游离前列腺特异抗原百分比/前列腺特异抗原密度在前列腺癌诊断中的应用

目的探讨游离前列腺特异抗原百分比（FPSA／TPSA值）／前列腺特异抗原密度[（F／T）／PSAD值]在前列腺癌诊断中的意义。方法回顾分析204例行经直肠超声引导前列腺穿刺活检患者的诊断资料,其中前列腺癌90例、良性前列腺增生114例,分析总PSA（TPSA）、FPSA／TPSA值、PSAD、（F／T）／PSAD值等指标在判断前列腺癌的敏感性为90％时的截点及相应的特异性。结果不同血清PSA水平（〈4．0,4．0～,10．1～和〉20．0μg／L）的前列腺癌患者的（F／T）／PSAD值与良性前列腺增生患者比较,差异有统计学意义（P〈0．05）;前列腺癌患者的（F／T）／PSAD值低于良性前列腺增生患者;（F／T）／PSAD值比FPSA／TPSA值和PSAD更有助于提高诊断特异性,在敏感性为90％左右的前提下,FPSA／TPSA值的特异性为31．6％,PSAD的特异性为45．6％,（F／T）／PSAD值的特异性为64．0％;PSA水平不同,取的（F／T）／PSAD值截点也不同：PSA〈4．0μg/L时截点为2．5,PSA为4．0～20．0μg／L时截点为0．8;PSA〉20．0μg／L时截点为0．5。结论应用（F／T）／PSAD值能够在保持较高敏感性的前提下,显著提高前列腺癌诊断的特异性。     

PSA、ECT骨显像诊断前列腺癌骨转移的临床价值

目的 :探讨前列腺特异抗原 (PSA)、发射型计算机断层扫描 (ECT)骨显像诊断前列腺癌骨转移的临床价值。方法 :对 6 7例 (骨转移组 4 4例 ,非骨转移组 2 3例 )前列腺癌病人的PSA、ECT与骨转移的关系进行回顾性分析。　结果 :ECT骨显像诊断前列腺癌骨转移的敏感性 91.6 7% ,骨显像表现为单个核素浓聚灶的病人 6例 ,仅 2例为前列腺癌骨转移。骨转移组与非骨转移组的PSA值差异有显著性 (87.2 8μg/Lvs 2 5 .37μg/L ,P <0 .0 1) ;PSA与骨转移的程度正相关 ,PSA <10 μg/L ,骨转移率为 0 ;PSA 10～ 2 0 μg/L ,骨转移率 7.6 9% ;PSA 2 0～ 6 0 μg/L ,骨转移率5 3.33% ;PSA 6 0～ 10 0 μg/L ,骨转移率 91.6 7% ;PSA >10 0 μg/L ,骨转移率 10 0 %。 　结论 :ECT骨显像对前列腺癌骨转移有较高的敏感性 ,但对单个转移灶诊断的特异性不高。对未经治疗的前列腺癌病人 ,PSA <10 μg/L ,前列腺癌骨转移的可能性极小 ;PSA >10 0 μg/L者 ,骨转移的可能性极大     

PSA密度对TPSA灰区前列腺癌的诊断意义

目的：探讨总前列腺特异性抗原（TPSA）位于灰区（4．0～10．0μg／L）时前列腺特异性抗原密度（PS—AD）在前列腺癌（PCa）诊断中的意义并确定合适的PSAD值界点。方法：对T-PSA在灰区的128例BPH及54例PCa的血清PSA相关检测结果进行回顾性分析,将所有病例以F／T-PSA=0．16为界点分为两组并分别对其PSAD值进行对比分析。结果：通过分析在不同F／T-PSA下不同PSAD对前列腺癌阳性率的影响表明,当F／T-PSA％0．16时,PSAD以0．15为界值,PSAD〉0．15患者的前列腺癌阳性率显著高于PSAD〈O．15患者的前列腺癌阳性率;F／T-PSA〉0．16时,PSAD以0．20为界值,PSAD〉0．20患者前列腺癌阳性率显著高于PSAD〈0．20患者的前列腺癌阳性率。结论：PSA、F／T-PSA、PSAD是诊断前列腺癌的敏感指标,而联合测定PSA、F／T-PSA及PSAD能显著提高T-PSA位于灰区时前列腺癌的诊断。当F／T-PSA〈0．16时,PSAD以0．15为界值,PSAD在前列腺癌的诊断中有显著意义（P〈0．05）;当F／T-PSA〉0．16时,PSAD无论以0．15或0．20为界值,PSAD在前列腺癌的诊断中均有显著意义（P〈O．05）,尤其当PSAD以0．20为界值时,PSAD在前列腺癌的诊断中意义更显著（P〈0．01）。故推荐在F／T-PSA〈O．16时PSAD以0．15为界值;在F／T-PSA〉0．16时PSAD以0．20为界值。     

ALP、PSA及其相关指标与前列腺癌骨转移的关系

目的 探讨ALP、PSA及其相关指标(fPSA、fPSA/tPSA、PSAD)与前列腺癌骨转移的关系,及对前列腺癌骨转移诊断的预测作用.方法 回顾分析2005年9月至2009年2月在我院经前列腺穿刺活检或手术后病理检查确诊的167例前列腺癌患者.以ECT、X线片、CT/MRI或骨活检诊断骨转移,分析ALP、PSA、fPSA、fPSA/tPSA、PSAD与前列腺癌骨转移的关系及对骨转移的诊断价值.结果 167例前列腺癌患者中骨转移104例(62.3%),非骨转移63例(37.7%).骨转移组ALP、PSA及PSAD明显高于非骨转移组(均P<0.01),而两组间fPSA/tPSA差异无统计学意义(P>0.05).PSA>50 ng/ml组骨转移率明显高于PSA>20～50 ng/ml组、>10～20 ng/ml组和≤10 ng/ml组(均P<0.05);ALP>90 U/L组骨转移率明显高于ALP≤90 U/L组(P<0.05);PSAD>0.4 ng·ml-1·cm-3组骨转移率明显高于PSAD≤0.4 ng·ml-1·cm-3组(P<0.05).以ALP>90 U/L、PSA>50 ng/ml和PSAD>0.4 ng·ml-1·cm-3为界分别分析ALP、PSA、PSAD、PSA+ALP、PSA+PSAD和PSA+PSAD+ALP对前列腺癌骨转移诊断的预测价值,发现指标联合应用后阳性预测值及阴性预测值较单一指标好,PSA+PSAD+ALP联合应用的敏感度、特异度、阳性预测值及阴性预测值最佳,分别为100%、79.17%、91.38%及100%.结论 ALP、PSA及PSAD均为判断前列腺癌患者有无骨转移的可靠指标,PSA+PSAD+ALP联合应用有助于预测前列腺癌骨转移,当患者PSA<50 ng/ml、PSAD<0.4 ng·ml-1·cm-3及ALP<90 U/L时,几乎可排除骨转移.     

PSA密度对PSA浓度轻度升高且肛指检查正常的前列腺癌诊断的意义

目的：探讨血中前列腺特异性抗原（PSA）浓度与前列腺体积的比值（PSA密度，PSAD）对PSA浓度在41～10μg／L之间、肛指检查（DRE）正常的良性前列腺增生（BPH）和前列腺癌（PC）鉴别诊断的意义、方法：对PSA浓度在4～10μg／L、DRE正常的12例PC和14例BPH病人的PSAD进行回顾性分析。PSAD为PSA浓度与前列腺体积的比值。结果：PC组和BPH组的PSA分别是6．20μg／L和6．16μg／L．两组相比差异不显著（P＞0．05）．而PSAD分别是0．29和0．16．两组相比差异显著（P＜0．01）、当取PSAD阈值为M＞0．20时．鉴别诊断的准确性最高．为76．92％．敏感性和特异性分别为75．00％和78．57％。结论：PSAD有助于鉴别PSA在4～10μg／L之间、DRE正常的BPH和PC．具有较高的敏感性和特异性，可减少不必要的活检，推荐使用的PSAD闭值为＞0．20。     

前列腺特异抗原水平为4～10 μg/L的前列腺癌诊断对策

目的评价现有的前列腺特异抗原(PSA)修正方法对PSA在4~10μg/L的前列腺癌的诊断价值。方法选取经直肠B超引导下前列腺多点穿刺活检血PSA测值在4~10μg/L的86例患者,分析其PSAD、PSATZ、F/T比值及PSA修正方法各域值范围内,对前列腺癌诊断的敏感度及特异度。结果PSAD、PSATZ和F/T比值在各域值范围内,对诊断前列腺癌的敏感度均未超过50%,将PSAD域值设为0.18μg/L/cc时有较高的敏感度,F/T比值设为0.25时有较高的特异度,而PSATZ在各域值范围内对前列腺癌的敏感度及特异度无显著优势。结论PSA修正方法不能有效提高国人血PSA4~10μg/L的前列腺癌检出率;当PSAD超过0.18μg/L应建议患者作前列腺穿刺活检,F/T比值小于0.25则应增加穿刺点。     

血清PSA与前列腺癌骨转移的关系

目的:探讨血清前列腺特异抗原(PSA)预测前列腺癌骨转移的价值.方法:以全身核素骨显像为金标准,回顾性分析放免法测定的58例前列腺癌骨转移和63例非骨转移患者血清PSA水平与骨转移的关系.结果:血清PSA≤10/μg/L者骨转移的发生率极低,发生率为0.PSA≥20 μg/L者有骨转移的可能,骨转移的发生率为50%.PSA≥40/μg/L者骨转移的可能性极大,骨转移的发生率为68%.结论:对于新诊断而未治疗的前列腺癌的患者,PSA<10μg/L者无骨痛或病理性骨折时不必行全身核素骨显像检查.PSA≥20μg/L者应常规行全身核素骨显像检查,以早期确诊前列腺癌骨转移.     

前列腺穿刺病理组织学类型在不同PSA水平中的分布

目的：探讨前列腺穿刺病例PSA水平与病理组织学类型的关系,为制订国人穿刺指导原则提供参考。方法：收集经直肠超声引导前列腺系统穿刺活检的634例患者的PSA水平与病理组织学资料,对不同PSA水平下的前列腺穿刺主要病理组织学类型的分布情况进行统计分析。结果：PSA≤4．0、4．1～10．0、10．1～20．0、〉20．0μg／L各组中前列腺穿刺肿瘤阳性率分别是11．6％、26．8％、39．8％、68．6％;67．0％的良性病例PSA〉4．0μg／L,14．1％的良性病例PSA〉20．0μg／L。BPH、PIN和炎症在各PSA组分布差异无统计学意义（P=0．245）,高中低分化的前列腺癌在各组中分布差异有统计学意义（P=0．000）,PSA〉20．0μg／L组的前列腺癌多为低分化癌。结论：国人中有相当多的良性前列腺疾病患者PSA异常升高,部分良性患者的PSA可达到较高水平;PSA〉20．0μg／L的前列腺痛患者恶性程度较高。     

f-PSA/t-PSA比值在良性前列腺增生和前列腺癌鉴别诊断中的应用

目的：探讨血清总前列腺特异性抗原（t-PSA）及游离前列腺特异性抗原（f-PSA）在BPH和PCa患者中的表达，评价t-PSA与f-PSA／tPSA在BPH和PCa鉴别诊断中的应用价值。方法：对经直肠超声引导下前列腺穿刺活检诊断为BPH和PCa的患者，结合其术前的t-PSA及f-PSA检测结果，进行回顾性分析和统计。结果：在t—PSA％4．0μg／L的患者中，f-PSA／t—PSA〈0．16者共6例（BPH3例；PCa 3例），〉0．16者共20例（BPH13例；PCa例7）；4．0≤t—PsA〈10．0μg／L的患者中，f-PSA／t—PSA〈0．16者共17例（BPH5例；PCa 12例），〉0．16者共24例（BPH21例；PCa3例）；10．0≤t—PSA〈100μg／L的患者中，f-PSA／t-PSA〈0．16者共49例（BPH19例；PCa30例），〉0．16者共31例（BPH22例；PCa9例）；t—PSA≥100μg／L的患者16例，均为PCa，f-PSA／t—PSA比值均〈0．16。结论：BPH患者随年龄增长t—PSA逐渐升高，但f-PsA／t—PSA值差异无统计学意义（P〉0．05），而不同年龄的PCa患者t-PSA、f-PSA及f-PSA／t-PSA值均差异无统计学意义（P〉0．05）；t-PSA水平在4．0～10．0ug／L的PCa患者和t—PSA在10～100μg／L的PCa患者相比，其f-PSA／t—PSA比值差异无统计学意义（P〉0．05）；对于4．0≤t—PSA〈10．0的患者，结合f-PSA／t-PSA〈0．16，能更有效地区别BPH和PCa（P〈0．05），但是，对于t—PSA％4．0μg／L的PCa患者来说，f-PSA/t-PSA比值对其与BPH的鉴别意义不大（P〉0．05）。     

前列腺炎患者治疗前后PSA变化及其临床意义

目的：探讨伴有PSA升高的ⅢA型前列腺炎患者药物治疗后血清PSA的变化,评估PSA变化率对疗效的预测价值。方法：收集2010年9月-2012年3月期间门诊就诊的有4μg／L〈PSA〈50／μg／L,拟诊断为ⅢA型前列腺炎患者60例,所有患者均予以抗感染治疗4周,分别于治疗前后行血清PSA检测和填写慢性前列腺症状评分表（NIH—CPSI）,并对相关资料予以总结分析研究。结果：穿刺活检患者共60例,其中12例证实为PCa,43例为慢性前列腺炎,5例为BPH。前列腺炎患者治疗前后PSA相关指标（PSA,游离／总PSA,PSA密度）和CPSI评分均出现显著变化,各指标差异均有统计学意义（P〈0．05）;PSA变化率（PSA—VCh）对鉴别诊断PCa有一定价值,在最佳临界点-5．22％处,敏感度和特异度分别为84．7％和78．6％;治疗后前列腺炎症分级与PSAD及CPSI间存在相关性（r=0．518,r=0．379,P均〈0．05）,PSA—VCh与△CPSI及患者治疗前PSA均呈中等相关（r=0．481,r=0．410,P均〈0．01）。结论：抗感染治疗后,可使伴有PSA升高的ⅢA型前列腺炎患者主客观指标均得以改善;PSA变化率可作为评估慢性前列腺炎治疗效果的有价值指标,并为排除PCa提供依据。     

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.     

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.     

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.