肿瘤标志物CA19-9、CA242、CEA和CA125联合检测在胰腺癌诊断中的意义

目的 探讨肿瘤标志物CA19-9、CA242、CEA和CA125单项检测和联合检测对胰腺癌患者的临床诊断价值.方法 检测48例胰腺癌患者以及48例健康体检者外周血清中四种肿瘤标志物的水平,并对结果进行分析.结果 胰腺癌患者血清中CA19-9、CA242、CEA与CA125的含量显著高于正常时照组,两者比较差异有统计学意义(P<0.01).单项检测时CA19-9、CA242、CEA与CA125的敏感性分别为79.2%、54.2%、50.0%和35.4%.特异性分别为87.5%、89.6%、79.2%和70.8%.联合检测时敏感性为93.8%,特异性为100%.结论 CA19-9、CA242、CEA与CA125联合检测敏感性和特异性都明显高于单项检测.联合检测较单项血清标志物检测能提高胰腺癌的诊断率.     

血清CA19-9和CEA检测在胰腺癌诊断中的价值

目的 探讨血清CA19-9和CEA检测对胰腺癌诊断的价值.方法 选取西安交通大学医学院第一附属医院2003年1月至2005年12月期间44例胰腺癌病人及同期64例健康查体者,应用免疫放射法检测肿瘤标志物CA19-9和CEA在血清中的水平.采用的正常参考值分别为CA19-9＜39U/ml,CEA＜3.4 ng/ml.结果 胰腺癌病人血清中CA19-9和CEA水平明显高于健康查体者(P＜0.01),而血清中AFP水平无统计学差异(P＞0.05).CA19-9和CEA联合检测对胰腺癌诊断的敏感性高于单一检查,但联合检测与单一检测之间的特异性无明显差异.AFP与CA19-9、CEA的两联或三联检测均不能提高诊断的敏感性和特异性.胰腺癌病人血清中CA19-9和CEA水平在Ⅰ+ⅡA期和ⅡB+Ⅲ+Ⅳ期间均不存在显著型差异.但是,血清中CA19-9和CEA联合检测对ⅡB+Ⅲ+Ⅳ期胰腺癌诊断的敏感性较Ⅰ+ⅡA期胰腺癌升高,差异具有统计学意义(P＜0.05).结论 CA19-9和CEA的联合检测可弥补单项指标检测的不足,明显提高诊断胰腺癌敏感性.同时,CA19-9和CEA检测对提示胰腺癌发生肠系膜血管侵犯、淋巴结或胰外器官转移具有一定意义.     

多肿瘤标志物的联合检测和分析对胰腺癌诊断的价值探讨

目的探讨肿瘤标志物的联合检测和分析对胰腺癌诊断的价值。方法应用蛋白芯片技术同时检测CA19-9、CEA、CA242、-βHCG、AFP、Free-PSA、Ferritin、NSE、PSA、CA125、CA15-3和HGH共12种肿瘤标志物在患者血清中的表达。试验分3组:胰腺癌组81例,良性胰腺病组57例,正常对照组547例。结果12种肿瘤标志物在胰腺癌、良性胰腺病和健康对照组之间表达的差异明显。总的表达强度为胰腺癌组>良性胰腺病组>健康对照组。胰腺癌组中CA19-9、CEA、CA242、β-HCG、AFP、CA125和HGH的表达强度显著高于良性胰腺病组(P<0.05)。同时CA19-9、CEA、CA242、Fer-ritin、-βHCG、AFP、CA125、HGH和CA15-3的阳性率也明显高于良性胰腺病组(P<0.05)。CA242、CA19-9、CEA和CA125对胰腺癌诊断的敏感性均高于50%,特异性均高于70%,准确性均高于60%。其中以CA242的敏感性、特异性和准确性最高,分别为72.8%、89.5%和79.7%。同时CA242、CA19-9和CEA联合检测的敏感性和准确性较之单项检测明显升高。两两联合的准确性均为85.9%以上,3种联合准确性则高达97.8%。结论肿瘤标志物CA242、CA19-9和CEA的联合检测可明显提高胰腺癌的诊断率。     

血清学肿瘤标志物与胰腺癌诊断及分期的关系

目的 探索血清学肿瘤标志物CA19-9、CEA及CA50与胰腺癌的早期诊断及分期的关系.方法 通过收集分析安徽医科大学附属省立医院普外科2013年1月-2015年10月收治入院的51例胰腺癌患者、10例胰腺良性肿瘤患者、12例慢性胰腺炎患者血清中CA19-9、CEA及CA50的测量值,比较它们在不同分期的胰腺癌及其他胰腺疾病中血清含量的不同.结果 CA19-9在不同分期胰腺癌及其他胰腺疾病中表达差异有统计学意义(P＜0.05).CEA及CA50在胰腺癌与胰腺其他疾病中表达差异具有统计学意义(P＜0.05).但CEA在Ⅰ期与Ⅱ期、Ⅰ期与Ⅲ期、Ⅱ期与Ⅲ期患者血清中的表达差异无统计学意义(P＞0.05).CA50在胰腺癌Ⅰ期与Ⅲ期、Ⅱ期和Ⅳ期中表达差异无统计学意义(P＞0.05).CA19-9诊断胰腺癌的阳性率高于CEA及CA50,CA19-9、CEA及CA50三者同时检测诊断胰腺癌的阳性率最高.结论 CA19-9、CEA及CA50在血清中的表达水平对于胰腺癌的早期诊断有一定的相关性,在胰腺癌分期中CA19-9的诊断价值最高.     

血清CA19-9、CA242、CEA及CA125在胰腺癌诊断和预后中的价值

目的探讨CA19-9、CA242、CEA和CA125四种肿瘤标志物单独检测或联合检测在胰腺癌诊断和预后中的价值。方法测定并分析我院2007年1月至2009年12月期间收治的63例胰腺癌患者、33例胆管癌和27例胰腺良性疾病患者血清中CA19-9、CA242、CEA和CA125水平,并对术后胰腺癌患者进行随访。结果胰腺癌患者血清中CA19-9、CA242、CEA和CA125水平明显高于胰腺良性疾病患者和胆管癌患者(P<0.05)。单项检测中血清CA19-9的敏感性最高,达79.4%(50/63),但其特异性(61.7%)低于CA242(83.3%)和CEA(80.0%)。联合检测CA19-9+CA242+CEA的特异性最高,达93.3%(56/60)。当肿瘤位于胰腺体/尾部时CA19-9水平显著高于其在胰腺头部或全胰腺时(P<0.05)。胰腺癌Ⅳ期患者的CA19-9和CA242水平显著高于Ⅰ或Ⅱ/Ⅲ期患者(P<0.05)。本组失访15例,48例获得随访,随访时间平均6个月(2~12个月)。胰腺癌患者术后0.5及3个月血清中CA242、CA19-9较术前明显降低(P<0.05)。结论单项检测CA19-9可以提高胰腺癌诊断的敏感性,联合检测CA19-9+CA242+CEA可以提高胰腺癌诊断的特异性,CA19-9和CA242对胰腺癌的治疗效果及预后判断更具有价值。     

Ⅰ期、Ⅱ期胰腺导管腺癌根治术后血清CA125、CEA、CA19-9及预后分析

目的研究Ⅰ期、Ⅱ期胰腺导管腺癌根治术后患者血清CA125、CEA、CA19-9水平及预后分析,为患者的诊断提供临床指导。方法选取2017年2月至2020年3月期间在本院行胰腺导管腺癌根治术的60例Ⅰ期、Ⅱ期患者作为研究对象。随机分为对照组和观察组,各30例,检测所有患者血清癌抗原125(CA125)、癌胚抗原(CEA)、糖链抗原19-9(CA19-9)水平,探究这三种标志物对胰腺癌的诊断和预后价值。结果术后3种标志物CA19-9、CA125、CEA的水平和阳性率显著低于术前,差异有统计学意义(P0.05);三种标志物CA19-9、CA125、CEA联合的诊断性显著高于各单一指标组,CA19-9的特异性、敏感性、准确性显著高于CA125和CEA,CEA的诊断性显著高于CA125,差异有统计学意义(P0.05)。结论 CA125和CEA的检测水平对胰腺癌的诊断和预后有一定的辅助作用,联合CA19-9三种指标水平诊断和预后效果更好。     

术前联合检测血清肿瘤标志物诊断消化系统肿瘤的临床价值

目的探讨几种血清肿瘤标志物术前检测在消化系统肿瘤诊断中的应用价值。方法回顾性分析90例已确诊的消化系统恶性肿瘤的术前血清的及37例对照者的肿瘤标志物AFP、CEA、CA50、CA19-9和CA242的水平,应用放射免疫分析技术检测这些肿瘤标志物的含量。结果胃癌组的阳性率分别为AFP(12.00%)、CEA(68.00%)、CA50(28.00%)、CA19-9(48.00%)和CA242(12.00%);肝癌组的阳性率分别为AFP(81.25%)、CEA(12.50%)、CA50(62.50%)、CA19-9(50.00%)和CA242(6.25%);胰腺癌组的阳性率分别为AFP(55.56%)、CEA(41.18%)、CA50(27.78%)、CA19-9(72.22%)和CA242(88.89%);结肠癌组的阳性率分别为AFP(22.58%)、CEA(35.48%)、CA50(83.87%)、CA19-9(90.32%)和CA242(29.03%);对照组的阳性率分别为AFP(8.11%)、CEA(2.70%)、CA50(5.41%)、CA19-9(0.00%)和CA242(0.00%);联合检测的阳性率分别为76.00%、68.75%、94.44%和93.55%。结论多种肿瘤标志物联合检测可以提高消化系统恶性肿瘤诊断的阳性率,在肿瘤的术前诊断中有较高的临床应用价值。     

多种肿瘤标志物联合检测对肝门胆管癌诊断的意义

目的:探讨联合检测肿瘤标志物CA50,CA125,CA242,CA19-9及CEA对肝门胆管癌诊断的意义.方法:选择近2年间住院且术后病理证实为肝门胆管癌患者90例作为观察组,同期胆道良性病变患者91例作为对照组,采用全自动电化学发光分析仪测定两组患者术前血清中CA50,CA125,CA242,CA19-9及CEA的水平.分别计算两组血清中5种肿瘤标志物的敏感性、特异性及准确性.结果:观察组血清CA50,CA242,CA19-9及CEA的水平明显高于对照组(均P＜0.01),而观察组血清CA125水平与对照组血清CA125水平比较无统计学差异(P＞0.05).血清CA19-9在肝门胆管癌中阳性率最高(86.67％),次为CA242( 63.33％)及CA50 (60％);两组患者血清中5种标志物的阳性率比较,除CA125外,各相应组间差异具有统计学意义(P＜0.05).对于肝门胆管癌的诊断,血清CA19-9灵敏度最好(93.98％),而CEA的特异度最好(94.60％).结论:联合检测CA50,CA242,CA19-9和CEA有助于肝门胆管癌与胆道良性疾病鉴别.     

磷脂酰肌醇蛋白聚糖1联合肿瘤标志物检测对胰腺癌的诊断价值

目的探讨血清磷脂酰肌醇蛋白聚糖1(GPC-1)在胰腺癌中的表达及联合糖类抗原19-9(CA19-9)与癌胚抗原(CEA)对胰腺癌的诊断价值。方法招募2018年10月至2020年7月青岛市市立医院收治的胰腺癌患者60例,并选取同期就诊的胰腺良性病变患者31例、健康对照者50名,酶联免疫吸附试验检测血清GPC-1表达情况,免疫化学发光法检测血清CA19-9、CEA水平,采用受试者工作特征曲线(ROC)评价三者单独及联合检测对胰腺癌及血清学标志物阴性的胰腺癌的早期诊断价值。结果胰腺癌患者血清GPC-1表达水平与血管侵犯、胰管扩张、TNM分期、淋巴结和远处转移相关(均P0.05)。血清GPC-1、CA19-9、CEA在胰腺癌中均呈高表达(P0.05),单一指标诊断胰腺癌时,GPC-1的诊断价值高于CA19-9及CEA;在区分胰腺癌与健康对照、胰腺良性病变时,GPC-1+CA19-9、GPC-1+CEA或三者联合的曲线下面积(AUC)较单一指标明显增大,且三者联合诊断价值最高(AUC分别为0.916、0.870)。CA19-9、CEA单阴及双阴性的胰腺癌患者其GPC-1表达水平均高于健康对照者及胰腺良性病变患者,差异有统计学意义(P0.05)。GPC-1在鉴别CA19-9、CEA单阴或双阴性的胰腺癌与健康对照、胰腺良性病变患者时,AUC为0.683～0.825,敏感度为71.4%～87.5%,特异度65.0%～82.9%,准确性73.9%～84.7%。结论胰腺癌中高表达的血清GPC-1与血管侵犯、胰管扩张、TNM分期、淋巴结和远处转移相关,血清GPC-1与CA19-9、CEA联合检测可提高胰腺癌的诊断价值,弥补传统单项血清学标志物检测的不足,是一种方便敏感的胰腺癌辅助筛查手段。     

六种血清肿瘤标志物在胰腺癌临床诊断中的意义

目的：评价血清肿瘤标志物检测对胰腺癌的诊断及胰腺良恶性疾病的鉴别诊断的价值。方法：回顾性分析191例患者血清中CA19-9、CA242、CA125、CA50、癌胚抗原（CEA）及甲胎蛋白（AFP）水平,将胰腺癌与肝脏恶性肿瘤、胃肠道恶性肿瘤、胆道恶性肿瘤及其他良性疾病进行对比,分析其临床价值;同时与胰腺良性占位进行比较,分析肿瘤标志物在已明确的胰腺占位性病变中的鉴别诊断价值。绘制各肿瘤标志物的ROC曲线,计算曲线下面积（AUC）并进行分析处理。结果：6种肿瘤标志物中,CA19-9、CA50和CA242水平在胰腺癌组均高于胰腺良性疾病组、肝脏恶性肿瘤组、胃肠道恶性肿瘤组和其他良性疾病组,差异有统计学意义（P〈0.05）。胰腺癌组CA125、CEA水平亦高于胰腺良性疾病组（P〈0.05）。CA19-9的敏感性为79.49%,阴性似然比为0.28,其AUC为0.925。结论：CA19-9、CA50和CA242对胰腺与非胰腺疾病鉴别有意义;CA19-9对胰腺肿瘤良恶性鉴别的综合诊断能力较其他肿瘤标志物强,对胰腺恶性肿瘤与胆道恶性肿瘤鉴别能力较差。     

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.