结节性甲状腺肿和甲状腺癌关系的临床研究

目的探讨结节性甲状腺肿和甲状腺癌的关系.方法应用免疫组化法检测结节性甲状腺肿58例,结节性甲状腺肿伴增生结节15例,甲状腺癌44例,正常甲状腺组织20例标本中p27蛋白的表达.结果 p27蛋白表达阳性率在正常甲状腺组织为60.5%,结节性甲状腺肿为38.6%,甲状腺癌为34.1%,无结节性甲状腺肿伴增生结节,结节性甲状腺肿和甲状腺癌的p27蛋白表达阳性率明显高于结节性甲状腺肿伴增生结节的表达阳性率,均有显著性差异（P＜0.01）.结论结节性甲状腺肿合并增生结节可能为癌前病变.     

MUC1在甲状腺癌及甲状腺良性病变组织中的表达及意义

目的检测多态性上皮粘蛋白 (polymorphicepithelialmucin ,PEM ,又名MUC1)在甲状腺癌及甲状腺良性病变组织 (结节性甲状腺肿 ,甲状腺腺瘤 )中的表达 ,探讨其在甲状腺癌诊断和免疫治疗中的意义。方法采用免疫组化方法检测 6 8例甲状腺癌及 18例甲状腺良性病变组织、10例甲状腺正常组织中MUC1的表达。结果甲状腺癌组织中MUC1阳性表达 5 1例 ,免疫组化染色表现为胞浆内深棕色或棕黄色颗粒 ;结节性甲状腺肿 ,甲状腺腺瘤MUC1阳性表达 4例 ,甲状腺滤泡上皮腺腔缘为黄色或棕黄色颗粒 ;正常甲状腺组织中阳性表达 1例。MUC1在甲状腺癌组织中的阳性表达率与甲状腺良性病变组织及甲状腺正常组织相比 ,差异有显著性 (χ2 =17 2 0 ,P <0 0 1)。MUC1在甲状腺癌组织中阳性表达与甲状腺癌的病理类型和颈淋巴结有无转移无关 (χ2 =0 72 ,P >0 0 5 )。结论MUC1在甲状腺癌组织中的表达及其分布特点可作为甲状腺癌的鉴别诊断指标。     

Smad4蛋白在结节性甲状腺肿与甲状腺癌并存组织中的表达及其影响

目的:研究结节性甲状腺肿与甲状腺癌并存病变组织中Smad4蛋白的表达及其影响。方法:采用免疫组化SP法对结节性甲状腺肿并存甲状腺癌组织84例、结节性甲状腺肿并存甲状腺瘤50例组织及相应的40例结节性甲状腺肿组织中的Smad4进行检测。结果:Smad4蛋白在甲状腺癌、甲状腺瘤、结节性甲状腺肿组织中的阳性表达率分别为52.38%、74.00%、82.50%,甲状腺癌组织阳性表达率低于甲状腺瘤及结节性甲状腺肿者阳性表达率(P0.05或P0.01)。Smad4蛋白在乳头状癌、滤泡状癌、未分化癌的阳性表达率分别为57.45%、58.33%、23.08%,未分化癌Smad4蛋白阳性表达率低于乳头状癌及滤泡状癌者表达率(P0.05)。结论:检测Smad4蛋白表达对阐述结节性甲状腺肿与甲状腺癌并存病变的生物学行为及评估其预后具有重要意义。     

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目的　探讨局灶性甲状腺炎和甲状腺癌的关系及手术治疗的可行性与必要性。方法　应用免疫组织化学方法对 30例局灶性甲状腺炎 ,2 0例甲状腺乳头状癌 ,2 0例结节性甲状腺肿 ,5例正常甲状腺组织分别进行Bax、Ki- 6 7染色 ,并对甲状腺炎病人进行 12～ 40个月随访。结果　局灶性甲状腺炎标本Bax阳性分级明显高于其它各组 ;Ki- 6 7阳性细胞数低于甲状腺癌 ,明显高于结节性甲状腺肿和正常甲状腺标本 ;随访 30例甲状腺炎病人甲状腺功能正常。结论　局灶性甲状腺炎细胞增殖加速 ,应进一步探讨其癌变倾向 ,手术切除效果良好     

Bmi-1基因在甲状腺乳头状癌中的表达及意义

目的 分析Bmi-1基因在甲状腺疾病组织中的表达,探讨Bmi-1与甲状腺乳头状癌转移的相关关系及临床意义.方法 采用RT-PCR法检测8例正常甲状腺、18例结节性甲状腺肿、24例甲状腺乳头状癌组织中Bmi-1基因的表达,运用Fisher确切概率法分别对正常组、结甲组和甲癌组检验,判断Bmi-1在各组中的表达.结果①Bmi-1基因阳性表达在正常甲状腺中仅1例(12.5%),在结节性甲状腺肿中有3例(16.7%),而在甲状腺癌中有19例(79.2%),3组阳性率比较差异有统计学意义(P<0.05);②在24例甲状腺癌中,有淋巴结转移的16例(66.67%),无淋巴结转移的8例(33.33%),2组间比较差异有统计学意义(P<0.05);③以年龄为界,在19例阳性表达的甲状腺癌中,年龄≥45岁的12例(63.16%),<45岁的7例(36.8%),2组间比较差异有统计学意义(P<0.05).结论 ①研究证实Bmi-1基因在甲状腺癌中的阳性率明显高于良性甲状腺疾病和正常甲状腺组织;②Bmi-1的表达与淋巴结的转移及年龄有显著相关性,提示它对判断甲状腺乳头状癌的转移机制及预后有一定的临床价值.     

血管内皮生长因子和碱性成纤维细胞生长因子在甲状腺癌中的表达及临床意义

目的　探讨血管内皮生长因子 (VEGF)、碱性成纤维细胞生长因子 (bFGF)在甲状腺癌中的表达及临床意义。方法　用免疫组织化学SP法检测 90例甲状腺乳头状癌、14例甲状腺未分化癌和 10例正常甲状腺组织中VEGF、bFGF的表达情况 ,并分析其与相关临床病理因素的关系。结果在甲状腺癌组织中VEGF、bFGF表达阳性率分别为 6 3 5 %和 5 9 6 % ,均显著高于正常甲状腺组织( χ2 =12 5 81,P <0 0 1)、( χ2 =12 5 81,P <0 0 1) ;未分化癌组织中VEGF、bFGF的表达阳性率分别为 92 9%和 85 7% ,均显著高于乳头状癌 ( χ2 =6 0 2 9,P <0 0 5 )、( χ2 =4 5 77,P <0 0 5 ) ;VEGF和bFGF表达阳性率均与甲状腺癌淋巴结转移有关 ( χ2 =4 0 2 5 ,P <0 0 5 )、( χ2 =4 712 ,P <0 0 5 ) ;两者在甲状腺癌中的表达阳性率呈明显正相关性 (γ =0 5 96 ,P <0 0 5 )。结论　VEGF、bFGF是评价甲状腺癌生物学行为及预后的两个重要指标     

甲状腺病变组织中端粒酶活性的测定及其意义

目的 了解几种常见甲状腺病变组织中端粒酶活性的区别。方法 用端粒重复序列扩增法测定19例甲状腺癌、15例甲状腺癌癌旁组织、21例甲状腺腺瘤、17例结节性甲状腺肿及13例正常甲状腺组织端粒酶的活性。结果 94．74％（18／19）的甲状腺癌表达端粒酶活性,与癌旁组织（6．67％）、甲状腺腺瘤（4．67％）、结节性甲状腺肿（0％）及正常甲状腺组织（0％）比较,差异均有显著性意义（P＜0．0001）。结论 端粒酶是甲状腺癌定性的良好标志物,且在甲状腺病变的鉴别诊断中具有重要意义。     

CXC趋化因子受体7和B7-H4在甲状腺癌组织的表达及其临床意义

目的探讨CXC趋化因子受体7(CXCR7)蛋白和B7-H4蛋白在甲状腺癌组织中的表达, 以及两者与甲状腺癌病理特征的关系及临床意义。方法收集2017年1月至2022年9月广东医科大学附属医院病理确诊的131例甲状腺肿瘤患者的组织标本, 其中33例甲状腺瘤组织标本、98例甲状腺癌组织标本, 同时另选择20例正常甲状腺组织标本为对照组。采用免疫组织化学法检测上述组织中CXCR7蛋白和B7-H4蛋白的表达水平, 组间比较采用χ2检验, 分析CXCR7蛋白和B7-H4蛋白的表达水平与甲状腺癌临床病理参数的关系。结果正常甲状腺组织、甲状腺瘤组织和甲状腺癌组织中的CXCR7蛋白表达率分别为15.00%(3/20)、42.42%(14/33)和77.55%(76/98), 两两之间比较差异有统计学意义(χ2=14.167、29.371、4.299, P<0.05), CXCR7表达水平与甲状腺癌TNM分期、病理类型、颈淋巴结转移明显相关(χ2=8.989、6.144、5.532, P<0.05), CXCR7表达水平与甲状腺癌性别、年龄、组织分化程度、包膜浸润无明显相关(χ2=0.002...     

端粒酶活性在甲状腺肿瘤中的表达及意义

目的探讨端粒酶活性在甲状腺癌各病理类型中的表达及其作为甲状腺肿瘤标志物的可能性。 方法采用以PCR技术为基础的TRAP-银染定性和半定量法,检测73例不同种甲状腺组织中的端粒酶活性。 结果正常甲状腺组织中的端粒酶活性阳性率为0（0/8）,结节性甲状腺肿为15.0%（3/20）,甲状腺腺瘤为10.0%（1/10）,乳头状腺癌为75.0%（15/20）,滤泡状腺癌为80.0%（8/10）,髓样癌为100.0%（3/3）,未分化癌为100.0%（2/2）。良恶性组中的端粒酶活性阳性率差异有统计学意义（χ²=36.24,P<0.01）。 结论端粒酶活性在甲状腺癌各个类型中都有高表达,可作为甲状腺肿瘤诊断的理想标志物,尤其是对良恶性甲状腺滤泡性腺瘤的鉴别。端粒酶活性与甲状腺癌组织的分化程度无关,与甲状腺癌的预后可能有关,即端粒酶活性愈强,其预后愈差。     

CCR7在甲状腺乳头状微小癌中的表达及临床意义

目的探讨CCR7在甲状腺乳头状微小癌中表达情况及其与甲状腺乳头状微小癌临床病理特征的关系。方法采用免疫组织化学S-P法检测31例甲状腺乳头状微小癌,34例直径>1 cm的甲状腺乳头状癌、34例结节性甲状腺肿以及12例甲状腺乳头状微小癌对侧正常甲状腺组织中CCR7的表达情况。结果 CCR7在甲状腺乳头状微小癌及直径>1 cm甲状腺乳头状癌中的表达阳性率均为100%,其差异无统计学意义(P>0.05),而在结节性甲状腺肿和正常甲状腺组织中CCR7的表达阳性率分别为64.7%和33.3%,与甲状腺乳头状微小癌相比差异有统计学意义(P<0.05)。CCR7的表达与患者性别、年龄、侵犯甲状腺被膜及淋巴结转移均无关(P>0.05)。结论 CCR7的表达在甲状腺乳头状微小癌和直径>1 cm甲状腺乳头状癌中均呈高表达,两者可能具有相同的生物学特性,两者均易发生颈淋巴结转移,均需要进行颈淋巴结(中央区)清扫。     

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.     

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.     

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.     

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.     

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.