硬膜外麻醉下胆囊切除术对骨骼肌葡萄糖转运蛋白-4 mRNA表达的影响

目的观察上腹部手术对骨骼肌葡萄糖转运蛋白-4(Glut4)mRNA表达的影响.方法硬膜外麻醉下经腹胆囊切除术患者10例,分别于进腹和关腹时取腹直肌1g,用Trizol一步法抽提肌细胞总RNA,通过RT-PCR方法,获得Glut4 mRNA扩增产物,每例表达值以(目的基因/βactin)×100%表示,同时测定进腹和关腹时血糖、胰岛素值.结果与进腹时相比较,关腹时Glut4 mRNA表达值明显降低(P＜0.05),血糖明显升高(P＜0.05).血浆胰岛素水平无明显改变(P＞0.05).结论上腹部手术后,肌细胞Glut4 mRNA的表达明显降低.本结果提示应激状态下,GLut4的合成受到影响,可导致术后胰岛素拮抗现象.     

术前静脉输入葡萄糖对胸科手术病人骨骼肌葡萄糖转运蛋白4基因表达的影响

目的 观察术前输入葡萄糖对胸科病人手术前、后骨骼肌葡萄糖转运蛋白4基因(Glut-4 mRNA)表达的影响。方法择期食管癌根治手术病人12例,随机分为常规禁食组(Ⅰ组)和输入葡萄糖组(Ⅱ组),分别于进胸和关胸时各取第8肋间骨骼肌1 g;用TRlzol一步法提取骨骼肌细胞总RNA,通过RT-PCR方法,获得Glut-4 mRNA扩增产物;每例表达值以目的基因/β-actin×100％表示,同时测定进胸和关胸时血糖和胰岛素。结果 与进胸时相比较,关胸时Glut-4 mRNA表达值均明显降低(P<0.05),血糖明显升高(P<0.05);但关胸时Ⅱ组Glut-4 mRNA表达值明显高于Ⅰ组(P<0.01)。结论 术前输入一定量葡萄糖可减轻术后Glut-4 mRNA表达受抑制程度,缓解术后胰岛素抵抗现象。     

糖尿病对大鼠胫骨前肌烟碱型乙酰胆碱受体的影响

目的 探讨糖尿病对大鼠胫骨前肌烟碱型乙酰胆碱受体（nAChR）表达和功能的影响。方法SPF级成年雄性SD大鼠48只,6～8周龄,体重200～250g。采用随机数字表法将大鼠分为四组：正常对照组（NC组）、糖尿病2周组（D2组）、糖尿病4周组（D4组）和糖尿病8周组（D8组）,每组12只。取大鼠胫骨前肌,采用Western blot法检测ε-nAChR、γ-nAChR及α7-nAChR蛋白含量,RT-PCR法检测ε-nAChR、γ-nAChR及α7-nAChR mRNA表达量。采用I125-α-银环蛇毒素对运动终板nAChR进行放射性标记,根据放射性强度值计算运动终板nAChR的数目、密度和终板面积（ESA）。检测罗库溴铵预处理的胫骨前肌运动终板,记录运动终板nAChR与罗库溴铵浓度为2.5、5.0、7.5、10.0 μg/ml时的结合力。
结果 与NC组比较,D2组γ-nAchR和α7-nAchR mRNA表达量明显升高,ESA明显增大（P<0.05）;D4组γ-nAchR、α7-nAchR蛋白含量明显升高,ε-nAchRh、γ-nAchR和α7-nAchR mRNA表达量均明显升高,ESA明显增大,罗库溴铵浓度为2.5、5.0 μg/ml时nAChR与罗库溴铵结合力均明显降低（P<0.05）;D8组ε-nAchR、γ-nAchR、α7-nAchR蛋白含量和mRNA表达量均明显升高,胫骨前肌运动终板nAChR数目明显增多、密度明显增大、ESA明显增大,罗库溴铵浓度为2.5、5.0、7.5、10.0 μg/ml时nAChR与罗库溴铵结合力均明显降低（P<0.05）。与D2组比较,D4组ε-nAchR和γ-nAchR蛋白含量均明显升高,ε-nAchR和α7-nAchR mRNA表达量明显升高,nAChR数目明显增多、ESA明显增大,罗库溴铵浓度为5.0 μg/ml时nAChR与罗库溴铵结合力均明显降低（P<0.05）;D8组ε-nAchR、γ-nAchR、α7-nAchR蛋白含量和mRNA表达量均明显升高,nAChR数目明显增多、密度明显增大、ESA明显增大,罗库溴铵浓度为2.5、5.0、7.5、10.0 μg/ml时nAChR与罗库溴铵结合力均明显降低（P<0.05）。与D4组比较,D8组ε-nAch、γ-nAchR蛋白含量和mRNA表达量均明显升高,nAChR数目明显增多、密度明显增大,罗库溴铵浓度为7.5 μg/ml时nAChR与罗库溴铵结合力明显降低（P<0.05）。
结论 糖尿病可影响nAChR的表达和功能,使胫骨前肌γ-nAChR和α7-nAChR蛋白含量升高,ε-nAChR蛋白含量先降低后逐渐升高,ε-nAChR、γ-nAChR和α7-nAChR mRNA表达量升高,运动终板nAChR数目增多、密度增大、与罗库溴铵结合力降低。     

体外循环心脏手术中骨骼肌TNF-α和IL-8 mRNA表达的变化

目的 观察体外循环(CPB)心脏手术期间腹直肌TNF-α IL-8 mRNA表达的变化。方法 选择10例风湿性心脏病瓣膜置换术患者,分别于劈胸骨和关胸时在胸部正中切口下缘取腹直肌2g,用Tizol试剂提取总RNA,以RT-PCR测定TNF-α、IL-8 mRNA表达量,并分别在麻醉前、劈胸骨、CPB15 min、开放升主动脉后5 min、关胸时取静脉血以酶联免疫放射法测定TNFα和IL-8的含量。结果与劈胸骨时相比较,关胸时患者TNF-α、IL-8 mRNA表达明显增强(P<0.05),CPB 15min、开放升主动脉后5min、关胸时患者血TNF-α、IL-8水平明显高于麻醉前(P<0.05)。结论 体外循环中患者骨骼肌TNF-α、IL-8 mRNA表达明显升高,血TNF-α、IL-8含量也增高,这些变化可能在CPB期间全身炎性反应中起重要作用。     

不同剂量胰升血糖素样肽-1对大鼠肝切除术后糖代谢的影响

目的:探讨不同剂量胰升血糖素样肽-1（GLP-1）对大鼠肝切除手术后早期糖代谢紊乱的影响。方法:方法通过大鼠肝切除术观察手术后1 d葡萄糖耐量的改变与GLP-1，胰岛素(I)和胰升血糖素(G)的关系，以及静脉输注不同剂量GLP-1的影响。结果:大鼠肝切除术后第1天静脉葡萄糖耐量实验的峰值血糖及30 min血糖均明显高于正常对照组（ 均P<0.01），且曲线下面积（AUC 0-30）也明显高于正常对照组(P<0.01)；GLP-1低剂量组术后1 d峰值血糖与肝切除手术组间的差异无显著性（P>0.05）；GLP-1高剂量组术后1 d峰值血糖明显低于肝切除手术组和GLP-1低剂量组(P<0.05和P< 0.01)， 30 min血糖明显低于肝切除手术组(P<0.01), AUC 0-30明显低于肝切除手术组和GLP-1低剂量组(均为P<0.01)。肝切除手术组术后1 d胰岛素明显下降，胰升血糖素明显升高（P<0.05），致I/G值下降。GLP-1低剂量组术后1 d胰岛素明显低于高剂量组（P<0.05），胰升血糖素则明显升高（P<0.05），致I/G值明显低于高剂量组（P<0.01）。结论:大鼠肝切除术后早期，GLP-1的促进胰岛素分泌和抑制胰升血糖素释放的作用减弱，增加剂量后仍可增强其效应，进一步改善机体对葡萄糖的利用。     

全阻断胃窦癌根治术阻断效果研究

目的 评估全阻断胃窦癌根治术减少术中癌细胞转移的效果。方法 选取复旦大学附属华山医院76例2008 年7 月至2010 年9 月收治的胃窦癌病人,随机分为两组,分别施行全阻断胃窦癌根治术（阻断组）和传统胃癌根治术（常规组）,进腹后及术中分别抽取门静脉血和腹腔灌洗液,RT-PCR测定样本中CEA mRNA和CK20 mRNA的表达情况;阻断组胃壁注射纳米炭后观察阻断区内外淋巴结有无黑染。结果 进腹后,阻断组门静脉血CEA mRNA和CK20 mRNA阳性率分别为10%（4/40）和15%（6/40）,常规组为8.3%（3/36）和11.1%（4/36）,两组差异无统计学意义（P>0.05）;术中牵拉胃癌病灶时,阻断组门静脉血CEA mRNA和CK20 mRNA的阳性率分别为7.5%（3/40）和15%（6/40）,常规组为30.5%（11/36）和36%（13/36）,两组差异具有统计学意义（P<0.05）;腹腔灌洗液CEA mRNA和CK20 mRNA的表达率差异无统计学意义。阻断区内淋巴结明显黑染,而阻断区外无淋巴结黑染。结论 全阻断胃窦癌根治术可以有效地阻断术中癌细胞血行和淋巴转移。     

胃转流术对2型糖尿病大鼠胰岛细胞胰岛素受体及胰岛素受体底物2表达的影响

目的：探讨胃转流术对2型糖尿病大鼠胰岛细胞中胰岛素受体（IRc）及胰岛素受体底物2（IRS-2）表达的影响。 方法：高糖高脂饮食联合腹腔注射小剂量链脲佐菌素建立2型糖尿病大鼠模型,将造模成功的大鼠分为模型组和胃转流组,另取正常大鼠作为正常对照组,胃转流组大鼠行胃空肠吻合术加空肠侧侧吻合,模型组与正常对照组大鼠均行假手术。检测术前及术后8周大鼠空腹血糖、血清胰岛素,计算胰岛素敏感指数（ISI）,用免疫组化法检测胰腺组织IRc及IRS-2的表达。 结果：与正常对照组比较,模型组与胃转流组术前空腹血糖均明显升高,ISI均明显降低,但术后胃转流组两项指标均较模型组明显改善（均P<0.05）;各组胰岛素水平手术前后均无统计学差异（均P>0.05）。术后8周,胃转流组胰岛细胞IRc和IRS-2表达量均明显高于模型组（均P<0.05）,其中IRc表达量仍低于正常对照组（P<0.05）,但IRS-2表达量与正常对照组接近（P>0.05）。 结论：2型糖尿病大鼠胰岛细胞中IRc及IRS-2表达下调,而胃转流术能够使其表达显著增加,这可能是该手术产生对2型糖尿病产生疗效的机制之一。     

11 胰升血糖素样肽-1对肝切除后肝细胞胞浆游离钙影响的实验研究

目的:探讨胰升血糖素样肽-1（GLP-1）对肝切除后肝细胞胞浆游离钙的影响。方法:将大鼠随机分2组，A组不切肝,B组切肝65%。于术后第1，3，5天收集血标本5mL测定血糖、GLP-1、胰岛素(In)和胰升血糖素(G1)。同时用酶法分离制备肝细胞悬液。以Fura-2/AM荧光指示剂，用荧光分光光度仪检测肝切除后肝细胞的荧光强度及GLP-1对荧光强度的影响。结果:B组肝切除术后血糖明显增高（P<0.05），血浆GLP-1也明显高于A组（P<0.001），尤以术后第1天更显著; In则明显下降（P<0.001）,而G1手术后升高，但差异无显著性（P>0.05），术后In/GL值明显下降（P<0.05）。所测正常肝细胞［Ca2+］i为（707.46±122.59）nmol/L，肝切除术后第1，3，5天肝细胞［Ca2+］i较正常肝细胞略降低（P>0.05）;加入GLP-1后肝细胞［Ca2+］i略有升高（P>0.05）。结论:大鼠肝切除术后存在明显胰岛素抵抗，主要系因胰岛素水平明显下降，致In/G1值也明显降低的结果;GLP-1的拟胰岛素作用并非通过增加肝细胞［Ca2+］in而实现的。     

胃良恶性病变组织中VHL和HIF-1α及其mRNA表达与MV计数的关系

目的：研究胃良恶性病变组织中VHL和HIF-1α及其mRNA表达水平和MV计数及其临床病理意义。方法：取49例胃癌,20例癌旁组织,36例淋巴结转移灶和80例不同类型胃良性病变手术切除或胃镜活检标本常规制作石蜡包埋切片,用EnVisionTM免疫组化法检测VHL和HIF-1α表达和MV计数,用原位杂交法检测VHL和HIF-1αmRNA表达。结果：胃癌组织VHL及其mRNA表达阳性率明显低于癌旁组织及各类型胃良性病变（P<0.05或P<0.01）,胃癌组织HIF-1α及其mRNA表达阳性率明显高于癌旁组织及各类型胃良性病变（P<0.05或P<0.01）,胃癌组织MV计数明显高于癌旁组织和各种类型胃良性病变（P<0.01）, VHL及其mRNA阴性表达和（或）HIF-1α及其mRNA阳性表达的癌旁组织及胃良性病变黏膜上皮均呈轻至重度不典型增生;胃癌原发灶与相应淋巴结转移灶比较VHL和HIF-1α及其mRNA表达阳性率及MV计数间,差异无统计学意义（P>0.05）。胃癌组织学分级Ⅱ级、浸润深度T1+T2、无淋巴结转移及无远处转移病例HIF-1α及其mRNA表达阳性率及MV计数明显低于组织学分级Ⅲ+Ⅳ级、浸润深度T3+T4、区域淋巴结转移及远处器官转移者（P<0.05或P<0.01）,但VHL及其mRNA表达阳性率则与HIF-1α相反（P<0.05或P<0.01）;N1站淋巴结转移者VHL及其mRNA表达阳性率明显高于N2+N3站淋巴结转移病例（P<0.05）;VHL和HIF-1α及其mRNA在胃癌组织中表达呈高度不一致性（χVHL=14.66,P<0.01;χ VHLmRNA=6.74,P<0.05）;VHL及其mRNA阳性者或HIF-1α及其mRNA阴性者MV计数明显低于VHL及其mRNA阴性或HIF-1α及其mRNA阳性者（P<0.01）。结论：VHL和HIF-1α及其mRNA表达水平可能是反映胃癌发生、进展、临床生物学行为及预后的重要标记物,VHL和HIF-1α及其mRNA在胃癌组织中表达可能存在负性调节作用;VHL及其mRNA可能抑制胃癌组织中微血管生成,HIF-1α及其mRNA可能促进微血管生成。     

胰岛素对急性重症胆管炎脓毒症大鼠骨骼肌代谢的影响

目的 探讨胰岛素对大鼠急性重症胆管炎（ACST）脓毒症状态下泛素系统介导骨骼肌蛋白质分解的调理作用。方法 20只雄性SD大鼠按月龄、体重同窝饲养,随机分为假手术组（SO）、ACST脓毒症模型组（AS）、低剂量胰岛素ACST脓毒症模型组（LIAS,胰岛素给予量为2.4 mU·kg-1·min-1）、高剂量胰岛素ACST脓毒症模型组（HIAS,胰岛素给予量4.8 mU·kg-1·min-1）,每组5只。所有大鼠均行正常血糖钳夹模型制备,并通过调节25%葡萄糖的输注率（GIR）将血糖维持在5～6 mmol/L的稳态;只有当血糖超过11.9 mmol/L时才需加用胰岛素。采用高效液相-色谱分析法检测伸趾长肌内3-甲基组氨酸（3-MH）;RT-PCR法检测伸趾长肌内编码泛素、蛋白酶体C2亚基的mRNA表达变化。结果 AS组大鼠伸趾长肌内3-MH含量为（3.69±0.20）nmol/g,较SO组（2.07±0.13）nmol/g显著升高（P＜0.001）;且显著高于HIAS组（2.39±0.21）nmol/g（P＜0.001）和LIAS组（2.87±0.19）nmol/g（P＜0.001）。HIAS组大鼠伸趾长肌内3-MH含量较LIAS组显著降低（P＜0.001）。AS组大鼠伸趾长肌内泛素mRNA表达较SO组明显升高,其相对表达量增加了19.70倍。LIAS组泛素mRNA相对表达量为6.96（范围为4.17～11.67）、HIAS组相对表达量为1.89（范围为1.43～2.48）,与AS组比较均明显下降（P=0.028,0.009）。HIAS组泛素mRNA表达水平低于LIAS组（P=0.009）。AS组大鼠伸趾长肌内蛋白酶体C2亚基mRNA表达较SO组明显升高,其相对表达量增加了191.34倍。LIAS组蛋白酶体C2亚基mRNA相对表达量为31.12（15.74～61.39）、HIAS组蛋白酶体C2亚基mRNA相对表达量为7.67（4.08～14.50）,与AS组比较表达均明显下降（P值均为0.009）。HIAS组C2亚基mRNA表达水平低于LIAS组（P=0.009）。结论 急性重症胆管炎脓毒症状态下,胰岛素可抑制骨骼肌蛋白降解,该作用可能是在基因水平通过抑制泛素-蛋白酶体通路表达和活化而实现的。     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.