退行性脊柱侧凸患者椎旁肌退变与脊柱-骨盆参数的关系

目的 :分析退行性脊柱侧凸(adult degenerative scoliosis,ADS)患者椎旁肌(多裂肌、竖脊肌)MRI影像退变程度与脊柱-骨盆参数之间的关系,为ADS患者矢状位失平衡评估提供新的线索。方法:回顾性分析在我院就诊的女性ADS患者52例,年龄55～65岁,收集患者人口统计学资料,分别测量患者腰椎MRI上L1～S1椎间盘层面椎旁肌(多裂肌、竖脊肌)横截面积(cross-sectional area,CSA)、脂肪化比例(fat saturation fraction,FSF),并在患者脊柱全长X线片上测量冠状位和矢状位的影像学参数,包括冠状位Cobb角、矢状位垂直偏距(sagittal vertical axis,SVA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆倾斜角(pelvic tilt,PT)、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、PI-LL,对椎旁肌L1～S1各层面FSF行单因素方差分析并进行LSD事后多重比较,利用Pearson相关分析比较椎旁肌退变程度和脊柱-骨盆参数之间的关系。结果:L1～S1各层面FSF有显著性差异(P0.01),L5/S1层面椎旁肌FSF明显大于其他层面(P0.05)。冠状位Cobb角与L1/2、L2/3、L3/4、L4/5椎间盘层面CSA呈负相关(r=-0.358、-0.367、-0.329、-0.283,P0.05)。椎旁肌FSF与PT在L1～S1各层面呈正相关(r=0.487、0.394、0.354、0.356、0.355,P0.05),而与SS呈负相关(r=-0.494、-0.440、-0.373、-0.301、-0.300,P0.05)。椎旁肌FSF与LL在L1/2、L2/3层面呈负相关(r=-0.398、-0.328,P0.05)。椎旁肌总体FSF(TFSF)与PT呈正相关(r=0.395,P0.01),与LL呈负相关(r=-0.345,P0.05)。L1～S1各层面椎旁肌CSA、FSF与SVA、PI、TK的Pearson相关分析结果无统计学意义(P0.05)。BMI与L1～S1各层面椎旁肌CSA呈正相关(P0.05),而与椎旁肌各层面FSF的Pearson相关分析结果无统计学意义(P0.05)。结论:在ADS患者中,椎旁肌FSF与PT有明显的正相关性,提示椎旁肌的退变可能参与了脊柱退变和代偿机制的过程,椎旁肌FSF可能反映了ADS患者矢状位失平衡的严重程度。     

年龄因素下中老年人脊柱-骨盆参数与腰椎旁肌退变的相关分析

目的 分析年龄因素下中老年人脊柱-骨盆参数与腰椎旁肌退变的相关性。方法 将194例中老年体检者按照年龄段不同分为A组(40～49岁，59例)、B组(50～59岁，77例)及C组(60～69岁，58例)。比较3组脊柱-骨盆参数及腰椎旁肌退变程度指标，分析3组脊柱-骨盆参数与L_3～4、L_4～5、L₅～S₁节段腰椎旁肌横截面积(CSA)/椎体CSA的相关性。结果 (1)骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、骨盆入射角(PI)、PI与LL的差值(PI-LL) 3组比较差异均无统计学意义(P>0.05)。(2)各腰椎节段腰椎旁肌CSA/椎体CSA:随A、B、C组均呈逐步下降趋势(P<0.05);3组组内不同腰椎节段腰椎旁肌CSA/椎体CSA:随L_3～4、L_4～5、L₅～S₁均呈逐步下降趋势(P<0.05)。(3) 3组PT、SS、LL、PI与各腰椎节段腰椎旁肌CSA/椎体CSA的相关...     

退行性脊柱矢状面失衡患者腰椎椎旁肌的特点及其与失平衡程度之间的关系

目的 :分析退行性脊柱矢状面失衡患者腰椎椎旁肌特点及其与脊柱矢状面失平衡之间的关系。方法 :回顾性分析2017年1月～2020年9月收治的退行性脊柱矢状面失衡患者的临床资料。其中男49例,女71例,平均年龄70.5±9.2岁。采用站立位全脊柱X线侧位片评估患者矢状面的脊柱骨盆参数,包括C7矢状垂直轴(C7-SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)及骶骨倾斜角(SS)。在轴向T2加权MRI上定量测量每例患者在各个腰椎节段对应的椎旁肌总面积(TCSA)及其相对横截面积(RtCSA),功能性横截面积(FCSA)及其相对横截面积(RCSA),各节段肌肉的脂肪浸润程度(FI%),椎旁肌的退变通过RCSA及FI%的数值来反映。分别根据年龄(中年组65岁,老年组65～75岁,高龄组75岁)及性别分组,比较各组之间的椎旁肌退变差异。另外,根据脊柱矢状面失平衡的严重程度,将120例患者分为两组:轻度失衡组患者89例(MI组,SVA 5～10cm)和重度失衡组31例(SI组,SVA10cm)分析椎旁肌退变特点。采用多元线性回归分析腰椎椎旁肌退变与年龄、性别、体质指数(BMI)、失平衡严重程度之间的相关性。结果:女性患者椎旁肌的平均FI%显著高于男性患者,但男性的平均TCSA显著高于女性,两者差异均具有统计学意义(均P0.05)。在不同年龄段的脊柱矢状面失衡患者中,三组患者从L1/2至L5/S1节段上椎旁肌退变参数FI%及RCSA均存在明显统计学差异(均P0.05),其中高龄组患者退变程度最为明显,而对于参数RtCSA只在L1/2到L3/4节段上存在统计学差异。在不同严重程度的失衡患者中,重度失衡组在脊柱骨盆参数上拥有更小的PI、LL及TK值,而拥有更大的PI-LL,差异具有统计学差异(均P0.05);在椎旁肌肉参数上,从L2/3到L5/S1节段上两组的RCSA具有统计学差异(均P0.05),而两组参数TCSA之间只在L4/5和L5/S1节段有统计学差异(均P0.05),两组椎旁肌的脂肪浸润率之间无统计学差异(均P0.05)。椎旁肌肉退变参数(TCSA、FI%、RCSA)与年龄、性别、BMI及失衡严重程度之间的多元线性回归分析提示TCSA、FI%、RCSA与年龄、性别、BMI有关,而与矢状面失平衡严重程度(SVA)之间无线性相关。结论:在脊柱退变性矢状面失衡住院患者中,年龄、性别及BMI都与腰椎椎旁肌肉的退变有着一定的联系;尽管脊柱矢状面的失平衡程度(SVA)与椎旁肌退变之间无显著相关性,但是重度的脊柱矢状面失衡提示更加显著的椎旁肌退变。     

退变性腰椎侧凸患者矢状面平衡的特点及对腰椎侧凸的影响

目的 :分析退变性腰椎侧凸矢状面平衡参数的特点及其对腰椎侧凸的影响,探讨矢状面平衡参数改变在退变性腰椎侧凸进展中的作用。方法:回顾分析2012年3月～2017年3月经我院诊治的退变性腰椎侧凸患者(病例组)90例,男37例,女53例,年龄51～77岁(57.1±5.8岁)。选取同时期、同年龄段及同性别比的无腰椎侧凸的55例腰椎退行性疾病患者作为照组(对照组),男31例,女24例,年龄50～76岁(56.8±6.1岁)。所有患者均行脊柱全长X线检查,同时填写Oswestry功能障碍指数(Oswestry disability index,ODI)、视觉模拟评分(visual analogue scale/score,VAS)及脊柱侧凸研究学会22项(scoliosis research society-22,SRS-22)量表。测量矢状面平衡相关参数:(1)脊柱参数,脊柱矢状轴(sagittal vertical axias,SVA)、胸椎后凸角(thoracic kypho-sis,TK)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacrum slop,SS);(2)骨盆参数,骨盆入射角(prlbrv in-cidence,PI)、骨盆倾斜角(pelvic tilt,PT);(3)脊柱-骨盆参数,T1骨盆角(T1 pelvic angle,TPA)、L1骨盆角(L1pelvic angle,LPA)。比较两组患者各矢状面平衡参数是否具有统计学差异,分析各矢状面平衡参数与生活质量及腰椎侧凸Cobb角的相关性。结果:两组患者的SVA、TK、PI、PT及TPA差异无统计学意义(P0.05);SS、LL及LPA差异有统计学意义(P0.05)。两组患者ODI、VAS及SRS-22差异有统计学意义(P0.05)。病例组资料相关性分析显示,ODI、VAS及SRS-2与矢状面平衡参数SS、LL及LPA有显著相关性(-1r1,P0.05),与SVA、TK、PI、PT及TPA无显著相关性(P0.05);侧凸Cobb角与LL呈负相关(-1r0,P0.05);与SS及LPA均呈正相关(0r1,P0.05)。进一步回归分析显示,侧凸Cobb角与SS、LL及LPA存在直线回归关系(F=417.331,P0.01),其回归方程为Cobb角=19.526-8.223×LL+3.727×SS+1.618×LPA。结论:退变性腰椎侧凸患者矢状面平衡参数以LL和SS改变为主,表现为LL减小及SS增大并随侧凸的加重而进展,降低了患者的生活质量。     

儿童SDSG 5/6型发育不良性腰椎滑脱患者手术治疗后骨盆平衡情况变化

目的 :探讨在儿童重度发育不良性腰椎滑脱伴不平衡型骨盆[即脊柱畸形研究学组(Spinal Deformity Study Group,SDSG)分型5和6型]患者中手术复位及重建腰骶前凸对骨盆平衡的影响。方法 :回顾性分析2015年2月～2019年2月手术治疗的23例儿童重度发育不良性腰椎滑脱患者,男2例,女21例,年龄9.6±2.4岁。均为L5滑脱,术前均伴有骨盆后倾。SDSG分型5型21例,6型2例。均行减压复位腰骶后凸矫正内固定融合术。测量术前及术后1年随访时脊柱骨盆矢状面相关参数,包括骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、L5倾斜角(L5 slope,L5S)、腰椎前凸角(lumbar lordosis,LL)、滑脱程度(slip percentage,SP)、SDSG发育不良腰骶角(SDSG dysplastic lumbosacral angle,SDSG-dys LSA)、Boxall′s滑脱角(Boxall′s slip angle,BSA)、Dubousset′s腰骶角(Dub-LSA)、腰骶后凸角(kyphotic Cobb angle,k-Cobb)。根据术后1年时骨盆旋转情况分为术后平衡型骨盆组和不平衡型骨盆组,对比两组患者后凸改善、滑脱复位率及近端固定椎的差异。结果:随访26±11个月(13～48个月),术后1年时PI无显著性改变(P0.05),SS及Dub-LSA较术前均有显著性增加(P0.05);PT、L5S、LL、SP、SDSG dys-LSA及BSA较术前均有显著性减少(P0.05);k-Cobb由术前11.6°±12.8°改善至-11.5°±16.3°(P0.05);滑脱复位率为(85.5±16.4)%。术后1年时23例患者中有5例(22%)骨盆改善为平衡型,骨盆平衡组患者滑脱复位率显著性高于不平衡组(90.9%vs. 76.2%,P0.05),两组腰骶后凸改善及近端固定椎位置无显著性差异(P0.05)。结论 :手术治疗儿童SDSG5/6型发育不良性腰骶滑脱可有效改善脊柱-骨盆矢状位序列,部分患者可从不平衡型骨盆改善为平衡型骨盆,且骨盆平衡的改善与滑脱复位相关。     

骨盆矢状位参数变化与腰椎滑脱症患者临床疗效的相关性研究

目的研究骨盆矢状位参数变化与腰椎滑脱症患者临床疗效的相关性。方法选择2012-04-2015-04期间在我院接受腰椎融合手术的75例腰椎滑脱症患者为观察组,接受椎间孔腰椎椎体间融合术;选择同一时间段内在我院接受体检的健康志愿者60例作为对照组。行腰椎侧位X线检查并测定骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、椎间隙高度(DH);采用VAS量表、JOA量表以及ODI指数评价疼痛程度和功能障碍程度。结果手术前,腰椎滑脱患者PI、PT明显高于对照组,SS、LL、DH明显低于对照组(t=4.979~27.630,P0.05);手术后3个月,腰椎滑脱患者PI、PT明显高低于手术前,SS、LL、DH明显高于手术前(t=3.957~23.995,P0.05),VAS评分、ODI指数低于手术前,JOA评分高于手术前(t=25.524~39.151,P0.05);PI、PT与VAS评分、ODI指数呈正相关,与JOA评分呈负相关(r=-0.425~0.412,P0.05);SS、LL、DH与VAS评分、ODI指数呈负相关,与JOA评分呈正相关(r=-0.432~0.415,P0.05)。结论骨盆矢状位参数PI、PT、SS、LL、DH与腰椎滑脱症患者手术前后疼痛程度、功能障碍程度的改善密切相关。     

退变性腰椎侧凸脊柱-骨盆参数测量及临床意义

目的测量退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者骨盆-脊柱参数并分析其临床意义。方法选取2006年3月—2014年3月在本院脊柱外科就诊的DLS且有完整影像学资料的患者30例(DLS组)及影像学资料完整的无DLS者30例(对照组),测量2组的骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacrum slope,SS)、腰椎前凸角(lumbar lordosis,LL)、胸椎后凸角(thoracic kyphosis,TK)、矢状位平衡(sagittal vertical axis,SVA)。结果 DLS组的LL值明显小于对照组,差异有统计学意义(P0.05);PT、SVA值明显大于对照组,差异有统计学意义(P0.05)。2组的SS、PI及TK值差异无统计学意义(P0.05)。2组的SS与LL、PT与SVA均有相关性。对照组骨盆参数之间(PI、SS及PT)均有相关性,但DLS组骨盆参数之间均无相关性。对照组中LL与SVA显著相关,但DLS组中LL与SVA无相关性。结论骨盆形态的变化与脊柱的矢状位序列密切相关,DLS患者表现为更小的LL以及更大的SVA。     

椎旁肌退变在峡部裂性腰椎滑脱与退变性腰椎滑脱的比较

目的比较峡部裂型腰椎滑脱患者和退变性腰椎滑脱患者椎旁肌退变参数之间的差异, 并分析椎体滑移率(SP)与椎旁肌退变的相关性。方法分析2018年1月至2022年12月于郑州大学第一附属医院骨科住院并接受手术治疗的腰椎滑脱症患者的临床资料, 分为峡部裂组(83例)和退变组(118例)。用ImageJ软件测量L3椎弓根水平MRI图像L3椎体、竖脊肌(ES)、多裂肌(MF)以及腰大肌(P)的横截面积(CSA)及各肌肉脂肪浸润面积(FCSA), 计算各椎旁肌的脂肪浸润率(FIR)。椎旁肌横截面积与L3椎体横截面积之比定义为相对面积(RCSA)。腰椎侧位数字化X光片上测量滑移距离, 计算相应SP。用SPSS软件行数据录入及分析。分析两组间椎旁肌RCSA和FIR差异, 以及SP与椎旁RCSA和FIR的相关性。结果退变组MF-RCSA、ES-RCSA及P-RCSA均显著低于峡部裂组(0.61±0.19比0.71±0.23、2.12±0.54比2.32±0.71、0.81±0.29比0.93±0.34, t=3.173、2.525、2.681, P<0.05)。退变组ES-FIR和P-FIR均显著高...     

经椎弓根截骨对强直性脊柱炎胸腰椎后凸畸形脊柱-骨盆参数的影响

  目的 探讨经椎弓根椎体截骨(pedicle subtraction osteotomy, PSO)治疗强直性脊柱炎胸腰 椎后凸畸形术后脊柱-骨盆参数的变化及意义。 方法回顾性分析2006 年7月至2010 年10 月在我: 行L1 PSO矫形内固定术的21 例强直性脊柱炎胸腰椎后凸畸形患者。男18 例, 女3 例;年龄(35.6±10.8) 岁(21~53 岁)。所有患者手术前后均摄站立位全脊柱正、侧位X线片。统计测量所有患者的术前、术后即 刻X线片的胸椎后凸(thoracic kyphosis, TK)、腰椎前凸(lumbar lordosis, LL)、全脊柱最大后凸Cobb 角 (globe kyphosis, GK)、固定节段角度(angle of the fusion levels, AFL)、矢状面平衡(sagittal vertical axis, SVA)、骨盆投射角(pelvic incidence, PI)、骶骨倾斜角(sacral slope, SS)和骨盆倾斜角(pelvic tilting, PT)。 结果脊柱-骨盆相关参数中, 除TK 和PI 外, 其余参数手术前后相比较差异均有统计学意义(P < 0.01)。LL 的变化与PT(r=0.59, P=0.005)、SS(r=0.64, P=0.002)、SVA(r=0.49, P=0.025)及AFL(r=0.60, P= 0.004)的变化存在线性相关, PT的变化与SS(r=0.94, P=0.000)的变化存在线性相关, AFL的变化与PT (r=0.59, P=0.005)、SS(r=0.61, P=0.003)的变化存在线性相关。 结论 PSO能够显著地改善强直性脊柱炎 胸腰椎后凸畸形患者脊柱-骨盆矢状面形态;LL的重建与骨盆矢状面形态的改变密切相关。     

腰痛的髋关节骨关节炎患者腰椎-骨盆矢状位参数的研究

目的 探讨髋关节骨关节炎(hip osteoarthritis, HOA)对腰椎-骨盆矢状位参数的影响及与腰痛的关系。方法 回顾性分析2018年1月～2019年12月本院收治的60例HOA患者作为HOA组,选取同期50例正常成人作为对照组。测量两组研究对象的腰椎前凸角(lumbar lordosis, LL)、骨盆投射角(pelvic incidence, PI)、骨盆倾斜角(pelvic tilt, PT)、骶骨倾斜角(sacral slope, SS)。根据是否伴有腰痛,将HOA组再分为腰痛组、无腰痛组。比较两组间、两亚组间及两亚组与对照组间腰椎-骨盆矢状位参数的差异。分析HOA组各参数与腰部VAS评分之间的相关性。结果 两组间比较,HOA组LL小于对照组(P<0.05);两组间PI、PT、SS差异无统计学意义(P>0.05)。HOA患者腰痛组的LL、SS小于无腰痛组(P<0.05),PT大于无腰痛组(P<0.05);两亚组间PI比较差异无统计学意义(P>0.05)。腰痛组与对照组比较,腰痛组LL小于对照组(P<0.05);两组间PI、PT、SS...     

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.     

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 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.     

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.     

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.     

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.     

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.