腹腔镜阑尾切除术技术上安全可行,且美容效果较好。     

瘢痕隐藏式与传统腹腔镜阑尾切除术的对比研究

目的探讨瘢痕隐藏式腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的应用价值。方法回顾性分析2011年7月~2016年6月107例瘢痕隐藏式LA(瘢痕隐藏组)和134例传统LA(传统组)的临床资料,比较2组手术时间、术中出血量、术后排气时间、疼痛评分、术后并发症、术后住院时间、美容评分。结果 2组患者均手术成功,无中转开放。瘢痕隐藏组术后并发症1例(切口感染1例),传统组术后并发症2例(切口感染1例,切口脂肪液化1例)。瘢痕隐藏组与传统组手术时间[(48.0±15.9)min vs.(45.2±11.5)min,t=1.585,P=0.114]、术中出血量[(12.9±8.4)ml vs.(14.0±10.7)ml,t=-0.870,P=0.385]、术后排气时间[(1.3±0.7)d vs.(1.3±0.5)d,t=0.000,P=1.000]、疼痛评分[(4.9±1.2)分vs.(5.2±1.5)分,t=-1.683,P=0.094]、术后并发症发生率[0.9%vs.1.5%,χ~2=0.000,P=1.000]、术后住院时间[(3.2±1.1)d vs.(3.5±1.4)d,t=-1.814,P=0.071]差异均无显著性,瘢痕隐藏组美容评分明显高于传统组[(4.4±0.6)分vs.(4.0±0.9)分,t=3.949,P=0.000]。结论瘢痕隐藏式腹腔镜阑尾切除术治疗急性阑尾炎安全可行,美容效果极佳。     

全结肠系膜切除术在腹腔镜辅助右半结肠癌根治术中的应用

目的探讨全结肠系膜切除术(complete mesocolic excision,CME)在腹腔镜辅助右半结肠癌根治术中的安全性。方法回顾性分析2012年1月~2013年6月接受CME腹腔镜辅助右半结肠癌根治术40例的临床资料,选取2011年1月~2011年12月同一手术组施行的开腹右半结肠癌根治术38例作为对照组,比较2组患者术中、术后情况。结果腹腔镜组清扫淋巴结(22.1±7.8)枚,明显多于开腹组(18.6±4.3)枚(t=2.436,P=0.017),其中Ⅱ期淋巴结清扫数目无统计学差异(t=0.758,P=0.454),Ⅲ期腹腔镜组明显多于开腹组[(23.0±6.0)枚vs.(18.2±5.1)枚,t=2.699,P=0.000]。2组患者手术时间、术中出血量差异无统计学意义(t=0.716,P=0.476;t=-1.547,P=0.126)。腹腔镜组术后引流管拔出时间[(9.0±1.3)d vs.(10.3±2.2)d,t=-2.950,P=0.004],术后排气时间[(3.1±1.2)vs.(4.8±1.4)d,t=-5.767,P=0.000],术后进食时间[(4.3±0.8)d vs.(6.2±1.3)d,t=-7.817,P=0.000],术后住院时间[(10.6±2.8)d vs.(15.8±4.6)d,t=-6.065,P=0.000],术后并发症发生率(10.0%vs.28.9%,χ2=4.504,P=0.034)均显著短于/低于开腹组。结论 CME在腹腔镜辅助下右半结肠癌根治术中安全、可行,可保证切除系膜的完整性和清扫更多的淋巴结,但并不会增加手术风险和术后并发症发生率。     

非气腹单孔拖出式腹腔镜阑尾切除术与常规腹腔镜阑尾切除术的比较

目的 探讨非气腹单孔拖出式腹腔镜阑尾切除术的疗效.方法 2010年1月~2012年1月对93例慢性阑尾炎、急性单纯性阑尾炎分别施行非气腹单孔拖出式腹腔镜阑尾切除手术（单孔组,n=42）和常规腹腔镜阑尾切除术（常规组,n=51）,比较2组手术时间、术后排气时间、术后住院时间及费用.结果 单孔组8例为后位阑尾,无法单钳局部分离,改行传统腹腔镜下阑尾切除;常规组51例行传统腹腔镜下三孔阑尾切除术,无中转开腹.单孔组手术时间（26.1±3.2）min,显著短于常规组（47.1±4.4）min（t=-23.912,P=0.000）;单孔组术后恢复排气时间（12.1±2.1）h,显著短于常规组（20.1±1.9）h（t=-18.231,P=0.000）;单孔组术后住院时间（2.1±0.7）d,明显短于常规组（3.1±0.6）d（t=-7.039,P=0.000）;单孔组住院费用（5066.7±99.6）元明显少于常规组（5996.7±119.3）元（t=-37.543,P=0.000）.93例术后随访3～6个月,平均5.3月,均无并发症发生.结论 非气腹单孔拖出式腹腔镜阑尾切除术手术安全可行,与常规三孔法腹腔阑尾切除术相比,恢复快、费用少,切口瘢痕藏于脐部,美容效果更好.     

手术时机对急性阑尾炎治疗效果的影响

目的:研究手术时机对急性阑尾炎治疗效果的影响。方法:回顾分析2015年1月至2017年10月为236例患者行腹腔镜阑尾切除术的临床资料。根据发病至手术的时间分为早期组(72 h施术)与延期组(72 h施术),比较两组手术时间、术中出血量、术后胃肠功能恢复时间、术后住院时间、住院费用、中转开腹率、并发症等情况。结果:早期组与延期组手术时间[(42.7±15.4)min vs.(85.1±21.6)min]、术中出血量[(12.1±5.6)ml vs.(26.2±4.2)ml]、术后胃肠功能恢复时间[(1.7±0.9)d vs.(3.8±1.4)d]、术后住院时间[(3.3±1.2)d vs.(7.6±1.8)d]、住院费用[(1.02±0.12)万元vs.(1.69±0.10)万元]差异有统计学意义(P0.05),两组中转开腹例数(0 vs.2)、并发症发生率差异无统计学意义(P0.05)。结论:手术时机直接影响急性阑尾炎的治疗效果,发病时间72 h施术可加速患者康复,减少术后痛苦。     

腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效对比分析

目的比较腹腔镜和开腹阑尾切除术治疗急性阑尾炎的手术效果及其优缺点。方法回顾性分析2013年1月至2014年12月期间在笔者所在医院科室行阑尾切除术的急性阑尾炎患者的资料,纳入研究患者201例,分为腹腔镜组(102例)和开腹组(99例),比较2组患者手术中以及手术后的相关临床指标。结果腹腔镜组和开腹组患者术前基线特征比较差异无统计学意义(P0.05),具有可比性。腹腔镜组患者的手术时间、术后肠道功能恢复时间、下床活动时间以及住院时间短于开腹组,但住院费用高于开腹组,差异均有统计学意义(P0.05);同时,2组患者的腹腔感染率、腹腔引流率及30 d内再入院率相近,差异无统计学意义(P0.05)。多因素回归分析结果显示,阑尾穿孔及腹腔镜手术能够增加腹腔引流率〔OR=2.710,95%置信区间(1.129,6.507),P=0.026〕。结论腹腔镜手术和开腹手术都是治疗急性阑尾炎安全有效的方法。但与开腹阑尾切除术相比,腹腔镜阑尾切除术具有手术时间短、切口感染率低、术后下床时间早、肠道功能恢复快和住院时间短的优势,尽管住院费用更高,仍可作为急性阑尾炎的首选方法。此外,腹腔镜阑尾切除术是影响腹腔引流的独立危险因素。     

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.