膀胱肿瘤术前活检和术后标本病理分级差异性分析

目的 分析膀胱肿瘤术前活检和术后病理结果的差异性,探讨其原因及对治疗方案选择的意义. 方法 回顾性分析膀胱镜活检诊断膀胱肿瘤并手术的病例112例次,对比分析术前活检及术后标本病理分级结果. 结果 112例术前活检病理分级为乳头状瘤34例,G1 50例,G2 21例,G3 7例.术后标本病理分级为乳头状瘤15例,G1 43例,G2 39例,G3 15例.总体一致率为55.4%,低估率为42.0%. 结论 膀胱肿瘤术前活检标本相对术后病理标本分级仔在低估现象,可能导致治疗不足.     

窄带显像膀胱镜对膀胱肿瘤手术前后病理核分级差异的影响

目的 探讨窄带显像膀胱镜能否减少膀胱肿瘤手术前后病理核分级的差异.方法 采用WHO/ISUP 2004病理分级标准并结合临床情况,对205例膀胱肿瘤术前活检病理、术后病理分级等进行分析.对接受保留膀胱手术的患者进行随访并观察膀胱肿瘤复发情况.结果 白光膀胱镜组109例,术前G0 23例,G1 60例,G2 22例,G3 4例;术后G0 15例,G1 41例,G2 31例,G3 22例;活检低估51例（46.8%）,高估7例（6.4%）,一致51例（46.8%）.窄带显像膀胱镜组96例,术前G0 15例,G1 45例,G2 30例,G3 6例;术后G0 14例,G1 21例,G2 46例,G3 15例;活检低估45例（46.9%）,高估14例（14.6 %）,一致37例（38.5%）,两组相比差异无统计学意义.但单独观察G1亚组,窄带显像膀胱镜G1组低估率高于白光膀胱镜G1组（62.2% vs 41.7%）,窄带显像膀胱镜G1组一致率低于白光膀胱镜G1组（24.4% vs 50.0%）,两组差异有统计学意义（χ2=7.067,P=0.029）.行白光膀胱镜者平均随访33个月（4～62个月）,复发38例;行窄带显像膀胱镜者平均随访15个月（3～32个月）,复发9例,两组差异有统计学意义（χ2=5.25,P=0.02）.结论 窄带显像膀胱镜不能减少膀胱肿瘤术前活检分级低估现象.     

原发性T1G3膀胱癌复发后病理分级减低现象的临床意义

目的 探讨原发性T1G3膀胱癌复发后病理分级减低现象的临床意义。方法 回顾性分析1995年至2004年收治55例原发性T1G3膀胱癌患者的临床资料。55例首次手术方法均采取经尿道膀胱肿瘤电切术，术后均出现复发，次数1～9次。依据复发后是否发生病理分级减低分为2组：A组21例（38．2％），复发后有病理分级减退现象；B组34例（61．8％），复发后病理级别不变。对2组患者性别、年龄、肿瘤大小、是否多发、术后是否膀胱灌注、复发后肿瘤是否浸润肌层、肿瘤病理分级改变以及无瘤生存期等资料进行对比分析。结果 A组原发肿瘤直径〉3cm者9．5％（2／21），复发后肿瘤肌层浸润者23．8％（5／21）；而B组分别为38．2％（13／34）和52．9％（18／34），2组差异有统计学意义（P=0．020，0．033）。2组患者5年无瘤生存率分别为（66．8±16．6）％和（50．5±12．9）％，差异有统计学意义（P=0．038）。Cox多因素回归分析显示，病理分级减退现象为影响生存率的独立指标（P=0．044）。结论 原发性T1G3膀胱癌患者复发后病理分级减低者预后相对较好，复发后病理分级减低可作为判断预后的独立因素。     

膀胱

不同类型膀胱癌组织中环氧化酶-2的表达及意义，膀胱癌术前活检分级低估现象分析，原位回肠和乙状结肠尿流改道术临床疗效比较，改良Kock回肠代膀胱术51例报告,女性腺性膀胱炎的诊断及外科治疗（附226例报告）,经尿道膀胱肿瘤电切术后单次髂内动脉栓塞化疗治疗难治性膀胱癌，[编者按]     

同时性尿路上皮多器官肿瘤

目的探讨同时性尿路上皮多器官肿瘤的临床特点，提高诊治效果。方法对获随访的65例同时发生于多个尿路器官的尿路上皮肿瘤进行回顾性总结。男39例，女26例。年龄45～79岁，平均66岁。肾盂癌合并输尿管癌21例，输尿管癌合并膀胱癌17例，肾盂癌合并膀胱癌14例，同时合并肾盂输尿管膀胱癌13例。T1 6例，T2 35例，T3 22例，T4 2例。G1 5例，G2 32例，G3 28例。随访6个月～14年。结果术前诊断同时存在尿路上皮多器官肿瘤59例（90．8％）。术前诊断准确率B超32．3％（21／65），IVU 45．3％（29／64），逆行肾盂造影56．8％（25／44），CT 81．5％（53／65），螺旋CT尿路三维重建91．7％（11／12），CT三维重建联合膀胱镜检查100．0％（12／12）。术后再发膀胱癌46例（70．8％），2年内再发36例。G1、G2、G3术后膀胱癌再发率分别为20．0％、81．3％和67．9％，G1与G2～G3两组比较差异有统计学意义（P＜0．05）。T1、T2、T3术后膀胱癌再发率分别为66．7％、80．0％和63．6％；T4 2例均于术后短期内死亡，无膀胱癌再发。术后即时膀胱灌注化疗术后膀胱癌再发率63．2％（12／19），未灌注化疗者73．9％（34／46）。3年生存率41．7％，5年生存率30，6％。结论螺旋CT三维成像加膀胱镜检查是发现同时性尿路上皮多器官肿瘤的良好方法。同时性尿路上皮多器官肿瘤术后容易再发膀胱癌，肿瘤细胞分化不良者术后膀胱癌的再发率高。术后密切观察，建议除定期膀胱镜检查外，尚需行尿路造影检查。     

与Cytokeratin 20相比，Uroplakin Ⅱ是膀胱癌淋巴结转移分子诊断更有前途的标记物

目前，根治忡膀胱全切术后淋巴结病理检查方法费时费力。作者对膀胱癌患者盆腔淋巴结表达Uroplakin Ⅱ（UP Ⅱ）和Cytokeratin 20（CK20）的情况进行了系统研究。21例膀胱癌患者接受了根治性膀胱全切和盆腔淋巴结清扫术，共取到82个盆腔淋巴结和19个膀胱肿瘤标本以备逆转录聚合酶链反应（RT-PCR）实验。19例膀胱肿瘤标本中，UPⅡ和CK20 mRNA表达分别为19例（100．0％）和13例（68．4％）；16例病理证实盆腔淋巴结转移的淋巴结标本中，     

预防肾盂输尿管癌术后再发膀胱癌的手术方法研究

目的探讨预防。肾盂输尿管癌术后再发膀胱癌的手术方法。方法对156例单纯。肾盂癌、单纯输尿管癌中获随访的139例患者资料进行同顾性总结。肾盂癌78例。输尿管癌61例。肿瘤细胞分级：G1 19例，G2 88例，G3 32例。肿瘤分期：Ta—T1 38例，T2 80例，T3～T4 21例。肿瘤直径0．8—6．0cm。结果139例均行根治性。肾、输尿管及管口周围部分膀胱壁（1．5—2．0cm）切除术。术后随访1～10年。再发膀胱癌55例，占39．6％。肾盂癌术中先用纱条结扎输尿管后游离切除患肾输尿管及管口周围部分膀胱者术后膀胱癌再发率18．5％（5／27），未先结扎输尿管者再发率27．5％（14／51）。术后当日膀胱灌注化疗者膀胱癌再发率32．3％（10／31）。术后3周开始膀胱灌注化疗者膀胱癌再发率34．9％（30／86）。术后当日及术后序贯膀胱灌注化疗者术后膀胱癌再发率20．0％（4／20），单纯术后序贯膀胱灌注化疗者膀胱癌再发率39．3％（26／66）。2者比较差异有统计学意义（P〈0．01）。结论术后当日及术后序贯膀胱灌注化疗可有效降低。肾盂输尿管癌术后膀胱癌的再发率，游离切除。肾输尿管前先结扎输尿管对预防肾盂癌术后再发膀胱癌可能有益。     

前列腺干细胞抗原在膀胱尿路上皮癌组织中的表达及其临床意义

目的探讨前列腺干细胞抗原（PSCA）在膀胱尿路上皮癌组织中的表达情况,并分析其与膀胱癌临床病理特征及复发的关系。方法选择105例膀胱尿路上皮癌标本,20例癌旁正常膀胱组织标本。癌标本中非肌层浸润性癌74例,肌层浸润性癌31例;G1 26例、G2 54例、G3 25例;单发肿瘤63例,多发肿瘤42例;非肌层浸润性癌中未复发31例,复发43例。采用SP免疫组织化学方法检测膀胱癌和癌旁正常组织中PSCA蛋白的表达,并结合临床病理资料进行分析。结果正常膀胱组织中无PSCA蛋白表达,癌组织中随病理分级和分期增加,PSCA相对表达量逐渐增高。G1、G2、G3 膀胱癌PSCA蛋白表达阳性率分别为23．1％、46．3％,76．0％,差异均有统计学意义（P〈0．001）。非肌层浸润性肿瘤和肌层浸润性肿瘤中PSCA蛋白表达阳性率为47.3％和71．0％,差异有统计学意义（P=0．004）。随访3～54个月,非肌层浸润性膀胱癌中,复发组与未复发组中PSCA蛋白高表达阳性率为65．1％和32.3％,差异有统计学意义（P〈0．001）。结论PSCA蛋白高表达与膀胱尿路上皮癌的恶性程度及预后相关,检测PSCA有助于膀胱癌的诊断及评估预后。     

Survivin在膀胱移行细胞癌中的表达及其临床意义

目的比较Survivin在正常组织与膀胱移行细胞癌中表达的差异，分析其表达与膀胱移行细胞癌生物学特性及预后的关系。方法选用中山大学附属第三医院2001年至2006年间外科切除及活检的膀胱癌石蜡块标本40例，其中24例为浅表性膀胱癌组织，16例为浸润性膀胱癌组织。另取10例正常膀胱组织石蜡块标本，用免疫组化染色显示组织中Survivin表达，并对结果进行相应的统计学分析。结果10例正常膀胱组织中未见Survivin表达。于G，级、G：级、G，级膀胱癌组织中Survivin的表达率分别为20％（2／10）、38．9％（7／18）、75％（9／12）。经多因素分析，Survivin的表达与膀胱癌细胞的病理分级及患者的无瘤生存时间相关，而与其肿瘤分期及生存率不相关。结论正常膀胱组织不表达Survivin。Survivin的表达率随肿瘤细胞分化程度的降低而升高。Survivin的表达水平反映患者的无瘤生存率，是预测膀胱癌复发的独立预后因子。     

膀胱癌患者尿NMP22与尿脱落细胞学检测的临床价值

目的研究核基质蛋白22（NMP22）与尿脱落细胞学在膀胱癌早期诊断、监测复发及判断预后中的临床价值。方法收集96份尿液标本,其中包括45例膀胱癌术前患者（经术后病理证实）,20例膀胱癌术后复测患者及3l例良性泌尿系疾病患者。均通过酶联免疫吸附法（ELISA）检测NMP22值,将其结果与尿脱落细胞学通过,检验的形式进行对比。结果45例膀胱癌术前患者NMP22的含量为9．3—112．5U／mL,中位数为48．7U／mL;31例良性泌尿系患者NMP22的含量为2．1～14．7U／mL,中位数为7．9U／mL;20例膀胱癌术后患者NMP22的含量为4．3～18．7U／mL,中位数为8．9U／mL,膀胱癌术前患者NMP22中位数明显高于良性泌尿系患者NMP22中位数,差异有显著统计学意义（P〈0．05）。以NMP22≥10U／mL为临界值,NMP22诊断膀胱癌的敏感性为82．2％,特异性为70．9％;尿细胞学的敏感性为31．1％。特异性为100％。20例膀胱癌术后患者经膀胱镜证实复发有9例。结论NMP22可以作为膀胱癌的早期筛查和术后随访的有效标志物。     

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.