Impact of dopamine and endothelin-1 antagonism on portal venous blood flow during laparoscopic surgery.

BACKGROUND: Recent data indicate that pneumoperitoneal carbondioxide (CO2) insufflation impairs hepatic macro- and microcirculation. Whether dopamine and endothelin-1 (ET-1) antagonists might restore liver blood during laparoscopic surgery has not yet been investigated. METHODS: For this study, 30 male WAG/Rij rats were randomized into two groups to obtain pneumoperitoneum with CO2 (n=15) or helium (n = 15). All the animals were implanted with a polyethylene-50 cannula into the right vena jugularis and a Doppler ultrasound flow probe around the portal vein. In each group, the rats were administered dopamine (n = 5); JKC-10, JKC-301, which is a selective endothelin-1 (ET-1) antagonist (n = 5), or sodium chloride as a control (n = 5). Portal blood flow was measured during intraabdominal pressures 2 to 12 mmHg. Data were analyzed using the Kruskal-Wallis h-test. RESULTS: The application of dopamine and ET-1 antagonists significantly improved portal blood flow over that of the control animals (p <0.05). No significant differences were found between CO2 and helium insufflation (P > 0.05). CONCLUSIONS: Dopamine and ET-1 antagonism restore portal blood flow during laparoscopic surgery independently of the insufflation gas. Whether improved hepatic perfusion might have beneficial effects on liver function needs further investigation.

Myelotoxicity of Cyclophosphamide, Methotrexate and 5-fluorouracil Regimen in the Early Stage Breast Cancer Patients with Diabetes Mellitus.

CMF (cyclophosphamide, methotrexate and 5-fluorouracil) is one of the most commonly used chemotherapy (CT) regimens in breast cancer. To the best of our knowledge there are no published studies on the toxicity of this regimen in the existence of diabetes mellitus (DM), in the literature. We retrospectively analyzed the myelotoxicity of CMF CT after 40 adjuvant cycles of 18 diabetics, according to WHO toxicity scala. Leucopenia/granulocytopenia was the most prominent toxicity (observed in overall 30% of the cycles), but it was relatively mild (5% grade III and 2.5% grade IV granulocytopenia). Anemia was only grade I (10% of the cycles), and there was no trombocytopenia. Two of the cases with grade III and IV granulocytopenia, had grade I and II urinary tract infections respectively, following the CT. The case with grade IV granulocytopenia and infection had received G-CSF. We conclude that CMF regimen is tolerable in DM as regard to its myelotoxicity. However, the patients should be closely monitored as infections may easily arise in parallel to deepening leucopenia in DM. Further extended studies would be appropriate on the toxicity of CMF as well as the other common CT regimens in DM.

Hypomagnesemia and mild rhabdomyolysis in living related donor renal transplant recipient treated with cyclosporine A.

Since cyclosporine A (CsA) had been used in renal transplant recipients, important improvements in short-term and long-term graft survivals have been detected. In spite of these improvements CsA seems to have several adverse effects. First, CsA leads to nephrotoxicity. Moreover, CsA affects the other organs and systems (skin, liver, nervous system, etc.) and causes, increased risks of infections and malignancies. Hypomagnesemia is one of the side effects of CsA therapy, but it is a rare condition in living related donor renal transplant recipients. It may also cause multi-system dysfunction, especially hypocalcemia and hypokalemia, which cannot be corrected without magnesium therapy. In addition, rhabdomyolysis was detected in animals, but it has not been reported in living related donor renal transplant recipients. In this case report, a living related donor renal transplant recipient who suffered from hypomagnesemia and mild rhabdomyolysis due to CsA therapy will be described and discussed.