前列腺体积参数与良性前列腺增生临床参数的相关性研究

目的　探讨前列腺体积参数与良性前列腺增生 (BPH)临床参数之间的相关性　方法　回顾性分析 80例资料完整的BPH行开放性手术患者的相关资料。　结果　前列腺体积 (6 7.8± 33.9)ml,移行带体积 (42 .8± 2 4.9)ml,移行带指数 (0 .6 199± 0 .140 0 ) ,前列腺症状评分 (2 5 .0± 5 .5 ) ,标本重 (42 .7± 2 5 .1)g ,PSA(4.0 5± 3.90 )ng/ml。手术标本重量与前列腺体积 (r=0 .872P <0 .0 0 1)、移行带体积 (r =0 .97P <0 .0 0 1)、移行带指数 (r=0 .44 9P <0 .0 0 1)呈显著正相关关系 ;PSA与前列腺体积 (r=0 .2 13P =0 .0 33)、移行带体积 (r=0 .2 2 4P =0 .0 17)、移行带指数 (r =0 .314P =0 .0 36 )呈正相关 ;IPSS与前列腺体积 (r=0 .0 10P =0 .72 5 )无相关 ,与移行带体积 (r=0 .314P =0 .0 36 )、移行带指数 (r=0 .32 1P =0 .0 0 1)呈正相关。尿潴留与非尿潴留组 :前列腺体积 (P >0 .0 5 )差别无显著性意义 ,移行带体积 (P <0 .0 5 )、移行带指数 (P <0 .0 5 )、PSA(P <0 .0 1)组间差别有显著性意义。　结论　前列腺体积参数中移行带体积、移行带指数与临床症状、梗阻程度关系密切 ,能更好地反映BPH的严重程度 ;移行带体积能较好预测增生腺体的大小 ;随着移行带指数增高 ,尿潴留的危险性相应增加。     

新疆维吾尔族人群雄激素受体基因CAG重复多态性与良性前列腺增生的关系

目的　初步探讨雄激素受体 (AR)基因CAG重复多态性与良性前列腺增生 (BPH)的关系。　方法　收集 80例维吾尔族BPH患者和 4 0例健康者外周血标本 ,应用PCR和直接测序法行AR基因CAG重复长度测定。分析评价CAG重复长度与BPH的关系。　结果　BPH组CAG重复次数范围 13～ 30 ,平均 2 2 .78。对照组CAG重复次数范围 14～ 2 9,平均 2 2 .38。两组比较差异无显著性意义 (P >0 .0 5 )。CAG重复长度 <2 2和≥ 2 2比较 ,其OR值为 1.0 6 (95 %CI 0 .4 6～ 2 .4 8,P >0 .0 5 )。CAG重复长度与BPH患者年龄 (γ =- 0 .0 6 ,P >0 .0 5 )、国际前列腺症状评分 (IPSS) (γ =0 .11,P >0 .0 5 )无相关性 ,而与前列腺的体积相关 (γ =- 0 .2 6 ,P <0 .0 5 )。在BPH患者 ,前列腺体积随着CAG重复次数的增加而减小 ,差异有显著性意义 (趋势检验P <0 .0 5 ) ,CAG重复长度≤ 2 0与≥ 2 5相比 ,前列腺体积差异有显著性意义 (P =0 .0 5 )。　结论　AR基因CAG重复长度与BPH腺体的增长有关。     

外周血雄雌激素水平及雄雌激素比与前列腺增生的相关性研究

目的:探讨外周血雄激素(T)、雌激素(E2)及雄雌比与前列腺增生(BPH)的相关性。方法:选取我院体检中心及泌尿外科2019年8月—2020年8月期间的体检人员(n=136)及BPH住院患者(n=61);收集并分析两组外周血T、E2、T/E2、PSA及前列腺B超。结果:随年龄的增长,雄激素(T)水平出现下降,与年龄表现低度线性负相关,其相关系数R=-0.11(|R|0.4);雌激素(E2)没有变化,趋势线几乎呈水平线。T/E2与年龄呈现低度线性负相关,其相关系数R=-0.15(|R|0.4);前列腺体积增大,与年龄变化表现为显著性线性正相关,相关系数R=0.56(0.4|R|0.7)。T与前列腺体积呈低度线性负相关,其相关系数R=-0.006(|R|0.4);E2与前列腺体积表现低度线性正相关,相关系数R=0.12(|R|0.4);T/E2与前列腺体积表现低度线性负相关,相关系数R=-0.18(|R|0.4)。BPH组与正常组E2水平之间差异无统计学意义(P0.05);BPH组与正常组对比,T和T/E2差异有统计学意义(P0.05)。结论:BPH患者与外周血T、E2及T/E2均存在相关性。     

前列腺假定圆面积比在评价膀胱出口梗阻中的意义

目的　分析经直肠超声 (TRUS)测定良性前列腺增生相关指标对诊断膀胱出口梗阻的意义。　方法　良性前列腺增生患者 78例。年龄 6 2～ 78岁 ,平均 (71.6± 5 .0 )岁。IPSS 18～ 2 8,平均 2 2 .0± 2 .2。应用TRUS测定前列腺体积的相关指标 ,同时行尿动力学检查并计算AG值。将年龄、前列腺体积、移行带体积、移行带指数 (TZI)、假定圆面积比 (PCAR)、IPSS等参数分别与AG值进行相关性分析。　结果　前列腺体积 (70 .0 2± 6 2 .10 )ml、移行带体积 (36 .33± 39.37)ml、TZI 0 .4 8±0 .15、PCAR 0 .72± 0 .10。最大尿流率 (Qmax) (8.2 5± 4 .2 1)ml/s、最大尿流率时逼尿肌压力(Pdet.Qmax) (83.2 8± 32 .5 6 )cmH2 O(1cmH2 O =0 .0 98kPa)。相关分析提示 ,TZI(r =0 .75 7,P =0 .0 15 )、IPSS(r =0 .6 93,P =0 .0 2 8)、PCAR(r =0 .80 6 ,P =0 .0 0 8)与AG值显著相关。多元回归分析结果显示 :TZI、PCAR为AG的相关因素 (复相关系数r =0 .95 2 ,决定系数r =0 .90 6 ,校正决定系数r =0 .86 9,P =0 .0 0 3) ,两者的标准化偏回归系数分别为 0 .4 4 0 (P =0 .0 18)和 0 .717(P =0 .0 14 ) ,PCAR对AG的影响强度约为TZI的 1.6 3倍。除外TZI的影响后 ,PCAR为ΔAG的独立相关因素(偏相关系数r =0 .883,P =0 .0 0 8)。     

性激素结合球蛋白介导前列腺细胞内cAMP激活的实验研究

目的 观察雌、雄激素对性激素结合球蛋白(SHBG)预处理的人前列腺细胞释放cAMP的影响,探讨SHBG在良性前列腺增生发病机制中的可能作用.方法 将新鲜前列腺组织标本修剪消化后行原代培养,密度梯度离心分离增生性前列腺上皮细胞和间质细胞,分别在WAJC404和RPMI 1640培养基中37℃,5%CO2条件下选择性培养.将不同浓度的雌二醇(E2)、双氢睾酮(DHT)与SHBG预处理过的前列腺细胞作用15 min,放射免疫法检测细胞内cAMP水平.对照细胞不经SHBG预处理.结果 0～100 nmol/L范围内,E2可以刺激SHBG预处理的人增生性前列腺细胞释放cAMP,50 nmol/L E2作用最强,其cAMP值为(6.72±0.23)pmol/μl,是基线值的3.57倍(P＜0.01),而E2和DHT对未经SHBG预处理的前列腺细胞均无刺激作用.雌激素拮抗剂三苯氧胺(Tam)不能抑制E2刺激SHBG预处理的前列腺细胞释放cAMP,Tam+E2组与E2组cAMP值分别为(1.83±0.21)、(1.85±0.24)pmol/μl,差异无统计学意义(P=0.15).0～100 nmol/L范围内,E2能刺激SHBG预处理的前列腺上皮细胞、间质细胞释放cAMP,间质细胞比上皮细胞的cAMP值升高更显著(P＜0.01).结论 SHBG可介导E2激活前列腺细胞内的第二信使系统,这种作用主要发生在间质细胞内,进一步可能协同雄激素通过间质上皮相互作用参与良性前列腺增生的发生.     

雄激素致去势大鼠前列腺增生的组织形态学研究

目的 :探讨前列腺增生大鼠前列腺的组织形态学改变。　方法 :采用SD大鼠去势后皮下注射丙酸睾酮法复制前列腺增生模型 ,用水取代法测量前列腺体积 ,苏木精 伊红染色观察前列腺增生组织结构 ,同时结合图像分析系统半定量检测前列腺增生内腺体、间质的形态计量学改变 ,并使用逐步引入剔出模型进行多元线性回归分析。结果 :与正常对照组比 ,模型组前列腺体积明显增大 (P <0 .0 1) ,腺腔扩张、间质增多 ;腺体面积、腺体相对总体积、单位体积内腺体平均直径、平均体积、平均表面积均明显增高 (P <0 .0 1) ,腺体数目、腺体数密度、腺体表面积 /腺体体积、腺体平均曲率显著减少 (P <0 .0 5～ 0 .0 1) ,体积密度无差异 ;间质面积明显减少 (P <0 .0 1) ,但间质相对总体积明显增加 (P <0 .0 5 )。回归分析结果 ,前列腺体积与腺体相对总体积和间质相对总体积呈明显正相关 (r分别为 0 .989和 0 .789,P均 <0 .0 0 1) ;前列腺体积与腺体平均体积呈明显正相关 (r =0 .82 4 ,P <0 .0 0 1)。　结论 :雄激素致去势大鼠前列腺增生以腺上皮增生为主 ,表现为腺腔的扩张 ,同时伴间质组织的增生     

良性前列腺增生与下尿路症状及急性尿潴留的关系

目的　探讨前列腺移行带增生与下尿路症状 (LUTS)及急性尿潴留 (AUR)的关系。方法　将 119例良性前列腺增生(BPH)患者按有无AUR及LUTS严重程度分为 3组 :无AUR但LUTS较重者为A组 ,有AUR且LUTS较重者为B组 ,有AUR但LUTS较轻者为C组。对各组行I PSS评分 ,测量F PSA、T PSA及F/T PSA ;耻骨上经膀胱切除前列腺时观察移行带向膀胱内突出情况及前列腺部尿道狭窄情况 ,术后测定移行带质量 (TZW ) ,计算移行带体积 (TZV)。结果　各组F/T PSA、TZW、TZV差别无统计学意义 (P >0 .0 5 )。A、B两组I PSS评分及前列腺部尿道狭窄百分比明显高于C组 (P <0 .0 5 ) ;A组F PSA、T PSA、移行带向膀胱内突出百分比明显低于C组 (P <0 .0 5 ) ,而B、C两组这 3项指标无明显差异 (P >0 .0 5 )。A组F PSA、T PSA明显小于B组 (P <0 .0 0 1) ,I PSS、前列腺部尿道狭窄及移行带向膀胱内突出百分比与B组无显著性差异 (P >0 .0 5 )。结论　前列腺移行带质量及体积与BPH引起的LUTS及AUR的发生无关 ;而移行带的增生使前列腺部尿道狭窄、延长是BPH引起的LUTS的主要原因 ;移行带向膀胱突出则是AUR的主要原因。BPH合并AUR的患者F PSA及T PSA均明显增高 ,F/T PSA变化则不明显。     

雄激素对大鼠腹叶前列腺GDNF mRNA表达的影响

目的 :探讨雄激素对大鼠腹叶前列腺中胶质细胞源性神经营养因子 (GDNF)mRNA表达的影响。　方法 :2 4只SD大鼠分为 3组 ,其中A组 (n =8)为假手术对照组 ,B组 (n =8)为去势组 ,C组 (n =8)为雄激素替代组 (去势后肌注十一酸睾酮 5 0mg/kg) ;术后 3d处死 ,通过半定量RT PCR检测GDNFmRNA在去势前后和雄激素替代组大鼠腹叶前列腺中的表达变化。　结果 :去势后大鼠前列腺的体积萎缩变小 ;雄激素替代组出现前列腺增生变大 ;对照组正常的大鼠前列腺有GDNFmRNA表达 ,去势组GDNFmRNA表达量减少 ,雄激素替代组GDNFmRNA表达量增加。与正常对照组比较 ,去势组的GDNFmRNA表达量显著减少 (P <0 .0 5 ) ,雄激素替代组的GDNFmRNA表达量显著增加(P <0 .0 5 )。　结论 :雄激素可增加GDNFmRNA表达 ,促进前列腺细胞生长。     

良性前列腺增生与前列腺癌患者血清总PSA水平与游离PSA比值的比较

目的　探讨血清总前列腺特异性抗原 (T PSA)水平及游离PSA比值 (F/T)在良性前列腺增生 (BPH)与前列腺癌 (PCa)鉴别诊断中的作用。　方法　对 10 3例PCa患者及 810例BPH患者T PSA及F/T值的差异进行分析比较。　结果　BPH患者血清T PSA <4、4～及 >10ng/ml者分别占 71.7%、2 2 .1%、6 .2 % ,PCa患者分别为 10 .7%、17.5 %和 71.8% ,两组间差别有极显著性意义 (P<0 .0 0 5 )。当F/T值 <0 .16时 ,两组患者血清T PSA <4及 4～ 10ng/ml的例数差别有极显著性意义 (P <0 .0 0 5 ) ;但T PSA >10ng/ml的患者 ,两组间差别无显著性意义 (0 .1

10ng/ml时 ,F/T值则无明显鉴别意义     

不同前列腺组织中睾酮及双氢睾酮含量测定的研究

目的　研究雄激素在前列腺增生症及前列腺癌发生中的作用。　方法　分别测定正常人、前列腺增生症患者以及前列腺癌患者血清和前列腺组织中睾酮 (T)及双氢睾酮 (DHT)的浓度。　结果　表明随着年龄增长 ,正常人血清中T水平逐渐下降而DHT浓度保持相对稳定。前列腺增生症或前列腺癌患者血清中两种雄激素浓度与正常对照组相比差异无显著性意义 (P >0 0 5 )。长期服用非那雄胺治疗的前列腺增生症患者血清中的DHT水平明显降低而T水平基本不变。各种组织中DHT的含量均为T的几十倍以上 ,前列腺增生症及前列腺癌组织中DHT的含量明显高于正常组织 (P<0 0 1) ,而各组之间组织中睾酮含量差异无显著性意义 (P >0 0 5 )。长期应用非那雄胺治疗前列腺增生患者组织中DHT的含量没有明显降低 ,而且不同部位增生组织中DHT的含量差异有显著性意义。　结论　前列腺增生症及前列腺癌组织中DHT的高浓度积聚与其发病密切相关 ,组织中DHT的积聚可能是由于前列腺局部 5a 还原酶增高所致 ,而且前列腺组织中可能存在着不止一种 5a 还原酶的作用。     

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.     

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.