进展期胃下部癌D2根治术第13组淋巴结清扫的意义

目的 探讨进展期胃下部癌D2根治术第13组淋巴结清扫的必要性及可行性.方法 收集2001年1月至2007年6月问行胃下部癌D2/D2+根治术治疗、经病理确诊为腺癌且随访资料完整的胃癌患者共379例,依据第13组淋巴结清扫与否将患者分为清扫组与未清扫组.回顾性分析患者的临床病理资料,总结影响进展期胃下部癌预后的临床病理因素以及第13组淋巴结清扫的必要性和可行性.结果 379例患者中清扫组100例(26.4％),清扫组中淋巴结转移阳性患者9例(9.0％).清扫组与未清扫组患者性别、年龄、肿瘤最大径、分化程度、Borrmann分型、十二指肠浸润、浸润深度、淋巴结转移、TNM分期、手术时间、术中失血量、术后并发症的差异均无统计学意义(P＞0.05).Kaplan-Meier生存分析及Log-rank检验结果显示,清扫组的5年生存率(46.0％)明显高于未清扫组(36.5％,x2=4.452,P＜0.05).单因素分析显示,年龄(x2=7.539)、第13组淋巴结清扫与否(x2 =4.452)、肿瘤最大径(x2=7.100)、十二指肠浸润(x2=9.106)、浸润深度(x2=7.428)、淋巴结转移(x2=45.046)、TNM分期(x2=57.008)与进展期胃下部癌预后相关(P＜0.05);多因素分析显示,年龄(HR =0.500,95％ CI:0.343 ～0.730)、肿瘤最大径(HR=0.545,95％ CI:0.339～0.876)、十二指肠浸润(HR =5.821,95％CI:2.326～14.572)、肿瘤浸润深度(T4:HR=2.087,95％ CI:1.283 ～3.394)是影响进展期胃下部癌预后的独立危险因素(P＜0.05).结论 对TNMⅡ～Ⅲ期进展期胃下部癌患者行D2+第13组淋巴结清扫是必要且安全可行的.     

肿瘤最大径最佳截点与结直肠癌临床特点及预后的关系

目的：分析结直肠癌肿瘤最大径最佳截点及其与患者临床病理特点及预后的关系。方法：选择2006年1月—2012年7月行结直肠癌根治术与术后行规范化辅助治疗的结直肠癌患者 119例的临床资料。采用Kaplan-Meier生存分析方法,筛选结直肠癌肿瘤最大径的最佳截点值;分析肿瘤最大径与结直肠癌患者临床病理因素的关系,并分析结直肠癌患者预后影响因素。结果：以最大径4 cm为截点,两侧患者生存率差异最明显（65.5% vs. 51.1%,χ2=9.922,P=0.002）,故确定结直肠癌肿瘤最大径最佳截点值为4 cm。肿瘤最大径<4 cm患者与≥4 cm患者在肿瘤T分期、淋巴结检出总数、血清CEA方面差异有统计学意义（均P<0.05）。单因素分析显示,肿瘤最大径、T分期、M分期、血清CEA水平、是否输血与结直肠癌预后有关（均P<0.05）;多因素分析表明,肿瘤最大径、T分期、是否输血是结直肠癌预后的独立影响因素（均P<0.05）;按肿瘤最大径分层分析,T分期是≥4 cm患者预后的独立影响因素（HR=2.244,95% CI=1.079~4.665,P=0.030）,但以上因素对肿瘤最大径<4 cm患者预后影响不明显（均P>0.05）。结论：肿瘤最大径可作为影响结直肠癌预后的独立影响因素,其最佳截点值为4 cm,参照该截点值,有助于对患者临床特点及预后作出判断。

     

多梳蛋白4与含FERM结构域蛋白4A在胃癌组织中的表达及与意义

目的:探讨胃癌组织中多梳蛋白4(Cbx4)和含FERM结构域蛋白4A(FRMD4A)表达及其与胃癌患者临床病理参数及预后的关系。方法:收集2010年2月—2013年11月收治的112例胃癌患者的手术标本(癌组织及癌旁组织)及临床病理资料,用qRT-PCR和免疫组化法中检测标本中Cbx4、FRMD4A mRNA与蛋白表达;分析胃癌组织Cbx4和FRMD4A蛋白表达水平与临床病理参数及生存率的关系,并分析影响胃癌预后的因素。结果:与癌旁正常组织比较,胃癌组织中Cbx4和FRMD4A mRNA与蛋白表达水平均明显升高(均P0.05)。Cbx4及FRMD4A蛋白表达水平与胃癌患者T分期、N分期、分化程度及远处转移明显有关(均P0.05);Cbx4、FRMD4A蛋白阳性表达组胃癌患者5年生存率均明显低于各自阴性表达组患者(χ~2=15.42,P=0.000;χ~2=21.55,P=0.000)。Cox多因素分析显示,Cbx4(HR=2.754,95%CI=1.827～4.151,P=0.000)和FRMD4A(HR=3.129,95%CI=2.282～4.290,P=0.000)蛋白表达水平以及T分期(HR=1.432,95%CI=1.241～1.652,P=0.005)、远处转移(HR=1.257,95%CI=1.208～1.308,P=0.032)是影响胃癌患者预后的独立危险因素。结论:Cbx4及FRMD4A在胃癌组织中高表达,且与患者的不良临床病理特征及预后密切相关,可能对胃癌病情评估及预后判断有一定意义。     

2010年第7版肾癌新分期的应用效果评估

目的 探讨2010年第7版肾癌新分期系统的临床应用效果.方法 收集1981年1月至2003年12月手术治疗的695例肾癌患者的存档资料,分别按照国际抗癌联盟及美国癌症联合会2002年第6版和2010年第7版肾癌分期系统进行临床病理分期,观察不同分期患者的生存情况,应用Kaplan-Meier法、Log-rank检验、Cox比例回归风险模型进行统计学分析.结果 按照新分期系统,第6版分期系统中T2期171例中120例归入T2a期,51例归入T2b期,13例因肿瘤侵犯肾上腺而归入T4期,3例并发肾静脉瘤栓者归入T3a期.按第6版分期系统,T3a期中单纯肾周脂肪阳性患者的预后与单纯肾上腺阳性患者比较差异有统计学意义(P=0.008),单纯肾上腺阳性患者预后与T4期肾癌患者比较差异无统计学意义(P=0.412).新分期系统中,T2b与T3a期预后差异无统计学意义(P=0.741),将T3a期以7 cm为分界点分类后,T3a期(肿瘤最大直径≤7 cm)与T2a期的预后相近(P=0.342),T3a期(肿瘤最大直径＞7 cm)预后与T2b比较差异有统计学意义(P=0.019).结论 第7版肾癌分期系统显示了更好的分期特异性.     

直肠癌根治性切除术后局部复发的危险因素分析

目的 分析影响直肠癌根治性切除术后局部复发的危险因素.方法 回顾性分析2000年1月至2009年3月中山大学附属第六医院行直肠癌根治性切除术后获得完整随访150例患者的临床资料.其中局部复发的患者(复发组)50例,按照性别相同,年龄相差≤3岁进行1∶2配对,挑选出100例直肠癌根治性切除术后未局部复发患者(未复发组)作为对照.筛选出肿瘤位置、术后化疗、肿瘤分化程度、脉管或神经浸润、T分期、肿瘤直径、获取淋巴结总数、阳性淋巴结数目作为分析因素.对8项变量进行单因素分析,比较两组之间的差异,分析直肠癌局部复发的相关危险因素.计数资料采用x2检验,计量资料先进行正态性检验,正态分布资料采用两独立样本t检验,非正态分布资料采用两独立样本Wileoxon秩和检验.多因素分析采用Logistic回归模型.结果 本组患者随访至2013年1月,中位随访时间为52个月,复发组患者死亡22例,未复发组患者死亡32例.单因素分析结果表明:复发组和未复发组患者在肿瘤位置、T分期方面比较,差异有统计学意义(x2=6.407,9.652,P＜0.05).两组患者在术后化疗、肿瘤分化程度、脉管或神经浸润、肿瘤直径、获取淋巴结总数、阳性淋巴结数目方面比较,差异无统计学意义(x2=1.349,0.342,0.656,Z=7142.5,8214.5,7241.5,P＞0.05).多因素分析结果表明:肿瘤位置(低位)、T分期(T4期)是影响直肠癌根治性切除术后局部复发的因素(Wald=3.954,5.615,P＜0.05).进一步分析结果表明:与高位直肠癌患者比较,中位直肠癌局部复发率没有明显改变(OR=1.893,P＞0.05);而低位直肠癌局部复发率则明显升高(OR=3.201,P＜0.05).与T2期患者比较,T3期直肠癌患者局部复发率没有明显改变(OR=4.913,P＞0.05);T4期直肠癌患者局部复发率明显升高(OR=16.103,P＜0.05).结论 低位直肠癌和T分期影响直肠癌根治性切除术后患者肿瘤局部复发,手术根治程度指标对于判断此类患者预后、指导后续治疗意义重大.     

肿瘤大小对T3期胃癌患者预后的影响

目的探讨肿瘤大小对T3期胃癌患者预后的影响。方法对408例L期胃癌患者施行胃癌D2根治术,应用Cox比例风险模型对肿瘤大小进行最佳截点的筛选。对全组T3期胃癌患者的预后因素进行单因素及多因素分析：并对大直径组及小直径组胃癌患者的预后因素进行多因素分析。结果本组408例T3期胃癌患者通过Cox比例风险模型筛选出肿瘤大小的最佳截点为8cm。肿瘤大于或等于8cm的胃癌患者（大直径组）85例．小于8cm的胃癌患者（小直径组）323例：大直径组和小直径组术后5年生存率分别为33．8％和52．2％,差异有统计学意义（P〈0．05）。通过Cox比例风险模型分析显示,肿瘤大小、淋巴结转移、Boi Tmann分型和肿瘤部位是影响全组患者预后的独立因素（均P〈0．01）：进一步按肿瘤大小进行分层预后分析显示,Borrmann分型和淋巴结转移是影响大直径组患者预后的独立因素（均P〈0．05）;淋巴结转移是影响小直径组患者预后的独立因素（P〈0．01）。结论以8cm为界值进行B期胃癌患者的预后判断准确性最高。肿瘤大小是影响B期胃癌患者预后的独立因素。     

D-二聚体对胃癌患者的转移诊断价值及评估预后的研究

目的 探讨胃癌患者术前D-二聚体对诊断胃癌转移和评估胃癌患者预后的价值.方法 回顾性分析2010年1月-2011年1月安徽医科大学第一附属医院收治的132例胃癌患者完整的临床病理及随访资料.以D-二聚体等于1.465 mg/L为分界值,将患者分为低D-二聚体组和高D-二聚体组,通过x2检验分析D-二聚体水平与患者临床病理特征的关系,并用Kaplan-Meier法和rank检验进行生存分析,采用Cox回归模型分析患者的预后因素.结果 共132例胃癌患者纳入本研究.卡方检验结果提示D-二聚体与患者性别、肿瘤大小、淋巴结转移、TNM分期、分化程度无明显相关(P均＞0.05),而与年龄(x2 =4.311,P＜0.05)、侵犯深度(x2=4.996,P＜0.05)和胃癌是否远处脏器转移(x2=8.300,P＜0.05)相关;胃癌远处脏器转移患者血浆中D-二聚体浓度为(1.39±0.73) mg/L,胃癌非远处脏器转移患者血浆中D-二聚体浓度为(0.97 ±0.83) mg/L,差异具有统计学意义(P =0.023),手术后5年内死亡的胃癌患者血浆中D-二聚体浓度为(1.22±0.92) mg/L,在手术后5年存活的胃癌患者血浆中D-二聚体浓度为(0.78±0.58) mg/L,差异具有统计学意义(P=0.001);Kaplan-Meier生存分析提示高D-二聚体组的胃癌患者总生存率远低于低D-二聚体组(P＜0.01);单因素分析结果表明性别、D-二聚体、肿瘤大小、肿瘤浸润深度、淋巴结转移和TNM分期与胃癌患者总生存率有关(均P ＜0.05),多因素Cox回归模型分析显示D-二聚体为影响胃癌患者预后的独立因素(P＜0.01).结论 D-二聚体可能对判断胃癌患者是否转移提供一定的诊断价值,同时D-二聚体是影响胃癌患者预后的独立预测因素.     

CD157在胃癌组织中的表达与临床意义及其对胃癌细胞侵袭的影响

目的 探讨CD157蛋白在人胃癌组织中的表达情况及其与胃癌患者临床病理指标和预后的关系;初步探讨CD157对胃癌AGS细胞侵袭转移的作用及其机制.方法 用免疫组织化学方法检测CD157蛋白在90例胃癌及配对癌旁组织中的表达,分析其表达结果与胃癌患者的临床病理资料和预后的相关性.通过小干扰RNA(small interfering RNA,siRNA)转染人胃癌AGS细胞下调CD157的表达,用Transwell侵袭实验检测CD157对胃癌AGS细胞侵袭能力的影响.结果 CD157蛋白在胃癌组织及癌旁组织的表达率分别为67％和12％,差异有统计学意义(x2=55.84,P＜0.01);CD157蛋白的表达水平与肿瘤浸润深度(x2=12.503,P＜0.01)、淋巴结转移(x2=8.693,P=0.003)和远处转移(x2=4.944,P=0.027)相关,而与年龄(x2=1.659,P=0.198)、性别(x2=1.431,P=0.232)和分化程度(x2 =0.407,P=0.856)无相关;CD157高表达组胃癌患者中位生存期短于低表达组(29.2个月比46.0个月,x2=4.438,P=0.036).与对照组相比,siRNA组CD157 RNA表达(t=45.004,P＜0.01)和蛋白表达(t=32.877,P＜0.01)降低,侵袭能力减弱(F=98.455,P＜0.01).结论 CD157高表达与胃癌的浸润、转移和不良预后有关,下调CD157表达可抑制胃癌细胞侵袭能力.     

影响胰头癌根治术预后的多因素分析——肿瘤出芽是预后的独立影响因素

目的探讨肿瘤出芽在胰头癌根治术后评价预后中的作用。方法肿瘤出芽定义为肿瘤浸润前沿的单个或一簇个数<5的肿瘤细胞,200倍显微镜视野下(0.785 mm2)计数肿瘤出芽的个数。回顾性分析2005～2010年67例因胰头癌行根治性切除术患者的临床病理资料及随访资料,对影响预后的临床病理因素进行多因素分析。结果 (1)67例胰头癌患者中肿瘤出芽个数0～59个/0.785 mm2,中位数19个/0.785 mm2。采用接受者运行曲线(ROC)定义肿瘤出芽个数≥17为肿瘤出芽高密度组,<17为肿瘤出芽低密度组。本研究肿瘤出芽高密度组39例(58.2%),低密度组28例(41.8%)。肿瘤出芽高密度组年龄小(P=0.007),T分期高(P=0.007),N分期高(P=0.002),AJCC分期高(P=0.004),神经浸润发生率高(P=0.004),组织学分级高(P=0.001),术后早期复发多(P=0.001),2年生存率低(P=0.000)。(2)存活26例,死亡41例。中位生存时间12个月(3～59个月)。单因素分析结果显示,T分期(P=0.009)、N分期(P=0.003)、AJCC分期(P=0.006)、组织学分级(P=0.034)和肿瘤出芽(P=0.000)与胰头癌患者的生存时间有关,多因素Cox回归分析结果显示,肿瘤出芽高密度是胰头癌患者预后的独立影响因素(HR=3.093,95%CI 1.314～7.283,P=0.010)。结论肿瘤出芽高密度是胰头癌根治性切除术后预后不良的重要因素。     

肿瘤大小对各T分期胃癌患者预后影响的分析

目的探讨肿瘤大小对各T分期胃癌患者预后的影响。方法收集535例行根治术胃癌患者的临床资料,采用ROC曲线下面积取截断点,根据肿瘤直径分为4.5 cm组和≥4.5 cm组。应用Kaplan-Meier生存曲线比较相同T分期中不同肿瘤大小对胃癌患者预后的影响。结果肿瘤直径4.5 cm组和≥4.5 cm组患者术后5年累积生存率分别为66.9%和28.3%,其差异有统计学意义(P0.05)。在T1期患者中,肿瘤直径≥4.5 cm组与4.5 cm组之间预后差异无统计学意义(P0.05);在T2及T3期患者中,肿瘤直径≥4.5 cm组和4.5 cm组之间预后差异有统计学意义(P0.05);在T4期患者中,肿瘤直径≥4.5 cm组和4.5 cm组之间预后差异无统计学意义(P0.05)。结论肿瘤大小是影响T2及T3期胃癌患者预后的重要因素之一。     

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.