低温对缺血预调心肌保护作用的影响

目的:为确定体外循环心脏直视手术时应用"缺血预调"(IPC)的可能性,分别在两部分实验中研究了(1)IPC对长时间低温缺血心肌的保护作用.(2)IPC期间心肌低温对IPC诱导心肌保护作用的影响.方法:建立离体灌注的大鼠工作心脏模型,稳定后施行不同的预调方案,进而缺血停搏.在预调处理前和缺血再灌注后两次测定工作心脏的主动脉流量(AF).在第一部分研究中,离体心脏在18℃低温条件下缺血60分钟,IPC方案为1b组:5分钟缺血+5分钟再灌注(5×1);1c组:5分钟缺血+5分钟再灌注,反复2次(5×2);1d组:5分钟缺血+5分钟再灌注,反复3次(5×3).1a组为对照组,缺血前不施行预调处理.在第二部分研究中,离体心脏在37℃条件下常温缺血15分钟,实验组(包括6组:Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ和Ⅶ组)的预调方案均为5×1,但IPC期的心肌温度不同,其中:Ⅱ组为37℃,Ⅲ组32℃,Ⅳ组27℃,Ⅴ组22℃,Ⅳ组17℃,Ⅶ组12℃.Ⅰ组为对照组,缺血前不施行预调处理.结果:在第一系列研究中,对照组的主动脉流量(AF)仅恢复到缺血前的2.7%.预调各组的AF恢复程度显著提高,与对照组比较1b组为22%(P＜0.01),1c组为34%(P＜0.0,1d组为14,9%(P＜0.05).5×2的预调方案具有最强的心肌保护作用.在第二系列研究中,预调期温度高于22℃的各组AF恢复程度显著提高.其中Ⅱ组为76%,Ⅲ组70%,Ⅳ组71%,Ⅴ组62%.而对照组AF恢复不足20%(Ⅱ、Ⅲ、Ⅳ、Ⅴ组与对照组比较,P＜0.05),Ⅵ组和Ⅶ组的AF恢复值与对照组比较差异均不显著,表明IPC期心肌温度低于22℃时,无心肌保护作用.结论:无论在常温或低温(＞22℃)条件下进行缺血预调均有显著的心肌保护作用,IPC有可能应用于改进体外循环合并中度低温时心脏手术的心肌保护.     

吡那地尔预处理对体外循环犬心肌的保护效果

目的 探讨ATP敏感性钾通道开放剂(KCOs)吡那地尔(Pinacidil)药物预处理对常温及低温犬体外循环(CPB)晶体高钾停搏液间断灌注心肌的保护效果。方法 18条犬随机分为三组,每组6条,分别建立犬的常温及低温CPB全心缺血Pinacidil预处理模型。对照组(A组):低温CPB,主动脉根部灌注4℃St.Thomas停搏液(K~+16mmol/L)10ml/kg,阻断30min复灌一次(1/2首量);B组:常温CPB,主动脉根部灌注37℃含氧Pinacidil液(0.083mg/kg);C组:低温CPB,主动脉根部灌注液同B组。三组心脏均接受60min缺血和30min再灌注。阻断主动脉前,开放后15min、30min测血液动力学改变;并循环5min,阻断循环30min、60min及开放循环20min于左心室取心肌组织,测定心肌腺苷酸含量。结果 再灌注期间C组的血液动力学指标明显好于A、B组(P<0.01),而B组又较A组好(P<0.01)。缺血及再灌注期间C组心肌的ATP含量也明显高于A、B组(P<0.01),B组又高于A组(P<0.01)。结论 Pinacidil预处理时对CPB下缺血心肌具有良好的保护效果,低温的效果优于常温。     

常温缺血预处理对幼兔未成熟心肌的保护作用

目的研究常温缺血预处理(IP)对幼兔未成熟心肌的保护作用。方法将24只幼兔分为四组。组1IP1次;组2IP2次;组3IP3次;对照组。应用Langendorff心脏灌注方法,对3～4周龄幼兔离体心脏实施不同次数的5分钟缺血、5分钟再灌注的常温IP,常温缺血45分钟,再灌注30分钟。于平衡灌注末、缺血前、再灌注3分钟、5分钟、10分钟、20分钟和30分钟分别测定左心室发展压(LVDP)、左心室最大上升及下降速率(±dp/dtmax),再灌注末测定心肌组织三磷酸腺苷(ATP)含量、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。结果再灌注30分钟时,组1和组2LVDP、+dp/dtmax恢复率显著高于对照组（P<0.05,P<0.01）,组3LVDP、±dp/dtmax的恢复率与对照组比较差别无显著性意义。再灌注末组1、组2和组3心肌ATP含量显著高于对照组（P<0.05）。组2MDA含量显著低于组1、组3和对照组（P<0.05）。结论IP对未成熟心肌具有保护作用,其中2次IP的保护作用最好,而3次的保护作用减弱,表明IP对未成熟心肌的保护作用具有饱和效应和累计现象。     

维拉帕米和三七总皂甙对犬心肌的保护作用

目的:应用犬低温体外循环灌注模型,评价在心停跳液中添加维拉帕米或三七总皂甙的心肌保护作用。方法:实验犬24只,随机分为4组(只数=6)。A组为冷钾停跳液组,B组为A组 维拉帕米(0.5mg/L),C组为A组 三七总皂甙(50mg/L),D组为A组 三七总皂甙(150mg/L)。心脏缺血停跳前、缺血停搏90分钟和再灌注30分钟分别测定心功能指标,超氧化物岐化酶(SOD)和脂质过氧化物丙二醛(MDA)的生成,磷酸肌酸激酶(CPK)及其同功酶(CPK-MB)活力。在心肌缺血90分钟再灌注30分钟后取心肌组织行超微结构的检查。结果:心功能指标(MAP、LVP、 dp/dtmax)恢复比值,SOD及MDA生成,CPK和CPK-MB活力A组与B组、C组、D组比较有显著差异(P<0.01),其中B组、C组与D组比较有显著差异(P<0.01)。心肌超微结构的保护在A组最差,D组最好,B组、C组较好。结论:在停搏液中加维拉帕米或小剂量的三七总皂甙具有良好的心肌保护作用,加入较大剂量的三七总皂甙效果最佳。     

常温体外循环下常温充氧晶体和氧合血停搏液持续灌注的心肌…

对比研究常温体外循环下常温充氧晶体和氧合血停搏液持续灌注对阻断升主动脉后犬心肌的保护效果，１５只犬随机分三组，每组５只，即低温体外循环冷搏液间断灌注组；常温体外循环常温氧合血停搏液持续灌注组；常温体外循环常温充氧晶掏搏液持续灌注组。观察了阻断升主动脉前心肌超微结构，腺苷酸含量（ＡＴＰ、ＡＤＰ、ＡＭＰ）、脂质过氧化物、水含量及血流动力学的变化。结果显示，温血组和温晶组在阻断升主动脉１５分钟、５０分钟     

鞘内注射吗啡预处理激活大鼠δ、κ、μ受体致心肌保护

背景鞘内注射小剂量吗啡可产生与静脉注射吗啡相似的心肌保护作用,但鞘内注射吗啡预处理（IT—MPC）与缺血预处理（IPC）作用强度的差别还未知,IT-MPC是否由阿片类受体所介导也未阐明。因此,本实验比较IT—MPC与IPC作用强度差别并探讨阿片类受体的作用。方法80只SD大鼠麻醉后开胸,成功置入鞘内导管后随机分为13组（n=6—7）。IPC组接受3次5分钟缺血-5分钟再灌注的心肌IPC（阻闭左冠状动脉）,随之给予30分钟缺血-2小时再灌注诱导心肌缺血再灌注（IR）损伤。IT-MPC组按剂量不同分为4个亚组（分别是0．03、0．3、3及30μg／kg）,以3次5分钟注射-5分钟间停的模式平均注入鞘内,随之诱导IR损伤。静脉注射吗啡预处理组（IV-MPC）组经静脉给予吗啡300μg／kg,对照组鞘内给予10μl生理盐水。受体阻滞剂组选择在IT—MPC（3μg/kg）前分别给予选择性δ、κ、μ受体阻滞剂NTD、nor-BNI及CTOP,以评价阿片类受体亚型的作用。通过2,3,5-tripheny ltetrazolium染色,计算心肌梗死面积（IS）,即梗死心肌占缺血危险区（AAR）的百分比。结果与对照组相比,鞘内注射0．3～30μg／kg吗啡降低心肌IS,3组IS／AAR分别为33％±10％（0．3μg／kg）、29％±10％（3μg／kg）、29％±16％（30μg/kg）,对照组为53％±8％（P〈0．01）。IT-MPC降低心肌IS／AAR程度与IV-MPC（33％±6％,P=0．84）及IPC（22％±4％,P=0．41）相近。注射选择性受体阻滞剂后,由IT-MPC（3μg/kg）产生的心肌预处理效果降低（NTD＋IT-MPC,50％±9％：nor-BNI＋IT-MPc,43％±6％;CTOP＋IT—MPC,53％±9％;与对照组相比,P=0．14）。结论IT—MPC产生与IPC及IV—MPC相近的心肌保护作用,其机制涉及到δ、κ、μ受体。     

体外循环中心肌细胞膜蛋白巯基结合位置的自旋标记——ESR研究

探讨缺血再灌注损伤对心肌细胞膜蛋白巯基的影响,评价四种心肌保护方法的保护作用。方法运用电子自旋共振技术（ＥＳＲ）,研究体外循环中猫心肌细胞膜蛋白巯基结合位置的变化情况。结果在主动脉阻断期间和再灌注早期,各组Ｗ／Ｓ均显著减小,再灌注后期,各心肌保护组有不同程度恢复,其中未行心肌保护组减小最明显,常温体外循环温血停搏液持续顺灌组减小最小且恢复最佳。结论常温体外循环温血停搏液持续顺灌使心肌细胞膜蛋白流基得到最佳保护。     

上调miRNA-133a表达对心肌缺血再灌注损伤的保护作用

目的 观察上调miRNA-133a表达是否可改善缺血再灌注损伤后心肌损害及心脏功能.方法 建立活体大鼠心肌缺血再灌注损伤模型.将实验动物随机分为5组:(1)空白对照组(Sham组);(2)缺血再灌注损伤组(I/R组);(3)缺血再灌注损伤+miRNA-133a模拟物agomiR-133a组(I/R+ agomiR-133a组);(4)缺血再灌注损伤+阴性对照序列组(I/R+ scramble组);(5)缺血再灌注损伤组+生理盐水组(I/R+ NS组).于再灌注24h分别使用实时定量聚合酶链反应(Real-TimePCR)法检查心肌内miRNA-133a表达水平;经胸超声心动检查大鼠心脏功能;2,3,5-氯化三苯基四氮唑(TTC)染色检测心肌梗死以及TdT介导的dUTP缺口末端标记(TUNEL)检测心肌细胞凋亡.结果 I/R+ agomiR-133a组心肌内miRNA表达水平显著高于I/R组(P＜0.01).上调miRNA-133a表达水平可显著减少再灌注后心肌梗死面积[(37.0±3.1)％比(58.0±4.4)％,P＜0.01],抑制心肌细胞凋亡(38.4±6.0比15.7±5.2,P＜0.01),并改善心脏功能[LVEF:(64.8 ±2.9)％比(52.8±4.0)％,LVFS:(31.1±1.2)％比(25.2±0.8)％,P＜0.01].NS与scramble对再灌注后心肌损伤及心脏功能无显著影响.结论 上调心肌内miRNA-133a表达水平可显著减轻缺血再灌注损伤24h后心肌损害,并改善心脏功能.     

体外循环缺血-再灌注心肌肌钙蛋白I丢失与心功能障碍的关系

目的　探讨体外循环缺血 -再灌注心肌肌钙蛋白 I(Tn I)丢失与心功能障碍的关系。　方法　 12条雄性杂种狼犬 ,按体外循环升主动脉阻断时间不同分为两组 :组 (n=6 ) :主动脉阻断 2 5分钟 ;组 (n=6 ) :主动脉阻断 15 0分钟。分别于转流前、主动脉开放后 10分钟、30分钟、6 0分钟时测定动脉和冠状静脉窦血清 Tn I浓度 ,同时监测围术期冠状静脉窦血流量和血流动力学。　结果　再灌注后冠状静脉窦血清 Tn I浓度持续高于动脉血清 Tn I浓度 (P<0 .0 1) ,提示心肌丢失 Tn I。组 与组 比较 ,组 心肌 Tn I丢失水平更显著 ,且终止体外循环后心脏指数、每搏指数、左心室每搏作功指数均显著降低 (P<0 .0 5 )。　结论　体外循环缺血 -再灌注心肌 Tn I丢失程度与心功能障碍的发生密切有关 ,提示心肌细胞 Tn I丢失很可能是导致缺血后心肌功能障碍的分子基础之一。     

无创远程肢体缺血联合处理对大鼠肾脏急性缺血再灌注损伤的保护作用

目的 探讨无创远程肢体缺血联合处理对大鼠肾脏急性缺血再灌注损伤的保护及作用机制.方法 30只健康雄性SD大鼠,随机分为3组(每组10只):A组为假手术组(Sham组)、B组为缺血再灌注组(IR组)、c组为无创远程肢体缺血联合处理组(RIperC+ RIpostC组).再灌注24h测定血清中肌酐(cr)和尿素氮(BUN)含量,肾脏组织中髓过氧化物酶(MPO)活力、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活力并在光镜下观察肾脏组织形态学变化.结果 B组的Cr(429.52±29.08) μmol/L、BUN(39.05± 2.23) mmol/L、MPO(7.31±1.48) U/g、MDA (3.94±0.48) nmoL/mgprot均高于A组Cr(103.91±21.45)μmol/L(P＜0.001)、BUN(12.20±1.86) mmol/L(P＜0.001)、MPO(2.25±0.89) U/g(P=0.009)、MDA(1.95±0.29) nmol/mgprot(P=0.003);而SOD(4.03±0.38) U/mgprot低于A组SOD(6.819±0.68) U/mgprot(P=0.003).c组的Cr(244.85±40.30) μmol/L(P=0.002) 、BUN(23.48±1.80) mmol/L(P＜0.001)、MPO(3.65±0.73) U/g(P =0.045)、MDA(2.19±0.31) nmol/mgprot(P=0.006)均低于B组,而SOD(5.71±0.30) U/mgprot(P=0.003)高于B组.A组组织形态基本正常,c组组织形态学改变较B组明显减轻.结论 无创远程肢体缺血联合处理对肾脏急性缺血再灌注损伤有显著保护作用.其保护作用可能通过对肢体短暂的缺血再灌注激发了机体内源性的抗氧化能力,从而达到减轻肾脏的急性缺血再灌注损伤.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

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.