急性单纯性阑尾炎抗生素使用的策略及其价值的临床观察

目的:探讨对于急性单纯性阑尾炎患者抗生素使用策略及其临床价值。方法:选取2016年2月1日—2019年2月1日我院普外科所收治的60例急性单纯性阑尾炎患者,随机分成对照组(行阑尾切除手术治疗)和观察组(使用抗生素类的药物治疗),每组30例,比较治疗前后两组临床相关指标、临床疗效及并发症发生情况,比较治疗前后两组白细胞计数、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平。结果:观察组体温恢复正常时间、下床活动时间与住院天数均明显短于对照组(P<0.05),疼痛缓解所需时间两组无显著差异(P>0.05);对照组临床治愈率为93.33%(27/30),高于观察组76.67%(23/30)(P<0.05);观察组治疗后并发症发生率为6.67%(2/30),低于对照组的13.33%(4/30)(P<0.05);治疗前两组白细胞计数及炎性因子水平无差别(P>0.05),治疗1周后观察组白细胞计数、IL-6、TNF-α、CRP水平分别为(8.07±0.82)×109/L、(27.66±4.85)ng/mL、(1.48±0.33)mg/L、(60.54±12.87)mg/L,较对照组低[白细胞计数、IL-6、TNF-α、CRP水平分别为(10.14±0.96)×109/L、(49.78±5.37)ng/mL、(2.21±0.41)mg/L、(91.32±13.16)mg/L](P<0.05)。结论:对于急性单纯性阑尾炎的患者使用抗生素治疗,虽存在一定的复发倾向,但能有效改善患者临床相关指标及降低并发症发生率,减轻患者炎性反应。     

不同治疗方法对移位型股骨颈骨折髋关节功能及相关细胞因子的影响

目的：探讨全髋关节置换术与动力髋螺钉内固定术两种治疗方法对移位型股骨颈骨折髋关节功能及对血清炎性因子和骨折延迟愈合生化指标的影响。方法：选取 2014 年 7 月—2016 年 7 月该院收治 100 例移位型股骨颈骨折患者的临床资料进行回顾性分析,将行全髋关节转换术患者 52 例做为观察组,行髋螺钉内固定术患者 48 例做为对照组,对比分析两组患者治疗前与术后 12 个月时髋关节功能改良 Aubigné-Postel 评分和并发症发生情况,及手术前与手术后 1 周血清白细胞介素 -6（IL-6）、肿瘤坏死因子 -α（TNF-α）、白细胞介素 -1β（IL-1β）等炎性因子、术后 12 周血清胰岛素样生长因子 -1（IGF-1）、人可溶性细胞间黏附分子 -1（sICAM-1）、血清可溶性血管细胞黏附分子 -1（Svcam-1）、Ⅰ型胶原羧基端肽β 特殊序列（β-CTX）等骨折延迟愈合生化指标水平。结果：术后 12 个月观察组髋关节功能改良 Aubigné-Postel 评分优良率（82.96%）明显高于对照组同期评分优良率（62.50%）,比较差异有统计学意义（P<0.05）;两组术后 12 个月,观察组并发症发生率 1.92%（1 例）,明显低于对照组 29.17%（14 例）,比较差异有统计学意义（P<0.05）;治疗前观察组IL-6、TNF-α、IL-1β 水平分别为（9.8±1.1）pg/mL、（2.3±0.4）ng/mL、（2.9±0.3）pg/mL,对照组分别为（9.9±1.2）pg/mL、（2.2±0.4）ng/mL、（2.8±0.3）pg/mL,比较差异无统计学意义（P>0.05）;治疗后 1 周,两组 IL-6、TNF-α、IL-1β 水平均明显上升,观察组分别为（11.1±1.3）pg/mL、（3.2±0.4）ng/mL、（3.2±0.4）pg/mL,对照组分别为（15.2±1.5）pg/mL、（5.5±0.5）ng/mL、（5.7±0.6）pg/mL,两组比较,观察组明显低于对照组,比较差异有统计学意义（P<0.05）;治疗前观察组血清胰岛素样生长因子 -1（IGF-1）、血清可溶性血管细胞黏附分子 -1（Svcam-1）、Ⅰ型胶原羧基端肽 β 特殊序列（β-CTX）分别为（207.2±44.1）ng/mL、（913.2±55.2）ng/mL、（458.6±32.5）pg/mL,对照组分别为（205.9±43.7）ng/mL、（908.6±54.7）ng/mL、（461.3±29.7）pg/mL,比较差异无统计学意义（P>0.05）;治疗后 12 周,观察组 IGF-1、Svcam-1、β-CTX 分别为（338.1±53.3）ng/mL、（611.3±44.6）ng/mL、（498.1±30.5）ng/mL,对照组分别为（411.6±65.8）ng/mL、（319.1±31.5）ng/mL、（526.4±41.3）pg/mL,两组 IGF-1、β-CTX 水平较治疗前明显上升,Svcam-1 水平明显下降,观察组变化幅度明显优于对照组,比较差异有统计学意义（P<0.05）。结论：全髋关节置换术对移位型股骨径骨折,引起的炎性反应较小,能明显降低术后并发症,具有较好的远期疗效。     

精浆中MIP-1α与TNF-α测定的临床意义

目的:观察巨噬细胞炎性蛋白1α(MIP-1α)与肿瘤坏死因子α(TNF-α)含量在男性不育患者精浆中的变化,以及对精子的影响。方法:应用酶联免疫吸附试验(ELISA)与放射免疫分析(RIA)方法分别对110例不育男性和30例生育男性精浆MIP-1α与TNF-α含量进行测定,并与精液中精子浓度、活力、活动率、白细胞含量和血液中抗精子抗体(AsAb)情况进行对比分析。结果:不育症组精浆MIP-1α与TNF-α含量[(179.45±24.54)pg/ml和(4.66±2.01)ng/ml]均明显高于生育组[分别为(89.64±13.27)pg/ml和(2.90±1.23)ng/ml],两者之间均存在显著性差异(P<0.01),而且以少精子症不育症组最为显著。精浆MIP-1α与TNF-α含量在不育症组的精子活力不良组[(196.04±23.54)pg/ml和(5.31±2.47)ng/ml]、活动率下降组[(210.39±21.43)pg/ml和(5.14±2.61)ng/ml]、WBC精液组[(203.14±24.65)pg/ml和(5.28±2.66)ng/ml]和血清AsAb阳性组[(234.05±27.60)pg/ml和(5.63±2.31)ng/ml]中均分别高于精子活力正常组[(154.22±26.38)pg/ml和(3.94±2.09)ng/ml]、活动率正常组[(139.87±27.62)pg/ml和(4.11±2.26)ng/ml]、非WBC精液组[(155.76±21.42)pg/ml和(4.04±2.24)ng/ml]和血清AsAb阴性组[(124.85±23.56)pg/ml和(3.69±2.15)ng/ml],两者之间均存在显著性差异(P<0.05或P<0.01),而且均以血清AsAb阳性组增高最为显著。结论:精浆MIP-1α与TNF-α含量与精子数量和功能之间密切相关,检测精浆MIP-1α与TNF-α含量可以判断男性不育症患者的状态,帮助临床进行有价值的治疗。     

经脐单孔腹腔镜治疗胃十二指肠溃疡穿孔的临床研究

目的:探讨经脐单孔腹腔镜修补术治疗胃十二指肠溃疡的疗效及其对机体炎症反应的影响。方法:选取2016年10月—2020年5月我院收治的胃十二指肠溃疡穿孔患者90例,采用随机数字表法分为单孔组(n=47)和多孔组(n=43),单孔组行经脐单孔腹腔镜胃十二指肠溃疡穿孔修补术,多孔组行传统多孔腹腔镜胃十二指肠溃疡穿孔修补术。比较两组患者手术情况、胃肠功能恢复情况及术后并发症发生情况;对比两组患者术前、术后1 d、术后7 d及术后14 d 降钙素原(PCT)、白细胞介素-6(IL-6)及总免疫球蛋白E(T-IgE)水平。结果:与多孔组比较,单孔组患者术后镇痛剂使用率(18.60% vs 4.26%)、住院时间[(8.54±1.68)vs(7.22±1.43)]明显降低(P<0.05),术后肠鸣音出现时间[(31.15±4.13)h vs(27.70±3.36)h]、胃肠功能恢复时间[(40.74±6.08)min vs(33.58±5.63)min]、首次排气时间[(51.73±6.68)vs(41.13±5.67)]及首次排便时间[(59.52±8.38)vs(46.48±7.12)]均显著缩短(P<0.05)。单孔组术后7 d、14 d,血清PCT、IL-6及T-IgE水平显著低于多孔组[术后7 d,PCT:(0.32±0.15)ng/mL vs (0.43±0.17)ng/mL,IL-6:(1.05±0.26)pg/mL vs (1.15±0.39 )pg/mL,T-IgE:(119.59±28.51)IU/mLvs(125.46±25.63)IU/mL;术后14 d,PCT:(0.27±0.11)ng/mL vs (0.37±0.19)ng/mL,IL-6:(0.94±0.41)pg/mL vs(1.06±0.32)pg/mL,T-IgE:(96.51±32.15)IU/mLvs(102.83±21.36)IU/mL],差异有统计学意义(P<0.05)。单孔组患者术后并发症发生率为2.12%,显著低于多孔组(13.95%),差异有统计学意义(P<0.05)。结论:经脐单孔腹腔镜修补术治疗胃十二指肠溃疡穿孔疗效显著,能有效缩短患者住院时间,降低患者术后并发症发生率,促进患者胃肠功能恢复,减轻机体炎症反应,具有较好的临床应用价值。     

中药穴位热敷对急性阑尾炎腹腔镜术后胃肠运动功能的影响

目的:探讨中药穴位热敷对急性阑尾炎腹腔镜术后胃肠运动功能的影响。方法:收集2017年10月—2020年10月本院通过腹腔镜手术治疗的165例急性阑尾炎患者,根据随机数字表法将其分为两组,对照组82例术后行常规治疗,观察组83例术后在常规治疗基础上予以中药穴位热敷治疗,对比两组中医症状评分、临床疗效、胃肠激素水平及患者胃肠运动功能恢复时间。结果:观察组治疗后腹胀评分是(1.52±0.36)分,纳差评分是(1.55±0.33)分,呕吐评分是(4.77±0.56)分,腹痛评分是(1.69±0.23)分,分别低于对照组的(2.19±0.35)分、(2.24±0.29)分、(2.13±0.22)分及(2.65±0.38)分,差异有统计学意义(P＜0.05);观察组总有效率是97.59%,高于对照组的89.02%,差异有统计学意义(P＜0.05);观察组治疗后胃泌素(GAS)是(154.26±7.21)pg/mL,胃动素(MTL)是(230.45±15.27)pg/mL,分别高于对照组的(138.41±7.62)pg/mL、(230.45±15.27)pg/mL,差异有统计学意义(P＜0.05);观察组首次排气时间是(19.86±4.58)h,首次排便时间是(32.76±4.64)h,肠鸣音恢复时间是(11.67±2.33)h,住院时间是(5.23±1.21)d,分别短于对照组的(19.86±4.58)h、(45.67±5.78)h、(18.34±3.65)h及(7.86±1.23)d,差异有统计学意义(P＜0.05)。结论:中药穴位热敷可有效提升急性阑尾炎腹腔镜术后胃肠运动功能干预效果及患者胃肠激素水平,并且有助于缩短患者胃肠运动功能恢复时间。     

CO2气腹对荷瘤大鼠IL-1β、IL-6和腹膜巨噬细胞功能的影响

目的采用种植性大鼠肝脏肿瘤模型观察CO2气腹对细胞因子和腹膜巨噬细胞功能的影响.方法荷瘤大鼠32只随机分为4组(n=8)对照组(仅麻醉)、开腹组、免气腹组和CO2气腹组.术后2、24 h收集血清,检测血清中的IL-1β、IL-6水平;术后48 h,收集培养腹膜巨噬细胞,检测巨噬细胞产生的TNF-α水平.结果术后2、24 h开腹组IL-6的水平分别为(57.92±2.06)pg/ml,(35.49±1.15)pg/ml,显著高于CO2气腹组(14.64±0.34)pg/ml,(15.39±0.86)pg/ml,免气腹组(24.75±1.53)pg/ml,(17.10±0.97)pg/ml和对照组(17.75±1.60)pg/ml,(14.55±0.25)pg/ml(P＜0.05).术后2 h开腹组IL-1β的水平为(92.63±4.81)pg/ml,显著高于CO2气腹组(57.94±4.46)pg/ml、免气腹组(58.48±3.20)pg/ml和对照组(58.99±2.30)pg/ml(P＜0.05).CO2气腹组腹膜巨噬细胞产生的TNF-α水平为(35.69±3.54)pg/ml,显著低于免气腹组(68.87±4.08)pg/ml、开腹组(82.96±5.39)pg/ml和对照组(66.45±7.96)pg/ml(P＜0.05).结论腹腔镜术后机体应激反应较小,CO2气腹可能抑制腹膜巨噬细胞的功能.     

隔药灸治疗术后早期炎性肠梗阻的疗效观察

目的:观察隔药灸治疗术后早期炎性肠梗阻的疗效及对血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的影响。方法:将78例术后早期炎性肠梗阻患者分为观察组和对照组各39例。对照组接受生长抑素(0.25mg/h连续滴注)治疗,治疗组接受天枢、大肠俞穴隔药灸治疗。7 d后观察主要症状、肠功能评分、CRP、TNF-α、IL-6水平,总结疗效。结果:观察组和对照组总有效率分别为92.31%、76.92%(P0.05),观察组治疗后肛门恢复排气时间、腹部症状缓解时间、肠鸣音恢复时间分别为(3.49±1.37)d、(3.68±1.03)d、(2.14±0.55)d,均分别短于对照组的(5.05±1.50)d、(5.85±1.68)d、(4.01±0.95)d,P0.05。治疗后观察组CRP、TNF-α、IL-6水平分别为(6.04±1.10)mg/mL、(60.05±5.12)ng/mL、(28.06±4.02)pg/mL,均低于对照组的(8.13±1.65)mg/mL、(73.11±6.93)ng/mL、(56.14±5.86)pg/mL,P0.05。结论:隔药灸能够明显改善术后早期炎性肠梗阻患者的症状,有效调节血清CRP、TNF-α、IL-6水平。     

小儿腹腔镜阑尾切除术与传统阑尾切除术创伤反应的对比研究

目的比较腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和传统阑尾切除术(open appendectomy,OA)治疗小儿阑尾炎创伤反应的差异。方法从2002年5月至2004年2月收治160例小儿阑尾炎,其中行LA69例,OA91例,术前和术后12h采血,应用酶链免疫吸附试验测定血清白介素6(IL-6)和C反应蛋白(CRP)水平。结果手术时间:LA组(33±15)min比OA组(45±9)min短(t=6·40,P<0·01);住院时间:LA组(4·3±1·5)d比OA组(6·6±1·2)d短(t=10·91,P<0·01)。术后切口感染:LA组1例(1·5%),OA组10例(11·0%),两者之间差异有统计学意义(χ2=4·19,P<0·05)。OA组IL-6术后较术前升高值明显高于LA组[(60±20)pg/ml比(28±8)pg/ml,P<0·01]。CPR在OA组术后升高值亦明显高于LA组[(83±11mg/L比(24±6)mg/L,P<0·01]。结论LA治疗小儿阑尾炎较OA手术时间短、创伤小、恢复快、并发症少。     

腹腔镜阑尾切除术对阑尾炎患者血清炎性因子和胃肠功能的影响

目的探讨腹腔镜阑尾切除术对阑尾炎患者血清炎性因子和胃肠功能的影响。 方法选取205年1月至2017年3月于本院接受阑尾切除术治疗的155例阑尾炎患者,根据手术是否引入腹腔镜分为观察组（85例）与对照组（70例）,观察组患者接受腹腔镜阑尾切除术治疗,对照组患者接受开腹阑尾切除术治疗,分析两组患者手术前后血清炎性因子水平和术后胃肠功能恢复指标。 结果两组患者术前血清α-肿瘤坏死因子（TNF-α）（t = 0.171、P = 0.865）、C-反应蛋白（CRP）（t = 0.556、P = 0.579）和淀粉样蛋白A（SAA）（t = 0.317、P = 0.752）差异无统计学意义。手术后,观察组患者血清TNF-α（t = 2.634、P = 0.009）、CRP（t = 6.140、P < 0.001）和SAA（t = 2.160、P = 0.032）显著低于对照组,差异均具有统计学意义。观察组患者手术时间显著长于对照组（t = 6.703、P < 0.001）,术中出血量（t = 14.168、P < 0.001）、术后肠鸣音恢复时间（t = 3.859、P < 0.001）、术后肛门排气时间（t = 3.374,P = 0.001）、术后肛门排便时间（t = 2.994、P = 0.003）和术后住院时间（t = 6.917、P < 0.001）均显著低于对照组,差异有统计学意义。 结论与开腹阑尾切除术相比,阑尾炎患者腹腔镜阑尾切除术后血清炎性因子水平下降更显著,胃肠功能恢复更快。     

基于中医特色快速康复外科理念探讨腹腔镜胆囊切除术围手术期护理干预效果

目的:评价基于中医特色快速康复外科理念探讨腹腔镜胆囊切除术围手术期护理的干预效果。方法:选2018 年7 月—2019 年6 月期间本院肝胆科收治的行腹腔镜胆囊切除术的胆囊结石或胆囊息肉患者120 例,随机分成3 组,最后完成治疗及随访者114 例,其中观察组37 例(基于中医特色快速康复外科护理),对照1 组38 例(传统常规护理),对照2组39 例(快速康复外科护理)。比较3 组患者术前30 min 口渴情况,术后首次下床活动时间,术后首次排气时间,术后住院天数及术后相关并发症情况,检验并比较3 组术前1 天、术后第2 天的血清C 反应蛋白(CRP)及白细胞介素-6(IL-6)水平。结果:患者术前总口渴率观察组10.81%,对照2 组7.69%,均低于对照1 组的31.58% ;观察组患者首次排气时间(23.32±7.47) h、术后住院天数(2.31±1.03) d,少于对照1 组(31.95±10.38) h、(3.71±1.93) d,及对照2 组(27.21±8.56) h、(2.86±1.26) d,观察组首次下床活动时间(6.52±1.24) h,对照2 组(6.87±1.91) h,均早于对照1 组(11.65±5.78) h。术后观察组患者CRP(19.21±7.76) mg/L,IL-6(11.39±2.76) pg/mL,均低于对照1 组(28.36±11.35) mg/L、(15.49±5.77)pg/mL,及对照2 组(23.12±8.35) mg/L、(13.01±3.98) pg/mL。3 组患者术后胆漏、穿刺处皮下出血或感染、腹腔感染等术后并发症差异均无统计学意义(P >0.05)。结论:基于中医特色快速康复外科理念的腹腔镜胆囊切除术围手术期护理干预,提高患者围手术期舒适度,加快术后恢复,具有一定的临床应用价值。     

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.