基于临床、超声及基因特征列线图预测甲状腺乳头状癌侵袭性

目的 观察基于临床、超声及基因特征的列线图预测甲状腺乳头状癌(PTC)侵袭性的价值。方法 回顾性分析207例PTC患者,根据术后病理所示病灶侵及甲状腺被膜和/或发生患侧颈部淋巴结转移与否分为侵袭组(n=130)及非侵袭组(n=77);对比2组临床、超声及基因特征,筛选PTC侵袭性的危险因素,并以之建立列线图模型,观察其预测PTC侵袭性风险的价值。结果 2组患者年龄,结节最大径、与被膜直线距离、微钙化、数目和分布,以及BRAF V600E基因检测差异均有统计学意义(P均＜0.05)。结节最大径＞1 cm[OR=2.540,95%CI(1.341,4.810),P=0.004]、微钙化[OR=2.276,95%CI(1.203,4.308),P=0.011]、双侧叶多灶[OR=3.414,95%CI(1.578,7.385),P=0.002]及突变型BRAF V600E[OR=2.663,95%CI(1.147,6.182),P=0.023]为PTC侵袭性的独立危险因素。列线图模型预测PTC侵袭性的曲线下面积为0.747[95%CI(0.679,0.815)]。结论 以基于结节最大径、微钙化、数目和分布及BRAF V600E基因检测的列线图预测PTC侵袭性具有一定价值。     

超声引导经皮微波消融治疗结直肠癌肝转移瘤不良事件及其影响因素

目的 探讨超声引导经皮微波消融（MWA）治疗结直肠癌肝转移瘤（CRLM）不良事件（AE）及其影响因素。方法 回顾性分析427例接受超声引导经皮MWA治疗的CRLM患者,共治疗614例次、1 334个病灶,统计术后AE发生率及其影响因素。结果 AE总发生率4.89%（30/614）,无消融相关死亡。影响AE的危险因素包括穿刺针数（OR=1.301,P=0.005）、高危部位病灶（OR=2.829,P=0.025）、病灶数>5（OR=4.655,P=0.010）、腹腔手术史（OR=7.716,P=0.047）及肝吸虫病（OR=17.683,P=0.005）。结论 超声引导经皮MWA治疗CRLM的AE发生率较低,AE发生与病灶数目、高危部位、穿刺针数、腹腔手术史及肝吸虫病有关。     

超声引导下颈中间丛阻滞联合甲状腺囊下阻滞用于微波消融甲状腺结节

目的 观察超声引导下颈中间丛阻滞（ICPB）联合甲状腺囊下阻滞用于微波消融甲状腺结节的价值。方法 前瞻性纳入68例单发结节性甲状腺肿患者,随机将其分为干预组（n=34）和对照组（n=34）。对干预组于超声引导下ICPB联合甲状腺囊下阻滞消融,对照组于常规局部浸润麻醉后行甲状腺结节微波消融,对比组间一般资料、术中及术后情况,消融过程及消融后2、4、8及24 h分别记为T1、T2、T3、T4及T5。评价ICPB联合甲状腺囊下阻滞用于微波消融甲状腺结节的价值。结果 最终60例入组,干预组、对照组各30例;干预组患者T1~T3期间心率-血压乘积（RPP）及T1~T4期间视觉模拟量表（VAS）评分均显著低于对照组（P均<0.05）,而T2及T3期间40项恢复质量（QoR-40）评分显著高于对照组（P均<0.05）。干预组术中接受利多卡因者占比及剂量、术后口服对乙酰氨基酚占比及剂量均显著低于对照组（P均<0.05）。干预组术后未见明显并发症,对照组术后4例声嘶、2例呕吐。结论 超声引导下ICPB联合甲状腺囊下阻滞用于甲状腺结节微波消融安全性较高,可提供有效围手术期镇痛。     

超声引导下细针穿刺抽吸甲状腺结节标本质量的影响因素

目的 观察超声引导下细针穿刺抽吸（US-FNA）甲状腺结节标本质量的影响因素。方法 选取388例接受US-FNA的甲状腺结节患者（共436个结节）,根据标本背景的血液成分、细胞数目、存留组织框架及细胞破坏程度将其分为诊断优越组（n=325）和非诊断优越组（n=111）,比较其超声特征,主要包括结节最大径、形态、边界、回声、钙化及血供,分析影响US-FNA标本质量的因素。结果 组间甲状腺结节最大径、内部钙化及Adler血供差异均有统计学意义（P均<0.05）。甲状腺结节最大径及钙化为US-FNA标本质量的影响因素（P=0.010、0.002）。结论 超声所见甲状腺结节最大径及钙化为其US-FNA标本质量的影响因素。     

临床-超声列线图预测急性缺血性脑卒中短期预后

目的 观察临床-超声列线图预测急性缺血性脑卒中（AIS）短期预后的价值。方法 回顾性分析168例接受血管内介入治疗的AIS患者,根据治疗后3个月改良Rankin量表评分将其分为预后良好组（n=134）及预后不良组（n=34）。比较组间临床及超声资料,采用最小绝对收缩和选择算子（LASSO）算法及Cox回归方程分析AIS短期预后的独立影响因素,以之分别构建临床、超声及临床-超声列线图模型;绘制受试者工作特征曲线,计算曲线下面积（AUC）,评估各模型预测AIS短期预后的效能。结果 发病至入院时间、美国国立卫生院卒中量表（NIHSS）评分、Alberta卒中项目早期CT评分（ASPECTS）、斑块时间-强度曲线强度均值（TIC-M）及峰值强度（TIC-P）和伽马拟合曲线的AUC均为AIS短期预后的独立影响因素（P均＜0.05）。临床、超声及临床-超声列线图模型预测AIS短期预后的AUC分别为0.888、0.758及0.921,以临床-超声列线图模型的预测效能最高（P均＜0.05）。结论 临床-超声列线图可有效预测AIS短期预后。     

对比冷冻消融与微波消融治疗兔VX2椎旁肿瘤的有效性及安全性

目的 对比冷冻消融（CA）与微波消融（MWA）治疗兔VX2椎旁肿瘤的有效性及安全性。方法 选取48只新西兰大白兔建立VX2椎旁肿瘤模型并随机分为CA组（n=24）及MWA组（n=24）,比较组间完全消融率、生存率、布里斯托尔兔疼痛量表（BRPS）评分及并发症发生率。结果 CA组完全消融率及治疗后21天生存率分别为91.67%（22/24）及33.33%（8/24）,均高于MWA组［66.67%（16/24）及16.67%（4/24）］（P均＜0.05）。CA组治疗后4 h、1天、4天、7天及14天BRPS评分均低于MWA组（P均＜0.001）;2组上述时间点BRPS评分均低于治疗前（P均＜0.05）。CA组并发症发生率（3/24,12.50%）低于MWA组（8/24,33.33%）（P＜0.05）。结论 CA治疗兔VX2椎旁肿瘤的安全性及有效性均优于MWA。     

血清IL-8、VEGF水平与下肢动脉硬化闭塞症患者支架植入术后1年内支架内再狭窄的关系

背景与目的 支架植入术是治疗下肢动脉硬化闭塞症（ASO）的主要治疗方式之一,可有效恢复血管畅通,改善患者临床症状,但部分患者术后1年内易出现支架内再狭窄。支架内再狭窄可导致患者较差的预后,因此明确影响ASO术后支架再狭窄的病理机制具有重要意义。血清白细胞介素8（IL-8）与血管内皮生长因子（VEGF）分别是反映机体炎症和血管内皮功能的指标,与ASO的发生关系密切,但是否与ASO患者支架植入术后支架再狭窄相关尚不明确。鉴于此,本研究对IL-8、VEGF水平与ASO患者支架植入术后1年内支架内再狭窄的关系进行探讨,并建立预测支架植入术后1年内支架内再狭窄的列线图模型。方法 选取2020年1月—2022年10月河南省南阳市第一人民医院血管外科接受支架植入手术治疗的100例ASO患者为研究对象,术后随访1年,根据随访结果将受试者分为再狭窄组和未再狭窄组。收集受试者人口学特征、术后血清IL-8与VEGF水平及其他相关指标等。采用单因素和Logistic回归分析影响支架植入术后1年内支架内再狭窄的危险因素。基于危险因素构建预测支架植入术后1年支架内再狭窄的风险列线图预测模型,并对构建的预测模型进行验证。结果 随访期间失访4例,失访率为4.00%（4/100）。96例患者中29例患者发生支架内再狭窄,支架内再狭窄率为30.21%（29/96）。Logistic回归分析结果显示,年龄≥60岁（OR=4.191）、Fontaine分期（Ⅳ期）（OR=2.863）、完全闭塞（OR=2.445）、下肢血管病变长度≥7.15 cm（OR=3.343）、术后IL-8≥1.02 ng/mL（OR=6.482）、术后VEGF≥158.37 pg/mL（OR=10.402）是影响支架植入术后1年支架内再狭窄的独立危险因素（均P<0.05）。对基于以上因素构建的列线图预测模型的验证结果显示,校正曲线贴近于理想曲线;C指数为0.857（95% CI=0.785~0.952）;受试者工作特征（ROC）曲线结果显示,列线图风险模型预测支架植入术后1年支架内再狭窄的ROC曲线下面积为0.852（95% CI=0.631~0.979）,敏感度、特异度分别为92.50%、78.40%。结论 ASO患者支架植入术后血清IL-8、VEGF水平与支架内再狭窄的发生率关系密切,术后血清IL-8、VEGF水平越高,患者术后支架内再狭窄的发生风险越高,以此为基础构建的列线图模型预测模型有助于临床医生对ASO患者提供更好的治疗和随访方案。     

MRI多参数评估经皮微波消融治疗乳腺良性病变效果

目的 观察MRI多参数评估经皮微波消融（MWA）治疗乳腺良性病变的效果。方法 回顾性分析63例接受超声引导下经皮MWA治疗乳腺良性病变（共66个病灶）患者的消融前及消融后6个月乳腺MRI,对比消融前与6个月后病灶MRI表现,包括病灶最长径、体积、T1信号、T2信号、弥散加权成像（DWI）信号、表观弥散系数（ADC）及增强特点,根据实体瘤疗效评价标准评估经皮MWA治疗效果。结果 63例66个乳腺良性病灶均消融成功。相比消融前,消融后6个月病灶最长径及体积缩小,T1信号升高、T2及DWI信号减弱、ADC升高,增强信号减弱（P均<0.01）。消融后6个月,66个病灶中,18个完全缓解,46个部分缓解,2个疾病稳定。结论 MRI多参数有助于评估经皮MWA治疗乳腺良性病变的效果。     

对比乙型与丙型肝炎背景下肝细胞癌患者经微波消融治疗后预后

目的 对比观察微波消融（MWA）治疗乙型（HB）与丙型肝炎（HC）背景下肝细胞癌（HCC）的预后。方法 回顾性分析HCC伴HB（HB-HCC）及HCC伴HC（HC-HCC）各159例患者资料,比较组间肿瘤学结局,分析患者死因,观察HCC患者MWA后总生存期（OS）的危险因素。结果 HC-HCC组OS率低于HB-HCC组（P=0.045）,组间无病生存率（P=0.095）及癌症特异性生存率（P=0.189）差异均无统计学意义。相比HB-HCC组,HC-HCC组患者死于肝硬化并发症的风险更高（HR=2.339,P=0.043）。Child-Pugh B级（HR=3.082,P＜0.001）、肝炎病毒载量＞500 IU/ml（HR=1.654,P=0.006）及病灶最大径≥3.0 cm（HR=1.541,P=0.017）均为HCC患者MWA后OS的独立危险因素。结论 相比HB-HCC患者,HC-HCC患者MWA后OS较短。     

超声造影联合声辐射力脉冲弹性成像评估微波消融治疗大鼠肝泡型棘球蚴病

目的 观察超声造影（CEUS）联合声辐射力脉冲（ARFI）弹性成像技术评价微波消融（MWA）治疗大鼠肝泡型棘球蚴病（HAE）效果的价值。方法 将40只HAE大鼠模型分为实验组（n=30）和对照组（n=10）。实验组予超声引导下MWA,对照组仅常规饲养。术前及术后1个月采用二维超声、CEUS和ARFI测量2组病灶最大径,以及实验组病灶边缘带平均灰阶比值与剪切波速度（SWV）。完成检测后处死大鼠,对组织切片行常规HE染色、CD34免疫组织化学染色及Masson染色,计数病灶边缘带微血管密度（MVD）及纤维化面积。结果 术后1个月,3种方法所测实验组病灶最大径均较术前缩小（P均<0.001）,对照组病灶最大径均较入组时增大（P均<0.001）;CEUS、ARFI所测病灶最大径均大于二维超声（P均<0.05）,CEUS与ARFI组间差异无统计学意义（P均>0.05）。术后1个月实验组病灶边缘带平均灰阶比值低于术前,平均SWV高于术前（P均<0.001）;病灶边缘带MVD低于而纤维化面积高于对照组（P均<0.001）,MVD与病灶边缘带灰阶比值呈正相关（r=0.541,P=0.011）,SWV与纤维化面积呈正相关（r=0.494,P=0.023）。结论 CEUS联合ARFI对评估MWA治疗大鼠HAE效果具有一定应用价值。     

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.