他莫昔芬治疗血液透析女性患者骨质疏松的临床观察

目的 观察他莫昔芬对维持性血液透析（MHD）女性患者骨质疏松的治疗作用.方法 选取100例MHD女性患者按有/无骨质疏松分为A组（n=60）与B组（n=40）,再将A组随机分为A1组（n=30,服用他莫昔芬、骨化三醇和碳酸钙）与A2组（n=30,不服用他莫昔芬,余同A1）;观察治疗前后（12个月）患者疗效、副作用及血清雌二醇（E2）、骨形态发生蛋白-2（BMP-2）、全段甲状旁腺素（iPTH）等指标的变化;并以E2、BMP-2水平对入组患者骨质疏松的诊断进行ROC曲线分析.结果 A1组疗效显著优于A2组（P＜0.05）,两组副作用差异无统计学意义（P＞0.05）;治疗前A组E2、BMP-2水平显著低于B组,治疗后A1组E2、BMP-2水平显著高于A2组（P＜0.05）,治疗前后iPTH、Ca水平差异无统计学意义（P＞0.05）;多元线性回归提示治疗前A组及治疗后A2组iPTH与BMD值呈负相关（P＜0.05）,E2、BMP-2、Ca与骨密度（BMD）值呈正相关,且E2、BMP-2对BMD值影响最大.B组及治疗后A1组各指标与BMD值无线性回归关系.ROC曲线提示E2、BMP-2与入组患者BMD值关系密切.结论 他莫昔芬可能是通过提高MHD女性患者体内E2、BMP-2水平从而安全有效的治疗骨质疏松,且E2、BMP-2是影响MHD女性患者骨质疏松的重要因子.     

新型雌激素对女性血透患者骨质疏松的临床干预

目的：观察雌激素他莫昔芬对维持性血液透析（ MHD）女性患者骨质疏松的治疗作用。方法选取50例MHD女性患者按有／无骨质疏松分为A组（n＝26）与B组（n＝24）,再将A组随机分为A1组（n＝13,服用他莫昔芬、骨化三醇和碳酸钙）与A2组（ n＝13,不服用他莫昔芬,余同A1）;观察治疗前后（12个月）患者疗效、副作用及血清雌二醇（ E2）、骨形态发生蛋白－2（BMP－2）、全段甲状旁腺素（iPTH）等指标的变化;并以E2、BMP－2水平对入组患者骨质疏松的诊断进行ROC曲线分析。结果A1组疗效显著优于A2组（P＜0．05）,两组副作用差异无统计学意义（P＞0．05）;治疗前A组E2、BMP－2水平显著低于B组,治疗后A1组E2、BMP－2水平显著高于A2组（P＜0．05）,治疗前后iPTH、Ca水平差异无统计学意义（P＞0．05）;多元线性回归提示治疗前A组及治疗后A2组iPTH与BMD值呈负相关（P＜0．05）,E2、BMP－2、Ca与骨密度（BMD）值呈正相关,且E2、BMP－2对BMD值影响最大。 B组及治疗后A1组各指标与BMD值无线性回归关系。 ROC曲线提示E2、BMP－2与入组患者BMD值关系密切。结论他莫昔芬可能是通过提高MHD女性患者体内E2、BMP－2水平从而安全有效的治疗骨质疏松,且E2、BMP－2是影响MHD女性患者骨质疏松的重要因子。     

维持性血液透析患者血浆同型半胱氨酸与骨密度的相关性研究

目的 探讨维持性血液透析（MHD）患者血浆同型半胱氨酸（Hcy）与指骨骨密度（BMD）的关系.方法 选择2006年2月至2010年2月在我院住院的MHD患者94例,分别将男性和女性患者分为3组,骨质疏松组：T值＜-2;骨量减少组：T值-2～-1;正常骨量组：T值＞-1.分别比较3组男性和3组女性患者年龄、血钙、血磷、碱性磷酸酶（ALP）、血浆Hcy.对血浆Hcy水平与指骨BMD进行相关性分析,用逐步回归法以指骨BMD为自变量建立多元线性回归方程以分析指骨BMD的影响因素.结果 骨质疏松组年龄均大于骨量减少组和正常骨量组（P＜0.05）,骨量减少组年龄大于正常骨量组（P＜0.05）.3组血钙、血磷、ALP、Hcy差异无统计学意义（P＞0.05）.男性血浆Hcy水平与指骨BMD无相关性（r=0.267,P＞0.05）.年龄是指骨BMD的影响因素（回归系数b1=-0.002,P=0.022）.骨质疏松组血浆Hcy水平均高于骨量减少组和正常骨量组（P＜0.05）,而骨量减少组和正常骨量组Hcy差异无统计学意义（P＞0.05）.3组血钙、血磷、ALP差异无统计学意义（P＞0.05）.女性血浆Hcy水平与指骨BMD呈负相关（r=-0.527,P＜0.05）.年龄和Hcy是指骨BMD的影响因素（回归系数b1=-0.002,P=0.011;回归系数b4=-0.003,P=0.048）.结论 女性MHD患者高血浆Hcy水平可能与指骨BMD降低有关,男性MHD患者血浆Hcy水平与指骨BMD无相关性.血浆Hcy升高可能是女性MHD患者骨质疏松潜在的危险因素.     

血清FGF-23和Klotho蛋白水平与尿毒症患者骨密度的相关性研究

目的分析尿毒症维持性血液透析(MHD)患者血清成纤维细胞生长因子23(FGF-23)和Klotho蛋白水平与骨密度(BMD)的相关性。方法 2017年1月至2018年6月,我院收治了130例MHD患者。双能X线骨密度仪用于检查MHD患者股骨颈和腰椎的BMD。将患者分为3组:正常骨量组,骨量减少组和骨质疏松组。进行ELISA以测量血清FGF-23,Klotho蛋白和1,25(OH)_2D_3水平。还测量了其他参数,包括钙(Ca),磷(P)和甲状旁腺激素。结果 130例MHD患者中,49.60%的患者合并骨质疏松症,32.80%的患者出现骨量减少。骨质疏松症组血清FGF-23水平最高。然而,根据BMD分组,3组血清FGF-23水平差异无统计学意义(P0.05)。Spearman相关分析还指出血清FGF-23水平与BMD之间缺乏相关性。骨质疏松组血清Klotho蛋白水平明显低于正常骨量组和骨量减少组(P0.05)。血清Klotho蛋白水平与股骨颈和腰椎的BMD和T值呈正相关。多元线性回归分析结果显示,血清Klotho蛋白水平是影响MHD患者BMD的主要因素之一。结论血清FGF-23水平与MHD患者BMD变化无关,而血清Klotho蛋白水平与BMD变化密切相关。     

有氧运动联合褪黑素对二型糖尿病大鼠骨质疏松影响的实验研究

目的观察有氧运动和褪黑素对二型糖尿病大鼠骨质疏松的影响。方法成年雌性SD大鼠80只,6周龄,随机分为安静对照组(N)、糖尿病对照组(D)、正常有氧运动组(E)、糖尿病有氧运动组(DE)、正常褪黑素组(M)、糖尿病褪黑素组(DM)、正常有氧运动褪黑素组(EM)、糖尿病有氧运动褪黑素组(DEM),观察各组大鼠体重、脊椎骨以及左右股骨骨密度(BMD)、观察大鼠血糖、血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、血清总钙(Ca)、无机磷(P)和甲状旁腺素(PTH)的变化。结果与N组相比,E、M和EM组大鼠体重、血糖、血Ca、血P和血PTH无明显变化(P0.05),血清SOD、GSH-Px水平、腰椎和左右股骨BMD显著升高(P0.05),血清MDA水平显著降低(P0.05),D组大鼠体重、血清SOD、GSH-Px水平、血Ca、腰椎和左右股骨BMD显著降低(P0.05),血糖、血清MDA和血PTH水平显著升高(P0.05),血P无明显变化(P0.05);与D组比较,DE、DM组大鼠体重、血清SOD、GSH-Px水平、血Ca、腰椎和左右股骨BMD显著升高(P0.05),血糖、血清MDA和血PTH水平显著降低(P0.05),血P无明显变化(P0.05),有氧运动和褪黑素同时干预效果更好。结论有氧运动和褪黑素均能改善糖尿病骨质疏松,且两者联合干预的效果更加显著,其可能与通过提高糖尿病大鼠的抗氧化应激能力,调节糖的代谢从而有效地的降低血钙和PTH,改善BMD来缓解骨质疏松有关。     

维生素D缺乏的女性髋部骨折患者中血清甲状旁腺素值与股骨颈骨密度的相关性

目的探讨维生素D缺乏的女性髋部骨折患者中血清甲状旁腺素(PTH)值与股骨颈骨密度(BMD)的相关性。方法将128例维生素D缺乏(血清25-羟基维生素D水平50 nmol/L)的女性髋部骨折患者根据血清PTH水平分为PTH正常组(n=86)和PTH升高组(n=42)。测定股骨颈BMD、BMD(T值)及各临床指标。各临床指标与股骨颈BMD(T值)的相关性采用多元logistic回归分析。结果年龄、PTH:PTH正常组显著低于PTH升高组(P 0. 05)。血磷、肾小球滤过率、BMD(T值)、BMD:PTH正常组显著高于PTH升高组(P0. 05)。多元线性回归分析结果显示,血清PTH、年龄与股骨颈BMD呈负相关(P 0. 05),BMI与股骨颈BMD呈正相关(P 0. 05)。PTH正常组中有52例(60. 47%) BMD(T值)≤-2. 5,PTH升高组中有30例(71. 43%) BMD(T值)≤-2. 5。多元logistic回归分析结果显示,血清PTH、BMI是BMD(T值)≤-2. 5的影响因素(P 0. 05)。结论维生素D缺乏的女性髋部骨折患者中,PTH水平与股骨颈BMD密切相关。维生素D缺乏症的防治在血清PTH升高的女性髋部骨折患者中可能尤为重要。     

老年男性骨密度与IGF-1及骨代谢相关激素的关系研究

目的：探讨老年男性骨密度（BMD）与胰岛素样生长因子-1（IGF－1）及骨代谢相关影响激素的关系。方法：采用双能X线骨密度仪测量120例正常老年男性骨密度（BMD）、血IGF－1及生长激素（GH）、雌二醇（E2）、血睾酮（T）、甲状旁腺激素（PTH）等指标，并与青中年男性对照，进行统计分析。结果：老年男性胰素样生长因子－1、雌二醇（E2）及血睾酮（T）呈现随着年龄增长而降低的趋势，并且在骨质疏松组均显低于非骨质疏松组（P＜0．01），IGF－1与骨密度（P＜0．01）、E2（P＜0．005）、T（P＜0．05）呈正相关。结论：IGF－1的增龄性减少同时伴雌激素、雄激素水平的降低可能是老年男性骨质疏松发生的重要机制。     

肝硬化、肝癌患者骨代谢生化指标与骨质疏松的临床研究

目的 观察肝硬化、肝癌患者骨质疏松的发生率探讨其发病机制。方法 选择病毒性肝炎肝硬化患者40例、肝癌患者20例分别作为研究组,选择40例原发性骨质疏松和骨量减少患者作为对照组,采用双能X线吸收仪(DXA)检测骨密度(BMD),并检测骨代谢相关指标,采用放射免疫分析法测定血清骨钙素(BGP)、甲状旁腺激素( PTH)、血钙(Ca) ,磷(P)。结果 肝炎肝硬化患者中骨量减少及骨质疏松发生率为65 %( 26/40),肝癌组中骨质疏松发生率为70% (14/20),均明显高于对照组22.5 %( 9/40 ),差异有统计学意义(P<0.05),在Child-Pugh C级患者更显著(90.9% )。肝硬化、肝癌组的BMD , Ca较对照组降低((1.90±0. 33vs2. 31±0. 11 mmol/L),血清PTH水平明显高于对照组,有统计学意义P< 0. 05。随着肝功能损害加重,肝硬化、肝癌患者的血Ca逐渐下降,血中PTH水平逐渐升高,BGP水平降低,骨形成减少,原发性骨质疏松不存在这种关系。肝硬化、肝癌患者的BMD与Ca呈正相关,(r =0. 483,P <0.05)。结论 肝硬化、肝癌患者骨质疏松发病率明显升高,且发病率随肝功能损害的逐渐加重而逐渐升高,其机理可能与血钙降低、维生素D,Ca,P的代谢紊乱及PTH升高有关。     

男性老年性骨质疏松患者血清IGF-Ⅰ测定及临床意义

目的探讨胰岛素样生长因子-Ⅰ(IGF-Ⅰ)与男性老年性骨质疏松的关系.方法对26例老年骨质疏松男性患者和28例男性对照者行IGF-Ⅰ等生化指标测定,同时测定骨密度.结果老年男性骨质疏松患者腰椎和左股骨颈骨密度显著低于对照组(P＜0.001;P＜0.001);血清IGF-Ⅰ水平明显低于对照组(80.40±17.41)ng/mL与(157.82±28.80)ng/mL(P＜0.001),而血钙、血磷和碱性磷酸酶(ALP)水平在两组间差异无显著性.对照组和骨质疏松组腰椎、左股骨颈骨密度均与血清IGF-Ⅰ水平高度相关(对照组:r=0.455,P＜0.05;r=0.493,P＜0.01;骨质疏松组:r=0.529,P＜0.01;r=0.657,P＜0.01),而与血钙、血磷、ALP水平无关.结论 IGF-Ⅰ水平与骨质含量具有良好的相关性.IGF-Ⅰ水平测定可作为诊断男性老年性骨质疏松的一项指标.     

维持性血液透析患者血清mir-26a、IGF-1表达与血管钙化的关系

目的:检测维持性血液透析(MHD)患者血清mir-26a、IGF-1水平,并分析其与血管钙化的关系。方法:选取2015年04月～2018年08月南京扬子医院血透室治疗时间大于6个月的MHD患者120例为研究对象,其中无钙化组34例,轻度钙化组51例,重度钙化组35例。利用全自动生化分析仪检测血清钙(Ca~(2+))、磷(P~(3-))、尿素(UREA)、肌酐(CRE)、白蛋白(Alb)、碱性磷酸酶(ALP)水平;利用血液分析仪检测患者血清血红蛋白(Hb)水平;利用ELISA法检测血清促甲状腺旁腺激素(PTH)水平;利用全自动发光仪检测血清IGF-1水平;使用X光片检查患者腰椎侧位、骨盆及双手等并参照Adragao等方法进行钙化评分;利用实时定量PCR(qRT-PCR)检测血清mir-26a水平。结果:随钙化程度加重,患者年龄、血清ALP、CRE、PTH、P~(3-)、钙化评分显著升高(P0.05),血清Alb、Hb水平显著降低(P0.05);重度钙化组血清IGF-1水平较无钙化及轻度钙化组患者升高(P0.05);重度及轻度钙化组血清mir-26a水平较无钙化组显著降低(P0.05),轻度钙化组血清mir-26a水平较无钙化组显著降低(P0.05);血管钙化MHD患者血清mir-26a与IGF-1水平负相关(P0.05),MHD患者血管钙化程度与血清mir-26a水平负相关,与IGF-1水平正相关(P0.05);Logistic分析表明,血清ALP、miR-26a、IGF-1是MHD患者发生血管钙化的危险因素(P0.05)。结论:与无钙化患者比较,血管钙化MHD患者血清miR-26a水平显著降低,IGF-1水平升高,与血管钙化疾病发生及病情严重程度有关。     

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.     

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.     

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.