rhPTH（1-34）治疗OVX大鼠骨质疏松延后效应的初步研究

目的观察重组人甲状旁腺激素（1-34）[rhPTH（1-34）]对卵巢摘除（OVX）大鼠骨质疏松症的治疗作用及停药后效应.方法应用双侧卵巢摘除方法建立模拟绝经后骨质疏松大鼠模型;给予皮下注射20μg/kg/d rhPTH（1-34）治疗8周,观察其骨量、骨生物力学、骨小梁形态计量及骨代谢相关血、尿生化指标,综合评价PTH对模型大鼠的治疗效果;同时观察停药8周后上述指标的变化.结果外源性PTH（1-34）治疗能显著增加模型大鼠的骨量、骨力学性能,改善骨微结构、增加骨转换.用药组的骨密度、股骨三点弯曲与腰椎压缩最大载荷、腰椎骨小梁百分面积显著高于对照组（P＜0.05～0.001）;血ALP（P＜0.05～0.01）与尿Pyd（P＜0.05）保持高水平;PTH停药8周后大鼠股骨与腰椎骨密度、股骨三点弯曲与腰椎压缩最大载荷及腰椎骨小梁百分面积均较停药前显著降低（P＜0.05～0.001）,但仍显著高于OVX对照组（P＜0.05～0.001）.结论外源性PTH（1-34）可显著增加OVX大鼠的骨量,提高骨力学性能,改善骨微结构,对卵巢摘除诱导的大鼠骨质疏松具有明显治疗作用;停药后出现骨量的快速丢失,骨力学性能下降等变化,但仍显示出其对OVX大鼠骨骼的保护作用.     

胎肾细胞悬液对维甲酸所致骨质疏松大鼠部分钙调节激素的影响

目的探讨胎肾细胞悬液改善维甲酸所致大鼠骨质疏松的机理,为临床用药提供客观依据.方法通过静脉输注胎肾细胞悬液,采用放免分析法测定维甲酸所致骨质疏松大鼠血清雌二醇、降钙素、甲状旁腺素、骨钙素等钙调节激素含量,观察胎肾对上述指标和骨形态的影响.结果与维甲酸造模组比较,胎肾细胞悬液组大鼠血清雌二醇、降钙素、骨钙素水平升高,甲状旁腺素降低（P＜0.05）,胫骨骨重、灰重和骨基质均增加（P＜0.01）,胫骨骨长变化不大（P＞0.05）.骨病理形态计量中,胎肾细胞组大鼠骨小梁厚度、面积及密度均高于模型组,而骨小梁间隙明显缩小（P＜0.05）.结论胎肾细胞改善维甲酸所致大鼠骨质疏松机制与部分钙调节激素的变化有关.     

鲑鱼降钙素对去卵巢大鼠骨髓细胞OPG、RANKL基因和蛋白表达的影响

[目的]观察鲑鱼降钙素(sCT)对去卵巢大鼠骨密度(BMD)、血清Ⅰ型胶原交联羧基末端肽(ICTP)变化的影响,以及骨髓细胞骨保护素(OPG)和核因子κB受体活化因子配体(RANKL)的基因表达和两者在胫骨骨骺端蛋白含量的变化.[方法]取3个月龄雌性SD大鼠24只,随机平均分3组:假手术组(Sham)、鲑鱼降钙素处理组(sCT)、安慰剂组(OVX).采用双侧卵巢切除术复制骨质疏松大鼠模型.术后2周CT组予鲑鱼降钙素皮下注射12周,应用双能X线吸收仪法(DXA)测BMD,ELISA法测量血清ICTP浓度,qRT-PCR法定量骨髓细胞OPG和RANKL的mRNA表达量,免疫组织化学染色法测定胫骨干骺端OPG和RANKL蛋白表达量.[结果]与OVX组比较,sCT组的腰椎BMD上升显著(P＜0.05),但股骨BMD改变不明显(P＞0.05);血清ICTP含量显著降低(P＜0.05);骨髓细胞RANKL的mRNA表达量变化不大(P＞0.05),但OPG的mRNA表达量升高(P＜0.05),OPG/RANKL的比率升高(P＜0.05);胫骨干骺端也呈现出RANKL蛋白改变不明显(P＞0.05),而OPG的蛋白分泌增加(P＜0.05),从而OPG/RANKL的比率高于OVX组(P＜0.05)的现象.[结论]降钙素可以预防腰椎BMD的丢失,降低血清ICTP水平,在体内可能主要通过上调OPG的mRNA表达和蛋白分泌,影响OPG/RANKL/RANK系统,影响破骨细胞功能,抑制骨吸收,进而达到预防绝经后骨质疏松的目的.     

共轭亚油酸c9,t11-CLA及t10,c12-CLA对大鼠骨髓细胞骨代谢相关基因表达的影响

目的 观察c9,t11-CLA及t10,c12-CLA干预后,大鼠骨髓细胞过氧化物酶体增殖物激活受体2(PPARγ2)及核因子(NF)-κB活化受体配体(RANKL)、碱性磷酸酶(ALP)、骨保护素(OPG)、NF-κB活化受体(RANK)、抗酒石酸酸性磷酸酶(TRAP) mRNA表达的变化,探讨其对骨代谢的影响.方法 体外培养大鼠骨髓细胞,分别加入c9,t11-CLA及t10,c12-CLA干预24h,逆转录-聚合酶链反应(RT-PCR)检测PPARγ2、RANKL、ALP、OPG、RANK、TRAP mRNA表达水平,比较其对骨髓细胞上述基因表达的影响.结果 (1)c9,t11-CLA呈剂量依赖性下调RANK、TRAP mRNA表达,组间比较差异有统计学意义(P＜0.05,P＜0.01),而其对RANKL、ALP、OPG及PPARγ2 mRNA 表达的影响不明显.(2) t10,c12-CLA呈剂量依赖性上调RANKL、OPG mRNA的表达,同时下调 RANK、TRAP及PPARγ2 mRNA的表达,组间比较差异有统计学意义(P＜0.05,P＜0.01),但对ALP mRNA的表达无明显影响.结论 c9,t11-CLA可能通过抑制破骨细胞标记物基因表达阻断骨髓细胞向破骨细胞分化,而t10,c12-CLA在抑制破骨细胞标记物基因表达的同时也可促进成骨细胞标记物基因表达,两者均有利于骨形成.     

甲状旁腺激素联合辛伐他汀对成骨细胞分化及OPG和RANKL mRNA表达的影响

目的联合甲状旁腺激素(rhPTH1-34)和辛伐他汀(SIM)在体外对乳鼠颅盖骨成骨细胞分化及骨保护素(OPG)和核因子κB受体活化因子配体(RANKL)基因表达的影响。方法以乳鼠成骨细胞为体外试验模型,rhPTH1-34(10-9mol/L)联合不同浓度SIM(10-8、10-7、10-6mol/L)作用于体外培养的乳鼠成骨细胞,采用对硝基苯磷酸盐(PNPP)法测定碱性磷酸酶(ALP)活性;RT-PCR法测定OPG和RANKL基因的表达。结果 rhPTH1-34和SIM单独给药均可促进成骨细胞ALP活性及OPG基因、降低RANKL基因表达(P0.05);两者联合后与SIM单独作用组比较,ALP活性明显增加,并能协同促进OPG、降低RANKL基因表达(P0.05)。结论 rhPTH1-34和SIM联合应用对成骨细胞分化和代谢有协同作用。     

甲状旁腺激素在体外对破骨细胞分化及骨重吸收能力的影响

目的 探讨甲状旁腺激素(PTH)在体外直接对破骨细胞(OCs)分化及骨吸收能力的影响，以及其与成骨细胞(OBs)中核因子kB受体激活剂受体配体(ligand of receptor activator of nuclear factor kappa B，RANKL)基因和OPG(osteoprotegerin)基因表达的关系。方法体外直接用PTH诱导C3h小鼠全骨髓分化出OCs，用牙片小坑法(pits assayr)观察OCs对骨的重吸收能力。并采用多重RT-PCR方法检测在不同PTH作用浓度和不同作用时间的条件下,OBs中RANKL基因和OPG基因的表达情况。结果(1)PTH在体外可诱导C3h小鼠全骨髓分化出OCs，且在一定浓度范围内，随着PTH增加，OCs的形成数目和骨组织的破坏程度随之增加；(2)在一定PTH浓度和时间范围内，OBs中的RANKL-mRNA及OPG-mRNA表达呈剂量依赖性和时间依赖性。结论 PTH在体外可通过诱导RANKL基因和OPG基因表达而直接影响OCs的分化和骨重吸收功能。     

不同浓度15d-PGJ2对骨髓细胞PPARγ2及骨代谢相关基因表达的影响

目的观察不同浓度15d-PGJ2对大鼠骨髓细胞过氧化物酶体增殖物激活受体γ2(PPARγ2)及骨代谢相关基因核因子-κB活化受体配体(RANKL)、碱性磷酸酶(ALP)、骨保护素(OPG)、核因子-κB活化受体(RANK)及抗酒石酸酸性磷酸酶(TRAP)mRNA表达水平的变化,探讨PPARγ2内源性配体15d-PGJ2对骨髓细胞PPARγ2及骨代谢相关基因表达的影响。方法体外培养大鼠骨髓细胞,加入不同浓度15d-PGJ2(0、10、20、30μmol/L)干预24h后,采用半定量逆转录PCR(RT-PCR)检测骨髓细胞PPARγ2、RANKL、ALP、OPG、RANK、TRAPmRNA表达水平,比较不同浓度15d-PGJ2对骨髓细胞PPARγ2及骨代谢相关基因表达的影响。结果不同浓度15d-PGJ2呈剂量依赖性下调RANKL、ALP、OPGmRNA的表达水平,同时呈剂量依赖性上调PPARγ2、RANK、TRAPmRNA的表达水平,组间比较差异均有统计学意义(P0.05,P0.01)。结论 15d-PGJ2可能通过激活PPARγ2转录活性抑制骨髓细胞成骨细胞标记物基因的表达,促进破骨细胞标记物基因的表达,这可能是15d-PGJ2参与增龄相关的骨质疏松发生的原因之一。     

地塞米松对成骨细胞保护蛋白mRNA的调节

目的：观察皮质醇激素对成骨细胞OPG基因表达的调节，探讨激素通过成骨细胞影响破骨细胞骨吸收的分子机理。方法：体外培养大鼠成骨细胞，分别予不同时间、剂量地塞米松进行干预实验，提取总RNA进行半定量逆转录PCR分析，检测OPGmRNA水平的改变。结果：地塞米松可以抑制OPGmRNA的表达，作用强度随时间，剂量而改变。结论：激素引发的骨质疏松与其下调成骨细胞OPG基因表达，诱导破骨细胞形成，增加骨吸收有关。     

Smad4促进成骨分化的机制研究

目的 探讨Smad4基因促进成骨分化的作用机制。方法 采用条件性基因敲除技术Cre/loxp,制备骨细胞特异性敲除Smad4小鼠(Smad4otcko),小鼠胚胎骨骼透明染色分析胚胎期小鼠长骨生长状况;待小鼠成长至1月龄,X-ray检测突变小鼠与对照组小鼠的骨密度差异;静态骨组织形态学分析检测突变鼠及对照鼠的骨量变化、成骨细胞数量变化等差异;实时荧光定量PCR检测Smad4突变鼠股骨成骨细胞相关因子Runx2、ALP、OSX及OCN;破骨细胞TRAP染色分析Smad4突变鼠破骨细胞形态及数量变化;qPCR检测突变鼠股骨破骨吸收标志基因RANKL、OPG,并计算RANKL/OPG比率。结果 Smad4基因敲除小鼠在胚胎期未出现长骨生长异常。X线结果显示,1月龄时,与对照组小鼠相比,Smad4突变鼠的骨密度降低（P＜0.05）,静态骨组织形态学分析表明突变鼠松质骨减少,皮质骨变薄,骨小梁数量减少（P＜0.05）;Smad4突变鼠成骨细胞标志基因表达量显著降低,成骨细胞的数量明显减少（P＜0.05）;RANKL作为破骨吸收标志物表达上调、作为其拮抗剂的OPG表达量下调,RANKL/OPG比率增高（P＜0.05）。结论 Smad4基因通过促进成骨分化,降低破骨吸收从而来维持骨稳态。     

甲状腺机能亢进症患者骨密度及骨代谢改变

目的：探讨甲状腺机能亢进症（甲亢）患骨密度与骨代谢指标的改变。方法：本用二维骨密度仪测定65例甲亢患及38例健康对照骨密度,同时测定血清钙、碱性磷酸酶（AKP）、甲状旁腺激素（PTH）、降钙素（CT）、并计算PTH/CT比值及24小时尿钙值。分为3组：甲亢合并OP组;甲亢骨矿含量正常组及健康对照组。结果：甲亢合并OP组24小时尿钙、血AKP高于另两组（P＜0.05)甲亢组CT明显低于对照组,PTH/CT比值明显高于对照组,且甲亢合并OP组更明显（P＜0.05、P＜0.01)。结论：甲亢为高转换型OP,PTH、CT、PTH/CT比值对研究甲亢合并OP有重要参考价值。     

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.