放线菌素D和VM-26对大鼠胶质瘤细胞增殖的影响的体内实验研究

目的研究放线菌素D（Actinomycin D，ACTD）和替尼泊苷（Teniposide，VM-26）对大鼠胶质瘤细胞增殖的体内治疗效果。方法将野生型的C6鼠胶质瘤细胞接种于鼠脑右侧尾状核（对照组10只，空载组10只），并对鼠脑内已形成的C6胶质瘤分别用ACTD及VM-26抗瘤缓释剂瘤区原位注射（治疗组各10只）。观察各组大鼠的一般情况、生存期、肿瘤病理学和磁共振成像（MRI）动态改变，采用PCNA计数、TUNEL法检测肿瘤细胞增殖活性及凋亡。结果对照组及空载组大鼠平均生存期为19．3天，ACTD组6只及VM-26组3只大鼠生存期明显延长，存活期超过200天；除因病理检查人为处死各2只外，ACTD组治疗后4周内死亡2只，VM-26组5只。MRI检查对照组大鼠脑内有明显瘤灶，治疗组大鼠脑内瘤灶治疗后明显减少或消失，均与病理学检查结果一致，而且治疗组大鼠C6细胞增殖活性降低，大量细胞凋亡，ACTD较VM-26显著。结论ACTD可望成为体内局部应用治疗胶质瘤的优选化疗药物。     

丙泊酚对大鼠局灶性脑缺血-再灌注低氧诱导因子-1和热休克蛋白70的影响

目的 观察丙泊酚对大鼠局灶性脑缺血-再灌注后低氧诱导因子(HIF-1)和热休克蛋白70(HSP70)的影响,探讨丙泊酚脑保护作用机制.方法 32只雄性sD大鼠,随机均分为四组,采用可逆性大脑中动脉内线栓法建立局灶性脑缺血-再灌注模型,缺血2 h再灌注24 h后断头取脑,采用免疫组化法检测HIF-1和HSP70.HE染色,光镜观察细胞形态学改变.结果 大鼠局灶性脑缺血-再灌注后大脑皮质和海马区出现神经细胞的坏死和凋亡改变,HIF-1和HSP70的表达均增加,给丙泊酚后神经细胞的肿胀、坏死、凋亡明显减少,HIF-1和HSP70蛋白的表达受到明显抑制.结论 丙泊酚对大鼠局灶性脑缺血-再灌注损伤的保护机制与减少HIFll、HSP70的表达有关.     

转染人β干扰素基因的骨髓间充质干细胞治疗大鼠颅内胶质瘤

目的 观察转染人β干扰素基因(hIFN-β)的骨髓间充质干细胞(MSCs-hIFN-β)治疗大鼠颅内恶性胶质瘤的作用.方法 重组腺病毒介导hIFN-β基因转染的大鼠骨髓间充质干细胞(MSCs-hIFN-β)和C6胶质瘤细胞体外共培养,噻唑蓝(MTT)比色法检测C6细胞活力,酶联免疫吸附试验(ELISA)检测培养液上清hIFN-β含量;制作SD大鼠颅内胶质瘤模型,并用MRI和组织病理学检查予以证实;MSCs-hIFN-β瘤内注射观察荷瘤鼠的临床表现和生存时间,MRI检查肿瘤的大小,并行大鼠C6胶质瘤组织病理学检查和肿瘤组织hIFN-β免疫组织化学染色.结果 体外共培养发现C6细胞的生长被不同程度地抑制,C6细胞培养上清hIFN-β的含量随着MSCs-hIFN-β的密度增加,其含量也增加;体内实验发现MSCs-hIFN-β、MSCs、生理盐水瘤内注射治疗10 d后肿瘤平均体积分别为(8.43±1.32)、(35.84±2.36)、(37.26±2.91)mm3,治疗组和对照组比较差异有统计学意义(P＜0.01);治疗组较对照组生存期明显延长(P＜0.01).结论 MSCs-hIFN-β能抑制胶质瘤细胞的增殖,延长颅内荷瘤鼠的生存期.     

细胞因子信号转导抑制因子3抑制血小板衍生生长因子-BB诱导的血管平滑肌细胞炎症反应的作用及其机制

目的 探讨细胞因子信号转导抑制因子3( SOCS3)抑制血管平滑肌细胞炎症反应的作用及机制.方法 用携带大鼠SOCS3基因的腺病毒(pYrAd-rSOCS3)转染血小板衍生生长因子-BB(PDGF-BB)刺激的大鼠动脉血管平滑肌细胞.实时定量聚合酶链反应(Real time-PCR)检测SOCS3、白细胞介素(IL) -1β、IL-6、肿瘤坏死因子(TNF)-α、单核细胞趋化蛋白-1(MCP-1)及细胞间黏附分子-1(ICAM-1)mRNA表达.Western blot检测SOCS3、信号转导及转录激活因子3(STAT3)、P-STAT3、IL-1β、IL-6、TNF-α、MCP-1及ICAM-1的的蛋白表达.结果 PDGF-BB刺激血管平滑肌细胞24h后,SOCS3、STAT3、P-STAT3、IL-1β、IL-6、TNF-α、MCP-1及ICAM-1表达均上调;pYrAd-rSOCS3转染血管平滑肌细胞后再用PDGF-BB刺激,其SOCS3表达进一步上调,但STAT3、P-STAT3、IL-1β、IL-6、TNF-α、MCP-1及ICAM-1表达明显下调.结论 上调血管平滑肌细胞SOCS3表达通过负反馈调节酪氨酸蛋白激酶(JAK) -STAT3信号通路,抑制STAT3的激活及磷酸化而下调炎性细胞因子表达.     

亚甲蓝对C6胶质细胞的增殖抑制和促凋亡作用

亚甲蓝(Ⅷ)是噻嗪染料类化合物，为水溶性色素。对胶质瘤细胞代谢研究表明MB可直接杀伤及抑制其在体外的生长。我们采用大鼠C6脑胶质瘤细胞作为研究MB的工作模型，观察MB对C6细胞增殖抑制和诱导凋亡的作用，探讨MB的抗胶质瘤的作用。     

新型聚β-羟基丁酯作为血管组织工程支架材料的实验研究

目的：探讨经改性处理后的可降解生物材料聚β-羟基丁酯(PHB)作为血管组织工程支架材料与血管平滑肌细胞的细胞相容性。方法：采用体外培养的免血管平滑肌细胞接种在经胶原包埋处理后的管型PHB支架材料上，用相差显微镜和扫描电镜观察细胞的粘附和生长情况，并行HE染色观察。结果：免血管平滑肌细胞在改性后的管型PHB支架材料上粘附生长良好，扫描电镜下可见细胞生长融合成片状，HE染色示细胞在PHB材料上生长良好。结论：改性后的聚β-羟基丁酯材料与兔血管平滑肌细胞有较好的生物相容性。     

人肝癌转移抑制基因存在的功能研究

目的 寻求人8号染色体上存在肝癌转移抑制基因的功能证据.方法 前期通过微细胞介导的染色体转移方法(MMCT),将正常人8号染色体导入到大鼠肝癌高转移细胞株C5F中获得的微细胞杂交克隆Ne08/C5F-1～10和大鼠肝癌细胞株CSF,分别被接种到6～7周龄雌性BALB/CA裸鼠皮下进行自发转移实验,观察皮下成瘤及肺部大体转移灶形成情况,肺组织连续切片并计数镜下转移灶,结果进行单因素方差分析.结果 所有微细胞杂交克隆均能皮下成瘤,微细胞杂交克隆的自发转移实验发现有6个杂交克隆出现肺转移表型的明显抑制(P<0.05),其中2个杂交克隆肺转移表型发生完全抑制.结论 人8号染色体对大鼠肝癌高转移细胞株CSF的成功导入改变了CSF的转移表型,提供了人8号染色体上存在肝癌转移抑制基因的直接的功能证据.     

重组腺病毒介导TIMP-1基因对肝癌的治疗作用

目的探讨携带人基质金属蛋白酶组织抑制因子(hTIMP)-1的重组腺病毒(Adh- TIMP)-1对人肝癌生长、转移、血管形成以及凋亡的作用。方法构建AdhTIMP-1感染人肝癌细胞并接种于裸鼠皮下观察其成瘤情况;建立荷瘤鼠模型,观察AdhTIMP-1对肿瘤生长的作用;计数荷瘤鼠肺转移结节;CD34免疫组织化学观察肿瘤血管生成;TUNEL法检测肝癌细胞凋亡。结果AdhTIMP-1感染的HepG2细胞成瘤量下降4倍(P<0．01),荷瘤鼠瘤体内注射AdhTIMP-1使肿瘤生长减少45％(P<0．01),组织血管密度减少47％(P<0．05),肺转移结节减少70％(P<0．01),肿瘤组织中细胞凋亡增加3倍(P<0．05)。结论AdhTIMP-1能抑制肝癌的生长、转移及血管形成,诱导肝癌细胞凋亡,可用于肝癌基因治疗的研究。     

组织蛋白酶B在人颅内动脉瘤瘤壁的表达及意义

目的 观察组织蛋白酶B(CatB)在颅内动瘤内的表达情况,评估其对瘤壁血管平滑肌细胞凋亡的作用,以此揭示颅内动脉瘤可能形成的机制.方法 以2006年11月至2009年2月的20例显微手术切除的颅内动脉瘤标本为研究对象,取脑外伤后内减压术切除的正常脑皮层动脉血管6例作为对照,通过透射电镜了解其超微结构变化;应用免疫组化的方法检测标本中CatB、α平滑肌激动蛋白(α-SMA)和半胱大冬酶-3(Caspase-3)的表达,并对染色强度进行分级;通过Real-time PCR的方法检测标本内的CatB mRNA表达.结果 (1)免疫组化结果:动脉瘤组CatB、Caspase-3表达指数高于对照组.而动脉瘤组α-SMA表达低于对照组(P<0.05);CatB与caspase-3、α-SMA及动脉瘤的大小具有相关性(P<0.01).(2)Real-time PCR:CatB mRNA在颅内动脉瘤的表达为对照组的3.8倍(P<0.01).(3)透射电镜的观察:动脉瘤瘤壁血管平滑肌细胞明显减少,基质纤维断裂消失;部分血管平滑肌细胞核内见染色体边聚,核固缩,并有胞浆或胞核部分脱落或裂解成碎片,还有部分瘤壁可见典型的凋亡小体.结论 CatB可能参与了颅内动脉瘤的形成与生长.     

蓝舌病毒湖北株对小鼠肾癌细胞体内外的杀伤效应

目的 观察蓝舌病毒湖北株(BTV-HBC3)对小鼠肾癌细胞株Renca体内外的杀伤效应.方法 接种1 MOI的BTV-HBC3于Renca细胞,观察Renca感染后的细胞病变效应(CPE),应用扫描电镜观察感染48 h后的超微结构,以噻唑蓝(MTT)比色法检测病毒分别以不同感染复数(MOI)感染Renca细胞后24、36、48 h的细胞存活率,并应用琼脂糖凝胶电泳分析感染后48 h的Renca细胞及其对照组病毒基因组.同时制备BALB/C小鼠Renca细胞荷瘤动物模型,观察应用BTV-HBC3处理后皮下荷瘤生长,并进行苏木素-伊红(HE)染色病理分析,应用免疫组织化学检测病毒蛋白的表达.结果 Renca细胞感染BTV-HBC348 h后,CPE程度大于90%,透射电镜下,胞质内可见增殖的病毒颗粒,呈晶格状排列.Renca细胞接种1 MOI的BTV-HBC3 24、36、48 h后细胞的存活率分别为(44.45±5.26)%、(30.47±4.77)%、(20.34±5.26)%,且该病毒对Renca细胞的杀伤作用呈现一定的量效关系;感染后细胞进行琼脂糖电泳可以检测到特异性长(L)、中(M)、短(S)3组分片段的病毒的dsRNA基因组;体内实验表明BTV-HBC3也明显抑制肿瘤生长(P<0.01);组织病理学观察中肿瘤组织未见坏死区,可见大片透明空泡样组织,肿瘤组织内可见腺体样结构,而小鼠其他各脏器组织切片中未见病毒感染,治疗组肿瘤组织可见病毒蛋白的阳性染色,其余组织器官经免疫组织化学分析未见病毒蛋白表达.结论 蓝舌病毒湖北株对小鼠肾癌细胞体内外具有显著的靶向杀伤效应.     

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.