膀胱移行细胞癌Mta-1表达及与ER、u-PA/PAI-1、MVD的相关性研究

目的 研究膀胱移行细胞癌（BTCC）中转移相关基因（Mta-1）表达，分析其与BTCC临床分期、病理分级、转移及复发的关系，探求其可能的分子作用机制。方法 免疫组化方法检测42例BTCC组织Mta-1、雌激素受体（ER）、尿激酶型纤溶酶原激活物（u-PA）、Ⅰ型纤溶酶原激活物抑制物（PAI-1）的表达；CD34标记血管内皮细胞，计数肿瘤组织微血管密度（MVD）；分析Mta-1与BTCC的侵袭转移、血管生成及复发间的关系及Mta-1表达与ER、u-PA、PAI-1表达及MVD的相关性。结果 BTCC Mta-1蛋白表达阳性率为73．8％（31／42），正常膀胱组织无一例阳性表达，P〈0．01；Mta-1蛋白表达阳性率随BTCC临床分期及病理分级的升高而增加，肿瘤复发组（100．0％，15／15）高于无复发组（59．3％，16／27），肿瘤转移组（100．0％，14，／14）高于无转移组（60．7％，17／28）（P〈0．05）。BTCC组织中ER表达阳性率随肿瘤临床分期和组织学分级的升高而降低；有转移者14例均无表达（0．0％），28例未转移者中13例有表达（53．6％）（P〈0．05）；复发组15例中仅1例表达（6．7％），未复发组27例中12例表达（44．4％）（P〈0．05）。BTCC中ER与Mta-1蛋白表达呈负相关（r=-0．739，P〈0．01）。BTCC组织和正常膀胱组织中u-PA表达阳性率分别为59．5％（25／42）和16．7％（2／12），BTCC组明显高于对照组（P〈0．05）。BTCC中u-PA蛋白表达与Mta-1蛋白表达呈正相关（r=0．875），而与PAI-1蛋白表达呈负相关（r=-0．535）。PAI-1表达阳性率对照组（50．0％，6／12）明显高于BTCC组（19．0％，8／42）（P〈0．05）。PAI-1蛋白表达与Mta-1蛋白表达呈负相关（r=-0．706）。BTCC中MVD与Mta-1蛋白表达呈正相关（r=0．683）。结论 Mta-1在BTCC中高度表达，并随肿瘤临床分期和病理分级的升高而增加，与肿瘤的转移及复发密切相关。Mta-1参与BTCC的侵袭、转移，可能与上调u-PA蛋白、下调PAI-1蛋白的表达，促进血管生成有关。Mta-1在BTCC侵袭和转移中的作用亦与ER的负调节机制有关。     

膀胱移行癌中HYAL-1、CD44v6及MVD的临床意义

目的探讨膀胱移行细胞癌（BTCC）中1型透明质酸酶（HYAL-1）、CD44v6的表达、微血管密度（MVD）及其在预后中的意义。方法用免疫组化SABC法对54例BTCC标本和6例正常膀胱黏膜组织中HYAL-1、CD44v6及MVD检测并分析HYAL-1、CD44v6及MVD与BTCC生物学特性和预后之间的关系。结果 HYAL-1在BTCC中有较高水平的表达（59.3%）,其表达阳性率随着BTCC临床分期、病理分级的升高而增加（P〈0.05）,与肿瘤的数目、复发及预后密切相关（P〈0.05）,与MVD有关（r=0.26,P=0.01）。CD44v6在BTCC中的表达随着肿瘤分级、分期的增高而逐渐减弱或缺失（P〈0.05）;MVD则随着临床分期和病理分级的提高,其相应的值也明显增加（P〈0.01）,与肿瘤复发明显相关（P〈0.01）。结论 HYAL-1可能是判断BTCC患者预后的独立指标。     

EphB4在膀胱移行细胞癌中的表达及其与肿瘤微血管密度的关系

目的：研究EphB4在膀胱移行细胞癌组织中表达的意义及其与肿瘤微血管密度（MVD）的关系。方法：应用免疫组织化学方法检测44例膀胱移行细胞癌组织中EphB4蛋白的表达，同时采用CD34标记微血管进行肿瘤MVD计数。结果：EphB4的表达与膀胱移行细胞癌的病理分级和临床分期呈正相关（P〈0．05）；EphtM阴性组与EphB4阳性组之间肿瘤MVD计数的差异具有统计学意义（P〈0．01）；EphB4阳性程度不同的两组间的差异无统计学意义（P〉0．05）。结论：EphB4的表达与膀胱移行细胞癌的恶性程度以及与肿瘤血管的形成均密切相关，有可能成为膀胱移行细胞癌靶向治疗的新靶点。     

Ⅱ型环氧合酶在膀胱移行细胞癌中的表达及与肿瘤血管发生的关系

目的:研究Ⅱ型环氧合酶(Cox -2)在膀胱移行细胞癌中的表达,探讨它与膀胱癌病理分级及临床分期的关系及其临床意义,并研究它与血管内皮细胞生长因子(VEGF)及微血管密度(MVD)表达的关系,从而探讨Cox- 2在膀胱肿瘤血管发生中所起的作用。方法:应用免疫组化方法检测Cox- 2、VEGF及MVD在94 例膀胱移行细胞癌、12例膀胱良性病变和5例膀胱癌旁正常组织中的表达。结果:Cox- 2的表达随着膀胱癌分级分期的上升而呈上升趋势(P<0.05);在膀胱癌中,Cox 2 表达与VEGF表达( r=0.716, P=0.000)关系十分密切,与MVD表达存在明显相关性( r=0.458,P=0.000)。结论:Cox- 2在膀胱癌中均为高表达,它的表达参与了肿瘤的发生及恶性进展,并且与膀胱肿瘤新生血管发生有着密切关系。     

膀胱癌bFGF、MVD与其组织学分级及预后的关系

目的 :探讨成纤维细胞生长因子 (b FGF)在膀胱移行细胞癌中的表达及与肿瘤微血管密度 (MVD)的关系 ,并分析两者与膀胱癌病理分级、临床分期的关系。方法 :应用免疫组织化学方法 (L SAB)检测 6 7例膀胱移行细胞癌、9例正常膀胱组织中的 b FGF表达 ,同时测定 MVD。结果 :膀胱癌组织中 MVD明显比正常膀胱组织高(P <0 .0 1) ,分化越差 MVD越高 ,而高分化膀胱癌的 MVD与正常膀胱组织 MVD的差异无显著性意义 (P >0 .0 5 ) ;有肌层浸润组 MVD明显高于无肌层浸润组 (P <0 .0 1) ;术后肿瘤复发组 MVD显著高于未复发组 (P <0 .0 1) ;5年死亡组 MVD显著高于 5年生存组 (P <0 .0 1)。 b FGF在正常膀胱组织中无表达或低表达 ,在膀胱癌组织中为强表达 (72 .8% ) ,并与 MVD呈正相关 (P <0 .0 5 ) ,与膀胱癌病理分级和临床分期密切相关 (P <0 .0 5 )。结论 :b FGF、MVD与膀胱癌组织学分级和预后密切相关 ,膀胱移行细胞瘤是典型的血管依赖性病变     

凋亡抑制因子Livin在膀胱移行细胞癌组织中的表达及意义

目的：研究凋亡抑制蛋白家族(IAP家族)新的凋亡抑制因子Livin在膀胱移行细胞癌(BTCC)中的表达及其与肿瘤分级、分期、复发之间的关系。方法：采用免疫组织化学SP法,对54例BTCC和8例正常膀胱组织中Livin的表达情况进行检测,分析其在膀胱癌组织和非膀胱癌组织中的表达及其与肿瘤病理学分级、临床分期和患者复发情况的关系。结果：Livin在8例正常膀胱组织中均不表达,而在54例膀胱移行细胞癌组织中表达率为85．2%(P＜0．01)。Livin的表达和膀胱移行细胞癌的病理分级、临床分期、是否复发无明显相关(P＞0．05)。结论：细胞凋亡抑制因子Livin在BTCC组织中表达上调,提示Livin可能通过抑制细胞凋亡,对BTCC的发生发展起重要作用;Livin在膀胱癌中的高表达有望成为一种有效、敏感的瘤标,并为BTCC的基因治疗提供新的靶点。     

膀胱移行细胞癌中微血管密度检测的临床意义

目的 探讨检测膀胱移行细胞癌（BTCC）组织中微血管密度（MVD）的临床意义。方法 应用免疫组织化学LDP法检测61例BTCC，10例正常膀胱组织的MVD。结合临床病理资料进行分析和评价。结果 ①BTCC组织中MVD明显比正常膀胱组织高（P〈0．01）；②浸润型BTCC组MVD明显高于浅表型BTCC组（P〈0．01）；③肿瘤分化越差MVD值越高（P〈0．01）；④高MVD组较低MVD组复发率高（P〈0．01）。结论 MVD与BTCC组织学分级、临床分期和预后密切相关，是BTCC细胞生物学行为的一种较理想的标志物。     

血小板源性生长因子-D在膀胱癌中的表达及其临床意义

目的 观察血小板源性生长因子-D(PDGF-D)在膀胱移行细胞癌(BTCC)中的表达,探讨PDGF-D与膀胱移行细胞癌的发生发展之间的关系及其临床意义.方法 分别采用实时定量逆转录-聚合酶链反应(real-time RT-PCR)法和蛋白免疫印迹(Western blot)法检测62例膀胱移行细胞癌组织、10例癌旁正常膀胱组织中PDGF-D mRNA和蛋白的表达,并分析其与临床病理之间的关系.结果 PDGF-D mRNA在BTCC中的表达量是正常对照组的1.89倍,PDGF-D蛋白在癌组织中的表达明显高于正常膀胱组织(相对吸光度比值:正常组0.231±0.041,癌症组0.689±0.083,P＜0.05).而且随着肿瘤病理分级的升高及淋巴结转移的出现,PDGF-D mRNA和蛋白的表达水平均逐渐升高,各组问差异有统计学意义(P＜0.05).但不同分期的癌组织中PDGF.D mRNA和蛋白的表达水平的差异无统计学意义(P＞0.05).结论 PDGF-D表达增强与膀胱癌的发生及分化、转移密切相关,可能在膀胱癌的发生发展中发挥重要作用.     

Skp2和P27kip1在膀胱移行上皮细胞癌中的表达及意义

目的:探讨Skp2和P27kipl在膀胱移行上皮细胞癌(BTCC)中的表达及临床意义.方法:采用免疫组化SP法观察74例BTCC和13例正常膀胱黏膜石蜡标本中Skp2和P27kipl的表达情况,并结合临床资料分析它们的免疫活性在正常膀胱黏膜和膀胱移行上皮细胞癌上表达的差异,以及和肿瘤分级、分期、等病理参数之间的关系.结果:膀胱移行上皮细胞癌中Skp2和P27kipl阳性表达率分别为43.24%和45.95%.Skp2在BTCC中的阳性表达率明显高于正常膀胱黏膜(7.69%),在BTCC中随病理分级升高而升高,但与临床分期无明显的统计学意义,复发组高于初发组,在初法或复发组及瘤体大小组没有明显的统计学意义;P27kipl在BTCC中的阳性表达率低于正常膀胱黏膜(76.92%),并随病理分级、临床分期升高而下降,在初发组高于多复发组,其他两组病理参数组则没有明显的统计学意义;Skp2与P27kipl二者在BTCC中的表达呈负相关性(r=-0.335,P=0.004)并具有统计学意义.结论:Skp2和P27kipl在膀胱移行上皮细胞癌中的表达是判断其生物学行为的重要指标之一,并可能为以后治疗肿瘤提供一个新的靶点.     

人丝氨酸蛋白酶抑制因子HAI-1在膀胱移行细胞癌中的表达及意义

目的 检测HAI-1基因在膀胱移行细胞癌(BTCC)中的表达,探讨与BTCC临床病理参数间的关系及其临床意义.方法 应用免疫组化SP法检测HAI-1在BTCC及正常膀胱黏膜中的表达,并结合临床病理资料分析.结果 HAl-1在BTCC及正常膀胱组织中均有表达;在BTCC中的表达阳性率明显低于正常膀胱组织,差异有统计学意义(P＜0.001);HAI-1表达随肿瘤病理分级、临床分期的升高、肿瘤转移的发生而显著性降低(P＜0.001).结论 HAI-1异常表达在BTCC的发生发展过程中可能具有重要作用,HAI-1蛋白可作为判断BTCC恶性程度及预后的新型生物学标记.     

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.