CD/5-FC系统对胰腺癌裸鼠移植瘤的抗血管形成作用的初步探讨

目的　探讨自杀基因系统对胰腺癌裸鼠移植瘤的微血管形成的抑制作用。方法　构建含大肠杆菌胞嘧啶脱氨酶 (cytosinedeaminase ,CD)基因的腺病毒穿梭载体 pAdTrack CMV CD ,与骨架载体pAdEasy 1在细菌内重组为 pAd CD ,经 2 93细胞包装、扩增 ,氯化铯密度梯度离心制备纯化高效的CD腺病毒液 ,建立胰腺癌裸鼠皮下移植瘤模型 ,观察CD基因的原位治疗及微血管形成抑制情况。结果　含CD基因腺病毒载体经酶切鉴定正确 ,包装纯化后 ,检测病毒滴度为 2× 10 11pfu/ml,体内实验显示CD基因原位转导对裸鼠胰腺癌移植瘤的微血管形成具有较明显的抑制效应。结论　腺病毒介导CD/ 5 FC自杀基因系统 ,不仅可以直接杀灭癌细胞 ,而且还可通过抑制移植瘤微血管的形成来抑制胰腺癌细胞的生长 ,可作为胰腺癌基因治疗的有效方法。     

联合胞嘧啶脱胺酶与尿嘧啶磷酸核糖转移酶基因治疗小鼠胃癌

目的探讨联合应用尿嘧啶磷酸核糖转移酶(UPRT)基因对胞嘧啶脱胺酶(CD)/氟胞嘧啶(5-FC)前药转换酶系统抗瘤作用的增强效应。方法将携带UPRT基因和CD基因的逆转录病毒载体通过PA317细胞包装成完整的病毒颗粒并浓缩和纯化。建立615小鼠胃癌皮下移植瘤模型,瘤内反复多次注射携带UPRT和CD基因的逆转录病毒,同时腹腔内给予5-FC,观察抑瘤效果。结果逆转录病毒介导CD基因瘤内原位转导,同时联合应用5-FC进行治疗,结果发现,在肿瘤接种后第12天,对照组肿瘤体积为(2.367±0.371)cm3,而CD/5-FC治疗组肿瘤体积大小为(0.704±0.358)cm3,肿瘤生长明显受抑(P<0.0005)。联合转导UPRT基因后,于肿瘤接种后第16天,肿瘤体积为(0.731±0.255)cm3,而单独应用CD基因治疗组肿瘤体积为(1.455±0.370)cm3,从而证实联合转导UPRT基因可进一步增强CD/5-FC自杀基因系统的抑瘤作用(P<0.001)。结论联合转导UPRT基因,可显著增强CD/5-FC自杀基因系统的抗瘤效应。     

胞嘧啶脱氨酶对表达不同水平癌胚抗原的大肠癌细胞株的杀伤作用

目的:探讨特异性胞嘧啶脱氨基酶(cytosine deaminase,CD)/5-氟胞嘧啶(5-fluorocytosine,5-FC)系统对表达不同水平癌胚抗原(CEA)的大肠癌细胞株的选择性杀伤作用。方法:用脂质体法将逆转录病毒载体G1CEACDNa和pCD2分别转导入大肠癌LoVo和SW480细胞株。将转染成功pCD2、G1CEACDNa及未转基因之LoVo和SW480细胞分别接种到BALB/c裸鼠皮下。成瘤2周后,每天腹腔注射500mg/kg的5-FC,观察治疗效果。治疗21d后处死动物,肿瘤标本称重后,以RT-PCR法检测目的基因在肿瘤组织中的表达;显微镜下观察肿瘤病理学变化。结果:目的基因在肿瘤组织中获稳定表达。治疗21d后,在LoVo细胞肿瘤中,G1CEACDNa阳性组和pCD2阳性组肿瘤分别重(60.8±15.3)mg和(410.5±56.3)mg,与未转基因组[(3018.5±453.5)mg]比较均有明显差异(p<0.01,t=4.512; P<0.01,t=3.320);G1CEACDNa阳性组与pCD2阳性组比较,亦有显著差异(P<0.05,t=2.375)。在SW480肿瘤细胞中,G1CEACDNa阳性组和pCD2基因阳性组肿瘤分别重(356.5±23.5)mg和(463.5±56.9)mg,与对照组[(3263.5±450.6)mg]比较有显著差异(P<0.01,t=4.547;P<0.01,t=4.475),但G1CEACDNa阳性组与pCD2基因阳性组之间无明显差异(P>0.05)。结论:组织特异性CD/5-FC系统对大肠癌细胞LoVo和SW480均有明显的选择性     

胞嘧啶脱氨酶/5-氟胞嘧啶自杀基因治疗系统对恶性脑胶质瘤荷瘤裸鼠的抗肿瘤作用

目的 评判胞嘧啶脱氨酶/5-氟胞嘧啶(CD/5-FC)自杀基因治疗系统对恶性脑胶质瘤的抗肿瘤效果.方法 采用Lipofectamine2000TM脂质体介导方法将CD基因转染17251恶性胶质瘤细胞系,并接种于裸鼠前臂皮下,成瘤后腹腔注射5-FC(每13500mg/kg体重)10 d,观察荷瘤鼠肿瘤的生长情况,8周后比较转染组与对照组肿瘤的体积与重量,并进行病理形态学分析.结果 U251细胞获得CD基因的成功转染,5-FC用于不同组别荷瘤裸鼠,8周后转染组肿瘤体积(0.09±0.03)cm3和重量(0.28±0.11)g明显小于对照组(1.81±0.77)cm3和(1.63±0.80)g;形态学揭示转染组肿瘤细胞出现明显的凋亡与坏死.结论 裸鼠在体实验研究表明:CD/5-FC自杀基因治疗系统是治疗恶性脑胶质瘤行之有效的手段之一.     

胸苷激酶和胞嘧啶脱氨酶融合基因抑骨肉瘤生长的研究

目的观察单纯疱疹病毒-胸苷激酶/胞嘧啶脱氨酶融合自杀基因(HSV-TK/CD)对裸鼠骨肉瘤生长的影响。方法人骨肉瘤细胞系MG-63细胞于裸鼠成瘤后将其分为6组:(1)PBS对照组;(2)重组腺病毒(adenovirus,Ad)-Lac-Z/GCV 5-FC组;(3)Ad-TK/GCV组;(4)Ad-CD/5- FC组;(5)Ad-TK/GCV Ad-CD15-FC组;(6)Ad-TK-CD/GCV 5-FC组。各组经治疗后观察肿瘤的生长状况及组织病理学改变。结果(2)组与(1)组比较,肿瘤体积与肿瘤坏死程度差异无统计学意义(P>0.05);与(1)、(2)组比较,(3)～(6)组肿瘤的生长均受到明显抑制(P<0.05),且(5)、(6)组与(3)、(4)比较差异有统计学意义(P<0.05)。结论融合自杀基因HSV-TK/CD对裸鼠骨肉瘤生长有明显的抑制作用。     

5-氟胞嘧啶对CD基因修饰的胰腺癌细胞作用的电镜观察

目的　应用微观检查方法探讨 5 氟胞嘧啶 (5 flurocytosine,5 FC)对胞嘧啶脱氨酶 (cyto sinedeaminase ,CD)基因修饰的胰腺癌细胞体外、体内杀伤的作用机制。方法　构建含大肠杆菌胞嘧啶脱氨酶基因的腺病毒载体 ,经包装、扩增后制备纯化高效的CD腺病毒液 ,体外培养胰腺癌细胞并建立胰腺癌裸鼠皮下移植瘤模型 ,电镜下观察转染CD基因及加入前药 5 FC后胰腺癌细胞的微观变化情况。结果　含CD基因腺病毒载体经酶切鉴定正确 ,病毒滴度为 2× 10 11pfu/ml,电镜观察到CD/5 FC系统对胰腺癌的体外杀伤是一种凋亡现象而非坏死 ,而体内实验观察到坏死与凋亡并存 ,同时亦观察到淋巴细胞浸润。结论　CD/5 FC系统对胰腺癌的作用 ,有多种因素及旁观者效应参与其内。体外结果显示 ,凋亡小体的摄入和毒性代谢产物的直接作用可能起主要作用。体内实验结果显示细胞坏死与凋亡并存 ,免疫反应在抑制肿瘤生长中也起着重要作用。     

腺病毒介导胞嘧啶脱氨酶基因对直肠癌细胞的杀伤作用

目的 探讨腺病毒载体介导的胞嘧啶脱氨酶（CD）基因转染和CD/5-FC对直肠癌细胞的杀伤作用。方法 用重组腺病毒介导外源CD基因转移到人直肠癌细胞株HR-8348,通过检测腺病毒的转导效率,CD基因表达,以及集落形成实验,细胞存活率测定,裸鼠移植癌治疗实验,观察分析CD/5-FC对癌细胞的杀伤作用,结果 重组腺病毒介导CD基因转染,在癌细胞中得到高效表达。CD/5-FC系统对转染含CD重组腺病毒HR-8348细胞的集落形成,细胞生长均有明显的抑制作用,而对无CD基因转染癌细胞无影响,在转染和未转染CD基因的HR-8348混合体系中,CD/5-FC除了杀伤转染CD基因的癌细胞外,对周围的无CD转染癌细胞也有明显的杀伤作用。表现出很强的“旁观者效应”。裸鼠皮下移植癌治疗实验结果表明,CD/5-FC对HR-8348实体癌生长抑制率为71.5%。结论 CD/5-FC对腺病毒介导CD基因转染的直肠癌细胞有很强的杀伤作用和显著的“旁观者效应”。     

白介素-2基因增强胞嘧啶脱氨酶基因的抗结肠癌效应

目的探讨联合应用白介素(IL)-2基因与胞嘧啶脱氨酶基因(EC-CD)对结肠癌的治疗效应。方法分别以重组腺病毒载体AdCMVCD、AdCEACD转导EC-CD基因;AdCMVIL-2转导人IL-2基因。分别在体外、内(Balb/cnu/nu裸鼠)研究EC-CD基因联合人IL-2基因对LOVO细胞肿瘤的治疗作用。结果LOVO细胞受AdCMVIL-2感染后,细胞生长有比较明显的抑制。AdCEACD/氟胞嘧啶(5-FC)联合AdCMVIL-2可增强对LOVO细胞的细胞毒作用(P=0.001),肿瘤生长明显抑制(P=0.000),联合治疗的效果与单用AdCMVCD/5-FC接近(P=0.815)。结论联合IL-2基因可明显增强EC-CD基因抗肿瘤效应,且可弥补靶向性载体治疗效率较差的缺点。     

AdKDR-CDglyTK融合基因系统治疗胰腺癌的实验研究

目的 观察腺病毒介导的KDR启动子驱动的CD/TK融合双自杀基因系统(以下简称为AdKDR-CDglyTK)对胰腺癌的治疗作用.方法 采用培养细胞移植法,将人胰腺癌细胞系Capan-2接种于裸鼠背部皮下,建立裸鼠人胰腺癌移植瘤模型.将20只裸鼠随机分为4组,每组5只.分组方法:Ⅰ组:注射重组腺病毒AdKDR-CDglyTK与前药5-FC与GCV;Ⅱ组:仅注射前药5-FC与GCV;Ⅲ组:仅注射重组腺病毒AdKDR-CDglyTKⅣ组:空白对照,不施加任何处理.重组腺病毒AdKDR-CDglyTK采用瘤体内多点注射,5-FC与GCV给药方法采用腹腔内注射的方法,观察各组小鼠的生存状况及肿瘤体积、瘤重、肿瘤生长抑制率、常规病理等指标;应用透射电镜观察细胞超微结构,用TUNEL法检测细胞凋亡率,比较观察各治疗组的治疗效果;并对各组的肿瘤组织行RTPCR的检测,以了解有无双自杀基因CDglyTK的表达.结果 第Ⅰ组裸鼠移植瘤的生长显著受到抑制,第Ⅱ、Ⅲ、Ⅳ组肿瘤生长情况无明显差别.第Ⅰ组肿瘤细胞凋亡指数为(34.20±4.60)%,较对照组显著增加(P=0.00).结论 AdKDR-CDglyTK联合前药5-FC及GCV对人胰腺癌Capan-2细胞具明显的抑制作用,并且诱导裸鼠体内人胰腺癌Capan-2细胞的凋亡.其可能的机制是通过下调凋亡抑制基因Bcl-2的表达.     

腺病毒介导双自杀基因CD/TK对人肝癌细胞株Bel7402的抑制作用

目的探讨含胞嘧啶脱氨酶(CD)／5-氟胞嘧啶(5-Fc)单纯疱疹病毒1型胸腺嘧啶激酶基因融合自杀基因(CD／TK)的重组腺病毒治疗肝癌的疗效。方法重组腺病毒Ad．CD／TK感染人肝癌细胞Bel7402,用噻唑蓝(MTT)方法观察不同浓度5-Fc和无环鸟苷(GCV)对其杀伤效应; 建立Bel7402裸鼠皮下移植瘤模型,瘤内注射Ad．CD／TK,腹腔注射GCV(50 mg／kg体重)和／或5- Fc(500 mg／kg体重)10 d,观察肿瘤生长抑制效应。结果在对感染Ad．CD／TK的Bel7402细胞的体外杀伤实验中,GCV的IC50为(12．1±2．3)μmol／L,5-Fc的IC50为(223±15)μmol／L,并且两者有协同效应。在Bel7402裸鼠移植瘤模型中,联合Ad．CD／TK和GCV、5-Fc能够显著抑制肿瘤的生长。结论腺病毒为载体的双自杀基因转染和前药的应用对人肝癌细胞的体内、体外治疗疗效明显。     

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.     

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.