胃癌腹膜种植转移的危险因素及预后分析

目的:探讨胃癌腹膜转移的危险因素及其预后.方法:回顾性分析352例胃癌患者的临床病理资料进行.结果:全组腹膜转移的发生率为15.1％ (53/352).单因素分析显示,胃癌腹膜转移与性别、组织学类型、浸润深度、淋巴结转移、TNM分期、手术方式及局部复发等有关(均P＜0.01);多因素分析显示,胃癌腹膜转移独立危险因素是胃壁浸润深度( P=0.016,95％CI=0.570～0.945),TNM分期(P＜0.001,95％CI=2.414～4.027),淋巴结转移(P=0.027,95％CI=1.041～1.964),手术方式(P＜0.001,95％CI=1.203～1.870),局部复发(P＜0.001,95％CI=1.376～2.871);腹膜转移患者1,2年生存率分别为44％和10％,而无转移患者分别为97.0％和74.0％,两组间生存率差异有统计学意义(x2=249.411,P＜0.001).结论:胃癌伴腹膜转移预示肿瘤的恶性程度高,预后较差;而胃壁浸润深度,TNM分期,淋巴结转移,手术方式及局部复发等因素是影响胃癌腹膜种植转移的独立危险因素.     

胃癌患者术前中性粒细胞与淋巴细胞比与临床病理特征及预后关系

目的:探讨胃癌患者术前中性粒细胞与淋巴细胞比(NLR)与临床病理特征及预后的关系。方法:回顾性分析2010年1月—2011年1月安徽医科大学第一附属医院收治的269例胃癌患者的临床病理及随访资料。根据受试者工作特征曲线,确定NLR的截断值为2.4(敏感性:53.3%,特异性:71.4%),将患者分为低NLR组(NLR2.4,153例)和高NLR组(NLR≥2.4,116例),比较两组患者临床病理特征及生存率的差异,并分析胃癌患者的预后因素。结果:比较结果显示,两组年龄、性别、淋巴结转移无明显差异(均P0.05),但高NLR组较低NLR组肿瘤直径大、肿瘤浸润深度深、TNM分期高(均P0.05);全组患者5年总生存率为44.3%,生存分析显示,高NLR组患者总生存率明显低于低NLR组(χ~2=17.511,P0.01);单因素分析结果表明,术前NLR、肿瘤大小、肿瘤浸润深度和TNM分期与胃癌患者总生存率有关(均P0.05),多因素分析显示,NLR和肿瘤大小为影响胃癌患者预后的独立因素(均P0.05)。结论:术前NLR是影响胃癌患者预后的独立预测因素,高术前NLR值提示胃癌患者有较差的临床病理情况及生存预后。     

CD157在胃癌组织中的表达与临床意义及其对胃癌细胞侵袭的影响

目的 探讨CD157蛋白在人胃癌组织中的表达情况及其与胃癌患者临床病理指标和预后的关系;初步探讨CD157对胃癌AGS细胞侵袭转移的作用及其机制.方法 用免疫组织化学方法检测CD157蛋白在90例胃癌及配对癌旁组织中的表达,分析其表达结果与胃癌患者的临床病理资料和预后的相关性.通过小干扰RNA(small interfering RNA,siRNA)转染人胃癌AGS细胞下调CD157的表达,用Transwell侵袭实验检测CD157对胃癌AGS细胞侵袭能力的影响.结果 CD157蛋白在胃癌组织及癌旁组织的表达率分别为67％和12％,差异有统计学意义(x2=55.84,P＜0.01);CD157蛋白的表达水平与肿瘤浸润深度(x2=12.503,P＜0.01)、淋巴结转移(x2=8.693,P=0.003)和远处转移(x2=4.944,P=0.027)相关,而与年龄(x2=1.659,P=0.198)、性别(x2=1.431,P=0.232)和分化程度(x2 =0.407,P=0.856)无相关;CD157高表达组胃癌患者中位生存期短于低表达组(29.2个月比46.0个月,x2=4.438,P=0.036).与对照组相比,siRNA组CD157 RNA表达(t=45.004,P＜0.01)和蛋白表达(t=32.877,P＜0.01)降低,侵袭能力减弱(F=98.455,P＜0.01).结论 CD157高表达与胃癌的浸润、转移和不良预后有关,下调CD157表达可抑制胃癌细胞侵袭能力.     

细胞因子诱导的杀伤细胞治疗胃癌对其无瘤生存的影响

目的 探讨体外诱导自体细胞因子诱导的杀伤细胞(CIK)治疗胃癌以无瘤生存为结局的相关因素.方法 应用生物技术体外诱导自体细胞因子激活的杀伤细胞进行临床应用.选择1998年1月1日至2009年12月31日在苏州大学附属第三医院手术治疗并经病理诊断的胃癌病例181例.采用Kaplan-Meier及Log-rank检验比较化疗联合CIK细胞治疗组(CIK治疗组)和化疗组对胃癌无瘤生存的影响.结果 对影响预后的重要因素如性别、年龄、胃癌部位、肿瘤大小、组织学类型、浸润深度、淋巴结转移、病理分级等因素进行分析,两组间差异无统计学意义;CIK治疗组胃癌患者的无瘤中位生存时间明显高于化疗组(x2=9.722,P＜0.01);且生存时间和CIK细胞治疗次数呈正相关(x2=14.769,P＜0.01).结论 CIK细胞治疗可以显著延长胃癌患者的中位生存时间.     

肿瘤最大径对T4a期胃癌患者预后的影响

目的 评价肿瘤最大径对T4a期胃癌患者预后的影响.方法 Kaplan-Meier生存分析筛选T4a期胃癌肿瘤最大径的最佳截点值,并据此将患者分为2组.比较2组患者的临床病理因素,对T4a期胃癌进行单因素和多因素分析,并对预后独立影响因素进行分层分析.结果 T4a期胃癌肿瘤最大径最佳截点值为8 cm.2组患者的肿瘤部位(x2=15.695)、分化类型(x2=4.393)、大体形态(x2=5.629)和早期复发(x2=4.292)差异有统计学意义(P＜0.05).单因素分析显示年龄(x2 =4.463)、肿瘤最大径(x2=9.057)、Borrmann分型(x2=6.679),分化类型(x2 =5.122)、肿瘤部位(x2=8.707)和N分期(x2=132.954)与T4a期胃癌预后相关(P＜0.05);多因素分析显示肿瘤最大径(HR =1.339),分化类型(HR=1.169)和N分期(HR=1.876)为T4a期胃癌预后独立影响因素(P＜0.05).进一步按肿瘤最大径分层分析,N分期(HR =2.014)和分化类型(HR=1.192)是最大径＜8 cm组T4a期胃癌预后独立影响因素(P＜0.05),N分期(HR=1.876)是最大径≥8 cm组T4a期胃癌预后的独立影响因素(P=0.000).预后独立影响因素分层分析显示,无淋巴结转移或低分化的T4a期胃癌,≥8 cm组的5年生存率明显低于＜8 cm组(HR=0.182、0.653,P＜0.01).结论 肿瘤大小截点值为8 cm时,肿瘤最大径是影响T4a期胃癌预后的独立影响因素,可显著影响无淋巴结转移或低分化胃癌患者的预后.     

进展期胃下部癌D2根治术第13组淋巴结清扫的意义

目的 探讨进展期胃下部癌D2根治术第13组淋巴结清扫的必要性及可行性.方法 收集2001年1月至2007年6月问行胃下部癌D2/D2+根治术治疗、经病理确诊为腺癌且随访资料完整的胃癌患者共379例,依据第13组淋巴结清扫与否将患者分为清扫组与未清扫组.回顾性分析患者的临床病理资料,总结影响进展期胃下部癌预后的临床病理因素以及第13组淋巴结清扫的必要性和可行性.结果 379例患者中清扫组100例(26.4％),清扫组中淋巴结转移阳性患者9例(9.0％).清扫组与未清扫组患者性别、年龄、肿瘤最大径、分化程度、Borrmann分型、十二指肠浸润、浸润深度、淋巴结转移、TNM分期、手术时间、术中失血量、术后并发症的差异均无统计学意义(P＞0.05).Kaplan-Meier生存分析及Log-rank检验结果显示,清扫组的5年生存率(46.0％)明显高于未清扫组(36.5％,x2=4.452,P＜0.05).单因素分析显示,年龄(x2=7.539)、第13组淋巴结清扫与否(x2 =4.452)、肿瘤最大径(x2=7.100)、十二指肠浸润(x2=9.106)、浸润深度(x2=7.428)、淋巴结转移(x2=45.046)、TNM分期(x2=57.008)与进展期胃下部癌预后相关(P＜0.05);多因素分析显示,年龄(HR =0.500,95％ CI:0.343 ～0.730)、肿瘤最大径(HR=0.545,95％ CI:0.339～0.876)、十二指肠浸润(HR =5.821,95％CI:2.326～14.572)、肿瘤浸润深度(T4:HR=2.087,95％ CI:1.283 ～3.394)是影响进展期胃下部癌预后的独立危险因素(P＜0.05).结论 对TNMⅡ～Ⅲ期进展期胃下部癌患者行D2+第13组淋巴结清扫是必要且安全可行的.     

贲门癌淋巴结外软组织转移的临床病理特征及预后分析

目的 探讨贲门癌淋巴结外软组织转移(EM)与各种临床病理特征的相关性及其对患者预后的影响.方法 回顾性分析2002年1月至2007年1月行根治性手术切除并经病理诊断明确的323例贲门癌患者的临床病理资料.其中男性272例,女性51例;年龄22～85岁,中位年龄63岁,分析EM阳性与患者临床病理因素的相关性及其对患者术后复发和生存的影响.结果 323例患者中有67例(20.7％)术后检出EM阳性,EM阳性与肿瘤Lauren分型、分化程度、浸润深度及淋巴结转移相关(x2 =4.647 ～27.216,P ＜0.05).EM阳性与阴性患者的5年生存率和中位生存时间分别为12.3％、34.1％和20、39个月,5年生存率差异有统计学意义(x2=23.936,P=0.000).多因素分析表明,肿瘤浸润深度、淋巴结转移和EM是贲门癌患者预后的独立危险因素.至随访截止,EM阳性患者的累积复发率高于EM阴性患者(59.7％比35.9％,x2=12.409,P=0.000).分层分析显示,有淋巴结转移患者中,EM阳性患者累积复发率高于EM阴性患者(60.9％比40.0％,x2=8.410,P=0.004),EM阳性患者5年生存率低于EM阴性患者(12.9％比30.1％,x2=12.939及P=0.000).结论 EM是贲门癌患者独立预后因素.EM阳性患者术后复发风险高,生存时间短.     

腹腔冲洗细胞学检查对胃癌预后的临床评估及意义

目的 评估腹腔冲洗细胞学检查(PLC)对胃癌预后判断的价值.方法 收集胃癌及对照组患者的腹腔冲洗液标本,采用不同方法检测其中的游离癌细胞,并评价其与临床病理参数的关系.结果 PLC检测阳性率为31.8%,经相关分析,胃癌患者PLC阳性率与下列4种参数均成正相关:肿瘤分化程度(P＜0.05),浸润深度(P＜0.01),淋巴结转移(P＜0.01),TNM分期(P＜0.05).而与肿瘤的大小无关;肿瘤大小分组间差异无统计学意义(P＞0.05).检测阳性组与阴性组术后1年复发率和生存率比较,差异均有统计学意义.结论 PLC检测可作为判断胃癌侵袭转移、术后复发情况及患者预后的参考指标之一.     

D-二聚体对胃癌患者的转移诊断价值及评估预后的研究

目的 探讨胃癌患者术前D-二聚体对诊断胃癌转移和评估胃癌患者预后的价值.方法 回顾性分析2010年1月-2011年1月安徽医科大学第一附属医院收治的132例胃癌患者完整的临床病理及随访资料.以D-二聚体等于1.465 mg/L为分界值,将患者分为低D-二聚体组和高D-二聚体组,通过x2检验分析D-二聚体水平与患者临床病理特征的关系,并用Kaplan-Meier法和rank检验进行生存分析,采用Cox回归模型分析患者的预后因素.结果 共132例胃癌患者纳入本研究.卡方检验结果提示D-二聚体与患者性别、肿瘤大小、淋巴结转移、TNM分期、分化程度无明显相关(P均＞0.05),而与年龄(x2 =4.311,P＜0.05)、侵犯深度(x2=4.996,P＜0.05)和胃癌是否远处脏器转移(x2=8.300,P＜0.05)相关;胃癌远处脏器转移患者血浆中D-二聚体浓度为(1.39±0.73) mg/L,胃癌非远处脏器转移患者血浆中D-二聚体浓度为(0.97 ±0.83) mg/L,差异具有统计学意义(P =0.023),手术后5年内死亡的胃癌患者血浆中D-二聚体浓度为(1.22±0.92) mg/L,在手术后5年存活的胃癌患者血浆中D-二聚体浓度为(0.78±0.58) mg/L,差异具有统计学意义(P=0.001);Kaplan-Meier生存分析提示高D-二聚体组的胃癌患者总生存率远低于低D-二聚体组(P＜0.01);单因素分析结果表明性别、D-二聚体、肿瘤大小、肿瘤浸润深度、淋巴结转移和TNM分期与胃癌患者总生存率有关(均P ＜0.05),多因素Cox回归模型分析显示D-二聚体为影响胃癌患者预后的独立因素(P＜0.01).结论 D-二聚体可能对判断胃癌患者是否转移提供一定的诊断价值,同时D-二聚体是影响胃癌患者预后的独立预测因素.     

直肠癌淋巴结转移与临床病理特征分析(附79例报道)

目的 探讨直肠癌淋巴结转移与临床病理特征及术后生存率之间的关系.方法 分析79例行全直肠系膜切除术患者的性别、年龄、肿瘤原发灶大小、大体类型、浸润深度、组织学类型、分化程度及术前血清癌胚抗原(CEA)水平与术后淋巴结病检转移情况及生存率的关系.结果 单因素分析结果发现,肿瘤大小、大体类型、浸润深度、组织学类型、分化程度及血清CEA水平与淋巴结转移有关;进一步多因素分析结果提示,肿瘤大体类型和浸润深度与淋巴结转移有关.无淋巴结转移组生存率高于有淋巴结转移组(Χ2=18.806,P=0.000);淋巴结转移数<4个组生存率高于淋巴结转移数≥4个组(Χ2=4.659,P=0.031).结论 直肠癌患者的临床病理特征在一定程度上反映淋巴结转移情况,了解其间关系有利于对直肠癌淋巴结转移情况的评估和预后的判断.     

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.     

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.