胆管癌抗原肽对转染全长野生型p53的树突状细胞免疫功能的影响

目的　研究胆管癌抗原肽对转染全长野生型 p5 3的树突状细胞 (wtp5 3DC)免疫功能的影响。方法　将全长野生型 p5 3导入脂质体内并转染小鼠骨髓来源的DC ,然后用胆管癌抗原肽修饰wtp5 3DC ,检测这种树突状细胞的抗原提呈功能。结果　抗原肽修饰的wtp5 3DC和单纯DC这 4种上清 3种细胞因子含量明显增加为 :( 5 45 .2± 12 .1)ng/L ,( 5 11.1± 13 .3 )ng/L ,( 5 3 7.1±11.1)ng/L ;wtp5 3DC刺激小鼠脾脏T细胞增殖水平明显高于对照组 (P <0 .0 1) ;该细胞高表达B7 1、B7 2、MCH Ⅰ、MCH Ⅱ (P <0 .0 5 ) ;能够特异性地杀伤胆管癌细胞 ,杀伤率为 81.6%。结论全长野生型 p5 3基因转染与胆管癌抗原肽联合修饰树突状细胞能诱导小鼠细胞毒性T淋巴细胞的特异性。     

胆管癌抗原肽对转染全长野生型p53的树突状细胞免疫功能的影响

目的研究胆管癌抗原肽对转染全长野生型p53的树突状细胞(wtp53DC)免疫功能的影响。方法先将全长野生型p53导入脂质体内并转染小鼠骨髓来源的DC,然后用胆管癌抗原肽修饰wtp53DC,检测这种树突状细胞的抗原提呈功能。结果抗原肽修饰的wtp53DC和单纯DC的上清3种细胞因子含量明显增加,分别为(545.2±12.1)ng/L,(511.1±13.3)ng/L,(537.1±11.1)ng/L(P<0.05);wtp53DC刺激小鼠脾脏T细胞增殖水平明显高于对照组(P<0.01);该细胞高表达B7-1、B7-2、MHC-Ⅰ、MHC-Ⅱ(P<0.05);能够特异性地杀伤胆管癌细胞,杀伤率81.6%。结论全长野生型p53基因转染+胆管癌抗原肽联合修饰树突状细胞能诱导小鼠细胞毒性T淋巴细胞的特异性。     

胃癌抗原肽Hsp70复合物对转染全长野生型p53的树突状细胞免疫功能的影响

目的 应用联合修饰的树突状细胞(DC)在体外诱导高效而特异的抗胃癌免疫效应。方法 先将全长野生型p53导入脂质体内并转染小鼠骨髓来源的DC,然后用胃癌抗原肽-HSP70复合物等因素修饰已转染全长野生型 p53的 DC(wt-p53 DC),检测这种DC诱导小鼠脾脏淋巴细胞特异的细胞毒性T淋巴细胞(CTLs)的能力,分泌细胞因子功能,以及表面分子表达的高低。结果Western blot检测转染小鼠 p53cDNA的 BMDC及其培养上清中均可以检测到 p53表达;细胞因子含量明显增加(P<0.05),而的其他组的细胞因子含量与对照相比,无显著变化;经流式细胞仪(FACS)检测 wt-p53DC表面高表达 B7-1、B7-2、MCH-Ⅰ、MCH-Ⅱ;脾淋巴细胞经刺激后,能够特异性地杀伤胃癌细胞,杀伤率为91.6％。结论 全长野生型p53基因转染+抗原肽联合修饰DC能诱导小鼠细胞毒性T淋巴细胞的特异性,显著提高DC的抗原提呈功能。     

胃癌肿瘤裂解物修饰的树突状细胞体外诱导抗原特异性细胞毒T淋巴细胞

目的　利用树突状细胞呈递肿瘤抗原的特性提高细胞毒T淋巴细胞 (CTLs)对胃癌细胞的杀伤活性。方法　胃细胞癌患者外周血来源的有核细胞体外经GM -CSF和IL -4诱导产生树突状细胞 ,负载肿瘤裂解物后诱导自体CTLs产生。用细胞毒试验检测CTLs杀伤活性 ,和用ELISA测定细胞因子的分泌。结果　胃癌患者自体来源的DC裂解物能诱导产生的CTLs对自体胃癌细胞具有高杀伤率 ,可达 83 % ;致敏的DC组中IL -12与TNF -α的浓度 ( 1161± 2 3 9pg/ml,10 44± 3 12 pg/ml)显著高于未致敏的DC组 ( P <0 .0 5 )。结论　DC能呈递胃癌裂解物 ,诱导产生抗原特异性CTLs。     

转Survivin基因树突状细胞抗消化道肿瘤的免疫效应研究

目的　研究转染Survivin的树突状细胞 (DC)在体外诱导高效而特异的抗消化道肿瘤免疫效应。方法　用脂质体作为介质 ,将Survivin基因转染入DC ,用Westernblot法检测培养上清Survivin的表达 ,检测这种DC分泌细胞因子白介素 (IL 12 )、肿瘤坏死因子 (TNF) α的功能 ,以及表面分子CD1a、CD83、MHcⅡ、CD80、CD86表达的高低 ,用MTT法诱导人特异的细胞毒性T淋巴细胞 (CTLs)的能力。结果　培养上清中均可以检测到Survivin表达 ;转基因DC的上清IL 12、TNF α两种细胞因子含量为 (2 65 .2± 3 2 .7)ng/L和(4 3 7.1± 83 .5 )ng/L明显比单纯DC组高(P <0 .0 5 ) ;转基因DC表面高表达CD1a、CD83、MHCⅡ、CD80、CD86;转基因的DC提呈的T细胞对胃癌细胞、结肠癌细胞、胆管癌细胞杀伤率分别为 :65 %、77%、85 % ,而未修饰的单纯DC杀伤作用较低。结论　Survivin基因转染修饰的DC能诱导细胞毒性T淋巴细胞的特异性 ,显著地提高DC的抗原提呈功能 ,体外能诱导高效而特异的抗癌免疫效应。     

负载肾癌肿瘤裂解物的树突状细胞诱导产生抗原特异性细胞毒T淋巴细胞

目的　利用树突状细胞呈递肿瘤抗原的特性提高细胞毒T淋巴细胞 (CTLs)对肾癌细胞的杀伤活性。　方法　肾细胞癌患者骨髓来源的有核细胞体外经GM CSF和IL 4诱导产生树突状细胞 ,负载肿瘤裂解物后诱导自体CTLs产生。用细胞毒试验和ELISA测定CTLs杀伤活性和细胞因子的分泌。　结果　肾癌患者自体来源的DC Tuly能 (1)增加CTLs增殖 ,16d时使T细胞增殖达 4 3倍 ;(2 )上调CTLs中CD3 和CD8 T细胞群 ;(3)诱导产生的CTLs对自体肾癌细胞具有高杀伤率 ,显著高于异体肾癌和异种肿瘤细胞 (P <0 .0 5 ) ;(4)上调TNF α分泌。　结论　DCs能呈递Tuly抗原。诱导产生抗原特异性CTLs,提示DC Tuly具有为肾癌患者制作疫苗和进行特异性CTLs过继免疫治疗的临床应用前景     

肝癌细胞裂解物致敏DC疫苗诱导的肿瘤特异抗瘤效应

目的　研究肝癌细胞裂解物致敏的树突状细胞 (DC)疫苗诱导的体内、外抗瘤效应。方法　体外实验 :将肿瘤细胞裂解物致敏的DC与T细胞共培养 ,4d后收获致敏的T细胞 ,观察其对野生型肿瘤细胞的杀伤反应并检测培养液中的IFN γ分泌情况。体内实验 :观察肿瘤细胞裂解物致敏的DC疫苗对小鼠皮下肝癌发生的抑制作用。结果　在效 :靶比分别为 5 0 .0∶1.0、2 5 .0∶1.0、12 .5∶1.0时 ,肝癌细胞裂解物致敏的DC组与DC组诱导的肿瘤杀伤活性分别为 (4 5 .7±3 .2 ) %对 (2 6.5± 2 .5 ) % ;(3 1.0± 2 .7) %对 (14 .3± 3 .3 ) % ;(2 7.8± 1.7) %对 (9.9± 0 .6) % (在各效靶比 ,P <0 .0 1) ,混合细胞培养上清液中IFN γ浓度则为 (2 60 3 .3± 2 60 .0 )ng/L对 (5 0 1.0±5 0 .0 )ng/L。在体内则可有效抑制小鼠皮下肝癌的发生。结论　肝癌细胞裂解物致敏的DC疫苗可以诱导肿瘤特异的抗瘤效应     

腺病毒介导G250基因转染树突状细胞激活免疫效应细胞治疗肾癌的实验研究

目的 探讨以腺病毒(Ad)载体介导肾癌相关抗原G250基因转染制备树突状细胞(DC)瘤苗.体外诱导自体T淋巴细胞特异性抗肾癌免疫效应. 方法 自健康人外周血中提取单核细胞,将贴壁细胞分为3组(Ad-G250基因转染组、G250蛋白致敏组、未致敏组),用粒细胞-巨噬细胞集落刺激因子和诱导活化;3组DC细胞中分别加入自体T淋巴细胞,获得细胞毒性T淋巴细胞(CTL).RT-PCR检测G250在DC细胞内的转录情况;流式细胞仪检测DC表面标志分子和G250抗原蛋白的表达情况;四甲基偶氮唑盐法检测3组CTL对肾癌细胞株786-0和肺癌细胞株A549的杀伤活性. 结果 Ad-G250高效转染DC,G250阳性细胞率为(52.2±1.5)%,G250蛋白在DC:内成功表达:基因转染组DC中成功扩增出G250产物;Ad-G250转染的DC表面标志CD_(80)、CD_(83)、CD_(86)、CD_(1a)、HLA-DR表达高于其他2组.差异均有统计学意义(P<0.05).Ad-G250基因转染组、G250蛋白致敏组、未致敏组诱导的3组CTL对786-0靶细胞杀伤活性分别为(83.4±2.8)%、(79.6±2.4)%、(77.3±2.1)%,组间比较差异有统计学意义(F=69.172,P=0.000);3组CTL对A549靶细胞杀伤活性差异无统计学意义(F=0.373,P=0.693). 结论 以Ad为载体介导抗原基因转染DC,并诱导特异的CTL,技术上可行,所诱导的CTL杀伤活性强,有望成为一种肿瘤免疫治疗方法.     

干扰素γ诱导蛋白10基因修饰小鼠树突状细胞的抗前列腺癌作用研究

目的　探讨转染干扰素γ诱导蛋白 10 (IP 10 )基因构建的加载树突状细胞 (DC)瘤苗 ,对特异性细胞毒T淋巴细胞 (CTL)的诱导作用。　方法　将RM 1细胞的裂解产物作为肿瘤抗原加载小鼠骨髓来源的DC(Tuly DC) ,将IP 10DNA插入真核表达质粒 ,通过脂质体法将IP 10基因转染至Tuly DC ,构建DC瘤苗 ;RT PCR法检测IP 10基因转染成功 ,趋化实验检测对淋巴细胞的趋化作用 ,混合淋巴细胞反应 (MLR)检测瘤苗刺激T细胞的增殖能力 ,MTT法检测瘤苗诱导的特异性CTL的杀伤活性。　结果　转染DC的IP 10表达明显增强 ,其上清对淋巴细胞有较强的趋化作用 ;DC瘤苗刺激T细胞增殖能力增强 ,每分钟闪烁计数值分别为 18913.0 9± 2 735 .33(1∶10 )和 17736 .6 7± 2 5 31.70 (1∶2 0 ) ,与各对照组相比差异有显著性意义 (P <0 .0 1) ;DC瘤苗诱导的CTL对RM 1细胞的特异性杀伤率分别为 (37.95± 5 .2 6 ) % (效靶比 2 0∶1)和 (43.87± 7.6 3) % (效靶比 4 0∶1) ,均高于各对照组 ,差异有显著性意义 (P <0 .0 1)。　结论　所构建的前列腺癌DC瘤苗能有效提高其抗原提呈功能和特异性CTL的诱导。     

负载肿瘤抗原的DC疫苗体外诱导的特异性抗膀胱癌效应研究

目的 探讨负载膀胱癌抗原成分树突状细胞(dendritic cells,DC)疫苗的制备和体外诱导T淋巴细胞特异性杀伤膀胱癌细胞的作用.方法 冻融法制备EJ细胞裂解物抗原成分,体外培养的人外周血单个核细胞(hu-PBMC)在rhGM-CSF、rhIL-4、TNF-α诱导下分化出DC,负载EJ细胞裂解物抗原后制备膀胱癌DC疫苗;免疫磁珠分离法从人免疫重建Balb/c裸小鼠脾脏组织中分离CD3+ T淋巴细胞,3H-TdR掺入试验测定DC疫苗刺激自体T淋巴细胞增殖的能力,51Cr释放试验检测DC疫苗诱导的T细胞对EJ细胞的杀伤作用.结果 Hu-PBMC在细胞因子rhGM-CSF、rhIL-4和TNF-α的刺激下分化为成熟DC,负载EJ抗原的DC疫苗体外可使同源T淋巴细胞活化,增殖指数增加,活化的T淋巴细胞对EJ细胞的杀伤率为(62.58±6.13)%,和对照组比较差异有统计学意义(P＜0.05).结论 负载膀胱癌冻融抗原的DC疫苗体外可诱导人T淋巴细胞活化增殖,对EJ细胞有明显的杀伤作用.     

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.