肺癌组织中肿瘤血管生成的检测及其意义

目的 检测肺癌组织中的血管生成情况,并探讨其与肺癌淋巴结转移、肿瘤细胞凋亡及增殖的关系。方法 应用免疫组化方法标记肿瘤微血管,ＴＵＮＥＬ方法检测肿瘤细胞凋亡,流式细胞术检测肿瘤细胞增殖。结果 肿瘤微血管密度（ｍｉｃｒｏｖｅｓｓｅｌ ｄｅｎｓｉｔｙ,ＭＤ）在各类型肺癌中差异无显著性意义（Ｐ〉０．０５）。Ⅰ期肺癌中ＭＤ显著低于Ⅱ期和Ⅲ期肺癌（Ｐ〈０．０１）。发生淋巴结转移组ＭＤ显著高于无淋巴结转移组（     

瘤内血管密度与胃癌生物学行为的相关性研究

目的探讨肿瘤内血管生成与胃癌淋巴结转移及预后的关系。方法采用免疫组织化学ＳＰ法,用抗ＦⅧ因子多克隆抗体对４０例进展期胃癌内的血管进行标记分析。结果淋巴结转移组血管密度（３０±３）显著高于无淋巴结转移组（２０±３）（Ｐ＜００１）,瘤内血管密度与胃癌病理分型无关（Ｐ＞００５）、与胃癌术后５年生存率呈明显负相关（Ｐ＜００５）。结论瘤内血管密度与胃癌淋巴结转移密切相关,此法对判断胃癌的预后具有重要的临床意义。     

Ⅰ期乳癌骨髓微小癌转移及nm23表达的研究

目的 探讨Ⅰ期乳癌患者原发癌的ｎｍ２３表达及其与骨髓小癌转移（ＢＭＭ）的关系，方法 以抗上皮细胞膜及ｎｍ２３－Ｈ１单克隆抗体为探针，应用免疫组化技术，对５２例Ⅰ期乳癌患者进行ＢＭＭ及乳癌原发灶ｎｍ２３表达进行检测。结果 在Ⅰ期乳癌中，１９．２％（１０／５２）存在ＢＭＭ；在低分化乳癌组中，ＢＭＭ的阳性率（３５．０％，７／２０）明显高于高分化组（９．３％，３／３２）（Ｐ〈０．０５）。在ＢＭＭ阳性组中，     

肾盂癌P16蛋白的表达及意义

目的 探讨Ｐ１６蛋白与肾盂癌病分级、临床分期、预后及肿瘤增生活性的关系。方法：采用免疫组织化学技术对３１例肾盂癌标本中Ｐ１６蛋白表达进行检测。结果 ３１能盂癌Ｐ１６蛋白表达阳性率为５８．１％，其中Ⅰ级、Ⅱ级和Ⅲ级肿瘤阳性率分别为７５．０％、６６．７％和２５．０％（Ｐ〈０．０５），Ｔ１～Ｔ２和Ｔ３～Ｔ４期肿瘤阳性率分别为６６．７％和４６．２％（Ｐ〈０．０５）。显示Ｐ１６蛋白表达阳性率随肾盂癌病理分级     

食管癌组织中P16蛋白表达及其临床意义

目的探讨Ｐ１６蛋白表达在食管癌中的临床意义。方法应用免疫组织化学Ｓ－Ｐ法研究了６１例食管癌组织标本中Ｐ１６蛋白表达与食管癌临床病理特征及预后的关系，以及与增殖细胞核抗原（ＰＣＮＡ）的关系。结果Ｐ１６蛋白阳性表达率为４４．３％，其表达与浸润程度、有无淋巴结转移在统计学上无差异（Ｐ＞０．０５），与分化程度、ＴＮＭ分期有关（Ｐ＜０．０５），与ＰＣＮＡ之间存在相关（Ｐ＜０．０１），与术后肿瘤有无转移、复发在统计学上有差异（Ｐ＜０．０５），Ｐ１６阳性表达组的术后生存时间明显高于阴性组（Ｐ＜０．０１）。结论食管癌组织中Ｐ１６蛋白表达对细胞增殖起负性调控作用，检测其表达有助于对食管癌患者预后的判断。     

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目的 为晚期胃癌合理选择非治愈性手术方式提供依据。方法 按病情程度、生物学行为分组,评价５７８例非治愈性手术的Ⅲｂ、Ⅳ期胃癌病例手术后效果。结果 姑息切除、改道及探查手术三组间,手术越大并发症越多（Ｐ〈０．０５）,手术死亡率差别不大（Ｐ〉０．０５）。术后２年生存率姑息切除明显优于改道和探查组（Ｐ〈０．０５）。无腹膜、肝脏及远处转移组及有腹腔转移、无肝转移组姑息切除术后各年生存率差异均无显著意义（Ｐ     

肿瘤内血管密度与胃癌预后的关系

目的 探讨肿瘤内血管生成与胃癌生物学行为和预后的关系。方法 采用免疫组化ＳＰ法，用抗ＦⅧ因子多克隆抗体对５６例进展期胃癌内的血管进行标记分析，并用Ｃｏｘ模型对瘤内血管密度影响预后的几个临床病理因素进行多因素分析。结果 瘤内血管密度淋巴结转移组（３２．０１±２．３２）明显高于无淋巴结转移组（２０．３６±１．８７，Ｐ〈０．０１），瘤内血管密度与胃癌术后５年生存率呈明显负相关（Ｐ〈０．００５）。结论 瘤     

胃癌及其癌旁病变中p16,nm23—H1基因蛋白的表达及意义

目的：应用免疫组化方法探讨ｐ１６蛋白在胃癌发生中的作用。方法：应用免疫组化方法对５７例胃癌切除标本进行Ｐ１６蛋白和ｎｍ２３－Ｈ１基因产物的表达检测。结果：５７例胃癌中Ｐ１６蛋白表达阳阳性率４０／５７（７０．２％），显著低于癌旁无正常胃粘膜（Ｐ〈０．０１）。胃癌高发化组的阳性率显著高于低分化组（Ｐ〈０．０５），不同临床分期（ＵＩＣＣ分期）及有无淋巴结转移的胃癌病例中，Ｐ１６蛋白的表达差异无显著性。癌     

nm23-H1 基因产物表达与胃癌生物学行为及淋巴结转移规律的关系

目的探讨ｎｍ２３Ｈ１基因表达与胃癌生物学行为及淋巴结转移规律的关系。方法应用免疫组织化学方法观察了ｎｍ２３Ｈ１基因产物／核苷二磷酸激酶（ｎｍ２３／ＮＤＰＫ）在７５例胃癌组织中的表达。结果胃癌ｎｍ２３／ＤＮＰＫ表达阳性率为５９％，在浸透浆膜（Ｔ３、Ｔ４），淋巴结转移５个以上及Ⅱ站以远者，Ⅲ、Ⅳ期和伴腹膜转移的胃癌中表达明显减低（Ｐ＜００５）。在不同大体类型、分化程度和生长方式的胃癌中，ｎｍ２３Ｈ１表达差异无显著意义（Ｐ＞００５）。ｎｍ２３Ｈ１阳性组和阴性组５年生存率分别为６１％和３５％，二者差异有显著意义（Ｐ＜００５）。结论ｎｍ２３Ｈ１基因表达与胃癌浸润转移和预后有关，对评估淋巴结转移程度可能有重要意义     

nm23低表达及c—erb—B2过度表达与乳癌淋巴结转移的关系

目的　探讨ｎｍ２３ 及ｃｅｒｂＢ２ 表达与乳癌生物学行为及淋巴结转移的关系。方法　应用免疫组化ＡＢＣ 法对５８ 例乳癌中ｎｍ２３ 及ｃｅｒｂＢ２ 表达进行测定。结果　ｎｍ２３低表达或ｃｅｒｂＢ２ 过表达者淋巴结转移率明显高于正常表达者（ Ｐ ＜ ０ ．０１ ,Ｐ ＜ ０ ．０１ ） ;在Ⅲ期乳癌中,ｃｅｒｂＢ２ 过表达显著高于Ⅰ期（ Ｐ ＜ ０ ．０５） ;在ｎｍ２３ 低表达组中,ｃｅｒｂＢ２ 过表达率明显高于对照组（ Ｐ ＜ ０ ．０１） 。在ｎｍ２３ 低表达及ｃｅｒｂＢ２ 过表达同时阳性者中,淋巴转移率高达８８．９ ％ 。结论　通过ｎｍ２３ 及ｃｅｒｂＢ２ 表达检测对正确估计肿瘤淋巴道转移的可能性、潜能及预后有较大意义,二者同时呈阳性者意义尤为重大。     

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.