BRMS1蛋白在乳腺癌中的表达及临床意义

目的 探讨乳腺癌组织中BRMS1(breast cancer metastasis suppressor 1)蛋白的表达及其临床意义.方法 采用免疫组织化学EliVision二步法检测80例乳腺癌、20例癌旁正常组织、15例正常乳腺组织中BRMS1蛋白的表达,并对其与临床病理特征的关系进行分析.结果 BRMS1蛋白在乳腺癌组织中的阳性表达率为40%(32/80),显著低于癌旁正常乳腺组织80%(16/20)和正常乳腺组织100%(15/15),P＜0.05.在TNM分期中Ⅰ期和Ⅱ期的表达阳性率(52.63%、54.55%)显著高于Ⅲ期的阳性表达率(14.29%),P＜0.05,在有腋窝淋巴结转移的乳腺癌组织中BRMS1蛋白表达率(14.71%)显著低于无腋窝淋巴结转移组(58.70%),P＜0.05,且与乳腺癌组织中ER表达状态相关(P＜0.05).结论 BRMS1蛋白表达下调可能促进了乳腺癌的侵袭、转移过程的发生发展.     

Pokemon、E-cadherin和CD44v6蛋白在乳腺癌组织中的表达及其与影像学特征的关系

目的 检测Pokemon、E-cadherin和CD44v6蛋白在乳腺癌组织及癌旁组织中的表达,探讨其与影像学表现的关系.方法 60例新鲜乳腺癌标本,所有标本均含有乳腺癌组织及癌旁组织,采用免疫组织化学法分别检测Pokemon、E-cadherin和CD44v6蛋白的表达.用B超观察乳腺癌的影像学特征.结果 乳腺癌组织中Pokemon蛋白表达率为75.0%,高于癌旁乳腺组织中Pokemon蛋白表达率31.7%(P＜0.05),乳腺癌组织中E-cadherin蛋白的阳性表达率(55.0%)明显低于癌旁乳腺组织中E-cadherin蛋白的阳性表达率(100.0%)(P＜0.05),乳腺癌组织中CD44v6蛋白的表达率(60.0%)显著高于癌旁乳腺组织CD44v6蛋白的表达率(5.0%)(P＜0.05).超声观察,Pokemon、E-cadherin和CD44v6蛋白的表达与乳腺癌的浸润、转移明显相关.结论 Pokemon、E-cadherin和CD44v6蛋白可能在乳腺癌发生、发展及转移中发挥作用,Pokemon、E-cadherin和CD44v6蛋白与超声影像结合可能与乳腺癌的预后有关.     

Syk和SYK-mRNA在乳腺浸润性导管癌中的表达及其与腋窝淋巴结转移的关系

目的 探讨Syk及其编码基因SYK-mRNA在乳腺癌中的表达及其与腋窝淋巴结转移的相关性.方法 分别采用免疫组化SP法和原位RT-PCR方法 同步检测52例乳腺浸润性导管癌(其中有腋窝淋巴结转移者32例)和39例乳腺非癌组织中Syk蛋白和SYK-mRNA的表达.结果 Syk 和SYK-mRNA在乳腺癌中的阳性表达率分别为42.3%(22/52)和38%(20/52),均显著低于非癌组织.Syk和SYK-mRNA表达的一致率为91%.无淋巴结转移组的乳腺癌Syk和SYK-mRNA阳性表达率均显著高于有淋巴结转移组的乳腺癌,但两组的Syk和SYK-mRNA表达量差异均无统计学意义.结论 Syk(SYK-mRNA)的表达缺失与乳腺癌腋窝淋巴结转移有关,SYK-mRNA基因可能是乳腺癌的一种候选抑癌基因.     

Gli1蛋白在乳腺癌组织中的表达及意义

目的探讨Gli1在乳腺癌组织中的表达及其意义。方法采用免疫组化S-P方法测定64例乳腺癌组织以及52例癌旁正常乳腺组织、42例乳腺纤维腺瘤组织中Gli1蛋白的表达情况。结果 Gli1蛋白在癌旁乳腺组织及纤维腺瘤组织中不表达或弱表达,在乳腺癌组织中的明显表达,差异有统计学意义（P〈0.05）;Gli1蛋白在乳腺癌患者腋窝淋巴结有无转移中的表达差异有统计学意义（P〈0.05）,在Ⅲ期乳腺癌中的阳性表达率高于Ⅰ~Ⅱ期乳腺癌（P〈0.05）。结论 Gli1蛋白与乳腺癌组织的发生发展有一定的关系。     

乳腺癌组织中缺氧诱导因子-1α的表达及其与增殖细胞核抗原、微血管密度的关系

目的探讨乳腺癌组织中缺氧诱导因子-1α(HIF-1α)的表达及其与增殖细胞核抗原(PCNA)、微血管密度(MVD)及临床病理因素的关系。方法采用免疫组化SP法检测乳腺纤维腺瘤、普通乳腺增生组织和乳腺癌组织中HIF-1α及PCNA蛋白的表达,用CD34单克隆抗体标记血管内皮细胞并计数MVD。结果HIF-1α蛋白在乳腺纤维腺瘤、普通乳腺增生组织中不表达;在乳腺导管内原位癌中表达阳性率为55.0%(11/20),浸润性乳腺癌中为85.0%(51/60);HIF-1α表达与淋巴结转移及雌激素受体状态有关(P<0.01)。乳腺癌中PCNA高表达率为75.0%(60/80),其中导管内原位癌中为65.0%(13/20),浸润性癌中为78.3%(47/60)。乳腺癌中HIF-1α表达与PCNA呈正相关(r=0.693,P<0.01),与导管内原位癌中MVD亦呈正相关(r=0.682,P<0.05),与浸润性癌中MVD无相关关系。结论HIF-1α在乳腺癌组织中的表达明显上调,与肿瘤细胞增殖、血管形成、淋巴结转移、雌激素受体状态相关,提示HIF-1α对乳腺癌的肿瘤细胞增殖、血管形成、生长和侵袭、转移起重要作用,有望成为肿瘤治疗的新靶点。     

磷脂酰肌醇蛋白聚糖-3在乳腺癌组织中的表达及其意义

目的探讨磷脂酰肌醇蛋白聚糖-3(glypican-3)在乳腺癌组织中的表达及其与乳腺癌临床病理参数的关系。方法采用RT-PCR方法检测52例乳腺癌组织及其癌旁组织中glypican-3基因的表达,计算其阳性率;并用Western blot方法检测该基因在乳腺癌组织及其癌旁组织中的蛋白表达。结果 glypican-3 mRNA在乳腺癌组织中表达率明显低于癌旁组织(P<0.05);在有淋巴结转移者中的表达率明显低于无淋巴结转移者(P<0.05);癌组织分化程度越低,glypican-3 mRNA的表达率越低(P<0.05);但其与患者的年龄、肿瘤的大小无关(P>0.05)。glypican-3蛋白在乳腺癌组织中表达亦明显低于癌旁正常组织(P<0.05),在有淋巴结转移者中的表达量明显低于无淋巴结转移者(P<0.05),癌组织分化程度越低,glypican-3蛋白的表达量越低(P<0.05)。结论 glypican-3在乳腺癌组织中的低表达可能与乳腺癌的发生发展及侵袭转移有关。     

乳腺癌微环境中调节性T细胞表达及其意义研究

目的探讨CD4+CD25+Foxp3+调节性T细胞(Treg)在诱导乳腺癌免疫耐受中的作用和机制。方法选取河北医科大学第二医院腺体外科乳腺癌标本40例(淋巴结无转移20例,转移20例)、乳腺纤维腺瘤标本20例,分别应用流式细胞术(FCM)和免疫组化检测CD4+CD25+Foxp3+Treg、TGF-β和IL-10在乳腺癌原发灶、癌周组织、腋窝淋巴结以及乳腺纤维腺瘤中的表达。结果乳腺癌原发灶中三指标表达程度,均较乳腺纤维腺瘤中高(P<0.05);原发灶中表达程度,均高于癌周组织和腋窝淋巴结(P<0.05);淋巴结转移组中癌周组织三项指标表达低于腋窝淋巴结(P<0.05),而淋巴结未转移组中,癌周组织和腋窝淋巴结表达无差异(P>0.05)。结论 CD4+CD25+Foxp3+Treg在乳腺癌微环境中富集可能是导致乳腺癌免疫逃逸的重要因素;CD4+CD25+Foxp3+Treg与TGF-β和IL-10具有一定的协同作用。     

乳腺癌中PTEN和Basigin1蛋白的表达与其临床病理学特征的关系

目的探索乳腺浸润性导管癌中10号染色体同源缺失性磷酸酶-张力蛋白(PTEN)和基质金属蛋白酶诱导因子1(Basigin1)蛋白的表达,并分析其与乳腺浸润性导管癌临床病理学特征及分子亚型的关系。方法回顾性收集郑州人民医院2014年1月至2015年12月期间的76例乳腺原发浸润性导管癌病理活检标本,以及同期的20例乳腺良性增生组织,采用免疫组织化学染色法检测组织中PTEN蛋白和Basigin1蛋白的表达情况,分析其表达与临床病理学特征及分子亚型的关系,以及二者表达的相关性。结果乳腺浸润性导管癌组织中PTEN蛋白的高表达率低于乳腺良性增生组织[56.6%(43/76)比85.0%(17/20),χ2=5.457,P=0.019],而Basigin1蛋白的高表达率高于乳腺良性增生组织[51.3%(39/76)比25.0%(5/20),χ2=4.417,P=0.036]。在乳腺浸润性导管癌组织中,PTEN蛋白的高表达与WHO分级和淋巴结转移状况均相关(P0.05);Basigin1蛋白的表达与WHO分级、淋巴结转移状况和TNM分期均相关(P0.05)。PTEN蛋白的高表达与乳腺癌的分子亚型有关(P0.001),其在Luminal A型和Luminal B型中的高表达率高于Her-2过表达型和基底样亚型;Basigin1蛋白的高表达与乳腺癌的分子亚型也有关(P0.001),其在Her-2过表达型和基底样亚型中的高表达率高于Luminal A型和Luminal B型。在乳腺浸润性导管癌组织中,PTEN蛋白与Basigin1蛋白的表达呈负相关(rs=–0.481,P0.001)。结论乳腺浸润性导管癌中可能存在某些机制,使PTEN蛋白和Basigin1蛋白共同促进乳腺癌的发生和发展。     

乳腺癌浸润和转移与乙酰肝素酶表达的关系

目的 观察乙酰肝素酶(Hpa)在乳腺癌的表达,探讨它们的表达与乳腺癌浸润、转移的关系及临床意义.方法 对60例未行任何化疗、放疗和内分泌治疗的原发性乳腺癌病理标本进行分析,应用苏木素-伊红(HE)染色观察乳腺癌的组织形态和病理学变化;应用免疫组织化学法检测乳腺癌患者癌组织、癌旁2 cm乳腺组织及距癌组织5 cm以上的正常乳腺组织中Hpa的表达.结果 60例乳腺癌病理标本免疫组织化学结果显示,乳腺癌组织Hpa阳性表达率为68.33％ (41/60),癌旁组织(癌旁2 cm)Hpa阳性表达率40.00％(24/60),正常组织Hpa阳性表达率0.00％ (0/60).统计分析结果显示,与正常对照组织比较,Hpa在癌组织和癌旁组织表达升高且差异有统计学意义(P＜0.01).Hpa的表达与乳腺癌临床病理标志的相互关系分析结果显示:Hpa的表达与乳腺癌患者体内瘤块直径、组织学分级、腋下淋巴结状况及临床分期明显相关(P＜ 0.05),与患者年龄无明显相关(P＞0.05).而且具有腋下淋巴结转移的患者Hpa阳性表达率显著高于无腋下淋巴结转移组(P＜0.01).结论 Hpa在乳腺癌中的表达均较高,明显高于癌旁组织及正常乳腺组织;Hpa的表达与乳腺癌肿瘤大小、组织学分级、临床分期、淋巴结转移密切相关,与患者的年龄无明显相关.     

趋化因子受体5表达与乳腺癌临床病理特征及预后的相关性研究

目的 探讨趋化因子受体5(CCR5)在乳腺癌病灶和腋窝转移淋巴结中的表达及其与临床病理意义.方法 收集72例乳腺导管浸润癌及其腋窝淋巴结组织,50例乳腺纤维腺瘤组织,40例正常乳腺组织石蜡标本切片.采用免疫组化方法检测CCR5的表达情况;同时检测乳腺癌组织中C-erbB-2,p53,Ki-67,ER,PR的表达情况,并与临床病理资料进行统计学分析.结果 (1)乳腺癌组织中CCR5蛋白表达阳性率达84.72%(61/72),乳腺纤维腺瘤组织中表达阳性率较低(14%,7/50),正常乳腺组织中不表达CCR5;(2)乳腺癌CCR5表达与腋窝淋巴结转移呈正相关(X<'2>=4.982,P=0.026,r=0.305);(3)50例伴腋窝淋巴结转移的患者中,乳腺癌原发灶及转移淋巴结同时表达CCR5阳性者39例,具有较高的同源性;(4)乳腺癌CCR5表达与癌基因C-erbB-2之间呈低度正相关(P<0.05,r=0.291);(5)乳腺癌CCR5表达与患者年龄、绝经与否、肿瘤最大径、肿瘤分期等临床特征无关(均P>0.05);(6)乳腺癌CCR5表达与p53,Ki-67,ER,PR无关表达(均P>0.05).结论 CCR5在乳腺癌的发生、发展及腋窝淋巴结转移方面起一定作用;CCR5可间接作为预测乳腺癌腋窝淋巴结转移及预后判断的指标之一.     

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.