MCM5和E2F-1在胃癌组织中的表达及临床病理意义

目的：观察微小染色体维持蛋白5（MCM5）和转录因子1（E2F-1）在胃癌组织中的表达及其与胃癌病理参数之间的关系,探讨二者相关性。方法：采用免疫组织化学SP方法,对57例胃癌患者的癌组织及20例正常胃黏膜进行检测,分析MCM5、E2F-1蛋白表达及其与胃癌病理参数之间的关系。结果：MCM5在胃癌组中的阳性表达率为71～％（41／57）,显著高于正常组0（0／20）,2组差异有统计学意义（P〈0．001）.E2F-1在正常胃组织、胃癌组织中的阳性表达率分别为35．0％（7／20）,66．7％（38／57）,差异有统计学意义（P〈0．05）。MCM5和E2F-1的表达与性别、年龄、胃癌分化程度、浸润深度、淋巴结转移、远处转移及TNM分期均无关（P〉0.05）。MCM5和E2F-1在胃癌组织中的表达呈正相关（r=0．635,P=0．000）。结论：MCM5和1E2F-1在胃癌细胞中阳性表达,参与了胃癌的发生、发展oMCM5和E2F-1可能共同作用于胃癌发生的早期阶段。     

E2F-1、E2F-3在膀胱癌组织的表达及临床意义

目的：探讨膀胱癌转录因子E2F-1、E2F-3的表达及临床意义。方法：应用免疫组织化学方法检测39例膀胱癌与12例正常膀胱粘膜中E2F-1、E2F-3的表达,以统计学方法分析其表达与肿瘤分级、分期、复发之间的关系。结果：E2F-1在膀胱癌组织与正常膀胱粘膜中的阳性表达率分别为82．1％（32／39）和41．7％（5／12）,差异有统计学意义（P〈0．05）。癌组织E2F-1的表达在不同的临床病理特征之间差异无显著性;E2F-3在膀胱癌组织与正常膀胱粘膜中的阳性表达率分别为53．8％（21／39）和91．7％（11／12）,差异有显著性（P〈0．05）。癌组织中E2F-3的表达在不同的分级、分期之间差异有显著性（P〈0．05）。结论：E2F的异常表达参与膀胱癌的发病过程,并可在一定程度上反映肿瘤的恶性程度。     

磷脂酶Cε1在胃癌组织中的表达及与胃癌患者预后的关系

目的探讨磷脂酶Cε1（PLCε1）在胃癌组织中的表达及其临床意义。方法收集浙江省人民医院2005年1月至2007年12月间125例胃癌手术标本及其癌旁胃黏膜组织,应用免疫组织化学染色方法检测PLCε1在胃癌及癌旁组织中的表达,并通过实时荧光定量PCR检测其中41例胃癌及其癌旁组织中PLCε1mRNA表达水平。分析PLCε1蛋白表达与胃癌临床病理特征及预后的关系。结果PLCε1蛋白在胃癌和癌旁组织中的阳性表达率分别为53．6％（67／125）和24．0％（30／125）,差异有统计学意义（P〈0．01）;在65．9％（27／41）的胃癌组织中PCLε1mRNA表达水平较癌旁胃黏膜上调2倍以上。PLCε1蛋白表达与胃癌分化程度、浸润深度、淋巴结转移、远处转移及TNM分期有关（均P〈0．01）。PLCε1阴性与阳性表达者5年总体生存率分别为54．O％和31．2％,差异有统计学意义（P〈0．01）;但多因素分析显示,PLCε1表达并不是影响胃癌患者预后的独立因素（P〉0．05）。结论PLCε1在胃癌组织中高表达,且与胃癌的恶性生物学行为相关。     

黏着斑激酶的高表达与人胃癌侵袭和转移的关系

目的 探讨胃癌侵袭和转移过程中黏着斑激酶（FAK）的表达与其生物学行为的关系。方法 用免疫组化SABC法检测10例行胃癌根治术所收集的癌组织、癌旁组织、正常胃黏膜组织和胃区域淋巴结标本中FAK的表达情况。结果FAK表达强阳性率在胃癌组织中（78．0％）明显高于正常胃黏膜组织（10．0％）及癌旁组织（20．0％），P〈0．01，正常胃黏膜组织与癌旁组织中的表达差异无统计学意义（P〉0．05）。FAK表达强阳性率在淋巴结有转移和无转移患者中分别是68．8％（22／32）和33．3％（6／18），前者明显高于后者（P〈0．05）；在有转移的淋巴结中和无转移的淋巴结中分别是87．2％（136／156）和40．9％（18／44），前者明显高于后者（P〈0．01）；FAK表达强阳性率与胃癌浸润深度和分化程度有关，浸润深度越深，细胞分化越低，表达强阳性率越高（P〈0．05）；与Borrmann分型、肿瘤部位及大小无关（P〉0．05）。结论 FAK表达与胃癌发生、发展有关，FAK表达增高是胃癌细胞浸润和转移的重要原因之一，检测癌组织中FAK表达水平，有助于进一步了解胃癌的生物学行为，有利于治疗与预后判断。     

CDX-2和KAI-1在结肠癌中的表达及临床意义

目的探讨尾型同源盒转录因子-2（CDX-2）和抑癌基因KAI-1在结肠癌中的表达并分析其临床意义。方法应用免疫组织化学SP法检测50例结肠癌组织及相应癌旁组织和25例正常结肠黏膜组织中CDX-2和KAI-1蛋白的表达,分析其表达与结肠癌患者临床病理特征的关系以及二者表达的相关性。结果①在结肠癌组织及相应癌旁组织（距癌组织≤2cm）和正常结肠黏膜组织中CDX-2蛋白表达阳性率分别为34％（17／50）、54％（27／50）及88％（22／25）,KAI-1蛋白表达阳性率分别为30％（15／50）、58％（29／50）及92％（23／25）,CDX-2和KAI-1在结肠癌组织中的蛋白表达阳性率均分别明显低于相应癌旁组织（P〈0．05）及正常结肠黏膜组织（P〈0．05）,其在癌旁组织中的表达阳性率也均明显低于正常结肠黏膜组织（P〈0．05）。②CDX-2和KAI-1蛋白表达阳性率与结肠癌淋巴结转移、浸润深度及分化程度均有关（P〈0．05）,即在有淋巴结转移、浸润深度浸及浆膜及分化程度较低者中CDX-2和KAI-1蛋白表达阳性率均明显低于其在无淋巴结转移、浸润深度未及浆膜及分化程度较高者（P〈0．05）,二者均与患者的发病年龄和性别无关（P〉0．05）。③Spearman等级相关分析表明,CDX-2和KAI-1蛋白阳性表达呈正相关（rs=0．544,P〈0．01）。结论CDX-2和KAI-1的表达可能与结肠癌的发生、发展、浸润、转移及预后相关,联合评价其功能可能对结肠癌治疗具有一定指导意义。     

醛酮还原酶1-B10在胃癌组织中的表达及其临床意义

目的探讨醛酮还原酶1-BIO在胃癌组织中的表达及其与临床病理特征和预后的关系。方法通过荧光定量PCR法检测36例胃癌组织及其配对癌旁组织中AKRlBl0mRNA的表达量,采用免疫组织化学法检测100例原发胃癌组织及70例非肿瘤胃黏膜组织中AKRlB10蛋白表达情况。结果PCR结果显示,91．7％（33／36）癌旁非肿瘤胃黏膜组织中AKRlB10mRNA的表达高于其配对胃癌组织[8．3％（3／36）,P=0．000]。100例胃癌组织中33例（33．0％）AKRIBl0蛋白阳性表达,70例非肿瘤胃黏膜上皮中65例（92．9％）AKRlB10的阳性表达。两者比较,差异有统计学意义（Jp=0．000）。胃癌组织中AKRIBIO的表达与患者性别、年龄、肿瘤部位及分化程度无关（p〉0．05）,而与肿瘤大小（P=O．000）、浸润深度（P=0．004）、淋巴结转移（P=0．028）、远处转移（P=0．031）和临床TNM分期（P=0．000）有关。AKRlB10阳性表达患者的5年生存率显著高于阴性表达者（60．6％比32．8％,P〈0．01）。结论胃癌组织中AKRlB10的表达下调与胃癌进展有关,提示预后不良。     

Syndecan-1和MMP-1在胃癌组织中的表达及其临床意义

目的：探讨Syndecan-1和MMP－1在胃癌组织中的表达及意义。方法：应用SP免疫组化染色技术，检测82例胃癌、18例异型增生及36例正常胃黏膜组织中Syndecan-1和MMP－1的表达。结果：胃癌组织Syndecan-1表达阳性率为57．32％（47/82),胃异型增生组织为83．33％（15／18），正常胃黏膜组织均呈Syndecan-1阳性表达。胃癌组织的Syndecan-1表达与正常胃黏膜上皮、胃异型增生组织中的表达相比差异显著（P＜0．01）。胃癌组织的MMP－1表达阳性率为98．78％（81／82），其中强阳性表达占45例（54．88％）；胃异型增生组织MMP－1阳性率为88．89％（16／18），无强阳性表达；正常胃黏膜组织MMP－1表达阳性率为5．56％（2／36）。胃癌组织的MMP－1表达与正常胃黏膜上皮、胃异型增生组织中的表达相比差异显著（P＜0．01）。Syndecan-1表达的减弱、MMP－1表达的增强与胃癌的淋巴结转移、静脉侵犯、淋巴管仇犯、浸润深度、TNM分期显著相关（P＜0．05）。Syndecan-1表达与MMP－1表达呈负相关。结论：联合检测Syndecan-1和MMP－1对胃癌的早期诊断及判断预后有参考价值。     

用基因芯片筛选胃黏膜癌变相关基因

目的 用基因芯片技术筛选与胃黏膜癌变相关的基因。方法 利用Affymetrix公司生产的U133A基因芯片，对癌旁黏膜和切缘正常胃黏膜基因表达谱进行检测，并利用生物信息学方法对检测结果进行分析。结果 （1）癌旁黏膜与正常胃黏膜比较差异3倍以上共有150个基因，其中表达上调[SLR（信号比的对数值）〉1．5]有130个，表达下调（SLR〈-1．5）有20个。从表达差异的基因功能分类看，以酶和酶调控子活性改变最多（28，占18．7％）；其次是与核酸结合活性相关基因（17，占11．3％）；第三是与信号传导活性相关基因（15，占10％）；第四是与蛋白结合活性相关基因（13，占8．7％）。除了40个功能未知的基因占总数26．7％外，以上4大类共占基因总数的48．7％。（2）癌旁黏膜（P）和胃癌（T）同时与正常胃黏膜比较，有71个相同的基因表达差异。其中表达上调（癌旁上皮SLR〉1．5）有61个，表达下调（癌旁上皮SLR〈-1．5）有10个。71个同时出现癌旁黏膜和胃癌的基因在染色体定位，发现19号染色体异常基因最多有11个；其次是1、2、16、17号染色体，分别是6个；5、14、22号和Y染色体未发现异常的基因。结论 71个癌旁黏膜与胃癌同时出现、表达相同的基因可能与早期胃癌的演化有关。酶和酶调控子活性、核酸结合活性、信号传导活性和蛋白结合活性4大类相关基因是研究胃癌发生的重要基因。19号染色体及1、2、16、17号染色体是研究胃癌发生的重要基因位点。     

EphrinA1在原发性肝细胞癌中的表达及临床意义

目的探讨原发性肝细胞癌中EphrinA1的mRNA和蛋白表达水平及其临床意义。方法应用逆转录聚合酶链反应（RT-PCR）及免疫组织化学方法检测EphrinA1的mRNA及蛋白在40例肝癌及相应的癌旁肝组织和10例正常肝组织中的表达水平,并分析其与临床病理学特点之间的关系。结果40例肝癌组织及相应的癌旁肝组织和10例正常肝组织中均有EphrinA1 mRNA的表达。RT-PCR分析显示EphrinA1mRNA在肝癌组织（0．5413±0．1527）中的表达显著高于癌旁肝组织（0．3895±0．0549,P〈0．05）和正常肝组织（0．3770±0．1055,P〈0．05）,而在癌旁肝组织（0．3895±0．0549）和正常肝组织（0．3770±0．1055）中的表达差异无统计学意义（P〉0．05）。从正常肝组织、癌旁肝组织到肝癌组织,EphrinA1蛋白的阳性表达率分别为20％（2／10）、35％（14／40）和62％（25／40）,呈递增趋势（x^2=14．762,P〈0．05）。EphrinA1蛋白的过表达与肝癌细胞的分化程度、门静脉癌栓的形成及淋巴结转移等临床病理因素有关（P〈0．05）。结论EphrinA1蛋白的过表达与肝癌细胞的分化程度、淋巴结转移和门静脉癌栓有密切联系,提示其可能在肝癌的恶性转化、侵袭和转移过程中发挥重要作用。     

SEPTIN9在胃癌组织中的表达及临床意义

目的探讨SEPTIN9在胃癌组织中的表达及临床意义。方法从我院内镜室收集102例胃癌组织及其癌旁组织标本,通过组织微阵列和免疫组织化学染色方法检测胃癌及其癌旁组织中SEPTIN9蛋白表达水平,并结合相应的病理资料,分析SEPTIN9与胃癌组织分化程度的关系。结果在102例胃癌组织中,84例（82．4％）SEPTIN9表达阳性;在102例癌旁组织中,35例（34．3％）表达阳性,胃癌组织中SEPTIN9的阳性表达率显著高于癌旁组织（X2=48．424,P=0．000）。在58例高中分化胃癌组织中,23例（39．6％）SEPTIN9高表达,在44例低分化胃癌组织中,40例（90．9％）SEPTIN9高表达,二者高表达率有显著性差异（x2=27．931,P=0．000）。结论SEPTIN9在胃癌组织中高达,且与胃癌的分化程度有关。     

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.