尿沉渣分析仪和显微镜镜检两种方法检测尿中管型的比较

目的:对尿沉渣分析仪和显微镜镜检两种方法检测尿中管型进行比较.方法:尿沉渣分析仪使用UF-50尿液沉渣自动化分析仪(简称UF-50),尿沉渣镜检使用奥林巴斯显微镜和AnKe TDL-5-A台式离心机,检测500份尿液标本,对尿液管型的检测结果进行比较分析.结果:500份标本中,UF-50检测阳性的有98例,而镜检阳性的有35例,假阳性率为13.7%;UF-50检测阴性尿标本402例,而镜检阳性的有4例,假阴性率为1.0%.结论:与显微镜镜检相比,尿沉渣分析仪检测尿液管型存在一定的假阳性和假阴性,临床工作中应将两种方法结合起来,以提高检出率及准确性.     

尿液干化学法检测尿隐血与尿液沉渣镜检红细胞比较

目的:探计尿液干化学法检测隐血结果与尿液沉渣显微镜检查尿红细胞符合率.方法:对1753位门诊患者的尿液隐血与尿液沉渣镜检红细胞比较分析.结果:尿液干化学法与镜检法存在着差异.结论:只用尿液干化学法而不用显微镜检查是不可取的,尿中的红细胞还是要以镜检为准.     

尿液干化学分析法与尿沉渣镜检的比较分析

目的对尿液干化学法与尿沉渣镜检两种检测方法进行比较分析。方法对2230份尿液标本采用尿干化学分析仪和显微镜进行检测,并对检测结果进行比较。结果尿液显微镜检查、干化学分析法检测红细胞阳性率分别为11.52%（257/2230）、17.13%（372/2230）;白细胞阳性率分别为15.02%（335/2230）、11.61%（259/2230）。结论两种方法检测尿液结果有一定的差异,两种方法检验方法各有优缺点,应将两种方法结合起来综合分析。     

UF-1000i全自动尿沉渣分析仪在浆膜腔积液常规检查中的应用

目的:探讨UF-1000i全自动尿液分析仪在浆膜腔积液常规检测中的临床应用价值.方法:对患者浆膜腔积液同时运用传统手工镜检法和UF-1000i全自动尿液分析仪法进行检测,并比较两种方法检测浆膜腔积液中的细胞总数、白细胞数和间皮细胞数.结果:两种方法各细胞间均无显著性差异(P＞0.05).结论:用UF-1000i全自动尿液分析仪检测浆膜腔积液标本简单、易行,检测结果对相关疾病有更好的临床应用价值.     

各种尿液分析方法在肾小球性血尿鉴别中的作用比较

镜下血尿的鉴别对于肾小球疾病的诊断、治疗具有重要意义。何谓镜下血尿，国外认为显微镜检测尿红细胞≥2，高倍视野(HP)，国内既往认为尿沉渣镜检红细胞≥3／HP即为镜下血尿。丛玉隆等认为，采用干化学分析法检测尿标本，若红细胞数≤10，μl，可以免去镜检，直接根据干化学法作出报告。如果尿液中红细胞数大于上述数值，则需进一步检测鉴别红细胞来源。     

流式尿有形成分分析仪UF-1000i联合相差显微镜在血尿来源诊断中的应用评价

目的：评价UF-1000i流式尿有形成分分析仪、尿干化学分析仪及相差显微镜联合应用在血尿来源鉴别中的应用价值。方法：选取33例肾小球性血尿、23例非肾小球性血尿,分别用UF-1000i流式尿有形成分分析仪检测尿红细胞数量、尿70%红细胞前向散射光强度（RBC-P70Fsc）、尿红细胞前向散射光分布宽度（RBC-Fsc-DW）;用URISYS2400尿干化学分析仪检测蛋白（PRO）;用相差显微镜检测尿红细胞数量、畸形红细胞比率。结果：对于血尿来源的鉴别,UF-1000i检查的敏感度100%,特异度82.6%,相差显微镜检查的敏感度93.9%,特异度91.3%。UF-1000i诊断肾小球性血尿的敏感度、特异度ROC曲线下面积为0.966（P〈0.01）,相差显微镜诊断肾小球性血尿的敏感度、特异度ROC曲线下面积为0.967（P〈0.01）。二者曲线下面积比较,差异无统计学意义（u=0.03,P〉0.05）,二者诊断血尿来源的准确度相同。尿干化学分析中,尿蛋白阳性对于判断肾小球性血尿的敏感度为81.8%,特异度为65.2%。结论：联合UF-1000i流式尿有形成分分析仪、尿干化学分析仪及相差显微镜是鉴别血尿来源的最好策略。     

尿液样本应用AX-4280与UF-1000i 联机检测与显微镜镜检符合率的影响因素研究

目的:探讨AX-4280与UF-1000i联用中,性别、AX-4280等级及UF-1000i定量参考值范围等因素对显微镜镜检符合率的影响.方法:收集1 220例尿液标本,经AX-4280及UF1000i检测及显微镜镜检,进行结果判读及分析.结果:经联机检测全阴性标本中,男性标本RBC、WBC与镜检结果阴性符合率为99.56%;女性标本的符合率为98.69%,WBC 99.56%.AX-4280检测非全阴性与镜检结果阴性符合率,在UF-1000i参考范围内的男性标本阴性符合率总体要高于女性标本,而在UF-1000i定量参考范围外的男性、女性标本RBC及WBC与镜检结果阳性符合率各有高低.相关性分析显示,与AX-4280相比,UF1000i与镜检结果具有更好的相关性.结论:性别、AX-4280等级及UF-1000i定量值能影响显微镜镜检符合率,对相关影响因素的分析将为提高工作效率及为临床诊断提供准确数据奠定实验基础.     

UF-50尿沉渣分析仪检测管型准确性的探讨

目的:探讨UF-50尿沉渣分析仪检测尿中管型的准确性及其影响因素.方法:随机收集住院患者的晨尿标本500份,先用UF-50尿沉渣分析仪自动选样模式检测,后再将标本离心取沉渣于Olympus显微镜下镜检.将两种方法检测的结果作比较.结果:500份标本中,UF-50尿沉渣分析仪检测管型阳性的有82例,显微镜下镜检管型阳性的有29例,两者检测的结果不符的确56例,占11.2％.其中UF-50尿沉渣分析仪检测管型的假阳性率为10.6％,假阴性率为0.6％.将UF-50尿沉渣分析仪与显微镜检测管型的阳性率进行x2检验,P＜0.05.结论:UF-50尿沉渣分析仪对尿中管型的检测存在较高的假阳性率.对UF-50尿沉渣分析仪检测管型阳性的标本仍需用显微镜进行复检,对病理性管型阳性的标本需用显微镜做进一步的分类,给临床提供更确切的诊疗信息.     

菌尿对尿液分析仪红细胞和隐血测定的影响

尿红细胞检测是诊断泌尿系统疾病、特别是肾病的重要实验指标之一。但在实际检测过程中,由于菌尿标本常出现尿液分析仪检测法和人工镜检法结果不一致的现象,即假性血尿。随着自动化干化学尿液分析仪的广泛应用,这一现象势必影响临床检测结果的准确性,为此．笔者就菌尿导致尿液分析仪产生假性血尿的原因进行了分析。现报告如下。     

武汉地区健康人群尿沉渣参考区间的调查

目的:用UF-1000i全自动尿沉渣分析仪调查武汉地区健康人群尿有形成分的参考区间.方法:在武汉同济医院体检中心共收集13～86岁341个中段尿液标本(要求各体检项目及干化学检洲均正常),并在收集后两个小时内对样本用UF-1000i进行检测.结果:UF-1000i检测武汉地区健康人群尿液有形成分生物参考区间:RBC男:0～19.43女:0～27.96;WBC男:0～11.45女:0～17.09;EC男:0～8.65女:0～35.77;CAST男:0～2.80女;0～2.80;BACT男:0～31.05 女:0～803.47.健康人群尿液RBC、WBC、EC、BACT性别之间差异正著.结论:男女的尿液有形成分生物参考区间应分别设定,本研究为临床尿泣生物参考区间的设定提供参考.     

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.     

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.     

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.     

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.