TSRH器械在特发性脊柱侧凸中的应用

[目的]观察TSRH三维矫形系统矫正特发性脊柱侧凸冠状面、矢状面和轴状面的疗效,评价应用钉棒系统和钉钩棒系统随访时的效果。[方法]分析采用TSRH系统治疗特发性脊柱侧凸79例,男48例,女31例,平均15.5岁。全部应用椎弓根螺钉系统56例,胸椎应用椎弓根钩或椎板钩,腰椎应用椎弓根螺钉23例。对照分析2组的矫正效果。[结果]术后冠状位矫正为18~31°,矫正率为56%~87%,平均为68%,矢状位矫正为21~33°,平均25°,旋转矫正Ⅰ度。身高平均增高3 cm。63例平均随访2.5 a,2组冠状面和矢状面的矫正率以及冠状面矫正度的丢失有明显的差异。[结论]TSRH矫形系统治疗脊柱侧凸可得到满意的治疗效果,应用椎弓根螺钉效果更佳。     

椎弓根螺钉固定系统对特发性脊柱侧凸矫正效果的影响

目的:探讨经椎弓根螺钉固定对特发性脊柱侧凸矫正效果的影响。方法:66例特发性脊柱侧凸患者分别采用钩-棒、钩-钉-棒或钉-棒固定的方法进行矫正,对各组患者的一般情况、畸形程度、矫正效果和并发症进行分析比较。结果:各组在畸形程度、手术时间以及手术并发症等无显著性差异,椎弓根钉-棒固定组在冠状面和矢状面的矫正率和维持矫正效果均较钩-棒或钩-钉-棒固定组明显提高。结论:在不增加并发症的前提下,椎弓根螺钉固定可以提高特发性脊柱侧凸的手术矫正效果。     

置钉密度与Lenke1型青少年特发性脊柱侧凸矫正率的相关性

[目的]回顾性分析全椎弓根螺钉矫形治疗Lenke 1型青少年特发性脊柱侧凸矫正率与置钉密度间的相关性.[方法]2007～2009年,56例行后路全椎弓根螺钉矫形内固定的Lenke 1型青少年特发性脊柱侧凸患者纳入回顾性研究.测量术前、术后影像学资料,分析侧凸矫正率与置钉密度的相关性.[结果]所有患者无手术相关的严重并发症发生.主胸弯角度由术前平均53.4°±11.7°矫正为18.4°±10.5°(P<0.05),冠状面平均矫正率为66.8%.胸椎后凸由术前31.8°±4.39°降至22.3°±3.13°(P<0.05).平均置钉密度为1.56 (1.0～2.0).矢状面胸椎后凸的减小与冠状面Cobb角的矫正度数和矫正率明显相关(P<0.05).置钉密度与侧凸矫正率无相关性.[结论]椎弓根螺钉系统治疗胸椎特发性侧凸可以获得良好的冠状面矫形,但会造成矢状面胸椎后凸减小.置钉密度与侧凸的矫正率无相关性.     

椎弓根螺钉间隔置钉治疗特发性脊柱侧凸5年随访疗效分析

[目的]评估对具有良好柔韧性的特发性脊柱侧凸患者采用椎弓根螺钉间隔置钉三维矫形术后随访5年以上手术疗效。[方法]对51例侧凸角度<75°,柔韧度>40%的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉三维矫形,分析术前、术后即刻及末次随访时主弯侧凸Cobb角、顶椎旋转、冠状面平衡、矢状面平衡及手术时间、术中失血量、并发症等。[结果]主胸弯侧凸Cobb角由术前(53.6±6.6)°矫正为(15.8±7.4)°,末次随访为(17.7±6.1)°;顶椎旋转由术前(21.4±7.1)°矫正为(9.6±3.0)°,末次随访时为(11.0±3.3)°;冠状面C7铅垂线与骶正中线距离术前、术后即刻及末次随访分别为(-6.3±11.2)mm、(-3.7±8.0)mm、(-3.9±5.5)mm;矢状面C7铅垂线与S1椎体后上缘距离术前、术后即刻及末次随访分别为(-13.3±10.7)mm、(-2.1±5.2)mm、(-2.9±5.0)mm。患者侧凸Cobb角、顶椎旋转、冠状面及矢状面平衡术前、术后比较差异均有统计学意义(P<0.05),末次随访与术后相比差异无统计学意义(P>0.05)。术后2例内固定失败,3例出现远端延长现象,1例发生伤口表浅感染。术中平均失血量为825 ml,手术时间为155 min。与常规手术方式相比,本组患者椎弓根螺钉置钉数量减少52%。[结论]对于良好柔韧性的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉可获得良好的矫形效果,并具有缩短手术时间、减少术中失血、节省手术费用等优点。     

短钉多点锚定与钉钩混合系统矫治神经纤维瘤病脊柱侧凸的比较

[目的]比较后路短钉多点锚定与钉钩混合系统矫治Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的疗效。[方法]回顾性分析2005年～2017年手术治疗的Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸患者42例,其中,21例采用后路短钉多点锚定钉棒系统矫治,21例采用钉钩混合系统矫治。比较两组手术时间、出血量、融合节段数;影像测量冠状面Cobb角、顶椎偏距、顶椎旋转度、矢状面后凸。[结果]两组患者均顺利手术,均未出现神经、血管损伤等严重并发症。多点锚定组手术时间稍长、术中出血量稍多于混合系统组,但差异无统计学意义(P>005)。平均随访时间多点锚定组(39.75±20.06)个月,混合系统组(34.50±13.77)个月,两组患者一般情况好,患者外形、躯干平衡较术前明显改善。影像学评估方面,两组患者术后和末次随访时主弯冠状面侧凸Cobb角、顶椎偏距、顶椎旋转度、矢状面后凸Cobb角均较术前显著减少,差异有统计学意义(P<0.05)。多点锚定组在术后即刻和末次随访时的主弯冠状面Cobb角、顶椎偏距、顶椎旋转度均小于混合系统组,差异有统计学意义(P<0.05)。多点锚定组矫正丢失率为(2.20±2.21)%,而混合系统组为(3.57±1.40)%。[结论]对Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的矫治,短钉多点锚定与钉钩混合系统均可获得较满意的矫形融合效果,而短钉多点锚定的畸形矫正率更高,矫正丢失率更低。     

凸侧旋棒与凹侧旋棒矫正Lenke I型AIS至少2年随访效果评估

[目的]评估Lenke I型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)采用后路凸侧旋棒矫形与凹侧旋棒矫形至少2年的随访效果。[方法]收集本中心2008年7月~2011年7月间收治的Lenke I型AIS患者66例,平均年龄14.9岁,术前主弯均70°。按术中矫形技术分为凸侧旋棒组(32例)和凹侧旋棒组(34例),所有患者均具有完整术前、术后及术后2年的全脊柱正侧位X线片以及术前、术后CT平扫。研究分析两组病例的主弯Cobb角及其矫正率、T_(5~12)后凸角、顶椎偏移距离(apical vertebral translation,AVT)、C_7偏离骶骨中央垂线距离(coronal C_7 to centre sacral vertical line,C_7-CSVL)和C_7偏离骶骨后上角距离(the sagital C_7 to centre sacral vertical line,C_7-SSVL),置钉密度及置钉破壁率,并进行统计学比较。[结果]两组患者皆成功获得手术矫正,术中及术后2年随访无严重并发症发生;凸侧旋棒组和凹侧旋棒组的术前主弯Cobb角分别从平均(53.2±10.7)°和(51.2±10.8)°(P=0.455)矫正至术后平均(8.0±7.3)°和(12.9±7.0)°(P=0.008),平均矫正率为(86.2±12.7)%和(75.3±13.0)%(P=0.001);T_(5~12)后凸分别从术前平均(18.4±12.6)°和(23.2±19.3)°(P=0.248),矫正至术后平均(20.2±10.9)°和(21.8±8.9)°(P=0.533);术后冠状面和矢状面皆获得良好平衡。所有病例的凸侧和凹侧总椎弓根螺钉破壁率分别为1.2%和3.9%(P=0.162);凸侧旋棒组和凹侧旋棒组的总椎弓根钉破壁率分别为1.3%和3.2%(P=0.01)。[结论]青少年脊柱侧凸采用凸侧旋棒技术矫正是一种安全有效的方法,较凹侧旋棒矫形具有更好的侧凸矫形效果和置钉安全性;结合胸椎小关节松解、体内折弯和增加凹侧预弯棒角度有助于矢状面后凸的维持或矫正,且至少2年随访的矫形效果维持良好。     

后路半椎体切除器械矫正内固定治疗先天性脊柱侧凸

[目的]探讨后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸的临床疗效.[方法]2002年7月～2006年12月,后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸39例,男22例,女17例;平均年龄8.3岁(3～15岁).完全分节性半椎体30例,部分分节性半椎体9例.内固定器械包括ISOLA 16例、CD-Horizon 10例、MOSS-Miami 10例、TSRH 3例.术前后摄站立位全脊柱正侧位片,观察手术前后侧凸的矫正率及躯干平衡情况.[结果]术后随访1～4.5年,平均2.8年,术前冠状面Cobb's角平均48°,术后13°,末次随访平均13.2°,平均矫正率70.2%.矢状面Cobb's角术前平均39°,术后12.1°,末次随访12.7°,平均矫正率68.7%.所有患儿植骨融合牢固,躯干平衡良好.无神经系统并发症,无植入物折断及松动、无感染等并发症,1例出现曲轴现象.[结论]后路半椎体切除、器械矫正内固定对先天性脊柱侧凸是一种安全、有效的矫治方法.先天性脊柱侧凸应提倡早期手术矫治.     

连续置钉或间隔置钉矫治LenkeⅠ型青少年特发性脊柱侧凸的效果

目的:对比后路间隔置钉或连续置钉矫治LenkeⅠ型青少年特发性脊柱侧凸的效果。方法:将2004年1月～2006年6月期间收治的32例LenkeⅠ型青少年特发性脊柱侧凸患者随机分成两组,一组手术方法为后路矫形侧连续置入椎弓根螺钉进行矫形(连续置钉组);另一组手术方法为后路矫形侧均间隔一个椎体置入椎弓根螺钉进行矫形(间隔置钉组)。记录所有患者冠状面和矢状面的术前侧凸Cobb角、术后侧凸Cobb角、术后侧凸矫正率并进行两组间比较分析。结果:两组患者术中均无神经脊髓损伤。胸椎侧凸冠状面、矢状面Cobb角连续置钉组术前分别为62.7°±12.7°、28.3°±11.6°;术后分别为14.5°±6.9°、20.5°±10.7°;间隔置钉组术前分别为63.9°±10.9°、28.1°±10.8°,术后分别为14.7°±6.4°、21.0°±10.3°;连续置钉组和间隔置钉组术前C7铅垂线与S1椎体后缘的距离分别为-3.3±6.1cm、-4.4±4.8cm,术后分别为1.4±3.3cm、0.9±3.0cm。两组患者术前及术后冠状面、矢状面侧凸Cobb角及C7铅垂线与S1椎体后缘距离无统计学差异(P0.05)。结论:间隔置钉和连续置钉矫正LenkeⅠ型青少年特发性脊柱侧凸效果相比较无统计学差异。     

应用全椎弓根钉棒系统矫治青少年特发性脊柱侧凸32例体会

[目的]回顾分析应用全椎弓根钉棒系统矫治青少年特发性脊柱侧凸32例,通过主客观两方面评价术后疗效并浅谈体会.[方法]2005年4月～2009年4月,通过一期后路全椎弓根钉棒系统矫治32例青少年特发性脊柱侧凸患者,男20例,女12例,年龄12～18岁,平均14.3岁;双肩相对高度平均为2.5 cm;交界性后凸25例病人未在正常范围内;术前冠状面主凸Cobb角平均为59.5°(41.4°～89.7°);通过影像学检查对手术效果及躯干平衡情况进行分析,并记录术前、术后随访时cobb角,应用t检验进行统计学分析;主观评价指标应用脊柱侧凸SRS-22量表进行测试.[结果]所有患者术后平均随访26个月(24～48个月),双肩相对高度平均为0.5 cm,外形明显改善;术前交界性后凸未在正常范围内的25例病人,术后22例已恢复正常;术后冠状面主凸平均Cobb角为22.4°,平均矫正率为62%,按P=0.05为显著性检验水准将术前、术后随访时Cobb角进行t检验,P＜0.05,有显著性差异;应用脊柱侧凸 SRS-22量表进行测试,所有家属对手术效果均表示较满意.[结论]后路全椎弓根钉棒系统治疗青少年特发性脊柱侧凸,只要固定椎选择合理、椎弓根钉准确植入、同时掌握正确的转棒技术,就能获得满意的疗效.     

应用椎弓根钉棒系统矫治脊柱侧凸

目的探讨应用椎弓根钉棒系统矫正脊柱侧凸三维畸形的效果。方法应用椎弓根钉棒系统矫治特发性脊柱侧凸23例,年龄14～28岁,平均17岁;冠状面Cobb角38°~108°,平均62.46°,矢状面后凸角(T1～T12)-8°～60°,平均43°;旋转畸形Ⅰ～Ⅲ度。采用撑开、加压和旋转的方法对脊柱畸形进行矫正,最上达T2椎弓根水平。结果术中椎弓根螺钉一次置入成功率为96%,术中及术后均未出现脊髓损伤及神经功能障碍,术后Cobb角5°~42°,平均20°,平均矫正率71.06%。矢状面后凸角(T1～T12)5°～41°,平均24°。旋转畸形矫正Ⅰ～Ⅱ度。术后平均随访20个月,末次随访冠状面角度丢失率平均5.8%,无内置物松动及断裂现象。结论椎弓根钉棒矫形系统具备三维矫形能力,操作方便,用椎弓根钉连接矫形棒和脊柱增加了矫正力和稳定性。     

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.