药物涂层球囊治疗股腘动脉硬化闭塞症的临床疗效及安全性

目的探讨药物涂层球囊(DCB)治疗股腘动脉硬化闭塞症的有效性及安全性。方法经预扩张筛选后,将拟接受经皮腔内血管成形术(PTA)的54例股腘动脉硬化闭塞症患者随机分为试验组(n=27)及对照组(n=27),PTA术中分别采用DCB及普通球囊。PTA术后随访6个月,比较2组疗效及安全性,并对术中出现的非限流性夹层患者进行对比分析。结果剔除失访者后,最终试验组26例、对照组20例患者纳入研究。试验组术后6个月踝肱指数(ABI)、股腘动脉最小管腔直径(MLD)均高于对照组(P均0.05);Rutherford分级、股腘动脉狭窄程度、晚期管腔丢失(LLL)值、再狭窄率及靶病变血运重建(TLR)发生率均低于对照组(P均0.05)。试验组及对照组出现非限流性夹层的患者分别为14例及8例;2组出现非限流性夹层的患者间术后6个月ABI、Rutherford分级差异均无统计学意义(P均0.05),其余各疗效评价指标差异均有统计学意义(P均0.05)。2组间主要不良事件发生率及截肢率差异均无统计学意义(P均0.05)。结论 DCB治疗股腘动脉硬化闭塞症的近期疗效优于普通球囊,且二者安全性相似;对于PTA术中出现非限流性夹层患者,DCB疗效仍优于普通球囊。     

药物涂层球囊PTA治疗下肢动脉硬化闭塞症

目的 观察药物涂层球囊经皮腔内血管成形术（PTA）治疗下肢动脉硬化闭塞症（LEAOD）的临床效果。方法 将43例LEAOD患者（43条患肢）随机分为观察组（21例）和对照组（22例）。对观察组给予药物涂层球囊PTA治疗,对照组行普通球囊PTA。记录2组患者术前及术后7天Fontaine分期,分别于术前及术后1、3、6个月统计靶动脉段股浅动脉血管内径、再狭窄率及踝肱指数（ABI）,术后6个月时靶动脉段股浅动脉血管狭窄情况。结果 术后7天2组Fontaine分期均较术前降低（P均<0.05）。观察组术后1、3、6个月时靶动脉段股浅动脉内径均大于对照组（P均<0.05）,再狭窄率均低于对照组（P均<0.05）;术后3、6个月观察组ABI均大于对照组（P均<0.05）。术后6个月时,观察组14例靶动脉段股浅动脉血管狭窄率<30%、4例30%~50%、3例>50%（无100%者）,对照组2例狭窄率<30%、10例狭窄率30%~50%、10例>50%（2例100%）,组间比较差异有统计学意义（P<0.01）。结论 药物涂层球囊PTA治疗LEAOD安全、有效,能够降低再狭窄率,且近期疗效优于普通球囊。     

紫杉醇涂层球囊与普通球囊治疗腘动脉硬化闭塞症效果的倾向性评分匹配分析

背景与目的 药物涂层球囊（DCB）作为一种新的介入治疗技术已逐渐广泛应用，但目前主要集中在冠脉血管领域，在外周血管的应用研究相对较少，尤其是针对跨关节的腘动脉的研究更是罕见。因此，本研究比较DCB与普通球囊（CB）用于腘动脉硬化闭塞症中的近期疗效与远期预后，探讨DCB在该领域中的应用价值。方法 回顾性分析2014年3月—2020年4月河北医科大学第一医院血管外科行介入球囊扩张治疗的65例腘动脉硬化闭塞症患者临床资料，其中29例行DCB治疗（DCB组），36例行CB治疗（CB组）。采用1∶1倾向性匹配（PSM）方法对两组患者进行匹配，比较匹配后两组患者术后的腘动脉通畅率、踝肱指数（ABI）指标、Rutherford分级情况及截肢、血栓形成、血管内再狭窄等终点事件的发生情况。结果 两组共21对匹配成功，匹配后两组患者术前临床资料均衡可比（均P>0.05）。匹配后，两组患者术后3、6个月时腘动脉通畅率及ABI比较差异无统计学意义（均P>0.05），术后12个月，DCB组腘动脉通畅率、ABI明显高于CB组（65.71% vs. 49.55%；0.71 vs. 0.55，均P<0.05），而Rutherford分级明显优于CB组（P<0.05）；DCB组患者术后1年截肢、血栓形成、血管内再狭窄等终点事件的总发生率低于CB组（23.81% vs. 57.14%，P<0.05）；Log-rank检验结果显示，两组患者术后随访期间终点事件发生情况差异有统计学意义（χ2=5.654，P<0.05）。结论 DCB与CB治疗腘动脉硬化闭塞症的近期疗效相当，但远期DCB能够明显提高术后腘动脉通畅率、减少终点事件的发生。     

斑块旋切术联合药物涂层球囊治疗股腘动脉支架内再狭窄效果

目的 观察TurboHawk旋切系统联合药物涂层球囊（DCB）治疗股腘动脉支架植入术后支架内再狭窄（ISR）的临床效果。方法 回顾性分析63例股腘动脉支架植入术后ISR患者,根据手术方式将其分为2组,观察组（n=28）接受TurboHawk旋切联合DCB治疗,对照组（n=35）接受单独DCB治疗,对比2组临床效果及预后。结果 63例治疗均获成功,无死亡或截肢病例。术前、术后7天及6个月2组踝肱指数（ABI）差异,术前、术后即刻及6个月靶血管最小管腔直径（MLD）差异均无统计学意义（P均>0.05）。术后12个月观察组ABI、MLD均高于对照组,晚期管腔丢失率（LLL）低于对照组（P均<0.05）。观察组术后3、6、12个月靶血管一期通畅率分别为100%（28/28）、89.29%（25/28）及78.57%（22/28）,对照组分别为91.43%（32/35）、71.43%（25/35）及51.43%（18/35）,2组术后3、6个月靶血管一期通畅率差异无统计学意义（P均>0.05）,术后12个月观察组高于对照组（P=0.028）。结论 血管腔内斑块旋切术联合DCB治疗股腘动脉ISR效果较好,近中期效果尤为显著。     

股-腘动脉硬化闭塞症球囊扩张术与自膨式支架治疗疗效比较

目的通过比较和分析球囊扩张术与自膨式支架治疗股—腘动脉硬化闭塞症患者临床疗效来探讨两者临床应用价值。方法随机选取2017年5月至2018年5月80例股-腘动脉硬化闭塞症按照治疗方法分组为对照组与观察组,每组分别为40例。其中对照组行球囊扩张术治疗;观察组采用自膨式支架治疗。术后给予阿司匹林、低分子肝素、氯吡格雷治疗,并加强康复训练;评价两组临床疗效,比较两组治疗前后不同Rutherford分级变化;检测两组患者治疗前后不同时段时患肢踝肱指数(ankle brachial index,ABI)情况;随访12个月,记录两组预后。结果观察组治疗总成功率95.0%(38/40),明显高于对照组80.0%(32/40),P0.05。两组患者治疗后Rutherford分级较治疗前显著变化,而观察组治疗后Rutherford分级变化较对照组明显,P0.05。两组患者治疗后1个月、6个月、12个月时ABI指数较治疗前显著升高,而观察组各时间点ABI指数升高程度较对照组更显著,P0.05。随访12个月,观察组患者术后再狭窄、闭塞发生率及再手术率明显低于对照组,P0.05;两组术后12个月内死亡及截肢率相比较,P0.05。结论相比球囊扩张术来说,采用自膨式支架治疗股—腘动脉硬化闭塞症患者疗效更显著。     

TurboHawk斑块切除系统联合药物涂层球囊在治疗股腘动脉硬化闭塞性疾病中的应用

目的:评价应用Turbo Hawk斑块切除系统联合药物涂层球囊(DCB)治疗股腘动脉硬化闭塞性疾病的安全性和有效性。方法:2016年4月—2017年10月,对17例股腘动脉硬化闭塞性疾病患者应用Turbo Hawk斑块切除系统联合DCB治疗。17例患者平均年龄(66.9±10.5)岁;其中男14例,女3例;股腘动脉狭窄病变13例,闭塞性病变4例;术前Rutherford分级2~5级;术前踝肱指数(ABI)为0.49±0.18。结果:17例患者的血管病变全部经腔内开通成功,其中1例股动脉穿孔患者行补救性覆膜支架植入术,另1例远端栓塞患者经股动脉切开球囊导管取栓后血流恢复通畅,技术成功率88.2%。术后ABI为0.99±0.27,明显高于术前(P=0.03)。术后3、6个月一期通畅率分别为94.1%,88.2%,二期通畅率100%。结论:Turbo Hawk斑块切除系统联合药物涂层球囊治疗股腘动脉硬化闭塞性疾病安全有效,早期效果满意。     

药物涂层球囊治疗股腘动脉硬化闭塞症的临床研究

目的:探讨药物涂层球囊(DCB)治疗股腘动脉硬化闭塞症的有效性和安全性。方法:回顾性分析2016年6月—2017年1月应用DCB治疗股腘动脉硬化闭塞症34例患者(42条患肢)。原发狭窄性病变28条患肢,支架内再狭窄病变4条患肢,闭塞性病变10条患肢,病变长度(126±85)mm,术后3~6个月进行随访,观察晚期管腔损失(LLL)、最小管腔直径(MLD)、再狭窄率、临床驱动靶血管血运重建率(TLR)、踝肱指数(ABI)以及临床不良事件发生情况。结果:34例患者手术技术成功率100%,患者术后MLD、ABI均较术前明显改善(均P0.05);术后6个月随访LLL为(0.08±0.94)mm、靶病变再狭窄率为9.52%(4/42)、TLR为2.38%(1/42),Rutherford分级均较术前得到改善。3例患者出现术中并发症:2例动脉夹层,使用直径稍大球囊压迫,夹层消失,1例血管破裂,植入Viabahn覆膜支架。结论:DCB治疗股腘动脉硬化闭塞症安全、有效。     

Rotarex经皮机械血栓切除术与开放取栓治疗急性下肢动脉血栓形成

目的 对比Rotarex经皮机械血栓切除术(PMT)与开放取栓治疗急性下肢动脉血栓形成的效果。方法 回顾性分析32例接受Rotarex PMT(PMT组)及45例接受经股动脉切开取栓(开放组)治疗的急性单侧下肢动脉血栓患者,对比组间球囊使用率及支架植入率,治疗相关并发症发生率、踝肱指数(ABI)变化、疼痛缓解及血管恢复通畅情况,以及截肢率及死亡率。结果 对全部患者均成功完成治疗。PMT组球囊使用率及支架植入率均高于开放组(P均＜0.05)。组间治疗相关并发症发生率差异无统计学意义[3.13%(1/32) vs. 13.33%(6/45),χ²=2.358,P=0.229]。治疗前组间ABI差异无统计学意义(P＞0.05),治疗后3天PMT组ABI低于开放组[(0.77±0.01) vs. (0.84±0.17),P=0.013],治疗后1个月PMT组ABI高于开放组[ (0.80±0.15) vs. (0.72±0.12),P=0.010]。治疗后1个月,PMT组疼痛改善率为90.63%(29/32),高于开放组[77.78%(35/45),P=0.033]。治疗后1、3、6及12个月,组间血管通畅率差异均无统计学意义(P均＞0.05)。治疗后12个月,PMT组截肢率及死亡率[9.38%(3/32)、3.13%(1/32)]与开放组[8.89%(4/45)、4.44%(2/45)]差异均无统计学意义(P均＞0.05)。结论 Rotarex PMT治疗急性下肢动脉血栓与开放取栓效果相当,且更利于缓解症状。     

远端通过导管推越技术机械取栓治疗大脑中动脉M1段急性闭塞

目的 观察将治疗时间窗延长至16 h并以远端通过导管推越(ADVANCE)技术机械取栓治疗大脑中动脉M1段急性闭塞的效果。方法 回顾性分析60例因大脑中动脉M1段或颈内动脉合并大脑中动脉M1段闭塞(发病至介入治疗动脉穿刺时间≤16 h)而接受数字减影血管造影(DSA)引导下机械取栓治疗的急性缺血性脑卒中患者,其中28例以ADVANCE技术首次取栓(观察组)、32例以血栓抽吸术取栓(对照组),对比组间疗效及并发症。结果 观察组术后血管再通成功率[89.29%(25/28)]与对照组[93.75%(30/32)]差异无统计学意义(P=0.876)。观察组首过效应(FPE)率高于对照组,首次血管再通取栓次数及穿刺至血管开通时间均少于对照组(P均＜0.05)。术后1周美国国立卫生研究院卒中量表(NIHSS)评分及术后90天预后良好率组间差异均无统计学意义(P均＞0.05)。观察组术中血管痉挛发生率低于对照组(P＜0.05),2组颅内出血、远端栓塞、新发梗死及死亡率差异均无统计学意义(P均＞0.05)。结论 将治疗时间窗延长至16 h,以ADVANCE技术机械取栓治疗大脑中动脉M1段急性闭塞安全、有效。     

药物涂层球囊治疗股总动脉病变的有效性及安全性

目的观察药物涂层球囊(DCB)治疗股总动脉病变的有效性和安全性。方法回顾性分析11例接受DCB治疗的股总动脉病变患者。结果 11例中,股总动脉闭塞7例,重度狭窄4例;9例为原发病变引发狭窄,2例为支架内再狭窄;股总动脉病变累及股浅动脉5例,单纯股总动脉病变6例。5例接受减容联合药物球囊、6例接受单纯药物球囊治疗,技术成功率100%。术后均未出现相关并发症,术后30天内无死亡。有效随访10例,随访12个月,累积一期通畅率为85.75%,均未行靶病变重建,2例发生截肢;术后12个月Rutherford分级及踝肱指数(ABI)均较术前明显改善(P均0.05)。结论 DCB治疗股总动脉病变短期疗效好,安全性高。     

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.     

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.     

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.     

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.