光动力治疗裸鼠胰腺癌及其机理的实验研究

目的 探讨在裸鼠胰腺癌瘤内注射光敏剂血卟啉衍生物（HpD）、竹红菌甲素（HA）及2－丁胺－2－去甲氧基竹红菌甲素（2－BA－2－DMHA）后，光动力治疗（PDT）的效果及其作用机理。方法 将人胰腺癌细胞株SW1990接种到裸鼠皮下，建立胰腺癌动物模型，而后将光敏剂HpD、HA及2－BA－2－DMHA注射入肿瘤，再用激光照射肿瘤局部，观察PDT治疗胰腺癌的效果。另以第Ⅷ因子为标记，采用免疫组化LSAB法研究肿瘤血管损伤的情况。结果 PDT对胰腺肿瘤有明显杀伤作用，能使胰腺肿瘤生长速度明显减慢。免疫组化染色明显，PDT可引起血管内皮细胞损伤和血管结构破坏。结论 PDT对胰腺癌有治疗作用，血管损伤是其杀伤肿瘤的重要途径。     

光动力治疗人胆管癌细胞荷瘤裸鼠的实验研究

目的研究光动力疗法(photodynamic therapy,PDT)对人胆管癌荷瘤裸鼠的治疗效果,探讨其抗肿瘤性、安全性及腹腔注射和瘤内注射光敏剂两种不同给药途径疗效的差异。方法人胆管癌细胞QBC939接种于Balb/c裸小鼠皮下,建立荷瘤动物模型。以血卟啉衍生物(HpD)作光敏剂,采用腹腔内和瘤内注射2种不同给药方式,后以波长630 nm的激光照射肿瘤组织,观察PDT后肿瘤体积变化和病理改变。结果接受光动力治疗的两组肿瘤生长速度明显减慢,瘤内局部注射给药组疗效与腹腔给药组差异无统计学意义(P>0.05);组织学检查见肿瘤组织有广泛坏死,各组裸鼠心、肝、肺、肾组织切片未见病理性结构改变。结论HpD,PDT对人胆管癌荷瘤裸鼠的肿瘤组织有杀伤作用,使肿瘤生长减慢;HpD-PDT杀伤胆管癌移植瘤的深度可达0.8cm;在本实验光照条件下的PDT治疗是安全的。     

5-氨基乙酰丙酸介导的光动力学对裸鼠人胃癌移植瘤的治疗作用

目的观察5-氨基乙酰丙酸（5-ALA）介导的光动力学治疗对裸鼠人胃癌移植瘤的治疗作用。探索5-ALA介导的光动力学（PDT）治疗胃癌的可能机制。方法以MGC-803人胃癌细胞制备裸鼠人胃癌移植瘤模型：整体荧光成像系统下观察动物瘤体发出的荧光信号：测量荷瘤对照组、单纯激光组、单纯5-ALA组和5-ALA介导的PDT治疗组治疗后第1、3、7、14、21天的裸鼠肿瘤大小并计算肿瘤体积：末次测量后切除肿瘤行病理检查和透射电镜观察，TUNEL法检测组织细胞凋亡。结果常规方法培养MGC一803人胃癌细胞并接种裸鼠．可以成功制备出裸鼠人胃癌移植瘤的模型：荷瘤裸鼠肿瘤组织在特定波长的荧光激发下可发出特有的红色荧光。荷瘤对照组、单纯激光组、单纯5-ALA组和5-ALA介导的PDT治疗组治疗后第1、3、7、14、21天4组间的肿瘤体积差异有统计学意义（肚1003．086，P=0．000），PDT治疗组明显小于其他3组；病理检查提示．PDT治疗后肿瘤细胞大片凝固性坏死；透射电镜观察提示，PDT治疗组肿瘤组织存在大量死亡细胞及部分凋亡细胞：TUNEL法检测发现，PDT治疗组的肿瘤组织凋亡指数显著高于其他3组（χ^2=18．237．P=0．000）。结论5-ALA介导的PDT对于裸鼠人胃癌移植瘤具有明显的治疗效果．而单纯给予5-ALA或激光辐射对肿瘤无明显抑制作用；肿瘤细胞的坏死及凋亡是5-ALA介导的PDT产生细胞毒作用的重要机制。     

血管生长抑素基因抑制胰腺癌裸鼠移植瘤血管生成的实验研究

目的:探讨人血管生长抑素基因对胰腺癌裸鼠移植瘤生长及血管生成的影响。方法:建立人胰腺癌细胞株BXPC-3裸鼠移植瘤模型,应用人血管生长抑素基因质粒转染胰腺癌裸鼠移植瘤,观察移植瘤生长情况。采用免疫组织化学技术检测肿瘤血管内皮生长因子(VEGF)表达情况和微血管密度(MVD)差异,透射电子显微镜观察肿瘤细胞情况。结果:治疗组肿瘤体积明显小于空白对照组和空质粒组(P<0.01),VEGF主要表达在肿瘤细胞的胞质内,治疗组、空白对照组和空质粒组平均灰度分别为179.57±5.22、150.87±3.44和163.40±3.54;阳性单位分别为14.94±2.26、31.26±2.72和29.21±2.95;MVD分别为10.60±74.56、19.33±2.52和18.67±5.29,治疗组与空白对照组和空质粒组比较,差异有统计学意义(P均<0.05)。电子显微镜下治疗组可见大量肿瘤细胞坏死。结论:人血管生长抑素基因能明显抑制胰腺癌裸鼠移植瘤血管生成,促进肿瘤细胞坏死,进而抑制肿瘤生长。     

胞嘧啶脱氨酶/5-氟胞嘧啶系统治疗胰腺癌体内实验研究

目的探讨胞嘧啶脱氨酶(CD)基因对胰腺癌的杀伤作用机制。方法 应用细菌内同源重组法构建含CD基因的腺病毒载体,将Patu8988、SW1990胰腺癌细胞皮下接种BALB/C裸鼠建立胰腺癌的移植瘤模型,重组CD腺病毒液以1010 pfu/ml原位注射入肿瘤,每周2次,24 h后腹腔给予前药5-氟胞嘧啶(5-FC),连续4周。结果 CD基因原位转导的裸鼠移植瘤生长明显受抑。Patu8988移植瘤治疗组肿瘤重量为(587.7±107.8)mg,SW1990移植瘤组治疗组肿瘤重量为(597.6±159.4)mg,对照组重量为(2 042.4±608.0)mg(P<0.01)。结论重组CD基因的腺病毒载体对胰腺癌不仅转染效果强,加用前药5-FC后,可直接或通过旁观者效应抑制移植瘤的生长。     

VEGF_(121)反义核酸抑制裸鼠胰腺癌移植瘤的增殖及血管生成

目的:探讨VEGF121反义核酸对裸鼠胰腺癌移植瘤的增殖及血管生成的影响,探索通过VEGF反义核酸抑制肿瘤生长.方法:将稳定转染有VEGF反义核酸pcDNA3-ASVEGF121的胰腺癌细胞系Bx-PC-3接种于裸鼠背部皮下.将实验鼠分为实验组、对照组和空白组.定期测定裸鼠移植瘤体积,免疫组织化学法检测裸鼠移植瘤VEGF、Flk-1表达水平.测定裸鼠移植瘤微血管密度.结果:VEGF反义核酸转染BxPC-3细胞后,裸鼠胰腺癌移植瘤生长明显减缓.移植瘤VEGF表达明显受到抑制,Flk-1表达水平上调.裸鼠胰腺癌移植瘤微血管密度明显降低.结论:人反义核酸VEGF121能显著抑制裸鼠胰腺癌移植瘤的增殖,并能抑制裸鼠胰腺癌移植瘤的血管生成.     

区域性缺血对裸小鼠胰腺移植癌及癌周胰腺组织的影响

目的 为缺血疗法在胰腺癌的临床应用提供基础研究资料。方法 在建立人胰腺癌细胞株裸小鼠胰腺原位称植瘤模型的基础上,结扎荷瘤裸鼠胃十二指肠动脉,胰十二指肠下动脉及背胰动脉,诱导胰腺右叶区域性缺血,观察缺血对裸小鼠胰腺移植癌生长,移植癌及癌周胰腺组织病理形态学的影响。结果 缺血组移植癌生长缓慢,倍增时间延长,移植癌体积,癌细胞增殖指数及蛋白质含量在术后3,7,细胞浸润;癌周胰腺组织腺泡萎缩破坏,可见广泛纤维化及淋巴细胞浸润,结论 区域性缺血对裸小鼠胰腺移植癌有确切的杀伤和抑制效应,癌周胰腺组织的缺血性改变可能不利于移植癌的生长。     

环氧合酶2对胰腺癌新生血管生成的调节作用及其机制

目的　探讨环氧合酶 2 (COX 2 )在胰腺癌新生血管生成中的调节作用及其作用机制。方法　应用免疫组织化学染色研究人胰腺癌组织COX 2、血管内皮细胞生长因子 (VEGF)表达 ;同时标记肿瘤新生血管内皮细胞vWF和血管壁Ⅳ型胶原 ,计算肿瘤组织微血管密度 (MVD)。建立裸鼠胰腺癌细胞株PC 3移植瘤 ,观察选择性COX 2抑制剂Celebrex对肿瘤组织MVD的影响 ,并应用免疫组织化学染色和逆转录聚合酶链式反应 (RT PCR)研究裸鼠移植瘤组织VEGF表达变化。结果　COX 2在人胰腺癌组织中表达阳性率为 87 5 % ,VEGF阳性率为 5 8 3%。COX 2强阳性组MVD平均值显著高于COX 2弱阳性 +阴性组 ,P <0 0 1。VEGF阳性组MVD平均值高于VEGF阴性组 ,但无统计学差异 ,P >0 0 5 ;Pearson相关性检验结果表明COX 2与vWF和Ⅳ胶原标记的MVD均有明显的相关性 (相关系数分别为 0 5 99和 0 6 ) ,P <0 0 5。在裸鼠移植瘤的体内实验中 ,与对照组MVD(6 3 89± 13 6 7)相比 ,Celebrex处理组MVD为 32 2 5± 12 99,两者差异显著 ,P <0 0 1。免疫组织化学染色和RT PCR结果表明Celebrex处理组肿瘤组织VEGF表达较对照组明显下调。结论　COX 2与胰腺癌新生血管生成密切相关 ,其高表达促进了胰腺癌新生血管生成 ;可能作用机制是上调促血管生成因子VEGF     

CDHS 801治疗膀胱癌的光动力学实验动物研究

目的 研究光敏剂CDHS 801体内光动力治疗膀胱癌机理.方法 创建膀胱癌裸鼠动物模型后,腹腔注射CDHS 801,12小时后激光照射肿瘤后处死动物,然后取瘤体进行H.E.染色、免疫组化及电镜观察.结果 激光照射后6h.肿瘤表面皮肤水肿.浅表血管扩张充血.H.E.染色发现肿瘤血管充血、血管形成血栓、大片区域肿瘤细胞变形坏死,TUNEL染色发现肿瘤细胞核内出现棕黄色颗粒,电镜提示细胞核内染色质浓集、边集于核膜下并出现新月体样变化,伴有线粒体肿胀、膜破裂、嵴断裂或消失等现象.结论 CHDS 801光动力学体内治疗膀胱癌的机理,既有PDT(photodynamic therapy)产生ROS对细胞直接杀伤作用,也有引起血管损伤导致肿瘤缺血缺氧间接杀灭肿瘤的作用,诱导肿瘤发生凋亡是其杀灭肿瘤的主要机理.     

红色荧光蛋白标记的胰腺癌裸鼠原位移植瘤转移模型的建立

目的 建立稳定、高表达红色荧光蛋白(RFP)标记的胰腺癌裸鼠原位移植瘤自发转移模型.方法 将稳定、高表达RFP的人胰腺癌细胞株SW1990-RFP注射至裸鼠皮下,建立人胰腺癌裸鼠皮下移植瘤模型.通过外科手术原位移植裸鼠皮下荧光肿瘤组织小块,建立人胰腺癌裸鼠原位移植瘤自发转移模型.应用整体荧光成像系统评价人胰腺癌裸鼠原位移植瘤模型肿瘤转移及微转移的发生情况.结果 成功建立12只人胰腺癌裸鼠原位移植瘤自发转移模型,建模成功率为100%.应用整体荧光成像系统可以实时监测原发肿瘤的牛长状况以及在肿瘤生长早期即可检测到各脏器微小转移的发生.结论 本实验所建立的RFP标记的胰腺癌裸鼠原位移植瘤自发转移模型稳定、可靠,可以在体外无创性动态观察肿瘤的发生、发展,具较强的灵敏性及特异性.     

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.