截骨矫形联合软组织手术治疗高弓内翻足伴跖内收的短期疗效

目的 探讨跖骨截骨联合跟骨截骨以及软组织手术治疗高弓内翻足伴跖内收的短期疗效。方法 回顾性分析2018年2月至2021年9月我院采用跖骨截骨联合跟骨截骨以及软组织手术治疗的14例（16足）高弓内翻足伴跖内收病人的临床资料。男6例（6足）,女8例（10足）;单左足5例,单右足7例,双足2例;平均年龄为24.5岁（18~35岁）,病程3~10年。病人术前均有足部的高弓内翻畸形伴疼痛,保守治疗无效。根据术前负重位X线片测量跖内收角（MAA）评估前足内收程度,中度10足,重度6足。评估术前及末次随访时的MAA、距骨第1跖骨角、跟骨倾斜角、后足力线位跟骨外翻角和美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分系统评分。结果 术后病人伤口均一期愈合。1例（1足）术后4个月穿正常鞋下地行走时出现转移性跖痛,配矫形鞋垫后症状消失。14例（16足）病人均获得了随访,随访时间为18~24个月,平均21.4个月。末次随访时,MAA为8.53°±0.69°,距骨第1跖骨角为3.58°±0.52°,跟骨倾斜角为24.75°±2.77°,跟骨外翻角为2.67°±1.78°,AOFAS评分为（90.08±5.62）分,均明显优于术前［25.89°±3.62°,8.67°±1.97°,38.17°±7.83°,-29.08°±8.51°,（45.08±9.09）分］,差异有统计学意义（P＜0.05）。结论 跖骨截骨联合跟骨截骨以及软组织手术治疗高弓内翻足伴跖内收的短期疗效显著。     

双侧足母趾籽骨对足母趾外翻矫正手术效果的影响研究

目的 探讨足母趾胫侧籽骨及腓侧籽骨对足母趾外翻矫正手术效果的影响。方法 回顾性分析2010年1月至2013年12月来我院接受近端或远端Chevron截骨矫正治疗的110例足母趾外翻病人。根据病人有无双侧足母趾籽骨分为双侧足母趾籽骨组（30例）和非双侧足母趾籽骨组（80例）。其中,双侧足母趾籽骨组行跖骨近端Chevron截骨矫正治疗4例,跖骨远端Chevron截骨矫正治疗26例;非双侧足母趾籽骨组行跖骨近端Chevron截骨矫正治疗15例,跖骨远端Chevron截骨矫正治疗65例。记录并比较两组病人术前一般资料,手术前后影像学资料测量足母趾外翻角、跖骨间夹角、跖骨远端关节面固有角,比较其手术前后及组间的美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society, AOFAS）踝与后足功能评分。结果 两组病人术后足母趾外翻情况均明显改善。两组病人术后的足母趾外翻角、跖骨间夹角、跖骨远端关节面固有角及AOFAS评分均较术前明显改善;但上述指标组间比较,差异均无统计学意义（P＞0.05）。结论 双侧足母趾籽骨对近端或远端Chevron截骨矫形治疗足母趾外翻畸形手术无明显影响。     

微创截骨手法整复术治疗拇外翻

目的： 探讨微创截骨手法整复术治疗拇外翻的临床疗效。方法： 自2018年1月至2019年5月采用微创截骨手法整复术治疗拇外翻患者31例（42足）,其中男3例,女28例;年龄18~76（50.1±4.9）岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1,2跖骨间角（inter metatarsal angle,IMA）,第1,2跖骨长度差变化,术后采用美国矫形骨科学会足踝外科学组（American Orthopaedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分系统进行功能评价。结果： 31例（42足）患者获得随访,时间14~18（15.1±1.2）个月。HVA、IM分别由术前的（38.5±5.4）°、（13.0±1.1）°矫正到术后的（14.3±4.7）°、（9.1±1.5）°（P<0.05）。术前1、2跖骨长度差为2~-4（-0.59±1.80） mm,术后为0~-6（-3.53±1.60） mm,平均第1跖骨短缩2.94 mm,差异有统计学意义（P<0.05）。AOFAS评分由术前的（57.8±9.7）分提高到术后的（92.1±9.3）分,手术前后比较差异有统计学意义（P<0.05）;其中优23足,良16足,可3足。结论： 微创截骨手法整复术手术时间短、切口小、能够有效纠正拇外翻畸形、改善前足功能,获得良好疗效。     

改良旋转Scarf截骨术在中重度踇外翻治疗中的应用

目的 探讨改良旋转Scarf截骨术在中重度踇外翻手术治疗中的临床疗效。方法 回顾性分析2018年1月至2019年6月于我院手术治疗的100例中重度踇外翻病人的临床资料,平均年龄为47.6岁（17~84岁）,其中男13例,女87例,双足病例38例,共138足,均应用改良旋转Scarf截骨术手术治疗。术前、术后均经X线负重正侧位检查,双盲法测量踇外翻角（HVA）、第一、二跖骨间夹角（IMA）、近端关节面固有角（DMAA）、胫侧籽骨位置。采用美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）足踇趾、跖趾关节、趾间关节功能评分评价疗效。结果 术后平均随访18.7个月（12~30个月）。病人术后HVA、IMA、DMAA、胫侧籽骨位置均明显低于术前,差异均有统计学意义（P＜0.05）。末次随访时AOFAS评分[（94.7±5.8）分]较术前[（45.4±5.1）分]明显提高,差异有统计学意义（P＜0.05）。病人足疼痛、外形、功能明显改观,穿鞋及生活质量得到极大提高。结论 对于中重度踇外翻,采取改良旋转Scarf截骨术具有明确的临床疗效。     

旋转Scarf截骨术治疗拇外翻合并第1跖骨旋转

目的：探讨旋转Scarf截骨术治疗拇外翻（hallux valgus,HV）合并第1跖骨旋转的临床疗效。方法：自2018年1月至2019年10月采用旋转Scarf截骨术治疗35例（40足） HV合并第1跖骨旋转畸形患者,其中男5例,女30例;年龄25~76（40.32±5.43）岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1、2跖骨间角（intermetatarsal angle,IMA）,第1跖骨远端关节面角（distal metatarsal articular angle,DMAA）,第1跖骨长度（the first metatarsal length,FML）,术后采用美国矫形骨科学会足踝外科学组（American Orthopedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分和疼痛视觉模拟评分（visual analogue scale,VAS）系统进行功能评价。结果：35例（40足）均获得随访,时间12~36（14.35±3.62）个月。HVA、IMA和DMAA分别由术前的（36.32±4.51）°、（14.21±3.22）°和（28.35±4.32）°矫正到术后的（14.32±5.71）°、（5.83±3.97）°和（7.32±2.14）°（P<0.05）。手术前后FML比较,差异无统计学意义（P>0.05）。AOFAS评分和VAS分别由术前的（57.00±4.31）分、（6.00±1.21）分改善至末次随访时的（90.31±3.28）分、（1.42±0.83）分（P<0.05）;根据AOFAS评分,结果优23足,良15足,可2足。结论：旋转Scarf截骨术矫正力度大、维度高,能够有效纠正HV合并第1跖骨旋转畸形,改善前足功能,获得良好疗效。     

Scarf与第1跖骨双平面截骨治疗拇外翻畸形的病例对照研究

目的：比较Scarf截骨术与第1跖骨双平面截骨术（double metatarsal osteotomy,DMO）治疗中重度拇外翻的临床疗效。方法：回顾性分析2017年1月至2019年12月治疗的50例（81足）中重度拇外翻畸形患者,根据截骨方式不同分为Scarf截骨术（Scarf osteotomy,SO）组或DMO组。SO组26例（44足）,男1例,女25例;年龄48~65（55.50±4.67）岁;中度18例（30足）,重度8例（14足）。DMO组24例（37足）,男1例,女23例;年龄45~62（52.10±6.80）岁;中度14例（24足）,重度10例（13足）。手术前后在足部负重正位X线片上测量并比较拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）及远端跖骨关节面角（distal metatarsal articular angle,DMAA）,第1跖骨相对长度（relative length of first metatarsal,RLFM）的变化情况。术前及末次随访时采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society,AOFAS）拇趾、跖趾、趾间关节评分进行临床疗效评价。观察两组患者负重时间及并发症情况。结果：50例患者均获得随访,SO组随访时间12~36（20.50±6.22）个月,DMO组16~28（19.80±2.44）个月,两组随访时间比较,差异无统计学意义（P>0.05）。所有切口Ⅰ期愈合,术后（20.31±3.17）个月截骨均愈合,SO组术后1例出现获得性拇内收畸形,未出现转移跖痛;DMO组术后2例发生转移性跖痛。两组手术前后HVA、IMA、DMAA、AOFAS评分比较,差异无统计学意义（P>0.05）;术前两组RLFM比较,差异无统计学意义（P>0.05）,两组末次随访时RLFM比较,差异有统计学意义（P<0.05）。SO组部分负重时间及完全负重时间显著早于DMO组（P<0.05）。结论：Scarf截骨与第1跖骨双平面截骨均可有效治疗中重度拇外翻畸形,影像学及临床评估相似,但术后第1跖骨相对长度SO组较DMO组延长,Scarf截骨下地负重时间早于第1跖骨双平面截骨。     

改良Ludloff截骨联合Reverdin截骨治疗中重度足母外翻

目的 探讨改良Ludloff截骨联合Reverdin截骨治疗合并第一跖骨远端关节面角（distal metatarsal articular angle, DMAA）增大的中重度足母外翻的疗效分析。方法 回顾性分析自2015年2月至2017年2月我科治疗的DMAA增大的中重度足母外翻病人32例（40足）。其中,男4例（5足）,女28例（35足）;年龄为29~78岁,平均52.4岁。术前行足部负重位X线检查：足母外翻角（hallux valgus angle, HVA）为30°~55°,平均42.4°±3.30°;第一、二跖骨间夹角（intermetatarsal angle, IMA）为13°~24°,平均17.7°±1.9°;DMAA为17°~39°,平均22.6°±1.1°。行患足美国足踝外科协会（American Orthopaedic Foot and Ankle Society, AOFAS）评分标准评分为41~87分,平均（68.3±2.9）分。均采用改良Ludloff截骨联合Reverdin截骨。对比手术前后HVA、IMA及DMAA,参照AOFAS评分标准进行手术疗效分析。结果 32例病人术后获得6~18个月随访。所有病人无感染、骨折不愈合、跖骨头坏死及畸形复发等并发症的发生,有1足切口延迟愈合。术后6个月行X线检查,HVA为13.2°±3.1°、IMA为8.1°±1.7°、DMAA为7.6°±1.2°,以上指标较术前减小,差异均有统计学意义（均P＜0.05）。术后6个月AOFAS评分：优29足,良8足,可3足,优良率为92.5%。AOFAS评分为（77.0±3.0）分较术前升高,差异具有统计学意义（t=41.18,P=0.004）。结论 改良Ludloff截骨联合Reverdin截骨治疗合并DMAA增大的中重度足母外翻可以很好的纠正畸形。     

第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻

目的：探讨第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻临床疗效。方法：回顾性分析自2017年3月至2021年8月接受第1跖趾关节融合结合旋转Weil截骨治疗的重度跖内收型拇外翻患者37例（69足）,男8例（11足）,女29例（58足）;年龄67~83（70.03±2.87）岁;左侧3例,右侧2例,双侧32例。分别于术前、术后6周及末次随访时,采用疼痛视觉模拟评分（visual analogue scale,VAS）进行疼痛缓解程度评价。术前及末次随访时采用美国骨科足踝外科学会（American Orthopaedic Foot and Ankle Surgery,AOFAS）前足评分对患足功能进行评价。并测量手术前及末次随访时拇外翻角（hallux valgus angle,HVA）,第1、2跖间角（intermetatarsal angle,IMA）的变化情况。结果：37例（69足）患者获得随访,时间12~48（22.8±0.6）个月。术后7~10（8.00±1.21）周第1跖趾关节处达到骨愈合,无延迟愈合及不愈合发生。术前HVA （44.30±2.84）°与末次随访（15.20±2.13）°比较,差异有统计学意义（t=65.781,P<0.05）;IMA角与末次随访比较,差异无统计学意义（P>0.05）。VAS由术前的（6.73±1.48）分改善至术后6周的（2.78±0.71）分（t=3.279,P<0.05）,与末次随访（1.16±1.12）分比较差异有统计学意义（t=4.859,P<0.05）。AOFAS前足评分由术前的（52.14±5.78）分提高至末次随访时的（86.70±4.86）分;结果优25足,良40足,可4足。结论：采用第1跖趾关节融合结合外侧足趾旋转Weil截骨治疗重度跖内收型拇外翻可以明显缓解患者前足的疼痛及外观,并且稳定了第1序列,明显改善了患者的行走功能。     

泰勒空间外架技术结合足部“U”形截骨治疗创伤后马蹄内翻足畸形

目的 探讨泰勒空间外架（Taylor spatial frame,TSF）技术结合足部“U”形截骨治疗创伤后马蹄内翻足的临床疗效。方法 回顾性分析2016年7月至2019年7月应急总医院收治的42例创伤后马蹄内翻足病人的临床资料,其中男31例,女11例,平均年龄为24.3岁。马蹄足畸形平均跖屈70°。术前测量畸形参数。术中依据Ilizarov穿针原则安装TSF,足部“U”形截骨同期行微创软组织松解术。术后根据处方调整TSF,行康复训练。截骨处愈合后去除外固定架,佩戴支具。定期门诊复查,记录疼痛视觉模拟量表（visual analogue scale, VAS）评分及美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足功能评分。结果 本组平均手术时间为85.6 min（60~110 min）,术中平均出血量为15.5 mL（10~20 mL）。42例病人均获随访,平均随访时间为18个月（12~24个月）。术后平均40.7 d（26~80 d）踝关节恢复背伸5°~10°;佩戴外支架行走时间平均为12.7周（10~16周）。5例病人6处针道轻度感染。1例发生近端半针断裂。所有病人无血管、神经损伤。3例患足复发跖屈畸形,约10°。随访结束时所有病人均可达到不扶拐步行状态。末次复诊时AOFAS评分,优18例,良18例,可4例,差2例,优良率为85.7%;AOFAS评分为（89.4±8.0）分,较术前（52.7±1.0）分显著增加,差异有统计学意义（t=-6.085,P=0.010）。VAS评分为（2.8±1.3）分,较术前的（6.7±1.4）分明显降低,差异有统计学意义（t=0.464,P=0.025）。结论 TSF结合足部“U”形截骨是治疗创伤后马蹄内翻足畸形的有效方法。     

改良Chevron截骨术联合Akin截骨术治疗足母中重度外翻的临床分析

目的 探究改良Chevron截骨术联合Akin截骨术治疗中重度足母外翻的临床效果。方法 回顾性分析2015年1月至2017年1月我院收治的50例中重度足母外翻病人的临床资料,依据手术治疗方式的不同将其分为改良Chevron截骨治疗组（20例,36病足）和联合手术治疗组（30例,50病足,改良Chevron截骨术联合Akin截骨术）。应用美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society, AOFAS）踝与后足功能评分系统评价患足功能,采用疼痛视觉模拟量表（visual analogue scale, VAS）评估两组病人患足疼痛情况,测量两组病人手术前后的足母外翻角（hallux valgus angle, HVA）和第1、2跖骨间角（inter-metatarsus angle, IMA）评价手术效果。结果 联合手术治疗组病人的术中出血量为（33.75±5.27） ml,手术时间为（55.14±12.89） min,均高于改良Chevron截骨治疗组［（12.88±4.75） ml,（27.67±10.12） min］,差异均有统计学意义（t=3.293,P=0.018;t=4.293,P=0.012）。联合手术治疗组术后1周、1个月、1年的VAS评分［（3.24±0.98）分、（2.17±0.45）分、（1.31±0.12）分］均优于改良Chevron截骨治疗组［（3.42±0.74）分、（2.57±0.36）分、（1.88±0.45）分］,差异均有统计学意义（t=2.267,P=0.028;t=2.991,P=0.017;t=2.542,P=0.021）。两组病人术后的HVA、IMA、AOFAS评分、满意度评分、AOFAS优良率比较,联合手术治疗组［12.67°±2.13°、8.31°±1.02°、（81.21±9.24）分、（91.67±4.12）分、88.8%］优于Chevron截骨治疗组［10.42°±3.52°、7.59°±1.33°、（62.22±6.42）分、（75.32±5.91）分、60.00%］,差异均有统计学意义（t=2.742,P=0.037;t=2.984,P=0.029;t=3.342,P=0.012;t=3.943,P=0.007;χ²=7.274,P=0.032）。结论 改良Chevron截骨术联合Akin截骨术治疗中重度足母外翻具有更好的术后效果,值得进一步推广应用。     

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.     

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.