胃癌及癌旁组织中SKP2和p27蛋白表达及相互关系研究

目的研究胃癌及其癌旁组织中SKP2和p27蛋白表达水平,探讨两者的相互关系及其临床意义。方法49例胃癌及20例癌旁组织常规制作石蜡包埋切片,SKP2和p27染色方法为SP免疫组化法。结果胃癌组织中SKP2表达阳性率及其评分值明显高于癌旁组织（P〈0．01）,而p27则相反（P〈0．05,P〈0．01）;SKP2表达阳性和（或）p27表达阴性的癌旁组织呈中至重度不典型增生。SKP2和p27蛋白表达与癌细胞浸润深度、有无淋巴结转移、淋巴结转移分站及有无远处转移有关（P〈0．05,P〈0．01）。在胃癌组织中SKP2与p27评分值之间呈负相关（r=-0．65,P〈0．01）。结论SKP2和p27可能是反映胃癌发生、进展、生物学行为及预后的标记物。     

p27kipl和cyclin D1在肾细胞癌中的表达及生物学意义

目的 探讨细胞周期蛋白依赖性激酶抑制蛋白p27kipl(p27)和细胞周期蛋白D1（Cyclin D1)与肾癌生物学行为的关系。方法 采用免疫组化SP法测定41例肾透明细胞癌及21例正常肾组织石蜡切片中p27蛋白和Cyclin D1蛋白的表达。结果 p27在正常肾组织的阳性率分别为82．4％、57．1％、20．0％,p27表达与肾癌的分级呈负相关（P＜0．01）。Cyclin D1在正常肾组织中的阳性率为33．3％。在肾癌组织中的阳性率为68．3％（P＜0．01）。Cyclin D1在G1、G2、G3肾癌组织的阳性率分别为88．2％、71．4％、30．0％,Cyclin D1蛋白的表达与肾癌的分级亦呈负相关（P＜0．05）。p27和Cyclin D1间在肾癌中的表达呈正相关（P＜0．001）,r=0.6。结论 p27和Cyclin D1与肾癌的组织学分级呈负相关,提示p27和Cyclin D1有可能作为判别肾癌分化 程度的标志物,并可能成为判断预后的有用指标。     

Survivin蛋白在肝门部胆管癌中的表达及其与p53相关性的研究

目的：检测肝门部胆管癌中凋亡抑制因子Survivin蛋白的表达，研究其与肝门部胆管癌的临床特征的关系，并探讨其与p53的相关性。方法：采用免疫组织化学方法检测86例肝门部胆管癌组织、10例癌旁组织（距肿瘤边缘约1．0cm）及10例正常胆管组织中Survivin蛋白和p53蛋白的表达，结合临床病理学资料进行统计学分析。结果：86例肝门部胆管癌组织中，Survivin蛋白阳性率为82．6％（71／86），p53蛋白阳性率为76．7％（66，86），Survivin与p53在癌旁组织和正常胆管组织中均呈阴性表达，与癌组织相比差异有统计学意义（P〈O．05）；Survivin表达与肝门部胆管癌病理分级、Bismuth分型、患者的性别及年龄和肿瘤大小均无关（P〉0．05），但淋巴结转移阳性组Survivin蛋白表达水平明显高于淋巴结转移阴性组，差异有统计学意义（P〈0．05）；p53蛋白在肝门部胆管癌中与肿瘤组织病理分级、淋巴结有无转移相关（P〈0．05），与其他病理学特征无关（P〉O．05）。71例Survivin阳性表达者中同时表达p53阳性者58例，15例阴性表达者中表达p53阳性者8例，两者差异有统计学意义（P〈0．05）。结论：肝门部胆管癌组织中Survivin和p53的表达显著高于癌旁组织和正常胆管组织，其在肝门部胆管癌的发展、转移过程中可能具有重要作用。     

微小RNA-183在Ⅱ期胃癌中的表达及与埃兹蛋白的相关分析

目的探讨微小RNA-183（miR-183）和埃兹蛋白（Ezrin）在Ⅱ期胃癌中的表达情况及临床意义。方法采用实时定量PCR检测72例Ⅱ期胃癌及癌旁组织中miR-183表达．免疫组织化学SP法检测相应癌组织中Ezrin表达．分析miR-183与Ⅱ期胃癌临床病理特征和预后的关系及与Ezrin表达的相关性。结果miR-183在Ⅱ期胃癌组织中的表达低于癌旁组织（相对表达量中位值0．676比1．000,P〈0．05）;miR-183表达下调与肿瘤细胞分化程度（0．429比0．907,P〈0．05）和淋巴结转移相关（0．507比0．908,P〈0．05）;miR-183低表达组生存时间[（63．0±4．0）个月]低于高表达组[（75．2±3．8）个月,P〈0．05];相关性分析显示。miR-183与Ezrin表达呈负相关（r=-0．272,P〈0．05）。结论miR-183在Ⅱ期胃癌中表达下调,与胃癌的分化、转移及预后相关。Ezrin可能为其调控蛋白之一。     

膀胱移行细胞癌组织中p53和血管内皮生长因子表达的关系及临床意义

目的研究p53和血管内皮生长因子（VEGF）在膀胱移行细胞癌（BTCC）组织中的表达及与BTCC临床参数的关系。方法免疫组织化学LDP法检测86例BTCC组织及10例正常膀胱组织中p53蛋白及VEGF的表达。BTCC病理分级（WHO）：G126例，G248例，G312例；临床分期（UICC）：浅表性66例，浸润性20例；随访10个月一8年，复发30例。结果BTCC组织中p53与VEGF阳性表达率分别为46．5％（40／86）和66．3％（57／86）。正常膀胱组织p53及VEGF均无表达。p53表达与VEGF表达呈明显正相关（P〈0．05）；二者均与BTCC的组织学分级显著相关（P〈0．05）；浸润性肿瘤阳性表达率明显高于浅表性肿瘤（P〈0．01）。p53阳性和VEGF阳性表达的肿瘤复发迅速，p53阴性而VEGF阳性表达较阴性表达者预后差。结论p53和VEGF与BTCC组织学分级和预后密切相关。BTCC是典型的血管依赖性病变，p53可能通过p53-VEGF调节旁路途径促进BTCC的肿瘤血管形成，联合检测p53和VEGF的表达可作为判断BTCC生物学行为及预后的重要指标。     

EphA2mRNA和VEGF在肝癌细胞中的表达及其关系

目的探讨肝癌（hepatocellular carcinoma，HCC）细胞中EphA2 mRNA（erythropoietin producing hepatoma cell lines）和VEGF（vascular endothelial growth factor）的表达及其关系。方法用原位杂交的方法检测53例HCC组织及其癌旁组织中EphA2 mRNA表达，并用免疫组织化学的方法检测HCC组织中VEGF的表达。结果53例肝细胞癌组织及癌旁组织中EphA2 mRNA的阳性率分别为86．79％（46／53）和69．81％（37／53），其差异有显著的统计学意义（W=2289．500，P〈0．001）；肝癌组织中VEGF的阳性率为75．47％（40／53），癌旁组织中VEGF的表达为阴性。肝癌组织中EphA2 mRNA和VEGF的表达显示：（1）表达水平与是否患有肝硬化无关；（2）表达水平分别与肝癌的临床病理学Edmondson分级呈明显的正相关（r=0．452，P=0．001；r=0．333，P=0．015）；（3）二者之间的表达水平呈明显的正相关（r=0．425，P=0．002）。结论本实验表明：肝癌细胞中EphA2 mRNA和VEGF呈过量表达；肝癌细胞中EphA2 mRNA和VEGF的表达与肝癌细胞恶性程度以及二者之间密切关联。     

Cyclin D3、Cyclin D1、p27KIP1在膀胱尿路上皮细胞癌中的表达及其关系

目的 探讨膀胱尿路上皮细胞癌(UCCB)组织中Cyclin D3、Cyelin D1和p27KIP1的表达及关系.方法 采用免疫组织化学方法测定50例UCCB组织、癌旁组织及15例正常膀胱黏膜组织的Cyelin D3、Cyelin DI和p27KIP1表达情况;逆转录-聚合酶链反应(RT-PCR)方法测定CyclinD3 mRNA的表达情况.结果 Cyclin D3蛋白在UCCB、癌旁黏膜及正常膀胱黏膜中的表达率分别为32.00%(16/50)、12.00%(6/50)和6.67%(1/15),在UCCB组织中的表达高于癌旁黏膜和正常膀胱黏膜中的表达,差异有统计学意义(P<0.05),和病理分级、肿瘤大小及1年内肿瘤复发明显相关(P<0.05);Cyelin D3 mRNA在膀胱癌组织与癌旁组织和正常组织间,差异均有统计学意义(P<0.01).CycLin D1阳性率为80.00%(40/50),和病理分级及1年内肿瘤复发明显相关(P<0.05);p27KIP1阳性率为46.00%(23/50),和病理分级及1年内肿瘤复发明显相关(P<0.05).p27KIP1蛋白与Cyclin D3蛋白、Cyefin D1蛋白在UCCB中的表达呈负相关(r=-0.5472,P<0.01:r=-0.5417,P<0.01).Cyelin D3和Cyclin D1蛋白表达呈正相关(r=0.3430,P(0.05).结论 UCCB组织中Cyclin D3、Cyclin D1和p27KIP1表达明显相关,三者联合检测对UCCB的诊断治疗和估计预后有一定意义.     

PTEN和p27及cyclin D1蛋白在大肠癌组织中的表达及相关性研究

目的：研究大肠癌组织中PTEN、p27和cyclinD1蛋白的表达及三者间的关系。方法：应用免疫组铡匕学方法检测58例大肠癌组织、58例癌旁组织和14例正常大肠黏膜中PTEN、p27和cyclinD1蛋白的表达情况。结果：大肠癌组织中PTEN和p27蛋白的阳性表达率分别为65．52％（38／58）和53．45％（31／58），较癌旁组织和正常组织明显刚氏（P〈0．05）；cyclinD1蛋白的阳性表达率为60．34％（35／58）,较癌旁组织及正常组织显著升高（P〈0．05）。三者在大肠癌组织中的表达存在相关性，且均与肿瘤的分化程度、有无淋巴结转移和Dukes分期有关（P〈0．05）。结论：PTEN、p27和cyclinD1基因的异常改变参与大，且三者之间存在相关性。联合检测三者表达水平可作为评价大肠癌病理生物学行为的客观指标之一。     

p16、p21蛋白和增殖细胞核抗原在胃癌中的表达及其相互关系

目的 探讨p16、p21蛋白和增殖细胞核抗原（PCNA）在胃癌发生、发展中的作用及临床意义。方法 应用免疫组织化学法,以46例胃癌及癌旁组织中p16 、p21蛋白和PCNA进行检查。结果 胃癌组织中p16、p21蛋白和PCNA的阳性率分别为21．05％、28．26％、73．91％,与癌旁组织中的阳性率为58．705、65．21％、23．91％差异有显著性（P＜0．05）。在胃癌的不同病理参数（淋巴结转移,分化程度,浸润深度及TNM分期）中,p16,PCNA和p21蛋白表达则分别在全部4个,前2个,前2个参数中存在着明显差异（P＜0．05）。p16、p21蛋白和PCNA在肿瘤的部位、大小、患者性别及年龄间差异无显著性（P＞0．05）。p16原癌基因蛋白质与PCNA,p21与PCNA阳性表达存在明显差异（P＜0．05）,而p21表达与p16表达之间则差异无显著性（P＜0．05）。结论 p16、p21蛋白和PCNA是胃癌发生、发展过程中的重要因素,且与胃癌临床病理参数密切相关。     

p53,p21在乳癌中的表达及意义

目的 探讨p53,p21蛋白在乳癌中表达的临床意义。方法 用免疫组化SP法对20例癌旁乳腺组织和69例乳癌组织中p53和p21蛋白进行半定量检测。结果 癌旁乳腺组织中p53和p21表达阴性;乳腺癌组织中p53和p21阳性率分别为47．8％和43．5％;随细胞分化程度降低;p53表达阳性率明显升高,p21表达的阳性率明显降低。p21表达的阳性率在有、无淋巴结转移组差异显著（P＜0．05）;p53阳性、p21阴性组术后5年无瘤生存率明显低于p53阴性、p21阳性组（P＜0．05）;在乳癌组织中p21表达与p53明显相关（P＜0．05）。结论 p53和p21在乳癌中的表达可判断乳癌细胞分化程度及患者预后。     

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.     

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.