甲强龙对重症急性胰腺炎大鼠低钙血症和甲状旁腺激素受体表达的影响

目的观察重症急性胰腺炎（SAP）血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）、血清钙和甲状旁腺激素受体（PTHR）的表达水平及相互关系，探讨甲强龙干预后的变化。方法将SD大鼠36只随机分为3组，假手术组（SO）、SAP组、SAP甲强龙治疗组（SAP＋MP）各12只，以5％牛磺脱氧胆酸钠逆行胰胆管注射建立SAP模型，观察各组血清钙、淀粉酶、TNF-α、IL-6、腹水量和胰腺病理改变，逆转录-聚合酶链反应（RT-PCR）分析肾脏和骨组织PTHR mRNA表达水平。结果SAP组制模后血清TNF-α、IL-6升高，而肾脏和骨PTHR mRNA表达下调（P〈0．01），血清钙显著降低，以12h最为明显；血清TNF-α、IL-6与血清钙、肾脏和骨PTHR mRNA表达水平呈负相关。与SAP组比较，SAP＋MP组血清TNF-α、IL-6水平明显下降。而PTHR mRNA表达上调（P〈0．01）。低钙血症和胰腺局部的病理改变得到改善，存活率显著提高。结论肾脏和骨组织PTHR mRNA表达下调是SAP低钙血症的重要原因之一，可能与炎症细胞因子的过度释放有关。甲强龙可抑制炎症细胞因子的释放，提高PTHR mRNA表达水平，改善低钙血症。     

栗精胺对重症急性胰腺炎大鼠肾脏损伤保护作用的研究

目的探讨栗精胺(CS)对重症急性胰腺炎(SAP)大鼠肾损伤的保护作用及其可能的分子机理。方法将24只SPF级成年雄性SD大鼠随机分为假手术组(SO组)、SAP组和CS组,每组8只大鼠。采用逆行胰胆管注射5%牛磺胆酸钠溶液(1 mL/kg)的方法建立大鼠SAP肾损伤模型。CS组大鼠在SAP建模后立即经腹腔注射CS生理盐水溶液(200 mg/kg)。SO组大鼠开腹后仅翻动十二指肠及胰腺后关腹。建模后12 h处死大鼠,采集3组大鼠的血清、胰腺及肾脏组织标本。采用全自动多功能生化分析仪检测大鼠血清中的尿素氮(BUN)水平、肌酐(Cr)水平及淀粉酶(AMY)活性;采用HE染色并在光镜下观察大鼠胰腺及肾脏组织的病理学改变;采用免疫组织化学染色法检测3组大鼠肾脏组织中核因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)、细胞间黏附分子-1(ICAM-1)及含半胱氨酸的天冬氨酸蛋白水解酶-3(Caspase-3)蛋白的表达。结果 (1)在胰腺及肾脏病理损伤程度方面,SAP组大鼠较SO组严重,但CS组大鼠却较SAP组有所减轻。(2)与SO组比较,SAP组大鼠的血清Cr水平、BUN水平及AMY活性均较高(P0.05);与SAP组比较,CS组大鼠的血清Cr水平、BUN水平及AMY活性均较低(P0.05)。(3)与SO组比较,SAP组大鼠肾脏组织中NF-κB、TNF-α、ICAM-1及Caspase-3蛋白的积分光密度值(IOD值)均较高(P0.05);与SAP组比较,CS组大鼠肾脏组织中NF-κB、TNF-α、ICAM-1及Caspase-3蛋白的IOD值均较低(P0.05)。结论 CS可减轻SAP大鼠的急性肾损伤,其机制可能是通过抑制NF-κB的活化,下调下游炎性介质如TNF-α和ICAM-1蛋白的表达,以及抑制凋亡蛋白Caspase-3的表达来发挥保护作用的。     

急性坏死性胰腺炎肺组织炎性介质mRNA表达与肺损伤的关系

目的 探讨急性坏死性胰腺炎(ANP)大鼠肺组织白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及细胞间黏附分子(ICAM-1)等炎性介质mRNA表达与肺损伤的关系.方法 33只Wistar大鼠随机分为正常对照和胰腺炎不同时间点(1、4、12和24 h)各组,应用3.5%牛磺胆酸钠逆行胰胆管注射制备ANP模型.采用RT-PCR法检测ANP肺组织IL-6、TNF-α及ICAM-1 mRNA表达,同时观察血淀粉酶及脂肪酶、胰腺和肺组织湿/干重比率及病理改变.结果 造模ANP 1 h后肺组织IL-6、TNF-α及ICAM-1 mRNA水平(1.25±0.16、0.33±0.09及082±0.03)较正常对照组(0.07±0.02、0.06±0.02及0.41±0.04)表达增高(P<0.05),并持续升高至12及24 h(分别为1.674±0.14、0.99±0.11、1.17士0.05及1.87±0.05、0.96士0.06、1.11士0.04),同时伴有肺组织病理损害,其严重程度与肺TNF-α及ICAM-1 mRNA表达、肺组织湿/干重比率与TNF-α、IL-6、ICAM-1 mRNA表达的相关系数分别为0.93及0.70(P<0.05).结论 大鼠ANP早期肺组织IL-6、TNF-α及ICAM-1mRNA即过度表达,肺IL-6、TNF-α及ICAM-1mRNA过度表达是ANP肺损害发生的原因之一,肺损伤严重程度与IL-6、TNF-α及ICAM-1mRNA表达的高低有关.     

一氧化碳释放分子对重症急性胰腺炎肺损伤保护作用的实验研究

目的 探讨一氧化碳释放分子(CORM-2)对大鼠重症急性胰腺炎(SAP)肺损伤的保护作用及机制.方法 30只雄性Wistar大鼠随机分为3组(n=10):sham组、SAP组,CORM-2组.以3.5%牛磺胆酸钠逆行注射胰胆管的方法制作SAP模型.CORM-2组于SAP造模0.5 h后经阴茎背动脉注射CORM-2(8 mg/kg).各组均于造模6 h后取材,测定血清肿瘤坏死因子-α(TNF-α)含量;采用RT-PCR法检测肺组织细胞因子诱导的中性粒细胞趋化因子(CINC)及细胞间黏附分子-1(ICAM-1)mRNA的表达;同时检测肺组织髓过氧化物酶(MPO)活性、湿/干重比及对肺脏进行病理学评分.结果 与SAP组相比,CORM-2组血清TNF-α水平、肺组织病理损伤程度、湿/干重比、MPO活性、CINC及ICAM-1 mRNA的表达均显著降低(P＜0.05).结论 应用CORM-2能够降低血清TNF-α水平、下调肺组织CINC及ICAM-1 mRNA的表达,进而有效地抑制肺组织中性粒细胞的大量浸润,从而对SAP肺损伤起到明显的保护作用.     

氟比洛芬酯预先给药对大鼠全脑缺血再灌注损伤的影响

目的 探讨氟比洛芬酯预先给药对大鼠全脑缺血再灌注损伤的影响.方法 健康雄性SD大鼠84只,体重200～350 g,随机分为4组(n=21):假手术组(S组)、缺血再灌注组(IR组)、氟比洛芬酯5 mg/kg组(F_1组)和氟比洛芬酯10 mg/kg组(F_2组).采用夹闭双侧颈总动脉联合低血压法建立全脑缺血再灌注模型.F_(1,2)组分别于缺血前15 min静脉注射氟比洛芬酯5、10 mg/kg.于再灌注6 h(T_1)、24 h(T_2)、72 h(T_3)时随机取7只大鼠行神经功能缺陷评分(NDS),采用放射免疫法测定血清肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)的浓度,RT-PCR法测定海马组织核因子-κB(NF-κB)mRNA及细胞间粘附分子-1(ICAM-1)mRNA的表达水平,并观察海马CA1区病理学结果 .结果 与S组比较,其余3组T_(1～3)时NDS升高,海马组织ICAM-1 mRNA、NF-κB mRNA表达上调,T_(1,2)时血清TNF-α浓度升高,T_(1～3)时血清IL-1β浓度升高 (P<0.05或0.01);与IR组比较,F_(1,2)组T_(1～3)时NDS降低,海马ICAM-1 mRNA、NF-κB mRNA表达下调,T_(1,2)时血清TNF-α冉档停琓_(1～3)时血清IL-1β浓度降低(P<0.05或0.01);与F_1组比较,F_2组T_(2,3)时海马ICAM-1 mRNA表达下调,T_2时血清IL-1β浓度降低(P<0.05或0.01).IR组、F_1组及F_2组海马组织病理学损伤程度依次减轻.结论 氟比洛芬酯预先给药可减轻大鼠全脑缺血再灌注损伤,且呈剂量依赖性,其机制可能与抑制海马组织炎性反应有关.     

参附注射液对大鼠重症急性胰腺炎及其肝损伤的保护作用

目的 探讨参附注射液(SFI)对大鼠重症急性胰腺炎(SAP)及其肝损伤的保护作用和可能机制.方法 42只雄性Wistar大鼠随机分为3组.SAP组(n=18),采用逆行十二指肠胰胆管注射50%牛磺胆酸钠溶液制备SAP模型;SAP+SFI组(n=18),建模前2 h给予SFI 10 mL/kg(体质量)预处理.假手术(SO)组(n=6).建模成功后3,6,12 h,分别取下腔静脉血液、胰腺和肝脏组织,并记录腹水量.光镜下观察肝胰病理改变;全自动生化分析仪检测血液淀粉酶和ALT水平;半定量RT-PCR检测肝脏组织中肿瘤坏死因子TNF-α mRNA的表达;SP免疫组化法检测肝脏组织中核转录因子-kB(NF-kB)活性.结果 SAP组肝胰病理改变严重程度、腹水量、血清淀粉酶和ALT水平随时间推移不断升高,显著高于SO组(P<0.01);肝脏TNF-α mRNA表达明显升高,术后6 h最显著,均显著高于SO组(P<0.01或P<0.05);肝脏NF-kB活性明显增强,术后3h最显著,均显著高于SO组(P<0.01或P<0.05).与SAP组相比,SAP+SFI组各时点肝胰病理改变程度、腹水量均显著降低(P<0.01或P<0.05),血液淀粉酶和ALT水平显著降低(P<0.01或P<0.05),肝脏TNF-αmRNA表达显著减少(P<0.01或P<0.05),NF-kB活性显著降低(P<0.01或P<0.05).结论 SFI对大鼠SAP具有防护作用,并能减轻其肝损伤.保护肝脏的机制可能与抑制NF-kB活化进而下调炎性细胞因子TNF-α mRNA表达水平有关.     

银杏叶提取物对重症急性胰腺炎大鼠脑组织中IL-1β、IL-6和TNF-α表达水平的影响

目的观察银杏叶提取物(ginkgo biloba extract,GBE)对重症急性胰腺炎(severe acute pancreatitis,SAP)大鼠胰腺及脑组织中IL-1β、IL-6及TNF-α表达水平的影响,探讨SAP脑损害的发病机理及GBE对脑损害的治疗效果。方法 54只Winstar大鼠随机分为正常对照组、模型组及治疗组3组,每组18只。正常对照组开腹仅翻动胰腺;治疗组及模型组采用胰腺被膜下注射5%牛黄胆酸钠法制作SAP模型,每隔8 h分别于腹腔内注射GBE和生理盐水。制模后6、12及24 h时段各组取材,测定血清淀粉酶值,光镜下行胰腺组织病理评分,免疫组化法测定胰腺和脑组织中IL-1β、IL-6和TNF-α的表达水平。结果血清淀粉酶值及胰腺组织病理评分值治疗组较模型组降低(P<0.01)。24 h与6及12 h时段比较,胰腺组织中IL-1β、IL-6和TNF-α表达水平,在模型组增高(P<0.05或P<0.01),在治疗组无明显变化(P>0.05);脑组织中IL-1β、IL-6和TNF-α表达水平,在模型组增高(P<0.05或P<0.01),在治疗组降低(P<0.05或P<0.01)。同时段比较,IL-1β、IL-6和TNF-α表达水平治疗组均较模型组降低(P<0.01)。结论 SAP时胰腺和脑组织中IL-1β、IL-6及TNF-α的表达明显增加,GBE对SAP时胰腺及脑组织中IL-1β、IL-6和TNF-α有抑制清除作用。     

罗格列酮对大鼠肾缺血再灌注损伤的保护作用研究

目的研究罗格列酮对肾缺血再灌注损伤的保护作用及潜在机制。方法将60只大鼠随机分成假手术组、缺血再灌注损伤组、罗格列酮10 mg/kg组、罗格列酮20 mg/kg组、罗格列酮40 mg/kg组和罗格列酮80 mg/kg组,每组各10只。利用血管夹夹闭大鼠双侧肾蒂构建肾缺血再灌注损伤模型。ELISA检测大鼠血清肌酐(Cr)、尿素氮(BUN)、白介素-8(IL-8)、肿瘤坏死因子(TNF-α)和白介素-6(IL-6)表达量;Western blot检测过氧化物酶体增殖物激活受体γ(PPAR-γ)和p-PPAR-γ表达水平;RT-PCR检测肾脏IL-8、TNF-α和IL-6信使核酸序列(mRNA)水平;黄嘌呤氧化酶法检测过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GPX)和超氧化物歧化酶(SOD)活性;TBA法检测丙二醛(MDA)的含量;过碘酸雪夫氏(PAS)染色检测肾组织病理形态。结果与假手术组相比,缺血再灌注损伤组肾组织病理损伤和Cr、BUN、IL-8、TNF-α、IL-6、p-PPAR-γ以及MDA表达水平均明显增加,而CAT、GPX和SOD活性明显降低以及PPAR-γ表达差异无统计学意义;与缺血再灌注损伤组相比,罗格列酮预处理可明显减少肾组织病理损伤和Cr、BUN、IL-8、TNF-α、IL-6以及MDA表达水平,但可明显增加CAT、GPX和SOD活性以及p-PPAR-γ表达水平,但对PPAR-γ表达水平无影响。结论罗格列酮预处理对大鼠肾脏缺血再灌注损伤具有保护,其作用机制与激活PPAR-γ抑制氧化应激和炎症相关。     

静脉注射含饱和氢气生理盐水减轻小鼠肾脏缺血再灌注损伤

目的 研究静脉注射含饱和氢气生理盐水对小鼠肾脏缺血再灌注(IR)损伤的保护作用及其机制.方法 健康、雄性的C57BL/6小鼠随机分为3组,每组10只.假手术组(SO组)小鼠仅接受中线开腹、双侧肾蒂游离及关腹操作;缺血再灌注组(IR组)小鼠用无损伤动脉夹同时钳夹双侧肾蒂,阻断45 min,制成肾脏IR损伤模型,并于肾脏缺血同时经尾静脉注射生理盐水,5 ml/kg;实验组小鼠制成肾脏IR损伤模型,并于肾脏缺血同时经尾静脉注射含饱和氢气生理盐水,5 ml/kg.各组小鼠于肾脏再灌注6 h时检测血清尿素氮(BUN)和肌酐(Scr);检测肾组织中丙二醛(MDA)和髓过氧化物酶(MPO)的含量;观察肾脏组织形态学变化并检测肾小管上皮细胞的凋亡情况;观察肾组织中巨噬细胞的浸润情况;检测各组小鼠肾组织中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-1β和IL-17 mRNA的水平.结果 实验组血清BUN和Scr水平明显低于IR组(P<0.05).实验组肾组织病理改变较IR组明显减轻,其肾小管损伤评分明显低于IR组(P<0.01),肾小管上皮细胞凋亡明显轻于IR组(P<0.05).实验组肾组织内MDA含量低于IR组(P<0.05).实验组小鼠肾组织内中性粒细胞和巨噬细胞的浸润较IR组减少(P<0.05).实验组TNF-α、IL-6、IL-1β和IL-17mRNA的水平均低于IR组(P<0.05).结论 静脉注射含饱和氢气生理盐水能够在一定程度上减轻肾脏IR损伤,其机制可能与抑制肾脏IR后炎症反应有关.     

补骨脂素对去势雌鼠E2、ERβ、TNF-α、IL-17的影响

目的观察补骨脂素对去势雌鼠E_2、ER_β、TNF-α、IL-17的影响,探讨补骨脂素防治绝经后骨质疏松的机理。方法选取3月龄雌性SD大鼠72只,随机分为假手术组、模型组、戊酸雌二醇对照组、壮骨止痛胶囊对照组、补骨脂素高剂量组、补骨脂素低剂量组,每组12只。除假手术组外,其它大鼠造成双侧去卵巢骨质疏松症病理模型,术后5d拆线后开始给药,连续13周。最后一次给药后次日取血标本采用ELISA检测血清中雌激素(E_2)、肿瘤坏死因子-α(TNF-α)、白细胞介素-17(IL-17)的含量。提取左股骨组织mRNA样本进行RT-PCR反应检测骨组织TNF-α、ER_β、IL-17基因的表达。取右股骨脱钙切片免疫组化检测ER_β表达。结果模型组去势雌鼠血清E_2水平显著低于假手术组(P0.01)。壮骨止痛胶囊显著升高血清E_2水平(P0.01),补骨脂素高剂量组血清E_2水平显著高于模型组(P0.01),补骨脂素低剂量组血清E_2水平与模型组相比无统计学差异(P0.05)。模型组血清TNF-α、IL-17水平及股骨TNF-α、IL-17mRNA表达显著高于假手术组(P0.01),股骨ER_β显著低于假手术组(P0.05)。戊酸雌二醇组血清TNF-α、IL-17水平及股骨TNF-α、IL-17mRNA表达显著低于模型组,股骨ER_β显著高于模型组(P0.05)。壮骨止痛胶囊组血清TNF-α、IL-17水平显著低于模型组(P0.05),股骨TNF-α、IL-17mRNA表达非常显著低于模型组(P0.01),而股骨ER_β显著高于模型组(P0.05)。补骨脂素高剂量组血清TNF-α水平及股骨TNF-αmRNA表达显著低于模型组(P0.05),而血清IL-17水平及股骨IL-17mRNA表达非常显著低于模型组(P0.01),股骨ER_β显著高于模型组(P0.05)。补骨脂素低剂量组血清TNF-α水平显著低于模型组(P0.05),但其股骨TNF-αmRNA表达与模型组相比无统计学差异,而血清IL-17水平及股骨IL-17mRNA表达显著低于模型组(P0.05),股骨ER_β与模型组相比没有统计学差异。结论补骨脂素可通过提高去势雌鼠血清E_2水平和股骨ER_β水平,降低去势雌鼠骨组织TNF-α、IL-17基因表达和血清TNF-α、IL-17水平发挥抗绝经后骨质疏松症作用。     

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 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.     

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.     

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.     

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.     

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.     

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.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.