男性血清抵抗素、脂联素水平与骨密度关系

目的 探讨男性血清抵抗素(Resistin)、脂联素(Adiponectin)、水平与骨密度(BMD)的关系.方法 用ELISA测定232名20-80 岁健康男性血清Adiponectin、Resistin;用DXA测定总体、腰椎正位、总髋部BMD,全身扫描测定体脂、瘦体重.结果 Resistin与体脂无相关性.Adiponectin与体脂呈负相关,校正年龄与体重指数后,相关性消失.Adiponectin与总体、腰椎正位、总髋部BMD呈负相关,校正年龄与体脂后,相关性存在.Resistin与总体、腰椎正位、总髋部BMD无相关性.多元线性回归分析显示Adiponetin是男性各部位BMD的影响因素.结论 Adiponectin与体脂相关,Adiponetin与各部位BMD呈负相关,是男性各部位BMD的影响因素.关于Adiponectin与骨代谢的关系,有待进一步深入研究.     

读《骨搬移治疗骨缺损与骨不连》有感

[目的]针对骨科学过细的分科、过分依赖高、新医疗技术以及替代重建为主导的发展方向,探索肢体损伤与重建的发展史,反思现代骨科医疗模式与生命本质、自然规律之间的关系.[方法]回顾生物进化与人类演化的历史,排列出己被科学证明的生命起源、细胞与骨结构的诞生、生物界骨与关节形成、发展、演化的历史年代,以及最终进化出脊椎动物和高级人类的形态结构.通过骨与关节进化的规律,总结人类进入社会后,肢体伤残与重建的发展脉搏.[结果]从生命的起源、骨与关节的发生、高等哺乳动物到人类的演化过程,有一条科学有序的演化序列,并不足大自然的随意或意外创造.人类肢体伤残的发生原因、医疗理念、选择的技术方法,与社会文明的发展、科学技术的进步、生活方式的改变有直接关系.现代礼会的科技水平、人类生活方式与思维理念发生巨大改变,肢体损伤与骨科疾病的发生原因与疾病种类也随之变化,但人体生命的自然属性没有改变.[结论]各种治疗骨科创伤与疾病的技术与方法只能顺应生命的自然过程,而不能过度干预.人类的文化理念、物质与精神需求可以飞扬,非生命物质的科学研究可以击破自然的某些规律,但生命科学的研究,医疗理念不能违背人体生命的自然过程与人性本质.观察、抚慰、看护与现代科技结合的适宜技术,仍是骨科医疗的基本原则,自然永远是医学的老师和本源.     

《中国普外基础与临床杂志》稿约

《中国普外基础与临床杂志》是由中华人民共和国教育部主管、四川大学华西医院主办的专业性学术期刊。其办刊宗旨是:面向临床,突出基础研究与临床应用相结合,理论与实践并重,提高与普及兼顾,为提高广大普外专业医生的疾病诊治水平服务。主要刊登普外专业和相关学科的临床研究成果,以及与临床联系紧密的基础研究、实验研究成果与进展。以从事普外专业的临床、科研、教学的高、中级人员,研究生,以     

从生物骨骼的起源与演变看肢体损伤与重建的发展史

[目的]针对骨科学过细的分科、过分依赖高、新医疗技术以及替代重建为主导的发展方向,探索肢体损伤与重建的发展史,反思现代骨科医疗模式与生命本质、自然规律之间的关系.[方法]回顾生物进化与人类演化的历史,排列出己被科学证明的生命起源、细胞与骨结构的诞生、生物界骨与关节形成、发展、演化的历史年代,以及最终进化出脊椎动物和高级人类的形态结构.通过骨与关节进化的规律,总结人类进入社会后,肢体伤残与重建的发展脉搏.[结果]从生命的起源、骨与关节的发生、高等哺乳动物到人类的演化过程,有一条科学有序的演化序列,并不足大自然的随意或意外创造.人类肢体伤残的发生原因、医疗理念、选择的技术方法,与社会文明的发展、科学技术的进步、生活方式的改变有直接关系.现代礼会的科技水平、人类生活方式与思维理念发生巨大改变,肢体损伤与骨科疾病的发生原因与疾病种类也随之变化,但人体生命的自然属性没有改变.[结论]各种治疗骨科创伤与疾病的技术与方法只能顺应生命的自然过程,而不能过度干预.人类的文化理念、物质与精神需求可以飞扬,非生命物质的科学研究可以击破自然的某些规律,但生命科学的研究,医疗理念不能违背人体生命的自然过程与人性本质.观察、抚慰、看护与现代科技结合的适宜技术,仍是骨科医疗的基本原则,自然永远是医学的老师和本源.     

正确选择临床基础研究的方法

医学科学研究的属性医学科学研究与其他自然科学研究一样,是认识客观事物、探索未知的认识过程。其是研究人体正常生理、病理、健康与疾病的科学。目的是揭示人体生命本质与疾病发生、发展的机制,认识人与环境的相互关系、健康与疾病相互转化的客观规律,     

北京、武汉、福建原发性骨质疏松症VDR I、VDR II-1、VDR II-2基因单核苷酸多态性研究

目的寻找骨质疏松相关基因的单核苷酸多态性位点(SNP),研究正常人群与骨质疏松患者,以及不同地区患者之间的SNP位点的差异.方法应用人类基因组学的方法,对北京、武汉、福建三个地域的417例被诊断为原发性骨质疏松症的患者(骨质疏松组其中北京组236例,武汉组123例,福建组61例)和60例正常人(对照组),进行了骨质疏松相关基因单核苷酸多态性比较研究.结果对对照组与骨质疏松患者组进行x2分析,VDR Ⅰ基因型总体水平比较差异无显著性;CC与TT、CC与CT、及TT与CT基因型比较差异均无显著性.VDRⅡ-1基因型总体水平比较,及CC与TT、CC与CT基因型比较差异均有非常显著性;TT与CT基因型比较差异无显著性.VDRⅡ-2基因型总体水平比较,及CC与TT、CC与CT、TT与CT基因型比较差异均无显著性.北京、武汉、福建三地区的VDRⅠ基因型总体水平,对照组与北京组、北京组与武汉组比较差异均有显著性;北京组与福建组、武汉组与福建组比较差异无显著性.VDRⅡ-1基因型总体水平,对照组与武汉组、对照组与福建组比较差异均有显著性;对照组与北京组、北京组与武汉组、北京组与福建组及武汉组与福建组比较差异无显著性.VDRⅡ-2基因型总体水平,北京组与武汉组、北京组与福建组及武汉组与福建组比较差异均无显著性.结论本实验研究涉及的VDR Ⅰ、VDRⅡ-1、VDRⅡ-2基因研究中,VDR Ⅰ、VDRⅡ-1对照组与原发性骨质疏松症基因的SNP位点差异有显著性.地区的差异主要表现在北京与武汉,未发现VDRⅡ-2基因的该SNP位点与中国人骨质疏松症有关.     

老年骨质疏松女性髋部骨密度、骨转换指标与血脂、血清尿酸相关性研究

目的研究老年骨质疏松女性髋部骨密度(bone mineral density,BMD)与血清总胆固醇(total cholesterol,TC)、血清甘油三酯(triglyceride,TG)、血清高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、血清低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)和血清尿酸(uric acid,UA)的相关性。方法收集2014年1月1日至2015年12月31日就诊的老年女性骨质疏松患者108例。记录患者的年龄、身高、体重、股骨颈BMD、股骨大转子BMD、股骨粗隆间BMD、髋部整体BMD、Ward’s区BMD、TC、TG、HDL-C、LDL-C、UA、血清I型胶原交联C末端肽(C-terminal crosslinking telopeptide of type I collagen,CTX)、I型原胶原N-端前肽(procollagen type I N propeptide,PINP)、25羟基维生素D(25-OH-Vit D,Vit D-T)及基础疾病情况等资料。髋部BMD、体质量指数(body mass index,BMI)、β-CTX、PINP、Vit D-T、TC、TG、LDL-C、HDL-C、UA相关性检验采用Pearson相关性检验。结果股骨颈BMD与年龄、β-CTX呈负相关,与BMI、Vit D-T、TG、UA呈正相关(r0,P0.05)。股骨大转子BMD与年龄、β-CTX呈负相关(r0,P0.05),与BMI、Vit D-T、TC、TG、LDL-C、UA呈正相关(r0,P0.05)。股骨粗隆间BMD与年龄、β-CTX、PINP呈负相关(r0,P0.05),与BMI、Vit D-T、TC、TG、UA呈正相关(r0,P0.05)。髋部整体BMD与与年龄、β-CTX呈负相关(r0,P0.05),与BMI、Vit D-T、TC、TG、LDL-C、UA呈正相关(r0,P0.05)。股骨Ward’s区BMD与年龄、β-CTX呈负相关(r0,P0.05),与BMI、Vit D-T、TC、LDL-C、UA呈正相关(r0,P0.05)。TC与β-CTX、PINP呈负相关(r0,P0.05),与Vit D-T、UA呈正相关(r0,P0.05)。TG与UA呈正相关(r0,P0.05)。HDL-C与Vit D-T、UA呈正相关(r0,P0.05)。LDL-C与β-CTX、PINP呈负相关(r0,P0.05),与Vit D-T、UA呈正相关(r0,P0.05)。结论骨质疏松患者髋部不同部位骨密度与血脂的相关性不同,适当水平的血清总胆固醇及尿酸有利于维持骨量,预防低骨量及骨质疏松的发生。     

北方汉族女性颧脂肪垫厚度和位置的初步超声测量

目的 探讨应用超声测量端坐位时颧脂肪垫的厚度,并得到脂肪垫的分布,找出青年人和老年人颧脂肪垫的差异,为悬吊颧脂肪垫的年轻化手术提供依据.方法 将24例北方汉族女性按照年龄随机分为3组.用Good-Q型超声机测量颧脂肪垫的厚度,对所得数据进行方差分析.结果 青年组与中年组在脂肪垫分布上没有显著差异.但是老年组在F与3、F与4、E与4、E与5、D与4、D与5、C与5、B与5、A与4、A与5交点和O点比青、中年组厚.结论 老年人面颊外侧脂肪增多,可能造成脂肪向外下方移位,导致出现衰老容貌.     

骨质疏松症患者血清骨代谢标志物分析与相关性研究

目的对西安地区部分骨质疏松症患者血清骨代谢标志物进行统计及相关性分析。方法纳入2018年4月至2019年3月经西安市红会医院诊治的原发性骨质疏松症患者295例,检测受试者血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、维生素D(vitamin D,维生素D)、甲状旁腺素(PTH)、I型前胶原N端肽(P1NP)、β-胶原特殊序列(β-Cross)的水平,运用R统计语言进行统计学处理及Pearson相关性分析。结果在大多数骨质疏松症患者中血清Ca、P是正常的;有20%~30%患者ALP升高;绝大多数患者维生素D缺乏或不足;PTH异常者以升高为主,少数女性患者PTH降低;大多数绝经前女性P1NP、β-Cross正常,在少数绝经前女性及1/3男性中出现升高,小部分绝经后女性出现下降,在小部分绝经后女性中升高。女性骨质疏松症患者中,血清ALP与P1NP、ALP与PTH、维生素D与β-Cross呈正相关(P<0.05),血清Ca与β-Cross、P与ALP、P与β-Cross、P与PTH、ALP与维生素D、ALP与β-Cross、维生素D与P1NP、维生素D与PTH、P1NP与β-Cross呈负相关(P<0.05)。男性骨质疏松症患者中,血清维生素D与β-Cross呈正相关(P<0.05),血清Ca与PTH、ALP与维生素D、维生素D与P1NP、维生素D与PTH、P1NP与β-Cross呈负相关(P<0.05)。结论骨质疏松症患者维生素D缺乏或不足情况严重,了解骨代谢标志物间的相关性有助于更好地理解骨质疏松症骨代谢异常机制。     

379例绝经前后妇女骨密度调查与身高的关系

目的了解妇女身高体重与体内骨含量的关系。方法采用米尺和磅秤测量身高和体重及双能X线骨密度仪测骨密度值和超声骨密度仪测左侧跟骨的SOS、STI、LBM。结果不同年龄组身高、体重及体块指数与超声速度、骨硬度指数、低骨量及骨密度值存在着统计学差异,随着年龄的增长SOS及STI呈现出下降趋势,其峰值在40岁之前;而低骨量LBM、骨质疏松发生率也明显增高。身高与SOS、STI、LBM呈正相关,与骨密度值无关;体重与STI、LBM、骨密度值呈正相关,与SOS值无关,BMI与SOS、STI呈负相关,与LBM、骨密度呈正相关。结论女性47岁后骨密度数据从"正常范围"转入低骨量,70岁后骨质疏松者明显增多,具有高度骨折风险。     

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.