高草酸尿和输尿管梗阻对鼠肾小管上皮细胞凋亡的影响

目的探讨高草酸尿和输尿管梗阻(UUO)对鼠肾小管上皮细胞凋亡的影响. 方法雄性成年Wistar大鼠40只,随机分为4组,每组10只,A组为对照组,B组为高草酸尿组,C组为输尿管梗阻组,D组为高草酸尿并输尿管梗阻组.所有大鼠均在术后2周处死并取左肾,常规HE染色检测肾小管间质草酸盐结晶沉着情况;原位末端标记法(TUNEL)检测肾小管上皮细胞凋亡情况. 结果 B组和D组组织切片肾小管腔内可见明显草酸盐晶体沉着,A组和C组未见晶体沉着.计数5个高倍镜视野的细胞,A、B、C、D各组肾小管上皮细胞凋亡数分别为1.1±1.1,31.3±8.0,145.0±33.4,275.8±51;A组与各组相比差异均有显著性意义(P<0.001),B组与C组、D组相比差异有显著性意义(P<0.001),C组与D组相比差异亦有显著性意义(P<0.01). 结论高草酸尿可致肾小管间质草酸盐结晶沉着;完全性输尿管梗阻并高草酸尿使肾小管上皮细胞凋亡水平明显增高,且造成肾脏损害,输尿管梗阻是比高草酸尿更重要的促细胞凋亡因素.     

人参皂甙Rg1对梗阻肾的保护作用

目的:探讨人参皂甙Rg1(G- Rg1)对梗阻肾的保护作用。方法:建立大鼠单侧输尿管梗阻(UUO)模型。假手术组:未行输尿管结扎即关腹;非治疗组:行左侧输尿管结扎后关腹;G- Rg1 组:行左侧输尿管结扎后关腹,并给予G -Rg1灌胃[120 mg/(kg·d)]。全部大鼠1 周后处死,取出左肾常规固定。免疫组织化学染色法检测Bax、PCNA、TGF -β1蛋白表达水平,并应用计算机图文系统进行分析。结果:UUO大鼠肾小管上皮细胞、肾间质细胞中Bax、PCNA蛋白表达显著增多,肾间质、肾小球中TGF- β1 蛋白表达显著增多。G- Rg1 明显抑制UUO大鼠肾小管上皮细胞中Bax蛋白表达(P<0.05),促进PCNA蛋白表达(P<0.05);抑制肾间质和肾小球中TGF- β1蛋白表达(P<0.05)。结论:Bax在梗阻肾小管上皮细胞凋亡、TGF- β1 在间质纤维化和肾小球硬化中可能起着重要的作用。G -Rg1可能有抑制梗阻肾小管上皮细胞凋亡、促进上皮细胞增殖、抑制间质纤维化和肾小球硬化的作用。     

单侧输尿管梗阻对对侧肾小管上皮细胞凋亡影响的研究

目的探讨单侧输尿管梗阻对对侧肾小管上皮细胞凋亡的影响。方法新西兰大白兔48只,随机建立右侧输尿管完全梗阻4周和8周组;部分梗阻4周和8周组;假手术4周和8周组动物模型,每组8只。分别于梗阻4周、8周时取对侧肾脏,称重后利用TUNEL法检测对侧肾小管上皮细胞凋亡,并行HE染色。结果梗阻4周、8周均引起对侧肾实质代偿性增生,与梗阻程度及时间正相关（P〈0.05）。梗阻4周组HE染色见少数肾小管扩张,腔内存在坏死脱落细胞,以完全梗阻明显,但8周较4周相应各组无明显变化。TUNEL法检测完全梗阻、部分梗阻及假手术4周组对侧近曲小管上皮细胞凋亡指数分别为（6.02±1.21）%、（3.87±1.70）%、（2.32±1.39）%;远曲小管上皮细胞凋亡指数分别为（12.08±2.33）%、（7.22±3.35）%、（3.38±2.34）%;8周组对侧近曲小管上皮细胞凋亡指数分别为（7.00±2.19）%、（4.47±2.11）%、（2.29±0.85）%;远曲小管上皮细胞凋亡指数分别为（13.02±3.16）%、（8.11±2.99）%、（3.63±1.96）%。相应各组组间比较均有统计学意义（P〈0.05）,但8周与4周相应各组比较均无统计学意义（P〉0.05）。结论单侧输尿管梗阻早期可引起对侧肾小管上皮细胞损害,但随梗阻时间的延长并未进一步加重。     

神经型一氧化氮合酶在肾盂输尿管连接部梗阻中的表达及意义

目的研究神经型一氧化氮合酶(nNOS)在肾盂输尿管连接部梗阻(UPJO)中的表达及意义。方法病例组36例,均为非管腔外压迫所致的UPJO狭窄段标本,且镜下具有UPJO基本特征:管壁肌层平滑肌稀疏,肌束变细,其间纤维结缔组织堆积。对照组20例为肾肿瘤、肾盂输尿管连接部(UPJ)切缘无肿瘤细胞浸润的UPJ标本。采用免疫组化SABC法对2组UPJ组织进行nNOS染色,并用图像分析进行定量分析比较。结果nNOS主要表达于UPJ肌层平滑肌细胞胞质。UP-JO组与对照组肌层表达的平均吸光度A值分别为0.208±0.014和0.230±0.016,2组比较差异有统计学意义(P<0.01)。结论UPJO中nNOS表达减少,提示NO合成减少可能参与UPJO发病过程。     

镰刀状肾实质切开对犬肾功能的影响

目的　探讨镰刀状肾实质切开对犬肾功能的影响。方法　将 1 8条成年犬分 3组 :实验组为镰刀状肾实质切开组 (A组 )、对照组为肾后唇中下 1 / 3肾实质切开组 (B组 )和无萎缩性肾实质切开组 (C组 )。观测 :术前 ,术后 1d、3d,1周、2周尿微量白蛋白 (ALB)、尿N 乙酰 β氨基葡萄糖酐酶 (NAG) ;术后 1周、1个月排泄性尿路造影 (IVU) ;术后 6月肾组织光镜和电镜结构。结果术后 1d、3d、1周、2周尿ALB和NAG值A组分别为 2 87.45± 8.2 3和 3 .45± 0 .2 8、32 7.87± 1 0 .98和 5 .2 5± 0 .48、468.36± 2 0 .66和 7.87± 0 .65、2 1 2 .87± 1 3 .65和 3 .0 1± 0 .1 7,与B、C两组比较 ,A组明显低于C组 (P <0 .0 1 ) ,A、B组间差异无显著性 (P >0 .0 5) ;术侧肾显影延缓时间A组 (1 35± 1 2 )s明显短于C组 (2 67± 2 8)s(P <0 .0 1 ) ,而与B组 (1 2 8± 1 5)差异无显著性 (P >0 .0 5) ;A、B组肾脏的病理改变明显轻于C组。结论　镰刀状肾实质切开对肾功能影响小 ,是治疗复杂性鹿角状肾结石的较理想术式     

输精管结扎对大鼠前列腺腹叶组织形态及细胞凋亡的影响

目的:通过观察输精管结扎后前列腺间质的变化以及前列腺细胞凋亡率,探讨输精管结扎对前列腺组织生长的影响及其机制。方法:SD大鼠45只,随机分为A、B、C 3组,每组15只。A组将大鼠双侧输精管结扎;B组皮下注射丙酸睾酮;C组皮下注射生理盐水。1个月后将大鼠处死,取前列腺腹侧叶,切片、HE染色,应用计算机图像分析系统检测各组前列腺间质、上皮及管腔的面积百分率。应用TUNEL法检测各组大鼠前列腺的细胞凋亡。结果:A、B、C组大鼠前列腺组织中间质面积比值分别为:(29.20±6.85)%、(48.90±6.49)%、(39.77±7.58)%,组间比较差异有显著性(P均<0.05)。3组前列腺组织中均有细胞凋亡发生,以上皮组织为主。A、B、C组大鼠前列腺组织细胞凋亡率分别为:(6.39±0.84)%、(2.62±0.57)%、(4.58±0.93)%。A组的细胞凋亡率显著高于B组和C组(P均<0.05)。结论:输精管结扎可诱导大鼠前列腺组织细胞凋亡,可能有助于预防前列腺增生的发生。     

膀胱出口部分梗阻大鼠逼尿肌微血管密度及凋亡相关因子PCNA、Bax的变化

目的探讨膀胱出口部分梗阻不同时期逼尿肌微血管密度及凋亡相关因子变化情况。方法Wistar大鼠40只,分为对照组、假手术组、梗阻2周组、梗阻5周组等4组,每组10只。采用免疫组化方法分析逼尿肌微血管密度及凋亡相关因子PCNA和Bax表达情况。结果对照组、假手术组、梗阻2周组和梗组5周组平均膀胱重量分别为(125．5±10．1)、(128．5±8．9)、(380．0±12．4)、(400．0±12．5)mg,微血管密度分别为(12．1±1．3)、(13．3±2．3)、(36．4±4．1)和(37．3±5．6)个,PCNA表达率分别为(38．2±17．2)％、(39．4±11．4)％、(64．1±11．5)％和(46．2±9．6)％,梗阻组和对照组、假手术组比较,差异均有统计学意义(P<0．01),梗阻5周和梗阻2周组比较,差异无统计学意义(P>0．05)。对照组、假手术组、梗阻2周组、梗阻5周组Bax表达率分别为(22．3±6．9)％、(23．5±11．6)％、(40．2±12．7)％和(48．5±10．6)％,梗阻组和对照组、假手术组比较,差异有统计学意义(P<0．01),梗阻5周和梗阻2周组比较,差异有统计学意义(P<0．05)。结论大鼠膀胱出口部分梗阻不同时期逼尿肌形态结构功能的变化,可能是逼尿肌微血管密度及凋亡相关因子PCNA和Bax动态变化的结果。     

单侧睾丸扭转引发对侧睾丸生精损伤免疫机制的实验研究

目的探讨单侧睾丸扭转对侧睾丸生精功能损伤的机理。方法雄性SD大鼠24只,随机分为3组,建立睾丸扭转动物模型。第1组为假手术组,第2、3组扭转左侧睾丸720°并固定维持,分别于12 h和24 h后复位固定。术后1个月留取对侧睾丸称重。应用流式细胞术(FCM)检测各组生精细胞凋亡和各级生精细胞计数,免疫组化SABC法检测抗精子抗体免疫复合物(IgG)在睾丸组织中的沉积。结果第1、2、3组对侧睾丸重量分别为(1555.73±72.34)、(1184.20±101.02)、(783.60±117.93)mg,凋亡细胞数依次为53.25±8.61、1622.00±129.31、3401.25±179.75,抗精子抗体阳性染色率为0、0.55±0.02、0.69±0.03,组间两两比较差异均有统计学意义(P<0.01)。与第1组相比,第2、3组对侧睾丸单倍体、二倍体和四倍体细胞群计数明显减少,同时可见抗精子抗体免疫复合物在睾丸组织中明显沉积,其差异均有统计学意义(P<0.01)。第2、3组间(除四倍体细胞群计数外)差异亦有统计学意义(P<0.01)。结论单侧睾丸扭转导致对侧睾丸生精细胞广泛凋亡,自体免疫反应可能在对侧睾丸生精功能损伤中起重要作用。     

大鼠可复性单侧输尿管部分梗阻中CTGF表达的研究

目的:从分子水平研究可复性单侧输尿管部分梗阻(partial unilateral ureteral obstruction,PUUO)后肾小球和肾小管的病理改变,观察梗阻后和解除梗阻后不同时段内结缔组织生长因子(connective tissue growth factor,CTGF)的表达情况,及其与梗阻解除前后肾病理变化情况的关系。方法:选择成年健康雄性Wistar大鼠72只,随机分组并作以下处理:1对照组24只,仅行左侧肾盂输尿管处游离+左侧腰大肌钝性分离术;2梗阻组24只,将左侧输尿管上段埋入腰大肌下建立PUUO动物模型;以上两组分别在术后1、2、4、8周各随机选取6只处死。3梗阻解除组24只,采用相同方法建立PUUO动物模型,术后8周行梗阻解除术,后1、2、4、8周各随机选取6只处死。所有处死大鼠均行肾脏病理学检查,用免疫组织化学及Western blot法检测CTGF蛋白在组织中的分布及表达水平。结果:梗阻组肾脏中不同时期CTGF蛋白的表达明显高于对照组,差异有统计学意义(P0.01),CTGF蛋白表达随着梗阻时间延长而显著上调;相较梗阻组,解除梗阻组中CTGF蛋白含量在解除梗阻后1周(实验开始9周)内的变化差异无统计学意义,2周(实验开始10周)、4周(实验开始12周)、8周(实验开始16周)分别与梗阻组4、2、1周比较,差异有统计学意义(P0.05)。结论:CTGF蛋白在大鼠肾积水病理形成过程中可能发挥重要调控作用,为先天性肾积水等临床疾病的机制研究提供了一定的参考依据。     

输尿管肾盂连接处梗阻的病因病理及诊治进展

输尿管肾益连接处（UPJ）梗阻是原发性肾积水的常见原因。近年来在对其病因病理、诊断及治疗方法等方面的研究均有较大进展，现综述如下。1病因病理引起UPJ梗阻的病因甚多，通过大体标本及光镜观察，归纳起来有3类：①管腔内狭窄：占87．2％，包括肌层发育缺陷、肾益输尿管瓣膜、伴肾旋转不全而并存的输尿管纠搭扭曲、肾盂输尿管高位连接等，其中肌层肥厚和纤维组织增生占90％。②管腔外压迫：如纤维带粘连、迷走血管压迫致使UPJ扭曲。③功能性梗阻：其特点是UPJ无明显的腔内狭窄及院外压迫因素，逆行造影输尿管导管能顺利通过，但却有…     

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.