雷帕霉素和中药百令胶囊对大鼠小肠移植后细胞凋亡和FasL mRNA表达作用

目的：观察雷帕霉素（RAPA）和中药百令胶囊对大鼠小肠移植后细胞凋亡和凋亡基因FasL表达的作用。方法：以SD大鼠为假移植组作对照（1组），采用Wistar→SD大鼠异位小肠移植模型根据不同处理分为排斥组、RAPA2mg/kg和RAPA4mg/kg组以主RAPA2mg/kg加百令胶囊组，术后1、3、5、7d每组各取6只动物处死，获取移植肠组织进行病理学检查。取冰冻移植小肠标本行细胞凋亡的检测，采用QRT-PCR方法检测移植小肠村本FasLmRNA表达的情况。结果：排斥反应肆生时出现大量的肠上皮细胞凋亡，RAPA4mg/kg可显著地抑制肠细胞凋亡的发生，因2mg/kg与中药百令胶囊1mg/kg联合应用于术后7d抑的制凋亡的能力与RAPA4g/kg组无显著性差异。结论：细胞凋亡是诊断小肠移植排斥反应的一个良好的指示剂，RAPA4mg/kg可显著抑制细胞凋亡及凋亡基因FasLmRNA的表达，RAPA2mg/kg加百令胶囊虽有显著抑制细胞凋亡，但对FasLmRNA的表达无抑制作用。RAPA2mg/kg加百令胶囊联合应用对于抑制大鼠小肠移植排斥反应，抑制细胞凋亡是有相加或协同作用。     

脾肠联合移植对大鼠小肠移植免疫耐受的影响

目的　探讨脾肠联合移植对小肠移植免疫耐受的诱导作用。方法　选用SD大鼠为供体、Wistar大鼠为受体 ,进行异位全小肠和脾脏联合移植。实验分 3组 ,每组 6只。A组 :小肠移植非免疫干预组 ;B组 :受体脾切除 ,脾肠联合移植组 ;C组 :小肠移植环孢霉素A(CsA)治疗组。术后 3、5、7、10d取移植小肠回肠段 0 .5～ 1.0cm进行病理学检查 ,用病理图像分析系统测量黏膜厚度 ,绒毛高度和隐窝深度。采用TdT介导的脱氧核苷酸原位末端标记法 (TUNEL)检测 3、5、7d移植小肠黏膜细胞凋亡 ,评价移植小肠急性排斥反应损伤程度。结果　A、B两组均有不同程度的急性排斥反应损伤 ,但A组高于B组 ,移植后 3、5、7d分别属于轻、中、重度排斥 ,10d黏膜基本完全脱落。B组移植后 3、5d符合轻度排斥 ,7d中度以下排斥 4只 ,重度排斥 2只 ,10d中度排斥 2只 ,重度 4只 ,但仍可见黏膜层。C组移植后 10d 1只出现轻度排斥其余未见明显损伤。黏膜厚度、绒毛高度和隐窝深度B组明显高于A组 ,黏膜上皮细胞凋亡数目较A组低。结论　受体脾切除 ,脾肠联合移植可减轻移植小肠急性排斥反应损伤 ,诱导一定程度的小肠移植免疫耐受     

p38蛋白激酶在小肠移植后肠黏膜上皮细胞凋亡机理中的作用

目的 探讨p38蛋白激酶（p38 MAPK）在小肠移植早期排斥反应中肠黏膜上皮细胞凋亡机理中的作用。方法 选用近交系SD和Wistar大鼠进行节段性小肠移植，实验分3组：同基因移植组（Wistar→Wistar组）、异基因移植组（SD→Wistar组）和异基因移植加环孢素A组（SD→Wistar＋CsA组）。分别于移植术后1、3、5及7d采集移植肠管行病理学检查排斥反应，TUNEL法检测凋亡细胞，并行Western—blotting测定p38MAPK表达；同时，ELIsA法测定血清TNF—α活性。结果 SD→Wistar组肠黏膜上皮细胞发生轻、中、重度排斥反应中存在细胞凋亡，凋亡细胞数随排斥反应的加重而增加（P〈0．01）；Wistar→Wistar组排斥反应轻微，凋亡细胞数无明显变化（P〉0．05）；SD→Wistar＋CsA组随着CsA的应用，排斥反应逐渐得到控制，且凋亡细胞数也随着减少。SD→Wistar组及sD→Wistar＋CsA组的血清TNF-α随移植肠管上皮细胞凋亡的轻重而发生相应的变化（P〈0．01）。p38 MAPK在SD→Wistar组随凋亡细胞数增加而表达加强（P〈0．01），Wistar→Wistar组p38 MAPK表达无明显变化（P〉0．05），在SD→wistar＋CsA组随凋亡细胞数而发生相应的变化（P〈0．01）。小肠移植早期排斥反应中肠黏膜上皮细胞凋亡现象与p38MAPK呈正相关（r=0．875，P〈0．01），血清TNF-α与移植肠上皮细胞凋亡呈正相关（r=0．837，P〈0．01），血清TNF-α与p38 MAPK亦呈正相关（r=0．826，P〈0．01）。结论 大鼠小肠移植排斥反应中存在肠黏膜上皮细胞凋亡现象，p38 MAPK参与细胞凋亡信号转导过程并起重要作用。     

腺泡细胞凋亡在大鼠胰腺移植急性排斥反应中的意义

目的：观察移植胰腺的腺泡细胞凋亡及其与急性排斥反应的关系。方法：选用SD和Wistar大鼠进行全胰十二指移植。实验分为同基因移植组（Wistar→Wistar）和异基因移植组（SD→Wistar）两组。于术后第3d、5d和7d分批处死受体，取移植胰腺标本用HE染色和原位末端标记（TUNEL）技术检测移植胰腺切片，进行排斥反应的病理学评分和计数凋亡指数（AI）。结果：发生凋亡的细胞主要是腺泡细胞，同基因移植组胰腺有散在的腺泡细胞凋亡，AI在术后无明显变化。异基因移植组胰腺腺泡细胞凋亡在术后第3d、5d和7d逐渐升高，AI与急性排斥反应的病理学评分成正相关。结论：细胞凋亡与移植胰腺急性排斥反应的严重程度显著相关，凋亡指数可作为判断移植物损伤程度的指标，对急性排斥反应的诊断有一定的参考价值。     

TGF-β1mRNA与大鼠小肠同种异体移植急性排斥反应的关系

目的:研究TGF-β1mRNA与大鼠小肠同种异体移植急性排斥反应的关系.方法:试验分2组,Ⅰ组:Wistar→SD小肠移植;Ⅱ组Wistar→SD小肠移植 CsA.术后3,5,7d观察病理学改变并用半定量RT-PCR方法检测IFN-γ、IL-2、TGF-β1mRNA.结果:病理改变:Ⅰ组术后3d出现排斥反应,7d最重,Ⅱ组术后7d部分出现轻度排斥反应.Ⅰ组IFN-γ、IL-I mRNA术后明显增高,Ⅱ组术后略升高,两者相比差异有统计学意义(P＜0.01).Ⅰ组TGF-β1mRNA术后增高,Ⅱ组TGF-β1mRNA术后增高大于Ⅰ组,两者差异有统计学意义(P＜0.01).结论:TGF-β1mRNA转录水平增高可抑制大鼠小肠移植急性排斥反应.     

氨基胍与环孢素A联用对大鼠心脏移植后急性排斥反应的影响

目的：探讨氨基胍与环孢素A联用对同种大鼠心脏移植后急性排斥反应的影响。方法：受体SD大鼠心脏移植后分为4组：（1）对照组：术后不作任何处理;（2）低剂量环孢素A（CsA)组;术后0－7d肌肉注射CsA2mg.kg^-1.d^-1;（3）氨基胍（AG）组：术后0－7d皮下注射AG600mg.kg^-1.d^-1;（4）低剂量CsA加AG组;术后0－7d肌肉注射CsA2mg.kg^-1.d^-1及皮下注射AG600mg.kg^-1.d^-1。术后4d测定急性排斥反应时移植心的诱生型一氧化氮合酶（iNOS)的表达及血清一氧化氮（NO）含量,并观察移植心存活时间。结果与低剂量环孢素A组相比较,低剂量环孢素A与氨基胍联用组不仅显著地抑制移植心iNOS表达与NO产生（P＜0．05）;而且显著地减轻急性排斥反应（P＜0．01）,延长了移植心存活时间（P＜0．05）。结论低剂量环孢素A与氨基胍联用,协同抑制急性排斥反应时移植心iNOS活性及NO产生;显著地延长移植物存活时间。     

大鼠小肠移植早期应用趋化因子受体拮抗剂抑制移植物急性排斥反应

目的探讨趋化因子受体拮抗剂(MetRANTES)在小肠移植早期应用对排斥反应的免疫抑制作用及其与他克莫司的协同效应。方法SD大鼠为供者,Wistar大鼠为受者,建立异基因节段性异位小肠移植模型。移植后将大鼠分为4组,每组24只。第1组为对照组,移植前后不作任何处理;第2组为MetRANTES组,小肠移植后(0～7d)腹腔注射MetRANTES200μg/d;第3组为小剂量他克莫司(FK506)组,小肠移植后(0～7d)腹腔注射FK5060.5mg·kg-1·d-1;第4组为MetRANTES联合FK506组,2种药物的应用方法与第2、3组相同。观察移植大鼠的一般状况和存活时间以及免疫细胞浸润情况,并于移植术后3、5、7d分别取各组大鼠移植肠标本(n=6)进行组织病理学检查,采用免疫荧光染色和激光扫描共聚焦显微镜技术对移植肠RANTES和CD4 、CD8 、CD25 T淋巴细胞的表达进行连续定量测定。结果第1～4组大鼠平均存活时间分别为(7.37±1.19)d、(22.32±8.60)d、(23.64±6.58)d和(30.55±4.18)d,第2、3、4组大鼠与第1组相比,存活时间明显延长(P<0.01);第4组大鼠存活时间更长,与第2、3组比较,差异均有统计学意义(P<0.01)。第1组全部死于急性排斥反应及感染,组织病理学检查显示移植后第3、5、7d分别符合轻、中、重度排斥反应。第2、3、4组病理学检查无明显排斥反应征象。第1组大鼠的移植肠RANTES表达在术后各时段均显著高于其他3组(P<0.01),其动态变化与急性排斥反应的进程呈正相关;第2组和第4组大鼠移植肠RANTES、CD4 、CD8 和CD25 T细胞的表达均明显低于第1组(P<0.01)。结论MetRANTES能明显抑制小肠移植急性排斥反应,有效保护移植肠功能,显著延长移植物的存活时间,并可增强小剂量他克莫司的免疫抑制作用。     

大鼠移植小肠急性排斥反应期组织病理学研究

目的　探讨大鼠异位小肠移植急性排斥反应期移植小肠病理学特点及意义。方法　实验分 4组 ,每组 6只。A组为非手术对照组 ;B组为异系移植组 ;C组为同系移植组 ;D组为异系移植加环孢霉素A治疗组。术后 3 ,5 ,7,10d取移植小肠进行病理学检查 ,测量黏膜厚度 ,绒毛高度和隐窝深度 ;并检测 3 ,5 ,7d移植小肠黏膜细胞凋亡。结果　A组小肠黏膜正常 ;B组移植小肠炎性细胞浸润、黏膜结构破坏程度和黏膜细胞凋亡数目明显高于C ,D组 ,随移植时间的延长黏膜细胞凋亡数目增加 ,黏膜结构破坏程度加重 ;C组移植小肠黏膜结构损伤程度较B组轻 ;D组仅有少量炎性细胞浸润 ,间质轻度水肿 ,未见黏膜结构破坏。结论　炎性细胞浸润、黏膜细胞凋亡和黏膜结构破坏是移植小肠急性排斥反应损伤病理学变化的主要特点。动态观察移植小肠病理学变化和细胞凋亡 ,对诊断小肠移植急性排斥反应和估计损伤程度有一定的价值。     

转化生长因子β1与大鼠小肠同种异体移植急性排斥反应的关系

目的　研究转化生长因子 β1(TGF -β1)与大鼠小肠同种异体移植急性排斥反应的关系。方法　试验分 3组。Ⅰ组 :Wistar→SD小肠移植 ;Ⅱ组 :Wistar→SD小肠移植 +环孢素A(CsA) ;Ⅲ组 :Wistar→SD小肠移植 +重组人转化生长因子 β1(rhTGF -β1)。术后 3、5、7d观察病理学改变并用半定量RT -PCR方法检测干扰素γ(IFN -γ)、白细胞介素 2 (IL -2 )、TGF -β1mRNA。结果　病理改变 :Ⅰ组术后 3d出现排斥反应 ,7d最重 ;Ⅱ组术后 7d部分出现轻度排斥反应 ;Ⅲ组术后 5d出现轻度排斥反应 ,术后 7d中度排斥反应。Ⅰ组IFN -γ、IL -2mRNA术后明显增高 ;Ⅱ组术后略升高 ,与Ⅰ组相比差异有统计学意义 ( P <0 .0 1) ;Ⅲ组IFN -γ、IL -2mRNA术后升高 ,较Ⅰ组升高程度低 ,二者比较差异有统计学意义 (P <0 .0 5 )。Ⅰ组TGF -β1mRNA术后增高 ,Ⅱ组术后增高大于Ⅰ组 ,两者差异有统计学意义 (P <0 .0 1)。结论　TGF -β1可抑制大鼠小肠移植急性排斥反应     

大鼠小肠移植早期排斥反应中肠黏膜细胞凋亡与IL-1β的关系研究

目的明确小肠移植排斥反应中的细胞凋亡现象,并探讨白细胞介素1β(IL1β)在凋亡中的作用。方法选用SD/Wistar大鼠进行节段性小肠移植。实验分3组:同基因移植组(SD→SD);异基因移植组(Wistar→SD)和异基因移植加环孢素A治疗组(Wistar→SD+CsA)。术后第1,3,5,7天分别用TUNEL法检查移植肠上皮凋亡细胞,用ELISA法测定血清IL1β。结果TUNEL法显示:Wistar→SD组肠黏膜上皮细胞在其发生轻、中、重度排斥反应中存在细胞凋亡,凋亡细胞数随排斥反应的加重而增加(P<0.01),并显著高于SD→SD组(P<0.01)。Wistar→SD+CsA组细胞凋亡数亦有显著增加(P<0.01)。SD→SD组排斥反应轻微,凋亡细胞数无明显变化(P>0.05)。ELISA法显示:在SDSD组血清IL1β无明显变化(P>0.05),WistarSD组和Wister→SD+CsAz组随凋亡细胞数的增加血清IL1β亦增高(P<0.01)。IL1β增加与细胞凋亡指数增加呈正相关(r=0.798,P<0.01)。结论小肠移植排斥反应中存在细胞凋亡现象,IL1β在细胞凋亡发生中起促进作用。     

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.     

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.