腰椎间盘突出症患者突出椎间盘及相邻椎间盘退变程度的MRI分析

目的:分析腰椎间盘突出症患者突出椎间盘及相邻椎间盘的术前MRI表现,评估其退变程度。方法:回顾性分析2014年6月~2015年12月在宁夏医科大学总医院脊柱骨科已行手术治疗的的单节段腰椎间盘突出症患者100例,其中男56例,女44例,年龄23~79岁(51.68±5.60岁),将所有患者以10年为一年龄段进行分组。突出椎间盘发生在L4/5节段50个,其相邻椎间盘100个;L5/S1节段50个,其相邻椎间盘50个。观察术前腰椎MRI,椎间盘采用Pfirrmann分级标准进行评估;软骨终板形态以Pappou分级标准进行评估。年龄段间的比较采用单因素方差分析,相邻椎间盘与退变椎间盘间的相关性采用Pearson相关分析,相邻椎间盘间的比较采用t检验。结果:各年龄段L4/5、L5/S1突出椎间盘的Pfirrmann分级均在Ⅲ级以上、Pappou分级均在Ⅱ级以上,各年龄段间椎间盘退变结果有统计学差异(P0.05);而各年龄段间软骨终板退变结果无统计学差异(P0.05)。各年龄段间突出椎间盘发生在L4/5、L5/S1的上位相邻椎间盘Pfirrmann分级有统计学差异(P0.05),下位相邻椎间盘Pfirrmann分级各年龄段无统计学差异(P0.05),相邻椎间盘软骨终板退变结果各年龄段间无统计学差异(P0.05)。相邻的L3/4椎间盘Pfirrmann分级与突出的L4/5椎间盘Pfirrmann分级有相关性(r=0.696,P=0.000),相邻L5/S1椎间盘Pfirrmann分级与突出L4/5椎间盘Pfirrmann分级间无相关性(r=0.214,P=0.136);相邻的L3/4、L5/S1椎间盘软骨终板形态Pappou分级与突出的L4/5椎间盘软骨终板形态Pappou分级均有相关性(r=0.467,P=0.001;r=0.380,P=0.007)。相邻L4/5椎间盘的Pfirrmann分级与突出L5/S1椎间盘的Pfirrmann分级有相关性(r=0.549,P=0.000);相邻L4/5椎间盘软骨终板形态Pappou分级与突出L5/S1椎间盘的软骨终板形态Pappou分级有相关性(r=0.684,P=0.001)。L4/5椎间盘突出的相邻L3/4椎间盘Pfirrmann分级和软骨终板形态Pappou分级评分分别为3.26±0.87分、1.54±0.50分,均高于相邻L5/S1椎间盘的2.96±0.59分、1.23±0.49分(P0.05)。结论:腰椎间盘突出症患者突出节段的相邻椎间盘及软骨终板的退变与年龄及突出椎间盘退变程度关系密切,且相邻上位椎间盘较下位椎间盘退变更明显。     

围绝经期女性腰椎椎间盘退变程度的MRI观察

目的探讨围绝经期女性腰椎椎间盘MRI特点及相关退变规律。方法随机选择2014年1月—12月来本院就诊的成年男女患者各420例,记录患者年龄、身高、体质量指数(BMI)、吸烟史、高血压史、糖尿病史、月经史、职业等,每位患者均行腰椎MRI检查。女性患者按照月经史分为5个组:绝经前组(n=76),绝经0年且6年组(n=98),绝经≥6年且11年组(n=82),绝经≥11年且≤15年组(n=80),绝经15年组(n=84)。用Pfirrmann分级系统对腰椎椎间盘退变程度进行分级,用SPSS 19.0软件进行相关数据分析。结果男女患者年龄、BMI、糖尿病史、高血压史、职业等差异无统计学意义(P0.05);男性吸烟率明显高于女性,差异有统计学意义(P0.05)。男性患者Pfirrmann分级≥Ⅲ级的椎间盘比例高于女性(男78.2%,女60.8%),差异有统计学意义(P0.05);PfirrmannⅣ、Ⅴ级时差异更显著。在女性亚组中,绝经前组各椎间盘水平Pfirrmann平均分均显著低于各绝经组,差异有统计学意义(P0.05)。绝经≤15年时,绝经年限越高,L_1/L_2、L_2/L_3、L_4/L_5及L_5/S_1椎间盘Pfirrmann平均分越高,差异有统计学意义(P0.05);绝经≥11年且≤15年组与绝经15年组间各节段椎间盘Pfirrmann平均分差异均无统计学意义(P0.05)。结论男性患者腰椎椎间盘退变较女性严重。绝经后女性腰椎椎间盘退变较绝经前严重,且在绝经≤15年时,绝经年限越长,退变越严重;绝经15年后,腰椎椎间盘退变进程减缓。因此,雌激素水平下降可能是腰椎椎间盘退变的危险因素。     

腰痛患者腰椎3.0T MR弥散加权成像腰椎间盘表观弥散系数与椎间盘退变分级的相关性

【摘要】 目的：分析腰痛患者腰椎3.0T MR弥散加权成像（diffusion weighted image,DWI）椎间盘的表观弥散系数（apparent diffusion coefficient,ADC）与椎间盘退变形态学分级的相关性。方法：2012年6月~2012年11月对60例腰痛患者行腰椎3.0T MR T2加权成像（T2 weighted image, T2WI）和DWI扫描。男30例,女30例,年龄19～66岁,平均42.5±11.9岁。在MR常规T2WI序列上对腰椎间盘按Pfirrmann标准进行形态学分级,在矢状面ADC图上对正中层面椎间盘进行ADC值测量。对腰椎间盘ADC值与Pfirrmann分级之间的相关性采用Spearman相关分析,并对椎间盘不同Pfirrmann分级的ADC值进行单因素方差分析,如有差异进一步进行LDS法两两检验。结果： 腰椎间盘Pfirrmann分级为Ⅰ级45个（15%）,Ⅱ级61个（20.3%）,Ⅲ级74个（24.7%）,Ⅳ级113个（37.7%）,Ⅴ级7个（2.3%）。Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级椎间盘的ADC值分别为1.73±0.21、1.74±0.15、1.62±0.24、1.23±0.37、0.81±0.32（10-3mm2/s）。腰椎间盘不同Pfirrmann分级的ADC值有显著性差异（F=56.9,P=0.000）,不同分级间差异进一步行LDS法两两检验,Ⅰ级的ADC值与Ⅱ级比较无显著性差异（P＞0.05）,Ⅲ级、Ⅳ级、Ⅴ级分别与Ⅰ级、Ⅱ级比较均有显著性差异（P＜0.05）,Ⅲ级、Ⅳ级、Ⅴ级之间两两比较均有显著性差异（P＜0.05）。腰椎间盘ADC值与其Pfirrmann分级呈明显负相关（r=-0.624,P=0.000）。结论： 腰痛患者腰椎3.0T MR DWI腰椎间盘的ADC值与椎间盘退变分级呈负相关。     

腰椎间盘突出症患者下腰椎终板矢状面形态特征

目的:观察腰椎间盘突出症(lumbar disc herniation,LDH)患者下腰椎(L3～S1)终板矢状面形态特征。方法:回顾性分析2016年6月～2017年7月就诊我院的腰椎间盘突出症患者和无明确腰椎疾病的志愿者。共纳入LDH患者141例,其中男61例,女80例,年龄61.6±10.1岁(41～79岁),身体质量指数(BMI)为26.3±3.4(18.3～33.2)。对照组纳入志愿者109例,其中男47名,女62名,年龄55.4±12.2岁(40～87岁), BMI为25.3±3.6 (17.6～32.5)。在腰椎CT正中矢状面重建图像上测量LDH患者椎间盘突出节段的终板形态和志愿者腰椎L3下终板至S1上终板的终板形态学参数,包括终板屈曲深度(ECD)、矢状面屈曲角(SCA)和终板屈曲顶点位置(ECA);相应节段椎间盘退变程度在MRI上通过Pfirrmann分级进行评估。应用t检验比较LDH组与对照组终板矢状面形态学参数;选择L4/5和L5/S1两节段中相同退变程度(PfirrmannⅢ级,PfirrmannⅣ级)的椎间盘,比较LDH组患者和对照组志愿者的终板矢状面形态。将LDH组患者和对照组志愿者终板数据合并后按照椎间盘退变程度分组(PfirrmannⅡ级～PfirrmannⅤ级),应用Kruskal-Wallis检验比较不同退变程度椎间盘终板形态参数的组间差异。结果:LDH组各节段终板ECD均显著低于对照组(L4上终板P=0.016,其余终板P0.01),SCA均显著大于对照组(P0.01);除L3下终板外(P=0.014),所有节段终板ECA的组间差异无统计学意义(P0.05)。L4/5和L5/S1节段中PfirrmannⅢ级和Ⅳ级椎间盘终板,相同节段和退变分级的组间比较结果显示,LDH组终板ECD显著小于对照组(P0.05),SCA显著大于对照组(P0.05),ECA未出现组间显著性差异(P0.05)。不同退变程度椎间盘终板形态参数组间比较显示,随着椎间盘退变进展,各节段ECD降低(P0.01),SCA增大(P0.01),ECA未出现一致的组间变化趋势。结论:LDH患者相比对照组志愿者,其下腰椎终板矢状面屈曲程度较低,退变程度较高的椎间盘其终板屈曲程度较小。     

肥胖及骨密度与腰椎间盘退变程度的相关性研究

目的 分析不同体质量指数(body mass index,BMI)的腰椎间盘突出症患者骨密度(bone mineral density,BMD)、腰椎间盘退变程度差异,并探讨BMD与腰椎间盘退变程度的相关性.方法 回顾2017年1月～2020年1月因腰腿痛于本院脊柱骨科门诊就诊的137例腰椎间盘突出症患者临床资料.基于体质量指数,分为正常组(18.50.05);三组下腰椎椎体(L3、L4)BMD水平、下腰椎椎间盘(L3-4、L4-5)退变程度比较,差异有统计学意义(P<0.05),其中,肥胖组L3与L4 BMD水平、L3-4与L4-5段椎间盘退变程度均明显高于其他两组(P<0.05),超重组L3与L4 BMD水平、L3-4与L4-5段椎间盘退变程度明显高于正常组(P<0.05).Pearson相关性分析显示,L3 BMD水平与L3-4椎间盘退变程度呈负相关(r=-0.547,P<0.05);L4 BMD水平与L4-5椎间盘退变程度呈负相关(r=-0.741,P<0.05).结论 BMI与腰椎BMD、腰椎间盘退变程度存在关联;对于腰椎间盘突出症合并肥胖患者,更易发生下腰椎椎间盘退变,下腰椎椎体BMD与相邻椎间盘退变程度呈负相关,椎间盘退变程度随BMD水平升高有减缓趋势.     

绝经后女性骨密度与腰椎间盘退变程度的相关性研究

目的探讨绝经后女性骨密度与腰椎间盘退变程度的相关性。方法回顾性研究西南医科大学附属医院2017年1月至2019年12月收治的因慢性腰痛住院的251例绝经后女性患者。收集患者的年龄、绝经年限、体质量指数(body mass index,BMI)。采用双能X线骨密度仪检测患者腰椎(L_(1～4))及髋部平均骨密度,根据骨密度T值将患者分为骨量正常组(n=45)、骨量低下组(n=71)和骨质疏松组(n=135)。同时患者均行腰椎MRI检查,采用Pfirrmann分级系统评估腰椎间盘退变程度(L1/2、L2/3、L3/4、L4/5、L5/S1)。采用Spearman相关性分析骨密度与腰椎间盘退变程度的关系。结果骨质疏松组和骨量低下组的年龄、绝经年限显著大于骨量正常组(P0.05)。骨质疏松组和骨量低下组的BMI明显小于骨量正常组(P0.05)。骨质疏松组和骨量低下组的L1/2、L2/3、L3/4、L1～S1(L1/2～L5/S1的平均值)椎间盘退变评分明显高于骨量正常组(P0.05)。骨质疏松组的L4/5、L5/S1椎间盘退变评分高于骨量正常组(P0.05),骨量低下组与骨量正常组比较差异无统计学意义(P0.05)。相关性分析结果显示,骨密度与BMI呈正相关(P0.05),与年龄、绝经年限、L1/2、L2/3、L3/4、L4/5、L5/S1、L1～S1椎间盘退变评分呈负相关(P0.05)。结论绝经后女性骨密度与BMI呈正相关,与年龄、绝经年限、腰椎间盘退变程度呈负相关。绝经后女性骨密度越低,其腰椎退变程度越严重。     

绝经后女性骨密度与腰椎间盘退变的相关性分析

目的:观察绝经后女性腰椎和髋部骨密度与腰椎间盘退变的关系。方法:回顾性统计2017年12月～2018年12月因腰痛在我院脊柱外科门诊及住院的229例绝经后女性患者,记录患者年龄、身高、体重、糖尿病史、高血压病史、饮酒史、吸烟史等,采用双能X线骨密度测量仪检查患者腰椎椎体(L1～L4)骨密度和髋部平均骨密度,记录相应的T值,每例患者同时行腰椎MRI检查。根据骨密度T值≥-1.0为正常,-2.5 T值-1.0为骨量减少,T值≤-2.5诊断为骨质疏松,将患者分为骨质疏松组(n=78)、骨量减少组(n=73)和正常组(n=78)。每个节段腰椎间盘退变程度用Pfirrmann分级系统进行评分,用协方差和Spearman相关性分析来分析腰椎和髋部骨密度与腰椎间盘退变的关系。结果:骨质疏松组、骨量减少组和骨量正常组的年龄分别为67.17±9.99岁、65.66±10.71岁、55.29±12.35岁,骨质疏松组、骨量减少组年龄显著大于骨量正常组(P0.05);骨质疏松组的体重指数小于正常组(23.38±2.37kg/m~2 vs 24.72±2.96kg/m~2,P0.05);其余一般资料各组间无显著性差异(P0.05)。上腰椎(L1、L2)中,骨质疏松组腰椎间盘退变评分均较正常组低(2.24±0.82 vs 2.60±0.95,2.79±0.95 vs3.18±0.94,P0.05),而与骨量减少组比较无显著性差异(P0.05);下腰椎(L3、L4)椎体和髋部不同骨密度组之间椎间盘退变程度无显著性差异(P0.05)。各腰椎椎体骨密度分别与腰椎间盘平均退变程度呈正性相关(L1:r=0.185;L2:r=0.157;L3:r=0.180;L4:r=0.132;L1～L4:r=0.180;均P0.05),髋部骨密度与腰椎间盘退变的严重程度无统计学相关性。结论:绝经后女性腰椎间盘退变的严重程度与腰椎骨密度存在正相关关系,提示绝经后女性腰椎骨密度较高者椎间盘退变可能更严重,有必要进一步做腰椎CT或者MRI检查;股骨颈骨密度检查对骨质疏松诊断更有帮助。     

后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响

目的探讨后方韧带复合体对腰椎椎间融合术后早期相邻节段退变的影响。方法 2000年1月至2010年1月在我科实施后路腰椎减压椎间融合内固定治疗L4~5椎间盘突出患者60例。A组(30例)行保留后方韧带复合体的腰椎椎间融合术(posterior lumbar interbody fusion,PLIF),B组(30例)行切除后方韧带复合体的PLIF术。比较两组手术前、后日本骨科协会(Japanese orthopaedic association,JOA)评分及改善率。术前、末次随访时测量腰椎X线片上L3~4椎间盘的高度和椎间隙动态角度、L3~4椎体滑移距离并进行比较。术前及末次随访时对L3~4椎间盘进行Pfirrmann分级。结果手术前、后两组患者的JOA评分差异有统计学意义(P0.05),术后两组JOA评分差异均无统计学意义(P0.05),两组之间改善率差异无统计学意义(P0.05)。A组9例患者出现了L3~4节段的邻近节段退变(adjacent segment disease,ASD),B组17例出现了L3~4节段的ASD。其中A、B两组均有2例患者为有症状的ASD。术前两组患者X线片上L3~4椎间盘的高度、椎间隙动态角度、L3~4椎体滑移距离相比差异均无统计学意义(P0.05),而末次随访时差异有统计学意义(P0.05)。A组末次随访时Pfirrmann分级1级6例,2级22例,3级2例,无4、5级病例。B组末次随访时Pfirrmann分级1级4例,2级24例,3级2例,无4、5级病例。结论腰椎椎间融合术中保留后方韧带复合体可减少术后早期相邻节段退变的发生。     

Ⅱ型糖尿病与腰椎间盘退变的相关性

目的 :探讨Ⅱ型糖尿病(DM)与腰椎间盘退变的相关性。方法 :选择2013年因腰腿痛至我院脊柱外科门诊就诊并满足入选标准的390例50~60岁患者,详细记录患者DM病史,其中非DM患者123例(非DM组)、血糖控制较好患者140例(A组),血糖控制较差DM患者127例(B组);A组中DM≤10年68例(A1组),DM10年72例(A2组);B组中DM≤10年60例(B1组),DM10年67例(B2组)。用Pfirrmann评分系统对各组患者各节段腰椎间盘退变程度进行评分,用SPSS 19.0统计分析DM与腰椎间盘退变程度的相关性。结果:各组资料均服从正态分布(P0.05)。各组间一般资料无显著性差异(P0.05)。在L1/2~L5/S1每节段上,A1组Pfirrmann评分与非DM组无显著性差异(P0.05);A2、B1及B2组的Pfirrmann评分显著高于非DM组(P0.05)。A2、B2组Pfirrmann评分显著较A1、B1组高(P0.05);B1、B2组Pfirrmann评分均较A1、A2组高(P0.05)。在A、B组中,L1/2~L5/S1每一节段上腰椎间盘退变程度与DM病程呈显著性正相关(P0.05)。结论 :DM10年及血糖控制不良是腰椎间盘退变的危险因素,腰椎间盘退变程度与DM病程呈正相关。     

腰痛椎间盘高度与Pfirrmann退变分级的关系

[目的]探讨腰痛患者椎间盘高度与椎间盘退变程度的关系。[方法]回顾性分析2021年1月—2022年6月于本院脊柱外科就诊的151例腰痛患者的腰椎MRI资料，测量椎间盘高度，采用Pfirrmann标准对椎间盘退变程度分级，使用Spearman秩相关分析椎间隙高度与Pfirrmann的相关性。[结果]151例患者影像椎间隙高度由低至高依次为L_1～2、L₅～S₁、L_2～3、L_4～5、L_3～4，差异有统计学意义[(9.4±0.6)mm,(10.4±1.5)mm,(10.6±0.8)mm,(11.8±0.8)mm,(11.8±0.8)mm,P<0.05]；椎间隙Pfirrmann退变分级由轻至重依次为L_1～2、L_2～3、L_3～4,L₅～S₁、L_4～5，差异有统计学意义(P<0.05)。L_1～2至L     

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.     

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.