β—HCG测定作为膀胱癌预后指标的意义

７０例膀胱移行细胞癌β－ＨＣＧ免疫组织化学测定和３４例膀胱癌患者血清、尿β－ＨＣＧ放射免疫测定发现，随着肿瘤分级的上升，组织β－ＨＣＧ表达阳性率也提高；随着肿瘤分期进展，组织及血清、尿β－ＨＣＧ阳性率明显增高。研究表明，组织及血清、尿β－ＨＣＧ的测定可作为判断膀胱癌预后的指标，阳性者近期内肿瘤转移死亡率明显高于阴性者。     

BTA试验、尿β－HCG测定及尿液细胞学检查联合诊断膀胱肿瘤

ＢＴＡ试验、尿β－ＨＣＧ测定及尿液细胞学检查联合诊断膀胱肿瘤张爱民，李慎勤，杨德安，李香铁，王洪伟，韩玮，刘仰东我们采用膀胱肿瘤抗原（ＢＴＡ）试验结合β－ＨＣＧ测定和尿液细胞学检查检测膀胱肿瘤，自１９９５年１０月至１９９６年２月检测了３０例病人，结果...     

血和尿中人绒毛膜促性腺激素含量与膀胱肿瘤生物学行为的关系

用放射免疫方法（ＲＩＡ）检测２１例膀胱肿瘤患者（试验组）和同例数泌尿科非肿瘤患者（对照组）血和尿中人绒毛膜促性腺激素（β－ＨＣＧ）含量。试验组血样本β－ＨＣＧ均值为１８．２３ＩＵ／Ｌ，对照组为６．６０ＩＵ／Ｌ，Ｐ＜０．０２５，试验组尿β－ＨＣＧ均值为４９．９ＩＵ／Ｌ，对照组为７．３４ＩＵ／Ｌ，Ｐ＜０．０２５。结果表明：试验组血和尿中β－ＨＣＧ含量均显著高于对照组。并将试验组β－ＨＣＧ含量情况与肿瘤细胞病理分级作相关分析，血样本相关系数ｒ＝０．９３２７，尿样本ｒ＝０．８９８２。结果提示：试验组血和尿β－ＨＣＧ含量与肿瘤细胞的分级有密切关系，含量越高，细胞分化越低，肿瘤预后越差。     

血和尿中人绒毛膜促性腺激素含量与膀胱肿瘤生物学行为的…

用放射免疫方法检测２１例膀胱肿瘤患者和同例数泌尿科非肿瘤患者血和尿中人绒毛膜促性腺激素含量。试验组血样本β－ＨＣＧ均值为１８．２３ＩＵ／Ｌ，对照组为６．６０ＩＵ／Ｌ，Ｐ〈０．０２５，试验组尿β－ＨＣＧ均值为４９．９ＩＵ／Ｌ，对照组为７．３４ＩＵ／ＬＯ，Ｐ〈０．０２５。     

体外冲击波碎石术对肾脏组织损伤的探讨

为了探讨体外冲击波碎石对肾脏功能及组织是否会造成损伤，笔者对４７例患者进行了治疗前后血肌酐（Ｃｒ）、血尿素氮（ＢＵＮ）和尿Ｎ－Ｚ－酰－β－葡萄糖苷酶（ＮＡＧ）、血β２－微球蛋白（β２－ＭＧ）的测定。发现Ｃｒ、ＢＵＮ属正常范围，在评价肾功能损害方面意义不大，而尿ＮＡＧ、β２－ＭＧ则明显升高（Ｐ＜０．０１）．提示肾组织有损伤。据此，笔者主张两次治疗期间隔应不少于１～２周，每次冲击次数以２０００次为妥、低能量、高冲击频率治疗较为安全。     

膀胱移行上皮细胞癌产生的β－HCG是疾病进展和抗放射治疗的标记吗？

膀胱移行上皮细胞癌产生的β－ＨＣＧ是疾病进展和抗放射治疗的标记吗？［ＭｏｕｔｚｏｕｒｉｓＧ，ＢｒＪＵｒｏｌ，１９９３；７２（６）：９０７］人绒毛促性腺激素（ＨＣＧ）对滋养层肿瘤和生殖细胞肿瘤是一种有用的标记。非滋养层肿瘤如肺癌、肝癌、胃癌、乳腺癌和尿...     

比较基因杂交及其在睾丸生殖细胞肿瘤遗传学研究中的应用

采用比较基因杂交（ＣＧＨ）检测了２例睾丸生殖细胞肿瘤及１例非睾丸疾病（前列腺癌）的睾丸组织，以研究ＣＧＨ在实体瘤的应用和睾丸肿瘤的分子遗传学特性。结果表明，ＣＧＨ具有其它遗传学方法所不具备的特点，如１ｐ３２－３６、Ｘｐ１２－２２放大的发现等。对ＣＧＨ方法的原理及意义进行了探讨。     

自然流产夫妇巨细胞病毒抗体测定的临床意义

目的：探讨自然流产病人ＨＣＭＶ抗体测定的临床意义。方法；用市售ＨＣＭＶ－Ｉｇ的间接ＥＬＩＳＡ试剂盒测定病人血清中的ＨＣＭＶ－Ｉｇ滴度。结果：４２例ＲＳＡ病人、３３例早孕对照组、３７例正常对照组ＨＣＭＶ－ＩｇＧ，ＨＣＭＶ－ＩｇＭ抗体测定结果为：１０倍稀释的血清ＨＣＭＶ－ＩｇＧ在３组标本中的检出率分别为８８．１％，８７．９％和８３．５％，血清ＨＣＭＶ－ＩｇＭ抗体检出率分别为８３．３％、６６．７％和６７     

IgM捕获酶联免疫吸附法诊断巨细胞病毒感染在肾移植中的应用

应用捕获酶联免疫吸附法检测人巨细胞病毒抗体，以诊断肾移植受者ＨＣＭＶ感染。共检测１０份供者血清、２０份受者术前血清及３７例受者术后血清。结果肾移植受者ＨＣＭＶ－ＩｇＭ的阳性率明显高于其它二组；肾移植受者１５份双血清ＩｇＧ有４倍以上增高，同时ＩｇＭ均为阳性。本法不受特异性ＩｇＧ的竞争和类风湿因子干扰，与同属其它病毒无交叉反应，具有特异性强、灵敏度高、重复性好、简便快速等优点，是检验ＨＣＭＶ－ＩｇＭ较     

TGF－β_1蛋白的表达对膀胱癌生物学行为的影响

应用ＴＧＦ－β_１放免分析方法对１８例膀胱移行细胞癌进行研究，并选取９例正常膀胱为对照。结果显示：膀胱癌组织中ＴＧＦ－β_１蛋白表达量显著高于正常膀胱粘膜（Ｐ＜０．００１）。分期Ｔ_１组和Ｔ_２组ＴＧＦ－β_１蛋白表达量显著高于Ｔａ组（Ｐ＜０．０５和Ｐ≤０．００５）。Ｇ３组ＴＧＦ－β_１蛋白表达量显著高于Ｇ_１组（Ｐ≤０．０５）。应用￣３Ｈ－ＴｄＲ掺入实验研究表明：ＴＧＦ－β_１在体外可促进ＴＢＣ－１系膀胱癌细胞的体外生长。本组结果提示：ＴＧＦ－β_１蛋白的表达对膀胱癌的生物学行为有重要影响，对评估膀胱癌预后有重要意义。     

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.     

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.