甲胎蛋白异质体3含量对早期肝癌的预后价值

目的 探讨甲胎蛋白异质体3(lentil lectin-reactive alpha-fetoprotein-L3,AFP-L3)的含量对早期肝癌的预后价值.方法 97例早期肝癌患者根据术前AFP和AFP-13的含量分为:(1)AFP阳性、AFP-L3阴性组(29例):AFP＞20 μg/L & AFP-13＜15%;(2)AFP-L3、AFP均低含量组(16例):15%≤AFP-L3≤50% & 20 μg/L≤AFP≤200 μg/L;(3)AFP-L3、AFP均高含量组(13例):AFP-L3＞50% & AFP＞200 μg/L;(4)AFP-L3高含量、AFP低含量组(24例):AFP-13＞50%& 20 μg/L≤AFP≤200 μg/L;(5)AFP-L3低含量、AFP高含量组(15例):15%≤AFP-L3≤50% & AFP＞200 μg/L.对各组患者的肿瘤分化程度、术后1、2、3年生存率和无瘤生存率进行分析.结果 AFP-13阴性患者的肿瘤分化程度、术后3年生存率和无瘤牛存率明显优于AFP-L3阳性患者(χ2=21.051,10.043,4.450,6.977,25.566,P＜0.05).AFP-L3高含量组患者的肿瘤分化程度、术后1、2、3年生存率和无瘤生存率明显低于低含量组(χ2=7.938,3.488,9.085,P＜0.05).结论 AFP-L3含量的增高提示肿瘤恶性程度高,预后不良,尤其是AFP水平低时.手术前后检测AFP-L3含量对于患者预后的评价具有指导意义.     

肝动脉化疗栓塞联合射频消融术治疗中晚期肝癌的疗效

目的评价TACE联合射频消融(RFA)治疗中晚期肝癌的疗效。方法回顾性分析72例中晚期肝癌患者,其中35例行TACE联合RFA治疗(联合组),37例行单纯TACE治疗(对照组)。术后随访,比较两组短期疗效、治疗后肝功能、血清甲胎蛋白、并发症以及远期生存率。结果联合组术后总有效率(29/35,82.86%)明显高于对照组(20/37,54.05%;P=0.009)。联合组和对照组术后血清甲胎蛋白降至(102.19±32.13)μg/L、(218.46±49.87)μg/L(P0.001)。联合组1、2、3年生存率分别82.86%、54.29%、34.29%,中位生存期25个月;对照组分别为54.05%、32.43%、13.51%,中位生存期16个月;两组生存率差异有统计学意义(P=0.009)。联合组及对照组治疗后肝功能均有一过性改变,术后2周基本恢复,两组比较差异无统计学意义(P均0.05)。结论 TACE联合RFA治疗中晚期肝癌是有效的综合介入治疗方法。     

合并肝硬化中晚期肝癌TACE治疗后血清AFP检测的意义

目的 探讨合并肝硬化的中晚期肝癌患者血清AFP水平对经肝动脉化疗栓塞术（TACE）治疗预后的意义.方法 收集250例TACE术后的中晚期肝癌合并肝硬化患者的血清,采用放射免疫法测定患者血清AFP的水平.将测定的结果分成AFP升高组（＞20 μg/L,n＝165）例和正常组（＜20 μg/L,n＝85）,并对肝癌患者进行随访（1周～65个月,中位时间21.5个月）.用Kaplan-Meier生存曲线分析患者生存率,评估AFP水平及相关因素对中晚期肝癌患者预后的意义.结果 AFP升高组的1、2、5年生存率为57%、48%、5.1%,AFP正常组为37%、46%、12%.AFP升高组的1年生存率明显高于AFP正常组（P＜0.05）,AFP升高组5年生存率明显低于AFP正常组（P＜0.05）.结论 对于中晚期肝癌的患者,血清AFP水平高者较血清AFP水平低者短期预后好,但远期预后差.     

5-氟尿嘧啶缓释剂间质化疗在结直肠癌根治术中的应用效果和安全性观察

目的观察5-氟尿嘧啶缓释剂间质化疗在结直肠癌根治术中应用的效果和安全性。方法将2011年10月至2013年12月期间入我科行结直肠癌根治术的160例患者作为研究对象。用不完全随机方法将160例行结直肠癌根治术患者随机分成观察组(78例)和对照组(82例)。2组患者均行结直肠癌根治术,术后冲洗腹腔和盆腔;观察组术中植入5-氟尿嘧啶缓释剂进行间质化疗,植入部位为肿瘤切除区域及肠系膜动脉周围;术后2组患者均行常规化疗。观察2组患者术后并发症情况、术后局部复发率、肝转移率及术后24个月时的生存率。结果观察组和对照组患者在腹腔相关并发症及药物毒副作用发生率方面比较差异均无统计学意义(P0.05)。观察组患者术后12个月和24个月复发率分别为1.3%(1/78)和5.2%(4/78),分别明显低于对照组的8.5%(7/82)和23.2%(19/82),差异均有统计学意义(x~2=8.934,P=0.023;x2=14.834,P=0.004)。观察组肝转移率为10.3%(8/78),明显低于对照组的18.3%(15/82),差异有统计学意义(x~2=12.034,P=0.016);观察组术后24个月时的生存率为94.9%(74/78),明显高于对照组的84.1%(69/82),差异有统计学意义(x~2=11.465,P=0.010)。结论 5-氟尿嘧啶缓释剂间质化疗安全性高,可有效降低结直肠癌根治术后的复发率和肝转移率,延长患者生存时间。     

巨噬细胞移动抑制因子在肝癌诊断中的价值

目的 探讨巨噬细胞移动抑制因子(MIF)在肝癌诊断中的价值.方法 试验分为测试研究和验证研究.回顾性分析2004年1月至5月复旦大学附属中山医院收治的269例肝癌患者(测试肝癌组)和390例对照人群(测试对照组);8月至12月收治的173例肝癌患者(验证肝癌组)和257例对照人群(验证对照组);2005年1月收治的80例行根治性肝切除的肝癌患者的临床资料.收集测试研究和验证研究受试者术前体格检查的血浆标本和行根治性肝切除的肝癌患者术前、术后3、7、30 d的血浆标本,同时收集测试肝癌组患者术后的肝癌组织和癌旁(距肿瘤1cm)组织标本.采用ELISA法检测血浆中MIF水平,免疫组织化学法检测组织中MIF表达情况.非正态分布数据用中位数(四分位数间距)[M(QR)]表示,组间比较采用Mann-Whitney U检验,血浆和组织中MIF的关系采用Spearman相关分析,ROC曲线分析MIF的诊断价值.结果 在测试研究中,测试肝癌组和测试对照组受试者血浆MIF中位值分别为85.7 μg/L(58.8 μg/L)和15.5 μg/L(31.6 μg/L).其中测试对照组中的肝硬化患者、良性肝病患者和健康体检者血浆MIF中位值分别为24.9 μg/L( 12.6 μg/L)、12.5 μg/L(7.3μg/L)、13.2 μg/L(7.7 μg/L),两组各受试者血浆MIF比较,差异有统计学意义(F=54.235,P＜0.05).ROC曲线结果表明,当血浆MIF为35.3 μg/L时,可获得最大的曲线下面积.验证肝癌组与验证对照组比较,AUC值、灵敏度、特异度分别为92.1％、90.7％、93.4％.肝癌患者术前和术后3、7、30 d血浆MIF中位值分别为81.0μg/L(54.0μg/L)、76.1 μg/L(47.5 μg/L)、50.9 μg/L(40.7 μg/L)、18.7μg/L(15.1 μg/L),呈时间依赖性降低,术后30 d基本恢复到正常范围内.肝癌组织和癌旁组织MIF的中位表达强度分别为0.083和0.007,两者比较,差异有统计学意义(U=3.975,P＜0.05).肝癌患者血浆中MIF和相应的肝癌组织内MIF表达呈正相关(r=0.759,P＜0.05).结论 MIF与肝癌发生、发展密切相关,MIF可作为肝癌诊断的潜在分子标志物.     

规则性或非规则性肝癌切除术治疗单发小肝癌的预后分析

目的分析规则性或非规则性肝癌切除术治疗单发小肝癌的预后情况。方法回顾性分析2009年2月至2014年2月我院诊治的58例单发小肝癌患者临床资料,将实施规则性切除术者纳入对照组(n=28),实施非规则性切除术者纳入观察组(n=30),术后均随访3年,比较两组手术时间、住院时间、术中出血量、切除肿瘤直径、切缘大小,测定两组手术前后血清白蛋白(Alb)、谷丙转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)水平,并对比术后1~3年内两组复发率、无瘤生存率、总生存率及并发症发生率。结果观察组手术时间(180.23±1.66)min短于对照组,观察组切除肿瘤直径(6.13±1.32)cm、切缘大小(2.71±0.15)cm小于对照组,两组住院时间、术中出血量比较无显著差异(P0.05);术后观察组血清Alb(32.18±1.06)g/L、ALT(26.29±0.11)μmol/L较对照组显著下降,观察组TBIL(18.29±1.33)μmol/L、DBIL(13.24±1.20)μmol/L明显高于对照组(P0.05);观察组术后1年、2年、3年复发率、无瘤生存率、总生存率与对照组同时点比较均无统计学意义(PO.05);观察组术后并发症发生率6.67%低于对照组28.57%(P0.05)。结论非规则性肝切除术治疗单发小肝癌具有手术时间短、切缘小、并发症发生率低优点,术后肝功能恢复较规则性肝切除术好,术后3年内复发率、无瘤生存率、总生存率与规则性手术比较无显著差异,值得在临床推广实践。     

小鼠肝脏部分缺血再灌注损伤模型的建立

目的 建立小鼠肝脏部分缺血再灌注损伤模型并分析损伤评估指标的变化趋势.方法 采用96只7～8周龄的纯系C57BL/6雄性小鼠作为研究对象,建立70％肝脏缺血再灌注损伤模型.按照缺血时间将小鼠分为假手术组和缺血30、60、90 min组,每组24只.各组小鼠分别于再灌注后6、12、24和48 h处死.通过检测血清ALT、AST、TNF-α、IL-6和巨噬细胞炎性蛋白-2(MIP-2)水平以及病理组织学评分、细胞凋亡指数等方法评估各组小鼠肝组织的损伤情况.两独立样本比较采用t检验.结果 术后88只小鼠存活,8只死亡,造模成功率为91.7％ (88/96).假手术组、缺血30、60、90 min组ALT水平分别为(35±24) U/L、(1703±442) U/L、(5133±681) U/L和(8233±808) U/L,缺血30、60、90 min组ALT水平显著高于假手术组(t=6.54,12.97,17.56,P＜0.05);AST水平分别为(87±28) U/L、(2667 ±451) U/L、(6333±778)U/L和(9967±1168) U/L,缺血30、60、90 min组AST水平显著高于假手术组(t=9.89,13.89,14.65,P＜0.05);TNF-α水平分别为(14 ±5) μg/L、(83±14) μg/L、(133±17) μg/L和(202±21) μg/L,缺血30、60、90 min组TNF-α水平显著高于假手术组(t=7.78,11.82,15.34,P＜0.05);IL-6水平分别为(32 ±9) μg/L、(493±168) μg/L、(844±166) μg/L和(1345±198) μg/L,缺血30、60、90min组IL-6水平显著高于假手术组(=4.74,8.46,11.48,P＜0.05);MIP-2水平分别为(37±11) μg/L、(102±35) μg/L、(177±32)μg/L和(279±50) μg/L,缺血30、60、90 min组MIP-2水平显著高于假手术组(t=3.05,7.28,8.19,P＜0.05);细胞凋亡指数分别为1.7％±2.1％、22.7％±8.6％、54.3％±11.2％和76.3％±14.8％,缺血30、60、90 min组细胞凋亡指数显著高于假手术组(t=4.10,8.04,8.63,P＜0.05).在缺血时间相同的情况下,随着再灌注时间的延长,各监测指标呈“抛物线”样变化趋势.结论 小鼠肝脏部分缺血再灌注损伤模型能较好地反映小鼠肝组织的损伤情况.随着缺血时间的延长,小鼠肝脏的缺血再灌注损伤程度逐渐加重;随着再灌注时间的延长,ALT、AST、TNF-α、IL-6、MIP-2以及病理组织学评分和细胞凋亡指数均呈现“抛物线”样变化趋势.     

希罗达对人肝癌组织AFP mRNA表达影响的实验研究

目的　探讨希罗达 (Xeloda)对人肝癌组织AFPmRNA表达的影响。方法　抽提所收集的希罗达治疗组及对照组肝癌组织标本总RNA(共 4 1例 ) ,采用逆转录巢式聚合酶链反应 (RT nestedPCR)技术检测希罗达治疗组及对照组AFPmRNA的表达情况。结果　以RT nestedPCR扩增的AFP基因片段为 10 1bp ,与原设计一致。在希罗达治疗组中 ,2 1例肝癌组织标本中有 12例AFPmRNA呈阳性表达 ,阳性率为 5 7.14 % ;在对照组中 ,2 0例肝癌组织标本中有 18例AFPmRNA呈阳性表达 ,阳性率为 90 .0 0 % ,两者间差异有显著性意义 (P<0 .0 5 )。术后 4周 ,希罗达治疗组血清AFP浓度为 ( 2 3.2± 12 .8) μg/L ,明显低于对照组的 ( 39.6± 2 4 .3) μg/L(P<0 .0 5 ) ,而两者术前血清AFP浓度差异无显著性意义。结论　希罗达能有效抑制人肝癌组织AFPmRNA的表达 ,并降低其表达产物血清AFP浓度。其在治疗原发性肝癌的临床应用价值值得进一步研究     

血清甲胎蛋白作为BCLC C期肝细胞癌免疫联合靶向序贯外科治疗预后标志物的临床研究

目的分析甲胎蛋白预测晚期肝细胞癌患者免疫联合靶向序贯外科手术生存获益的价值。方法收集2018年12月至2021年12月解放军总医院肝胆胰外科医学部收治的免疫联合靶向序贯外科手术切除、初诊时血清甲胎蛋白阳性(>20 μg/L)的巴塞罗那临床肝癌分期(BCLC) C期肝细胞癌患者资料。入组50例患者, 其中男性45例, 女性5例, 年龄(53.0±10.5)岁。根据免疫联合靶向治疗后患者血清甲胎蛋白是否降至正常水平分为甲胎蛋白正常组(n=27, 甲胎蛋白≤20 μg/L)和对照组(n=23, 甲胎蛋白>20 μg/L)。门诊复查或电话随访患者生存和复发情况。Kaplan-Meier法计算生存率, 生存率比较采用log-rank检验。比较两组免疫联合靶向治疗的疗效。单因素和多因素Cox回归分析患者预后影响因素。结果两组均未达到中位生存期。甲胎蛋白正常组1、2年累积生存率分别为95.0%、88.2%, 对照组分别为73.4%、54.1%。甲胎蛋白正常组中位无复发生存期尚未达到, 对照组中位无复发生存期为11个月。甲胎蛋白正常组术后1年无复发生存率为78.1%, 对照组为39.5%。...     

腹腔镜精准肝切除临床应用价值分析

目的探讨腹腔镜精准肝切除与开腹常规肝切除治疗原发性肝癌的疗效。方法选取我院2013年5月~2015年5月原发性肝癌70例,按按照入院时间顺序编号,采用随机数字表随机分为对照组(n=35)与观察组(n=35),对照组接受开腹常规肝切除手术,观察组接受腹腔镜精准肝切除手术。比较2组患者手术情况、术后肝功能、并发症和预后等指标。结果观察组与对照组手术时间分别为(102.4±23.1)、(98.3±21.3)min,2组比较无明显差异(t=0.772,P=0.221)。观察组术中出血量(214.6±37.5)ml,明显少于对照组(379.3±45.1)ml(t=-16.612,P=0.000)。观察组住院时间(8.5±2.5)d,明显短于对照组(12.4±3.2)d(t=-5.682,P=0.000)。观察组术后AST(10.5±2.3)U/L,明显低于对照组(15.2±1.9)U/L(t=-9.320,P=0.000);ALT(21.4±2.8)U/L,明显低于对照组(30.2±3.3)U/L(t=-12.030,P=0.000);ALB(56.4±2.4)g/L,高于对照组(42.3±2.0)g/L(t=26.701,P=0.000);TBIL(17.3±1.6)μmol/L,明显高于对照组(15.6±1.1)μmol/L(t=5.180,P=0.000)。观察组并发症发生率5.7%(2/35),明显低于对照组22.9%(8/35,χ~2=4.200,P=0.040)。术后6个月观察组复发转移率3.1%(1/32),对照组转移复发率12.1%(4/33),2组患者转移复发率无明显差异(χ~2=0.801,P=0.371)。2组生存率log-rank检验存在显著差异(χ~2=5.300,P=0.021)。结论腹腔镜精准肝切除治疗原发性肝癌可行,具有创伤小、安全性高等特点,值得临床推广。     

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.