骨盆骨折出血超选择动脉栓塞的影像学基础

[目的]探讨骨盆动脉吻合的影像学特点及骨盆骨折出血超选择动脉栓塞的方法。[方法]自1999年1月-2005年6月，60例患者因血流动力学不稳而行骨盆动脉造影。男42例，女18例；年龄21—52岁，平均34．5岁。对造影片上骨盆动脉吻合出现的类型及数量进行观测。[结果]从骨盆的动脉造影上观测到的动脉吻合支为：腰动脉与髂腰动脉100％；髂腰动脉与旋髂深动脉88．33％：闭孔动脉与腹壁下动脉吻合（或髂外动脉）36．67％；臀下动脉与阴部内动脉吻合26．67％；骶外侧动脉与骶中动脉及对侧骶外侧动脉吻合100％；臀下动脉与旋股内外动脉及股深动脉升支吻合56．67％；臀上动脉与臀下动脉吻合61．67％。[结论]骨盆骨折出血时，应实施超选择栓塞即栓塞出血动脉的断端及其吻合支，从而减少动脉栓塞引起的并发症。     

骨盆环微创内固定治疗骨盆C型骨折

目的 :探讨骨盆前、后环微创内固定在骨盆C型骨折治疗中的可行性、技术要点以及临床效果。方法:自2010年12月至2015年12月,选择经髂腹股沟微创小切口重建接骨板内固定治疗骨盆前环损伤;经皮骶髂关节螺钉内固定治疗骨盆后环损伤患者18例,男11例,女7例;年龄29~68岁,平均43.6岁。骨折按Tile分型:C1型14例,C2型3例,C3型1例。耻骨骨折合并同侧骶骨骨折12例,耻骨骨折合并同侧骶髂关节脱位2例,双侧耻骨骨折合并单侧骶骨骨折伴耻骨联合分离3例,双侧耻骨骨折合并双侧骶髂关节骨折脱位1例。观察结果包括手术时间、手术出血量、腰骶神经及髂血管损伤情况、骨折复位情况等。结果:所有患者伤口Ⅰ期愈合,无感染、深静脉血栓、腰骶神经及髂血管损伤、异位骨化等并发症发生。根据Matta复位标准,优14例,良3例,可1例。16例患者获得随访,时间6~33个月,平均16.7个月。根据Majeed疗效评价标准,优15例,良1例,Majeed评分92.13±5.44。结论:骨盆前环损伤选择经髂腹股沟微创小切口重建接骨板内固定,骨盆后环损伤选择经皮骶髂关节螺钉内固定治疗骨盆C型骨折具有手术时间短、创伤小、出血少等优点,临床操作安全可行,疗效满意。     

螺旋CT三维重建在骨盆后环损伤的应用

目的探讨螺旋CT三维重建对骨盆后环骨折的诊断及治疗上的临床意义。方法2002年3月～2003年8月,对骨盆骨折且有完整X线平片和CT三维重建资料的19例患者进行回顾性分析,并对两种检查方法的结果进行比较。结果19例患者中,9例X线片漏诊或可疑,经三维CT检查后修正诊断。对于骶髂关节部分及前后分离、骶髂关节内碎骨、骶髂关节髂骨唇或骶骨唇骨折、骶骨骨折及复杂粉碎性的骨盆后环骨折,三维CT较X线片有明显的优势,能多层次清晰显示骨盆后环的骨折形态。结论三维CT检查对骨盆后环骨折的诊断、分类及指导治疗具有重要的意义和作用。     

骨盆后环损伤分型的临床意义

骨盆骨折前环后环同时损伤时,治疗应以后环为主,由于后环损伤可使骨盆失去稳定性,以致骨盆移位变形。故对这种损伤应以后环损伤为主进行骨折分型。后环损伤包括:骶髂关节脱位,骶髂关节韧带损伤,骶孔直线骨折,髂翼后部直线骨折。作者按照受伤时的体位和骨盆变形的不同,将后环损伤分为:压缩型,分离型和中间型。 压缩型:当骨盆受到侧方打击时,一侧髂骨向内压缩(内旋、内翻),先致耻坐骨枝骨折,打击力继续作用,可使骨盆后环的一处发生骨折     

选择性动脉造影与栓塞在血流动力学不稳定骨盆骨折诊治中的应用

目的 探讨选择性动脉造影与栓塞在诊治骨盆骨折伴血流动力学不稳定患者中的应用.方法 回顾性分析2002年1月至2008年12月收治的62例骨盆骨折伴动脉损伤患者资料,骨折采用AO分型:A2型2例;B1型6例,B2型9例,B3型8例;C1型16例,C2型13例,C3型8例.其中开放性损伤6例(Gustilo分型:Ⅱ型1例,Ⅲ型5例).多发伤患者46例,12例发生休克.62例患者在积极补液及应用血管活性药物的同时进行动脉造影检查,其中59例患者行栓塞治疗. 结果 62例患者行动脉造影79次,其中行2次以上动脉造影患者12例.损伤动脉由多至少依次为臀上动脉、髂腰动脉、骶外侧动脉、闭孔动脉、臀下动脉、阴部内动脉以及髂内动脉和髂外动脉的主干.32例患者伴有两条以上动脉(分支)损伤.59例行骨盆内动脉损伤栓塞治疗的患者中,56例有效.7例患者因腹腔脏器严重损伤抢救无效而死亡,10例失访,45例患者术后获6～52个月(平均14个月)随访.11例患者患侧臀部肌肉力量较健侧弱,未见其他明显并发症.12例多次行选择性动脉造影与(或)栓塞治疗的患者均获随访,其中2例发生患侧臀部肌肉力量减弱. 结论 选择性动脉造影与栓塞是诊治骨盆骨折患者动脉损伤的有效措施.对于多发动脉损伤或延迟动脉损伤的患者,重复性动脉造影和栓塞治疗是必要且安全有效的.     

骨盆后环损伤的内固定治疗

目的 探讨手术内固定治疗骨盆后环损伤的临床疗效.方法 对22例骨盆后环损伤患者分别采用微创技术椎弓根螺钉固定、骶髂关节空心螺钉固定及骨盆重建带后方髂髂固定3种方式治疗.结果 22例均随访,时间4~22个月.无切口感染、血管神经损伤及内固定松动或断裂,无骨折不愈合.结论 微创椎弓根螺钉固定、骶髂关节空心螺钉固定及骨盆重建带后方髂髂固定3种方式均为治疗骨盆后环损伤的有效方法,根据骨折类型及患者的情况选择不同的内固定方式,可获满意疗效.     

仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤

目的 探讨仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤的可行性、手术方法及疗效.方法 在10具尸体操作的基础上,2004年10月至2007年10月对14例骨盆后环损伤行仰卧位经皮骶髂置钉固定术.男7例,女7例;年龄28～75岁,平均41.6岁.Tile B型损伤4例,C型损伤10例.患者仰卧位,于"C"型臂X线机透视下以髂前上棘上2 cm与腋后线交点及髂前上棘与髂后上棘连线中、后1/3交点为进钉点,若两点距离较大,则在透视下确定最佳进钉点.进钉角度为向前20°～30°角,向尾端倾斜5°～15°.经皮骶髂置入一枚直径7.2 mm空心钛螺钉固定.术后摄骨盆正位、骶骨侧位X线片,并行骶髂关节CT扫描,观察螺钉在S1椎体的位置.结果 14例均获随访,平均随访16个月.术后3个月骨盆骨折均临床愈合.14例共置入15枚空心钛螺钉,未发生与置钉有关的并发症.随访期间无神经损伤、螺钉松动及断裂现象,无骨盆畸形及骶髂部疼痛.Majeed疗效评定标准优良率为92.9%.结论 采用体表双定位法,可提高仰卧位骶髂置钉固定术的安全性;仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤方便、可行.     

拉力螺钉固定技术在骨盆后环损伤中的临床应用

目的探讨应用拉力螺钉固定技术治疗骨盆后环部损伤的适应证、手术方法及疗效。方法1998年8月至2005年12月，对47例骨盆骶髂结构复合损伤患者分别采用后侧经骶髂关节的拉力螺钉固定方法，后侧跨骶骨的髂-髂拉力螺钉固定方法及骶-髂拉力螺钉加髂：髂拉力螺钉固定方法治疗骨盆后环损伤，男31例，女16例；年龄18～53岁，平均32岁。通过影像学检查明确47例患者有60侧骨盆骶髂结构复合损伤。按照AO骨盆环损伤方法分型：B型损伤20例，其中B2型9例，B3型11例；C型损伤27例，其中C1型8例，C2型12例，C3型7例。患者麻醉后取俯卧位，行闭合或开放复位后用拉力螺钉固定。所有操作均在C型臂X线机透视下进行。结果47例患者均获随访，随访时间6个月至6年6个月，平均27．7个月。平均手术时间为80min。47例共置入骶髂拉力螺钉104枚。患者在术后2～3个月双下肢可完全负重行走，并逐渐恢复体力劳动。仅发生3枚螺钉松动，未发生神经损伤及螺钉断裂等并发症，腰骶及下肢活动接近正常。结论拉力螺钉固定技术可使不稳定性骨盆后环获得良好的即刻复位和固定，恢复骨盆环的稳定性，适用于骶髂关节脱位及骶骨骨折患者。     

经骨盆前环皮下钢板内固定治疗骨盆前环骨折

[目的]介绍经骨盆前环皮下钢板内固定(APIF)术治疗骨盆前环骨折的手术技术,并报告8例患者的临床治疗体会。[方法]总结本院骨科2012年2⁷月间,8例骨盆前环骨折患者采用APIF手术治疗要点,包括手术适应证、切口定位、皮下隧道的创建、接骨板的塑形与固定、手术注意要点。术后逐月随访,分析患者恢复状况,评估APIF手术治疗骨盆前环骨折的安全性及疗效。[结果]8例患者骨盆手术时间207月间,8例骨盆前环骨折患者采用APIF手术治疗要点,包括手术适应证、切口定位、皮下隧道的创建、接骨板的塑形与固定、手术注意要点。术后逐月随访,分析患者恢复状况,评估APIF手术治疗骨盆前环骨折的安全性及疗效。[结果]8例患者骨盆手术时间20⁷0 min,平均35 min;出血量5070 min,平均35 min;出血量50¹00 ml,平均60 ml。患者术中均未发生血管、神经损伤。术后所有患者均无腹股沟区及大腿外侧的皮肤感觉异常,6例男性患者均无阴囊肿胀、疼痛。患者切口均一期愈合,无深静脉血栓形成。1例患者因其他疾病术后死亡,7例患者术后随访12100 ml,平均60 ml。患者术中均未发生血管、神经损伤。术后所有患者均无腹股沟区及大腿外侧的皮肤感觉异常,6例男性患者均无阴囊肿胀、疼痛。患者切口均一期愈合,无深静脉血栓形成。1例患者因其他疾病术后死亡,7例患者术后随访12¹8个月,术后随访X线片显示内固定牢固,骨折愈合良好。根据Majeed骨盆骨折评分系统进行功能评价,优6例,良1例。[结论]对于不稳定性骨盆前环损伤,APIF手术是一种安全性高、手术操作简便、微创、疗效肯定、并发症少的的固定方案。     

髂腰椎椎弓根螺钉联合骨盆前环钢板内固定治疗DenisⅡ型骶骨骨折并骨盆前环骨折

目的探讨髂腰椎椎弓根螺钉联合骨盆前环钢板内固定治疗DenisⅡ型骶骨骨折并骨盆前环骨折的临床疗效。方法回顾性分析2015年1月—2016年1月西安交通大学医学院附属红会医院收治的14例采用髂腰椎椎弓根螺钉联合骨盆前环钢板内固定治疗的DenisⅡ型骶骨骨折并骨盆前环骨折患者的临床资料。统计分析所有患者手术时间、术中出血量及并发症发生情况,骶神经功能Gibbons评分,骨盆损伤恢复情况Majeed评分,末次随访时骨盆X线片及CT资料上的骨折复位、内固定及愈合情况。结果所有手术顺利完成,随访12～24个月,平均16个月。手术时间3.5～4.6 h,平均4.0 h;术中出血量550～960 mL,平均770 mL。术后Gibbons评分为(2.00±1.07)分,较术前的(3.00±0.75)分明显改善,差异有统计学意义(P 0.05);Majeed评分系统量化评估盆骨损伤恢复情况,优9例,良4例,可1例。所有患者末次随访时骨盆X线片及CT示内固定在位,无断裂、松动,骶骨骨折及骨盆前环骨折完全骨性愈合。结论应用髂腰椎椎弓根螺钉联合骨盆前环钢板内固定治疗DenisⅡ型骶骨骨折并骨盆前环骨折疗效满意。     

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.     

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.     

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.     

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.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.