Exclusive use of calcium channel blockers in preoperative and intraoperative control of pheochromocytomas: hemodynamics and free catecholamine assays in ten consecutive patients.

This study investigates the role of nicardipine hydrochloride in preoperative and intraoperative blood pressure control and intraoperative catecholamines (norepinephrine and epinephrine) release in 10 patients undergoing pheochromocytoma resection. Nicardipine was used orally in the preoperative period for either 1 or 8 days (60 to 120 mg/24 hr) and then was infused during anesthesia until tumor removal, continuously at a rate of 2.5 to 7.5 micrograms/kg/min, depending on systolic arterial pressure level. All patients were successfully operated on. No severe hypertensive crisis occurred during tumor manipulation, although several patients had a 3- to 85-fold (norepinephrine) and 3- to 40-fold (epinephrine) increase of catecholamines from baseline levels. Hemodynamics data suggest that nicardipine caused significant inhibition of vascular smooth muscle contraction (42% decrease in systemic vascular resistance); calcium-dependent catecholamines release was not inhibited by nicardipine infused as mentioned. Use of nicardipine may be recommended for perioperative and intraoperative control of pheochromocytomas and might substitute for routine alpha-adrenergic blockade.

Dopamine-secreting pheochromocytoma: an unrecognized entity? Classification of pheochromocytomas according to their type of secretion.

A pheochromocytoma that exclusively secretes dopamine (DA) rather than predominantly DA among a blend of catecholamines is as yet unreported. Of the 50 patients with pheochromocytoma who have undergone surgery, 32 underwent treatment within the last 5 years (when DA assay has been available). One half of these patients (15/32) exhibited DA secretion either in mixed catecholamines (12 patients) or exclusively (three patients). All three patients with exclusive DA-secreting tumors were normotensive. Without hypertension, the clinical investigation was a diagnostic challenge (unexplained cough or flank mass with inflammatory features). All three tumors were malignant and two were ectopic. Five of the 12 patients with mixed catecholamine-secreting tumors whose secretions included DA were hypertensive. Five other patients had flank mass and one had an unexplained cough. Tumors were rather large, and three of the tumors with mixed secretion were ectopic. Of the 12 patients, seven had tumors that were judged to be malignant. Three patients exhibited a dramatic decrease in blood pressure under alpha-blockade, which was not used in subsequent cases. Predominant or exclusive secretion of DA would explain the lack of hypertension due to its antiadrenergic action that inhibits the vasoconstrictive effects of other amines. Hypertension in patients with pheochromocytoma might depend on the ratio of DA/noradrenaline + adrenaline.

[Massive pulmonary embolism due to post-traumatic pseudo-aneurysm due to rupture of the left hepatic artery, revealed by dissecting aneurysm below the capsule of the right lobe of the liver (author's transl)]. / Embolie pulmonaire massive due à un pseudo-anévrysme post-traumatique rompu de l'artère hépatique gauche, révélé par un hématome disséquant et sous-capsulaire du foie droit.

We report a case of trauma of the left lobe of the liver causing left centro-hepatic contusion (stage III) revealed by infective jaundice. Secondarily, the appearance of a right subcapsular hematoma corrected the diagnosis, permitting the authors to proceed to angiographic exploration and consider operation on the right side, but the patient had a massive pulmonary embolism. This case recalls the diagnostic difficulties soon after a contusion, the diffusion of a hematoma under pressure from left to right, then from the liver towards the hepatic venous system, the risk of pulmonary embolism, from an aneurysm of the hepatic artery.

[Use of a new solution of synthetic amino acids in postoperative surgical intensive care. Evaluation of the value of nitrogen intake started in the immediate preoperative period]. / Utilisation d'une nouvelle solution d'acides aminés de synthèse en réanimation chirurgicale post-opératoire. Appréciation de l'intérêt d'un apport azoté débuté dès la période pré-opératoire immédiate.

A new synthetic amino acid solution, Totamine, was studied in pre- and postoperative surgical intensive care in order to determine the possible value of beginning high protein intake during the preoperative period. A comparison was made between two groups of 11 and 15 patients respectively, divided on a strictly random basis, receiving 1200 calories and 12.4 g of nitrogen per day in the forme of Totamine carbohydrate concentrate, starting two days before operation in one of them and on the day of surgery in the other. No statistically significant difference was seen. Calorific and nitrogen intake in both cases appeared to be satisfactory during the early preoperative period and both local and general tolerance of the amino acid solution was excellent. During the late postoperative period, there was a tendency to negativisation of nitrogen balance which justified an increase in calorific and nitrogen intake.