Alternative forms of instrument actuation, camera control and master console ergonomics should be explored to improve instrument precision, sphere of action, size and minimize assistance required.

A series of in vitro studies were designed to determine whether di-(2-ethyl-hexyl)-phthalate (DEHP)-plasticized polyvinyl chloride (PVC) and DEHP itself initiated an inflammatory response in both human and rat blood. Additionally, the effect of methanol washing of the PVC on the inflammatory response was studied in both blood types. Blood from both species was exposed to first, no material; second, ground DEHP-plasticized PVC; third, methanol-washed ground DEHP-plasticized PVC; and fourth, known concentrations of DEHP. The expression of the integrin CD11b was employed as a marker of the inflammatory response. After 20 minutes' exposure to PVC, CD11b expression increased to 210 +/- 32% of baseline in human blood and to 238 +/- 21.7% in rodent blood. Both blood types showed an increase in CD11b expression with increasing concentrations of DEHP (214 +/- 40.8% of baseline levels in human blood and 237 +/- 14.5% in rodent blood at the highest concentration). Methanol washing resulted in a significant moderation in CD11b upregulation in both blood types; 117 +/- 27% of baseline in human and 150 +/- 14.7% in rodent. These results support the hypothesis that DEHP-plasticized PVC and DEHP itself are proinflammatory in blood from both species, and suggest that the rodent is an appropriate model for studies of this nature.

Cardiopulmonary bypass (CPB) has improved a great deal since its first applications in the early 1950s. If improvements are to be continued, a preclinical model of CPB for small animals is desirable, mainly because of convenience of equipment and low costs. We review the different models of CPB for rats that have been designed, discuss their characteristics and points where improvements may be made. We give suggestions and requirements for a new up-to-date model that could be a useful tool in continued research on the pathophysiology and therapeutic strategies of CPB.

Cardiopulmonary bypass (CPB) is associated with the production of inflammatory responses, which can have significant influence on prognosis. We studied the effects of leucocyte-depletion filters on inflammatory parameters and early postoperative prognosis during coronary revascularization. Twenty patients undergoing elective coronary revascularization were randomly divided into two groups. Ten patients had leucocyte-depletion filters added to the CPB circuit (treatment group) and 10 were used as control cases (control group). Expression of CD11b on neutrophils, and production of myeloperoxidase and lactoferrin, were measured in arterial samples between induction and 3 h postbypass. In addition, clinical parameters were measured during inpatient recovery. CD11b neutrophil expression, and myeloperoxidase and lactoferrin production, were found to be upregulated during CPB and then to decline to preoperative levels by the third postoperative hour. Blood transfusion requirements were reduced in the treatment group, equalling 1.5 +/- 1.2 units, compared to 2.7 +/- 1.1 units for the control group (p value = 0.034) and so were the volumes of crystalloid infused during the first 24 h postoperatively, equalling 3.9 +/- 1.21 in the treatment group and 3.3 +/- 0.71 in the control group (p value = 0.021). Overall, the application of leucocyte depletion produced an early clinical advantage, underlining the need for an improved understanding and manipulation of the inflammatory response to CPB.