Therapeutic results in low-rectal cancer patients treated with abdominosacral resection are similar to those obtained by means of anterior resection in mid- and upper-rectal cancer cases.

AIMS: To present the experiences of the Regional Comprehensive Cancer Center in Wroclaw with abdominosacral resection (ASR) carried out in low-rectal cancer patients. METHODS: Rectal cancer patients (n=294) were operated on by the same surgical team using the standardized TME technique between May 5, 1998 and February 23, 2001. Depending on the distance from the anal verge, the primary tumor was removed by means of standard abdominal resection (AR-mid- and upper-rectal cancers) or abdominosacral resection (ASR-low-rectal cancers). The patients who underwent the different operative procedures were comparable in terms of distributions of age, gender, tumor infiltration depth and regional lymph node involvement with no significant statistical difference between the groups. RESULTS: Ninety-seven cases were excluded from the analysis of survival based on exclusion criteria defined. Consequently, 197 cases were left for further analysis, including 154 patients operated on by AR and 43 who underwent ASR. AR and ASR patients did not differ significantly in terms of postoperative morbidity (11% and 14%, respectively), observed (57.1% vs. 60.4%) and relative 5-year survivals (74.3% vs. 73.2%) and the cumulative 5-year local recurrence rate (5.8% vs. 4.7%). CONCLUSION: The combined use of the modern TME technique and the "historical" abdominosacral excision of the rectum seems to give new, potentially attractive perspectives for successful surgical treatment of low-rectal cancers.

Removal of endogenous lactates via the peritoneum in experimental lactic acidosis.

Peritoneal dialysis was used in experimental lactic acidosis caused by hypoxia for the removal of endogenous lactate. Two types of dialysis fluid, with and without vasodilator sodium nitroprusside, added intraperitoneally were used. The addition of sodium nitroprusside increased peritoneal the clearance of lactate as did an alkaline dialysis fluid containing bicarbonate. The highest clearance values were observed when alkaline dialysis fluid was used together with sodium nitroprusside.

Genotoxicity of inhalation anesthetics halothane and isoflurane in human lymphocytes studied in vitro using the comet assay.

The alkaline single cell gel electrophoresis (comet) assay was applied to study genotoxic properties of two inhalation anesthetics-halothane and isoflurane-in human peripheral blood lymphocytes (PBL). The cells were exposed in vitro to either halothane (2-bromo-2-chloro-1,1,1-trifluoroethane) or isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether) at concentrations 0.1-10 mM in DMSO. The anesthetics-induced DNA strand breaks as well as alkali-labile sites were measured as total comet length (i.e., increase of a DNA migration). Both analysed drugs were capable of increasing DNA migration in a dose-dependent manner. In experiments conducted at two different electrophoretic conditions (0. 56 and 0.78 V/cm), halothane was able to increase DNA migration to a higher extent than isoflurane. The comet assay detects DNA strand breaks induced directly by genotoxic agents as well as DNA degradation due to cell death. For this reason a contribution of toxicity in the observed effects was examined. We tested whether the exposed PBL were able to repair halothane- and isoflurane-induced DNA damage. The treated cells were incubated in a drug-free medium at 37 degrees C for 120 min to allow processing of the induced DNA damage. PBL exposed to isoflurane at 1 mM were able to complete repair within 60 min whereas for halothane a similar result was obtained at a concentration lower by one order of magnitude: the cells exposed to halothane at 1 mM removed the damage within 120 min only partly. We conclude that the increase of DNA migration induced in PBL by isoflurane at 1 mM and by halothane at 0.1 mM was not a result of cell death-associated DNA degradation but was caused by genotoxic action of the drugs. The DNA damage detected after the exposure to halothane at 1 mM was in part a result of DNA fragmentation due to cell death.

Ultrastructural changes in the lung alveoli after cardiac surgical operations with the use of cardiopulmonary bypass (CPB).

Cardiac surgical procedures with the use of cardiopulmonary bypass (CPB) are commonly complicated by pulmonary dysfunction. The mechanisms of such injury are not well understood. The aim of the present study is to analyze morphologically (mainly ultrastructurally) alveolar injury, which occurred during cardiac surgical operations involving CPB, equipped with a hollow fiber oxygenator. Our study included 20 patients, aged 45-72, who underwent coronary artery bypass grafting. Lung biopsies were taken from the left upper lobe 20 minutes after stopping CPB. Pre-CPB biopsies served as controls. Tissue specimens used for electron microscopy were processed according to standard procedures. Light microscopy revealed only a few alterations in the terminal part of the respiratory tract. Frank edema was seen in some of the alveoli. Extravasated erythrocytes as well as some neutrophils were present in the alveoli and several alveolar capillaries were congested. Ultrastructural observations confirmed the above mentioned changes. Moreover, in many alveoli, extensive injury to air-blood barrier was observed. Type I pneumocytes and endothelial cells appeared swollen or necrotically changed. The cytoplasm of type II pneumocytes was swollen. In many alveoli, pulmonary surfactant could not distribute over the alveolar surface because of edema. Structures of pulmonary surfactant were also seen in alveolar capillaries. The results of this investigation suggest that CPB is associated with some injury to lung tissue. However, this injury seems to be temporary since all examined patients had an uneventful post-operative course.

[Preparation of the patient for reconstructive surgery of the abdominal aorta as an element in prevention of perioperative complications]. / Przygotowanie chorego do operacyjnej rekonstrukcji brzusznego odcinka aorty jako element prewencji powiklan okolooperacyjnych.

The tasks of an anesthetist in preoperative preparation of the patients submitted for reconstructive surgery of the abdominal aorta have been the subject of this paper. These tasks thought as an element of prevention of perioperative complications have been preceded by the description of characteristic of this steadily increasing population of patients with aortic abdominal aneurysm, or obliterative atheromatosis of the abdominal aorta (syndrome Leriche). There is a justified need for elective surgery in this population of patients because of the following premises: a substantial minor perioperative mortality (about 3% now) in the cases of aortic aneurysms, the steady high mortality in emergency operations and difficulty to foresee the dynamics in enlarging of aortic aneurysms, as well as the risk of their rupture. An elective surgery in Leriche syndrome decreases probability of splanchnic perioperative complications because of bowel ischaemia. Hypertension and ischaemic heart disease are detected in about 50% of described population and they comprise also the premises for perioperative complications in this group of patients. The risk of such a complications results also from clamping and declamping of the aorta, the necessary stages of aortic abdominal surgery. Characteristic pattern of described population and the pathomechanisms of perioperative complications call for precise and complex preoperative evaluation of these patients. Preoperative evaluation has been contemporary defined as a clinic of preoperative appraisal because of its importance. In elective procedures this clinic embraces two stages: prehospital and hospital. In both an anesthetist should play an integrative role in the activities of interdisciplinary team which prepares the patients for surgery. The peculiar task in this team belongs to the cardiologist, whose experience should also embrace the problems of surgical patients. The tasks of an anesthetic team in emergency concerning aortic surgery have been exposed in this paper. A proper understanding by anaesthetist of his/her role as an integrator of interdisciplinary team in perioperative stage of surgical disease is a new task for young doctors as well as for their teachers.

Observations on the effects of drugs used in general anaesthesia for ear operations on renal functions.

The purpose of this study was: 1) to observe the renal effects of atropine and pethidine administered intravenously in premedication, 2) to assess the renal effects of diethyl ether and halothane, 3) to study the effects of respiration on the renal functions in general anaesthesia and 4) to evaluate the antidiuretic action of Octapressin used for infiltration of the field of operation during anaesthesia. The studies on the renal effects of the drugs used in premedication were carried out on 27 patients. The renal effects of general anaesthesia and operation on renal functions were studied in 20 patients divided into 2 groups. Group I comprised of patients under diethyl ether anaesthesia while in group II halothane was used. In both groups subgroups A and B were isolated depending on the type of respiration applied during general anaesthesia (subgroup A -- manually assisted respiration, subgroup B -- spontaneous respiration). In all patients in groups I and II Octapressin was used for infiltration of the field of operation. Its renal effects were assessed on the results of determinations in 5 cases (subgroup II-A) anaesthetized with halothane and receiving manually assisted respiration. These results were compared with those in group III which comprised of 5 patients anaesthetized with halothane who were not given Octapressin infiltrations. The following conclusions have been drawn from these results: 1) Atropine and pethidine administered intravenously in therapeutic doses significantly reduce glomerular filtration. 2) Changes in renal functions observed during general anaesthesia and operation were the result of ADH secretion stimulation and changes in renal haemodynamics. 3) No differences were observed between the renal effects of diethyl ether and halothane which was due, probably, to compensatory renal mechanisms regulating renal circulation and osmotic equilibrium in the organism. 4) No differences were observed also in the renal effects of various method of ventilation used during anaesthesia. 5) Octapressin used in therapeutic doses for infiltration of the operation field had no potentiating effect on the antidiuretic action of general anaesthetic agents.

The effect of halothane on active transport of sodium in the epithelial cell.

The authors studied the effect of halothane on active transport of sodium in the epithelial cells using the method described by Ussing with frog skin as an experimental model. It was found that the action of the anasthetic agent on the active transport of sodium was biphasic, and this observation confirmed the results obtained with another experimental model. It was observed, moreover, that the mechanism of halothane action on the cell membrane it not identical with that of vasopressin, which was used in some of the present experiments before adding halothane. The present investigations suggest that halothane acts primarily on the cell membrane and not on the deeper situated intracellular structures.

The comparative evaluation of methoxyflurane and diethyl ether action upon an active sodium transport across isolated frog skin preparation.

The experiments were performed in vitro using the frog skin preparations and Ussing method. The effect of methoxyflurane was investigated in 18 sections and that of diethyl ether in 16 sections. Both the anaesthetics were found to affect the frog skin preparation in qualitatively similar way. They both demonstrated a two-phase character of action. Decrease in active sodium transport is preceeded by a transient increase in bioelectric indices of the membrane. The effect was reversible after removing of the drugs from the medium. In order to determine the mechanism of action of the two anaesthetics they were given in combination with ADH and insulin. It was found that the mechanism of action of both the drugs is not analogical to any of the hormones examined, at least, as far as the first phase of action is concerned.

Early haemorrhage from brachiocephalic trunk as a complication of tracheostomy.

A 27-year-old patient suffered injuries to the facial bones and brain contusion in a traffic accident. On the third day after the accident the patient was admitted to an intensive care unit in view of increasing respiratory failure. Tracheostomy was performed for prolonged controlled respiration. On the 6th day after tracheostomy the patient died from a sudden massive hemorrhage from the tracheostomy site. Autopsy findings showed that the direct cause of death was injury to the brachiocephalic trunk communicating with a focus of tissue necrosis in the tracheal wall. The authors stress the early development of this complication and the necessity of the earliest possible commencement of intensive care in cases of injuries to the facial bones.

Occupational exposure to inhaled anaesthetics: a follow-up study on anaesthetists of an eastern European university hospital.

BACKGROUND: Although no dose-response relationship for the health risks associated with the occupational exposure to inhaled anaesthetics exists, public health authorities recommend threshold values. The aim of the present study was to assess if and to what extent these threshold values are exceeded in an eastern European university hospital before and after measures had been taken to reduce occupational exposure. METHODS: At nine workplaces occupational exposure of anaesthetists to nitrous oxide and halothane or isoflurane was measured by means of photoacoustic infrared spectrometry. The measurements were carried out in 1996 and were repeated in 1997 after the installation of active scavenging devices at five workplaces and an air-conditioning system at one workplace. RESULTS: Occupational exposure to nitrous oxide and halothane or isoflurane was lower in 1997 compared to 1996. In 1997 most of the nitrous oxide values still exceeded the threshold value of 100 ppm, whereas most of the halothane and isoflurane values were already below the threshold values of 5 ppm and 10 ppm in 1996. CONCLUSION: The measures taken were effective in reducing waste gas exposure. Nevertheless, further efforts are necessary, especially for nitrous oxide, to reach western European standards. These efforts comprise structural measures such as active scavenging devices and air-conditioning systems at all workplaces, the use of total intravenous anaesthesia, low-flow anaesthesia and an appropriate working technique.

A follow-up study on occupational exposure to inhaled anaesthetics in Eastern European surgeons and circulating nurses.

OBJECTIVE: Although no dose-response relationship exists for the health risks associated with the occupational exposure to inhaled anaesthetics, public health authorities recommend threshold values. The aim of the present study was to assess whether and to what extent these threshold values are exceeded in surgeons and circulating nurses of an Eastern European university hospital, before and after measures had been taken to reduce occupational exposure. METHODS: At nine workplaces, occupational exposure to nitrous oxide and the volatile anaesthetic used (halothane or isoflurane) was measured within the breathing zones of surgeons and circulating nurses by means of photoacoustic infrared spectrometry. The measurements were carried out in 1996 and were repeated in 1997 after the installation of active scavenging devices at five workplaces, and an air-conditioning system at one workplace. RESULTS: Occupational exposure to nitrous oxide and halothane or isoflurane was lower in 1997 compared with that of 1996. In 1996, 89% of the nitrous oxide values were above the European threshold value of 100 ppm, whereas in 1997 approximately 50% were above this limit. In 1996 the majority of the measurements for the volatile anaesthetics were already below 5 ppm halothane and 10 ppm isoflurane and the number of measurements exceeding these limits was further reduced in 1997. CONCLUSION: The measures taken were effective in reducing waste gas exposure. Nevertheless, further efforts are necessary, especially for nitrous oxide, to reach Western European standards and to minimise possible health risks. These efforts comprise the installation of (active) scavenging devices, air-conditioning systems and new anaesthesia machines at all workplaces, the use of low-flow anaesthesia, the replacement of inhaled anaesthetics by intravenous anaesthetics and an appropriate working technique.