蛋白激酶Cα、βⅡ、ε、ζ在结肠癌组织中的表达及意义

为探讨蛋白激酶C（proteinkinaseC,PKC）α、βⅡ、ε、ζ在结肠癌组织中的表达及其与结肠癌发生、发展及转移的关系,采用免疫组织化学SP法检测64例原发性结肠癌（其中管状腺癌52例,包括高分化腺癌9例,中分化腺癌28例,低分化腺癌15例;黏液腺癌12例）及其淋巴结转移灶中PKCα、βⅡ、ε、ζ的表达情况。结果显示,PKCα、βⅡ在管状腺癌组织中的阳性表达率均高于黏液腺癌,P〈0．05;而PKCε在管状腺癌组织中的阳性表达率低于黏液腺癌,P〈0．05。在结肠癌淋巴结转移灶中PKCα的阳性表达率明显低于原发灶,P〈0．05。PKCε在管状腺癌高分化组的阳性表达率明显低于低分化组,P〈0．05,在各个肿瘤类型中,PKCζ的阳性率均较高,在90．0％以上。结果表明,PKCα、βⅡ、ε表达可能与结肠癌病理类型有关,而PKCε在黏液腺癌组织中的高表达可能与黏液分泌有关;PKCα可能在结肠癌的浸润、转移中起重要作用;PKCε高表达可能与结肠癌分化程度有关,PKCζ的阳性率较高,可能与肿瘤细胞的增殖或凋亡有关。     

金属硫蛋白和肿瘤增殖抗原在肾癌组织中的表达及意义

目的　探讨金属硫蛋白 (MT)和肿瘤增殖抗原 (Ki 67)在肾癌组织中的表达及意义。　方法　应用免疫组化SABC法检测 5 9例肾癌患者组织标本及 19例正常肾组织标本中MT及Ki 67蛋白表达 ,流式细胞术检测DNA含量及S期比例。　结果　MT在肾癌及正常肾组织中的阳性表达率分别为 5 2 .5 %和 78.9% (P <0 .0 5 ) ;G1表达率高于G2 、G3(P <0 .0 1) ,Ⅰ、Ⅱ期高于Ⅲ、Ⅳ期 (P <0 .0 5 ) ,有无淋巴结转移之间差别有显著性意义 (P <0 .0 1) ,不同直径肿瘤之间差别无显著性意义 (P>0 .0 5 )。MT( )及MT( - )患者术后 5年生存率分别为 5 8.1%和 2 8.6% (P <0 .0 5 )。肾癌组织Ki 67指数高于正常肾组织 (P <0 .0 1) ,且与病理分级、临床分期相关 ;Ki 67指数较高者 ,MT表达率较低 ,MT表达率及Ki 67指数分别与S期比例显著相关。　结论　MT及Ki 67蛋白可能参与肾癌的发生、进展及转移过程 ,可作为肾癌细胞增殖及预后估计的参考指标。     

Smad4在膀胱癌发生中的作用

目的　探讨Smad4 在膀胱癌发生中的作用。　方法　采用免疫组化方法对 4羟丁基亚基硝胺 (BBN)诱导大鼠膀胱癌组织Smad4 表达进行观察分析。　结果　Smad4 在增生膀胱粘膜中阳性表达率为 2 4% (5 / 2 1) ,膀胱癌组织中为 5 3% (17/ 32 ) ,P <0 .0 5。G1阳性表达率 35 % (7/ 2 0 ) ,G2 83 %(10 / 12 ) ,P <0 .0 5。Ta阳性表达率 36 % (8/ 2 2 ) ,T190 % (9/ 10 ) ,P <0 .0 5 ,差别均有显著性意义。随BBN作用时间延长膀胱癌组织Smad4 阳性表达率升高。　结论　Smad4 与大鼠膀胱癌形成有关 ,随病理分期、细胞分级增高阳性表达率升高。     

乳腺癌中雌激素受体亚型对血管内皮细胞生长因子表达的影响

目的　评价人乳腺癌新鲜标本中不同雌激素受体 (ER)亚型和血管内皮细胞生长因子(VEGF)的关系 ,探讨其在肿瘤血管生成中可能的作用。　方法　收集乳腺癌患者手术标本 86例 ,用蛋白质印迹法检测ERβ和VEGF含量 ,应用免疫组织化学的方法检测ERα的含量 ,对ER亚型和VEGF表达关系进行比较。　结果　 86例乳腺癌患者中VEGF高表达 4 4例 (5 1 2 % ) ,低表达 4 2例(48 8% )。VEGF与ERα表达差异无显著性意义 (P >0 0 5 ) ,但和ERβ表达差异有非常显著性意义 (χ2=7 36 ,P <0 0 1) ,ERβ高表达患者 ,VEGF水平明显升高。　 结论　乳腺癌患者中VEGF蛋白表达可能受ERβ亚型的影响。     

Fas配体诱导淋巴细胞凋亡与肾癌免疫攻击作用

目的　探讨Fas配体 (FasL)诱导淋巴细胞凋亡与肾癌免疫攻击作用的关系。　方法　采用免疫组化技术检测 4 4例肾癌组织FasL表达及肿瘤周围浸润淋巴细胞 (TIL)凋亡情况 ,并应用肾癌细胞株 786 0、GRC 1与JurkatT淋巴细胞共培养检测T细胞凋亡率。SP法检测Ki6 7表达 ,评价肾癌预后。　结果　 (1) 4 4例肾癌组织FasL表达阳性率 4 6 .5 % ,高于正常肾组织的 2 3.2 % ,差别有显著性意义 (P <0 .0 1)。随肾癌分期增加 ,FasL表达阳性率增加。肾癌FasL表达率与Ki6 7表达率呈显著正相关 (r =0 .93,P <0 .0 1)。 (2 )肾癌组织TIL凋亡率为 33.9% ,高于正常肾组织的3.5 % ,差别有显著性意义 (P <0 .0 1)。肾癌FasL表达率与TIL凋亡率呈显著正相关 (r =0 .96 ,P <0 .0 1)。 (3) 786 0FasL表达率 18.6 % ,GRC 1表达率 2 .3% ,二者差别有显著性意义 (P <0 .0 1)。Ju rkat细胞与 786 0细胞共培养的凋亡率 14 .9% ,与GRC 1共培养的凋亡率 1.3% ,二者差别有显著性意义 (P <0 .0 1)。中和抗体NOK 2中和 786 0细胞FasL后 ,与之共培养的Jurkat细胞凋亡率显著减少 (P <0 .0 1)。　结论　肾癌组织FasL表达增高 ,以此诱导淋巴细胞凋亡 ,实现对宿主的免疫攻击。     

低氧诱导因子2和血管内皮生长因子在膀胱癌中的表达及意义

目的　探讨低氧诱导因子 2 (EPAS1/HIF 2α)和血管内皮生长因子 (VEGF)在膀胱移行细胞癌中的表达意义。　方法　应用免疫组织化学技术检测 6 0例膀胱移行细胞癌 [Ⅰ级 2 8例 ,Ⅱ级 12例 ,Ⅲ级 2 0例 ;浅表性膀胱癌 (Tis～T1) 2 9例 ,浸润性 (T2 ～T4) 31例 ]和 8例正常膀胱组织中EPAS1/HIF 2α和VEGF的表达情况 ,χ2 检验分析其表达与膀胱癌分级和分期间的关系。　结果　EPAS1/HIF 2α和VEGF在正常膀胱组织中不表达 ,而在膀胱癌组织表达较强。 6 0例膀胱癌标本中EPAS1/HIF 2α阳性表达 34例 ,阴性 2 6例。病理分级Ⅰ级标本阳性表达 4例 (14 .3% ) ,Ⅱ级 11例 (91.7% ) ,Ⅲ级 19例(95 .0 % )。浅表性癌中阳性 5例 (17.2 % ) ,浸润性癌中阳性 2 9例 (93.5 % )。EPAS1/HIF 2α与肿瘤的病理分级 (r =0 .86 2 ,P <0 .0 0 1)和临床分期 (r=0 .80 5 ,P <0 .0 0 1)密切相关。 6 0例膀胱癌标本中VEGF阳性表达 4 4例。病理分级Ⅰ级标本阳性表达 12例 (42 .8% ) ,Ⅱ级 12例、Ⅲ级 19例均阳性表达。浅表性膀胱癌中阳性表达 14例 (48.3% ) ,浸润性癌中阳性表达 30例 (96 .8% ) ,VEGF表达与肿瘤病理分级 (r=0 .84 1,P <0 .0 0 1)和临床分期 (r =0 .819,P <0 .0 0 1)密切相关。EPAS1/HIF 2α表达与VEGF表达密切相关 (r=     

蛋白激酶C在肾盂输尿管癌细胞增殖及多药耐药中的作用

目的 探讨蛋白激酶C(PKC)在肾孟输尿管癌细胞增殖和多药耐药中的作用和意义。方法 采用免疫组化SP法对41例肾孟输尿管癌PKC，PCNA，MDR—PGP表达进行研究。结果 PKC阳性表达率为61％，T2/T3期与T1期比较有统计学意义(P＜O．05)，G2／G3级与G1级比较有明显差异(P＜O．05)。PCMA Ⅲ/Ⅳ级与I／Ⅱ级表达、T2/T3期与T1期比较均有显差异(P＜O．01)，G2/G3级与G1级比较有明显差异(P＜O．05)，同时发生多器官癌明显高于单发肾孟输尿管癌(P＜O．01)。MDR-PGP阳性表达率为63．4％，T2/T2期表达明显高于T1期(P＜O．05)，G2/G3级表达显高于与G1级(P＜O．01)。PKC、MDR—PGP阳性表达，PCNA增殖指数高，术后再发膀胱癌明显高于阴性表达和PCNA增殖指数低(P＜O．01)。PKC与PCNA表达显相关(P＜O.01)。PKC与MDR-PGP表达明显相关(P＜0．05)。PKC，MDR-PGP阳性表达，PCNA增殖指数高5a生存率分别低于阴性表达和PCNA增殖指数低(P＜O．05)。结论 PKC与肾孟输尿管细胞癌增殖和多药耐药密切相关，可能是判断肾孟输尿管癌预后的指标之一。     

ERβ蛋白在原发性乳腺癌中的表达及其意义

采用免疫组化PV 90 0 0法检测 46例原发性乳腺癌组织中的ERβ蛋白的表达 ,分析ERβ蛋白与乳腺癌临床病理生物学参数的关系。结果示 46例原发性乳腺癌组织中 ,ERβ的阳性表达率为5 8.7% (2 7/ 46) ,ERβ与ERα表达相关 ,在ERα( )组和ERα(-)组中其阳性表达率分别为 71%和3 3 .3 % ,两组差别有显著性 (P <0 .0 5 )。ERβ的表达与患者的年龄、绝经与否、肿瘤大小、淋巴结状况、组织学分级及PR均无关 (P >0 .0 5 )。ERβ表达与ERα相关 ,提示其在原发性乳腺癌的预后与内分泌治疗耐药中可能有一定价值     

蛋白激酶C在异氟醚诱导原代培养大鼠心肌细胞分泌血管内皮生长因子中的作用

目的 探讨蛋白激酶C(PKC)在异氟醚诱导原代培养大鼠心肌细胞分泌血管内皮生长因子(VEGF)中的作用.方法 1～3 d SD新生大鼠,分离培养原代心肌细胞,随机分为6组(n=6):对照组(C组)培养后的细胞不经任何处理;不同浓度异氟醚组(Ⅰ1组～Ⅰ3组)细胞分别经0.7%、1.4%、2.1%异氟醚处理6 h;PKC抑制剂组(P组)细胞培养液中给予PKC抑制剂--calphostin C,终浓度50 nmol/L;PKC抑制剂+异氟醚组(PI组)心肌细胞培养液中加入calphostin C 50 nmol/L后,置入无菌密闭容器,持续输入1.4%异氟醚6 h.采用ELISA法测定细胞培养液VEGF浓度,Western blot法测定心肌细胞PKC亚型的表达.结果 与C组比较,Ⅰ2组和Ⅰ3组细胞培养液VEGF浓度升高,Ⅰ2组胞浆PKCε表达下调,胞膜PKCε表达上调(P＜0.01),胞浆和胞膜PKCα、PKCδ和PKCζ表达差异无统计学意义(P＞0.05),P组上述指标差异无统计学意义(P＞0.05).与胞膜比较,C组和Ⅰ2组胞浆PKCα、PKCδ和PKCζ表达上调(P＜0.05).随异氟醚浓度升高细胞培养液VEGF浓度升高(P＜0.05).与Ⅰ2组比较,PI组细胞培养液VEGF浓度降低(P＜0.05).结论 异氟醚可通过PKCε从胞浆转位到胞膜的途径诱导心肌细胞分泌VEGF,是异氟醚心肌保护作用的机制之一.     

早期肾癌保肾手术切除范围的探讨

目的　探讨直径 4cm以下肾癌保肾手术的安全切除范围。　方法　直径≤ 4cm肾癌根治术标本 82例 ,标本分层切开 ,确定多中心病灶 ,假包膜外 15mm范围连续取材确定假包膜完整性及可能存在的假包膜外癌性浸润灶 ,并测量包膜外癌灶与原发灶的最大距离。采用免疫组织化学技术检测 41例直径≤ 4cm肾癌的增值细胞核抗原 (PCNA)蛋白表达 ,其中假包膜外癌灶阳性组 8例 ,阴性组 3 3例。　结果　 82例肾癌平均直径 (3 4± 0 8)cm (1 5～ 4 0cm)。其中 3 1 7% (2 6/82 )缺乏完整假包膜 ,17 1% (14/82 )存在 1种以上假包膜外癌灶 ,其中肾实质浸润 8例 ,小静脉癌栓 2例 ,多中心病灶 4例。假包膜外癌灶与原发灶距离平均 (0 5± 1 3 )mm ,95 %可信区间 (0 11,0 94)。取单侧百分位数P95为 4 9mm ,P97 5、P10 0 均为 5 0mm。 41例肾癌平均PCNA指数为 (2 9 5± 17 6) % (5 5 %～85 6% ) ,其中阳性组为 (49 6± 2 1 5 ) % ,明显高于阴性组 (2 4 6± 12 7) % (t=3 162 ,P =0 0 13 )。阳性组 8例中 ,PCNA高表达 5例 ,而阴性组 3 3例中 ,高表达率仅 18 2 % (6/3 3 ) ,(χ2 =6 44 2 ,P =0 0 11)。结论　直径≤ 4cm肾癌保肾手术安全切缘须包括假包膜外 5mm以上的正常肾实质。单纯肿瘤剜除术易造成肿瘤残留及局部复发     

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.