2型糖尿病患者合并骨量减少及骨质疏松症相关影响因素分析

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者合并骨量减少及骨质疏松症(osteoporsis,OP)相关影响因素。方法采用双能X线骨密度仪(DXA)测定617例住院T2DM患者股骨颈(N)及腰椎1~4(L1-4)的骨密度(bone mineral density,BMD),按BMD分为骨量正常、骨量减少及骨质疏松组,采用SPSS软件比较各组之间年龄、性别、病程及生化指标之间的差异性,分析T2DM骨密度相关影响因素。结果 OP组及骨量减少组女性比例、年龄均高于骨量正常组(P0.05),BMI低于骨量正常组(P0.05)。OP组T2DM病程大于骨量减少组及骨量正常组(P0.05),FPG、2h PG、糖化血红蛋白低于骨量正常组(P0.05),空腹C肽水平低于骨量正常组(P0.05)。血钙低于骨量减少组及骨量正常组(P0.05),骨量减少组空腹胰岛素水平低于骨量正常组(P0.05)。将上述结果进行Logistic回归分析结果显示:高龄、低FC-P水平、低Hb A1C、低BMI与T2DM合并骨量减少及OP有相关关系(P0.05)。结论老龄、低空腹C肽水平、低BMI的2型糖尿病患者易出现骨量减少及骨质疏松症。     

绝经后女性骨密度与腰椎间盘退变的相关性分析

目的:观察绝经后女性腰椎和髋部骨密度与腰椎间盘退变的关系。方法:回顾性统计2017年12月～2018年12月因腰痛在我院脊柱外科门诊及住院的229例绝经后女性患者,记录患者年龄、身高、体重、糖尿病史、高血压病史、饮酒史、吸烟史等,采用双能X线骨密度测量仪检查患者腰椎椎体(L1～L4)骨密度和髋部平均骨密度,记录相应的T值,每例患者同时行腰椎MRI检查。根据骨密度T值≥-1.0为正常,-2.5 T值-1.0为骨量减少,T值≤-2.5诊断为骨质疏松,将患者分为骨质疏松组(n=78)、骨量减少组(n=73)和正常组(n=78)。每个节段腰椎间盘退变程度用Pfirrmann分级系统进行评分,用协方差和Spearman相关性分析来分析腰椎和髋部骨密度与腰椎间盘退变的关系。结果:骨质疏松组、骨量减少组和骨量正常组的年龄分别为67.17±9.99岁、65.66±10.71岁、55.29±12.35岁,骨质疏松组、骨量减少组年龄显著大于骨量正常组(P0.05);骨质疏松组的体重指数小于正常组(23.38±2.37kg/m~2 vs 24.72±2.96kg/m~2,P0.05);其余一般资料各组间无显著性差异(P0.05)。上腰椎(L1、L2)中,骨质疏松组腰椎间盘退变评分均较正常组低(2.24±0.82 vs 2.60±0.95,2.79±0.95 vs3.18±0.94,P0.05),而与骨量减少组比较无显著性差异(P0.05);下腰椎(L3、L4)椎体和髋部不同骨密度组之间椎间盘退变程度无显著性差异(P0.05)。各腰椎椎体骨密度分别与腰椎间盘平均退变程度呈正性相关(L1:r=0.185;L2:r=0.157;L3:r=0.180;L4:r=0.132;L1～L4:r=0.180;均P0.05),髋部骨密度与腰椎间盘退变的严重程度无统计学相关性。结论:绝经后女性腰椎间盘退变的严重程度与腰椎骨密度存在正相关关系,提示绝经后女性腰椎骨密度较高者椎间盘退变可能更严重,有必要进一步做腰椎CT或者MRI检查;股骨颈骨密度检查对骨质疏松诊断更有帮助。     

绝经后女性骨密度与腰椎间盘退变程度的相关性研究

目的探讨绝经后女性骨密度与腰椎间盘退变程度的相关性。方法回顾性研究西南医科大学附属医院2017年1月至2019年12月收治的因慢性腰痛住院的251例绝经后女性患者。收集患者的年龄、绝经年限、体质量指数(body mass index,BMI)。采用双能X线骨密度仪检测患者腰椎(L_(1～4))及髋部平均骨密度,根据骨密度T值将患者分为骨量正常组(n=45)、骨量低下组(n=71)和骨质疏松组(n=135)。同时患者均行腰椎MRI检查,采用Pfirrmann分级系统评估腰椎间盘退变程度(L1/2、L2/3、L3/4、L4/5、L5/S1)。采用Spearman相关性分析骨密度与腰椎间盘退变程度的关系。结果骨质疏松组和骨量低下组的年龄、绝经年限显著大于骨量正常组(P0.05)。骨质疏松组和骨量低下组的BMI明显小于骨量正常组(P0.05)。骨质疏松组和骨量低下组的L1/2、L2/3、L3/4、L1～S1(L1/2～L5/S1的平均值)椎间盘退变评分明显高于骨量正常组(P0.05)。骨质疏松组的L4/5、L5/S1椎间盘退变评分高于骨量正常组(P0.05),骨量低下组与骨量正常组比较差异无统计学意义(P0.05)。相关性分析结果显示,骨密度与BMI呈正相关(P0.05),与年龄、绝经年限、L1/2、L2/3、L3/4、L4/5、L5/S1、L1～S1椎间盘退变评分呈负相关(P0.05)。结论绝经后女性骨密度与BMI呈正相关,与年龄、绝经年限、腰椎间盘退变程度呈负相关。绝经后女性骨密度越低,其腰椎退变程度越严重。     

2型糖尿病患者骨密度与胰岛素样生长因子-1、白介素-1β的相关性研究

目的探讨2型糖尿病(T2DM)患者骨密度(BMD)与胰岛素样生长因子-1(IGF-1)、白介素-1β(IL-1β)水平的关系。方法选择2型糖尿病患者测定骨密度,并根据骨密度选取骨量正常组、骨量减少组、骨质疏松组各20例,另选取20例健康体检正常且骨量正常者作为对照组,测定IGF-1、IL-1β。结果(1)T2DM骨量减少组、骨质疏松组的IGF-1浓度低于T2DM骨量正常组及正常对照组(P0.005)(2)T2DM骨质疏松组的IL-1β浓度高于T2DM骨量正常组及正常对照组(P0.005),高于T2DM骨量减少组(P0.05)。结论2型糖尿病患者随着骨密度的下降,IGF-1逐渐减少,IL-1β逐渐增加,二者可能影响2型糖尿病患者骨密度的变化。     

中老年2型糖尿病患者骨密度水平与代谢指标及并发症相关性分析

目的探讨中老年2型糖尿病(type 2 diabetic mellitus,T2DM)患者腰椎骨密度(bone mineral density,BMD)与代谢指标及糖尿病并发症的关系。方法回顾性分析228例中老年T2DM患者的住院资料,按腰椎1～4(L1-L4)BMD的水平分为骨量正常组(T-1.0SD)、骨量减少组(-2.5 SDT≤-1.0 SD)及骨质疏松组(T≤-2.5 SD),比较各组临床资料、血糖控制、代谢指标、糖尿病并发症情况,并分析腰椎BMD与各指标的相关性。结果 (1)随骨密度下降,体质量指数(body mass index,BMI)下降,女性比例、感觉阈值(vibration perception threshold,VPT)增加,差异有统计学意义(P0.01);骨质疏松组年龄、糖化血清白蛋白(glycated albumin,GA)大于骨量正常及骨量减少组(P0.01),且发生糖尿病足病明显增加(P0.05);骨质疏松组病程、空腹及餐后2 h血糖大于骨量减少组(P0.05),腰围、尿酸、甘油三酯低于骨量正常组(P0.01),高密度脂蛋白胆固醇(HDL-C)、血镁高于骨量正常组(P0.05);骨量减少组碱性磷酸酶高于骨量正常组(P0.05),腰围(P0.05)、尿酸(P0.01)、总胆固醇(P0.05)低于骨量正常组。(2)相关分析提示,腰椎BMD与年龄、性别(女)、GA、HDL-C、血镁、VPT(异常)呈负相关(P0.05);与腰围、BMI、尿酸、甘油三酯呈正相关(P0.01)。(3)以腰椎骨密度为因变量,进一步行多重线性回归分析,结果显示BMI、性别(女)、VPT(异常)、尿酸差异有统计学意义。结论女性患者和感觉阈值异常是T2DM患者骨密度降低的独立危险因素,而适当高BMI及高尿酸则是骨密度降低的保护因素。     

住院新诊断2型糖尿病患者骨密度及影响因素调查

目的观察住院新诊断2型糖尿病(T2DM)患者骨密度(BMD)改变情况并探讨其影响因素。方法选择北京大学人民医院新诊断T2DM患者111例(男性75例,女性36例),采用双能X线骨密度仪测定患者腰椎、股骨颈及全髋BMD,按T值不同分为2个亚组:骨量正常组(T值-1.0SD);骨量减少组(-2.5 SDT值≤-1.0 SD);比较两组之间各种生化指标及BMD的差异并进行相关性分析。结果 1、骨量减少组的年龄大于骨量正常组(P0.05),而体重及体重指数(BMI)低于后者(P分别0.05及0.01)。骨量减少组的稳态模型胰岛素抵抗指数取自然对数值(Ln(HOMA-IR))稍低于骨量正常组,而游离三碘甲状腺原氨酸(FT3)高于后者,差异有统计学意义(P均0.05)。骨量减少组合并脂肪肝的比例为51.2%,明显低于骨量正常组合并脂肪肝的比例71.9%,差异有统计学意义(P0.05)。2、骨量减少组的腰椎、股骨颈及全髋BMD均明显低于骨量正常组(P均0.01)。3、Pearson相关分析显示,腰椎骨密度与舒张压负相关(P0.05),与体重、空腹血糖(FBG)、Ln(HOMA-IR)正相关(P均0.01)。股骨颈及全髋骨密度均与年龄和高密度脂蛋白胆固醇(HDL-C)负相关,与体重、腰围、BMI及尿酸正相关(P均0.01)。在校正年龄、体重及BMI等影响因素后,股骨颈骨密度与HDL-C负相关(r=-0.269,P=0.028)。结论新诊断T2DM患者的骨密度除了与年龄及体重有关外,升高的HDL-C水平可能与骨密度降低有一定的关系。     

绝经后女性类风湿关节炎患者骨质疏松影响因素的回顾性研究

目的 通过分析绝经后女性类风湿性关节炎(RA)患者骨密度与临床资料的相关性,探讨影响骨密度的相关因素。方法 收集64例绝经后女性RA患者一般临床资料、腰椎及股骨的平均骨密度（BMD)、骨代谢指标、实验室检查指标,根据骨密度分为骨质疏松组和非骨质疏松组,比较临床资料并分析可能影响骨密度的因素。结果 64例患者平均年龄(58. 47 ±5.81) 岁,平均病程5.5(2.0,12.0)年。骨质疏松比例为62.5% (40/64)。骨质疏松组的绝经时间、ESR、纤维蛋白原、DAS28高于非骨质疏松组,绝经年龄、体重、BMI、ALB、DMARDs及抗骨吸收药物使用率低于非骨质疏松组,病程2年以上的患者骨质疏松发病率较高,其炎症指标亦高于同病程非骨质疏松组。简单相关分析提示BMD与绝经年龄、体重、BMI、ALB正相关,与 DAS28负相关。Logistic回归分析提示绝经年龄（OR = 4. 750,95%CI：1. 30247. 327,P = 0. 018)是影响绝经后女性RA患者 BMD的独立因素。多重线性回归方程提示BMD与BMI正相关,与DAS28负相关。结论 绝经后RA患者BMD受绝经年龄、BMI、DAS28的影响。绝经年龄是影响绝经后女性RA患者BMD的独立因素。     

广西南宁市区绝经后女性骨质疏松症流行情况及相关因素研究

目的了解广西南宁市绝经后女性骨质疏松症的患病情况及相关影响因素,为进一步预防干预提供理论依据。方法选取我院健康体检的216名绝经后女性作为研究对象,测定髋部及第1~4腰椎的骨密度,同时进行问卷调查。结果骨质疏松、骨量减少及骨量正常分别占38.89%、43.06%、18.05%,随着年龄增加,骨质疏松患病率明显升高(χ2=17.56,P=0.000);骨质疏松组年龄、体重指数(body mass index,BMI)、绝经年限、足月妊娠次数、户外活动次数、每次运动时间、活动程度、奶制品摄入及钙剂摄入情况与另外两组比较,差异均有统计学意义(P0.05),Logistics多因素回归分析表明,年龄、绝经年限与骨质疏松症呈正相关(OR=3.419,P=0.000;OR=2.569,P=0.016);而BMI、运动次数、饮牛奶及钙剂摄入与其呈负相关性(OR=0.517,P=0.000;OR=0.684,P=0.024;OR=0.589,P=0.021;OR=0.266,P=0.000)。结论广西南宁市区绝经后女性骨质疏松及骨量减少患病率高。BMI增高、运动次数多、饮牛奶及钙剂摄入是其保护因素,应加强宣教,从而预防和延缓骨质疏松的发生。     

老年糖尿病患者骨密度与血尿酸水平的相关研究

目的横断面观察老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨密度及血尿酸水平,探讨两者之间的相关性。方法选择明确诊断为T2DM且年龄在60岁以上的患者254例,搜集患者资料,分别行骨密度测定,依据T值水平将患者分为骨量正常组(n=89例),骨量减少组(n=86例)及骨质疏松组(osteoporosis,OP,n=79例);依据血尿酸水平将患者分为高尿酸血症组(血尿酸≥420μmol/L)和血尿酸正常组(血尿酸420μmol/L)。结果 (1)老年T2DM男性患者血尿酸及各部位骨密度值均高于女性,OP患病率低于女性,差异具有统计学意义(P0.05)。(2)男性患者血尿酸与腰椎1至4联合值(the lumbar vertebrae,L1-4)及Wards三角部位的骨密度呈正相关(r=0.366,P=0.009;r=0.367,P=0.008),女性患者血尿酸与各部位骨密度无明显相关性(P0.05)。(3)高尿酸血症组患者的血尿酸与股骨颈及大转子部位的骨密度呈负相关(r=-0.374,P=0.025;r=-0.535,P=0.001),血尿酸正常组血尿酸与股骨颈部位的骨密度呈正相关(r=0.212,P=0.010)。结论老年T2DM患者骨密度受性别及血尿酸水平的影响,正常偏高水平的血尿酸有利于稳定骨量。     

血清肿瘤标志物在2型糖尿病合并骨量异常患者中意义的研究

目的探讨2型糖尿病(type 2 diabetes,T2DM)患者血清中肿瘤标志物与骨密度(bone mineral density,BMD)的关系。方法随机纳入2014年2月至2015年12月就诊于石河子大学医学院第一附属医院内分泌科的T2DM患者240例,根据双能X线骨密度检查结果将研究对象分为T2DM并骨量正常组,T2DM并骨量减低组,T2DM并骨质疏松组,分别比较不同组肿瘤标志物及分析相关因素与骨量的关系。结果(1)与骨量正常组相比,骨量减少组的FPG升高(P0.05),与骨量正常组相比,骨质疏松组中的FPG升高(P0.01),与骨量正常组相比,骨质疏松组中的HbAlc升高(P0.05),与骨量正常组相比,骨量减少组和骨质疏松组中的FINS、HOMA-IR、HOMA-IS降低(P0.01)。(2)与骨量正常组相比,骨质疏松组CA199升高(P0.01)。(3)BMD(股骨颈)与血清CA199呈负相关(r=-0.192,P0.01)。(4)以CA199为因变量,年龄、体重、病程、BMI、FPG、HbAlc、FINS、HOMA-IR、HOMA-IS、BMD(股骨颈)为自变量做回归分析,BMD(股骨颈)(P=0.021,t=-2.328)进入回归方程,Y=34.674-22.65X。结论血清CA199在2型糖尿病合并骨质疏松组患者中升高,且在2型糖尿病患者中BMD越低,CA199水平越高。     

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.     

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.     

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.     

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.