八珍汤方对进展期胃癌淋巴细胞亚群的影响及意义

目的:探讨八珍汤加减方对进展期胃癌淋巴细胞的影响及意义。方法:将120例进展期胃癌患者随机分为两组,对照组常规行手术加辅助化疗,治疗组在对照组基础上予八珍汤加减方治疗。分别于新辅助化疗前1 d(T_1)、术前1 d(T_2)、术后14 d(T_3)、术后末次辅助化疗结束时(T_4)抽取外周静脉血,检测T淋巴细胞亚群的水平。结果:对照组在T_1所检测的CD3~+、CD4~+、CD8~+、CD19~+绝对计数及CD4~+/CD8~+比值与治疗组比较差异无统计学意义(P0.05);对照组在T_2、T_3、T_4所检测的CD3~+绝对计数低于治疗组(65.6±8.9 vs 68.9±6.2,63.3±7.2 vs 69.3±8.1,69.6±8.7 vs 74.8±6.9,P0.05);对照组在T_2、T_3、T_4所检测的CD4~+绝对计数低于治疗组(41.6±7.5 vs 45.2±6.9,43.3±8.4 vs 45.1±7.5,45.7±7.3 vs 48.9±8.2,P0.05);对照组在T_2、T_3、T_4所检测的CD19~+绝对计数低于治疗组(8.6±3.5vs 10.2±6.9,7.7±4.4 vs 9.1±3.5,8.3±3.3 vs 9.9±3.7,P0.05);对照组在T_2、T_3、T_4所检测的CD4~+/CD8~+比值低于治疗组(2.24±1.9 vs 2.82±2.5,1.94±2.1 vs 2.61±1.4,2.33±2.7 vs 3.09±1.9,P0.05);对照组在T_2、T_3、T_4所检测的CD8~+绝对计数均高于治疗组(18.6±3.8 vs 15.9±4.2,22.3±5.2 vs 17.3±4.1,19.6±4.6 vs 15.8±3.7,P0.05);治疗组因化疗副反应放弃术后辅助化疗的比例(8.3%)较对照组(26.7%)低,对比有统计学意义(P0.05)。结论:应用八珍汤加减方配合进展期胃癌的治疗,对于患者免疫功能可能具有改善和增强作用,对提高患者对化疗副反应的耐受力也有一定的功效。     

新辅助化疗(SOX方案)对局部进展期胃癌的疗效评估

目的评估新辅助化疗(SOX方案)对局部进展期胃癌的临床疗效,为临床胃癌的治疗提供参考。方法选取2016年6月至2017年6月医院收治的局部进展期胃癌60例,根据随机数字表法将患者分为研究组(n=30)与对照组(n=30)。研究组采用术前SOX方案化疗2~3周期+手术+术后原方案辅助化疗进行治疗,对照组采取手术+术后SOX辅助化疗进行治疗,对两组患者化疗疗效、手术并发症及无病生存期等进行观察比较。结果在化疗总有效率方面,研究组73.3%与对照组53.3%比较明显提高,差异具有统计学意义(P0.05);在肿瘤切除率方面,研究组根治切除率86.7%与对照组63.3%比较明显提高,差异具有统计学意义(P0.05);在不良反应发生率方面,研究组与对照组比较均无明显变化,差异无统计学意义(P0.05);随访期间,研究组2年生存率较对照组明显提高,差异具有统计学意义(P0.05)。结论新辅助化疗(SOX方案)对局部进展期胃癌患者进行治疗能够获得确切的临床疗效,可使分期降低,具有较高安全性,且能够使患者无病生存期提高,有助于患者生存,值得临床应用与推广。     

八珍汤加减联合化疗对小细胞肺癌患者 CD细胞及不良反应的影响

目的:探讨化疗联合或不联合八珍汤加减治疗小细胞肺癌(SCLC)的有效性、安全性。方法:选取2020年1月—2021年6月河北中医学院附属沧州中西医结合医院收治的SCLC患者120例,按随机数字表法分两组,对照组(n=60)予EP化疗方案(依托泊苷+顺铂),研究组(n=60)在对照组基础上联合八珍汤加减。对比两组疗效、CD细胞、生活质量、不良反应。结果:研究组客观缓解率(ORR)高于对照组(P＜0.05)。治疗后,对照组CD3+、CD4+、CD4+/CD8+均低于治疗前(P＜0.05),CD8+高于治疗前(P＜0.05),研究组CD3+、CD4+、CD4+/CD8+均高于治疗前(P＜0.05),CD8+低于治疗前(P＜0.05),且治疗后研究组CD3+、CD4+、CD4+/CD8+均高于对照组(P＜0.05),CD8+低于对照组(P＜0.05)。治疗后,两组EORTC-QLQ-C30量表各维度得分均高于治疗前(P＜0.05),且治疗后研究组EORTC-QLQ-C30量表各维度得分均高于对照组(P＜0.05)。研究组各不良反应的总发生率均低于对照组(P＜0.05)。结论:八珍汤加减联合化疗能提高SCLC患者疗效,改善患者免疫功能与生活质量,减轻化疗所致不良反应。     

奥沙利铂联合氟尿嘧啶、亚叶酸钙方案（mFOLFOX7）对进展期胃癌的疗效分析

目的：观察奥沙利铂联合氟尿嘧啶、亚叶酸钙方案（mFOLFOX7）在进展期胃癌综合治疗中的作用。方法：48例进展期胃癌患者随机分为2组,常规治疗组24例采用外科手术加辅助化疗,综合治疗组24例采用mFOLFOX7的新辅助化疗-手术-术后辅助化疗,观察新辅助化疗对进展期胃癌的作用和毒性反应并比较2组无肿瘤残留（R0）切除率,手术并发症发生率和无病生存率。结果：综合治疗组完全缓解（CR）＋部分缓解（PR）14例（58.3%）完成了R0切除;常规治疗组中7例（29.2%）完成了R0切除。2组患者R0切除率差异有统计学意义（P〈0.05）;而术后并发症发生率、无病生存率比较差异无统计学意义（P均〉0.05）。结论：mFOLFOX7新辅助化疗方案毒性反应较低,能提高进展期胃癌R0切除率,不增加手术并发症,但未能提高进展期胃癌患者的无病生存率。     

新辅助化疗联合手术治疗进展期胃癌的疗效观察

目的观察新辅助化疗联合手术治疗进展期胃癌的临床疗效。 方法按照双盲随机数字表法将68例进展期胃癌患者分为新辅助化疗组和对照组各34例,两组患者均行腹腔镜手术治疗,新辅助化疗组患者术前行新辅助化疗,运用SPSS 19.0统计学软件进行分析,近期疗效比较、手术切除率以及根治性切除率、术后并发症、术后1年生存率比较采用卡方检验,P<0.05表示差异有统计学意义。 结果新辅助化疗组总有效率为79.4%(27/34),降期率为41.2%;对照组总有效率为47.1%(16/34),降期率为14.7%。差异有统计学意义(P<0.05);新辅助化疗组手术切除率和根治性切除率均明显高于对照组(P<0.05);两组患者术后并发症发病率比较,差异无统计学意义(P>0.05);新辅助化疗组患者术后1年生存率明显高于对照组,差异有统计学意义(P<0.05)。 结论新辅助化疗联合手术治疗进展期胃癌可以有效提高手术效果和近期生存率,且毒副作用较轻,而远期效果还需进一步研究。     

进展期胃癌患者FOLFOX4与XELOX新辅助化疗的临床观察

目的：观察FOLFOX4和XELOX新辅助化疗方案对局部进展期胃癌的近期治疗效果以及毒副反应。方法：将2006年7月至2007年8月70例进展期胃癌患者随机分为3组,FOLFOX4新辅助化疗组25例,XELOX组20例,单纯手术组25例。新辅助化疗组行术前化疗2个疗程,化疗结束后4周进行胃癌根治术;单纯手术组行胃癌标准根治术（D2或D2＋）。结果：FOLFOX4组总有效率为52.0%,XELOX组总有效率为55.0%（P〉0.05）。FOLFOX4组恶心、呕吐、白细胞减少和口腔黏膜炎等毒副反应发生率高,而XELOX组以上毒副反应发生率低,仅表现为轻度的手足综合征。新辅助组患者根治性手术切除率为88.9%,单纯手术组为72.0%（P〈0.05）。结论：作为胃癌的新辅助化疗方案XELOX组与FOLFOX4组相似,进展期胃癌患者在新辅助化疗后,再进行手术治疗,可以提高手术根治率和切除率,但XELOX方案毒副作用较轻,化疗时间短,对机体损伤小,易于接受。     

进展期胃癌的新辅助化疗

目前国内临床治疗的胃癌患者大部分属于进展期,早期胃癌患者较少.进展期胃癌手术切除率低,预后差.进展期胃癌行新辅助化疗能使原发肿瘤降期,能提高根治性手术切除率,有改善患者生存率的可能.本文从进展期胃癌新辅助化疗的理论基础、研究现状与进展、效果评估、化疗用药等几个方面对进展期胃癌新辅助化疗进行综述,来说明术前新辅助化疗是进展期胃癌一种有效的治疗手段.     

SOX方案新辅助化疗应用于进展期胃癌的有效性和安全性研究

目的探讨进展期胃癌应用替吉奥胶囊联合注射用奥沙利铂（SOX方案）新辅助化疗的有效性和安全性。方法回顾性分析解放军总医院普通外科2009年11月至2010年9月收治66例符合入组条件的进展期胃癌患者临床病例资料。32例患者予以术前SOX方案化疗（新辅助化疗组）。SOX方案具体为：替吉奥胶囊80mg·（m2）-1·d-1,第1～14天．注射用奥沙利铂130mg／m2,第1天;3周重复。每2个治疗周期后进行化疗有效性和安全性评估。其余34例患者直接行外科手术（对照组）。统计所有手术患者R0切除率和D2淋巴结清扫率。结果新辅助化疗组化疗有效率为68．8％,疾病控制率为93．8％;3-4级不良反应主要为呕吐（12．5％）、肝功能异常（9．4％）、贫血（6．3％）、中性粒细胞减少（6.3％）和食欲减退（6.3％）;化疗后进行外科手术,其中25例（78．1％）行胃癌D2根治术,凡切除率为81．3％。对照组中,行D2根治术23例（67．6％）,与新辅助化疗组比较,差异有统计学意义（P=0．028）;R0切除率为73．5％,与新辅助化疗组比较,差异亦有统计学意义（P=0．040）。结论进展期胃癌应用SOX新辅助化疗具有较高的有效性,而不良反应率较低,能够提高D2根治率和R0切除率。     

观察FOLFOX新辅助化疗方案治疗不能切除的进展期胃癌的疗效

目的 研究奥沙利铂联合氟尿嘧啶和亚叶酸钙(FOLFOX)方案术前进行新辅助化疗对术前评估难以进行根治性手术的进展期胃癌患者的临床疗效及不良反应.方法 入组患者均为兰州军区兰州总医院2008年4月-2009年10月收治的16例晚期胃癌而无法行根治手术.新辅助化疗方案为:奥沙利铂130 mg/m~2第1天;氟尿嘧啶500 mg/m~2、亚叶酸200 mg/m~2第1～5天,每3周为1个周期,共2个周期.观察新辅助化疗后原发病灶的变化情况及用药后的不良反应.结果 新辅助化疗后13例患者获得肿瘤减期,疗程结束后4～6周11例进行根治性手术切除.临床完全缓解(CR)2例,部分缓解(PR)10例,疾病稳定(SD)3例,进展(PD)1例,总有效率为75.0%(12/16).不良反应主要为骨髓抑制、腹泻、恶心呕吐、外周神经感觉异常,经对症治疗后均能缓解.结论 奥沙利铂联合氟尿嘧啶及亚叶酸钙的新辅助化疗方案在不能手术切除的进展期胃癌的治疗中,显著提高手术切除率,耐受性良好,值得推广.     

腹腔镜胃癌根治术联合生物免疫疗法对患者免疫功能及生活质量的影响研究

目的:探讨腹腔镜胃癌根治术联合生物免疫疗法对患者免疫功能及生活质量的影响研究。方法:选取2013年1月—2014年2月行腹腔镜胃癌根治术治疗并完成辅助治疗的I~III期胃癌患者64例,根据患者采取的辅助治疗方案分为免疫组(n=36)和化疗组(n=28),免疫组患者术后采用生物免疫疗法治疗,化疗组患者术后采用化疗治疗。观察两组患者治疗后的临床疗效,分别于辅助治疗前后检测两组患者血清中CD3+、CD4+、CD4+/CD8+、NK细胞水平等免疫功能指标,并采取生活质量核心量表(QLQ-C30)评价两组患者辅助治疗结束后3个月的生活质量并进行比较。结果:免疫组患者辅助治疗开始后3周的总有效率为75.00%,明显高于化疗组患者的67.86%(P<0.05);免疫组患者在生物免疫治疗后血清中CD3+、CD4+、CD4+/CD8+、NK细胞比率较治疗前明显升高(P<0.05),且明显高于化疗组(P<0.05);免疫组和化疗组总体生活质量评分分别为(76.37±17.43)分和(70.14±15.28)分,组间差异有统计学意义(P<0.05);免疫组患者在情感功能、恶心呕吐、疼痛、食欲丧失、腹泻方面优于化疗组,差异军有统计学意义(P<0.05)。结论:腹腔镜胃癌根治术后给予生物免疫疗法,可有效增强患者术后免疫功能,整体提高患者术后生活质量。     

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.