组织间植入125I粒子诱导H22肝肿瘤细胞凋亡的研究

目的观察^125I粒子近距离照射对H22肝癌细胞凋亡的影响及其机制。方法用原位末端脱氧核苷酸转移酶标记法（TUNEL）检测^125I粒子近距离照射对H22细胞凋亡的影响；免疫组化Elivion^TM plus法检测Survivin蛋白的表达。60只小鼠分为A组：植入放射性粒子；B组：植入化疗药DDP；C组：植入放射性粒子和化疗药DDP；D组：正常对照组。结果^125I粒子近距离照射和／或化疗后对H22肝癌肿瘤体积抑制率A、B、C组分别为43．8％、40．7％和58．3％；凋亡指数（AI）分别为（25．15±10．36）、（33．42±12．25）和（42．34±13．95），与对照组D组（20．45±14．54）比较，C组其凋亡指数（AI）差异有统计学意义（P〈0．05）；Survivin蛋白的表达率分别为50．0％、55．6％和36．4％，与D组100．0％比较，C组表达率差异有统计学意义（P〈0．05）。结论^125I粒子近距离照射H22肝癌可有效诱导肝癌细胞凋亡，抑制肝癌细胞增殖；联合化疗药，其凋亡作用更强；Survivin可能参与了其中的调节作用。     

绿茶饮液对大鼠膀胱肿瘤生长和间隙连接蛋白43表达的影响

目的观察绿茶对大鼠膀胱肿瘤生长和间隙连接蛋白43（Cx43）表达的影响。方法以N-丁基-N-（4-羟丁基）亚硝胺诱导形成大鼠膀胱癌动物模型。将39只成年雄性Wistar大白鼠随机分成正常对照组、膀胱癌模型组和绿茶组。24周后在麻醉下切除大鼠膀胱肿瘤组织并观察病理学改变，称量瘤体湿重并计算抑瘤率，免疫组织化学和DNA原位缺口末端标记法分别检测肿瘤微血管密度（MVD）和细胞凋亡指数（AI），半定量逆转录聚合酶链反应和Western印迹检测膀胱肿瘤组织Cx43mRNA及其蛋白的表达水平。结果绿茶组的膀胱肿瘤癌变发生率、瘤体湿重、MVD分别为38．46％（5／13）、（4．47±1．01）g、（2977±776），均显著低于模型组83．33％（10／12）、（5．63±1．27）g、（3708±570）（Χ^2=0．041、t=0．018、t=0．014，P均〈0．05），瘤重抑制率为20．82％；AI（22．46±2．90）％明显高于模型组（4．92±1．00）％（t=0．000，P〈0．01）。绿茶组的Cx43mRNA和蛋白的表达均极显著高于模型组（t=0．002、t=0．000，P均〈0．01）。结论绿茶能上调Cx43在大鼠膀胱肿瘤组织中的表达和增强Cx43介导的间隙连接通讯功能，从而有效抑制大鼠膀胱肿瘤的生长。     

联合反义存活素、血管内皮生长因子治疗裸鼠骨肉瘤

目的探讨存活素（Survivin，SVV）、血管内皮生长因子（VEGF）反义寡核苷酸（ASODN）联合治疗裸鼠骨肉瘤。方法构建荷骨肉瘤裸鼠模型，采用瘤内注射给药方式（5mg,／kg体重），以反义SVV、反义VEGF对瘤鼠进行联合干预治疗1周，并与各单药组和空白对照组进行比较，观测各组裸鼠肿瘤生长情况、评估瘤体病理形态，免疫组织化学法检测移植瘤组织SVV、VEGF蛋白表达，DNA末端原位标记法（TUNEL法）检测肿瘤细胞凋亡水平。结果与对照组比较，各治疗组肿瘤生长均不同程度受抑，以联合组最为显著，瘤重仅为（0．52±0．01）g，抑瘤率IR为（42．80±0．88）％；各治疗组肿瘤细胞中SVV、VEGF蛋白表达有所减低，肿瘤细胞出现凋亡坏死改变，其中联合组细胞凋亡指数AI[（27．90±3．66）％]显著高于对照组[（7．10±2．05）％，Χ^2=46．27，P〈0．01]。结论联合应用SVV与VEGFASODN将对裸鼠荷骨肉瘤发挥更强的抗瘤效应。     

增殖及非增殖腺病毒载体介导的RNA干扰对肾癌细胞杀伤作用

目的比较荷载Ki67基因小干扰RNA（Ki67-siRNA）的增殖腺病毒ZD55-Ki67及非增殖腺病毒Ad-Ki67对肾癌细胞的杀伤作用。方法MOI=10的ZD55-Ki67、Ad-Ki67感染肾癌786-0细胞，2d后收集细胞，蛋白印迹法检测E1A表达；逆转录-聚合酶链反应（RT-PCR）、蛋白印迹法、免疫细胞化学法检测Ki67表达；原位末端标记法（TUNEL）检测凋亡。4d后噻唑蓝（MTT）法检测细胞存活率，7d后结晶紫染色法检测细胞毒性作用。结果感染ZD55-Ki67的786-0细胞表达E1A，感染Ad-Ki67的细胞不表达E1A。ZD55-Ki67、Ad-Ki67感染的786-0细胞Ki67mRNA表达率分别为（37．9±2．3）％、（64．1±1．9）％；Ki67蛋白表达率分别为（42．5±2．4）％、（60．1±2．2）％；Ki67染色阳性率分别为（20．8±2．8）％、（32．3±2．5）％；786-0细胞存活率分别为（22．2±3．0）％、（60．4±3．4）％；凋亡率分别为（53．0±3．7）％、（35．3±2．5）％，两种病毒处理之间差异均有统计学意义（P〈0．01）。结论ZD55．Ki67抑制786-0细胞Ki67表达及增殖、诱导凋亡及细胞毒性作用均显著优于Ad-Ki67。增殖腺病毒介导的RNA干扰杀伤肾癌细胞作用优于非增殖腺病毒。     

尿道压力测定在评价良性前列腺增生患者膀胱出口梗阻中作用的研究

目的探讨尿道压力测定在评价良性前列腺增生（BPH）患者膀胱出口梗阻中的作用。方法回顾性分析1999年9月至2005年7月因尿频、尿急、排尿困难等下尿路症状就诊的1281例BPH患者的尿动力学检查结果,患者平均年龄67岁。按照国际尿控协会标准,分为无梗阻组168例,可疑梗阻组287例和梗阻组826例。结果梗阻组与无梗阻组患者的平均年龄分别为70岁和57岁,膀胱容量分别为（259±67）和（353±27）ml,剩余尿分别为25．5（0～200）和0．7（0～15）ml,排尿量分别为（157±88）和（288±36）ml,排尿时间分别为（55±23）和（43±7）s。前列腺平台面积分别为（2052±446）和（1055±137）mm×cm H2O,前列腺长分别为（5．0±1．0）和（3．5±0．4）cm,功能曲线长度分别为（6．3±1．1）和（4．8±0．4）cm,膀胱颈压分别为（33．1±12．2）和（15．0±3．6）cm H2O,精阜压分别为（30．7±10．5）和（17．0±3．8）cm H2O,组间比较差异均有统计学意义（P〈0．01）。以压力流率测定结果为标准,受试者工作特征曲线显示,前列腺平台面积≥1440 mm×cm H2O作为判断梗阻标准,敏感性为95．2％,特异性为99．6％。结论前列腺平台面积可以作为判断BPH患者膀胱出口梗阻的有效指标。     

人端粒酶逆转录启动子驱动的单纯疱疹病毒胸苷激酶基因治疗裸鼠胰腺移植瘤的安全性研究

目的 探讨人端粒酶逆转录（hTERT）启动子驱动的单纯疱疹病毒胸苷激酶（HSV-TK）基因治疗裸鼠胰腺癌的安全性。方法 应用细菌内同源重组法构建hTERT启动子和常规巨细胞病毒（CMV）启动子驱动的HSV-TK基因真核表达载体PDC312-TP—TK，PSU-CMV-TK。制备腺病毒液，检测病毒滴度为1．9×10^10pfu／ml和1．4×10^10pfu／ml。建立裸鼠胰腺癌皮下移植瘤模型，分别以两种方法治疗后观察皮下移植瘤消退、HSV-TK基因表达情况、肝脏苏木素-伊红（HE）染色切片、肝功能。结果 PDC312-TP-TK组与PSU-CMV-TK组对肿瘤的抑瘤率分别为58．3％和65．6％，治疗组间差异无统计学意义（P〉0．05），杀伤方面具有一样的高效性；但其对肝脏的毒副作用远小于PSU-CMV-TK组，PDC312-TP-TK组血清中ALT，AST，ALP分别为（54．00±1．97）、（147．00±12．67）、（33．00±2．59）U／L而PSU-CMV-TK组中为（334．00±9．81）、（511．00±11．24）、（98．00±3．12）。差异有统计学意义（P〈0．01）。裸鼠肝脏苏木素-伊红（HE）染色中，仅PSU-CMV-TK组有肝脏坏死改变。逆转录-聚合酶链反应（RT-PCR）中也仅PSU-CMV-TK组检测到1143bp的TK基因片段。结论 hTERT启动子驱动的HSV-TK基因是一种新的靶向治疗方法，在具有治疗高效性的同时，更具有安全性。     

塞来昔布联合卡培他滨对裸鼠人肝癌模型中肿瘤细胞增殖与凋亡的影响

目的研究环氧化酶-2抑制剂塞来昔布（Celecoxib）和化疗药物卡培他滨（Capecitabine）对裸鼠人肝癌模型中肿瘤细胞增殖与凋亡的影响。方法建立LIC-D35裸鼠人肝癌模型,成瘤后40只裸鼠随机分成4组即对照组、塞来昔布组、卡培他滨组、联合用药组（卡培他滨与塞来昔布）。观察肿瘤大小,计算抑瘤率;采用RT-PCR方法观察肿瘤中COX-2的mRNA表达,并应用免疫组化法Ki一67检测肿瘤细胞增殖水平、末端脱氧核苷转移酶标记法（TUNEL）检测凋亡细胞。结果对照组、塞来昔布组、卡培他滨组、联合组瘤体体积分别为（3880±438）mm3、（3374±465）mm3、（1859±362）mm3和（981±197）mm3;塞来昔布组、卡培他滨组、联合用药组抑瘤率分别为15％、45％和71％。四组中Ki-67阳性率分别为46％、32％、25％和11％;肿瘤细胞凋亡指数D1分别为8％、22％、27％和38％;塞来昔布组、联合组肿瘤组织中COX-2mRNA表达显著低于对照组和卡培他滨组（P〈0．01）。结论塞来昔布可显著抑制裸鼠人肝癌模型中肿瘤细胞COX-2mRNA表达,抑制肿瘤细胞Ki-67表达,诱导肿瘤细胞凋亡。与卡培他滨联合应用可提高抗肿瘤效果。     

全反式维甲酸和三氧化二砷协同诱导胰腺癌细胞凋亡

目的研究与三氧化二砷（As2O2）具有协同效应治疗胰腺癌的药物。方法以胰腺癌细胞系SWl990为研究对象，观察5-氟尿嘧啶（5-Fu）、健择（Gemcitabine）和全反式维甲酸（AT—RA）与As2O3共同作用对细胞的影响。通过台盼蓝拒染法检测细胞生长和细胞活力，流式细胞仪检测AnnexinV或PI阳性细胞的含量，评价以上药物对细胞增殖和凋亡的作用。结果5-Fu和Gemcitabine与As2O3无协同效应。单独应用As2O3或ATRA均抑制SWl990细胞生长，不诱导细胞凋亡。其中，对照组活细胞密度为（8．5±0．3）×10^5个／ml，As2O3组为（4．4±0．1）×10^5个／ml，ATRA组为（6．7±0．2）×10^5个／ml。但是，As203和ATRA共同处理SWl990细胞后，细胞生长明显抑制，并诱导细胞凋亡。对照组活细胞密度为（8．5±0．3）×10^5个／ml，As2O3＋ATRA组为（3．3±0．1）×10^5个／ml；对照组细胞活力为（92，0±1．2）％，As2O3组为（90．0±1．3）％，ATRA组为（93．0±1．4）％，As2O3＋ATRA组为（65．0±2．1）％；对照组Annexin V和PI阳性细胞的含量为（6．0±1．2）％，As2O3组为（11．0±3．3）％，ATRA组为（5．0±1．4）％，As2O3＋ATRA组为（37．0±5．3）％。结论As2O3和ATRA可协同诱导胰腺癌细胞凋亡，两者联合应用可能作为胰腺癌辅助治疗的另一选择。     

重组分泌型内皮抑素腺相关病毒体内治疗膀胱癌

目的观察重组分泌型内皮抑素腺相关病毒（rAAV—ES）在裸鼠模型体内的抗肿瘤作用。方法以rAAV-ES转染（转染复数MOI=1×10^5）膀胱癌细胞（EJ）后建立裸鼠肿瘤模型，检测EJ细胞被转染后的成瘤率及肿瘤生长情况；裸鼠肌注rAAV—ES后检测内皮抑素在体内的表达；建立裸鼠肿瘤模型，检测全身应用rAAV-ES后抑制肿瘤发展的作用、对肿瘤微血管密度（MVD）的影响及其毒副作用。结果被rAAV-ES转染的EJ细胞成瘤率仅为对照组的2／5；体内实验证实肌注rAAV-ES后血清中内皮抑素长期高效表达（30～40）μg/L；全身应用后肿瘤生长速度减慢（32±9）d，瘤体微血管密度变低（8．30±3．14）／0．739mm^2，心脑组织学检查未见缺血和其他异常改变。结论rAAV-ES无毒副作用，可有效地抑制肿瘤的血管生成，从而抑制膀胱癌的发生、发展，其成功包装为原位基因治疗膀胱癌奠定了基础。     

组织因子途径抑制物2抑制胰腺癌血管生成的研究

目的研究组织因子途径抑制物2（TFPI-2）对胰腺癌血管生成的影响，探讨其抑制胰腺癌生长及侵袭、转移的机制。方法建立裸鼠角膜微囊移植模型，将3组细胞Pane-1TFPI-2、Pane-1-P和Pane-1-V分别接种裸鼠角膜微囊，观察角膜新生血管的形成；再将上述3组细胞接种于裸鼠皮下，观察裸鼠皮下肿瘤生长及转移情况，并采用抗CD34抗体进行血管免疫组织化学染色检测皮下肿瘤的微血管密度（MVD）。Pane-1-TFPI-2组为实验组，Panc-1-P和Pane-1-V组作为对照组。结果实验组角膜新生血管积分比对照组明显减少（P〈0．05），实验组和对照组裸鼠皮下均成瘤，实验组肿瘤体积（438．0±69．8）mm^3，对照组分别为（852．0±102．9）mm^3和（831．0±78．1）mm^3（P〈0．05）；同对照组比较，实验组未见明显远处转移，其肿瘤微血管密度（9．68±1．12），对照组分别为（18．69±2．51）和（20．32±2．08），差异有统计学意义（P〈0．05）。结论组织因子途径抑制物2能抑制肿瘤血管的形成，抑制胰腺癌生长。     

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.