阿仑膦酸钠抑制骨巨细胞瘤细胞生长和诱导其凋亡的研究

[目的]骨巨细胞瘤是一种潜在的恶性病变，具有手术后易复发的特点。二膦酸盐是抗骨质疏松药，可以抑制破骨细胞性骨吸收，近来发现其还有抗肿瘤作用。本研究是探讨第3代二膦酸盐——阿仑膦酸钠是否能够抑制骨巨细胞瘤细胞生长，诱导骨巨细胞瘤细胞凋亡，探讨应用二膦酸盐能否成为一个防止骨巨细胞瘤复发的方法。[方法]在体外培养骨巨细胞瘤细胞，给予不同浓度的阿仑膦酸钠，作用不同时间后，应用M1Tr法检测骨巨细胞瘤细胞的活性是否受到抑制，TUNEL染色法观察骨巨细胞瘤细胞经药物作用后是否发生凋亡，流式细胞术检测凋亡率，观察药物作用后凋亡蛋白Caspase-3活性的表达是否增加。[结果]经阿仑膦酸钠作用后瘤细胞活性减低，可以发现阿仑膦酸钠抑制骨巨细胞瘤细胞生长的作用可以随时间和浓度的增加而增高。TUNEL法观察到瘤细胞凋亡染色阳性，流式细胞仪检测阿仑膦酸钠作用后骨巨细胞瘤细胞的凋亡率也随着时间和浓度的增加而增高。进一步检测随着阿仑膦酸钠浓度的提高，骨巨细胞瘤细胞的Caspase-3活性表达也增加。[结论]阿仑膦酸钠对于体外培养的骨巨细胞瘤细胞的活性有抑制作用，可以抑制其生长并诱导肿瘤细胞内的Caspase-3活性表达，促其凋亡，阿仑膦酸钠可能成为治疗和预防骨巨细胞瘤复发的一个治疗方法，但还需要进一步的体内实验研究。     

X线照射对胆囊癌GBC-SD细胞增殖周期的影响

目的：探讨X线照射对胆囊癌细胞系GBC—SD的生长及对细胞增殖周期的影响。方法：分别给予体外培养的人胆囊癌细胞系GBC—SD以0,5,10,20Gy X线照射。通过MTT方法测定在不同剂量X线照射下的细胞生长变化。通过流式细胞仪检测胆囊癌细胞于照射后增殖周期时相的变化。结果：较大剂量的X线能抑制胆囊癌GBC-SD细胞系的生长,24h表现出明显的抑制作（P=0．002）;72h抑制作用更加显著（P〈0．001）：其作用呈现效应．剂量依赖性。流式细胞仪检测发现不同的剂量照射后,处于细胞周期不同阶段的细胞会发生不同的变化。24h：胆囊癌细胞的G0-G1、S期细胞比例减少．G2-M期细胞比例增加。72h：胆囊癌细胞的G0-G1细胞比例增加,S期、G2-M期细胞比例减少。实验同时发现小剂量的照射可刺激胆囊癌细胞的增殖,使S、G2-M期细胞增加;而提高照射剂量,使胆囊癌细胞生长停滞在G0～G1期．而S期、G2-M细胞百分比减少。结论：X线照射可通过改变细胞增殖周期分布比例抑制胆囊癌GBC-SD细胞的生长：增加照射剂量可提高胆囊癌的治疗疗效。     

咖啡酸苯乙酯对大肠癌SW480细胞生长和周期的影响

目的　探讨咖啡酸苯乙酯 (CAPE)对体外培养的大肠癌细胞SW 4 80增殖和细胞周期的影响。方法　不同浓度CAPE处理体外培养的大肠癌SW 4 80细胞后 ,采用MTT法检测细胞的增殖活性 ;流式细胞仪检测细胞周期分布。结果　CAPE处理SW 4 80细胞后 ,SW 4 80细胞的生长抑制率明显升高 ,抑制作用表现为剂量依赖性和时间依赖性。流式细胞仪细胞周期分析表明CAPE作用 2 4h后 ,细胞G0 /G1期比例上升 ,S期比例下降。同时发现CAPE作用后 ,细胞出现胞浆混浊 ,胞体缩小、变圆、皱缩 ,核固缩粹裂等凋亡形态学特征。结论　CAPE对大肠癌SW 4 80细胞株具有明显的生长抑制作用 ,其作用机制与阻滞细胞周期G1期和诱导细胞凋亡有关。     

骨巨细胞瘤辅助性化疗现代观点

作为骨巨细胞瘤的辅助治疗方法,化疗的必要性和适用范围一直存在争议.传统观点认为化疗不良反应大,可产生免疫抑制,影响骨质愈合;化疗药物一般只对增殖中的细胞有抑制作用,而骨巨细胞瘤细胞增殖比率不高,对化疗不敏感,疗效常不令人满意.进一步研究发现化疗药物对体外培养的骨巨细胞瘤细胞的克隆增殖有明显抑制作用,这为骨巨细胞瘤临床化疗提供了理论依据.临床治疗中对恶性程度高或手术彻底切除的骨巨细胞瘤多采用全身化疗或局部化疗.有学者证实瘤腔内化疗确实能杀灭残存的肿瘤细胞,全身或局部化疗能降低骨巨细胞瘤复发率和转移率.骨巨细胞瘤化疗的适应证、药物选择和应用方式,有待进一步研究.     

低氧对SD大鼠阴茎海绵体平滑肌细胞凋亡的影响

目的:探讨低氧和SD大鼠阴茎海绵体平滑肌细胞(CCSMC)凋亡的关系。方法:体外培养CCSMC,免疫组化鉴定细胞;低氧(1%O2浓度)干预12、24、48、72 h,常规氧浓度作为对照,流式细胞术测定细胞周期变化和凋亡情况。结果:体外培养的CCSMC生长良好,抗平滑肌α-肌动蛋白单克隆抗体免疫组化DAB法染色阳性。流式细胞术检测CCSMC G0/G1期在48 h内细胞比例逐渐增加,后下降;S期细胞比例与G0/G1期呈相反趋势;G2/M期细胞比例无明显规律。结论:CCSMC在低氧环境下,随时间的延长凋亡程度加重,48 h达到最大值,进一步延长时间细胞裂解,不能加重凋亡。     

咖啡因在骨肉瘤细胞株热化疗中增效作用的实验研究

目的探讨咖啡因结合顺铂热化疗对骨肉瘤细胞株 (OS－ 732)细胞毒性的影响。方法 43℃恒温条件下,骨肉瘤细胞株 (OS－ 732)分别经咖啡因、顺铂、咖啡因＋顺铂作用 1 h,分别采用体外 3－ (4, 5－ dimethylthiazol－ 2－ yl)－ 2,5－ diphenyltetrazolium bromide(MTT法 )细胞毒性试验和流式细胞仪 (FCM)分析,观察三者对细胞毒性及细胞周期的影响。结果咖啡因浓度为 0、 0.2、 2.0、 5.0、 10.0、 20.0 mmol/L时,其细胞毒性指数分别为 15.79％、 19.74％、 19.74％、 21.05％、 38.16％、 46.05％。顺铂浓度为 0、 0.1、 1.0、 10.0μ g/ml时,其细胞毒性指数分别为 15.79％、 25.00％、 30.26％、 44.74％。而浓度为 2.0、 5.0 mmol/L的咖啡因与浓度为 0.1、 1.0、 10.0μ g/ml的顺铂联合作用,其细胞毒性指数明显增加,最高达 64.47％。且结合 FCM分析显示其对细胞周期也有明显的影响, G0与 G1期细胞比例明显增加, G2与 M期明显减少。结论安全浓度的咖啡因在骨肉瘤细胞株 (OS－ 732)顺铂热化疗中有明显的增效作用。     

复方积雪草对肾小球系膜细胞及细胞外基质的影响

目的 :探讨复方积雪草在体外及体内对大鼠肾小球系膜细胞及细胞外基质增生的影响。方法 :体外实验在培养的大鼠肾小球系膜细胞中进行 :应用氮蓝四唑盐 (MTT)比色法、流式细胞术对DNA倍体进行分析 ,分别检测复方积雪草对系膜细胞增殖的影响。体内实验在单侧肾切除术合并阿霉素静脉双次注射的大鼠肾小球硬化模型中进行 ,用定量病理分析观察复方积雪草对系膜细胞增殖及系膜基质增殖的影响。结果 :体外实验提示 ,复方积雪草明显抑制血清加血管紧张素Ⅱ刺激的系膜细胞增殖 (与对照组比较P <0 .0 1) ,G0 /G1期细胞比例增加 ,S G2 /M期细胞比例逐渐下降 ,且呈量效和时效依赖关系。体内实验中 ,造模大鼠经复方积雪草治疗后第 8周 ,系膜细胞增殖、细胞外基质沉积均明显减少 (与对照组比较P <0 .0 1)。结论 :复方积雪草可以抑制系膜细胞增生 ,阻止系膜细胞由G1期进入S期 ,减少细胞外基质沉积     

咖啡酸苯乙酯对大肠癌SW480细胞生长和周期的影响

目的 探讨咖啡酸苯乙酯(CAPE)对体外培养的大肠癌细胞SW480增殖和细胞周期的影响。方法 不同浓度CAPE处理体外培养的大肠癌SW480细胞后，采用MTT法检测细胞的增殖活性；流式细胞仪检测细胞周期分布。结果 CAPE处理SW480细胞后，SW480细胞的生长抑制率明显升高，抑制作用表现为剂量依赖性和时间依赖性。流式细胞仪细胞周期分析表明CAPE作用24h后，细胞G0/G1期比例上升，S期比例下降。同时发现CAPE作用后，细胞出现胞浆混浊，胞体缩小、变圆、皱缩，核固缩粹裂等凋亡形态学特征。结论 CAPE对大肠癌SW480细胞株具有明显的生长抑制作用，其作用机制与阻滞细胞周期．G1期和诱导细胞凋亡有关。     

烧伤前后大鼠血清对骨髓基质细胞生物学行为的影响

目的:观察烧伤前后大鼠血清对体外培养的大鼠骨髓基质细胞的生物学行为的影响,为骨髓基质细胞在创伤修复中的应用奠定实验基础.方法:取Wistar大鼠,处死分离骨髓,原代培养骨髓基质细胞,传代后分别用含有10%胎牛血清、正常大鼠血清、烧伤后3d大鼠血清和烧伤后14d大鼠血清的F-12培养基培养,用MTT法测定其生长曲线,PI染色,流式细胞仪分析细胞周期、DNA含量和细胞凋亡率.结果:用含有10%大鼠血清的F-12培养基传代培养的细胞生长曲线相似,但与含有FCS的F-12培养基传代培养的明显不同.前者倍增时间缩短,N组、B1组、B2组细胞群体倍增时间分别为23.7h、18.6h、20.2h.平台期所能达到的细胞总数明显增加.烧伤后大鼠血清处理过的细胞中G0/G1期细胞比例明显低于其它两组,而S期细胞的比例则相反.正常大鼠血清处理过的细胞中G2+M期细胞的比例则比其它组明显升高.大鼠血清处理过的细胞中DNA含量明显高于胎牛血清培养的细胞,而烧伤后的大鼠血清处理过的细胞中DNA含量则明显高于正常大鼠血清处理过的细胞.而烧伤后3d的大鼠血清处理过的细胞的凋亡率比其它组细胞明显升高.结论:大鼠血清比胎牛血清能更好地促进大鼠体外培养的骨髓基质细胞生长;烧伤大鼠血清内可能含有多种能影响骨髓基质细胞生长的物质,且其含量随烧伤的时间改变而变化,对骨髓基质细胞生长的影响是复杂的.     

曲古抑菌素A诱导膀胱癌细胞p27kip1、XIAP表达的实验研究

目的 观察组蛋白去乙酰化酶(HDAC)抑制剂曲古抑菌素A(TSA)对体外培养膀胱癌细胞生长情况及相关基因(p27kip1、XIAP)表达的影响,并探讨其可能的作用机制.方法 采用MTT法检测不同浓度TSA(100、200、400、800nmol/L)对人膀胱癌BIU-87细胞生长的影响;流式细胞术(FCM)检测TSA处理后膀胱癌细胞周期分布的变化及对膀胱癌细胞凋亡的影响;Western blot检测TSA作用BIU-87细胞后p27kip1、XIAP蛋白表达的变化.结果 TSA体外能明显抑制BIU-87细胞的生长,且抑制作用呈明显的剂量、时间依赖性.FCM检测示处理后膀胱癌细胞阻滞于G0-G1期,Western blot结果示TSA处理能显著诱导p27kip1蛋白的表达和显著抑制XIAP蛋白的表达.结论 TSA可通过诱导细胞凋亡,使细胞阻滞于G1期而发挥体外抗膀胱癌作用,其作用机制可能涉及相关基因(p27kip1、XIAP)表达的调控.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.