胰腺癌微血管密度及血管内皮生长因子表达

目的　探讨胰腺癌组织中微血管密度 (MVD)和血管内皮生长因子 (VEGF)表达及其与淋巴结转移的关系。方法　采用免疫组织化学法及形态半定量方法对 31例胰腺癌和 7例正常胰腺组织进行MVD记数和VEGF表达检测。结果　胰腺癌组织中MVD记数、VEGF表达率分别为 11.0 5± 4.6 2、83% ,明显高于癌旁组织 5 .40± 1.71、2 0 %和正常胰腺组 6 .19± 1.5 6、14% (P <0 .0 1) ;淋巴结转移组MVD记数 ,VEGF表达分别为 13.0 0± 4.45、2 .0 0± 0 .95 ,明显高于无转移组 9.46±4.15、1.0 5± 0 .17和正常胰腺组 6 .19± 1.5 6、0 .14± 0 .38(P <0 .0 1)。MVD与VEGF表达呈正相关 (r =0 .418,P >0 .0 5 )。结论　MVD、VEGF表达高低可作为判断胰腺癌淋巴结转移、预后的指标。     

P物质及其受体在胰腺癌细胞中的表达

目的 了解P物质(SP)、神经激肽-1受体(NK-1R)及中性肽链内切酶(NEP)在胰腺癌细胞中表达。方法应用实时定量逆转录-聚合酶链反应(RQ-RT-PCR)技术,检测正常胰腺、胰腺癌组织和7株胰腺癌细胞中前速激肽原A(PPT-A)、NK-1R和NEP的mRNA表达,应用Westernblot检测NK-1R和NEP的蛋白水平。结果正常胰腺组织PPT-A的mRNA表达水平为0.430 0±0.464 7,胰腺癌组织中为1.790 0±1.833 1(P<0.05);正常胰腺NK-1R的mRNA表达水平为0.088 2±0.086 8,胰腺癌组织中为2.154 5±2.103 1(P<0.01);正常胰腺组织NEP的mRNA表达水平为3.234 7±6.301 0,胰腺癌为8.606 9±8.703 2(P>0.05)。Western Blot结果发现,胰腺癌组织中NK-1R蛋白也过度表达,而NEP的蛋白水平未相应上调。结论 胰腺癌组织中SP和NK-1R都明显上调,而SP的降解酶——NEP未相应上调,这表明胰腺癌组织中SP的产生与灭活的平衡被打破,产生过多的SP,发挥过度的生物学效应。     

Survivin基因在胰腺癌组织中的表达及与bcl-2和p53蛋白表达的关系

目的探讨Survivin基因在胰腺癌中的表达及与bcl 2、p5 3蛋白表达的相互关系。方法用RT PCR法检测 4 9例胰腺癌、5例慢性胰腺炎和 12例正常胰腺组织中SurvivinmRNA的表达 ,免疫组织化学法检测胰腺癌中bcl 2、p5 3蛋白表达。结果SurvivinmRNA在胰腺癌中表达率为76 % ,在慢性胰腺炎及正常胰腺组织中不表达 (P <0 0 5 )。Survivin基因表达与胰腺癌的分化程度、临床分期及淋巴结转移无相关性 (P >0 0 5 )。Survivin基因表达与bcl 2蛋白表达不相关 ,与p5 3蛋白表达显著相关。结论Survivin基因在胰腺癌中过度表达 ,提示该基因对胰腺癌发生和发展起重要作用 ;抑癌基因p5 3的失活与Survivin基因的表达可能在胰腺癌的发生中起协同作用。     

Survivin在胰腺癌中的表达及其与胰腺癌增殖活性的关系

目的探讨Survivin在胰腺癌中的表达及其与胰腺癌增殖活性的关系。方法用RT-PCR法检测6 2例胰腺癌、1 2例慢性胰腺炎和1 0例正常胰腺组织中Survivin mRNA的表达;用免疫组织化学法检测胰腺癌中增殖细胞核抗原(PCNA)的表达,并观察两者的关系。结果Survivin mRNA在胰腺癌中表达率为7 4.2%,在慢性胰腺炎及正常胰腺组织中不表达,前者与后两者差异有显著性(P<0.0 1);与胰腺癌的分化程度、临床分期及淋巴结转移无明显关系(P>0.0 5)。Survivin的表达与胰腺癌增殖活性有关;Survivin阳性肿瘤具有较高的增殖活性,其PCNA指数为(4 6.4±1 5.2)%,明显高于Survivin表达阴性肿瘤者(2 8.4±1 4.8)%(P<0.0 1)。结论Survivin基因在胰腺癌中过表达,并与胰腺癌的高增殖有关。提示该基因对胰腺癌的发生和发展起重要作用。Survivin基因有望成为胰腺癌诊断和治疗的新靶点。     

Her 2/neu和MMP2在胰腺癌中的表达及其意义

笔者应用免疫组织化学法检测Her 2 /neu和MMP2基因在 3 4例胰腺癌、5例胰腺囊腺瘤、5例胰腺囊肿和 2例正常胰腺组织中的表达水平。结果示胰腺癌中Her 2 /neu和MMP2表达明显高于胰腺正常组织和良性病变 (P <0 .0 5)。Her 2 /neu的表达在有淋巴结转移的胰腺癌中明显低于无淋巴结转移的胰腺癌 (P <0 .0 5) ;随TNM分期增高 ,其表达阳性率显著降低。MMP2表达在肿瘤直径大于 4.5cm及有淋巴结转移的胰腺癌中均明显高于肿瘤直径小于 4.5cm及无淋巴结转移者 (P <0 .0 5) ;随TNM分期增高 ,其表达阳性率也增高。MMP2在预后不良组中表达水平较生存组高 ,但差异无显著性 (P >0 .0 5)。提示Her 2 /neu和MMP2过度表达可能与胰腺癌的发生发展有关 ;Her 2 /neu可能在胰腺癌发生转移之前发挥作用 ,而MMP2与胰腺癌的侵袭、转移密切相关。检测二者表达水平对指导临床治疗和评估预后可能有较重要价值。     

转化生长因子α、表皮生长因子受体和p21蛋白在胰腺癌中的表达及其意义

目的　研究在胰腺癌不同临床分期和癌前病变中转化生长因子α (TGFα)、表皮生长因子受体 (EGFR)的表达情况及其与p2 1蛋白表达的关系。方法　应用免疫组织化学LSAB法检测 6 7例胰腺导管癌和 12例伴不典型增生的慢性胰腺炎组织中TGFα、EGFR和p2 1蛋白的表达。结果　TGFα和EGFR在不典型增生的慢性胰腺炎组织中表达阳性率分别为 83% (10 / 12例 )、75 % (9/ 12例 ) ,其共表达率为 75 % (9/ 12 ) ,显著高于正常胰腺组织 (P <0 0 1) ,与胰腺癌组织中的表达阳性率相比差异无显著意义 (P >0 0 5 )。早期胰腺癌中TGFα和EGFR的表达阳性率分别为 79%和 76 % ,高于晚期胰腺癌的 39%和 5 5 % (P <0 0 1)。TGFα与EGFR共同表达组细胞核增殖抗原计数值为 6 7± 8,显著高于非共同表达组的 39± 7(P <0 0 1)。TGFα表达与p2 1蛋白表达有明显的相关性 (P <0 0 5 )。结论　TGFα和EGFR的过量表达发生于胰腺癌的早期 ,与胰腺癌的起源有关。TGFα与p2 1蛋白的表达在胰腺癌的发生过程中起协同作用。     

TRAIL受体在胰腺癌中的表达

目的 研究肿瘤坏死因子相关凋亡诱导配体（TRAIL）受体在胰腺癌中的表达及意义。方法 应用半定量RT～PCR法检测TRAIL受体（死亡受体DR4、DR5和诱骗受体DcR1、DcR2）mRNA在胰腺癌组织及正常胰腺组织中的表达。结果 死亡受体DR4和DR5在所有胰腺癌组织和正常胰腺组织中均有表达，且在胰腺癌组织中的表达明显强于在正常胰腺组织中的表达（P〈0．01）。诱骗受体DcR1和DcR2在所有正常胰腺组织中均有表达，而在胰腺癌组织中仅有18例表达DcR1，有20例表达DcR2；诱骗受体DcR1和DcR2的表达水平在胰腺癌和正常胰腺组织中差异无统计学意义（P〉0．05）。胰腺癌组织中DR5的表达与肿瘤的分化程度和临床分期有关，分化程度越低，DR5的表达量越低，Ⅲ、Ⅳ期肿瘤DR5的表达显著低于Ⅰ、Ⅱ期（P〈0．05）。DR4、DcR1及DcR2在胰腺癌组织中的表达与肿瘤的分化程度和临床分期无关（P〉0．05）。结论 ①胰腺癌组织中普遍存在TRAIL受体的表达，并存在受体类型的表达差异，TRAIL基因受体在胰腺癌凋亡的调控机理中可能发挥重要作用。②胰腺癌组织中DR5的表达与肿瘤的分化程度及恶性程度相关；死亡受体DR4及诱骗受体DcR1和DcR2不能作为判断胰腺癌分化程度及恶性程度的指标。     

TRAIL受体在胰腺癌中的表达及意义

目的:研究肿瘤坏死因子相关凋亡诱导配体(TRAIL)受体在胰腺癌中的表达及意义。方法:应用半定量RT-PCR,检测TRAILR mRNA在胰腺癌组织,正常胰腺组织及胰腺癌细胞系ASPC-1、Can-pan-2中的表达。结果:死亡受体DR4、DR5在所有胰腺癌组织、正常胰腺组织及胰腺癌细胞系中均有表达,诱骗受体DcR1、DcR2在所有正常胰腺组织及细胞系中均有表达。死亡受体DR4、DR5在胰腺癌组织中有较高的表达,而在正常胰腺组织中呈中低水平表达(P<0.01)。胰腺癌细胞系中死亡受体DR4、DR5呈高水平表达,而诱骗受体DcR1、DcR2仅呈中低水平表达。结论:TRAIL受体在胰腺癌普遍表达,并存在受体类型的表达差异;死亡受体在胰腺癌中高表达,可能在TRAIL诱导胰腺癌细胞凋亡的机制中发挥重要的作用。     

苯乙酸和二甲基甲酰胺对胶质瘤同源盒基因表达影响的比较

目的　观察苯乙酸 (PA)和二甲基甲酰胺 (DMF)诱导分化胶质瘤细胞C6 过程中同源盒(Hox)基因表达的变化。方法　用逆转录 聚合酶链反应 (RT PCR)及图像分析法 ,检测PA、DMF对胶质瘤细胞C6 诱导分化过程中Hox基因组P1、P2、P3及特异Hox基因的表达。Hox基因(组 )表达水平用基因 (组 ) / β 肌动蛋白 (β actin)灰度比值表示。 结果　Hox基因组P2在胶质瘤细胞C6 中表达明显低于P1、P3组 [0 .682 5± 0 .0 987<0 .881 7± 0 .0 73 1 ,0 .860 8± 0 .0 881 ,(P<0 .0 0 1 ) ]。应用PA后 ,P2组HoxB2基因表达明显上调 [0 .776 3± 0 .1 2 4 1 >0 .483 9± 0 .1 34 3 ,(P <0 .0 0 1 ) ] ;应用DMF后 ,HoxB2基因表达无显著变化 ,差异无显著性 (P >0 .0 5)。HoxB4基因在应用PA和DMF前后均未见表达。结论　PA对HoxB2基因mRNA水平的表达有明显的上调作用 ,DMF对Hox基因表达无显著影响     

胰腺癌中血管形成因子和细胞粘附分子的表达研究

目的　探讨CD3 4 和血管内皮生长因子 (VEGF)、细胞间粘附分子 (ICAM 1)在胰腺癌(pancreaticadenocarcinoma ,PAC)组织、慢性胰腺炎组织 (chronicpancreatitis ,CP)中的表达及病理意义 ,明确血管形成在胰腺癌演化过程中所起的重要作用。方法　应用免疫组化Envission方法对 2 4例胰腺癌组织、2 4例慢性胰腺炎组织、7例正常胰腺组织 ,进行了CD3 4 、VEGF、ICAM 1的表达情况的检测。对CD3 4 阳性血管进行MVD计数 ,并结合胰腺癌的病理特征进行分析。结果　癌组织 (4 7 2±9 4 )和慢性胰腺炎组织 (4 0 8± 7 93)中微血管密度明显高于对照组 (9 85± 2 86 ) (P <0 0 1)。VEGF在正常胰腺组织中不表达 ,在胰腺癌组织中VEGF主要表达于肿瘤细胞和导管细胞的胞质中 ,在慢性胰腺炎组织中VEGF在叶间及叶内导管细胞均高表达。细胞间粘附分子ICAM 1在正常对照胰腺组织中未见表达 ,仅见于某些内皮细胞着色 ,在胰腺癌组织及慢性胰腺炎组织中 ,除内皮细胞高表达外 ,肿瘤细胞阳性表达亦较高 ,慢性胰腺炎中ICAM 1亦在叶间及小叶内导管细胞中高表达。结论　我们发现微血管形成及其调控因子、细胞粘附分子与慢性胰腺炎、胰腺癌的生物学行为密切相关 ,在胰腺癌的演变中亦起了不可低估的作用 ,抗血管形成治疗无论是对胰腺癌抑     

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.     

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.     

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.