术前超声检查鉴别甲状腺结节良恶性的临床价值

目的探讨术前超声检查鉴别甲状腺结节良恶性的临床价值。方法回顾性分析2019-10—2020-10间于郑州大学第二附属医院行手术治疗并经术后病理检查确诊的316例(372个结节)患者的临床资料。以术后病理结果为“金标准”,评价甲状腺结节良恶性的超声征象及其鉴别结节良恶性的临床价值。结果372个结节的病理结果:恶性结节155个,其中乳头状癌127个(81.93%)、滤泡状腺癌20个(12.90%)、髓样癌8个(5.16%)。良性结节217个,其中滤泡状腺瘤102个(47.00%)、乳头状腺瘤42个(19.35%)、结节性甲状腺肿48个(22.12%)、桥本甲状腺炎25个(11.52%)。以病理学结果为“金标准”,超声检查诊断恶性结节148个,良性结节213个,与病理学结果不符合11个。超声检查鉴别甲状腺结节良恶性的灵敏度为90.96%,特异性为98.16%,准确率为97.04%。阳性预测值为97.37%,阴性预测值为96.82%。结论术前对甲状腺行超声检查,对鉴别甲状腺结节的良恶性有较高的灵敏度、特异性、准确率、阳性预测值和阴性预测值,对临床早期诊断和制订治疗方案具有较高的参考价值。     

声触诊组织量化成像技术鉴别诊断甲状腺影像报告和数据系统4类甲状腺结节

目的探讨声触诊组织量化(VTQ)成像技术对甲状腺影像报告和数据系统(TI-RADs)4类结节的良恶性鉴别诊断价值。方法对88个常规超声评价为TI-RADs 4类的甲状腺结节行VTQ检查。比较VTQ与TI-RADs分类的诊断效能。结果 88个TI-RADs 4类甲状腺结节中,良性结节56个,恶性结节32个。以TI-RADs 4b类和4c类诊断为恶性结节,其诊断敏感度、特异度、阳性预测值、阴性预测值及准确率分别为90.63%(29/32)、57.14%(32/56)、54.72%(29/53)、91.43%(32/35)及69.32%(61/88)。甲状腺恶性结节VTQ值[(3.26±0.94)m/s]明显高于良性结节VTQ值[(2.03±0.61)m/s,t=7.082,P0.001]。VTQ的最佳诊断界值为2.795m/s,其诊断甲状腺结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为78.13%(25/32)、91.07%(51/56)、83.33%(25/30)、87.93%(51/58)及86.36%(76/88)。VTQ值诊断TI-RADs 4类甲状腺结节良恶性的特异度及阳性预测值明显高于TI-RADs分类(P均0.05)。结论 VTQ技术有助于TI-RADs 4类甲状腺结节的良恶性鉴别诊断,值得临床推广。     

超声引导下细针穿刺抽吸活检诊断甲状腺结节

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)对不同大小甲状腺结节的诊断价值。方法回顾分析在我院接受US-FNAB检查的689例患者736个甲状腺结节,超声测量结节最大径,并将其分为<5mm、5～10mm、>10mm组;对结节US-FNAB细胞学诊断结果与术后病理结果或随访结果进行比较,分析组间差异。结果 736个结节中,细胞学诊断恶性132个,可疑恶性61个,良性476个,不满意44个,不确定23个。经术后病理或临床随访,恶性结节208个,良性结节528个。恶性结节最大径小于良性结节(P<0.001)。5～10mm组结节的细胞学阳性率和实际恶性率均大于<5mm组及>10mm组(P均<0.05)。US-FNAB细胞学诊断甲状腺良恶性结节的敏感度为87.02%(181/208),特异度97.73%(516/528),准确率94.70%(697/736)。不同大小甲状腺结节US-FNAB检查的诊断敏感度、特异度、阳性预测值、阴性预测值及准确率差异均无统计学意义(P均>0.05)。结论 US-FNAB是判断甲状腺结节性质的有效手段,对不同大小结节都有较高诊断价值。     

超声造影鉴别诊断甲状腺良恶性结节

目的探讨CEUS鉴别诊断甲状腺良恶性结节的价值。方法回顾性分析62例患者67个甲状腺结节的CEUS表现。结果甲状腺恶性结节CEUS多表现为不均匀增强、边界不清,甲状腺良性结节多表现为周边环状强化。根据不均匀强化诊断恶性结节的敏感度为86.84%,特异度为44.83%,阳性预测值为67.35%,阴性预测值为72.22%;边界不清诊断恶性结节的敏感度81.58%,特异度65.52%,阳性预测值75.61%,阴性预测值73.08%;环状强化诊断良性结节的敏感度41.38%,特异度97.37%,阳性预测值92.31%,阴性预测值68.52%。结论 CEUS对鉴别诊断甲状腺良恶性结节具有一定价值。     

超声TI-RADS分类联合BRAFV600E基因检测在BSRTC Ⅲ类甲状腺结节中的意义

目的探索甲状腺影像报告与数据系统(TI-RADS)联合BRAFV600E对甲状腺细胞病理学Bethesda(BSRTC)分类为Ⅲ类结节的诊断意义。方法选取2018年8月至2020年8月于郑州大学第一附属医院行甲状腺超声引导下细针穿刺(US-FNA)且结果为BSRTC Ⅲ, 共199个结节, 以术后常规病理结果为金标准, 比较TI-RADS、BRAFV600E及两者联合对BSRTC Ⅲ类结节的诊断价值。结果 199个Ⅲ类结节, 术后病理:甲状腺乳头状癌77个, 良性结节122个。TI-RADS分类为4b、4c或5类诊断BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为90.9%、74.5%、69.3%、92.9%、80.9%。BRAFV600E诊断BSRTC Ⅲ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为89.6%、98.4%、97.2%、93.8%、95.0%。TIRADS 4b、4c、5类或BRAFV600E阳性为BSRTC Ⅲ类结节恶性的诊断标准, 其敏感度、特异度、阳性预测值、阴性预测值及准确性分别为98.7%、73.8%、70...     

常规超声TI-RADS分级结合造影检测在甲状腺结节诊断中的临床价值

目的探究常规超声TI-RADS分级结合造影检测在诊断甲状腺结节上的临床价值。方法对2016年1月至2018年12月在本院接受影像学检查的60例甲状腺结节患者(甲状腺结节共计73个)的病历资料进行回顾性分析。所有患者均接受常规超声TI-RADS分级以及超声造影检查,以术后病理学诊断结果为准,对比常规超声TI-RADS分级以及结合超声造影在诊断甲状腺结节良恶性上的诊断价值。结果术后病理学结果显示,60例患者共检出良性结节26个,恶性结节47个。TI-RADS联合造影在诊断甲状腺恶性结节上的准确度、敏感度、特异度以及阳性预测值、阴性预测值分别为91.78%、91.49%、96.15%、97.73%和86.21%,均明显高于TI-RADS(分别为75.34%、76.60%、73.08%、83.72%和63.33%),差异有统计学意义(P0.05)。结论常规超声TI-RADS分级联合超声造影在鉴别诊断甲状腺良恶性结节上效果良好,可显著提升甲状腺良恶性结节的诊断效能。     

SWE与实时组织弹性成像技术在甲状腺结节良恶性鉴别诊断中的价值分析

目的探究采用剪切波弹性成像(SWE)与实时组织弹性成像技术(RTE)对鉴别诊断甲状腺结节良恶性的价值。方法选择2015年10月至2016年10月收治的行甲状腺手术60例患者进行回顾性分析,共68个甲状腺结节。均在术前同时行SWE检查和RTE检查,并且所有患者均接受手术病理证实。结果 SWE检查甲状腺恶性结节的杨氏模值显著高于良性结节,差异有统计学意义(P0.05)。SWE与RTE两种诊断技术的灵敏度、特异度、阳性预测值及阴性预测值之间的差异无统计学意义(P0.05)。RTE诊断直径≤1 cm甲状腺结节良恶性的灵敏度显著高于SWE,差异有统计学意义(P0.05)。SWE技术诊断直径≥3 cm甲状腺结节良恶性的灵敏度、阳性预测值及阴性预测值均高于RTE,差异有统计学意义(P0.05)。结论 SWE与RTE鉴别诊断甲状腺结节良恶性均具有较高诊断价值,SWE对于大结节良恶性鉴别诊断具有更高价值,而直径≤1 cm的甲状腺结节宜采用RTE技术进行诊断。     

超声造影结合弹性成像技术在甲状腺良恶性结节鉴别诊断中的应用

目的研究超声弹性成像联合超声造影术诊断甲状腺良恶性结节的临床价值。方法选取2012年10月至2015年10月经医院确诊为甲状腺良恶性结节的患者纳入130例,其中恶性结节59个,良性93个。对超声弹性成像和超声造影术诊断甲状腺良恶性结节的特异度、敏感度、阴性预测值、阳性预测值及准确率进行评估。结果甲状腺良性结节超声造影检查以快进慢出、高增强为主;恶性结节以慢进快出、低增强为主。超声造影诊断良恶性结节的特异度为92.37%、灵敏度91.16%、阴性预测值93.39%、阳性预测值91.16%、符合率91.86%;超声弹性成像分别为:90.20%、89.69%、92.20%、87.12%、90.00%;两种超声方法联合诊断率分别为:95.63%、94.10%、95.63%、94.10%、95.00%,上述两种诊断方法均优于常规超声检查72.83%、57.35%、69.79%、60.94%、65.63%(P0.05);超声造影术联合超声弹性成像检查显著优于单一检查(P0.05)。结论超声弹性成像与超声造影术诊断鉴别良恶性结节均具有较高的临床应用价值,两种方法结合诊断鉴别可提高准确性和灵敏度,值得推广应用。     

超声规范化检查对甲状腺结节良恶性质的鉴别分析

目的探讨超声规范化检查在甲状腺良、恶性结节诊断中的价值。方法选取2015年2月至2016年3月黄石市中心医院治疗的甲状腺结节患者89例,共131个甲状腺结节,均行灰阶超声以及彩色多普勒超声检测,比较良、恶性结节超声特征。结果 131个结节中良性结节72个,恶性结节59个,良性结节以滤泡增生结节(83.33%)为主,恶性结节以乳头状癌(88.14%)为主。良恶性结节在形态、边界、后方衰减和钙化特征方面差异有统计学意义(χ~2=33.429、19.240、20.520、52.479,均P0.01),而在内部回声方面差异无统计学意义;良、恶性结节在环状血流、穿支血流、分支情况、走形情况、阻力指数方面差异有统计学意义(χ~2=9.133、13.384、15.782、15.728、8.285,均P0.01),而在血流丰富程度方面差异无统计学意义;灰阶超声判断恶性结节的敏感度为67.80%,特异度为73.61%,阳性预测值为67.80%,阴性预测值为73.61%;彩色多普勒超声判断恶性结节的敏感度为73.47%,特异度为73.61%,阳性预测值为65.45%,阴性预测值为80.30%;灰阶超声+彩色多普勒超声判断恶性结节的敏感度为74.58%,特异度为87.50%,阳性预测值为83.02%,阴性预测值为80.77%。结论超声规范化检查在甲状腺良、恶性结节诊断中有较好的应用价值,其中灰阶超声结合彩色多普勒超声诊断价值高,值得临床使用。     

2017版甲状腺影像报告和数据系统诊断甲状腺良恶性结节的价值

目的探讨2017版美国放射学院甲状腺影像报告和数据系统(TI-RADS)在评估甲状腺良恶性结节中的价值。方法采用2017版TI-RADS分类诊断标准,回顾性分析1 039例患者共1 109个甲状腺结节的声像图特征;以粗针穿刺活检或手术病理学结果为金标准,评价2017版TI-RADS对不同类别结节的诊断效能。结果良性结节551个,恶性结节558个;良恶性结节的成分、回声类型、纵横比、边界、有无钙化差异均有统计学意义(P均0.05)。TI-RADS 2～5类结节中,恶性率分别为0、5.45%(3/55)、22.29%(39/175)和58.84%(516/877),差异有统计学意义(P0.001)。以TI-RADS分类≥4为标准,诊断甲状腺恶性结节的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为99.46%(555/558)、9.80%(54/551)、54.91%(609/1 109)、52.76%(555/1 052)和94.74%(54/57)。结论根据2017版TI-RADS分类评估恶性甲状腺结节具有临床应用价值,但特异度较低,分类标准尚需进一步完善。     

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.