丹参对大鼠缺血再灌注肾组织一氧化氮合成酶mRNA表达的影响

目的：探讨丹参对肾缺血再灌注损作保护效应的分子机制。方法：以大鼠缺血再灌汪肾损伤为模型，采用组织细胞原位杂交有图像分析技术技术，检测cNOS（eNOS和nNOS）及iNOSmRNA在缺血再灌注肾组织中的表达，并测定肾组织NOS总活性有血肌酐（Cr）。结果：①3种NOS在正常肾组织中均有表达，其中eNOS表达最丰富，cNOS／iNOS比值为2．29。②缺血时，肾组织NOS总活性显著下降，3种NOSmRNA在皮质、髓质有小球中的表达均下调，以eNOS最显著，cNOS／iNOS比值呈下降（2．01）趋势。③再灌注后，3种NOSmRNA的表达明显上调，以iNOSmRNA最明显，cNOS／iNOS的比值降至1．77。④肾缺血注射丹参后再灌注，iNOSmRAN表达明显下调，而nNOSmRAN则显著上调，cNOS／iNOS比值处于正常范围（2．14），Cr含量下降至正常水平。结论：①皮质肾小管上皮中iNOS活性升同与再灌汪后肾功能进一步受损密切相关。②缺血再灌注肾损伤中，丹参抑制iNOSmRNA和促进cNOSmRNA的表达是其介导肾保护效应的重要分子机制。③cNOS／iNOS比值的恒定对肾血流量和肾小球滤过率（GFR）的调节可能具有重要的意义。     

大鼠肝缺血／再灌注后肝组织一氧化氮和不同亚型一氧化氮合酶的变化

目的探讨一氧化氮（NO）和一氧化氮合成酶（NOS）在肝缺血／再灌注（I／R）过程中的变化和作用。方法健康雄性SD大鼠24只，随机分为3组（每组8只）：①正常对照组，术中只分离肝周围韧带，不做肝门阻断及再灌注。②I/R组，进行45min的部分肝门阻断及60min的再灌注。③L-精氨酸（L—Arg）组，缺血前20min经阴茎背静脉注射L—Arg（300mg／kg），余同②组。实验结束后，取下腔静脉血2ml，并迅速切取缺血肝组织。检测血清丙氨酸转氨酶（ALT）、门冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）；测定肝组织中超氧化物歧化酶（SOD）、丙二醛（MDA）、黄嘌呤氧化酶（XOD）、一氧化氮（NO）和一氧化氯合成酶（NOS）等指标；观察光镜和电镜下肝组织学变化。结果与正常对照组相比，I／R组iNOS升高，NO降低；L-Arg组NO、eNOS均高于I／R组。2、3组比1组大鼠的肝组织病理损害重、肝功能差，L—Arg组病理损害较I／R组明显减轻、肝功能改善。结论NO对大鼠肝I／R损伤具有保护作用．不同亚型NOS的变化参与其中。     

中介素减轻大鼠肾脏缺血再灌注损伤

目的 探讨中介素(IMD)对大鼠肾脏缺血再灌注损伤(IRI)的影响,及其过程中一氧化氮合酶(NOS)的作用和机制.方法 将健康雄性Wistar大鼠分为4组:假手术组,行右肾切除术,1周后单纯分离左侧肾蒂及肾动脉,而不夹闭肾动脉；肾脏缺血再灌注(IR)组,行右肾切除术,1周后行左肾缺血再灌注手术；IMD基因转染组,右肾切除后左肾行超声微泡介导的IMD-pCDNA3.1(+)质粒转染术,饲养1周,再行左肾缺血再灌注手术；空质粒转染组,右肾切除后左肾行超声微泡介导的pCDNA3.1(+)质粒转染术,饲养1周,再行左肾缺血再灌注手术.大鼠于缺血再灌注术后24 h处死,用免疫组织化学方法检测肾组织IMD表达,取肾组织进行病理学观察,取血清测定尿素氮(BUN)和肌酐(Cr)浓度,检测肾组织中内皮型NOS(eNOS)、诱导型NOS(iNOS)以及神经型NOS(nNOS) mRNA及其蛋白的表达.结果 假手术组大鼠肾组织中IMD位于肾小管及间质细胞胞浆内,其表达灰度值为66±35;肾脏IR组大鼠肾小管上皮细胞和间质中IMD表达灰度值为176±48,高于假手术组(P＜0.01)；IMD基因转染组肾组织中IMD表达灰度值为262±68,高于肾脏IR组(P＜0.01)；空质粒转染组IMD表达灰度值为180±51,和肾脏IR组间表达的差异无统计学意义(P＞0.05).与肾脏IR组相比较,IMD基因转染组大鼠肾脏组织病理损伤程度较轻,血清BUN和Cr较低(P＜0.05),eNOS mRNA及eNOS表达升高(P＜0.05),iNOS mRNA及iNOS表达降低(P＜0.05),而两组间nNOSmRNA及nNOS表达的差异无统计学意义(P＞0.05).结论 中介素可能通过促进eNOS表达、抑制iNOS表达从而减轻大鼠肾脏IRI.     

缺血预处理对大鼠部分肝脏切除术后肝脏一氧化氮合酶的影响及意义

目的 探讨缺血预处理（IPC）对大鼠部分肝脏切除术后肝脏一氧化氮合酶（NOS）的影响及意义。方法 20只SD大鼠随机分为2组：单纯热缺血组（WI）和缺血预处理组（IPC）。WI组于缺血前、再灌注后0．5、1、2、3h，IPC组于IPC前、IPC结束时、再灌注后0．5、1、2及3h分别切取肝脏组织约0．1g，用荧光定量PCR法检测其内皮型NOS（eNOS） mRNA和诱导型NOS（iNOS） mRNA。结果 两组肝脏热缺血再灌注后早期eNOS mRNA表达均增强，IPC组的表达高于WI组（P〈0、01或P〈0．05）。两组肝脏热缺血再灌注1h后iNOS mRNA开始表达，IPC组的表达低于WI组（P〈0．05）。结论 IPC可能通过促进肝脏热缺血再灌注早期eNOS mRNA的表达和抑制其稍后iNOS mRNA的表达，而发挥其对大鼠肝脏切除术中肝脏热缺血再灌注损伤的保护作用。     

内源性一氧化氮在非创伤性缺血预处理中对兔肺的保护作用

目的探讨内源性一氧化氮（NO）在非创伤性缺血预处理（N—WIP）中对兔肺缺血／再灌注（I／R）损伤的保护作用及可能机制。方法采用N-WIP及经典缺血预处理（C-IP）的动物模型，比较两种缺血预处理方法中内源性NO对兔肺在缺血／再灌注损伤中的保护效应。将40只大白兔随机平均分为4组：对照组、I／R组、C—IP组和NWIP组。对比观察各组血清及肺组织中NO2^-／NO3^-、丙二醛（MDA）含量及超氧化物歧化酶（SOD）活性以及肺湿／干重比。结果N—WIP组和C-IP组的兔肺再灌注后NO2^-／NO3^-含量均高于I／R组（P〈0．01），甚至高于对照组（P〈0．05）。两种缺血预处理组SOD活性均高于I／R组（P〈0．01），肺湿／干重比和MDA含量均低于I／R组（P〈0．05，P〈0．01）。结论N-WIP与C-IP对移植肺在缺血／再灌注损伤中具有同等强度的保护作用。其机制可能是通过诱发内源性一氧化氮（NO）舒张血管，从而起到保护血管内皮的效应。     

臭氧氧化预处理在肾缺血再灌注损伤中对内皮型一氧化氮合酶表达的影响

目的 观察臭氧氧化预处理对大鼠急性肾缺血再灌注损伤的保护作用及其对内皮型一氧化氮合酶（eNOS）表达的影响.方法 38只8周龄雄性Wistar大鼠按随机数字表法随机分为4组.（1）假手术组（n＝8）：仅切除右肾;（2）缺血再灌注组（n＝10）：切除右肾、游离左肾后夹闭左肾动、静脉45 min再开通;（3）臭氧氧化预处理组（n＝10）：与缺血再灌注组建模方法一致,但在建模前15 d起每天1次经直肠灌注法吹入氧气和臭氧的混合气体5~5.5 mL;（4）氧气预处理组（n＝10）：与臭氧氧化预处理组建模方法一致,但经直肠仅吹入氧气（13 mg/kg）.建模后24 h检测各组大鼠血清肌酐、血尿素氮和血清一氧化氮浓度;48 h后采用免疫组织化学法和逆转录PCR法检测各组大鼠肾组织eNOS表达;蛋白质印迹法检测肾组织胞浆eNOS含量.结果 建模后24 h,缺血再灌注组大鼠血清肌酐为（117±20）μmol/L,血尿素氮为（32.8±7.6）mmol/L,血清一氧化氮为（58±12）μmol/L,均高于假手术组,差异有统计学意义（均P〈0.05）.臭氧氧化预处理组血清肌酐为（63±16）μmol/L,血尿素氮为（17.4±5.2）mmol/L,低于缺血再灌注组和氧气预处理组,差异有统计学意义（均P〈0.05）;血清一氧化氮为（84±14）μmol/L,均高于缺血再灌注组和氧气预处理组,差异有统计学意义（均P〈0.05）.臭氧氧化预处理组肾组织学Paller评分（41±6）低于缺血再灌注组（62±9）,eNOS灰度值（163±15）高于缺血再灌注组（126±18）,差异有统计学意义（均P〈0.05）.假手术组大鼠肾组织内有微量eNOS mRNA表达,缺血再灌注组、臭氧氧化预处理组和氧气预处理组eNOS mRNA表达增强,均高于假手术组（均P〈0.05）,臭氧氧化预处理组eNOS mRNA表达高于缺血再灌注组和氧气预处理组（均P〈0.05）.假手术组无明显eNOS蛋白表达,缺血再灌注组、臭氧氧化预处理组和氧气预处理组eNOS蛋白表达增强,均高于假手术组（均P〈0.05）,臭氧氧化预处理组eNOS蛋白表达高于缺血再灌注组和氧气预处理组（均P〈0.05）.结论 臭氧氧化预处理对大鼠肾缺血再灌注损伤有保护作用,作用机制可能与其诱导eNOS合成增多、一氧化氮产生增多有关.     

通心络胶囊对肾缺血再灌注损伤大鼠肾小管上皮细胞凋亡的作用研究

目的探讨通心络胶囊（Tongxinluo capsule,TXLC）对肾缺血再灌注损伤（I／R）大鼠肾小管上皮细胞凋亡的作用及其可能机制。方法将30只雄性Wistar大鼠随机分为假手术对照组（S组）;缺血再灌注组（I／R组）和缺血再灌注联合通心络胶囊预处理组（I／R＋T组）。每组10只。采用无创动脉夹夹闭大鼠双侧肾蒂45min,再灌注24h的方法制成急性肾I／R模型,其中I／R＋T组术前喂药7d。光镜下观察细胞结构改变;测定血肌酐（SCr）,并观察肾功能变化;测定肾组织中超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量;采用脱氧核苷酸末转移酶介导的DNA原位末端标记技术（TUNEL）检测细胞凋亡的情况。结果与S组比较,I／R组肾组织SOD活性明显降低,MDA水平明显升高,SCr明显升高;与I／R组比较,I／R＋T组肾组织SOD活性明显升高,MDA水平明显降低,SCr明显降低。I／R＋T组肾组织病理损伤较I／R组明显减轻。结论TXLC对大鼠急性肾I／R具有保护作用,可能是通过其抗氧化作用减少肾小管上皮细胞凋亡而实现的。     

大鼠肾脏缺血再灌注时的相关因子变化

热休克蛋白70（HSP70）、血红素氧合酶1（HO-1）和诱导型一氧化氮合酶（iNOS）是近年来在缺血及再灌注（I／R）中引起广泛关注的一些酶类。我们探讨上述因子及血管紧张素Ⅱ（AngⅡ）对缺血及I／R时肾脏的作用。     

姜黄素对缺血再灌注大鼠肾脏一氧化氮水平的影响

目的探讨姜黄素对缺血再灌注大鼠肾组织一氧化氮（NO）水平的影响。方法制作大鼠肾脏缺血及缺血再灌注（IR）模型,将48只大鼠随机分为假手术组、缺血组、IR1h组、IR6h组各8只;姜黄素中药干预组16只（不同再灌注时间1h、6h各8只）。用药组于肾动脉夹闭前30min给予姜黄素注射液20mg／kg尾静脉输入,开夹再灌注时又给予原药量的1／2;对照组同时给予等量0．9％氯化钠溶液尾静脉输入。另取仅作麻醉、开腹、不阻断肾血流的8只大鼠作为假手术组。不同时间摘取肾脏及颈动脉断开取血,用硝酸还原酶测定血液及肾组织匀浆的NO2%-和NO^3-含量。HE染色观察肾脏损伤程度。结果缺血时及IR后NO表达均明显增强（P〈0．05）,姜黄素干预组上述异常均明显减轻。单纯缺血组肾系数和SCr较假手术组比无明显变化,仅BUN高于对照组,而IR1h、IR6h组肾系数、BUN和SCr水平均高于假手术组,且随再灌注时间延长而显著增加（P〈0．01）。结论姜黄素能降低早期缺血再灌注大鼠血液及肾组织NO水平,其可能在减轻缺血与缺血再灌注组大鼠肾脏高滤过和肾脏肥大、改善肾脏结构和功能中发挥一定作用。     

缺血后处理对大鼠肾缺血再灌注损伤的影响

目的探讨缺血后处理对大鼠肾缺血再灌注（I／R）损伤的影响及其机制。方法18只雄性SD大鼠随机分为3组（n=6）：假手术组（S组）、缺血再灌注组（I／R组）和缺血后处理组（IPo组）。采用夹闭双侧肾蒂45min-再灌注6h制备肾脏缺血再灌注损伤模型。IPo组在夹闭双侧肾蒂45min后，再灌注10s，缺血10s，重复3次后，完全恢复肾血流。再灌注6h时开胸，取心脏血后处死大鼠，取肾组织。测定血清肌酐（Cr）、尿素氮（BUN）和尿酸（UA）浓度，肾组织中丙二醛（MDA）含量和超氧化物歧化酶（SOD）活性；光镜下观察肾组织病理学改变；采用原位末端脱氧核苷酸转移酶标记（TUNEL）法检测肾组织中凋亡细胞，光镜下计数凋亡细胞，并计算肾小管上皮细胞凋亡指数（AI）。结果与S组比较，I／R组和IPo组Cr和BUN浓度升高（P〈0．05），UA浓度差异无统计学意义（P〉0．05），肾组织SOD活性降低，MDA含量升高，肾小管上皮细胞凋亡指数增加（P〈0．05），病理损伤明显。与I／R组比较，IPo组Cr和BUN浓度降低（P〈0．05），UA浓度差异无统计学意义（P〉0．05），SOD活性升高，MDA含量降低，肾小管上皮细胞凋亡指数减少（P〈0．05），病理损伤减轻。结论缺血后处理能减轻大鼠肾缺血再灌注损伤，其机制与增强肾脏抗氧化能力和抑制肾组织细胞凋亡有关。     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.