三种胸腰段骨折分类法的可信度和可重复性研究

目的:探讨并比较AO分型、Denis分类、TLICS评分分类系统在胸腰段骨折诊断中的可信度和可重复性。方法:选择临床及影像学资料(X线片、CT、MRI)完整的31例胸腰段骨折患者,将该31例患者的资料提供给6名骨科医生,分别采用AO分型、Denis分类、TLICS评分分类三种方法进行脊柱骨折分类。3个月后进行重复分类。采用加权Cohen′s Kappa系数评价观察者间可信度和观察者内可重复性。结果:AO分型、Denis分类、TLICS评分分类的观察者间平均Kappa系数分别为0.517、0.639、0.713;三种分类方法的观察者内平均Kappa系数分别为0.766、0.832、0.804。结论:三种胸腰段骨折分类方法比较,TLICS评分分类方法的可信度和可重复性较高,Denis分类方法次之,AO分型方法较差,前者更具临床实用价值。     

胸腰段骨质疏松性骨折严重程度评分评估系统与骨质疏松性骨折分型的可重复性与可信度

目的 对比分析胸腰段骨质疏松性骨折严重程度评分评估系统(TLOFSAS)与骨质疏松性骨折(OF)分型评估胸腰椎骨质疏松性椎体压缩性骨折(OVCF)的可重复性与可信度.方法 选取2017年8月—2019年5月于巴中市中心医院就诊的146例胸腰椎OVCF患者为研究对象.以TLOFSAS与OF分型为标准,由6位脊柱外科医师分别对每例患者的临床资料进行独立评价,2周后再次进行独立评价.收集评估结果,分别行观察者内可重复性及观察者间可信度分析,应用Kappa一致性检验分析TLOFSAS与OF分型的差异性.结果 6位医师使用TLOFSAS共进行1752(146×6×2)次评估,其中<4分876次,4分582次,>4分294次;不同观察者间平均评分一致性为77.4％,平均可信度κ值为0.76,同一观察者内平均评分一致性为79.6％,平均可重复性κ值为0.786.6位医师使用OF分型共进行1752次评估,其中1型224次,2型694次,3型644次,4型154次,5型36次;不同观察者间平均评分一致性为84.3％,平均可信度κ值为0.79;同一观察者内平均评分一致性为85.2％,平均可重复性κ值为0.796.采取TLOFSAS评估的患者手术选择率(90.62％,58/64)高于OF分型(85.29％,58/68),但差异无统计学意义(P>0.05).结论 TLOFSAS与OF分型评估胸腰椎OVCF均具有较好的可重复性和可信度,值得临床推广应用.     

胸腰椎损伤分类及损伤程度评分系统的初步评估

目的 评估胸腰椎损伤分类及损伤程度评分系统(TLICS)的可信度(Interobserver reliability)和可重复性(Intraobserv er reproducibility),及其对胸腰椎损伤治疗的指导作用.方法 2006年1月～2007年6月收治脊柱胸腰段骨折48例,均行胸腰椎X线、CT、MRI检查,根据TLICS系统进行评定,3个月后进行再次评估.使用Cohen加权Kappa系数(Unweighted Co hen kappa coefficients)对观察者问一致性和可重复性进行分析.结果 计算TLICS亚类Kappa系数位于中度和较高可靠性之间(0.43～0.72).TLICS系统可重复性的Kappa系数则位于中度和较高度可重复性之间(0.55～0.76).TLICS系统诊断准确率为95.1%,敏感性87.5%,特异性96.8%.结论 TLICS分类系统具有较高的可靠性和可重复性,使用简单,易于掌握,此方法对于胸腰椎损伤的评估较全面和准确,可以作为患者临床治疗选择的依据.     

胸腰椎损伤分类及损伤程度评分系统的评估及初步应用

目的评估胸腰椎损伤分类及损伤程度评分系统(thoracolumbar injury classification and severity score,TLICS)的可信度(interobserver reliability)和可重复性(intraobserver reproducibility),及其对胸腰椎损伤治疗的指导作用。方法2006年1月~2007年1月入院的胸腰段骨折患者38例,均行胸腰椎X线、CT、MRI检查,经过神经学查体将神经损伤状态分为:无损伤、神经根损伤、马尾神经损伤、完全性脊髓损伤(ASIA A)及不完全性脊髓损伤。对于不完全性脊髓损伤按照ASIA系统进行运动功能分级(ASIA B、C、D)。根据影像学检查将骨折形态分为:压缩型、爆裂型、减力及旋转型、牵张型;将后纵韧带复合体(posterior ligamentous complex,PLC)损伤分为:无损伤型、不确定型、断裂型。分6组医生根据TLICS系统进行评定,计算损伤程度评分,并根据评分决定其治疗方案。3个月后进行再次评估。使用Cohen加权kappa系数(unweighted Cohen kappa coefficients)对TLICS总评分、骨折形态分型、神经损伤分型、PLC损伤分型、最终治疗方案等观察项间的可信度和可重复性进行分析。根据TLICS评分选择治疗方法,评估此组病例的神经功能恢复情况、并发症发生情况。结果计算TLICS亚类(骨折形态、PLC损伤状态、TLICS总分数、治疗推荐),Kappa系数位于中度和较高一致性之间(0.46~0.73),针对神经损伤状态亚类的Kappa系数为0.93,为高度一致性,诊断可信度较高,2次可信度评估的Kappa值差异无统计学意义。以相同方法分析TLICS系统可重复性,Kappa系数也位于中度和较高度一致性之间(0.42~0.75),针对神经损伤状态的Kappa系数为0.94,为高度一致性。TLICS系统诊断准确率为95.3%,敏感性为87.6%,特异性为97.3%。38例患者中6例TLICS总分≤3的患者均选择非手术治疗;6例=4分的患者其中2例行非手术治疗,4例行手术治疗;26例≥5分的患者均选择手术治疗。无神经损伤的患者8例,均未手术;有神经损伤30例患者均行手术治疗,根性损伤6例,不完全脊髓损伤14,完全性脊髓损伤5例,马尾神经损伤5例,术后22例患者神经功能得到不同程度的恢复,恢复率为73.3%。术后无神经损伤加重,并发症发生率低。结论TLICS分类系统具有较高的可靠性和可重复性,且使用简单,易于掌握,此方法对胸腰椎损伤的评估较全面和准确,可以作为患者临床治疗选择的依据。     

2种胸腰椎骨折分型在不同专业医师中应用的可信度和可重复性研究

目的探讨胸腰椎骨折的Denis分型和胸腰椎损伤分类及严重程度评分（TLICS）分型系统在不同专业医师中应用的可信度和可重复性。方法分别由不同专科医师采用2种分型方法对85例胸腰椎骨折进行分类,间隔2个月后再次分型。分析2种分型的观察者间可信度和观察者内可重复性。结果按观察者间可信度,Denis分型的Kappa值在0．632～0．735,平均为0．661（基本可信）。TUCS分型具体分值的Kappa值在0．217～0．316,平均为0．273（轻中度可信）。TUCS的推荐治疗分类Kappa值在0．641～0．764,平均为0．704（基本可信）。按观察者内可重复性,Denis分型Kappa值在0．375—0．580,平均为0．459（中度可信）。TLICS分型具体分值的Kappa值在0．319～0．478,平均为0．380（轻中度可信）。TLICS的推荐治疗分类Kappa值在0．617～0．785,平均为0．724（基本可信）。结论胸腰椎骨折的Denis分型在各个专业医师中应用的可信度较好,仍有一定的临床价值。TLICS评分的推荐治疗分型在各个专业医师中的可信度与可重复性均更高,更有利于相互交流及指导治疗。     

胫骨平台骨折AO、Schatzker和Hohl and Moore分型的可信度和可重复性比较及意义

目的比较研究胫骨平台骨折AO、Schatzker和Hohl and Moore分型的可信度和可重复性。方法 4名不同年资的观察者对60例胫骨平台骨折按这3种分型方法进行分型,8周后再对打乱顺序后同一组患者再次分型,通过Kappa值和分型一致平均百分比进行可信度和可重复性分析。结果不同观察者对AO、Schatzker和Hohl and Moore 3种分型可信度评估的Kappa值分别为0.502、0.675、0.391,最后分型判断一致平均百分比分别为70.6%、87.9%、56.3%。同一观察者前后两个阶段3种分型可重复性的Kappa值分别为0.807、0.926、0.739,最后分型判断一致平均百分比分别为89.1%、94.8%、82.1%。结论这3种分型方法均不是理想的分型系统,但Schatzker分型在可信度和可重复性上明显优于AO和Hohl and Moore分型,易于掌握,更适合指导胫骨平台骨折的治疗。但是目前需要创建更精确的评估方法对骨折分型进行综合、全面的评估。     

退变性腰椎滑脱French分型和CARDS分型的可重复性与可信度研究

目的 :对退变性腰椎滑脱的French分型及CARDS分型进行可重复性与可信度的对比分析,探讨两种分型在退变性腰椎滑脱患者中的应用价值。方法:回顾性分析2012年1月~2016年6月期间118例腰椎退变性滑脱(L4/5 91例、L5/S1 27例)患者,其中男性26例,女性92例,平均年龄61.1±8.1岁。3名脊柱外科医师对患者术前X线片独自进行两次测量,分别使用French分型和临床与影像学分型(clinical and radiographic degenerative spondylolisthesis,CARDS分型)进行评估和分型,收集结果 ,作同一观察者间可重复性及不同观察者间可信度分析。应用Kappa值比较分析两种分型的差异性。结果:3位观察者使用French分型系统共进行708次(118例×3×2次)分型,包括1型261次,2型107次,3型83次,4型54次,5型203次,观察者内分型一致率80.5%~86.4%(Kappa值0.740~0.815),属于"基本可信";观察者间分型一致率为79.7%~82.2%(Kappa值0.728~0.758),属于"基本可信"。测量并分型单个患者平均花费时间约138s。CARDS分型系统共708次分型中,包括A型(A1)19次,B型(B1 90次,B2 59次)149次,C型(C1 291次,C2 108次)399次,D型(D1 98次,D2 43次)141次,观察者内总体一致率90.7%~93.2%(Kappa值0.878~0.911),属于"完全可信";观察者间总体一致率88.1%~94.1%(Kappa值0.844~0.921),属于"完全可信"。测量并分型单个患者平均花费时间约67s。结论 :两种分型系统具有较高的可重复性与可信度,CARDS分型可信度与可重复性优于French分型。     

强直性脊柱炎后凸畸形的301分型

目的 :建立强直性脊柱炎(ankylosing spondylitis,AS)后凸畸形新的分型方法———301分型,并对其可信度和可重复性进行检验分析。方法:根据后凸顶点位置不同将AS后凸畸形分为4种类型:腰椎型(Ⅰ型)、胸腰椎型(Ⅱ型)、胸椎型(Ⅲ型)及颈椎或颈胸交界型(Ⅳ型),除Ⅰ型外其他各型分为2个亚型:腰椎尚存在前凸为A亚型,腰椎出现后凸为B亚型。依据该分型方法对309例在我院接受脊柱截骨术治疗的AS后凸畸形患者进行分型,统计各型所占比例。由5位脊柱外科医生分别根据该分型标准对随机抽取的30例AS后凸畸形患者的影像资料进行分型,2周后此5位医生对打乱秩序的相同资料再次进行分型,收集分型结果,计算Kappa值检验一致性。结果:按照301分型方法将AS后凸畸形分为4型共7个亚型,309例患者中,Ⅰ型52例(16.8%);Ⅱ型223例(72.2%),其中ⅡA型153例,ⅡB型70例;Ⅲ型33例(10.7%),其中ⅢA型25例,ⅢB型8例;Ⅳ型1例(0.3%),为ⅣB型。观察者间可信度为73.3%~86.7%,Kappa系数为0.761~0.847,可重复性为83.3%~93.3%,Kappa系数为0.821~0.925。结论 :应用301分型方法对AS后凸畸形分型简单易行,其可信度和可重复性较好。     

下颈椎损伤分型评分系统的可信度及可重复性研究

目的 评价下颈椎损伤分型(SLIC)评分系统的可信度及可重复性. 方法 应用SLIC评分系统对2008年5月至2010年4月收治的54例下颈椎损伤患者的术前正侧位X线片、CT、MRI和体格检查等无标记的影像及病历资料进行分型并评判.4周后,打乱资料顺序再次分型并评判.全部资料均不带与分型和(或)评分有关的任何标记.通过计算平均百分比确定分型一致率,应用Kappa值、组内相关系数(ICC)判定可信度和可重复性. 结果 SLIC评分系统中损伤形态和神经功能状况评判有中、高度一致性,可信度平均分别为62.7％(Kappa=0.502,ICC=0.581)、69.7％ (Kappa=0.616,ICC =0.867),可重复性平均分别为71.8％(Kappa=0.631,ICC=0.746)、79.6％ (Kappa=0.735,ICC=0.871).椎间盘韧带复合体(DLC)损伤判定的一致性相对较差,可信度平均为55.8％(Kappa =0.317,ICC=0.483),可重复性平均为68.9％(Kappa=0.517,ICC=0.643).总分一致性的可信度平均为30.7％(Kappa=0.218,ICC=0.725),可重复性平均为44.5％(Kappa=0. 394,ICC=0.812).治疗选择的可信度平均为72.4％(Kappa=0.431,ICC=0.578),可重复性平均为78.8％(Kappa=0.581,ICC=0.759).结论 SLIC评分系统中损伤形态、神经功能状况及治疗选择的评判有较好的一致性.MRI对判定韧带损伤的不确定性是影响DLC损伤一致性评判的重要因素.     

脊柱侧凸胸椎椎弓根形态学分型系统的可信度与可重复性研究

【摘要】 目的：探讨脊柱侧凸胸椎椎弓根形态学分型系统在临床应用中的可信度与可重复性。方法：1998年1月~2009年1月手术治疗脊柱侧凸患者60例,术前均行胸椎CT扫描、椎弓根轴位薄层重建。根据椎弓根松质骨管腔的形态特征将脊柱侧凸胸椎椎弓根分为正常型、狭窄型、峡部硬化型、完全硬化型（包括凹陷硬化和平直硬化两个亚型）和缺如型。应用64排CT多层重建技术,测量、分析60例常见类型脊柱侧凸患者1440个胸椎椎弓根CT轴位扫描结果,由3位不了解本研究目的的脊柱外科高年资住院医师,在同一时间分别对1440个胸椎椎弓根CT轴位扫描结果进行分型。间隔1个月后,再次由这3位住院医师对这1440个椎弓根进行分型。应用Stata 10.0软件,运用多类别多评估者的Kappa分析方法进行统计学分析,评价观察者间的可信度及观察者内的可重复性。结果：3位医师之间首次分型结果相同的百分比分别为88%、84%、92%,可信度的Kappa系数分别为0.7647、0.6590、0.8292;同一医师前后两次分型结果相同的百分比分别为95%、97%、96%,可重复性的Kappa系数分别为0.9227、0.9513、0.9117。结论：脊柱侧凸胸椎椎弓根形态学分型系统具有中、高度的可信度和极好的可重复性。     

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.     

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.     

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.     

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.     

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.     

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.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.