微骨折术治疗膝骨关节炎与髌内侧滑膜皱襞的相关性

目的研究不同解剖类型髌内侧滑膜皱襞对微骨折术治疗膝骨性关节炎患者手术前后的影响。方法收集2011-04-2014-01在安徽医科大学合肥第三临床医院关节镜手术治疗的30例膝骨性关节炎患者。将有无合并髌内侧滑膜皱襞分成两组,进行手术前后膝关节功能Lysholm评分,统计学采用两样本t检验。不同解剖类型髌内侧滑膜皱襞分成两组,进行手术前后膝关节功能Lysholm评分,统计学采用两样本t检验。结果不合并内侧滑膜皱襞评分高于合并组,手术前后膝关节功能Lysholm评分均有差异（P〈0.05）。A,B型髌内侧皱襞手术前后Lysholm评分高于C,D型髌内侧皱襞手术前后Lysholm评分（P﹤0.05）;C,D型髌内侧皱襞更影响疗效。30例膝骨性关节炎患者手术前后膝关节功能Lysholm评分有差异（P〈0.05）,术后评分较术前大幅提高。结论微骨折术治疗膝关节骨性关节炎效果满意。不同解剖类型髌内侧滑膜皱襞影响膝骨性关节炎手术前后的评分。特别是解剖类型为C,D型。术中准确处理髌内侧滑膜皱襞对微骨折术治疗膝骨性关节炎至关重要。     

膝骨关节炎肌骨超声与X线片表现的比较与分析

目的 :比较分析膝骨关节炎患者肌骨超声与X线片的表现特点,研究两者在膝骨关节炎诊断中各自的优势。方法:收集整理2015年2月至2015年5月门诊病历,按照纳入标准和排除标准收集膝关节骨性关节炎诊断患者的肌骨超声以及X线片表现,共纳入57例(66膝),其中女48例,男9例,年龄41~78岁,平均(58.9±9.8)岁,主要症状以双膝或单膝关节疼痛、屈伸不利、有确切的压痛点为主,平均病程(13.6±3.0)个月。对所收集的数据进行统计分析。结果:膝关节X线片Kellgren-Lawrence分级Ⅰ级患者的肌骨超声检查结果:滑膜增生9膝,关节积液20膝,半月板病变13膝,髌下脂肪垫炎症5膝,髌韧带病变8膝。Kellgren-Lawrence分级Ⅱ级患者肌骨超声检查结果:滑膜增生20膝,关节积液31膝,半月板病变22膝,髌下脂肪垫炎症16膝,髌韧带病变17膝。Kellgren-Lawrence分级Ⅲ级患者的肌骨超声表现:滑膜增生6膝,关节积液6膝,半月板病变7膝,髌下脂肪垫炎症7膝,髌韧带病变5膝。结论:肌骨超声可以很好地反应早期和中期膝骨关节炎患者膝关节周围软组织的病理变化,可以更好地定位膝关节骨性关节炎的病变位置,并且在X线片表现不明显时做到早期的病变发现。在临床过程中应将肌骨超声应用于膝骨关节炎的诊断之中。     

内侧与外侧髌旁入路TKA治疗膝关节骨性关节炎并膝外翻畸形的疗效分析

目的探讨内侧髌旁入路与外侧髌旁入路全膝关节置换术(TKA)治疗膝关节骨性关节炎合并膝外翻畸形的临床疗效。方法回顾性分析自2013-01—2017-12行TKA治疗的53例膝关节骨性关节炎合并膝外翻畸形,其中24例采用外侧髌旁入路(外侧组),29例采用内侧髌旁入路(内侧组)。结果 53例均获得随访,随访时间平均24(6～36)个月。内侧组2例出现足背皮肤感觉减退,积极康复锻炼后症状明显改善;1例膝关节内侧不稳,予以支具保护后症状改善。外侧组1例残存膝关节不稳,行肌肉锻炼后症状明显改善。外侧组膝关节HSS评分、生存质量评分明显高于内侧组,疼痛VAS评分低于内侧组,差异有统计学意义(P 0.05);但2组股胫关节外翻角、膝关节活动度比较差异无统计学意义(P0.05)。结论外侧髌旁入路TKA治疗膝关节骨性关节炎并膝外翻畸形能够有效重塑下肢力线、改善患者膝关节功能,同时可最大程度减小损伤和减轻疼痛,进而提高患者的生存质量。     

Lysholm评分系统评价髌股关节的应用研究

目的探讨Lysholm评分系统评价髌股关节的可靠性和有效性。方法笔者自2011-01—2014-06对63例膝关节髌股关节紊乱症行关节镜诊治术,术前根据Lysholm评分系统对患者进行评分。在关节镜下对每例膝的软骨损伤情况进行评估,采用Outbradge软骨损伤分度方法。评估区域根据Schematic髌股关节的分区方法,观察9个区域内软骨损伤的情况并记录。将Outbradge软骨损伤分度方法转换成计分方法,然后将软骨损伤的指数与Lysholm评分进行相关性分析。结果本组术中术后均未发生并发症,Lysholm评分为(56.5±18.7)分,髌股关节软骨损伤病理程度的计分为(12.8±8.4)分。Lysholm评分与髌股关节软骨损伤病理程度的计分两者经相关性分析得出两者呈直线负相关(r=0.81)。结论Lysholm评分系统能简单直接、全面可靠地评价髌股关节。其有效性和可靠性不是单纯通过临床症状来验证,而是通过软骨退变的病理程度和临床症状来共同验证的,对髌股关节炎的诊治和预后判断具有重要的临床意义。     

胫骨内侧关节线改变程度对单髁置换术患者膝关节屈伸功能的影响

目的探讨膝关节单髁置换术后胫骨内侧关节线改变程度对患者膝关节屈伸功能的影响。方法回顾性分析自2014-07—2017-05行单髁置换术治疗的48例原发性膝关节骨性关节炎。测量术前与术后3个月膝关节正位X线片胫骨内侧关节线改变程度;术后3个月记录膝关节屈曲0°、30°、60°、90°、120°时膝关节在内侧应力下小腿外翻的角度以评估胫骨平台内侧间隙,分析胫骨内侧关节线改变程度与膝关节KSKS评分、膝关节屈伸角度及不同屈曲角度应力下小腿外翻角度的相关性。结果胫骨内侧关节线改变程度与膝关节屈曲0°应力下小腿外翻的角度呈正相关(r=0.314,P=0.029),胫骨内侧关节线改变程度与膝关节屈伸改善角度呈负相关(r=-0.49,P 0.001)。胫骨内侧关节线改变3.6 mm者膝关节屈伸改善角度高于关节线改变≥3.6 mm者,差异有统计学意义(P=0.004)。胫骨内侧关节线改变3.6 mm者膝关节KSKS评分优于关节线改变≥3.6 mm者,差异有统计学意义(P=0.013)。结论单髁置换术后胫骨内侧关节线改变程度与膝关节屈伸改善程度、膝关节KSKS评分改善程度呈负相关,胫骨内侧关节线改变≥3.6 mm可能导致术后患者膝关节屈伸功能改善不佳。     

单髁置换术治疗膝内侧间室骨关节炎术后人工关节被遗忘评分

目的探讨单髁置换术(UKA)治疗膝内侧间室骨关节炎(OA)术后人工关节被遗忘评分(FJS)及其影响因素。方法采用UKA治疗32例膝内侧间室OA患者。比较术后1、3、6个月的FJS评分、疼痛VAS评分、膝关节活动度(ROM)、HSS评分,采用Pearson相关分析法评价FJS评分与VAS评分、膝关节ROM、HSS评分的相关性。结果 32例患者均获得随访,时间6～48个月。FJS评分、VAS评分、膝关节ROM及HSS评分术后3、6个月与术后1个月比较差异均有统计学意义(P 0.05),术后6个月与术后3个月比较差异均无统计学意义(P 0.05)。FJS评分与VAS评分呈正相关(r=0.862,P 0.05),FJS评分与膝关节ROM呈负相关(r=-0.998,P 0.05),FJS评分与HSS评分无明显相关性(r=0.956,P0.05)。结论 UKA治疗膝内侧间室OA疗效较好,术后进行良好的镇痛和膝关节锻炼可使患者获得较好的膝关节本体感觉和较高的满意度。     

外侧半月板撕裂关节镜术中保留不同半月板层厚对膝关节功能及骨性关节炎发生的影响

目的探讨外侧半月板撕裂关节镜术中保留不同半月板层厚对膝关节功能及骨性关节炎发生的影响。方法回顾性分析自2013-03—2015-01采用关节镜治疗的50例膝关节外侧半月板撕裂,19例未保留半月板层厚(未保留组),16例部分保留半月板层厚(部分保留组),15例完全保留半月板层厚(完全保留组)。比较3组末次随访时膝关节功能Lysholm评分、疼痛VAS评分、Kellgren-Lawrence影像学分级。结果 50例均获得平均22.7(17~32)个月随访。末次随访时,3组Lysholm评分差异有统计学意义(P0.05),进一步两两比较,部分保留组、完全保留组Lysholm评分明显高于未保留组,而部分保留组与完全保留组Lysholm评分差异无统计学意义(P0.05)。3组疼痛VAS评分、Kellgren-Lawrence影像学分级差异无统计学意义(P0.05)。结论外侧半月板撕裂关节镜术中保留不同半月板层厚者术后早期膝关节功能恢复更好,并且保留不同层厚半月板对早期膝关节骨性关节炎发生无明显影响。     

外侧半月板撕裂关节镜术中保留不同半月板层厚膝关节功能及骨性关节炎发生的影响

目的 探讨外侧半月板撕裂关节镜术中保留不同半月板层厚对膝关节功能及骨性关节炎发生的影响.方法 回顾性分析自2013-03-2015-01采用关节镜治疗的50例膝关节外侧半月板撕裂,19例未保留半月板层厚(未保留组),16例部分保留半月板层厚(部分保留组),15例完全保留半月板层厚(完全保留组).比较3组末次随访时膝关节功能Lysholm评分、疼痛VAS评分、Kellgren-Lawrence影像学分级.结果 50例均获得平均22.7(17～32)个月随访.末次随访时,3组Lysholm评分差异有统计学意义(P＜0.05),进一步两两比较,部分保留组、完全保留组Lysholm评分明显高于未保留组,而部分保留组与完全保留组Lysholm评分差异无统计学意义(P＞0.05).3组疼痛VAS评分、Kellgren-Lawrence影像学分级差异无统计学意义(P＞0.05).结论 外侧半月板撕裂关节镜术中保留不同半月板层厚者术后早期膝关节功能恢复更好,并且保留不同层厚半月板对早期膝关节骨性关节炎发生无明显影响.     

关节镜结合小针刀松解膝内侧副韧带浅层治疗退行性膝关节内侧半月板损伤

目的:探讨采用关节镜结合小针刀松解膝内侧副韧带浅层治疗退行性膝关节内侧半月板损伤的临床效果。方法:选择2016年2月至2018年11月存在膝关节内侧间隙局限性疼痛、绞锁、屈曲受限,X线Kellgren-Lawrence分级Ⅰ-Ⅱ级,MRI提示为膝关节内侧半月板损伤(Ⅲ度)患者56例(56膝),其中男30例(30膝),女26例(26膝),采用关节镜下内侧半月板成形加小针刀松解内侧副韧带浅层。采用Lysholm膝关节评分标准判断手术效果。结果:56例术后均获随访,时间3～24个月,平均10个月。根据Lysholm膝关节评分标准,末次随访膝关节评分(85.72±5.28)分,较术前(37.24±1.32)分提高(P0.05)。结论:关节镜结合小针刀松解膝内侧副韧带浅层治疗退行性膝关节内侧半月板损伤能有效改善膝关节内外侧力学平衡,促进患者膝关节功能的恢复,具有临床推广价值。     

膝关节镜联合C型臂治疗复发性髌骨脱位疗效分析

目的探讨膝关节镜联合C型臂透视下定位重建内侧髌股韧带等长点治疗复发性髌骨脱位的疗效。方法自2013年10月至2017年5月收治复发性髌骨脱位58例(63膝),男26例28膝,女32例35膝;年龄16~47岁,平均(21.8±7.16)岁。采用膝关节镜联合C臂机透视下定位内侧髌股韧带等长点,自体半腱肌肌腱移植双束解剖重建内侧髌股韧带治疗。对其进行影像学评价:Q角、胫骨结节股骨滑车沟(tibia tuberosity-trochlear groove,TT-TG),Insall-Salvati指数、髌股适合角、外侧髌股角、髌骨外移率;临床疗效评价包括国际膝关节评分委员会(International Knee Documentation Committee,IKDC)膝关节功能主观评分、Lysholm膝关节功能评分。结果所有病例均获得随访,随访时间1~40个月,平均21个月。术后恐惧试验均阴性,随访期间无髌骨再脱位及骨折发生。末次随访时髌股适合角(0.20±4.19)°,外侧髌股角(3.52±1.33)°,髌骨外移率(0.35±0.14)。与术前比较差异有统计学意义(P0.05);IKDC膝关节功能主观评分(87.46±4.04)分、Lysholm膝关节功能评分(87.28±3.33)分,与术前比较差异有统计学意义(P0.05)。结论膝关节镜联合"C"型臂透视下定位重建内侧髌股韧带等长点治疗复发性髌骨脱位的近期效果可靠。     

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.     

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.     

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.     

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.