体检人群血压水平与心电图异常检出率的关系

目的 探讨体检人群血压水平及其与心电图异常检出率的关系.方法 对5 480名体检人员系统查体,分析不同性别、年龄人群的血压水平及高血压患病率,以及不同血压水平的异常心电图检出率.结果 男性收缩压为(130.5士20.5)mmHg,舒张压为(80.2士27.8)mmHg;女性分别为(120.3士18.5)mmHg、(76.5士27.1)mmHg,男性显著高于女性(均P＜0.01);血压水平随年龄增长而增高,男性正常高限血压占12.24%,高血压占35.68%,女性分别为7.47%、21.20%,男性高血压患病率显著高于女性(P＜0.01);高血压者临床心电图异常如左室肥厚、左室高电压、ST-T改变、各类早搏、束支传导阻滞、房室传导阻滞、陈旧性心梗等的检出率显著高于非高血压者(均P＜0.01).结论 不同性别、年龄血压值水平不同,随着血压升高,临床心电图异常检出率明显增高;医务人员应根据个体差异建立分类护理档案实行分级管理,采取针对性的护理干预措施促进分群健康.     

哈萨克族人群腰围、体重指数与血压关系的研究

目的探讨哈萨克族人群腰围（WC）、体重指数（BMI）与血压水平、高血压患病率的关系。方法采用整群抽样方法随机抽取乌鲁木齐南山牧区甘沟乡〉18岁哈萨克族1233人进行身高、体重、WC和血压等测量。结果哈萨克族人群平均收缩压（143．92±20．07）mmHg，舒张压（96．23±9．78）mmHg；高血压检出率为52．39％；随着WC、BMI的增加，血压水平、高血压检出率呈明显上升趋势，WC、BMI与血压呈显著正相关（均P〈0．01）。结论哈萨克族人群高血压患病率较高，对超重或肥胖及腹型肥胖者，应采取有力的干预措施。     

运动训练联合基因治疗对肾性高血压大鼠肾功能的影响

目的观察运动训练联合β1肾上腺素能受体基因治疗对肾性高血压大鼠血压、肾功能、肾脏前肾素原mRNA、肾脏β1受体mRNA和蛋白的影响，探讨其改善肾功能的机制。方法两肾一夹法制作肾性高血压模型，基因治疗采用经鼠尾静脉注射阳离子脂质体与β1反义寡核苷酸方法。检测大鼠血压、肾功能变化。半定量RT—PCR测定肾脏β1受体mRNA、前肾素原mRNA水平。Western印迹法测检肾脏β1受体的蛋白水平。结果与模型组比较，运动联合基因治疗可使血压下降并维持4周，血压下降最高达41mmHg；尿蛋白量[（45．82±6．56）比（29．12±5．22）mg／L，P〈0．01】、BUN[（13．10±2．62）比（9．05±1．84）mmol／L，P〈0．05]显著降低（P〈0．01，P〈0．05）；内生肌酐清除率显著升高（P〈0．01）；前肾素原mRNA、β1受体mRNA、蛋白表达水平显著降低（P〈0．05）。结论运动训练联合β1受体反义基因治疗可以明显地降低血压，改善肾功能；且运动训练可以增强基因治疗对β1受体mRNA和蛋白的抑制作用，在转录和翻译水平抑制过度激活的β1受体的表达。     

倍他洛克用于气管插管期对BIS，ICP和血流动力学的影响

目的：观察长效选择性β受体阻滞剂—倍他洛克（metoprolol．美托洛尔）对丙泊酚麻醉诱导气管内插管期的BIS、ICP和血流动力学影响。方法：随机选择鼻蝶入路垂体瘤切除术病人100例，ASAⅠ-Ⅱ级，分为倍他洛克组（工组）和对照组（Ⅱ组），每组50例。工组於麻醉诱导期静脉注射倍他洛克60μg／kg；Ⅱ组静脉注射等容量生理盐水。麻醉诱导采用丙泊酚2mg/kg、芬太尼3μg／kg、罗库溴铵1mg／kg，OSS／A评分0级施行气管内插管．术中持续监测平均动脉压（MAP），心率（HR），颅内压（ICP）和脑电双频谱指数（BIS）。结果：倍他洛克组与对照组在气管插管后1min时的BIS分别为39±11和58±8，前者与插管前相比无显着性改变，而后者则较插管前有明显增高并延续至插管后5min（P〈0.05，P〈0.01），且其组间的显着性差异延续至插管后15min（P〈0.01）．倍他洛克组与对照组的MAP和HR在插管后3min和5min，均较插管前明显上升，对照组HR分别为89±11bpm和76±12bpm，MAP分别为122±16mmHg和106±18mmhg，倍他洛克组HR分别为81±12bpm和74±8bpm，MAP分别为111±18mmHg和97±17mmHg。两组相比，对照组的血流动力学显着性上升（P〈0.01），且其组间的显着性差异延续至插管后30min（P〈0.05，P〈0，01）。对照组的ICP於插管后3min上升为14．0±2.3mmHg，舆插管前相比有显着性差异（P〈0．05）；插管后5min，15min和30min的ICP分别为14.9±．0mmHg，15．5±2．6mmHg和14.4±2.7mmHg，显着性高於倍他洛克组（P〈0．05，P〈0．01）．两组插管后的ICP舆麻醉前比较均有显着性升高（P〈0。01）。结论：倍他洛克能减低麻醉诱导气管插管期的血流动力学波动和ICP升高，并抑制DIS反跳．     

低温氧合血微流量持续灌注保存大鼠心脏的效果

目的探讨低温氧合血微流量持续灌注保存大鼠心脏的效果。方法切取Wistar大鼠心脏，随机分为3组，实验组的心脏以4℃氧合血微流量（1ml／h）持续灌注低温保存10h；对照组的心脏以4℃St．Thomas液微流量持续灌注低温保存10h；单纯冷保存组的心脏以4℃St．Thomas液单纯浸泡保存10h。保存后的鼠心用Langendorff装置灌注，生物机能实验系统测定血流动力学指标；高效液相色谱仪测定心肌细胞的ATP含量；光镜和电镜观察心肌组织和线粒体的形态学改变。结果在再灌注30min时，实验组的左心室收缩压（LVSP）为（38．25±3．84）mm Hg，左心室发展压（LVDP）为（32．54±4．01）mm Hg，左心室压力微分（±dp／dt）为（1080±123）mm Hg／s；对照组的LVSP为（34．48±4．68）mm Hg，LVDP为（19．27±4．63）mmHg，±dp／dt为（935±196）mmHg／s；单纯冷保存组的LVSP为（32．14±4．95）mmHg，LVDP为（16．99±4．85）mmHg，±dp／dt为（825±302）mmHg／s，实验组的上述血流动力学指标优于对照组和单纯冷保存组（P〈0．05）。实验组心肌细胞的ATP含量为（1．759±0．502）μmol／L，对照组的ATP为（1．453±0．573）μmol／L，单纯保存组的ATP为（1．059±0．463）μmol／L，实验组的ATP含量明显高于对照组和单纯冷保存组（P〈0．05）。实验组的心肌组织和细胞超微结构的变化轻于对照组和单纯冷保存组。结论低温氧合血微流量持续灌注能改善大鼠心脏的保存效果。     

中分子羟乙基淀粉对脓毒性休克患者血流动力学和组织灌注的影响

目的探讨中分子羟乙基淀粉（中分子羟乙基淀粉）对外科手术后脓毒性休克患者血流动力学和组织灌注的影响。方法对20例脓毒性休克患者用中分子羟乙基淀粉进行液体复苏治疗,分别于复苏前、复苏达标后测定血流动力学指标、血乳酸浓度、胃黏膜二氧化碳分压与动脉血二氧化碳分压的差值（Pg-aCO2）、氧输送（DO2）和氧消耗（VO2）。结果复苏达标后心脏指数（cardiac index,CI）从复苏前的（4.4±1.0）L·min^-1·m^-2上升至（5.9±1.4）L·min^-1·m^-2（P〈0.01）;左心室每搏工作指数（left ventricular stroke work index,LVSWI）从复苏前的（37±12）J/m^-2上升至（51±14）J/m^-2（P〈0.01）;体循环血管阻力指数（systemic vascular resistance index,SVRI）从复苏前的（1069±408）kPa·s·L^-1·m^-2上升至（1384±485）kPa·s·L^-1·m^-2（P〈0.01）;血乳酸浓度从复苏前的（8±3）mmol/L下降至（6±4）mmol/L（P〈0.01）;Pg-aCO2从复苏前的（16±7）mmHg下降至（12±6）mm Hg（P〈0.01）;DO2从复苏前的（586±185）ml·min^-1·m^-2上升至（802±204）ml·min^-1·m^-2（P〈0.01）,VO2变化不明显。结论中分子羟乙基淀粉可以改善脓毒性休克患者的血流动力学指标和组织灌注。     

年龄小于45岁原发性慢性闭角型青光眼的显微手术治疗

目的探讨原发性慢性闭角型青光眼年轻患者临床治疗的经验和体会。方法对临床收治的41例52眼、年龄〈45岁、临床确诊为进展期或晚期原发性慢性闭角型青光眼的病例进行抗青光眼显微手术处理的病例进行回顾性分析。结果随访时间平均（32．50±5．08）个月；男16例，女25例；进展期28眼，晚期24眼；52眼均行抗青光眼手术-复合式小梁切除手术治疗；眼轴长平均（22．40±1．63）mm，其中〈21mm占17．31％，小眼球占13．46％；前房深度平均（1．90±0．39）mm，其中〈1．9mm占61．46％；超声生物显微镜检查高褶虹膜构型占59．62％，其中睫状突位置靠前者10眼；术前平均眼压（41．73±12．26）mmHg，末次术后平均眼压（12．03±4．57）mmHg，术前后眼压差异有统计学意义（t=3．520，P〈0．001）。术后并发症主要有浅前房，恶性青光眼。恶性青光眼手术处理方式包括玻璃体抽液、前段玻璃体切割以及超声乳化白内障吸除加人工晶状体植入术治疗。4眼因眼压控制不理想，行二次抗青光眼手术治疗。结论年轻原发性慢性闭角型青光眼患者，女性多见，多伴有眼轴短、前房浅等特点，抗青光眼复合式小梁手术治疗要注意防治术后浅前房、恶性青光眼的发生。术前详细检查、手术操作精细以及有效处理术后并发症将有助于提高手术成功率和减少并发症。     

胰岛素强化治疗对烫伤大鼠心肌保护作用的研究

目的 了解胰岛素强化治疗对重度烫伤大鼠心肌的保护作用，并探讨其作用机制。方法 将18只SD大鼠分为3组，每组6只。强化组及烫伤组大鼠背部脱毛造成30％TBSA的Ⅲ度烫伤。强化组伤后即输注胰岛素等渗盐水（含胰岛素0．12U／m1）及100g／L葡萄糖，使大鼠血糖水平控制在4．0～6．6 mmol／L之间，补液总量为2ml·kg^-1。·％TBSA^-1·8h^-1；烫伤组伤后仅给予等渗盐水，总量同前。假伤组模拟烫伤，伤后补充生理量的液体。于伤前及伤后1、2、3、4、5、6 h 抽取大鼠静脉血测定其血糖值。各组大鼠伤后均经右颈动脉插管人左心室并连接生理记录仪，观察左心室收缩压（LVSP）及左心室舒张末期压（LVEDP）。伤后6h，处死各组大鼠，留取左心室组织标本用于心肌细胞肌钙蛋白T的检测。结果 烫伤组大鼠伤后1～6h的血糖值为（7．6±1．7）～（8．4±4．7）mmol／L，均高于强化组[（4．5±0．9）～（5．2±1．3）mmol／L，P〈0．01]。伤后1h，烫伤组LVSP[（60±11）mmHg（1mmHg=0．133kPa）]降低、LVEDP[（21．3±11．3）mmHg]升高，与强化组[（72±8）、（11．7±5．2）mmHg]比较，差异有统计学意义（P〈0．05）。烫伤后各组大鼠肌钙蛋白T在心肌细胞内大量缺失，而强化组缺失程度明显低于烫伤组（P〈0．05）。结论 胰岛素强化治疗对重度烫伤大鼠左心室功能具有明显的保护作用，此作用可能与抑制心肌细胞蛋白的缺失有关。     

粘着斑激酶在PDGF-BB诱导MHCC-97H细胞黏附侵袭中的作用

目的观察不同浓度血小板衍生生长因子（PDGF-BB）诱导MHCC-97H细胞中粘着斑激酶（focal adhesion kinase，FAK）mRNA的动态变化及FAK在细胞黏附、侵袭的作用。方法不同浓度（1，2．5，5，10，25ng／m1）PDGF-BB诱导MHCC-97H人肝癌细胞，Real-time PCR方法检测FAK及MMP-2的mRNA动态变化，黏附实验、侵袭实验分别检测诱导后MHCC-97H细胞的黏附、侵袭能力的变化。结果诱导后MHCC-97H细胞FAKmRNA水平上调，在10ng／ml浓度时达到最高，为对照组的112．6倍；MMP-2mRNA水平上调并与FAKmRNA水平上调呈一致性，在10ng／ml浓度时达到最高，为对照组的56．9倍。诱导后各组黏附率分别为（66±1．84）%、（69±1．41）％、（69±2．42）％、（71±1．37）%和（66±3．28）%，与对照组的（54±2．08）％比较均有统计学意义（P〈0．001）；诱导后5ng／ml和10ng／ml组侵袭细胞数分别为（26．63±4．5）、（28．75±4．2）个，与对照组（21．5±4．0）个比较有显著性差异（P〈0．05，P〈0．001）。诱导后黏附率与侵袭细胞数变化在10ng／ml浓度时都达到高峰。结论PDGF-BB上调MHCC-97H细胞中FAK表达，上调FAK促进MHCC-97H细胞的黏附和侵袭能力。     

磁流体热疗对荷Lewis肺癌小鼠肿瘤细胞凋亡和周期的影响

目的探讨磁流体热疗对荷Lewis肺癌小鼠肿瘤细胞的凋亡和周期的影响。方法接种Lewis肺癌细胞悬液于C57BL／6小鼠的皮下，等肿瘤长至直径约为（0．8±0．1）cm时，随机分为4组：对照组、磁场组、磁流体组、实验组。加温治疗后48h，眼球取血，检测血中白细胞的变化，切取肿瘤标本，流式细胞仪检测细胞凋亡率和周期的变化。结果热疗后4组血中自细胞没有明显的变化（F=0．62，P=0．613）；肿瘤细胞凋亡率实验组为（63．55±8．39）％，对照组、磁场组、磁流体组分别为（28．43±6．29）％，（32．75±5．07）％，（32．42±6．15）％，实验组肿瘤细胞凋亡率明显高于其他3组（q=11．925，P〈0．05；g=10．458。P〈0．05；g=10．570，P〈0．05）；实验组细胞周期出现明显G1／G0期阻滞为（68．13±5．73）％显著高于对照组（47．95±9．98）％（q=5．501，P〈0．05），磁场组（49．23±6．62）％（q=5．152，P〈0．05），磁流体组（52．28±9．64）％（q=4．320，P〈0．05）。结论磁流体热疗可明显提高Lewis肺癌细胞的凋亡率，抑制Lewis肺癌细胞G1期向S期的进程。     

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.     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.