上皮间质转化与肝细胞癌肺转移的相关性研究

目的 研究上皮间质转化和肝细胞癌肺转移的关系.方法 2000年1月至2004年3月于中山医院肝外科手术病理诊断为肝细胞癌的患者中,根据术后随访期内有无肺转移分为有肺转移组和无远处转移组,每组随机选择50例患者的原位肝癌组织制成组织芯片.用免疫组织化学染色(二步法)方法检测组织芯片上肺转移组和无远处转移组患者的肝痛组织的上皮间质转化的标志(E-cadherin、Vimentin、Fibronectin),单因素和多因素分析这些标志和肝细胞癌肺转移的关系.结果 单因素分析了性别、年龄、HbsAg、甲胎蛋白(AFP)、肿瘤大小、数目、癌栓、包膜、肝门淋巴结、肿瘤分化程度、E-钙黏蛋白(E-cadherin)、波形蛋白(Vimentin)、纤维连接蛋白(Fibroneetin)的表达与肺转移的相关性,结果显示:患者AFP水平>400 ng/ml、肿瘤直径>10 cm、门静脉癌栓、分化程度低、E-cadherin的低表达、Fibronectin的高表达、Vimentin的高表达与肝细胞癌肺转移相关;多因素分析显示肿瘤直径>10 cm、门静脉癌栓、分化程度低、Fibronectin高表达是肝细胞癌肺转移的危险因素.结论 肝细胞癌患者肝癌组织的上皮间质转化与其发生肺转移有密切关系.     

肝癌发生肺转移的危险因素分析

目的 探讨肝癌发生肺转移的危险因素,为防治肝癌肺转移提供理论依据.方法 回顾性分析2008年1月至2012年3月福建医科大学附属第一医院收治的862例肝癌患者的临床资料.其中肺转移107例,将其血清AFP、GGT水平、是否合并HBV感染、肝内肿瘤情况、肝内肿瘤治疗情况等因素进行分析,寻找影响肝癌发生肺转移的危险因素.单因素分析采用COX比例风险模型,将有统计学意义的指标引入COX模型采用逐步后退法进一步进行多因素分析.结果 单因素分析结果显示:AFP≥400 μg/L、GGT≥150 U/L、合并HBV感染、肝内肿瘤数目≥2个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移是影响肝癌发生肺转移的危险因素,差异有统计学意义(RR=1.986,3.653,0.365,3.675,0.252,0.379,0.352,P＜0.05).多因素COX逐步后退法分析结果显示:AFP≥400 μg/L、合并HBV感染、肝内肿瘤数目≥2个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移的肝癌患者更容易发生肺转移,差异有统计学意义(RR=2.391,3.462,3.425,3.396,2.418,0.638,P＜0.05).结论 AFP ≥400 μg/L、合并HBV感染、肝内肿瘤数目≥2个、肿瘤未经手术切除或RFA、合并血管癌栓、伴有淋巴结转移者是肝癌发生肺转移的危险因素,抗病毒治疗、早期积极手术治疗肝内瘤灶可能对防治肝癌发生肺转移有重要意义.     

Hep-1表达对评价肝细胞癌手术切除预后的价值

目的:研究Hep-1与原发性肝细胞癌术后无瘤生存的相关性,探讨其预测手术疗效的价值。方法:对279例行手术切除并经病理证实的原发性肝细胞癌患者进行回顾性随访,将完整的随访资料同临床和病理特征进行单因素和多因素分析,单因素分析采用Kaplan-Meier法计算,Cox回归进行多因素分析。结果:单因素分析结果显示,年龄、肿瘤大小、门静脉癌栓、肿瘤包膜、子灶、微血管侵犯、Hep-1水平、pCEA水平、CD34水平、术前AFP值、BCLC分级等11个相关临床病理因素影响HCC术后无瘤生存时间;多因素分析显示,肿瘤有无包膜、门静脉癌栓、术前AFP值、有无子灶和术后Hep-1水平与无瘤生存期有着密切关系。结论:肝细胞癌患者术后病理免疫组织化学指标Hep-1能较客观地预测术后肿瘤复发情况,有助于临床医师治疗方法的选择。     

解剖性肝切除治疗肝细胞癌的长期结果和预后影响因素分析:附90例报告

目的 探讨解剖性肝切除治疗肝细胞癌的安全性、长期结果以及预后影响因素.方法 从2003年1月至2010年1月对90例可手术切除的肝细胞癌实施解剖性肝切除术,肿瘤大小:≤5 cm38例,＞5 cm 52例；肿瘤数目:单发病灶57例,2个以上多发瘤灶33例.肝癌合并肝硬化45例(50.0％)；合并脉管癌栓34例(37.78％).肝功能分级:Child-Pugh A级64例,B级26例.术中统计手术时间、出血量以及输血量；术后观察并发症、肝功能.采用Kaplan-Meier法计算无瘤生存率和累积生存率.肿瘤复发与相关单因素分析采用log-rank检验.通过Cox回归进行多因素分析确定影响患者无瘤生存期和总生存期的独立因素.结果 全组无死亡.术后并发症发生率为31.1％(28/90).术后复发率为51.1％(46/90),术后1、3、5年无瘤生存率分别为92.2％、67.3％和49.7％.切缘阳性(相对危险度为13.83,95％可信区间为4.56～41.96)和子灶(相对危险度为3.09,95％可信区间为1.60～5.98)为影响预后的独立因素.术后1、3、5年总的累积生存率分别为94.4％、80.0％和60.0％.Cox回归分析显示切缘阳性(相对危险度为19.22,95％可信区间为5.85～63.17)和TNM分期(相对危险度为2.013,95％可信区间为1.28～3.17)为影响预后的独立因素.结论 解剖性肝切除是治疗肝细胞癌安全有效的术式.术后复发主要与肿瘤切缘阳性和TNM分期有关.在保证切缘阴性方面,解剖性肝切除具有明显优势.     

围手术期检测肝细胞癌病人外周血AFP mRNA的临床意义

目的 检测围手术期肝细胞癌病人外周血AFP mRNA，通过随访评估其预后价值。方法 通过巢式RT-PCR的方法，在围手术期检测了45例肝细胞癌病人外周血中AFP mRNA的表达，并进行了1～20个月不等的随访。结果 在45例肝细胞癌病人外周血中，AFP mRNA的检出率分别是术前51．1％，术后7d24．4％，术后28d22．2％。多因素统计分析提示，术后28d外周血检出AFP mRNA是提示病人复发的独立预后因素。结论 采用巢式RT-PCR的方法检测肝细胞癌病人术后28d外周血AFP mRNA有助于预测肝癌转移复发。     

肝癌病人手术期间不同部位血液AFP mRNA定量检测及其意义探讨

目的 研究肝细胞性肝癌(HCC)病人手术期间不同部位血液甲胎蛋白信使核糖核酸(AFP mRNA)的水平变化，分析其与临床病理学特征和复发转移的关系。方法 18例HCC和6例非HCC肝肿瘤病人，于切除肿瘤前后抽取门静脉、肝静脉和外周静脉血各5m1，肝炎、肝硬化病人各10例取外周血5m1。应用TaqMan实时定量逆转录—聚合酶链反应(RT—PCR)检测AFP mRNA水平。结果 术前外周血AFP mRNA相对HCC的灵敏度为72．2％，特异性为76.9％，准确率为75．0％。HCC病人术后各部位血液AFP mRNA水平明显高于术前相应部位水平。血液AFP mRNA水平与肿瘤大小、分化程度、有无肝内播散、包膜完整性以及血清AFP浓度均无关，而有门静脉癌栓的病人术后肝静脉血AFP mRNA水平明显高于无癌栓者。术后2个月内复发者，术后门静脉和外周静脉血AFP mRNA水平明显高于末复发者。结论 TaqMan实时定量RT—PCR法检测HCC病人血液AFP mRNA有较高的敏感性和特异性。手术可能促进部分HCC细胞和肝细胞脱落入血。动态监测外周血AFP mRNA水平对术后早期复发有预测价值。     

肿瘤标志物在肝细胞癌合并门静脉癌栓诊断中的意义

目的:分析肿瘤标志物在肝细胞癌合并门静脉癌栓诊断中的意义.方法:回顾性分析1993年1月-2011年1月经影像学诊断为肝细胞癌并门静脉癌栓患者475例,同时随机选取同期经影像学诊断为肝细胞癌的手术患者977例.将甲胎蛋白(AFP)、癌胚抗原(CEA)、CA125作为实验因素.结果:2组一般情况差异无统计学意义(P＞0.05). ROC分析结果显示AFP、CA125的AUC面积分别达到0.814、0.783,AFP诊断界数值为32.91 ng/mL,CA125为113.65 U/mL.两者并联敏感性为0.909,特异性为0.410;串联时敏感性为0.520,特异性为0.970.当肝细胞癌患者满足AFP≥20 000 ng/mL时,其诊断敏感性为0.24,特异性为0.96,准确性为0.73,筛检阳性率0.76.结论:在检测肝细胞癌合并门静脉癌栓中尚无敏感性和特异性均令人满意的肿瘤标志物,AFP和CA125水平的检测对临床实践中判断是否合并门静脉癌栓有一定的指导意义.     

影响肝细胞癌患者肝移植后肿瘤复发及预后的相关因素

目的分析影响肝细胞癌（HCC）患者肝移植后肿瘤复发和预后的相关因素，总结HCC患者肝移植的选择标准。方法回顾性分析118例HCC肝移植受者的临床资料，应用单因素和多因素的分析方法，分析临床和病理等相关因素对HCC患者肝移植后肿瘤复发及预后的影响，筛选出影响肿瘤复发和预后的危险因素，并结合国际HCC肝移植受者选择标准运用于临床。结果HCC患者肝移植围手术期死亡8例，对存活的110例随访1～32个月，其中有41例肿瘤复发（37．3％），死亡39例（35．5％）；12、18和24个月的累积存活率分别是84．55％、70．30％和62．24％；12、18和24个月的无瘤存活率分别是69．05％、66．93％和61．38％。单因素分析结果显示癌栓形成、米兰标准、肿瘤大小、肿瘤分化程度以及pTNM分期对HCE患者肝移植后肿瘤复发有显著影响；癌栓形成、米兰标准、术前血清甲胎蛋白（AFP）水平、肿瘤分化程度以及pTNM分期对患者预后有显著影响；多因素分析显示，癌栓形成和肿瘤分化程度是肿瘤复发的独立影响因素，癌栓形成和术前AFP水平则是影响预后的独立危险因素。结论癌栓形成和肿瘤分化程度是影响HCC患者肝移植后肿瘤复发的独立因素，而癌栓形成和术前AFP水平是影响预后的独立危险因素。     

肝细胞癌肝切除术后预后影响因素分析

目的探讨影响肝细胞癌肝切除术后预后因素，为进一步治疗及判断预后提供依据。方法回顾性分析1994年10月至1998年10月中国医学科学院肿瘤医院手术切除的230例HCC病人资料。对可能影响预后的各种因素进行单因素分析，采用逐步回归法将可能对预后有影响的指标，依次引入Cox模型进行多因素分析。结果全组1、3、5年复发率分别为35．2％、52．1％、62．4％；总的1、3、5年生存率分别为79．1％、53．7％、40．2％。单因素分析显示肿瘤最大直径是否≥5cm、有无脉管瘤栓、术前AST、肝被膜受侵、肿瘤切缘为影响对肿瘤复发和无瘤生存率有影响（P〈0．05）。多因素分析显示脉管瘤栓、术前AST升高、肿瘤切缘、肝被膜受侵及肿瘤最大直径依次为影响预后的主要因素。结论肝细胞癌的预后是由多种因素决定的，脉管瘤栓、术前AST升高、肿瘤最大直径及肝被膜受侵是影响预后的最主要因素。早期发现、早期治疗是提高肝癌病人生存率的重要途径，对存在预后不良因素的病人，应加强术后随诊，及时发现术后复发和转移。     

影响肝内胆管细胞癌预后高危因素的临床回顾分析

目的 探究影响肝内胆管细胞癌(ICC)手术预后的可能因素,为进一步改善ICC的预后提供借鉴.方法 对2009年1月至2011年12月期间103例行根治性手术切除的ICC病人临床病理特征进行生存率、无瘤生存率的单因素分析,并通过Cox多因素分析得到有独立意义的预后指标.结果 103例ICC病人术后1年、3年生存率为77.70％、45.76％,无瘤生存率为67.65％、40.75％.单因素分析提示性别、肿瘤数目、肿瘤大小、脉管侵犯、淋巴结转移、术前CEA影响病人的无瘤生存率及生存率.Cox多因素分析提示脉管侵犯、淋巴结转移和术前癌胚抗原(CEA)是影响ICC病人生存的独立因素;肿瘤大小、神经束侵犯、脉管侵犯和术前CEA是影响ICC病人无瘤生存的独立因素.结论 ICC的局部侵犯和淋巴结转移是影响ICC病人预后的重要因素,如何进一步规范ICC的治疗,包括术前评估、术中手术方式(是否需常规的淋巴结清扫)、术后辅助方案的制定,需要多中心随机对照研究结果的支持.     

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.