Converting enzyme inhibition augments and competitive inhibition of angiotensin II partially restores reflex adrenal catecholamine release in anephric dogs.

Adrenal epinephrine (E) release after hemorrhage in anesthetized dogs is blunted by acute nephrectomy and restored by angiotensin II infusion. In the present study, we report the effect of converting enzyme inhibition by SQ 20881, a decapeptide, and of competition inhibition of angiotensin II by saralasin (1-Sar-8-Ala-Ang-II) on reflexly stimulated adrenal release of E and norepinephrine (NE) in three groups of acutely anephric dogs. Aortic catheters and adrenal vein to femoral vein Silastic shunts were placed in dogs anesthetized with pentobarbital and mechanically ventilated. Adrenal secretion rates were calculated from adrenal vein to aorta catecholamine concentration differences divided by measured adrenal venous flow. Catecholamine concentrations were determined with trihydroxyindole technique. Blood samples were obtained before and 15, 30, and 60 min after rapid hemorrhage to a stable mean arterial pressure of 50 mm Hg. Saralasin infusion (10 microgram/kg/min) supported adrenal E release in anephric hemorrhaged dogs toward secretion rates comparable to those seen in intact dogs. Anephric SQ 20881 (approximately 0.5 microgram/kg) recipients had delayed (60 min) augmented adrenal E and NE release after hemorrhage. In resting animals not reflexly stimulated by hypovolemia, neither drug provoked adrenal E or NE release. These results suggest an agonist effect of saralasin on reflex adrenal E release and increased responsiveness of the stimulated adrenal medulla under the influence of converting enzyme inhibition.

The morphologic effects of simultaneous infusion of levarterenol and phentolamine on the canine myocardium.

The effect of simultaneous administration of levarterenol and phentolamine on the myocardium over a 3 hour period was studied in 15 adult mongrel dogs. All animals receiving levarterenol alone had moderate-to-severe subendocardial hemorrhage and necrosis. Four of the 6 animals receiving the simultaneous infusion of levarterenol and phentolamine had little or no hemorrhage or necrosis. These differences are significant (p less than 0.02). It is concluded that the administration of phentolamine simultaneously with levarterenol affords a significant protective effect on the myocardium.

Allergic reactions to isosulfan blue during sentinel node biopsy--a common event.

BACKGROUND: Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy. METHODS: At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed. RESULTS: We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures. CONCLUSIONS: The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.

The effect of simultaneous administration of levarterenol and phentolamine on renal blood flow.

The effect of simultaneous administration of levarterenol and phentolamine upon renal blood flow was studied over a 3-hour period in 22 mongrel dogs. The infusion of levarterenol alone produced a fall in renal blood flow that ranged from 28 to 58% from the baseline value. When both drugs were administered simultaneously, renal flow fell only 17 to 22% from baseline (p less than 0.05). From these studies we conclude that the simultaneous administration of levarterenol and phentolamine in optimal ratios maintains renal blood flow near baseline levels.

A comparison of the hemodynamic effects of inotropic agents.

This experimental study was conducted to compare and contrast the cardiovascular effects of the drugs most commonly used to alleviate low-cardiac-output syndrome. Twenty-five adult mongrel dogs were infused with sodium pentobarbital (60 mg/min) until their cardiac output fell to 50+/-5% of the average control values determined by thermodilution technique prior to pentobarbital infusion. The dogs were then divided into six groups, and one of the following agents or combinations of agents was administered to each group: isoproterenol, glucagon, dopamine, dobutamine, levarterenol and phentolamine, or levarterenol and nitroprusside. All drugs, except for glucagon and the combination of levarterenol and nitroprusside, produced an increase in cardiac output above the nonfailure baseline values. However, this increase was accompanied by an undesirable, pronounced tachycardia except when levarterenol was used simultaneously with phentolamine. Both dopamine and the combined infusion of levarterenol and phentolamine proved the most effective in restoring systemic arterial pressure to near baseline values, and both were able to increase renal blood flow above the failure baseline values. While renal blood flow remained elevated with all dosages of levarterenol and phentolamine, it tended to decrease with larger doses of dopamine. These experiments demonstrate that there are major advantages in the use of simultaneously infused levarterenol and phentolamine for control of low-cardiac-output syndrome: increased cardiac output without elevated peripheral vascular resistance, restoration of systemic arterial pressure and consequent improved coronary flow, absence of tachycardia, and augmented renal blood flow.

Major pulmonary resection for bronchogenic carcinoma in the elderly.

The results of major pulmonary resection in 58 patients greater than 70 years of age were reviewed. The histological distribution and extent of nodal metastases in this age group are the same as in younger patients. The absolute five-year survival rate for the 55 patients undergoing curative resection was 30% (17 patients). It was 36% (11 patients) for those patients with squamous cell carcinoma and 22% (5 patients) for those with adenocarcinoma. The operative mortality was only 14% (8 patients). Of the 49 patients treated by lobectomy, 17 lived five years or more free of disease, whereas none of the 6 patients treated by pneumonectomy survived five years. The five-year survival rate of 30% in this series of elderly patients treated by major pulmonary resection makes resections in such patients with bronchogenic carcinoma worthwhile.

Carcinoma of the lung: results of treatment over ten years.

Mediastinal lymph node dissection in conjunction with pulmonary resection was performed on 437 patients with bronchogenic carcinoma at the University of Michigan Medical Center from 1959 to 1969. The absolute five- and ten-year survival rates for patients undergoing curative resection were 36.2 and 14.4%, respectively. The five-year survival of those without nodal metastases was 49.3%, and it was 31.1% in patients with hilar metastases only. The five-year survival of patients with mediastinal metastases who received radiation therapy was 23.1%. Of the 193 patients with squamous cell carcinoma, 43% lived five years free from disease. The five-year survival of patients undergoing resection who had no hilar lymph node metastases was 53%, and it was 47.5% in those with hilar metastases only. The five-year survival in patients with mediastinal metastases who received postoperative irradiation was 34.4%.

[The use of prostheses and traditional technics in the surgical treatment of laparocele. An experimental study]. / Impiego di protesi e tecniche tradizionali nel trattamento chirurgico del laparocele. Studio sperimentale.

The problem of surgical fixing for incisional hernia is still far from a final solution. Over the past few years, prostheses have been used in addition to traditional plastic surgery. The aim of this experimental study was to assess the efficacy of traditional techniques in comparison to modern methods using prostheses. For this purpose, two original experimental models were designed to assess parietal resistance. Ninety-six Wistar rats were subdivided into 4 group: 1) control; 2) "waistcoat" plastic surgery; 3) plastic surgery using a vicryl prosthesis. With the exception of rats in group 1, a lozenge-shaped section of abdominal wall was removed from all other rats and, subsequently, the wall was repaired using the above-mentioned methods. Rats were killed after 30-60-120-180 days and the abdominal walls were subjected to traction and pressure using specially designed experimental models. For the first 30 days, the walls with dacron and vicryl prostheses behaved in a similar way, and showed a greater resistance than the other two groups; but after day 120, the resistance of dacron prostheses was considerably greater than that of the other groups studied. In conclusion, plastic surgery based on the use of nonreabsorbable prostheses is now more efficacious than traditional plastic surgery in the surgical treatment of incision hernia.

[Changes in the levels of delta-aminolevulinic acid dehydratase in chronic alcoholic patients]. / Modificaciones de los niveles de ácido delta aminolevúlico dehidrasa en pacientes alcohólicos crónicos.

Medical and biochemical analysis were performed on 58 patients with chronic alcoholism. In accordance with medical characterisation, patients were divided in three groups: A (patients having only hepatopathy), B (patients with hepatopathy and neuropathy) and C (patients having only alcoholic neuropathy). Simultaneously, several parameters related to heme biosynthesis were examined. Urinary delta-aminolevulic acid (ALA), porphobilinogen (PBG) and porphyrins and fecal porphyrins measurements did not show significant difference among all studied groups. The activities of ALA-dehydratase (ALA-D), uroporphyrinogen-I-synthase (URO-I-S) and uroporphyrinogen-III-synthase (URO-III-S) were monitored in peripheral erythrocytes. From the enzymes measured, only ALA-D levels in groups B and C were significantly depressed (p < 0.002) compared with normal subjects. The decrease in ALA-D correlated with the degree of neuropathy.

[Echography as guidance in voluntary abortion]. / Impiego della indagine ecografica nella interruzione volontaria della gravidanza.

PIP: This retrospective study demonstrates the efficacy of ultrasound as it is used in the detection of abnormal pregnancy early in the gestational period and as a guide for voluntary abortion. The study also points out that the extrahospital centers whose duty it is to select and refer patients to the hospital are not capable of such selection. (author's)^ieng

Polypropylene suture in esophageal and gastrointestinal operations.

A comparison was made of the gross and microscopic wound healing and tissue reactivity between stainless steel wire, polypropylene and silk in anastomoses in the u-prepared colon of the dog. While all anastomoses healed irrespective of the suture material used, wire was associated with the least inflammatory response, silk the most and polypropylene intermediate, its low reactivity approaching that of wire. A clinical trial of Prolene for 71 varied anastomoses between pharynx, esophagus, stomach and colon in 47 patients undergoing esophageal resection and reconstruction or bypass was done. In four of the seven anastomotic disruptions which occurred, causative factors unrelated to the suture material could factorily in the remainder of these patients. Monotive suture which works well in esophageal and gastrointestinal anastomoses.

Surgical laparoscopy with intraoperative manometry in the treatment of esophageal achalasia.

The aim of this study was to describe and evaluate the laparoscopic treatment of esophageal achalasia in nine patients over a 35-month period. Five trocars were used to perform a Heller's myotomy to completely eliminate the cardial high-pressure zone, under manometric control. Intraoperative manometry also was used to calibrate a pick degrees 360 Rossetti's antireflux wrap. A complete regression of symptoms was observed postoperatively in seven of nine patients (77.8%); in two patients (22.2%) a moderate dysphagia persisted, but it disappeared 3 and 6 months, respectively. Only one intraoperative complication (esophageal perforation, recognized and laparoscopically repaired) occurred. At the present follow-up of 18 +/- 5.34 months (range 6-35), no dysphagia or symptoms related to reflux have been observed. Laparoscopic treatment of esophageal achalasia is considered a safe and effective procedure, and the results of this procedure are comparable with those of the open technique. Advantages common to other laparoscopic techniques are emphasized.

Taponamiento en el síndrome post lesiones cardíacas / Tamponade after cardiac injury syndrome

El Síndrome Pos pericardiotomía, el Síndrome de Dessler y la pericarditis Post traumatismo cardíaco son cuadros clínicos con signo sintomatología similar,con una patogenia autoinmune común.Los pacientes se presentan con fiebre, dolor toráxico,frote pericárdico,leucositosis y eritro elevada.El Taponamiento Cardíaco es infrecuente.Se presenta una caso de Síndrome Pos pericardiotomía con Taponamiento cardíaco recidivante que requirió una ventana pleuropercárdica y respondió al tratamiento con corticoides