乳腺癌外周血CK-19mRNA的表达及临床意义

目的：研究外周血CK-19 mRNA表达与乳腺癌临床生物学指标的关系,探讨其作为乳腺癌微转移标志物的可能性,并判断手术和化疗对血液微转移的影响。方法：应用RT-PCR技术检测50例乳腺癌患者（乳腺癌组）术前、术后第2天、第1次化疗结束后以及术后9～12个月外周血中CK-19 mRNA的表达情况,并以20例乳腺良性疾病（良性对照组）和20例正常健康女性（正常对照组）作为对照。结果：术前乳腺癌组外周血CK-19 mRNA阳性率为24.00%（12/50）,其中0～Ⅰ期15.38%（2/13）Ⅰ,Ⅰ期20%（6/30）Ⅰ,Ⅱ期57.14%（4/7）Ⅰ,Ⅱ期乳腺癌CK-19 mRNA阳性表达率明显高于0～Ⅱ、Ⅰ期（P〈0.05）;有淋巴结转移者42.11%（8/19）表达阳性,无淋巴结转移者12.94%（4/31）表达阳性,二者差异有统计学意义（P〈0.05）。良性疾病组CK-19 mRNA的阳性率为5.00%（1/20）,正常对照组均阴性,乳腺癌组与良性疾病组和正常对照组比较差异有统计学意义（P均〈0.01）。乳腺癌组术后第2天CK-19 mRNA阳性率为26%（13/50）,与术前比较差异无统计学意义（P〉0.05）。术后首次化疗结束后CK-19 mRNA阳性率为12%（6/50）,化疗前后差异有统计学意义（P〈0.01）。综合治疗9～12个月后CK-19 mRNA阳性率为10%（5/50）,与术前比较差异有统计学意义（P〈0.01）。外周血CK-19 mRNA阳性率与雌激素受体（ER）、孕激素受体（PR）、CerbB2、p53状态无关。结论：CK-19 mRNA可作为检测乳腺癌患者外周血微转移的分子学标志物,有助于早期预测乳腺癌发生血道微转移,对指导治疗和评估预后具有重要意义。     

实时定量荧光逆转录聚合酶链反应检测胃癌患者血CK20 mRNA及其意义

目的　研究胃癌患者外周血、肿瘤区域引流血中CK2 0mRNA的表达情况,探讨其临床意义。方法　用实时定量荧光逆转录聚合酶链反应(RT- PCR)方法,对6 0例健康献血员外周血和5 5例胃癌手术患者的手术前外周血、术中肿瘤区域血及术后外周血进行检测。结果　健康人外周血中CK2 0mRNA均为低表达,胃癌患者术前外周血中CK2 0mRNA的表达率为4 5 % ,Ⅲ、Ⅳ期胃癌患者术前外周血中表达率高于Ⅰ、Ⅱ期患者(P <0 .0 5 ) ;术中肿瘤区域引流血中CK2 0mRNA的表达率为6 4 % ,高于术前的4 5 % (P <0 .0 5 )。术前外周血中高表达的患者术后随访3～4 0个月中出现复发转移和死亡例数明显高于术前低表达的患者(P <0 . 0 5 )。结论　实时定量荧光RT PCR检测CK2 0mRNA可以评估胃癌血道微转移,有利于判断预后。     

胃癌患者外周血CD133 mRNA检测及其临床意义

目的 探讨胃癌患者外周血CD133 mRNA表达情况及其临床意义.方法 抽取10名健康志愿者（组1）、5例胃溃疡穿孔患者（组2）,18例胃癌术前患者（组3）及19例胃癌术后患者（组4）外周静脉血2 ml,分离单核细胞,采用半定量RT-PCR检测CD133 mRNA表达水平.结果 组3患者外周血CD133 mRNA灰度值显著高于组1和组2（P=0.001）.组4患者中12例复发转移者外周血CD133mRNA灰度值显著高于7例无复发转移者（P=0.042）.CD133 mRNA表达与淋巴结转移和肿瘤分期有关（P＜0.05）.CD133 mRNA灰度值与淋巴结转移率呈正相关（P=0.007）.结论 胃癌患者外周血高表达CD133 mRNA,其表达与淋巴结转移率正相关.胃癌术后外周血高表达CD133mRNA提示肿瘤复发或转移.     

膀胱移行细胞癌临床病理指标与外周血CK-20基因表达的相关研究

目的 探讨外周血角蛋白20（CK－20）基因表达在膀胱移行细胞癌微转移情况及其临床意义。方法 以逆转录多聚酶链反应（RT－PCR）检测91例膀胱癌不同临床分期及病理分级CK－20mRNA外周血表达情况。结果 91例膀胱癌外周血CK－20基因表达阳性47例(51.6%），外周血肿瘤细胞微转移与膀胱癌患者的临床分期密切相关（P＜0.05），而与病理分级无明显相关（P＞0.05），随访中未发现淋巴结转移的T1－2期患者，术后8个月2例复发且均为CK－20RNA表达阳性。结论 RT－PCR方法检测CK－20mRNA在外周血表达是判断膀胱癌微转移的重要标志，对准确分期及治疗有重要意义。     

乳腺癌微转移的CK19和CD44表达研究

目的探讨乳腺癌患者外周血中CK19和CD4 4mRNA的表达与术后乳腺癌微转移的关系。方法采用逆转录聚合酶链反应 (RT PCR)方法 ,检测 10 7例乳腺癌患者 (腋窝淋巴结癌转移阳性者 4 5例 ,腋窝淋巴结癌转移阴性者 6 2例 )手术前 2 4h和手术后 12d血中CK19与CD4 4mRNA的表达 ,同时与 35例良性乳腺病患者及 6 0例健康献血员进行比较。结果手术前 2 4h患者血中CK19和CD4 4mRNA阳性表达率分别为 31 8% (34/10 7)和 32 7% (35 /10 7) ,与手术后 12d和对照组比较差异均有显著性 (χ2 值 :CK19分别为 10 74、2 1 0 4 ;CD4 4分别为 8 70、2 0 18;均P <0 0 5 )。CK19与CD4 4检测血中乳腺癌细胞特异度为 88 7% ,此二项指标联合应用敏感度为 10 0 %。CK19与CD4 4均表达者的 5年生存率为 5 7 80 % (11/19) ,均不表达者的 5年生存率为 90 4 7% (19/2 1)。二者比较差异有显著性 (χ2 =4 0 4 ,P <0 0 5 )。结论联合检测乳腺癌患者血中CK19、CD4 4mRNA的表达 ,可提高诊断乳腺癌微转移的敏感性和特异性。     

外周血中生存素的表达与结肠癌预后的相关研究

目的 探讨检测外周血生存素(survivin)的表达与结肠癌复发、转移的关系.方法 采用反转录-聚合酶链反应-酶联免疫吸附试验(RT-PCR-ELISA)方法检测结肠癌患者外周血中survivinmRNA的表达,分析其与临床病理因素之间的关系.对其中51例患者进行36个月随访,比较复发及转移时间与外周血中survivin mRNA表达之间的关系.结果 95例结肠癌患者中35例survivin mRNA表达阳性(36.8％).肿瘤高中分化及低未分化患者survivin mRNA表达率分别为31.0％和45.0％(P＜0.05),浸润深度达浆膜层者表达率为44.0％,高于侵及黏膜下层及肌层者(20.0％)(P＜0.05),淋巴结有转移者表达率为47.5％,高于无淋巴结转移者(19.4％)(P＜0.05).随访发现外周血survivin表达阳性患者的复发及转移率(47.3％)明显高于阴性患者(16.6％).提示survivin mRNA在外周血的表达与肿瘤分化、浸润深度、淋巴结转移和临床分期有关,但与肿瘤部位无明显关系.结论 外周血survivin阳性患者易于复发或转移;外周血survivin的表达可作为评价结肠癌生物学行为及预后的参考指标.     

血清VEGF监测术后复发转移性乳腺癌的临床意义

探讨术后复发转移性乳腺癌患者血清VEGF表达及其临床意义.用ELISA检测50例复发转移性乳腺癌,20例原发性乳腺癌,20例乳腺良性疾病及15例健康女性血清VEGF的浓度.结果:复发转移组血清VEGF浓度高于原发组(P＜0.05)、良性疾病及健康对照组(P＜0.01).血清VEGF表达阳性率高于CEA、CA15-3( P＜0.05),而与CEA、CA15-3联合表达差异无显著性(P＞0.05),与复发转移部位、原肿瘤病理类型、腋淋巴结转移状况、ER、PR、HER-2表达及月经状况无关(P＞0.05).结论:复发转移组血清VEGF表达水平明显升高.单项检测VEGF优于CEA、CA15-3,与CEA和CA15-3联合检测表达相似.血清VEGF有望作为乳腺癌复发转移的一项监测指标.     

外周血甲胎蛋白mRNA和黑色素瘤抗原-1 mRNA联合表达与肝细胞癌术后复发转移的关系

目的 探讨外周血甲胎蛋白（AFP）mRNA和黑色素瘤抗原-1（MAGE-1）mRNA联合表达在早期发现肝细胞癌患者术后复发或转移的意义。方法 应用巢式逆转录聚合酶链反应技术分别在术前、术后1周和2个月检测142例行根治性切除的肝细胞癌患者外周血中AFPmRNA和MAGE-1mRNA的表达，随访时间从术后至22个月，中位随访时间为15．5个月。结果 外周血中MAGE-1mRNA和／或AFPmRNA的阳性率和肿瘤的病理分期呈正相关：肿瘤病期越晚，外周血中肝癌细胞的检出率越高（χ^2=17．873，P〈0．01）。AFPmRNA和Mage-1mRNA阳性率均与癌结节数目、门静脉癌栓、肝内、外转移等临床参数显著相关（χ^2=11．510，χ^2=15、149，χ^2=11．653，χ^2=6．805，均P〈0.01），而与肝癌分化程度、肿瘤直径等无相关性（χ^2=1．513，χ^2=1．343，均P〉0．05）。术后55例患者出现复发或转移，其中38例患者外周血MAGE-1mRNA和／或AFPmRNA持续阳性，14例由术前阴性转为阳性。而62例由术前阳性转为术后阴性者，随访中未见复发或转移。术后外周血AFPmRNA和／或MAGE-1mRNA阳性组中，有88．1％（52／59）的患者出现复发或转移，而阴性组中复发或转移者仅占3．6％（3／83），两组比较，差异有统计学意义（χ^22=103．817，P=0．000）。结论 联合检测外周血MAGE-1和AFPmRNA的表达可能早期发现肝细胞癌术后复发或转移，可以作为评估预后的指标。     

乳腺癌患者血清VEGF—C水平与癌组织C—erbB-2蛋白的表达及临床意义

目的 探讨乳腺癌患者血清血管内皮生长因子C (VEGF-C)水平及癌组织中C-erbB-2蛋白表达及其临床意义.方法 选取女性乳腺浸润性导管癌患者和乳腺良性病变患者各62例,采用ELISA法检测患者术前和术后1个月血清VEGF-C水平,免疫组织化学法检测乳腺癌组织C-erbB-2蛋白表达,分析VEGF-C与乳腺癌临床病理特征及C-erbB-2蛋白表达的关系.结果 乳腺癌患者术前血清VEGF-C水平为(279.65±17.34) pg/ml,乳腺良性病变患者为(167.26±12.15) pg/ml,两者比较差异有统计学意义(P＜0.01).乳腺癌患者术后1个月血清VEGF-C水平为(209.45±15.23) pg/ml,与其术前比较差异有统计学意义(P＜0.01).VEGF-C水平与原发肿瘤分期有关(P＜0.05),与患者年龄、肿瘤大小、有无淋巴结转移、绝经情况及ER和PR的表达无关(P>0.05).C-erbB-2蛋白在乳腺癌中的表达阳性率为54.84%(34/62),明显高于乳腺良性病变的11.29%(7/62),P＜0.01.乳腺癌腋窝淋巴结转移患者的C-erbB-2蛋白表达阳性率(69.44%)明显高于腋窝淋巴结无转移患者(34.62%,P＜0.05).血清VEGF-C水平随癌组织中C-erbB-2阳性表达强度增强而增高,两者呈正相关(r=0.813,P＜0.05).结论 乳腺疾病患者血清中VEGF-C水平可能成为鉴别乳腺良、恶性病变的辅助指标之一; C-erbB-2与乳腺癌淋巴结转移有关; 在乳腺癌的淋巴转移途径中VEGF-C可能与C-erbB-2存在着协同作用.     

大肠癌患者外周血CK20 mRNA的表达及其意义

目的　探讨大肠癌患者外周血CK2 0mRNA的表达及其意义。方法　用逆转录 聚合酶链反应 (RT PCR)方法检测 4 2例大肠癌患者术前、术后外周血及 2 0例大肠癌患者新鲜癌组织标本中CK2 0mRNA的表达 ,另以 2 0例健康成年自愿者作对照。结果　 4 2例大肠癌患者外周血CK2 0mRNA呈阳性表达者术前为 19例(45 .2 4 % ) ,术后为 14例 (33.33% ) ;2 0例大肠癌患者新鲜癌组织中CK2 0mRNA表达均为阳性。而正常对照组2 0例外周血CK2 0mRNA表达均为阴性。且大肠癌外周血CK2 0mRNA阳性表达与组织学类型无关 (P >0 .0 5 ) ,但与有无淋巴结转移、肝转移及Dukes分期有关 (P<0 .0 5 )。结论　检测外周血中CK2 0mRNA表达将有助于大肠癌的早期诊断、预后的判断及治疗方案的制定。     

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.