生长抑素类似物对人胆管癌细胞增殖和凋亡的影响

目的：探讨生长抑素类似物SMS201－995（SMS）对人胆管癌细胞体外增殖和凋亡的调控作用。方法：采用人胆管癌细胞系SK-ChA-1，应用生长曲线，流式细胞仪，片段DNA琼脂糖凝胶电泳，ANNEXIN,V－FITC技术及流式细胞仪间接免疫荧光技术等方法进行检测和观察。结果：在SMS作用下，SK－ChA-1细胞生长受到抑制，短时使细胞阻滞于G0／G1期，SMS处理SK－ChA-1细胞后，Annexin V-FITC标记的凋亡细胞增多，DNA凝胶电泳显示典型的凋亡梯状图谱，同时SMS可使细胞bcl-2蛋白表达下降，使bax蛋白表达升高，结论：SMS可明显抑制SK－ChA-1细胞生长，并能诱导该细胞凋亡，该细胞凋亡机理可能与凋亡调控基因bax和bcl-2的表达有关。     

bcl-2和bax基因与细胞凋亡的关系及在脊髓损伤中的作用

目的探讨bcl2和bax基因与细胞凋亡的关系及在脊髓损伤中的作用。方法采用Allen法挫伤大鼠T10节段脊髓,随机分为7组,其中6组为实验组,1组为对照组,每组在SCI后2、4、8、24h、3、7d取材,每一时间点4只。免疫组织化学法检测bax和bcl2基因表达,采用原位末端标记法检测凋亡细胞。结果正常组大鼠脊髓中未见凋亡细胞。实验组在损伤2h出现阳性细胞,伤后8h阳性细胞数目达高峰为84.53±8.00,以后逐渐减少。bax基因表达的高峰也在伤后8h为0.311±0.012,说明bax基因促进了细胞的凋亡,而此时bcl2基因开始出现表达增多,至伤后24h表达达高峰,之后缓慢降低,而与此相对应的是细胞凋亡开始逐渐减少(P<0.01)。结论凋亡相关基因bax与bcl2可能参与了脊髓继发性损伤,细胞凋亡在脊髓继发性损伤过程中起着关键性作用。     

细胞凋亡与增殖在先天性胆总管囊肿发病中的作用

目的　研究不同类型 (囊状、梭状型 )先天性胆总管囊肿壁细胞凋亡与增殖的关系 ,了解细胞凋亡 /增殖在胆总管囊肿中的作用。方法　以胆总管囊状扩张组 32例、梭状扩张组 35例及胆总管结石致胆管扩张组 (对照组 ) 2 5例为研究对象。术中取部分胆总管壁送检 ,观察胆总管壁损伤情况。用免疫组织化学法检测细胞凋亡的相关指标bcl 2、bax及细胞增殖指标PCNA的表达 ;用TUNEL法检测细胞凋亡情况。结果　囊状扩张组胆总管壁粘膜上皮细胞破坏严重 ,梭状扩张组镜下所见与囊状扩张组相似 ,但程度较轻。对照组胆总管粘膜上皮细胞破坏最轻 ,其凋亡细胞呈散在分布 ,上皮细胞和成纤维细胞凋亡阳性率较低 ,分别为 (2 .74± 1 .0 0 ) %和 (2 .95± 0 .87) % ;bcl 2、bax表达率较低 ,水平相似 (P>0 .0 5) ;PCNA表达率较高 ,分别为 (3 .74± 1 .0 0 ) %和 (3 .71± 1 .77) %。囊状扩张组与梭状扩张组囊壁残留上皮中的bcl 2和PCNA表达率低 ,分别为 (0 .99± 0 .51 ) %和 (0 .90± 0 .38) % ;bax呈高表达 ,bcl 2呈低表达 ,凋亡细胞阳性率较高 ,分别为 (1 3 .94± 4 .77) %和 (7.51± 3 .46) % ;成纤维细胞中的PCNA表达率较高 ,分别为 (9.91± 2 .91 ) %和(9.70± 3 .1 8) % ,bax呈低表达 ,bcl 2呈高表达 ,凋亡细胞阳性率较低     

5-氟尿嘧啶诱导直肠癌HR8348细胞凋亡作用的研究

目的　探讨 5 氟尿嘧啶 (5 fluorouracil ,5 FU )体外诱导直肠癌HR83 48细胞凋亡的作用及细胞凋亡与bcl 2、bcl xl、bax及 p5 3表达的关系。 方法　经 5 FU处理HR83 48细胞 2 4h后 ,用甲基绿 派若宁染色法和TUNEL法检测细胞凋亡情况 ,并用SP免疫组织化学法检测HR83 48细胞中bcl 2、bcl xl、bax和 p5 3的表达。 结果　HR83 48细胞经 5 FU作用 2 4h后 ,细胞凋亡指数 (AI)明显高于对照组 ,差异有显著性意义 (P<0 .0 1)。 5 FU作用不同时相bcl 2的表达评分结果与对照组比较差异均无显著性意义 ;不同时相bcl xl的表达评分结果与对照组比较稍降低 ;而bax的表达评分结果随时间延长明显增加 ,2 4h、3 6h的表达评分结果明显高于对照组 (P<0 .0 1) ,而 p5 3在 5 FU组和对照组各时相均未见表达。结论　 5 FU具有诱导HR83 48细胞凋亡的作用 ;5 FU可能通过上调bax的表达并改变bax/bcl xl的比值而诱导HR83 48细胞凋亡。     

骨关节炎软骨细胞凋亡调控基因的研究

目的　比较分析正常人及老年性骨关节炎患者软骨细胞bax和bcl 2的表达及细胞凋亡状况。　方法　取 9例骨关节炎患者的关节软骨做实验标本 ,以 6例无骨关节炎病史的意外死亡者关节软骨作为正常对照 ;采用逆转录 /聚合酶链反应 (RT PCR)方法检测bax和bcl 2mRNA表达 ,免疫组化检测bax和bcl 2蛋白 ;应用TUNEL方法进行凋亡细胞原位检测。　结果　骨关节炎患者和正常对照软骨细胞都能表达bax和bcl 2mRNA ;骨关节炎关节软骨细胞baxmRNA表达量较正常对照显著增高 (P <0 0 1) ,bcl 2mRNA表达量也高于正常对照组 (P <0 0 5 ) ,两组间bax/bcl 2表达量的比值差异无显著性意义 (P >0 0 5 ) ;免疫组化可检测到相应表达水平的蛋白 ;骨关节炎软骨细胞凋亡 (4%～ 14% )多于正常对照 (0～ 2 % )。　结论　软骨细胞凋亡受bax和bcl 2共同调节 ;bax和bcl 2的共同调节结果可能是OA患者软骨细胞凋亡增加 ,但凋亡率不高、病理过程进展缓慢的一个重要的原因     

奥曲肽对人胆管癌SK-ChA-1细胞增殖和侵袭能力的影响

目的　研究奥曲肽对胆管癌SK ChA 1细胞增殖和侵袭能力的作用。方法　用噻唑蓝比色法 (MTT)和3H 胸腺嘧啶脱氧核苷 (3H TdR)掺入法检测奥曲肽对胆管癌细胞株SK ChA 1生长的影响 ;侵袭能力为肿瘤细胞穿透被覆Matrigel胶的聚碳酸脂膜 (膜孔直径 1 2 μm)之细胞数。结果　奥曲肽在 0 .1～ 1 0 0 0 .0 μg/L浓度范围内能抑制SK ChA 1细胞生长和DNA合成 ;高浓度奥曲肽 (1 0 0 .0 μg/L和 1 0 0 0 .0 μg/L)作用后 ,SK ChA 1细胞穿过基底膜能力分别降低 (2 8.2±1 .3) %和 (2 9.3± 1 .7) % (P <0 .0 5)。结论　奥曲肽不仅具有抑制胆管癌细胞生长的作用 ,而且使其侵袭转移能力受到抑制     

大鼠牵张性脊髓损伤后细胞凋亡及相关基因表达的实验研究

目的观察大鼠牵张性脊髓损伤后细胞凋亡现象,检测脊髓损伤后凋亡相关基因的表达。方法大鼠脊髓T13～L2经牵张损伤,皮层体感诱发电位(CSEP)监测P1N1波幅下降至术前波幅70%后,分别于术后30min、6h、1、4、7、14、21d处死大鼠,取材(n=4)。应用流式细胞仪、原位末端脱氧核糖核苷酸转移酶介导dUTP标记(TUNEL)技术观察脊髓细胞凋亡情况,用免疫组化检测p53、bax和bcl2的表达。结果流式细胞仪及TUNEL法检测显示,损伤组术后6h凋亡细胞开始增多,术后7d细胞凋亡率达高峰,随后开始回落,持续21d,与空白对照组及椎板切除组比较,差异有显著性意义(P<005,001)。TUNEL法染色显示,白质中出现大量胶质细胞凋亡。免疫组化染色显示损伤组术后6h开始,p53、bax和bcl2阳性表达开始增多,p53阳性细胞数术后4d达高峰,bax和bcl2术后7d达高峰,损伤组各时相点的阳性表达与空白对照组与椎板切除组比较差异有显著性意义(P<005,001)。结论牵张性脊髓损伤后存在细胞凋亡现象,从形态上看包括神经元和胶质细胞凋亡,细胞凋亡是牵张性脊髓损伤继发损害中细胞死亡的一种重要形式,也是继发损伤期的重要病理变化。凋亡相关基因p53、bax大量表达,可能在脊髓细胞凋亡过程中起重要作用。     

阻塞性黄疸大鼠肝组织细胞凋亡及相关基因bcl-2、bax的表达

目的　探讨阻塞性黄疸肝损害的调控机制。方法　用末端脱氧核苷酸转移酶介导生物素标记(TUNEL)技术和免疫组织化学方法检测 4 0只阻塞性黄疸大鼠肝脏组织细胞凋亡状态及凋亡相关基因bcl 2和bax蛋白的表达。结果　胆总管结扎后 ,随结扎时间的延长细胞凋亡增加 ,结扎 14d后细胞凋亡达高峰 ,凋亡指数 (AI)达 5 8.2 3± 1.5 8,各组AI差异有显著性 (P <0 .0 5 )。在阻塞性黄疸过程中 ,bcl 2蛋白表达越强 ,bax蛋白表达越弱 ,AI亦越少。结论　bcl 2和bax蛋白均参与了阻塞性黄疸肝组织中细胞凋亡的调节。     

凋亡相关基因bcl-2和bax在大鼠自体移植静脉中的动态表达及意义

目的　探讨移植静脉中细胞凋亡及相关基因表达的动态变化及意义。方法　建立 10 0只Wistar大鼠自体颈静脉移植于肾下腹主动脉模型。采用原位DNA片断末端标记 (TUNEL)和免疫组织化学法 ,检测移植静脉血管平滑肌细胞 (VSMCs)凋亡及相关基因bcl 2和bax的表达。结果　术后 1～ 8周 ,移植静脉凋亡的VSMCs多于对照静脉 (P<0 .0 1) ;术后 2周为凋亡高峰 ,其凋亡细胞达 ( 2 8.5± 16 .6 ) % ,4～ 8周逐渐下降至 ( 8.1± 2 .8) % ;与对照静脉〔( 0 .5± 0 .2 ) %〕相比差异有显著性意义 (P<0 .0 1)。术后 1～ 2周 ,bcl 2表达增多〔( 2 2 .1± 5 .4 ) %〕 ,与对照组〔( 4 .3± 2 .1) %〕及 4～ 8周组间比较差异有显著性意义 (P<0 .0 1) ;移植后 1～ 6周 ,bax表达显著高于对照组〔( 5 .5± 2 .3) %〕及术后 8周组〔( 8.2± 2 .9) %〕 ,P<0 .0 1。结论　bcl 2与bax基因与移植静脉VSMCs的凋亡密切相关 ;VSMCs凋亡是移植静脉重塑和狭窄的重要因素     

反义寡核苷酸抑制结肠癌细胞bcl-2基因的表达并增强凋亡的研究

目的　观察反义寡核苷酸抑制结肠癌细胞bcl 2基因的表达并诱导凋亡和增强化疗的敏感性。方法　应用反义硫代寡核苷酸 (bcl 2SON)和顺铂共同处理结肠癌细胞系SW62 0 ,通过流式细胞仪观察其bcl 2蛋白表达的变化 ,并通过原位末端标记法 (TUNEL)染色和流式细胞仪检测细胞凋亡指数。结果　用bcl 2SON处理过的SW62 0细胞其bcl 2蛋白平均荧光强度 (MFI)为(40 .3± 8.7) %与空白对照及随机链对照组相比 ,差异有非常显著性 (P <0 .0 1 ) ,表明导入反义bcl 2后可明显抑制结肠癌细胞的bcl 2蛋白的表达。经bcl 2SON和 1 0mg/L顺铂共同处理的SW62 0细胞凋亡指数为 (64 .7± 8.4) % ,显著高于单纯顺铂处理组的 (2 3 .6± 6 .3) % (n =5 ,P <0 .0 1 )以及单纯bcl 2SON处理组的 (2 7.5± 5 .1 ) % (n =5 ,P <0 .0 1 )。而未经处理的对照组SW62 0细胞凋亡指数则为 (8.5± 1 .2 ) % ,显著低于后两组 (n =5 ,P <0 .0 5)。结论　bcl 2SON可通过抑制结肠癌细胞 (SW 62 0 )bcl 2蛋白的表达 ,诱导其凋亡 ,增强对化疗药物的敏感性     

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.