大鼠胚胎器官原基异种移植的形态与功能检测

目的 观察大鼠胚胎器官原基(后肾、胸腺)异种移植后的生长发育,作移植后肾、胸腺的形态检查,并检测移植后肾的功能.方法 取受孕第15天(E15)的Lewis大鼠胚胎后肾或胸腺分别植入Balb/c裸小鼠腹腔大网膜及肾包膜下,观察至移植术后第16周.移植术后第5周作移植后肾、胸腺的形态检查,并检测移植后肾的功能.结果 E15 Lewis大鼠胚胎后肾及胸腺在受体裸小鼠腹腔内发育增大明显,后肾伴有包裹性积液囊形成.移植后肾及胸腺行光镜和电镜检查可见发育完好的肾及胸腺的形态结构.移植后肾积液的肌酐、尿素氮浓度明显高于血清,但低于膀胱尿液中的浓度.后肾移植组双肾切除后的存活时间明显长于未作后肾移植组.至移植术后第16周,移植后肾出现萎缩硬化.结论 E15 Lewis大鼠胚胎后肾或胸腺原基异种移植至Balb/c裸小鼠,移植后肾及胸腺能够在宿主体内生长发育成近似正常器官的形态结构,移植后肾具有一定的泌尿功能.     

T细胞疫苗诱导大鼠同种异体肢体移植免疫耐受的实验研究

目的 探讨T细胞疫苗（TCV）诱导大鼠同种异体肢体移植特异性免疫耐受的作用。方法 制备受者Lewis大鼠针对供者DA大鼠的TCV，应用TCV，免疫正常Lewis大鼠共3次，每周1次。设TCV组和TCV未接种组，在接种前及接种后5d进行混合淋巴细胞培养（MLR）；设TCV组、CsA组和空白对照组，于接种后7d进行DA大鼠针对Lewis大鼠的同种异体肢体移植，在术后7d进行淋巴细胞毒检测，术后21d进行嵌合分析。结果 MLR显示，Lewis大鼠的脾细胞反应程度接种组显著低于未接种组（P〈0．01）；微量细胞毒测定显示，死亡细胞百分率在TCV组、CsA组、空白对照组3组比较性差异有统计学意义（P〈0．01）；嵌合分析显示经处理的Lewis大鼠脾脏，胸腺中检测出了DA大鼠源性的骨髓嵌合体。结论 T细胞疫苗可以抑制受者对供者的免疫应答；作为骨髓移植前预处理手段，T细胞疫苗接种后行吻合血管的骨髓移植成功地诱导出同种异体肢体移植嵌合耐受。     

深低温冻储在大鼠同种异体气管移植中免疫抑制作用

目的 探讨深低温冻储在同种异体气管移植中的作用。方法选择近交系Lewis大鼠自体气管移植（L-L组），及F344和Lewis行未冻储（F-L组）、冻储（CF-L组）同种异体气管移植，分别在术后2、7、30天观察各组移植段光镜下免疫排斥反应变化。结果①CF-L组在移植术后各时间点与F-L组相比较，炎细胞浸润程度及上皮下组织增殖相比显著降低（P〈0．05）。②CF-L组PBMC内γ-IFN表达量在术后2、7、30天均明显低于F-L组（P〈0．01）。③F-L组在移植术后2、7、30天，凋亡细胞计数均较L-L组和CF-L组高（P〉0．05）。结论深低温冻储可能通过调节同种异体气管移植术后Th型细胞因子的变化和移植物细胞凋亡，从而抑制了免疫排斥反应。     

直径2mm以下同种异体血管移植的实验研究

目的：探讨直径2mm以下同种异体血管移植的可行性。方法：随机选30只新西兰兔分成甲乙2组，每组15只。甲组移植低温贮存的同种异体股动脉15条，乙组采用移植自体动脉15条。结果：甲乙2组即刻通畅率分别为100％，术后5周～10个月内甲组通畅率86．1％，乙组为80％。2组组织学变化类似，无明显排异反应。结论：低温贮存的同种异体血管可做血管移植的代用品，而且取材方便，有一定的实用性。     

不同性别大鼠同种肾移植慢性排斥反应的比较

目的观察比较不同性别供体的移植肾慢性排斥反应。方法以雄性Lewis大鼠作受体，以雄、雌Fisher大鼠作供体，分为两组进行同种肾移植，建立大鼠同种肾移植慢性排斥反应动物模型。移植后每4周检测受者的24h尿蛋白、血肌酐、肌酐清除率；移植后24周处死受体大鼠，对移植肾进行显微镜检、免疫组化、核糖核酸酶保护测定等检测，对比两组数据评价供体性别对移植肾的影响。结果两组比较，第20周雄性供体组的24h尿蛋白（21．14±0．98）mg／24h、肌酐清除率（0．35±0．01），雌性供体组24h尿蛋白（24．15±2．38）mg／24h、肌酐清除率（0．33±0．02），具有明显差异，雌性供体组的肾功能明显严重受损。雄性供体组移植肾仅有低度间质纤维化和轻微的血管内膜增厚，肾小球硬化百分数（19．7±4．2）％，淋巴细胞CD5’数量（14．94-3．0），雌性供体组移植肾间质纤维化和血管内膜增厚更严重，肾小球硬化百分数（23．9±3．92）％，淋巴细胞CD5’数量（17．3±1．0），雌性供体组均高于雄性供者组，有统计学意义。雄性组TGF-B（0．01434-0．0031）和IL-6（0．0018±0，0024）的mRNA表达比雌性组TGF-B（0．0092±0．0018）和IL-6（0．000644-0．00022）高。结论在大鼠同种肾移植慢性排斥动物模型上，供体的性别对移植肾的功能和组织形态具有明显的影响。     

胰肾联合移植术: 附19例报告

摘要：目的 探讨胰肾联合移植术中药物的应用方法，以取得良好的术后效果。方法 19例胰肾联合移植受者，术中用药如下；以白蛋白（清蛋白）作为主要血管扩容剂，平均用量为1.5~2.0g/kg；电解质溶液输注量为30~50mL/kg；用异搏定（5mg/12h）、前列腺素E1 （100μg/12h）以减少移植器官的保存损伤；用生长抑素（3mg/12h）抑制移植胰腺外分泌功能。结果 19例受者移植胰腺通血后5~10min分泌含高淀粉酶（平均为20 800U/L）的胰液，供肾血管开放后2~10min，输尿管有尿液流出。术后2~4d肾功恢复，术后1.5h至9d停用胰岛素。结论 胰、肾联合移植术中合理应用白蛋白、血管扩张剂和生长抑素对移植胰、肾功能有良好作用。     

大鼠同种异体移植血管病变模型的建立

选择和建立合适的同种异体移植血管病变（AV）动物模型是开展AV研究的基础。我们采用近交系Lewis和乃44大鼠，建立降主动脉到腹主动脉AV模型，手术成功率高，为开展AV的研究提供了良好的平台。[第一段]     

大鼠全胰十二指肠肾脏整块联合移植

为适应胰肾联合移植（ＳＰＫ）发展的需要，在纯系Ｌｅｗｉｓ大鼠上建立ＳＰＫ模型，结果表明该术式切实可行，手术成功率在８２．６％，术后能长期存活，移植物血管通畅，从胰肾功能正常，胸腺外分泌引流入肠腔，尿路及代谢并发症发生率低，此模型可进一步用于ＳＰＫ有关的理论研究。     

经保存的大鼠胚胎后肾同种腹腔内移植模型的建立

目的建立胚胎后肾大网膜内移植大鼠模型,并探讨其在受者体内生长、发育情况。方法取孕16d(E16)和17d(E17)的SD大鼠胚胎,切取胚胎后肾,以组氨酸色氨酸酮戊二酸盐液(HTK液)保存3d,然后移植到切除单侧肾脏的成年SD大鼠的大网膜内,另设未经保存的E16胚胎后肾直接移植对照组。术后给予环孢素A皮下注射,术后3～4周后开腹观察器官形成情况;术后8周,切除受者自体肾脏,观察移植后肾的组织学形态,测定后肾功能。结果移植后3周,移植后肾肾单位、集合管及输尿管的结构正常,组织中少有淋巴细胞浸润,电镜显示移植后肾发育的肾血管球细胞及基底膜、近端肾小管、远端肾小管和集合管上皮细胞超微结构正常。移植后8周,移植后肾的湿重、体积、分泌尿量及内生肌酐清除率与对照组比较,差异无统计学意义(P>0.05)。结论E16、E17胚胎后肾大网膜内移植,并辅以环孢素A皮下注射,可以形成器官,并发挥功能。     

胰腺和肾脏在联合移植中排斥反应的比较

目的:比较胰腺和肾脏在联合移植中的排斥反应.方法:以大鼠同种异体胰肾联合移植为基础,对来自同一供体的联合移植的胰腺和肾脏排斥反应进行比较分析.结果:1.肾脏间质排斥反应出现较胰腺早.程度也较胰腺重,且以早期标本为著;2.胰肾血管排斥反应分级分布相似,无显著差异;3.胰肾间质排斥反应均早于血管出现,程度也较重     

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.