电化学发光免疫分析技术检测尿CK19片段的临床应用及其评价

目的　评价电化学发光免疫分析技术检测尿CK19片段在泌尿系统肿瘤诊治和复发监测中的作用。方法　应用电化学发光免疫分析技术 (ECLIA)测定 80例泌尿系统肿瘤、5 9例急性泌尿系统感染、6 1例肾病、11例前列腺炎、5 1例其他系统肿瘤及 171名无泌尿系统疾病和肺、食道及头颈部肿瘤的健康体检者 ,尿液中CK19片段含量。分析细胞分化程度、临床分期对尿CK19水平的影响。对 2 6名自愿者进行动态观察 ,对比分析尿、血清CK19检测及尿细胞学检查、膀胱镜检敏感性。结果　根据受试者工作特征曲线 (ROC)界定尿CK19临界值为 3 9μg/L ,泌尿系统肿瘤组尿CK19阳性率高达 92 5 % ,急性泌尿系统感染组 (尿感 )阳性率为 5 0 8% ,肾病组 18 0 % ,其他肿瘤组 2 5 5 % ,前列腺炎症组 9 1% ,正常对照组无 1例阳性。尿CK19检测阳性率高于血清CK19和尿细胞学检查 (血清CK19阳性率为 31 3% ,P <0 0 0 2 ,尿细胞学阳性率仅 2 2 2 % ,P <0 0 0 1) ,差异具有统计学意义。细胞分化程度低及有肌浸润和转移者尿CK19水平较高 ,14例膀胱癌术后复发病人尿CK19的阳性率高达 10 0 %。随机抽取 2 6例患者进行动态观察 ,1个月内 17例尿CK19水平下降 ,9例升高。经确诊 ,17例下降者均为泌尿系统感染 ,9例升高者中 ,8例膀胱移行细胞癌 ,1例     

急性一氧化碳中毒后迟发性脑病生化诊断指标的探讨

目的　探讨急性一氧化碳 (CO)中毒后迟发性脑病 (DEACMP)的生化诊断指标。方法　对 4 9例DEACMP患者均在急性期入院 3d内抽取血标本 ,进行血清髓鞘碱性蛋白 (MBP)、天冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LDH)、肌酸激酶 (CK)和神经元特异性烯醇化酶 (NSE)测定 ,并与对照组比较 ;对其中 34例于治疗 30d后再次采取标本复查 ,对比分析治疗前后上述指标的变化。结果　患者组急性期血清MBP、LDH和NSE水平明显高于对照组 [MBP :(6 6 7± 2 90 ) μg/L对 (1 96± 0 90 ) μg/L ,P <0 0 1;LDH :(12 9± 5 6 )U/L对 (10 3± 4 3)U/L ,P <0 0 5 ;NSE :(15 6 8± 7 5 0 ) μg/L对 (10 5 9±5 0 2 ) μg/L ,P <0 0 1],治疗后显著下降 ,与治疗前比较差异有显著意义 [MBP :(3 93± 1 6 4 ) μg/L对(6 5 6± 3 0 1) μg/L ,P <0 0 1;LDH :(10 6± 4 8)U/L对 (131± 5 5 )U/L ,P <0 0 5 ;NSE :(11 95± 5 6 6 )μg/L对 (15 73± 6 6 5 ) μg/L ,P <0 0 1]。患者组与对照组及患者组治疗前后血清AST和CK水平差异均无显著意义 (P >0 0 5 )。结论　血清MBP和NSE水平可作为DEACMP诊断和病情判断的生化指标 ,常规血清酶学检查的临床价值有限。     

不稳定型心绞痛患者血清肌钙蛋白Ⅰ的变化

目的 :对比观察不稳定型心绞痛与稳定型心绞痛患者血清中肌钙蛋白 (c Tn )升高与心脏事件的关系。方法 :对 5 0例不稳定型心绞痛患者 (U AP)、2 0例稳定型心绞痛患者及 2 0例健康人分别进行血清 c Tn 及肌酸激酶同工酶 (CK MB)测定 ,并观察住院期间心脏事件发生率。结果 :12 0例稳定型心绞痛患者 c Tn 定量为 (8.6 4± 3.12 )μg/ L ,CK MB值为 (14.5 0± 4.5 0 ) U / L ;U AP组 c Tn 定量为 (14.2 1± 4.2 6 )μg/ L ,CKMB值为 (16 .5 2± 5 .46 ) U / L ,c Tn 比较 P<0 .0 1,而 CK MB比较 P>0 .0 5。 2以 c Tn ≥ 10μg/ L为分界值 ,则 5 0例 U AP患者中 19例 c Tn 明显升高〔(16 .78± 4.5 2 ) μg/ L〕,同时测定 CK MB值为 (16 .82±4.2 1) U/ L;余 31例 c Tn 为 (9.12± 0 .18) μg/ L,其 CK MB值为 (16 .13± 4.5 0 ) U/ L;c Tn 比较 P<0 .0 1,而CK MB比较 P>0 .0 5。 3不稳定型心绞痛患者中 c Tn 升高组急性心肌梗死、心脏性猝死、顽固性心绞痛的发生率明显高于 c Tn 正常组。结论 :c Tn 对判断 UAP患者预后具有较高的预测价值。     

创伤性休克患者血脂多糖结合蛋白的浓度变化及其意义

目的　探讨创伤性休克患者血中脂多糖结合蛋白 (LBP)的变化规律及其临床意义。方法　动态监测 47例创伤性休克患者血LBP浓度 ,并对发生全身炎症反应综合征 (SIRS)或MODS的患者连续抽血 3次培养进行细菌学检查。比较创伤性休克和非休克 ,SIRS、MODS和非SIRS ,死亡组和存活组 ,血细菌培养阳和阴性患者之间LBP浓度的差异。描记所有创伤性休克患者LBP浓度的变化曲线。结果　创伤性休克患者血LBP浓度 [( 2 4 1± 11 3 ) μg/L]明显高于非休克患者 [( 8 9±6 4) μg /L] ,有显著性差异 ( P <0 0 1) ;SIRS、MODS组患者血LBP浓度 [( 3 8 7± 2 6 4)、( 4 2 6± 3 0 9) μg /L]明显高于非SIRS组患者 [( 19 1± 12 6) μg/L] ,有显著性差异 ( P <0 0 1) ;SIRS和MODS组之间 ,死 1 4亡组 [( 4 3 7± 2 9 1) μg/L]与存活组 [( 4 0 2± 3 1 2 ) μg/L]之间 ,14例血培养阳性 [( 3 8.7± 3 ) μg/L]与 3 3例阴性 [( 3 7 6± 2 7 8) μg/L]之间患者血LBP浓度差异均无统计学意义 (P >0 0 5 )。创伤性休克患者发病后 2 4～ 48h内 ,血LBP浓度开始升高 ,1周左右达高峰 ,此后逐渐下降 ,与患者的预后无明显相关。结论　LBP参与创伤性休克患者SIRS和MODS的发生 ,但并不与患者的预后密切相关 ;LBP可能与其他一些参与SIRS     

脑钠素检测对诊断无ST段抬高的急性冠脉综合征患者的意义

目的　探讨脑钠素 (BNP)测定对诊断无ST段抬高的急性冠脉综合征的临床意义。方法　将 5 4例无ST段抬高的急性冠脉综合征患者分为非Q波心肌梗死组 (NQMI组 ,n=2 5 )、不稳定型心绞痛组 (UA组 ,n =2 9) ,分别测定症状发作 6小时内及 2 4小时的BNP和心肌肌钙蛋白T(cTnT) ,并和 30例正常的健康体检者 (对照组 )作比较。结果　症状发作 6小时内 ,BNP含量NQMI组 (5 6 .30± 16 .8) μg/L ,UA组 (35 .30± 15 .4 0 ) μg/L ,均显著高于对照组 (10 .6 4± 1.80 ) μg/L(P <0 .0 1) ,cTnT无显著变化。症状发作 2 4小时 ,NQMI组BNP(15 7.0 0± 2 0 .4 0 ) μg/L和cTnT(9.32± 2 .8) μg/L ,显著高于对照组 (10 .4 6± 1.90 ) μg/L和 (0 .0 3± 0 .0 1) μg/L(P <0 .0 1) ,UA组cTnT有6 3.2 %的患者为正常值 (≤ 0 .1μg/L) ,而BNP显著高于对照组 (P <0 .0 1)。结论　血浆BNP含量有助于对无ST段抬高的急性冠脉综合征的早期诊断     

高效液相电化学法检测尿儿茶酚胺诊断嗜铬细胞瘤

目的　研究利用高效液名相电化学法检测尿液中儿茶酚胺水平 ,提高对嗜铬细胞瘤的诊断水平。方法　采用高效液相电化学法对 5 0名健康体检者 (男女各 2 5名 )、5 6例嗜铬细胞瘤患者 (男 31例 ,女 2 5例 ) 2 4h尿液中儿茶酚胺水平测定。结果　正常对照组儿茶酚胺中肾上腺素、去甲肾上腺素 ,多巴胺水平分别为 (10 .7±8.9) μg/2 4h ,(5 3 .2± 2 9.1) μg/2 4h ,(15 9.4± 10 4.7) μg/2 4h ;嗜铬细胞瘤组肾上腺素、去甲肾上腺素、多巴胺水平分别为 (6 1.6± 31.9) μg/2 4h ,(132 .0± 5 8.0 ) μg/2 4h ,(339± 6 9.9) μg/2 4h ,5 6例嗜铬细胞瘤患者的尿儿茶酚胺水平明显高于正常对照组 ,两组比较差异有显著性 (P <0 .0 1)。结论　高效液相电化学法测定尿儿茶酚胺特异性强 ,操作简单 ,结果准确 ,并能同时对肾上腺素、去甲肾上腺素和多巴胺直接测定 ,并适合大量标本的测定 ,值得推广     

急性肾炎恢复期尿微量蛋白与尿酶检测的临床意义

目的　探讨急性肾炎在临床治愈期尿微量蛋白联合尿酶检测的临床价值。方法　对 5 0例正常对照组和 30例急性肾炎组治愈期者采用酶联免疫吸附法检测尿微量白蛋白 (mALB)、视黄醇结合蛋白(RBP)、尿转铁蛋白 (TRF)和α1 微球蛋白 (α1 M ) ;终点法测尿N 乙酰 β D 氨基葡萄糖苷酶 (NAG) ;比色法测尿肌酐 (Cr)。结果　正常对照组尿mALB为 (3.6 1± 2 .4 6 )mg/L,RBP/Cr为 (7.4 6± 5 .0 2 ) μg/mmol,TRF/Cr为 (0 .0 5± 0 .0 3)mg/mmol,α1 M /Cr为 (0 .78± 0 .5 1)mg/mmol,NAG/Cr为(0 .5 2± 0 .4 6 )U/mmol,急性肾炎治愈期患者尿mALB为 (5 .12± 3.4 4 )mg/L ,RBP/Cr为 (8.87± 4 .4 5 ) μg/mmol,TRF/Cr为(0 .38± 0 .32 )mg/mmol,NAG/Cr为 (2 .13± 2 .0 2 )U/mmol,α1 M /Cr为 (0 .88± 0 .4 2 )mg/mmol;其检测的阳性率分别为 :mALB 4 0 % ,NAG 30 % ,RBP 13.3% ,TRF 2 0 % ,α1 M 3.3% ,NAG与mALB两项指标联合检测其阳性率为 4 6 .7%。结论　联合检测尿NAG与mALB在急性肾炎临床治愈期是判定肾脏损害及恢复情况的最灵敏与可靠的实验室指标。     

脑梗死患者血浆胆红素和氧化低密度脂蛋白水平变化及意义

目的　探讨脑梗死患者血浆胆红素浓度和氧化低密度脂蛋白 (ox-LDL)含量的变化以及它们在脑梗死中的作用。方法　用钒酸盐氧化法和酶联免疫吸附法 (ELISA)分别测定 75例急性期脑梗死患者血浆胆红素浓度和ox -LDL水平 ,并与 30例其他疾病对照组及 4 6例正常对照组进行比较。结果　 (1)脑梗死患者血浆胆红素浓度为 (11 8± 4 3) μmol L ,咀显低于其他疾病对照组 (14 9± 4 7) μmol L及正常对照组 (15 5± 5 5 ) μmol L ,差异有显著性 (P <0 0 1) ;脑梗死患者血浆ox -LDL水平为 (6 2 5 3± 2 5 7 2 )μg L ,明显高于其他疾病对照组 (4 71 9± 195 0 ) μg L及正常对照组 (4 32 7± 184 4 ) μg L ,差异有显著性(P <0 0 1)。 (2 )大梗死灶组血浆胆红素浓度 (9 5± 3 1)mol L明显低于中梗死灶组 (10 3± 4 4 ) μmol L和小梗死灶组 (12 7± 5 0 ) μmol/L ,P <0 0 1。而大梗死灶组血浆ox -LDL水平 (6 80 4± 2 4 7 1) μg L明显高于中梗死灶组 (5 81 5± 2 6 3 5 ) μg L和小梗死灶组 (5 0 4 2± 2 2 5 7) μg L ,P <0 0 1。 (3)胆红素降低程度和ox -LDL增高程度与神经功能缺损程度密切相关。 (4 )经相关分析 :脑梗死时总胆红素与血浆ox -LDL水平呈负相关 (r=- 0 5 93,P <0 0 1) ,总     

全自动酶法测定血清总和游离卡尼汀浓度及临床应用

目的　建立自动化测定血清总和游离L 卡尼汀浓度的酶分光光度法 (CAT BTND)。方法　对卡尼汀酯水解条件及 pH和L 卡尼汀乙酰基转移酶浓度等反应条件作最佳化研究 ,同时对该法进行方法学评估 ,并用该法测定了 119名正常人的血清样本。结果　该法最低检出限为 4 81μmol/L ,线性范围可达 150 μmol/L(r =0 999)。批内和批间的平均CV分别为游离卡尼汀 5 52 %和5 90 % ,辛酯卡尼汀为 5 78%和 6 14 %。平均回收率为 98 5%和 98 4%。在胆红素≤ 12 0 μmol/L ,血红蛋白≤ 7g/L和抗坏血酸≤ 50 0 μmol/L的情况下 ,对测定结果无显著性影响。正常参考范围 :成人 :男 (3 2名 )总卡尼汀 (48 5± 17 7) μmol/L ,游离卡尼汀 (3 9 2± 14 2 ) μmol/L ,卡尼汀酯 (9 3±5 3 ) μmol/L ;女 (3 1名 )总卡尼汀 (42 7± 17 3 ) μmol/L ,游离卡尼汀 (3 2 4± 18 0 ) μmol/L ,卡尼汀酯(10 5± 5 5) μmol/L。儿童 (年龄 9～ 12岁 ) :男 (3 1名 )总卡尼汀 (57 3± 19 3 ) μmol/L ,游离卡尼汀(45 1± 14 4) μmol/L ,卡尼汀酯 (12 3± 10 4) μmol/L ;女 (2 5名 )总卡尼汀 (59 4± 15 7) μmol/L ,游离卡尼汀 (46 6± 12 6) μmol/L ,卡尼汀酯 (12 8± 7 8) μmol/L。 结论　该法正确快速 ,可作为L 卡尼汀缺乏症     

肝硬化患者血浆一氧化氮、内皮素-1水平的变化

目的 :探讨肝硬化患者血浆一氧化氮及内皮素 1水平的变化及其临床意义。方法 :用放射免疫法检测肝硬化患者 5 8例 (男 3 9例 ,女 19例 ;年龄 2 4～ 76岁 ) ,及健康对照 2 0例 (男 15例 ,女 5例 )的血浆内皮素 -1水平 ;采用高效液相色谱分析法测定一氧化氮水平。结果 :肝硬化组血浆一氧化氮及内皮素 -1水平 ( 3 619.2 2± 82 6.16) μg/L ,( 89.3 2±3 8.96)ng/L ,明显高于对照组 ( 2 72 2 .5 3± 80 4.40 ) μg/L ,( 4 3 .10± 15 .83 )ng/L ,P <0 .0 1;腹水患者 ( 3 5 69.2 4± 892 .2 6) μg/L ,( 92 .3 6± 3 5 .0 7)ng/L ,高于无腹水患者 ( 2 83 4 .18± 812 .96) μg/L ,( 63 .2 7± 2 8.98)ng/L ,P <0 .0 5 ;且在肝功能Child Pugh分级中 ,具有C级、B级 >A级的规律。相关分析显示肝硬化患者血浆一氧化氮与内皮素 -1呈正相关。结论 :肝硬化患者血浆一氧化氮及内皮素 -1水平增高 ,在肝功能损伤及肝硬化血流动力学紊乱的发生中具有重要作用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.