nm23及E-钙黏连素蛋白表达与原发性肝癌肝移植术后肿瘤复发转移的关系

探讨nm23及E-钙黏连素(E-cadherin)蛋白表达与原发性肝癌(肝癌)肝移植术后肿瘤复发转移的关系.方法 选取2003年10月至2005年5月在中山大学附属第三医院行肝癌肝移植术的92例患者临床资料和术后病理标本.根据有否发生肿瘤复发(包括肝内复发和肝外转移)分为复发组(37例)和未复发组(55例).病理标本为两组患者手术切除的肿瘤组织和癌旁肝组织.采用免疫组织化学(免疫组化)方法对组织标本进行检测.比较92例患者的肝癌组织和癌旁肝组织中nm23和E-cadhefin的蛋白表达差异;分析nm23和E-cadherin蛋白表达与肝癌患者临床病理特征的关系;比较复发组和未复发组患者的肝癌组织中nm23和E-cadherin蛋白表达的差异.结果 92例患者中,肝癌组织nm23蛋白阳性表达49例(53%),癌旁肝组织则全部表达阳性(100%),两者比较差异有统计学意义(P<0.05);肝癌组织E-cadherin蛋白表达缺失39例(42%),而癌旁肝组织中有4例(4%)表达缺失,两者比较差异有统计学意义(P<0.05).肝癌组织中,nm23蛋白表达阴性与肿瘤分化程度、有否门静脉癌栓显著相关(均为P <0.05);E-cadhefin蛋白表达缺失与术前血清甲胎蛋白(AFP)水平、肿瘤大小及有否门静脉癌栓显著相关(均为P<0.05).复发组和未复发组的nm23蛋白表达阳性率分别为32% (12/37)和67% (37/55),两者比较差异有统计学意义(P<0.01).复发组和未复发组的E-cadherin蛋白表达缺失率分别为62% (23/37)和29% (16/55),两者比较差异有统计学意义(P<0.01).结论 肝癌组织中nm23和E-cadherin蛋白的表达对预测肝癌肝移植术后肿瘤复发转移具有重要意义.     

Tspan8过表达与肝癌转移潜能及预后的关系

目的:探讨Tspan8表达与肝癌侵袭转移及预后之间关系。方法:用q RT-PCR和Western blot检测不同肝癌细胞系及80例肝癌患者手术标本中Tspan8的m RNA与蛋白表达;应用组织芯片检测352例肝癌组织样本中Tspan8的表达,分析Tspan8表达与肝癌临床病理因素及复发与预后的关系。结果:Tspan8的m RNA与蛋白表达在高转移潜能肝癌细胞系(MHCC97-H、MHCC97-L)中的表达明显高于低转移潜能的肝癌细胞系(PLC/PRF/5、SMMC7721、Hep G2),在肝癌组织中的表达明显高于癌旁与正常肝组织,且在有肝内转移或血管侵犯患者癌组织中的表达明显高于无肝内转移及血管侵犯患者的癌组织(均P0.05)。Tspan8高表达是肝癌术后复发转移(HR=1.64,95%CI=1.21~2.23,P=0.002)和术后生存(HR=1.66,95%CI=1.23~2.25,P=0.001)的独立危险因素,Tspan8高表达患者术后5年总生存率明显低于Tspan8低表达组,术后复发时间明显短于低表达患者(均P0.05)。结论:Tspan8促进肝癌侵袭转移,Tspan8高表达患者预后不良。     

PPM1D mRNA表达与肝癌预后的相关性研究

目的 :探讨PPM1D m RNA表达与肝癌预后的相关性。方法:提取86例肝癌患者癌组织及癌旁肝组织总RNA,q PCR法检测PPM1D m RNA表达量,免疫组化检测蛋白表达水平。根据癌旁肝组织中PPM1D m RNA表达量,将肝癌患者分组为高表达组与低表达组,对两组患者临床资料及生存时间进行统计分析。结果:PPM1D m RNA在肝癌组织中表达水平显著高于癌旁组织,免疫组化检测蛋白表达水平证实上述结果。以癌旁肝组织PPM1D m RNA表达量为阈值,高表达组56例,低表达组30例。两组患者的AFP水平、肿瘤大小、肿瘤TNM分期以及肿瘤复发、家族史等临床病理因素差异有统计学意义(P0.01);年龄、性别、门静脉侵犯、淋巴结转移、HBV感染及酒精摄入史等因素差异无统计学意义(P0.05)。高表达组患者中位生存期为13个月,低表达组为32个月。结论:PPM1D m RNA表达水平可能与肝癌恶性程度相关,可能成为肝癌预后的预测因子。     

VEGF、uPA、ICAM-1和PCNA蛋白质表达与肝癌转移复发的关系

目的　探讨与肝癌转移、复发有关的分子生物学原因。　方法　采用免疫组化法检测1 2 3例肝癌手术标本VEGF等蛋白质表达及相关指标检测。　结果　肝内转移肝癌 (B组 )VEGF表达率高于无转移肝癌 (A组 ) (P <0 0 1 ) ,门静脉主干癌栓原发癌 (C组 )和癌栓 (D组 )高于B组 (P <0 0 5)。B组uPA蛋白质阳性表达率高于A组 (P <0 0 1 )。各组间ICAM 1蛋白质阳性表达率无差别(P均 >0 0 5)。A组 D组MVD和PCNA LI逐渐升高。A组 C组术后复发率和静脉侵犯发现率呈增加趋势。多元回归分析 ,术后复发与静脉侵犯 (r=0 783 ,P <0 0 1 )、MVD(r=0 1 4 3 ,P <0 0 5)相关 ;转移与PCNA LI(r=0 590 ,P <0 0 1 )、MVD(r=0 1 79,P <0 0 5)相关 ,与ICAM 1表达负相关。　结论　VEGF、uPA、ICAM 1蛋白质过度表达 ,细胞增殖参与肝癌转移、门静脉癌栓 (PVTT)形成和术后复发。肝癌迅速生长是肝内转移和PVTT形成的直接原因 ;显微镜下癌细胞静脉侵犯可作为预测肝癌术后复发的观察指标     

EphA7基因在原发性肝细胞癌中的表达及其临床意义

目的 探讨原发性肝细胞癌中EphA7 mRNA的表达及其临床意义.方法 应用逆转录-聚合酶链反应(RT-PCR)及实时荧光定量PCR法检测EphA7 mRNA在40例肝癌及相应的癌旁肝组织和10例正常肝组织中的表达,并分析其与肝癌临床病理因素之间的关系.结果 40例肝癌组织及相应的癌旁肝组织和10例正常肝组织中均有EphA7 mRNA的表达.实时荧光定量PCR分析显示EphA7 mRNA在肝癌组织(20.0711±32.0232)中的表达显著高于癌旁肝组织(4.5184±9.4738,P＜0.05)和正常肝组织(4.1764±4.7193,P＜0.05),而在癌旁肝组织和正常肝组织中的表达差异无统计学意义(P＞0.05).EphA7 mRNA的过表达与肝癌细胞的分化程度、门静脉癌栓的形成及淋巴结转移等临床病理因素有关(P＜0.05).结论 EphA7的过表达与原发性肝细胞癌的生物学行为密切相关,可能在肝癌的恶性转化、侵袭和转移过程中发挥作用.     

原发性肝细胞癌中EphA7蛋白的表达及其临床意义

目的 探讨酪氨酸蛋白激酶 EphA7 蛋白在原发性肝细胞癌中的表达及其临床意义.方法 应用免疫组化和 Western blot 方法检测 EphA7 蛋白在40例原发性肝细胞癌及相应的癌旁肝组 织和10例正常肝组织中的表达情况,并分析其与原发性肝细胞癌的临床病理因素之间的关系.结果 EphA7蛋白的表达主要位于原发性肝细胞癌细胞或肝细胞的胞质,以及纤维间隔内的血管内皮细胞.原发性肝细胞癌组织、癌旁肝组织及正常肝组织中均有EphA7蛋白的表达,Western blot分析结果显示EphA7蛋白在肝细胞癌组织(0.58±0.26)中的表达水平高于癌旁肝组织(0.40±0.22,P<0.05)和正常肝组织(0.32±0.16,P<0.05),而在癌旁肝组织和正常肝组织中的表达差异无统计学意义(P>0.05);EphA7蛋白的表达水平与原发性肝细胞癌细胞的分化程度、门静脉癌栓、淋巴结转移和甲胎蛋白水平等临床病理因素相关(P<0.05).结论 EphA7 蛋白的表达与原发性肝细胞癌的生物学行为密切相关,可能在原发性肝细胞癌的恶性转化、侵袭和转移过程中发挥重要作用.     

YB-1蛋白在肝癌细胞的表达部位及其意义

目的 探讨YB-1蛋白在肝细胞癌( Hepatocellular carcinoma,HCC)组织、2种肝癌细胞株、正常肝细胞株中的表达及其与肝癌患者临床参数的关系.方法 采用免疫组化检测YB-1蛋白在58例HCC组织及相应例癌旁组织、20例正常肝组织中的表达;用Western blot法检测上述HCC 组织、癌旁组织、正常肝组织及肝癌细胞株QGY-7701、SMMC-7721、正常肝细胞株L02中核移位YB-1蛋白表达.结果 免疫组化显示在HCC组织,YB-1蛋白主要表达于癌细胞胞浆,其阳性率(72.4％,42/58)明显高于癌旁(41.4％,24/58及正常肝组织(35.0％,7/2) (P＜0.05).其中18例(31.0％,18/58)HCC组织伴有明显YB-1核阳性表达,且核表达与HCC病理分级、门静脉癌栓、肿瘤大小相关(P＜0.05).Western blot检测同样证实核移位的YB-1蛋白在肝癌组织(0.474±0.107)显著高于癌旁组织及正常肝组织(P＜0.05).核移位的YB-1蛋白在2种肝癌细胞株中均高于正常肝细胞株(P＜0.05),其差异较织织更为明显.结论 YB-1蛋白在HCC中高表达及核移位可能促进了肝癌的发生发展,有可能成为肝癌治疗的新靶点.     

KAI1/CD82蛋白表达与肝细胞癌侵袭转移

目的　探讨KAI1/CD82蛋白表达与人肝细胞癌侵袭转移的关系。方法　构建肝癌组织芯片 ,收集肝细胞癌及癌旁肝组织 15 5例 ,癌栓 2 2例 ,肝内转移癌 4例 ,肝外转移癌 16例。正常对照肝组织 5例。应用免疫组织化学方法检测肝癌组织芯片中样本KAI1/CD82蛋白的表达。结果6 1% (95 /15 5 )肝细胞癌原发灶表达KAI1/CD82蛋白 ,仅有 32 % (7/2 2 )癌栓呈阳性表达 (P <0 0 5 )。不伴有肝外转移、肝内转移及癌栓形成肝细胞癌中KAI1/CD82蛋白表达率分别高于伴有肝外转移 (P =0 0 38)、肝内转移 (P <0 0 1)及癌栓形成者 (P <0 0 1)。KAI1/CD82蛋白在包膜完整与无包膜 (P <0 0 5 )、癌灶直径 <5cm与直径≥ 5cm(P <0 0 1)及血清AFP <4 0 0 μg/L与AFP≥ 4 0 0 μg/L (P =0 0 36 )肝细胞癌中表达率差异亦有显著意义。结论　肝细胞癌KAI1/CD82蛋白表达丧失可能与癌灶侵袭转移有关     

多梳基因Bmi-1在肝癌组织和门静脉癌栓组织中的表达及意义

目的 检测肝癌组织、癌旁肝组织、门静脉癌栓组织和正常肝组织中多梳基因Bmi-1 mRNA及其蛋白的表达,探讨Bmi-1与肝癌患者预后的关系.方法 回顾性分析2005年1月至2009年12月华中科技大学同济医学院附属同济医院收治的40例原发性肝癌患者的临床资料.收集患者手术标本,应用免疫组织化学法、Western blot和实时荧光定量PCR检测Bmi-1 mRNA和蛋白在肝癌组织(40例)、癌旁肝组织(40例)、门静脉癌栓组织(11例)和正常肝组织(10例)中的表达情况,分析Bmi-1与肝癌的临床病理特征关系.组间比较采用Nemenyi检验或Dunnett检验,不同病理因素与Bmi-1蛋白在肝癌组织中的表达差异比较采用x2检验或Fisher确切概率法,采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 正常肝组织、癌旁肝组织、肝癌组织和门静脉癌栓组织中Bmi-1 mRNA的相对表达量中位数分别为0.96、2.60、7.51和29.95.免疫组织化学检测结果提示,正常肝组织、癌旁肝组织、肝癌组织和门静脉癌栓组织中Bmi-1蛋白高表达率分别为10.0％、20.0％、67.5％和100.0％,肝癌组织和门静脉癌栓组织Bmi-1蛋白高表达率均明显高于正常肝组织和癌旁组织(x2=17.25、22.77,22,04、23.95,P＜0.05);Bmi-1蛋白在11例伴有门静脉癌栓的肝癌组织中也呈高表达.Western blot结果与免疫组织化学检测结果相符合.Bmi-1 mRNA及其蛋白的表达与Edmondson分级和门静脉癌栓有关(x2=5.572,P ＜0.05);与肿瘤直径、血清AFP值及HBsAg无关(x2=0.000,0.019,0.663,P＞0.05).术后生存分析结果显示,Bmi-1高表达的患者预后不良.结论 Bmi-1与肝癌的发生、侵袭能力和门静脉癌栓形成有关;Bmi-1高表达比Bmi-1低表达的患者预后差.     

Snail蛋白表达与肝细胞癌术后预后的相关性研究

目的研究Snail蛋白在肝细胞癌(HCC)中的表达及其与临床病理特征和术后预后的关系。方法应用免疫组织化学SP法,检测Snail蛋白在103例肝细胞癌及25例正常肝组织中的表达及其在细胞中的定位。结果Snail蛋白高度表达于肝癌组织的细胞核、细胞质,正常肝组织中表达较少甚至不表达,阳性率分别为51.5%和16%,两者差异有统计学意义(P0.05)。Snail在肝癌中的高表达与肝癌的pTNM分期、肿瘤有无包膜和微血管侵犯有关(P0.05)。结论HCC患者的术后的预后与Snail蛋白的表达有关,Snail蛋白有可能成为肝癌术后预测复发判断预后的生物学标志。     

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.     

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.