穿心莲内酯体外对人胃腺癌BGC823细胞增殖凋亡的影响

目的探讨穿心莲内酯（andrographolide,AD）对人胃癌细胞株BGC-823细胞增殖、细胞周期以及细胞凋亡的影响。方法分别采用MTT法、流式细胞术和流式细胞仪AnnexinV／PI双染色法检测AD对BGC-823细胞体外增殖、细胞周期和细胞凋亡的影响：应用光镜和透射电镜观察不同浓度的AD作用后BGC．823细胞形态学改变。结果各浓度组AD均对人低分化胃癌细胞株BGC-823的增殖有抑制作用。并具有时间和浓度依赖关系（均P〈0．05）。浓度7．5μg／ml以下的AD抑制效果较弱,而15．0-60．0μg／ml抑制效果显著提高（P〈0．05）,60．0μg／ml以上抑制率增高不显著（P〉0．05）。24、48和72h的IC50分别为（35．3±4．3）、（25．5±3．5）和（18．2±2．7）μg／ml。BGC-823细胞经AD作用后,G0／G1期细胞的比例增加,S期和G2/M期细胞的比例下降,细胞被阻滞在G0／G1期,呈浓度依赖关系。AD浓度为7．5、10．0和15．0μg／ml组作用24h后,早期凋亡率分别为（19．3±4．7）％、（29．4±4．1）％和（52．7±6．7）％,晚期凋亡率为（10．8±1．8）％、（10．9±4．7）％和（14．7±4．8）％,均显著高于阴性对照组的早期凋亡率[（3．4±1．0）％]和晚期凋亡率[（4．1±0．7）％],差异有统计学意义（均P〈0．05）,并呈浓度依赖关系。结论AD能抑制BGC-823细胞增殖、阻滞其细胞周期在G0／G1期和诱导其细胞凋亡．是潜在的胃癌抗肿瘤中药制剂成分。     

生长抑素抑制人结肠癌细胞增殖的实验研究

目的：研究外源性生长激素（GH）和生长抑素（SS）对人结肠癌细胞株HT-29的影响，并探讨其作用机制。方法：人结肠癌细胞株HT-29分成正常对照组、生长抑素组（SS组）、生长激素组（GH组）和生长抑素＋生长激素组（GH＋SS组）。MTT法测定细胞抑制率，流式细胞仪测定细胞周期分布、增殖指数、凋亡率，RT—PCR方法测定bcl．2及baxmRNA水平。结果：生长抑素能够明显抑制人结肠癌细胞株HT-29增殖（P〈0．01）、降低S期和G2／M期细胞比例（P〈0．05）、降低增殖指数（PI）（P〈0．05）、促进细胞凋亡（P〈0．01）、降低bcl-2mRNA表达（P〈0．05）、提高baxmRNA表达（P〈0．01），生长激素则无明显作用。GH＋SS组表现与SS组相似。结论：生长抑素可能通过抑制GdG．期细胞进入S期和G2／M期以及促进细胞凋亡两种途径抑制体外培养的人结肠癌细胞株HT-29增殖。生长抑素可能是通过改变bax基因和bcl-2基因的表达影响肿瘤细胞的凋亡。生长激素对体外培养的人结肠癌细胞株HT-29无显著影响。     

维生素E琥珀酸酯诱导MCF 7乳腺癌细胞的凋亡

目的检测维生素E琥珀酸酯（VES）对MCF-7乳腺癌细胞的增殖抑制和凋亡诱导作用，并分析凋亡诱导分子Fas表达的变化。方法人乳腺癌细胞株MCF-7[雌激素受体阳性，ER（＋）]以VES刺激12，24h和48h，VES浓度为5μg／mL，10μg／mL和20μg／mL，用MTT法测定VES对细胞增殖的抑制作用；以流式细胞仪分析细胞周期和细胞表面Fas的表达；Western蛋白印迹法检测VES作用后Fas蛋白水平的变化。结果VES对MCF-7乳腺癌细胞具有显著的抑制作用，并表现为时间和剂量依赖关系。MCF-7乳腺癌细胞的自然凋亡率为1．2％；5μg／mL，10μg／mL和20μg／mL的VES作用48h后凋亡率分别升高至11．2％，16．4％和41．2％。VES作用后乳腺癌细胞Fas蛋白水平和细胞表面Fas表达升高。结论VES对ER（＋）乳腺癌细胞具有显著的增殖抑制作用，并诱导细胞凋亡，其机制与细胞表面Fas表达上调有关。     

苦参碱对雄激素依赖性前列腺癌细胞的影响

目的：探讨苦参碱（Matrine）对雄激素依赖性前列腺癌细胞株（LNCaP）凋亡及前列腺特异抗原（prostate specific antigen,PSA）表达的影响。方法：分别用0.5g／L、1.0g／L、1.5g／L、2.0g／L浓度的苦参碱作用于LNCaP细胞12h、24h、36h后MTT法检测细胞生长活性;24h后流式细胞仪测定细胞凋亡的变化;24h后Western印迹法检测细胞内Bel-2和Bax的表达;12h、24h、36h后化学发光法检测LNCaP细胞培养液中PSA的变化。结果：苦参碱能抑制LNCaP细胞的生长,呈剂量与时间依赖性,不同浓度苦参碱组之间与不同作用时间组之间的差异均有统计学意义（P〈0.05）。苦参碱诱导LNCaP细胞凋亡,各浓度组凋亡细胞比例均显著高于对照组,差异有统计学意义（P〈0.05）;LNCaP细胞内Bcl-2含量呈浓度依赖性下降,Bax含量呈浓度依赖性升高（P〈0.01）;LNCaP细胞培养液中PSA的表达显著下降（P均〈0.05）。结论：苦参碱能显著抑制LNCaP细胞的体外生长,诱导其凋亡,并抑制PSA的表达。     

17-DMAG体外对结肠癌HT-29细胞增生和凋亡的影响

目的 观察17-二甲胺乙胺基-17-去甲氧基格尔德霉素(17-dimethylaminoethylamino-17-demethoxygeldanamyein,17-DMAG)对人结肠癌HT-29细胞增生抑制及诱导其凋亡的作用.方法 用CCK-8检测17-DMAG对结肠癌HT-29细胞增生的影响;DAPI染色在倒置荧光显微镜下观察17-DMAG作用于HT-29细胞24 h后细胞核的形态;AnnexinV-FITC/PI双染法流式细胞检测细胞凋亡率;免疫印迹实验分析Caspase-3蛋白表达水平变化.结果 17-DMAG呈时间-剂量-依赖性抑制HT-29细胞增生.0.1μmol/L、0.25μmol/L 、0.5μmol/L、1.0μmol/L、2.5μmol/L和0.5μmol/L作用于HT-29细胞24 h后,细胞增生抑制率分别为(14.36±0.95)％、(22.17±1.15)％、(28.45±1.16)％、(35.04±1.58)％、(46.85±2.44)％和(57.19±2.06)％;作用48h后,细胞增生抑制率分别为(20.80±1.17)％、(27.55±0.65)％、(33.33±1.23)％、(46.20±4.76)％、(55.45±4.47)％和(61.75±2.72)％;作用72h,细胞增生抑制率分别为(29.62±2.27)％、(39.19±1.74)％、(44.29±2.00)％、(50.66±2.17)％、(58.84±3.18)％和(70.74±2.65)％.DAPI染色倒置荧光显微镜观察0.25μmol/L、0.5μmol/L、1.0μmol/L与2.5μmol/L的17-DMAG作用HT-29细胞24h,均可见到细胞凋亡的改变.AnnexinV-FITC双染法检测结果显示,正常对照组HT-29细胞24h的自然总凋亡率(早期+晚期)为(2.72±0.57)％,0.25μmol/L、0.5μmol/L、1.0μmol/L和2.5μmol/L 17-DMAG干预24 h后细胞总凋亡率分别为(5.38±0.46)％、(6.88±0.52)％、(10.44±0.32)％与(17.87±4.66)％,不同浓度组的细胞凋亡率比较差异有统计学意义(P＜0.05).17-DMAG药物作用HT-29细胞24h,随着药物剂量的增加,cleaved Caspase-3的表达有增加趋势.结论 17-DMAG体外呈时间-剂量依赖性抑制HT-29细胞增生,诱导其通过Caspase-3途径凋亡.     

三氧化二砷对激素非依赖性前列腺癌PC-3细胞株Bc1-2、Bax表达的影响

目的了解三氧化二砷对激素非依赖性前列腺癌PC-3细胞株细胞增殖、细胞凋亡及bcl-2、bax基因表达的影响。方法分别以1、2、3、6、10μmol／L的三氧化二砷作用于PC-3细胞，48h后对细胞增殖活性、细胞凋亡及细胞bcl-2、bax基因表达的变化进行检测。结果各浓度的三氧化二砷均可抑制PC-3细胞增殖，并具有剂量依赖性。3、6、10μmol／L的三氧化二砷还可诱导PC-3细胞凋亡，计算细胞凋亡率分别为11．8％、12．7％、29．6％。逆转录聚合酶链反应（RT-PCR）检测PC-3细胞中bcl-2、bax表达的相对强度，发现bcl-2的表达强度随三氧化二砷浓度的升高而逐渐降低（P〈0．01），而bax表达强度变化不明显（P〉0．05）。结论三氧化二砷可有效抑制PC-3细胞增殖，诱导PC-3细胞凋亡，这一过程与三氧化二砷抑制PC-3细胞中bcl-2的表达有关。     

人重组白介素6对人结肠癌HT-29细胞黏蛋白表达的调控

目的研究人重组白介素6（rIL-6）对人结肠癌HT-29细胞中黏蛋白表达的调控,以期对结肠癌的发生发展进一步了解。方法采用流式细胞技术和RT-PCR分别检测1、2、5、10和20μg/L的rIL-6作用于HT-29细胞后黏蛋白1和黏蛋白2表达变化,采用Transwell细胞侵袭实验研究rIL-6对HT．29细胞侵袭力的影响。结果2μg／L以上的rIL-6能够促进结肠癌HT-29细胞中黏蛋白1的表达,分别为（12．5±1．6）％、（26．6±2．7）％、（33．9±2．8）％和（58．9±2．5）％,均高于阴性对照组（8．0±0．8）％（P〈0．01）。反之,2μg／L以上的rIL-6可抑制黏蛋白2的表达,分别为（30．5±2．6）％、（17．0±2．7）％、（11．0±2．0）％和（5．3±1．8）％,均低于阴性对照组（41．6±3．6）％（P〈0．01）。随着rIL-6浓度的增加,HT-29细胞的透膜细胞数增加（P〈0．01）。结论rIL-6能促进结肠癌HT-29细胞中黏蛋白1的表达．抑制黏蛋白2的表达,对结肠癌细胞的浸润有促进作用。     

塞来昔布对人结肠癌细胞生长及裸鼠肝转移瘤形成的影响

目的探讨塞来昔布对体外培养的结肠癌细胞生长及裸鼠肝转移瘤的影响。方法以人结肠癌细胞株HT-29（COX-2高表达）和HCT-116（COX-2低表达）为研究对象，采用噻唑蓝（MTT）比色法检测塞来昔布对2种细胞的增殖抑制效应，应用流式细胞术检测2种细胞的周期分布情况；将2种细胞接种裸鼠，观察其肝转移瘤形成情况。结果①塞来昔布对人结肠癌细胞株生长的抑制作用呈时间、剂量依赖性效应（P〈0．05，P〈0．01），且对HT-29细胞的作用强于HCT-116细胞（P〈0．05）。②塞来昔布可改变结肠癌细胞株细胞周期的分布，明显降低其增殖指数。③塞来昔布具有明显的抑制裸鼠肝转移瘤生长的作用。结论塞来昔布可能通过抑制COX-2酶活性而抑制结肠癌细胞的分裂和增殖，诱导其凋亡，干预结肠癌的转移与复发。     

靶向RNA干扰Survivin对结肠癌细胞HT-29增殖凋亡的影响

目的探讨肿瘤增殖型腺病毒（Ad-delE1b55KD-shRNA／Survivin-EGFP）介导的以人Survivin为靶标的RNA干扰对结肠癌细胞株HT-29中Survivin mRNA和蛋白表达及对HT-29增殖凋亡的影响。方法用Ad-delE1b55KD-shRNA／Survivin-EGFP转染结肠癌细胞株HT-29（以携带相同shRNA的增殖缺陷型腺病毒和脂质体载体为对照），用逆转录-聚合酶链反应（RT-PCR）和Western blot分别检测转染后的HT-29细胞中Survivin mRNA和蛋白表达的变化，用噻唑蓝（MTT）法、吖啶橙／溴乙锭荧光染色法、Annexin V-PE／7-AAD联合染色法检测细胞死亡率及凋亡率。结果与复制缺陷型腺病毒载体和脂质体载体比较，转染Ad-delE1b55KD-shRNA／Survivin-EGFP后，HT-29细胞中Survivin mRNA拷贝数及蛋白表达显著降低，其细胞死亡率和凋亡率显著提高（P〈0．05）。结论Ad-deIE1b55KD-shRNA／Survivin-EGFP介导的RNA干扰较之增殖缺陷型腺病毒载体和脂质体载体具有更高的干扰效率，且能高效地诱导结肠癌细胞凋亡并抑制其增殖。     

瘦素对人乳腺癌细胞系MCF-7增殖的影响及其作用机制探讨

目的 观察瘦素对人乳腺癌细胞系MCF-7增殖的影响，探讨其作用机制。方法 免疫荧光检测人乳腺癌细胞系MCF-7瘦素受体（OB．Rb）的表达。于MCF-7细胞中分别加入不同浓度的瘦素（0、10、50、100、150μg／L），作用不同的时间（6、12、24h），噻唑蓝（MTr）法检测各组细胞的增殖情况，同法分别检测STAT3抑制剂AG490和ERK1／2抑制剂PD98059对瘦素刺激MCF-7细胞增殖的影响。采用免疫印迹法（Westernblot）检测瘦素（100μg／L）作用于MCF-7细胞不同时间（0、20、40、60min）STAT3和ERK1／2的磷酸化水平。结果 免疫荧光检测证实MCF-7细胞存在瘦素受体（0B—Rb）表达。瘦素能明显促进MCF-7细胞的增殖，并呈时间和剂量依赖性，于100μg／L瘦素作用24h时增殖效应最大，100μg／L组与150μg/L组差异无统计学意义（P〉0．05）；不同浓度的AG490与PD98059均可明显抑制瘦素对MCF-7细胞的增殖，随着AG490与PD98059浓度增高，抑制作用逐渐增强；MCF-7细胞经100ng／ml瘦素处理后，随时间延长STAT3和ERK1／2磷酸化程度逐渐增高，且持续至少达60min。结论 瘦素可能通过激活STAT3和ERK信号通路促进入乳腺癌细胞系MCF-7的增殖。     

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.