高渗盐水对重症急性胰腺炎大鼠胰腺组织TNF-α、IL-10mRNA表达的影响

目的研究高渗盐水对重症急性胰腺炎大鼠胰腺组织TNF-α、IL-10mRNA表达的影响。方法Wistar大鼠48只，随机分为4组（每组12只）：正常对照组；SAP模型组；等渗盐水治疗组（NS）；高渗盐水治疗组（HTS）。制模后，等渗盐水和高渗盐水组于0、12、24、36h经右颈外静脉进行干预治疗，分别按2ml／kg给予0．9％和7．5％的NS、HTS，并于24、48h分两批处死大鼠，采用RT-PCR法检测胰腺组织TNF-α、IL-10mRNA转录水平，同时行胰腺组织学评分。结果SAP时胰腺组织TNF-α mRNA表达显著升高、IL-10mRNA表达略升高，高渗盐水干预可明显降低TNF-α mRNA表达而提高IL-10mRNA表达，同时使胰腺组织学评分得到改善。结论SAP时使用高渗盐水处理，可以改善促炎-抗炎细胞因子之间的平衡。     

高渗盐水对大鼠重症急性胰腺炎血清细胞因子水平的影响

重症急性胰腺炎 (SAP)是一种严重的全身性多器官损害性疾病 ,在发病早期 ,由于细胞因子、氧自由基等因素的作用[1] ,胰腺外器官损害远超出胰腺病变的本身。我们通过本研究尝试在大鼠SAP状态高渗盐水干预措施观察血清细胞因子水平变化及机制。一、材料和方法1.材料 :取雄性Wistar大鼠 48只 ,体重 2 5 0～ 3 0 0 g/只 ;L 精氨酸购自武汉亚法生物有限公司 ;肿瘤坏死因子 α(TNF α)、白细胞介素 6(IL 6)、白细胞介素 10 (IL 10 )免疫检测试剂盒购自法国Diaclone公司。2 .分组和模型制备 :随机分成对照组、模型组、等渗盐水组、高渗盐…     

大黄素对大鼠重症胰腺炎TNFα、IL-6及胰腺腺泡细胞凋亡的影响

目的 :探讨大黄素治疗重症急性胰腺炎 (SAP)的作用机理。 方法 :用胰胆管内逆行注射去氧胆酸钠法制作大鼠SAP模型 ,随机分为对照组、SAP组、大黄素治疗组 ,动态测定术后 0h、6h、12h各组血清TNFα及IL - 6浓度 ,并取胰组织作病理学检查 ,同时应用TUNEL技术分析大鼠胰腺腺泡细胞凋亡的变化。 结果 :发现大黄素给药后 6h及 12h时血清TNFα、IL - 6水平明显降低 ,腹水量减少 ,胰组织病变程度改善 ;术后 6hSAP组胰腺腺泡细胞凋亡指数为 (3 92± 0 94 ) ,大黄素治疗组为(2 6 5 0± 6 72 ) ,两组比较 ,P <0 0 5。 结论 :大黄素可明显抑制大鼠胰酶及TNFα、IL - 6的释放 ,并且诱导已受损的不可恢复的腺泡细胞凋亡 ,从而改善大鼠重症胰腺炎的病情发展。     

大黄素对重症急性胰腺炎大鼠核因子-кB的影响

目的 观察大黄素对重症急性胰腺炎(SAP)大鼠核因子-кB(NF-кB)的影响,探讨大黄素治疗SAP的作用机制.方法 胰胆管逆行注射牛磺胆酸钠建立大鼠SAP模型.将雄性Wistar大鼠随机分为SAP模型组、大黄素干预组(E1组)及正常对照组(Sham组).观测各组不同时间点(注射牛磺胆酸钠后3、6、12 h)血清淀粉酶、肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6的含量,胰腺病理组织学评分,免疫组织化学方法 检测各组胰腺组织的核因子(NF)-кB的表达.结果 与SAP组比较,EI组各时间点(3、6、12 h)的病理学评分(13.41±2.14比18.42±3.14比15.89±1.98)、血清淀粉酶(U/L)(3634.2±247.8比4758.5±305.2比4687.8±345.8)、TNF-α(g/L)(2.24±0.47比2.87±0.87比2.76 ±0.82)和IL-6(g/L)(2.14±0.34比2.83±0.44比2.71±0.37)明显降低(P＜0.05),NFKB p65阳性表达率(0.31±0.06比0.44±0.09比0.33±0.08)下降(P＜0.05).各时间点SAP大鼠胰腺组织NF-κB p65的阳性率随血清TNF-α及IL-6含量变化.结论 大黄素可能通过胰腺组织NF-κB而调控血清炎症因子含量,以降低SAP大鼠血淀粉酶,发挥治疗作用.     

丙酮酸乙酯对重症急性胰腺炎大鼠血清高迁移率蛋白-1水平的影响及意义

目的　探讨重症急性胰腺炎 (SAP)大鼠血清高迁移率蛋白 1(HMGB1)水平的变化规律 ,以及丙酮酸乙酯 (EP)对其水平的影响和意义。方法　采用胰管逆行灌注人工胆汁的方法复制大鼠SAP模型。随机分为正常对照组 (N组 ,n =8)、重症急性胰腺炎组 (SAP组 ,n =80 )、EP治疗组 (Treat组 ,n =3 2 )。Treat组建模 12h开始使用EP治疗。酶联免疫吸附试验检测各组动物血清肿瘤坏死因子 α(TNF α)、白细胞介素 1β(IL 1β)水平。Westernblot法检测血清HMGB1水平。另设实验组研究EP对SAP大鼠生存时间的影响。结果　SAP组大鼠血清TNF α和IL 1β水平在建模 3～ 6h达高峰 ,12h即大幅下降。SAP组大鼠血清HMGB1水平在建模后 12h明显升高 ,至 2 4和 48h仍维持在较高水平 [(161.4± 2 2 .8) μg/L和(98.7± 15 .8) μg/L]。Treat组血清HMGB1水平在建模 2 4、48h [(95 .3± 3 0 .1) μg/L和(4 2 .2± 2 1.5 ) μg/L]明显低于SAP组(P <0 .0 5 )。而血清TNF α和IL 1β水平与SAP组比较差异无显著性。Kaplan Meier分析显示 ,EP治疗组动物生存时间 (71± 6)h明显高于SAP组 (4 6± 4)h (P <0 .0 0 0 1)。结论　HMGB1作为晚期炎症因子参与了SAP的全身炎症反应。延迟的EP治疗仍能降低SAP大鼠血清HMGB1水平 ,延长动物生存时间。     

血红素加氧酶-1高表达对重症急性胰腺炎大鼠脏器功能的保护作用及其机制

目的探讨血红素加氧酶-1(heme oxygenase-1,HO-1)高表达对重症急性胰腺炎(SAP)大鼠胰腺、肝、肾的影响及作用机制。方法将雄性SD大鼠随机分为3组:SAP组、SAP腺病毒空载组、SAP腺病毒基因转染组。每组21只,其中15只用于观察制模后72 h内大鼠的生存率;6只用于观察制模后20 h的胰腺、肝脏和肾脏的组织病理学变化,检测3个脏器内HO-1、IL-10、TNF-α的表达情况,同时检测血清中HO-1、IL-10、TNF-α的含量。结果 SAP腺病毒基因转染组大鼠制模后72 h内生存率(24 h:86.7%vs60.0%;48 h:66.7%vs 13.3%;72 h:46.7%vs 6.7%)较SAP组显著提高(P<0.05)。SAP腺病毒基因转染组大鼠制模后20 h胰腺、肝脏和肾脏病理学评分显著低于SAP组(P<0.05)(胰腺:8.5±0.9 vs 11.3±1.4;肝脏:1.0±0.5 vs 1.8±0.4;肾脏:2.2±0.8 vs 4.2±1.2)。SAP腺病毒基因转染组大鼠胰腺、肝脏和肾脏组织中HO-1表达(胰腺:237.3±12.1 vs 160.4±11.5;肝脏:265.3±10.4 vs 166.2±12.3;肾脏:201.5±12.0 vs 124.8±10.4)和IL-10表达(胰腺:60.0±2.9 vs 33.9±2.6;肝脏:60.6±5.1 vs 37.2±3.0;肾脏:45.4±2.6 vs 25.8±3.0)较SAP组均显著升高(P<0.05),而TNF-α表达(胰腺:13.1±1.8 vs 25.2±2.4;肝脏:13.4±1.0 vs 24.3±2.3;肾脏:14.7±1.8vs 22.4±1.9)较SAP组显著下降(P<0.05);SAP腺病毒空载组数据在以上各项与SAP组均无明显差异(P<0.05)。SAP腺病毒基因转染组大鼠血清HO-1含量(1.3±0.1 ng/mL vs 0.9±0.1 ng/mL)和IL-10含量(120.9±8.1 pg/mL vs 85.7±5.6 pg/mL)较SAP组均显著升高(P<0.05),而TNF-α含量(28.1±3.0 pg/mL vs 47.8±6.5 pg/mL)较SAP组显著下降(P<0.05)。结论 HO-1高表达可保护SAP大鼠的胰腺、肝、肾脏器功能,可能是通过提高SAP状态下IL-10等抗炎细胞因子表达和抑制TNF-α等促炎细胞因子表达缓解或阻断胰腺的局部病变,提高生存率。     

环氧合酶-2在重症急性胰腺炎大鼠胰腺组织中表达的实验研究

目的　研究环氧合酶 -2 (COX 2 )在重症急性胰腺炎 (SAP)大鼠胰腺组织中的表达 ,探讨其在SAP发病中的机制。方法　健康成年雄性SD大鼠 40只随机分成重症急性胰腺炎组 (SAP ,n =2 0 )和正常对照组 (NC ,n =2 0 )。术后 12h两组各处死 10只大鼠 ,检测腹水量 ,血清淀粉酶活性、肿瘤坏死因子 -α(TNF α)浓度 ,血浆TXB2 和 6 keto PGF1α浓度及胰腺组织中COX 2的表达 ,光镜观察胰腺的病理变化 ,并进行评分。两组其余 10只大鼠观察 2 4h及 72h存活率。结果　SAP组 12h大鼠胰腺组织中COX 2蛋白表达为强阳性 ,而NC组中无COX 2的表达。血清淀粉酶活性、TNF α浓度 ,血浆TXB2 和 6 keto PGF1α浓度均显著高于NC组 (P <0 .0 1) ,SAP组腹水量生成显著增加 (P<0 .0 1)。光镜病理评分显示 ,SAP水肿、炎症、出血和坏死评分均较NC组有明显升高 (P <0 .0 5 )。SAP组大鼠 2 4h死亡率为 10 0 % ,NC组死亡率 2 4h为 0 ,48h为 10 .0 %。结论　重症急性胰腺炎时有COX 2的高表达和前列腺素 (PGs)升高 ,提示COX 2可能通过促进PGs升高而在SAP发病中起重要作用。     

大鼠重症急性胰腺炎肺泡巨噬细胞的活化和调控作用

目的 观察巨噬细胞中p38蛋白活化激酶对大鼠重症急性胰腺炎肺损伤的影响.方法 假手术组仅胆胰管注射生理盐水0.1 ml/100 g;5%的牛黄胆酸(0.1 ml/100 g)逆行注射到SD大鼠的胆胰管内,造成重症急性胰腺炎(SAP)分为SAP组和SB03580组(SB203580,0.5 mg/kg,静注).在6 h剖杀大鼠,查腹水,抽血检测血清淀粉酶(AMS)和肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6[酶联免疫吸附试验(ELISA)法];同时分别离心收集全肺肺泡巨噬细胞,免疫组织化学检测肺组织及其巨噬细胞中p38 MAPK的表达,同时检测肺组织中的TNF-α和IL-6;光镜下检测胰腺组织损害.结果 SAP组及SB组中AMS在6 h分别为(4865.12±890.35)IU/L和(2918.24±614.58)IU/L,差异有统计学意义.血清TNF-α分别为(106.59±43.71)ng/L和(76.43±38.43)ng/L;IL-6是(2203.76±640.85)ng/L和(1254.76±459.35)ng/L,差异有统计学意义(P<0.01).肺组织中的TNF-α和IL-6的升高与血中的一致.光镜下,胰腺组织内可见炎细胞浸润、充血、水肿和坏死;在SAP组中肺组织及其巨噬细胞中p38 MAPK强烈表达,TNF-α和IL-6的表达一致,SB治疗组表达下降.结论 TNF-α和IL-6在重症急性胰腺炎肺损伤起着重要作用;肺泡巨噬细胞中p38 MAPK表达对TNF-α和IL-6的转录和合成起重要作用.     

磷脂酶A2与NF-κB活化在大鼠急性坏死性胰腺炎肺损伤中的作用

目的:探讨磷脂酶A2 (PLA2 )与NF -κB活化在大鼠急性坏死性胰腺炎肺损伤中的作用。方法:Wistar大鼠随机分为假手术组、模型组、PLA2 抑制剂组。每组按不同时点(3h、6h、12h) ,分别测定血清淀粉酶、脂肪酶、PLA2 、TNFα、IL - 1、IL -6水平;测定肺组织MPO、PLA2 、TNFα、IL - 1、IL - 6水平;行肺、胰腺组织病理学检查;化学发光ELISA法检测肺泡灌洗液巨噬细胞NF -κB(P65)表达情况;每组12只用于观察2 4h死亡率。结果:PLA2 抑制剂组血清淀粉酶、脂肪酶、PLA2 ,肺组织及血清TNFα、IL - 1、IL - 6水平显著低于模型组(P值均小于0 0 1) ;肺组织MPO、PLA2 水平亦降低;肺泡灌洗液巨噬细胞NF -κB活性显著下降,同时肺脏及胰腺病理损害明显减轻;2 4h死亡率明显降低。结论:PLA2 可通过激活肺组织NF -κB ,上调多种细胞因子的表达而产生肺损害作用;阻断磷脂酶A2 可有效地减轻胰腺炎肺损伤     

依达拉奉联合乌司他丁对重症急性胰腺炎大鼠脑损伤的保护作用

目的 研究依达拉奉联合乌司他丁对重症急性胰腺炎(SAP)大鼠脑损伤的保护作用.方法 100只雄性远交系大鼠随机分为10组:正常对照6h组、48 h组,SAP 6 h组、48 h组,依达拉奉处理6h组、48 h组,乌司他丁处理6h组、48 h组,依达拉奉联合乌司他丁处理6h组、48 h组;每组各10只.分别在术后第6h、48 h观察神经功能评分.采集血液、胰腺组织、脑组织标本,观察血清淀粉酶水平、脑组织伊文蓝含量、脑组织含水量、胰腺组织及脑组织镜下病理学变化.应用放射免疫法检测血清肿瘤坏死因子(TNF)-α含量,逆转录-聚合酶链反应(RT-PCR)法检测脑组织TNF-α信使核糖核酸(mRNA)含量,免疫组织化学法检测脑组织核因子(NF)-κB p65活性.结果 依达拉奉联合乌司他丁处理48 h组血清淀粉酶水平、脑组织EB含量、脑组织含水量、胰腺组织及脑组织镜下病理学评分、血清TNF-α含量、脑组织TNF-α mRNA含量及脑组织NF-κB p65活性均较依达拉奉48 h组、乌司他丁48 h组及SAP 48 h组显著降低,而神经功能评分则显著升高(P＜0.01).结论 依达拉奉联合乌司他丁对SAP大鼠脑损伤有较好的保护作用.     

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.     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.