肝癌mRNA致敏的DC对SCID荷瘤鼠的抑瘤作用

目的通过重建人肝癌PBL-SCID嵌合模型来观察mRNA致敏的树突状细胞疫苗（mRNA DC）在体内的抑瘤效应并探讨机制。方法采用人外周血淋巴细胞腹腔注射法建立Hu-PBL-SCID鼠模型,尾静脉分别注射mRNA DC疫苗、抗CD4^＋、CD8^＋＋mRNA DC、未致敏的树突状细胞（DC）。每周1次,共两次,然后接种2×10^6HepG-2cells,观察鼠成瘤率、成瘤潜伏期、肿瘤体积以及测定特异性CTL活性。结果ELISA法可检测到鼠血清中人IgG水平,Hu-PBL-SCID嵌合模型重建成功,各组小鼠间成瘤率无明显差异,但mRNA DC组成瘤潜伏期延长,肿瘤生长缓慢,2周后肿瘤体积明显小于抗CD4^＋、CD8^＋＋mRNA DC组、DC组和PBS组,差异有统计学意义（P〈0.05）,实验组脾淋巴细胞对HepG-2细胞有特异性杀伤效应,而对胃癌SGC-7901细胞则无杀伤活性。结论mRNA致敏的树突状细胞疫苗体内能诱导产生明显的抑瘤作用。     

转染可溶性CD40基因的树突状细胞在体外对T淋巴细胞功能的抑制作用

目的探讨转染可溶性CD40(sCD40)基因的树突状细胞(DC)在体外对T淋巴细胞增殖和细胞毒性T淋巴细胞(CTL)的细胞毒活性的影响。方法采用脂质体转染法,将携带鼠CD40胞外区和绿色荧光蛋白的融合基因的质粒pEGFP-N1/sCD40转染小鼠DC细胞株(DC 2.4)。以Balb/c小鼠淋巴细胞为反应细胞,分别以转染组DC、空载体转染组(空载体组)DC和未行转染处理的DC(空白DC)作为刺激细胞,进行单向混合淋巴细胞培养,四唑氮化合物比色法检测细胞增殖情况。用乳酸脱氢酶释放试验和流式细胞术检测转染组DC及其培养上清液对CTL细胞毒活性及其凋亡的影响。结果转染组DC及其培养上清液对同种细胞刺激的淋巴细胞增殖反应有显著的抑制作用(P<0.05),并对特异性CTL的细胞毒活性具有明显的抑制作用(P<0.05);转染组DC可诱导CTL凋亡(P<0.05)。结论稳定表达sCD40-EGFP融合蛋白的DC,在体外对T淋巴细胞的增殖和CTL的细胞毒活性具有明显的抑制作用,并可诱导CTL凋亡。     

葡萄球菌肠毒素A对肝癌肿瘤浸润淋巴细胞抗瘤活性的作用

目的探讨葡萄球菌肠毒素A(SEA)对肝癌肿瘤浸润淋巴细胞(TIL)抗瘤活性的诱导作用。方法取5例手术切除肝癌标本,分离TIL,在SEA作用下进行培养。定时记数,了解其增殖情况。流式细胞仪检测其CD3、CD4、CD8表达情况,噻唑蓝(MTT)比色法测定其对HepG-2肝癌细胞株的细胞毒活性,酶联免疫吸附试验(ELISA)测定培养上清液中肿瘤坏死因子(TNF)-α和γ-干扰素(IFN-γ)浓度。结果在SEA刺激下,2周TIL扩增100倍。1周后CD3+细胞占95%以上,CD8+细胞较CD4+细胞增殖更迅速。TIL细胞毒活性随培养逐渐增强。在培养的前10d内,TIL产生大量的TNF-α峰值达(453.70±9.26)ng/L和IFN-γ,其峰值达(2013.22±20.41)ng/L。结论SEA可高效、迅速诱导肝癌TIL的抗瘤活性。     

淋巴细胞与肝癌细胞混合培养诱导特异性细胞毒T淋巴细胞的形成

目的 通过肝癌细胞和淋巴细胞混合培养，体外诱导产生高活性的肝癌特异性细胞T淋巴细胞（H－S－CTL）。方法 采用淋巴细胞和肝癌细胞混合培养技术，在IL－1，IL－2，IL－4和IL－6刺激下，诱导产生H－S－CTL，应用间接免疫荧光法和^51Cr释放法检测其对靶细胞的杀伤效应。结果 H－S－CTL与自身LAK相比，CD3＋，CD4＋和CD8＋细胞明显增多，抗肿瘤效应明显增强。结论 采用淋巴细胞和肝癌细胞混合培养同时应用白细胞介素可获得大量扩增的高活性的H－S－CTL。     

肿瘤细胞RNA转染活化的B细胞诱导的CTL抗肿瘤效应

目的探讨小鼠B淋巴细胞诱导特异性细胞毒性T淋巴细胞(CTL)的抗肿瘤免疫作用。方法分离、纯化B淋巴细胞,并在CD40配体(CD40L)和重组小鼠白介素4(rmIL-4)联合作用下活化;将活化B细胞与T细胞共同培养,检测T细胞增殖情况。提取肝癌细胞Hepa1-6总RNA转染B淋巴细胞作为实验组,并以小鼠肝细胞RNA,脂质体,1640培养基转染作为对照组。检测转染后各组B细胞表面抗原呈递细胞标记(CD40,CD80,CD86)及主要组织相容性抗原(MHC)的表达情况。转染的B淋巴细胞与T淋巴细胞混合培养,诱导、扩增CTL;以CTL作为效应细胞,Hepa1-6为靶细胞,检测CTL杀伤活性。检测转染后刺激T细胞分泌IFN-γ的水平。结果转染Hepa1-6总RNA的B淋巴细胞刺激T细胞增殖能力高于RNA对照组(P0.05)、脂质体对照组及空白对照组(P0.01)。经肝癌细胞Hepa1-6总RNA转染的B淋巴细胞,其组织相容性分子及共刺激分子表达明显高于其他对照组。将肝癌细胞Hepa1-6总RNA转染的B淋巴细胞与对照组B细胞诱导的特异性杀伤率进行比较,两者差异具有统计学意义(P0.05)。CD40L活化的B淋巴细胞刺激的T细胞,分泌INF-γ的水平显著高于对照组(P0.05)。结论以肝癌细胞Hepa1-6总RNA转染的B淋巴细胞,可有效诱导CTL杀伤肝癌细胞,为肝癌的免疫治疗提供了一种可能的新思路。     

应用MAGE-3抗原肽诱导肝癌患者细胞毒T淋巴细胞反应的研究

目的研究MAGE 3抗原肽对肝细胞癌 (HCC)患者进行免疫治疗的可行性。方法微量细胞毒法检测HCC患者中HLA A2表达情况 ,RT PCR方法检测肝癌组织MAGE 3基因mRNA表达情况。用免疫磁珠从患者外周血单个核细胞 (PBMC)中分离出CD8阳性细胞作为效应细胞 ;将其余自体CD8阴性的PBMC与MAGE 3抗原肽 (FLWGPRALV)短暂孵育 ,经γ射线照射后作为抗原呈递细胞 (APC) ,与CD8阳性效应细胞进行混合淋巴细胞培养 ,作为实验组 ,7d后再加入APC刺激患者效应细胞 1次。每周计数效应细胞数量 ,培养第 15天时作为细胞毒T淋巴细胞 (CTL)检测其杀伤活性。以表达MAGE 3和HLA A2的肝癌细胞系HLE作为靶细胞 ,采用IFN γ细胞因子分泌法 ,通过流式细胞仪检测具有分泌γ 干扰素 (IFN γ)的CD8阳性细胞的频数来反映CTL的杀伤活性。另设不加APC刺激的CD8阳性细胞 ,加IL 2培养作为对照组。结果本组 2 5例HCC患者中 9例HLA A2阳性表达 ;9例中 3例MAGE 3基因mRNA阳性表达 ,6例阴性表达。培养开始时 ,效应细胞为 1 0× 10 6/孔 ,2周后细胞增殖 4～ 6倍。分泌IFN γ的CD8阳性细胞的频数 ,3例MAGE 3阳性患者平均为 2 2 0 % ,6例阴性患者为 0 5 % ,两组间差异有非常显著意义 (P <0 0 1)。结论本实验结果表明 ,应用MAGE 3抗原肽 ,能在体外从HCC患者     

MAGE-3抗原肽体外诱导肝癌患者免疫应答的研究

目的：利用载有MAGE－3抗原肽的树突状细胞（DC）活化原发性肝细胞癌（HCC）患者T淋巴细胞，探讨是否可以体外诱导特异性细胞毒T细胞细胞（CTL）应答。方法：通过逆转录多聚酶链反应和测序分析MAGE－3多肽表位密集区的核苷酸变异状况，体外培养HLA－A2表型的HCC患者及正常献血员外周血来源DC，并经孵育携带MAGE－3／HLA－A2抗原肽FLWG－PRALV，用以活化T淋巴细胞，利用特异性杀伤实验检测CTL应答。结果：中国HCC患者表达的MAGE－3序列高度保守。用特定细胞因子和无血清培养基可成功培养HCC患者外周血精源的DC。经多肽冲击的DC诱导，3例HCC例者和3例正常献血员可成功培养HCC患者外周血来源的DC。经多肽冲击的DC诱导，3例HCC患者的3例正常献血员中各有2例产生CTL免疫应答。结论：载有MAGE－3抗原肽的DC可以体外诱导特异性的CTL免疫应答。提示HLA－A2限制性的MAGE－3抗原肽经DC递呈可以作为有潜力的肝癌免疫治疗疫苗。     

抑制Tregs增强DC/HCC融合疫苗诱导抗肝癌免疫反应的研究

目的 通过抑制荷瘤小鼠体内调节性T细胞(TregFoxp3+),探讨其增强DC/HCC融合细胞疫苗诱导抗肝癌免疫作用的相关机制.方法 皮下建立小鼠肝癌模型,24只小鼠随机分为4组:(1)环磷酰胺联合疫苗组[环磷酰胺(CTX)+ VAC];(2)疫苗组(VAC);(3)单纯环磷酰胺组(CTX);(4)对照组.各组治疗后,取外周血测定CD8+及CD4+淋巴细胞比例,同时取肿瘤组织及脾脏组织分别行苏木素-伊红(HE)染色和免疫组织化学观察肿瘤坏死和CD8+细胞及Treg+细胞的浸润,并用细胞计数试剂盒(CCK-8)检测脾脏淋巴细胞特异性细胞毒T淋巴细胞(CTL)活性.结果 与其他各组比较,CTX+ VAC组外周血CD4+及CD8+细胞比例增高[ CTX+ VAC:17.50％、14.69％;VAC:16.17％、13.07％;CTX:12.17％、11.59％;对照组:12.24％、11.16％];肿瘤组织可见大量肿瘤细胞坏死,脾脏组织中Foxp3+细胞浸润减少,CD8+细胞浸润增高,CTL对肿瘤细胞杀伤作用明显增强(P＜0.05).结论 通过CTX抑制荷瘤小鼠微环境及外周血中的Treg细胞,可以明显增强DC/HCC融合疫苗对肿瘤的杀伤作用.     

骨髓CD34+细胞人工血管内皮化实验研究

目的探讨骨髓CD34^ 细胞种植的人工血管内皮化和通畅性。方法取犬骨髓,经免疫磁珠分离出CD34^ 细胞,内皮细胞生长因子(vascular endothelial grow factor,VEGF)诱导并扩增;种植聚四氟乙烯(polytetra fluoro ethylene,PTFE)人工血管,再植入犬的下腔静脉和腹主动脉。结果骨髓分离的细胞经流式细胞仪鉴定为CD34^ 细胞,CD34^ 细胞经VEGF诱导培养后经免疫细胞化学和透射电镜检测证实为内皮细胞。内皮化人工血管植入动脉闭塞率0,狭窄率12．5％;人工血管植入静脉闭塞率12．5％,狭窄率25．0％。结论骨髓经免疫磁珠可分离出CD34^ 细胞,CD34^% 细胞经VEGF诱导可定向分化为内皮细胞。骨髓CD34^ 细胞经体外培养种植于PTFE人工血管,获得理想的内皮化和通畅率。     

重组腺病毒介导白细胞介素-18和甲胎蛋白基因修饰的树突状细胞体外诱导抗肝癌免疫活性的研究

目的 探讨甲胎蛋白(AFP)、白细胞介素(IL)-18基冈修饰树突状细胞(DC)较以往AFP基因修饰DC作为肝癌免疫治疗瘤苗是否更具优势.方法 分离外周血单个核细胞定向诱导为DC,以Ad-IL-18和Ad-AFP共感染DC,感染后细胞通过噻唑蓝(MTT)比色法检测其激活的T细胞对HepG2的杀伤活性.结果 检测结果显示目的 基因能够表达于DC细胞中.流氏细胞仪(FCM)结果显示共感染的DC细胞均高表达CD1a(73.4%)、CD11c(84.3%)、CD80(89.5%)、CD86(87.9%)和HLA-DR(91.7%).CTL结果显示IL-18/AFP-DC-T对HepG2的杀伤率(67.49±3.24)%明显高于对SMMC7721细胞(27.32±1.75)%和K562细胞(17.31±1.56)%的杀伤率,另外共感染IL-18/AFP-DC-T组对HepG2的杀伤率与AFP-DC-T、IL-18-DC-T组比较,其差异有统计学意义.结论 AFP和IL-18基因修饰DC,能够在体外诱导特异性细胞毒性T淋巴细胞(CTL)效应,而_且对HepG2细胞杀伤率大于AFP转染DC组.     

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.     

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.