原发性肝癌合并门静脉高压症病人行联合肝脾切除与单纯肝切除的回顾性研究

目的 探讨脾切除在合并轻中度乙型病毒性肝炎(简称乙肝)后肝硬化性门静脉高压症的原发性肝癌病人中的作用.方法 选取2002～2008年间符合下列条件的171例合并乙肝肝硬化性门静脉高压症的原发性肝癌病人进行回顾性对照研究:①术前血小板计数在50×109/L～80×109/L之间,白细胞计数＞2.0×109/L;②无食管静脉曲张或曲张程度≤F2;③肿瘤病灶经术前评估可切除.按是否接受同时性脾切除将病例分为联合肝脾切除组(SPH)及单纯肝切除组(HA),前者57例,后者114例.结果 两组病例在围手术期临床资料等方面差异无统计学意义(P＞0.05).脾切除对肝功能有短期改善作用,长期则无影响;对无瘤生存率(HA 26.3％、SPH 35.1％)及总生存率(51.8％与54.4％)无明显影响(P＞0.05).严重并发症发生率联合肝脾切除组病人(22.8％)较单纯肝切除组(7.9％)高(P＜0.01).结论 对于合并轻中度乙肝肝硬化性门静脉高压症的原发性肝癌病人,脾切除并无必要性,应慎行之.     

肝癌合并门静脉高压脾功能亢进105例的外科个体化治疗

目的：探讨肝癌合并门静脉高压脾功能亢进（脾亢）的外科个体化治疗措施。 方法：回顾性分析中山大学附属第一医院肝胆外科2002年1月至2011年12月10年间收治的105例肝癌合并门静脉高压严重脾亢的患者资料,57例行联合肝脾切除（联合组）,44例行单纯肝癌切除（肝切组）,4例行局部肝癌切除加脾动脉结扎术。 结果：联合组术后1~2周血小板及白细胞均恢复至正常,联合组与肝切组手术平均出血量分别为（903.62±139.24）ml和（802.56±146.52）ml（t = 3.535,P 〈 0.01）,差异有统计学意义,两组并发症分别为14例和15例,差异无统计学意义（χ2 =1.102,P 〉 0.05）,两组围手术期死亡各2例。 结论：联合肝脾切除治疗肝癌合并门静脉高压脾亢可作为首选,只要掌握好适应证,做好围手术期处理,手术是安全的,建立个体化治疗措施是降低术后并发症和死亡率,提高疗效的关键。     

2280例肝门胆管癌的荟萃分析

目的 探讨我国肝门部胆管癌(hilar cholangiocarcinoma,HCC)的流行病学、临床特点、诊断方法、Bismuth-Corlette分型、病理类型、治疗方式、并发症及预后,以期指导临床.方法 以肝门胆管癌为检索词,在中国知网、重庆维普、中国学术期刊网全文数据库CNKI进行检索.将所得22篇文献,共2280例HCC的临床资料进行统计学分析.临床资料分析及数据提取分别由两人完成.结果 与姑息性切除组比较,根治性切除组术后1年生存率(84.0％与46.8％,OR=5.71,95％CI 3.99～8.17,P＜0.01)和术后3年生存率(31.5％与13.5％,OR=4.43,95％CI 2.07～9.47,P＜0.01)均较高.与姑息性切除组相比,内外引流组术后1年生存率(27.2％与38.7％,OR=0.47,95％CI0.31～0.72,P＜0.01)较高.经卡方检验,我们同时发现2002年后HCC手术切除率比2002年前有上升(X2 =35.9588,P＜0.01),但根治性切除率却没有明显变化(X2=2.1052,P=0.1468).结论 根治性切除组术后1、3年生存率高于姑息性切除组.内外引流组术后1年生存率高于姑息性切除组.根治性切除术仍是治疗HCC最理想的方法.如果无法达到根治性切除,姑息性引流术是较好的选择.姑息性切除术并不能提高生存率,因而不被提倡.     

前入路与常规入路右半肝巨大肝癌切除手术疗效的Meta分析

目的 系统比较前入路与常规入路肝癌切除术治疗大肝癌的效果.方法 计算机检索Medline、Embase、Cochrane,CNKl、万方、维普数据库中截止2013年4月的相关文献,收集比较前入路切除与常规切除治疗肝癌的随机临床对照试验研究.采用Meta分析软件RevMan 5.0对数据进行统计分析.结果 共纳入8个随机临床对照试验,患者总数615例(前入路肝切除304例,常规入路肝切除311例).结果显示,前入路肝切除术中失血量[加权均数差(WMD)=-680.2 ml;95％CI,-1023.97～-336.43;P=0.0001]、外科并发症(OR=0.59;95％ CI,0.38～0.93;P=0.02)、围手术期病死率(OR=0.37;95％ CI,0.21～0.67;P=0.0009)、术中输血率(OR=0.38;95％ CI,0.25～0.59;P＜0.01)、住院时间(WMD=-4.75 d;95％ CI,-7.82～-1.67;P=0.002)、肿瘤破裂发生率(OR=0.33;95％ CI,0.11～0.97;P=0.04)明显优于常规入路切除术.两种入路手术时间无明显统计学意义.结论 前入路肝脏切除术与常规入路比较,具有术中出血量少,输血率、外科并发症发生率、肿瘤破裂发生率、围手术期病死率较低,住院时间较短等优点.两者手术时间比较无明显差别.     

肝脾联合切除治疗肝癌合并肝硬化脾功能亢进的Meta分析

目的 系统评价肝脾联合切除治疗肝癌伴肝硬化脾功能亢进的安全性和疗效.方法 计算机检索Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、万方数据库中的相关文献,所有检索均截止至2009年8月.由2名评价员筛选和提取资料,并用Minors量表进行质量评估.对符合纳入标准的研究采用RevMan5软件进行统计分析.结果 共纳入5个非随机对照试验,患者总数476例(肝脾联合切除组232例,单纯肝癌切除组244例).结果 显示肝脾联合切除组(HS组)与单纯肝癌切除组(H组)手术病死率和术后并发症发生率比较无统计学差异,OR值(95%CI)分别为0.57(95%CI 0.12～2.66,P=0.47)和0.93(95%CI 0.59～1.46,P=0.75).与H组相比,HS组术后CD4+T细胞比例、CD4+T细胞/CD8+T细胞比值、白细胞和血小板计数均明显上升,其WMD值(95%CI)分别为7.90(7.01～8.79,P＜0.01)、0.75(0.70～0.80,P＜0.01)、5.47(5.13～5.82,P＜0.01)、174.89(116.61～233.18,P＜0.01).术后CD8+T细胞下降,其WMD值(95%CI为-7.66(-8.53～-6.79,P＜0.01).两组术后5年生存率的OR值(95%CI)为1.37(0.86～2.18,P=0.18).结论 根据已有文献,肝脾联合切除术治疗肝癌伴肝硬化脾功能亢进未增加手术病死率及术后并发症发生率,且可显著提高患者术后白细胞和血小板计数,改善机体免疫功能,但目前证据未表明能提高术后5年生存率.

Abstract：

Objective To systematically evaluate the efficacy and safety of combined hepatectomy and splenectomy in hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism.Methods Medline (1966-August 2009), Embase (1974-August 2009), Cochrane Library, CBMdisc (1978-August 2009), and Wanfang Database were searched without language limitation. All relevant studies were screened and the data were extracted by two independent reviewers, and the methodological qualities of the included studies were evaluated by the Minors scale. The data were analyzed with the RevMan5 software. Results Five non-randomized comparative studies (NRCs) involving 476 patients (232 in HS group, 244 in control group) were enrolled into the analysis. There was no significant difference in the operative mortalities (OR=0. 57, 95%CI 0. 12-2. 66, P=0. 47) and postoperative morbidities (OR= 0. 93, 95 % CI 0.59- 1.46, P = 0.75) between the two groups. Compared with hepatectomy only, CD4+ T cell (WMD=7.90, 95%CI 7.01-8.79, P＜0.01), CD4+ T cell/CD8+ T cell ratio (WMD=0. 75, 95%CI 0. 70-0.80, P＜0.01), white blood cell count (WMD=5.47, 95%CI 5.13-5.82, P＜0.01) and platelet count (WMD=174.89, 95%CI 116.61-233.18,P＜0.01) were significantly higher, but CD8+ T cell (WMD = - 7.66, 95%CI - 8. 53～ - 6. 79,P＜0. 01) was lower compared with combined hepatectomy and splenectomy. There was no significant difference in the 5-year survival rates (OR= 1.37, 95%CI 0.86-2.18, P=0. 18). Conclusion Combined hepatectomy and splenectomy did not increase the operative mortalities and postoperative morbidities in hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism. The white blood cell and platelet counts markedly increased after surgery. There was no evidence to show any improvement in the 5-year survival.     

挽救性肝移植与再次肝切除治疗术后复发性肝癌疗效对比的Meta分析

背景与目的:挽救性肝移植(SLT)与再次肝切除术(RH)哪种治疗方式更有利于术后复发性肝癌患者,目前尚无一致结论,亦无大样本量的多中心研究予以证实。本研究通过Meta分析方法评价SLT与RH治疗术后复发性肝癌的临床疗效,以期为术后复发性肝癌的治疗选择提供参考。方法:检索多个国内外数据库,检索时间为建库起至2019年8月,收集比较SLT和RH治疗术后复发性肝癌临床疗效的临床研究。由2名研究者独立筛选文献和提取数据,并进行文献质量评价后,以总体生存率以及无瘤生存率为主要结局指标进行Meta分析。结果:最终纳入符合标准的6篇回顾性队列研究,共650例患者,其中SLT组134例,RH组516例。Meta分析结果显示,SLT组与RH组术后1、3年总体生存率差异无统计学意义(OR=1.70,95% CI=0.82～3.53,P=0.15;OR=1.10,95% CI=0.70～1.72,P=0.67),但SLT组5年总体生存率明显优于RH组(OR=1.56,95% CI=1.03～2.37,P=0.04)。SLT组1、3、5年无瘤生存率均明显优于RH组(OR=5.91,95% CI=3.16～11.05,P0.000 01;OR=3.98,95% CI=2.57～6.16,P0.000 01;OR=4.37,95% CI=2.03～9.44,P=0.000 2)。SLT组患者术后并发症发生率高于RH组(OR=4.67,95% CI=2.72～8.01,P0.000 01)。两组围手术期病死率差异无统计学意义(OR=3.92,95% CI=0.41～37.80,P=0.24)。SLT组患者术中出血量高于RH组、院时间长于RH组(均P0.05)。结论:SLT治疗术后复发性肝癌安全、有效;与RH比较,SLT可显著改善患者术后无瘤生存率,获得较好的远期预后。但供肝来源的短缺,使RH仍是复发性肝癌的重要治疗手段。     

肝癌合并肝硬化脾功能亢进的围手术期处理

目的 探讨肝癌联合脾切除对原发性肝癌合并肝硬化脾功能亢进患者手术安全性的影响以及围手术期处理原则.方法 回顾性分析1999年1月至2009年12月收治的177例原发性肝癌合并肝硬化脾功能亢进患者的临床资料,男性150例,女性27例,年龄25～76岁,平均(55±12)岁.按照是否联合脾切除术,将患者分为切脾组(n=71)和不切脾组(n=106).比较两组在手术安全性、术后并发症发生率、术后肝功能恢复、术后白细胞计数和血小板计数方面的差异.结果 两组患者术前一般情况及白细胞计数和血小板计数的差异无统计学意义(P＞0.05).切脾组术后第1、10、30天血小板计数分别为(88.4±23.6)×109/L、(345.3±98.2)×109/L、(210.8±92.2)×109/L,与不切脾组相比差异有统计学意义(P＜0.05).切脾组手术时间为(216±105)min,高于不切脾组的(135±60)min,差异有统计学意义(P＜0.05),但两组术中出血量及输血的差异无统计学意义.切脾组术后并发症发生率为11.3%,与不切脾组的6.6%相比差异无统计学意义.结论 只要严格掌握适应证,提高围手术期处理水平,肝癌合并肝硬化脾功能亢进患者行肝脾联合切除术是安全的.     

前入路与传统入路肝切除术治疗巨大肝癌临床疗效的Meta分析

目的 系统评价前入路与传统入路肝切除术治疗巨大肝癌的临床疗效.方法 以原发性肝癌、转移性肝癌、手术、肝切除术、前入路、绕肝提拉法、传统入路、hepatocellular carcinoma、metastatic liver cancer、HCC、surgery、liver resection、hepatectomy、hepatic resection、anterior approach、conventional approach和liver hanging maneuver等为关键词检索Cochrane library、PubMed、EMBASE、Web of Knowledge、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CMCC)、万方数据库.检索时间为各数据库建库至2013年12月.纳入行前入路肝切除术和传统入路肝切除术治疗巨大肝癌的中文和英文文献,再由2名研究者分别独立提取数据,并进行文献质量评价数据分析;应用Review Manager 5.1.2软件进行Meta分析.计数资料采用优势比(OR)分析统计,计量资料采用均数差(MD)分析统计,采用合并值及95％可信区间(95％ CI)表示.结果 共纳入符合标准的文献13篇,共1 287例肝癌患者,其中前入路肝切除术603例,传统入路肝切除术684例.3篇文献为随机对照试验,1篇偏倚风险高,2篇偏倚风险低;10篇文献为非随机对照试验,平均质量评价为7分(5～9分).Meta分析结果显示,近期疗效比较:与传统入路肝切除术比较,前入路肝切除术能减少术中出血量(MD=-349.39,95％CI:-636.90 ～-61.81,P＜0.05),降低输血率(OR=0.41,95％CI:0.24 ～0.72,P＜0.05),缩短手术时间(MD=-40.81,95％CI:-57.81 ～-23.80,P＜0.05);缩短平均住院时间(MD=-4.52,95％CI:-8.36 ～-0.69,P＜0.05);降低术后病死率和并发症发生率(OR =0.32,0.68,95％ CI:0.16～0.62,0.53 ～0.88,P＜0.05).远期疗效比较:前入路肝切除术能降低患者术后肿瘤复发率,有相对更高的1、3年总体生存率(OR=0.45,2.72,4.47,95％ CI:0.29 ～0.69,1.59 ～4.66,2.61 ～7.63,P＜0.05).结论 肝癌患者施行前入路肝切除术的围术期安全性与传统入路肝切除术相当,近期和远期疗效优于传统入路肝切除术.     

原发性肝癌合并脾功能亢进的外科治疗

目的 探讨原发性肝癌合并脾功能亢进的合理治疗方法。方法 1994年1月至2004年12月我院收治67例原发性肝癌合并脾功能亢进患者，17例行肝切除联合脾切除，7例行单纯肝切除，43例行肝动脉栓塞化疗联合脾动脉栓塞。结果 肝切除联合脾切除组术后30d患者脾功能亢进症状消失，外周血细胞恢复正常。单纯肝切除组术后脾功能亢进症状加重，其中6例于术后3～7个月分别行脾动脉栓塞治疗。肝动脉栓塞化疗联合脾动脉栓塞组治疗后30 d 79％（34／43）的病例脾功能亢进症状改善，外周血细胞恢复正常。结论 原发性肝癌合并脾功能亢进的处理应争取行肝切除联合脾切除治疗，如肝癌不能切除，则应争取行肝动脉栓塞化疗联合脾动脉栓塞治疗。     

肝门部胆管癌根治手术中联合血管切除及重建的临床疗效Meta分析

背景与目的:对于肝门部胆管癌(HCCA)而言,血管侵犯是主要的手术治疗障碍之一。联合血管切除及重建后的各个临床研究指标不一,结论也存在一定的争议,本研究通过Meta分析方法系统评价HCCA根治术中联合血管切除及重建的安全性、切除有效性及近远期疗效。方法:检索多个国内外数据库,收集HCCA根治术中联合血管切除及重建与无血管切除比较的研究,前者包括肝动脉切除及重建和门静脉切除及重建,检索起止时间均为2009年1月1日—2019年1月1日。采用Meta分析方法比较两种术式的安全性、根治效果及近远期疗效指标。结果:最终纳入18篇文献(均为回顾性研究),共3 260例患者,其中行联合血管切除及重建904例(血管切除组),未行血管切除2 356例(对照组);分亚组的研究中含肝动脉切除及重建237例(肝动脉切除亚组)与门静脉切除及重建560(门静脉切除亚组)。Meta分析结果显示,与对照组比较,血管切除组的术后总并发症(OR=1.09,95% CI=0.78～1.54,P=0.61)、肝衰竭(OR=0.84,95% CI=0.56～1.24,P=0.36)的发生率均无明显差异,但血管并发症(OR=6.79,95% CI=2.16～21.38,P=0.01)与肝脓肿(OR=7.47,95% CI=2.63～21.18,P=0.01)的发生率升高;术后病死率无统计学差异(OR=1.27,95% CI=0.84～1.93,P=0.25);术后1、3、5年的总体生存率差异均有统计学差异(OR=0.69,95% CI=0.56～0.85;OR=0.62,95% CI=0.52～0.75;OR=0.61,95% CI=0.49～0.76,均P0.05);R_0切除率无统计学差异(OR=0.96,95% CI=0.66～1.40,P=0.84)。亚组分析显示,肝动脉切除亚组和门静脉切除亚组与对照组总并发症发生率均无统计学差异(均P0.05);肝动脉切除亚组的5年总生存率低于对照组(OR=0.44,95% CI=0.30～0.67,P=0.01),但门静脉切除亚组的5年总生存率与对照组无明显差异(OR=0.89,95% CI=0.68～1.17,P=0.42)。此外,R_0切除组患者5年生存率高于R_1切除组,无淋巴结转移患者5年生存率高于有淋巴结转移患者(均P0.05)。结论:HCCA根治术中联合血管切除及重建是总体可接受的,可以一定程度上提高R_0切除率,改善患者预后。当合并门静脉侵犯时,可以行联合血管的R_0切除不增加术后并发症和死亡,也不会恶化预后。当合并肝动脉侵犯是手术R_0切除的唯一障碍时,不能简单地将其作为根治性手术的禁忌证,仍可以手术治疗,但需慎重处理,从而使患者获益。     

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.     

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.     

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.     

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.