胃肠胰神经内分泌肿瘤临床治疗及预后分析

目的 分析胃肠胰神经内分泌肿瘤(GEP-NENs)发病特点及影响预后的危险因素。方法 2009年1月～2016年12月我院住院治疗的GEP-NENs病人108例,随访36个月,分析其临床特征、病理特点。采用单因素分析和多因素Cox回归分析研究影响生存率的预后因素,Kaplan-Meier法进行生存分析。结果 患病男女比为1.16∶1,平均年龄(50.90±12.94)岁。好发部位依次为胰腺、直肠、胃体。肿瘤直径最小0.2 cm,最大13.2 cm,平均(1.90±1.94)cm。病理分类：神经内分泌瘤占88.9%,神经内分泌癌占11.1%。病理分级：G1级占52.8%、G2级占36.1%、G3级占11.1%。其中95.4%的病人进行了手术治疗,69.9%行根治性手术切除。随访3年总生存率为87.1%。单因素分析显示,病理类型、分级、临床分期、非功能性肿瘤、肿瘤直径、Ki-67指数、淋巴结转移以及远处转移是影响GEP-NENs病人预后的危险因素(P<0.05)。多因素分析显示,肿瘤直径及淋巴结转移是影响GEP-NENs病人预后的独立危险因素。结论 GEP-NENs病人预后与病理类型...     

不同病理分级的直肠神经内分泌肿瘤的临床特征与预后分析

目的 探讨不同病理分级的直肠神经内分泌肿瘤的临床特征与预后情况.方法 回顾性分析2001年1月至2012年4月解放军总医院确诊的183例直肠神经内分泌肿瘤患者的临床资料.从医生工作站及内镜中心数据库中,检索经内镜治疗和(或)外科手术治疗的直肠神经内分泌肿瘤患者的临床及病理资料.按照2010年WHO消化系统肿瘤分类标准,依核分裂象数对病理检查结果进行分级.通过返院复查及电话随访了解患者预后情况.以患者死亡或2014年7月为随访终点.多样本间率的比较采用双向无序卡方检验.结果 183例患者纳入研究.其中男120例,女63例,男女比例为1.9∶1.年龄为14 ～ 83岁,平均年龄为48岁.临床症状:便血者74例,健康体检无意发现者70例,腹痛及大便习惯改变者各9例,其他的临床表现有肿瘤标志物升高、腹胀或合并多种症状等,无一例表现为类癌综合征.183例患者中,同时伴发肠道息肉14例,合并管状腺瘤5例,合并结直肠腺癌3例,合并小细胞肺癌1例.肿瘤直径＜1 cm 162例,1～2 cm14例,＞2 cm7例.肿瘤距肛门距离为(5±3)cm.183例患者中,130例行内镜治疗,43例行外科治疗,10例误诊小息肉行钳除,未行进一步治疗.183例患者中,G1级158例(TNM Ⅰ期154例、Ⅱ期1例、Ⅲ期1例、Ⅳ期2例);G2级21例(TNM Ⅰ期13例、Ⅱ期3例、Ⅲ期3例、Ⅳ期2例);G3级4例(TNM Ⅰ期1例、Ⅲ期1例、Ⅳ期2例).183例患者中,有6例发生肝转移,9例发生淋巴结转移,14例患者死亡(G1级4例、G2级6例、G3级4例),5年生存率为92.35％(169/183).不同分级直肠神经内分泌肿瘤患者在肿瘤直径、肿瘤分期、肝转移、淋巴结转移、5年生存情况等方面比较,差异有统计学意义(x2=60.949,71.587,32.135,55.486,56.512,P＜0.05).结论 直肠神经内分泌肿瘤缺乏特异性临床表现,男性好发,部位多位于直肠中下段,多数肿瘤直径＜1 cm,多数患者为TNM Ⅰ期,G1级.不同分级的直肠神经内分泌肿瘤预后不同,按照2010年WHO消化系统肿瘤分类标准进行分级对预后有参考价值,制订治疗方案时应考虑分级的因素.     

胃神经内分泌肿瘤临床病理特点及预后分析

目的:探讨胃神经内分泌肿瘤临床病理特点及其预后.方法:回顾性分析近11年收治的52例胃神经内分泌肿瘤的临床及病理资料.结果:全组男39例,女13例,平均年龄59岁.根据WHO( 2010)神经内分泌肿瘤新分类标准,其中神经内分泌瘤(NET) 19例(1级12例,2级7例),神经内分泌癌(NEC) 29例,混合性腺神经内分泌癌( MANEC)4例.病变发生于贲门、胃底31例(59.6％),胃体11例(21.2％),胃窦10例(19.2％).主要临床表现为上腹饱胀不适和吞咽困难.50例接受手术治疗,其中NET患者经内镜切除5例,胃壁局部切除3例,根治性胃切除11例,术后病理显示14例(73.7％)肿瘤局限在黏膜及黏膜下层,淋巴结转移4例(21.1％),脉管瘤栓1例(5.3％);NEC及MANEC患者行开放式根治性手术17例,姑息性手术13例,单纯探查手术1例,术后病理显示29例(96.7％)肿瘤侵及或穿透浆膜,淋巴结转移27例(90％),脉管瘤栓16例(53.3％).随访2～106个月,19例NET术后局部复发2例(10.5％),远处转移3例(15.8％),死亡2例(10.5％),1,3,5年生存率分别为100％,89％和82％;29例NEC术后局部复发1例(3.4％),远处转移25例(86.2％),死亡21例(72.4％),1,3,5年生存率分别为69％,43％和21％;4例MANEC术后远处转移3例,死亡3例.结论:不同分类的胃神经内分泌肿瘤的临床病理特点及预后各有不同,NET多为早期病变,治疗效果较好;NEC及MANEC恶性程度高,侵袭性强,预后较差.     

剜除术治疗低级别无功能小胰腺神经内分泌肿瘤26例疗效分析

目的 探讨剜除术对低级别（G1、G2）无功能小（直径≤2 cm）胰腺神经内分泌肿瘤病人术后并发症和预后的影响。 方法 回顾性分析复旦大学附属中山医院普外科2009年1月至2018年12月收治的26例低级别（G1、G2）无功能小（直径≤2 cm）胰腺神经内分泌肿瘤病人的临床及随访资料。结果 26例病人均行胰腺肿瘤剜除术,手术时间（123.4±40.3）min,术中平均出血量（83.8±80.6）mL,术后共有7例（26.9%）病人发生胰瘘,其中3例（11.5%）为A级胰瘘,4例（15.4%）为B级胰瘘,术后平均住院时间为（12.2±8.9）d。术后随访6～119个月,平均随访时间64个月,1例失访,其余25例获得完整随访资料的病人均生存,其中1例病人于术后26个月发现肝转移,1例病人于术后29个月复发。 结论 剜除术治疗低级别无功能小胰腺神经内分泌肿瘤疗效确切,预后较好,但其远期预后仍需更长时间的远期随访结果验证。     

胃神经内分泌癌42例预后分析

目的探讨胃神经内分泌癌（NEC）的临床病理特征及预后。方法回顾性分析2006年5月至2011年7月间郑州大学附属肿瘤医院收治42例胃NEC患者的临床资料,总结其临床病理特征,并通过Logrank检验分析影响患者预后的因素。结果42例胃NEC患者占同期收治胃癌的0．83％（42／5046）,其中男性37例,女性5例,诊断年龄平均63岁。均接受手术治疗,其中R0切除者40例,R,切除者2例;术后有40例行常规氟尿嘧啶联合奥沙利铂辅助化疗。42例患者随访时间为4～70（中位26）月,中位生存时间为25月,1、3、5年总生存率分别为71．4％、26．2％和11．9％。单因素预后分析显示,肿瘤最大直径、肿瘤侵犯深度、淋巴结转移、淋巴管浸润、肿瘤分期及手术根治程度与患者预后有关（均P〈0．05）。结论胃NEC较为罕见,手术治疗是改善胃神经内分泌癌预后的关键,而术后综合治疗方案的选择仍需优化。     

消化系统神经内分泌肿瘤29例临床分析

目的探讨消化系统神经内分泌肿瘤（NEN）的诊断及治疗策略。方法回顾性分析2000年1月至2012年12月间大连医科大学附属第一医院收治的29例NEN患者的临床资料,依照新的WHO分类法对其治疗方式及预后进行重新评估。结果29例患者中男19例,女10例,平均年龄46．5岁。全部病例均无类癌综合征的临床表现。所有病例均行手术治疗,其中2例胃神经内分泌癌分别行根治性全胃切除和根治性远端胃切除;3例位于十二指肠,其中2例为神经内分泌癌、1例为神经内分泌瘤,均行胰十二指肠切除;2例小肠神经内分泌癌均行小肠部分切除术;3例位于阑尾,其中1例神经内分泌癌行根治性右半结肠切除,2例神经内分泌瘤行阑尾切除术;1例升结肠神经内分泌癌行根治性右半结肠切除术：18例位于直肠,其中4例神经内分泌癌行经腹直肠癌前切除术或腹会阴联合直肠癌根治术,14例神经内分泌瘤则予以经腹直肠前切除术、经肛局部切除术或内镜黏膜切除术。全组13例神经内分泌癌患者术后1年生存率为38．4％,3年生存率为7．7％;16例神经内分泌瘤患者术后5年生存率为8113％。结论消化系统NEN的临床表现无特异性,多位于直肠,手术治疗是有效的方法;神经内分泌癌预后较差,而神经内分泌瘤预后良好。     

十二指肠神经内分泌肿瘤的临床病理特征及预后分析

目的探讨十二指肠神经内分泌肿瘤的临床病理特征及预后。方法回顾性分析2012年1月至2021年12月华中科技大学同济医学院附属协和医院收治的35例十二指肠神经内分泌肿瘤患者的临床病理资料, 分析壶腹周围和非壶腹周围十二指肠神经内分泌肿瘤的临床病理特征差异, 采用Kaplan-Meier曲线进行生存分析, 并分析影响十二指肠神经内分泌肿瘤患者预后的临床因素。结果 35例患者中30例行肿瘤切除术, 其中7例(23%)术后发生不同程度的并发症, 经干预后均好转出院。随访期间共5例患者死亡, 行肿瘤切除术的30例患者中仅1例于术后30个月因疾病进展致死亡, 其余均未出现复发转移。单因素分析结果显示肿瘤大小、肿瘤分级、肿瘤部位均与患者的预后有关(均P<0.05);多因素分析结果显示肿瘤位于非壶腹周围患者的预后明显优于位于十二指肠壶腹周围的患者(P<0.01)。结论十二指肠神经内分泌肿瘤患者接受完整切除术后预后较好;与非壶腹周围相比, 位于壶腹周围的十二指肠神经内分泌肿瘤患者的预后相对较差。     

具有神经内分泌特征胃癌的诊治及预后分析

目的探讨具有神经内分泌特征胃癌的临床病理特点、治疗及预后。方法回顾性分析北京大学临床肿瘤学院1997年1月至2008年12月收治的19例具有神经内分泌特征胃癌病例的临床资料。结果本组19例患者中胃神经内分泌癌14例,其中9例位于胃底贲门,5例位于胃体;另5例胃癌伴神经内分泌分化者中2例位于胃底贲门,2例位于胃窦,1例位于全胃。根据2000年WHO肿瘤国际组织新分类标准．本组19例患者可分为Ⅰ型胃类癌2例（10．5％）,Ⅱ型散发性胃类癌9例（47．4％）,胃小细胞癌3例（15．8％）,胃癌伴神经内分泌分化5例（26．3％）。临床无特异性表现,诊断主要依靠病理及免疫组织化学检查。18例患者接受手术治疗,手术采用根治性胃大部切除术或全胃切除术．3例伴肝转移者行同时性肝转移灶切除：另1例胃体小细胞癌伴肝转移无耘．手术切除者予以单纯化疗。本组患者1年及3年生存率分别为73．7％和38．6％。结论胃神经内分泌癌好发于贲门、胃底部及胃体,胃癌伴神经内分泌分化可发生于胃的各个部位。免疫组织化学染色对该病的诊断具有重要价值。本病总体预后不佳．治疗应尽可能行根治性切除术。     

直肠神经内分泌肿瘤外科治疗

目的 探讨直肠神经内分泌肿瘤外科治疗经验.方法 回顾性分析2008年1月至2013年6月南京军区福州总医院普通外科23例直肠神经内分泌肿瘤手术患者的临床资料.结果 本组约占同期直肠肿瘤1.5％,其中男性16例,女性7例,中位年龄52.6岁（30～68岁）,平均肿瘤最大径2.2 cm（0.8～3.2 cm）,平均距肛缘距离为6.2 cm（3～12 cm）.经肛局部扩大切除7例,经腹直肠低位前切除术10例（腹腔镜手术6例）,经腹会阴联合直肠癌根治术6例（腹腔镜手术3例）,均获R0切除.其中G1级4例,G2级14例,G3级5例.无手术并发症和围手术期死亡.术后随访3个月至5年,10例发生局部复发或远处转移,8例死亡,3年和5年总体生存率分别为80.5％和55.1％.结论 应重视直肠神经内分泌肿瘤早期诊断和治疗,最大径小于1 cm者应积极内镜下治疗,最大径超过2 cm以及内镜下切除病理证实高风险者（组织学分级差、切缘阳性、可疑肌层受累）应接受根治性手术,腹腔镜手术具有一定优势.     

结直肠神经内分泌癌的临床诊治及预后

目的探讨结直肠神经内分泌癌的临床诊治及预后。方法回顾性分析1995年1月至2010年1月间河南省肿瘤医院收治的39例结直肠神经内分泌癌患者的临床资料。结果39例患者中男27例．女12例。所有病例均未出现内分泌紊乱的表现,术前有14例（35．9％）经病理学诊断为神经内分泌癌。22例患者行根治性手术．14例行姑息性切除术,3例仅行活检术。所有病例均予顺铂加依托泊苷的术后辅助化疗。36例切除的病灶中,27例（75．0％）有脉管浸润,29例（80．6％）有淋巴结转移：全组患者中有11例（28．2％）出现远处转移。病理分型：高分化型22例（56．4％）,中间型9例（23．1％）．小细胞型8例（20．5％）。全组患者术后获得4．67个月的随访,1、3、5年生存率分别为48．2％、16．5％和6．8％。患者的生存状况与肿瘤的分期、脉管浸润和手术根治性有关（P〈0．05）;而与年龄、性别、肿瘤的大小和位置无关（P〉0．05）。结论结直肠神经内分泌癌无特异性临床表现,恶性程度高．预后差,肿瘤分期、有无脉管浸润和能否根治切除是影响预后的重要因素。     

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.     

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.     

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.     

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.     

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.     

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.