乳腺癌高表达基因1对前列腺癌细胞神经内分泌转化的影响

目的观察乳腺癌高表达基因1(BCOX1)在前列腺癌细胞神经内分泌转化中的表达水平和生物功能。方法构建去雄激素诱导的神经内分泌样前列腺癌细胞模型。并检测BCOX1在LNCaP和AI-NEPC细胞中的表达差异。RNA干扰技术下调BCOX1在AI-NEPC细胞中表达后,检测神经内分泌细胞标记物NSE和CHGA的表达,并检测STAT3的表达和磷酸化水平。结果在AI-NEPC中BCOX1蛋白表达水平与LNCaP细胞相比明显增加。BCOX1mRNA水平在AI-NEPC中与LNCaP细胞相比显著增高(P0.05)。shRNA转染组中NSE和CHGA表达水平与未转染组和空载体转染组比较均明显下降(P0.05)。shRNA转染组中STAT3和磷酸化STAT3的表达水平较空载体转染组明显下调(P0.05)。结论 BCOX1在神经内分泌分化的前列腺癌细胞中高表达,下调BCOX1的表达可以影响前列腺癌细胞的神经内分泌样表型,并抑制STAT3的表达和磷酸化。     

细胞内胆固醇代谢在前列腺癌神经内分泌转化中的变化及意义

目的:建立前列腺癌雄激素非依赖进展过程中的神经内分泌转化(NED)体外细胞模型,分析前列腺癌NE细胞转化时细胞内胆固醇代谢及其调控可能的变化及意义。方法:去雄激素诱导建立前列腺癌LNCaP细胞NE模型,通过细胞形态学观察、蛋白印迹检测多种NE标记物(SgⅢ、NSE、CgA)表达、体外细胞增殖实验检测NE的发生;利用免疫荧光染色检测细胞内胆固醇和SgⅢ的表达及分布;利用半定量RT-PCR检测多种参与胆固醇合成、摄取相关蛋白基因(LDL-R、SREBP-1、SREBP-2)的表达。结果:去除雄激素后体外培养,LNCaP细胞胞体缩小,轴突增长,呈NE样改变;SgⅢ、NSE、CgA等多种NE标记物表达上调,并随着时间延长逐渐增多;同时细胞增殖能力显著降低(P<0.05)。NE转化后的LNCaP细胞内胆固醇分布呈现明显的轴突末端聚集趋势,但表达量并无显著改变,相应的细胞内参与胆固醇合成、摄取相关蛋白基因的表达也无显著性差异(P>0.05)。结论:短期去雄激素体外培养可成功诱导雄激素依赖的前列腺癌LNCaP细胞发生NED,NED后的细胞内胆固醇分布发生显著的轴突末端聚集趋势,以增强细胞内多种神经内分泌颗粒的形成。     

雄激素受体在雄激素非依赖性前列腺癌的表达

目的探讨雄激素受体(AR)在国人雄激素非依赖性前列腺癌(AIPC)的表达及其临床意义。方法采用免疫组化两步法,检测AR在15例AIPC和20例雄激素依赖性前列腺癌(ADPC)组织标本的表达水平。结果1例AIPC无AR表达,其余14例AIPC及全部ADPC均有AR高表达,AIPC染色的光密值为0.31±0.04较ADPC0.28±0.03升高。结论大多数国人AIPC均高表达AR,AR的异常表达可能在前列腺癌的进展中发挥重要的作用。     

类固醇受体辅活化子-1和核受体辅阻遏子在雄激素非依赖性前列腺癌的表达及临床意义

目的 探讨类固醇受体辅活化子-1（SRC-1）、核受体辅阻遏子（NCoR）在雄激素非依赖性前列腺癌（AIPC）的表达及临床意义。方法 采用免疫组化法检测20例激素依赖性前列腺癌（ADPC）、15例AIPC组织AR、SRC-1及NCoR表达。结果 1例AIPC无AR表达，其余AIPC及ADPC高表达AR。AIPC、ADPC均检测到SRC-1表达。SRC-1在AIPC的阳性率较ADPC组织明显升高（P〈0．01）。NCoR在AIPC、ADPC均有表达，但在AIPC的表达则出现明显降低（P〈0．01）。结论 SRC-1在AIPC表达升高和／或NCoR在AIPC表达降低引起的AR异常活化可能与前列腺癌（Pca）的进展有关。     

熊果酸对前列腺癌细胞雄激素非依赖性的逆转作用

目的 探讨中药成分熊果酸对雄激素非依赖性前列腺癌(AIPC)的治疗作用及其机制.方法 应用熊果酸处理体外培养的人雄激素依赖性前列腺癌(ADPC)细胞株LNCaP和AIPC细胞株DU145,噻唑蓝(MTT)比色法检测细胞活性及对人工合成雄激素R1881的反应性,免疫细胞化学检测熊果酸对雄激素受体(AR)、糖皮质激素受体(GR)、前列腺特异性抗原(PSA)及成活因子HSP90和白细胞介素(IL)-6表达的影响,逆转录.聚合酶链反应(RT-PCR)检测熊果酸对DU145细胞AR mRNA表达的影响.结果 熊果酸对不同浓度雄激素下的LNCaP细胞均呈浓度和时间依赖性生长抑制,20 mg/L的熊果酸作用96 h对LNCaP细胞的抑制率近50%.0.1 nmoL/L的R1881为最适生长浓度,熊果酸作用后,LNCaP细胞生长的最适雄激素浓度上升了10倍;熊果酸对DU145细胞的生长有浓度和时间依赖性抑制效应,DU145细胞对AR阻断剂羟氟他胺缺乏反应,熊果酸作用同时再应用氟他胺比单纯熊果酸的作用更明显,对细胞抑制率明显上升.熊果酸作用后,LNCaP和DUl45细胞IL-6、HSF90表达均明显下降(P＜0.05),DU145细胞GR表达明显降低(P＜0.01),AR和PSA蛋白及AR mRNA出现再表达.结论 熊果酸能改善前列腺癌细胞对雄激素的反应性,使LNCaP细胞对雄激素的依赖性加强,并诱发了DU145细胞对雄激素的反应性,其部分机制是降低了GR、HSP90、IL-6的表达并促进AR再表达.     

miR-21诱导FOXO1调控前列腺癌细胞EMT及侵袭转移

目的探讨miR-21诱导FOXO1调控前列腺癌细胞EMT及侵袭转移。方法人工合成miR-21 mimic/inhibitor及其对照组序列,分别转入前列腺癌细胞株C4-2、DU145中,收集细胞行RT-qPCR检测miR-21、FOXO1 mRNA表达,行Western blot检测FOXO1、E-cadherin和N-cadherin表达,行Transwell试验检测转染后前列腺癌细胞侵袭透膜能力变化。结果前列腺癌细胞株C4-2、DU145转染miR-21 mimic/inhibitor及对照序列后,RT-qPCR检测miR-21表达升高/降低明显(P0.05),RT-qPCR检测FOXO1 mRNA表达与miR-21一致。在Western blot结果中,转染miR-21 mimic前列腺癌细胞FOXO1、N-cadherin表达高于对照组,E-cadherin表达相反;转染miR-21 inhibitor前列腺癌细胞FOXO1、N-cadherin表达低于对照组,E-cadherin表达相反。Transwell试验显示,转染miR-21 mimic前列腺癌细胞侵袭透膜能力较对照组增强(P0.01),转染miR-21 inhibitor前列腺癌细胞侵袭能力较对照组减弱(P0.01)。结论 miR-21通过诱导FOXO1调控前列腺癌细胞EMT及侵袭转移。     

JKTBP在前列腺癌细胞系和组织中的表达差异及其意义

目的 研究在雄激素依赖性及雄激素非依赖性前列腺癌细胞系、组织和前列腺增生(BPH)组织中JKTBP的表达差异.方法 应用RT-PCR和Western blot比较雄激素依赖性前列腺癌(AD-PCa)细胞系LNCaP及雄激素非依赖性前列腺癌(AI-PCa)细胞系DU145 JKTBP mRNA和蛋白的表达差异;应用免疫组化方法比较BPH、AD-PCa和AI-PCa组织中JKTBP的表达差异.结果 在LNCaP细胞系中JKTBP mRNA和蛋白的表达水平均较低,相反,在DU145细胞系中两者均呈高表达,两细胞系间mRNA和蛋白的表达差异具有统计学意义(P<0.05).JKTBP在20例BPH组织中均表达阴性;在20例AD-PCa组织中有4例弱阳性,2例阳性,14例阴性;而在6例AI-PCa组织中5例呈强阳性表达,1例弱阳性;三组之间表达差异具有统计学意义(P<0.05).结论 JKTBP在AD/AI-PCa细胞系、组织和BPH组织中的表达存在差异,其可能参与了前列腺癌的进展过程,是前列腺癌进展的一个指标.     

缺氧诱导因子1α诱导人前列腺癌细胞上皮间质化改变的研究

目的:研究人前列腺癌细胞在缺氧诱导因子1α(HIF-1α)诱导下能否发生上皮细胞间质转化态(EMT)改变,进而致侵袭能力增强,并初步分析其分子机制。方法:应用RT-PCR技术检测LNCaP细胞及其亚细胞系C4、C4-2、C4-2B这4种EMT阴性的人前列腺癌细胞中波形蛋白(vimentin)mRNA表达情况,并凭此筛选出适合于进一步作转染诱导试验的细胞。用脂质体Lipofectamine2000包装重组真核表达载体pCDNA3.1(-)/HIF-1α和pCD-NA3.1(-)空质粒后,分别转染上步试验所挑选出的人前列腺癌细胞LNCaP,600μg/mLG418筛选抗性克隆。免疫荧光及Western印迹法鉴定HIF-1α表达,Western印迹法检测EMT标志蛋白——上皮型钙粘素(E-cadherin)和vimentin的表达,Transwell验证转染后LNCaP细胞侵袭能力的改变。结果:RT-PCR证实4种EMT阴性的细胞中,仅LNCaP表达有vimentin编码基因,适合作转染诱导试验。免疫荧光也观察到HIF-1α转染细胞胞质中荧光亮度较空质粒转染细胞和未转染细胞明显增强。Western印迹法证实HIF-1α转染细胞发生了EMT转化,其E-cad-herin表达缺失,而vimentin表达增加。同时,Transwell体外侵袭试验也发现,LNCaP/HIF1α细胞的体外侵袭能力显著高于LNCaP细胞和LNCaP/pCDNA3.1(-)细胞。结论:HIF-1α过表达可以通过调节两种EMT相关蛋白诱导人前列腺癌细胞LNCaP发生EMT改变并致其侵袭能力增强。     

神经内分泌分化对前列腺癌细胞生长及雄激素受体表达影响的实验研究

目的探讨神经内分泌分化对前列腺癌细胞生长的作用及对雄激素受体表达的影响。方法建立神经内分泌分化的前列腺癌细胞模型PC3MNE和LNCaPNE;采用甲基噻唑基四唑(MTT)试验观察其调节前列腺癌细胞生长的作用[以吸光度值(A)表示];采用逆转录聚合酶链反应和Western杂交方法检测LNCaPNE对LNCaP细胞雄激素受体表达的影响。结果PC3MNE的培养上清液可促进PC3M细胞的生长(A值在培养24h为034±018与050±009,48h为038±016与057±009,72h为038±015与055±005,P均<005);在有雄激素时,LNCaPNE的培养上清液不促进LNCaP细胞的生长,对其雄激素受体的表达也没有显著影响;去除雄激素后,LNCaPNE的培养上清液可促进LNCaP细胞的生长,并能下调其雄激素受体的表达(P均<005)。结论在雄激素阻断后,神经内分泌分化的前列腺癌细胞能以旁分泌的方式支持其他前列腺癌细胞生长,降低其雄激素受体的表达。     

粘附分子E-钙粘素/β-连环素在LNCaP和ARCaP亚细胞系中的差异性表达及意义

目的:检测粘附分子E-钙粘素/β-连环素(E-cadherin/β-catenin)复合体在LNCaP和ARCaP亚细胞系IF11、IA8中的差异性表达,以探讨E-cadherin/β-catenin复合体与前列腺癌转移侵袭的关系。方法:用Western印迹及免疫荧光鉴定LNCaP和ARCaP亚细胞系IF11、IA8中E-cadherin、β-catenin的表达以及分布情况。结果:Western印迹显示E-cadherin在LNCaP细胞系中表达较高,在IF11、IA8中表达缺失,β-catenin在IF11、IA8中表达显著高于LNCaP(P<0.01)。免疫荧光显示β-catenin在LNCaP细胞系中主要分布在细胞膜上,而在ARCaP亚细胞系IF11、IA8中,主要分布于细胞核中;E-cadherin在LNCaP细胞中主要分布在细胞膜上。结论:不同上皮细胞间质转化态(EMT)特性的前列腺癌细胞系中E-cadherin/β-catenin表达以及分布存在差异,β-catenin的核转位可能是诱发前列腺癌细胞系发生EMT改变的机制之一。     

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.     

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.     

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.     

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.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.