老年维持性血液透析尿毒症患者死亡原因及相关因素分析

目的：探讨老年维持性血液透析尿毒症患者的死亡原因及其相关因素。方法：回顾性分析2003年1月～2007年12月在我院透析中心进行维持性血液透析的老年尿毒症患者118例,以死亡患者为研究组,存活患者为对照组,探讨两组患者原发病、合并疾病和死亡原因,临床指标包括透析前及透析3个月时血尿素氮和血肌酐、血红蛋白、红细胞压积、血浆白蛋白、总胆固醇、三酰甘油、血钙、血磷、甲状旁腺素。结果：（1）糖尿病肾病（38．1％）是主要病因,死亡组与对照组相比,两组原发病的构成比无统计学差异（P〉0．05）;（2）与对照组相比,死亡组患者存在合并症的比例更高（P〈0．05）;（3）47例死亡患者中死于心血管疾病20例（42．6％）,脑血管疾病11例（23．4％）;（4）与对照组相比,死亡组患者的年龄、透析开始时尿素氮和血肌酐水平、血磷、钙磷乘积显著高于对照组（P〈0．05）;而血浆白蛋白、总胆固醇、三酰甘油、透析3个月时的尿素氮和血肌酐水平显著低于对照组（P〈0．05）;（5）Logistic回归分析的结果显示年龄、糖尿病、低血浆白蛋白、低总胆固醇是死亡的独立危险因素。结论：在老年维持性血液透析尿毒症患者,心脑血管疾病是死亡的主要原因。年龄、糖尿病、低血浆白蛋白、低总胆固醇是老年维持性血液透析尿毒症患者死亡的独立危险因素。     

前白蛋白与维持性血液透析患者死亡的关系

目的探讨前白蛋白与维持性血液透析(MHD)患者死亡的关系。 方法回顾分析了2012年1月至2018年6月北京民航总医院行维持性血液透析(透析龄≥3月)的患者的一般情况、生化指标以及预后;以死亡患者为研究组,存活患者为对照组;以t检验、非参数检验、χ²检验将两组患者数据进行比较,并使用Logistic回归分析的方法分析与MHD患者全因死亡相关的危险因素。 结果①纳入研究患者325例,平均年龄(63.4±13.4)岁,透析龄64.0(41.5±98.5)月,存活组210例、死亡组115例,死亡原因主要包括感染(24%)、心血管疾病(17%)、脑血管疾病(16%)、恶液质(12%)、肿瘤(10%)等。②死亡组白蛋白、前白蛋白、血肌酐、尿素氮、血磷、全段甲状旁腺激素均明显低于存活组(P<0.05);CRP(Z＝－5.824)、透析龄(Z＝－2.827)及年龄(t＝7.672)明显高于存活组(P<0.05)。男性与女性的死亡率无明显差别(χ²＝0.274,P>0.05),糖尿病组与非糖尿病组死亡率具有明显差异(χ²＝7.230,P<0.05)。③多因素Logistic回归分析显示年龄、透析龄、是否合并糖尿病、白蛋白、前白蛋白与MHD患者死亡独立相关;白蛋白(OR＝0.854)及前白蛋白(OR＝0.983)是独立保护因素(P<0.05);增龄(OR＝1.046)、透析龄延长(OR＝1.012)、合并糖尿病(OR＝2.201)是独立危险因素(P<0.05)。④前白蛋白与白蛋白正相关(r＝0.609,P<0.001),前白蛋白与其他营养指标相关性比白蛋白强。 结论前白蛋白与白蛋白对MHD患者的死亡具有独立保护作用,在预测MHD患者死亡时至关重要。     

血磷对于维持性腹膜透析患者全因死亡风险的预测研究

目的:探讨血磷对维持性腹膜透析患者全因死亡风险的预测作用。方法:选取2014年01月～2018年12月在上海市交通大学附属第六人民医院集团维持性腹膜透析的患者266例。检测空腹血磷水平及一般生化指标,根据血磷水平将患者分为观察组138例(血磷≥1.6 mmol/l),对照组128例(血磷1.6 mmol/l),随访至2018年12月,记录全因死亡事件发生。分析两组间一般情况、生化结果的差异及与临床病理生理特征的关系,受试者工作特征曲线(receiver operating characteristic,ROC)分析血磷水平在腹膜透析中预测全因死亡事件的诊断价值,应用多元logistics回归模型评估发病风险。结果:共有266例腹膜透析患者入选,随访期间共发生全因死亡事件133例。观察组中发生全因死亡事件概率高于对照组,观察组患者的年龄、Hb、血糖水平低于对照组,IPTH、总铁结合力、ALB水平高于对照组,结果差异具有统计学意义(P0.05),ROC曲线分析显示,血磷水平在腹膜透析患者中评判全因死亡有统计学意义,曲线下面积(area under curve,AUC)为AUC为0.645(95%Cl:0.57～0.71,P0.001),灵敏度为86.4%,特异性为35.6%,预测全因死亡的诊断界值为1.26 mmol/l。校正传统危险因素后,多因素logistics回归分析显示,高血磷是腹膜透析患者发生全因死亡的高危因素,风险OR为1.23(1.02～4.63,P0.05)。结论:高磷血症是维持性腹膜透析患者发生全因死亡的独立危险因素。     

糖尿病肾病血液透析病人的护理

目的:探讨糖尿病终末期肾病(DN)患者在维持性血液透析中的特殊护理.方法:对糖尿病终末期肾病患者在维持性血液透析中进行心理、饮食、专科特殊护理.结果:以糖尿病为原发病的终末期肾衰患者患心脑血管疾病和感染性疾病发生率较高,其中脑出血死亡3例,心肌梗塞1例.继续维持性血液透析22例.结论:以糖尿病为原发病的终末期肾衰发病率逐年上升,其死亡率明显高于非糖尿病患者,因此,如何提高糖尿病肾病患者的透析质量,减少透析并发症,提高其生存率,是糖尿患者血良透析护理工作的难点及重点.     

维持性血液透析患者心血管并发症及防治对策

目的:探讨维持性血液透析患者发生不良心血管事件的危险因素.方法:选取2010年12月～2011年12月于我科维持性血液透析患者70例.根据不良心血管事件确认标准分为有心血管疾病组45例,无心血管疾病组25例.记录两组患者年龄、性别、原发病、透析龄;同时记录血生化指标:血尿酸、血红蛋白、血浆白蛋白、总蛋白、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血钙、血磷、钙磷乘积、全段甲状旁腺素(iPTH)、25 -(OH) D3、碱性磷酸酶、尿素氮、肌酐水平.结果:有心血管疾病组年龄、透析龄明显高于无心血管疾病组(P＜0.01);有心血管疾病组患者血尿酸、血钙水平高于无心血管疾病组(P＜0.05),而血25- (OH)D3水平在有心血管疾病组明显低于无心血管疾病组(P＜0.01);二分类Log istic回归分析显示年龄、透析龄、低密度脂蛋白、钙磷乘积、25-(OH)D3、血尿酸是血液透析患者发生不良心血管事件的重要危险因素.结论:心血管疾病是血液透析患者常见的并发症之一,年龄、透析龄、低密度脂蛋白、钙磷乘积、25- (OH)D3、血尿酸是血透患者发生不良心血管事件的重要危险因素.     

单中心维持性血液透析患者死亡原因的危险因素分析

目的:分析维持性血液透析(maintenance hemodialysis,MHD)患者死亡的主要原因以及心脑血管疾病死亡的危险因素。方法:回顾性分析1997年1月1日～2017年1月31日在上海交通大学附属第一人民医院行MHD患者的临床资料,其中病史完整的MHD死亡患者106例,采用Logistic回归分析MHD患者心脑血管疾病死亡的危险因素。结果:106例死亡患者中有59例(55. 66%)死于心脑血管疾病,14例(13. 21%)死于营养不良,13例(12. 26%)死于感染,10例(9. 43%)死于肿瘤,10例(9. 43%)死于其他。对年龄、体重指数(BMI)及血液检查指标血红蛋白、尿素氮、肌酐、钙、磷、白蛋白、三酰甘油、总胆固醇、低密度脂蛋白、高密度脂蛋白等因素进行Logistic回归分析结果显示,血磷(OR=0. 436,95%可信区间0. 202～0. 941,P=0. 034)和总胆固醇(OR=0. 347,95%可信区间0. 151～0. 795,P=0. 012)是MHD患者心脑血管疾病死亡的危险因素。结论:MHD患者死亡的主要原因是心脑血管疾病,其次是营养不良、感染以及肿瘤。控制MHD患者的血磷和总胆固醇水平,有助于降低MHD患者心脑血管疾病的死亡率。     

单中心血液透析患者的死亡原因分析

目的 探讨本院血液透析患者死亡情况及原因,以改善血液透析患者的预后,提高其生存率,为以后透析患者的临床诊治提供依据。方法 收集2012年1月1日至2017年12月1日在本院透析中心登记的血液透析死亡患者的临床资料,分析死亡患者人数、年龄、透析龄、原发性肾脏病类型、死亡原因。结果 共纳入死亡人数113例,中位透析龄11.7个月。死亡原因分别为:心脑血管疾病(46例)、感染(13例) 、肿瘤晚期(4例)、其他原因(7例)。不同透析龄的死亡患者中,透析龄较短的患者贫血较重、白蛋白较低。结论 本中心血液透析死亡患者生存期较短,死亡患者中小于1年的透析龄患者比例最大。主要死亡原因是心脑血管疾病和感染。积极纠正贫血、改善营养状态可能有助于提高患者早期生存率。     

血液透析患者血清FGF23水平的影响因素及其与矿物质骨代谢异常的关系研究

目的分析维持性血液透析患者血清成纤维细胞生长因子23(FGF23)水平的影响因素,并探究其与矿物质骨代谢异常及血管钙化的关系。 方法2018年1月至2月期间纳入在南方医科大学附属东莞市人民医院进行维持性血液透析3个月以上患者380例,记录其性别、年龄、透析龄、透析充分性及降磷药物使用情况。透析前抽取血清检查钙、磷、全段甲状旁腺素(iPTH)及碱性磷酸酶等矿物质骨代谢指标,以及血红蛋白、白蛋白、血糖、血脂、血清超敏C反应蛋白(hs-CRP)、血清β2微球蛋白等指标。使用酶联免疫吸附法(ELISA)检测血清FGF23,多层螺旋CT进行冠状动脉钙化评分(MSCT)。采用t检验和卡方检验对维持性血液透析患者FGF23的影响因素进行单因素分析,之后使用多元线性逐步回归方法进行多因素分析。 结果本中心维持性血液透析患者血清FGF23中位数水平为8 905.3 ng/L,根据患者的FGF23水平50%中位数将患者分为低水平组(组1)和高水平组(组2)两组。单因素分析结果表明,透析龄、每次透析时间、透析超滤量及使用非含钙降磷药物和透析频次为FGF23水平的影响因素。透析龄更大,每次透析时间长,每周透析次数多、透析超滤量大的患者FGF23水平更高(均P<0.05)。在FGF23水平高于中位数的患者中,尿素氮、血肌酐和血清β2微球蛋白水平更高(均P<0.05)。多元线性回归分析显示,透析龄长和血肌酐升高是FGF23升高的危险因素(均P<0.001)。同时,高FGF23水平与血清钙、血清磷、iPTH水平和高冠状动脉钙化评分相关。 结论透析龄、每次透析时间、透析超滤量、透析频次、尿素氮、血肌酐、血清β2微球蛋白水平与维持血液透析患者FGF23升高有关。透析龄长和血肌酐高是FGF23升高的危险因素。FGF23与维持性血液透析患者矿物质骨代谢和冠状动脉钙化明显相关。     

维持性血液透析患者系统免疫炎症指数与衰弱的相关性分析

目的:探讨维持性血液透析患者衰弱和系统免疫炎症指数(SII)的相关性分析。方法:收集于山西医科大学第一医院肾内科规律血液透析患者共127例，根据衰弱筛查量表进行评分，并根据评分将患者分为无衰弱组、衰弱前组和衰弱组。收集患者的一般资料，包括年龄、性别、体重、体质指数、透析龄等，以及生化指标，包括血红蛋白、白蛋白、前白蛋白、尿素氮、血肌酐、总胆固醇、低密度脂蛋白、三酰甘油、中性粒细胞计数、血小板数、淋巴细胞计数等，计算得到SII。分析比较三组间的差异，衰弱发生的影响因素以及SII对于衰弱的预测价值。结果:收集的127例患者中，无衰弱组47例(37.0%)、衰弱前组41例(32.3%)、衰弱组39例(30.7%)。三组间年龄、透析龄、血红蛋白、前白蛋白、白蛋白、血肌酐和SII差异有统计学意义(P<0.05),其中年龄、透析龄、血肌酐、SII与衰弱的发生呈正相关(P<0.01),而血红蛋白、前白蛋白、白蛋白与衰弱的发生呈负相关(P<0.01)。SII、年龄、血红蛋白和白蛋白是血液透析患者衰弱发生的危险因素，而SII、年龄和白蛋白是衰弱前组发生的影响因素。结论:维持性血液透析患...     

高通量透析对维持性血液透析患者钙磷代谢的影响

目的 探讨高通量透析对维持性血液透析患者甲状旁腺素及钙磷代谢紊乱的影响.方法 40例维持性血液透析患者按随机数字表法分为高通量透析组及普通低通量透析组并治疗3个月.所有患者采集入组后第1天透析前、后血标本及治疗3个月后透析前血标本,检测血钙、磷及甲状旁腺激素水平,同时检测患者血清尿素氮、肌酐、白蛋白、血红蛋白、β2微球...     

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.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.