前列腺疾病诊断中血清游离态PSA指标的应用价值

目的探讨血清游离态ＰＳＡ（ＦＰＳＡ）和总ＰＳＡ（ＴＰＳＡ）及游离态／总（Ｆ／Ｔ）ＰＳＡ比值作为前列腺疾病诊断指标的价值。方法测定５６例未经治疗的ＢＰＨ病人和３９例前列腺癌病人血清ＦＰＳＡ和ＴＰＳＡ,并计算Ｆ／Ｔ比值。结果ＴＰＳＡ及Ｆ／Ｔ可有效区分ＢＰＨ和前列腺癌（Ｐ＜０．００５）,尤其在诊断灰区（ＴＰＳＡ为４．０～１０．０μｇ／Ｌ）中效果更明显。以ＴＰＳＡ≤１０．０μｇ／Ｌ,Ｆ／Ｔ≥０．１６为界值时,前列腺癌筛选的临床概率敏感度为９４．７％。结论ＦＰＳＡ和Ｆ／Ｔ比值的引入,使血清ＰＳＡ测定更为精细,保持了实验的高敏感度,尤其是在前列腺癌的诊断灰区     

F／TPSA在TPSA4—10μg／L之间的前列腺增和玫前列腺癌鉴别诊断中的 …

目的：探讨总前列腺特异性抗原（ＴＰＳＡ）与游离流列腺特异性抗原（ＦＰＳＡ）的比值在ＴＰＳＡ４－１０μｇ／Ｌ之间的良性前列腺增生（ＢＰＨ）和前列腺癌（ＰＣ）中鉴别诊断的意义，方法：采用放免法对２８１例病人的ＴＰＳＡ和ＦＰＳＡ进行测定，并计算Ｆ／ＴＰＳＡ，其中ＴＰＳＡ在４－１０μｇ／Ｌ的ＰＣ和ＢＰＨ病人分别是１０例和５１例，结果：ＰＣ组和ＢＰＨ组的ＴＰＳＡ分别是６．２２μｇ／Ｌ和６．０４μｇ／Ｌ，两组     

前列腺增生行电切术后其特异性抗原浓度变化的研究

目的：探讨良性前列腺增生（ＢＰＨ）病人行标准经尿道前列腺电切术（ＴＵＲＰ）后菜前列腺特异性抗原（ＰＳＡ）值的变化。方法；采用放射免疫法对６２例因ＢＰＨ而行标准ＴＵＲＰ的病人术前及术后３－４个月的ＰＳＡ进行测定。结果；ＰＳＡ值由术前的４．３μｇＬ降为１．８μｇ／Ｌ，平均减少５８％，前列腺体上术前的４６．５ｍｌ减少为２４．４ｍｌ，平均减少４８％，相当于每切除１ｇ前列腺组织，ＰＳＡ下降０．１１μ／Ｌ；术     

PSA密度对PSA浓度轻度长高且肛指检查正常的前列腺癌诊断的意义

目的：探讨血中前列腺特异性抗的（ＰＳＡ）浓度与前列腺体积的比值（ＰＳＡ密度，ＰＳＡＤ）对ＰＳＡ浓度在４－１０μｇ／Ｌ之间，肛指检查ＤＲＥ）下沉的衣性前列腺增生（ＢＰＨ）和前列腺癌（ＰＣ）鉴别诊断的意义。方法：地ＰＳＡ浓度４－１０μｇ／Ｌ、ＤＲＥ正常的１２例ＰＣ和１４例ＢＰＨ病人的ＰＳＡＤ进行回顾性分析。ＰＳＡＤ为ＰＳＡ浓度与前列腺体积的比值。结果：ＰＣ组和ＢＰＨ组的ＰＳＡ分别是６．２０μｇ／Ｌ和６     

PSA,PSAD诊断前列腺癌的临床意义

采用放射免疫分析方法测定２０例前腺癌病人的血清前列腺特异抗原（ＰＳＡ）和前列腺特异抗原密度（ＰＳＡＤ），以３８例前列腺增生症作为对照，评价二者对前列腺癌的诊断价值，探讨其与临床分期和病理分级的关系。结果ＰＳＡ界限值定为４μｇ／Ｌ时，其诊断敏感度为８５．０％，特异度为３９．５％，准确度为５５．２％。ＰＳＡ界限值为１０μｇ／Ｌ时，敏感度８０．０％，特异度７６．３％，准确度为７７．６％。用ＰＳＡＤ诊断前列腺癌，敏感度为８５．０％，特异度为７８．９％，准确度为８１．０％。结果显示ＰＳＡＤ可更有效地诊断前列腺癌。ＰＳＡ与临床分期成正相关，而ＰＳＡＤ与临床分期成负相关。ＰＳＡ与病理分级有一定关系。     

BPH并发与未并发急性尿潴留患者术前血清PSA对比观察

为了解前列腺增生症并发急性尿潴留与未并发发尿潴留者血清前列腺特异性抗原的变化，对２１例ＢＰＨ并发急性尿潴留及２４例ＢＰＨ未并发尿潴留者术前血清ＰＳＡ进行了对比观察。结果显示ＢＰＨ并发急性尿潴留组血清ＰＳＡ异常者占７６．２％，平均血清ＰＳＡ为１４．２μｇ／Ｌ，其中ＰＳＡ〉１０．０μｇ／Ｌ，占５２．４％。     

前列腺体积对前列腺特异抗原的影响

目的：研究前列腺特异怕（ＰＳＡ）与前列腺增生腺体体积的关系及其在前列腺癌（ＰＣａ）诊断中的价值。方法：７５例前列腺增生症（ＢＰＨ）患者根据其ＰＳＡ〉或≤４μｇ／Ｌ分为两组,另有２５例ＰＣａ患者,术后用放射免疫法测定血清ＰＳＡ《所有患者经Ｂ超测出前列腺体积,用ｔ检验和相关分析研究各组间的差异及相关性。结果：ＰＳＡ〉４μｇ／Ｌ的ＢＰＨ较之ＰＳＡ≤４μｇ／Ｌ者,腺体体积显著增大且ＰＳＡ和ＰＳＡ密度（ＰＳ     

PSA及PSAD测定对前列腺癌的诊断价值

应用双抗体夹心酶标免疫法对无选择性２０１例无明显良性前列腺增生（ＢＰＨ）症状的４５岁以上男性进行血清前列腺特异抗原（ＰＳＡ）及前列腺特异抗原密度（ＰＳＡＤ）测定，并以慢性前列腺炎１４例，ＢＰＨ已作前列腺切除１１例作为对照。结果发现：ＰＳＡ随年龄增大而增高，至７０岁以后未再继续增高。ＰＳＡ＞４μｇ／Ｌ者２２例，其中１１例在Ｂ超引导下作前列腺穿刺活检，１０例为ＢＰＨ，１例为前列腺癌。ＰＳＡ及ＰＳＡＤ对鉴别ＢＰＨ与前列腺癌价值不大，ＢＰＨ手术后ＰＳＡ逐步下降至正常     

游离与总PSA比值——一种前列腺癌检测的可靠指标

用放射免疫方法测定１１７例前列腺疾病患者血清游离ＰＳＡ（ＦＰＳＡ）、总ＰＳＡ（ＴＰＳＡ）值，并计算游离与总ＰＳＡ比值（Ｆ／Ｔ比值）。其中前列腺癌３１例，前列腺增生８６例。结果显示：Ｆ／Ｔ比值前列腺癌组明显低于前列腺增生组（Ｐ＜０．０１）。认为Ｆ／Ｔ比值可用于区别前列腺癌与前列腺增生，尤其当ＰＳＡ水平限定在４～１０μｇ／Ｌ范围内，应用Ｆ／Ｔ比值较ＰＳＡ为优     

血清PSA、f-PSAR与前列腺重量相关性研究

目的：探讨前列腺增生症（ＢＰＨ）人群中前列腺重量（ＰＷ）与血清前列划抗原（ＰＳＡ）、血清液离前腺特异抗原百分率（ｆ－ＰＳＡＲ）的相关性,方法：术前测定１４６例ＢＰＨ患者血清ＰＳＡ〈其中５１例测定了血清游离前列腺特异抗原值,对血清ＰＳＡ〉１０μｇ／Ｌ患者行前列腺穿刺活检以排除前列腺癌,术后对前列腺手术标本进行称重,并按〈２５ｇ,２５￣５０ｇ、５１￣７５ｇ、〉７５ｇ分为４组,均经病理证实为ＢＰＨ,对忾     

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.     

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.     

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.     

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.