Effects of growth hormone in patients receiving total parenteral nutrition following major gastrointestinal surgery.

The purpose of the present study was to determine whether the administration of a biosynthetic human growth hormone was capable of enhancing the efficacy of total parenteral nutrition. Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided into two groups. Group I (n = 20) treated only with PN, and Group II (n = 18) treated as in Group I plus human growth hormone (4 IU daily). Our study shows that the administration of human growth hormone produces a statistically significant increase in serum levels of growth hormone, somatomedin-C, transferrin, albumin and total proteins. It also causes a positive nitrogen balance from the first 24 hours onward. These findings suggest that the administration of human growth hormone produces an increase in protein synthesis, perhaps through somatomedin-C as mediator.

[Physiology and physiopathology of postoperative disease. Therapeutic implications]. / Fisiología y fisiopatología de la enfermedad postoperatoria. Implicaciones terapéuticas.

The organism responds to each and every aggression by means of a neuro-endocrine activation, which is translated into a metabolic change. The action of the surgeon should not be any other than to improve the neuro-endocrine-metabolic response. This review describes the physiological and physiopathological occurrences which develop in every traumatized patient.

[Growth hormone and its effects on cholesterol and lipoprotein metabolism following surgical intervention (hGH and cholesterol metabolism during surgery)]. / La hormona de crecimiento y sus efectos sobre el metabolismo del colesterol y lipoproteínas postagresión quirúrgica (hGH y metabolismo del colesterol tras la cirugía).

The objective of this work was to determine whether the increase in serum GH, IGF1, glucose and insulin levels caused by the administration of hGH modifies the normal response of cholesterol and lipoproteins to surgical aggression. A prospective, randomized, and double blind study is carried out in 28 patients operated for gallstones and diverticulitis. The control group (n = 15) was not given anything except conventional fluidtherapy in the postoperative period: the patients in the hGH (n = 13) group were also given 8 IU of hGH during the first five days after the intervention. The comparative study of the triglycerides, cholesterol, LDLc, HDL-c, and A-1 B apolipoproteins shows that in the group treated with hGH the normal response of cholesterol and lipoproteins to surgical aggression is attenuated.

[Minimally aggressive surgery in advanced cancer of the colon]. / Cirugía mínimamente agresiva en el cáncer de colon avanzado.

We evaluated minimally aggressive surgery in the treatment of metastasic cancer of the colon in 6 patients: 2 females and 4 males, with an average age of 71.8. Preoperative studies showed cancer of the colon (right colon = 4; sigmoid colon = 2) with multiple hepatic metastasis. In all cases laparoscopic mobilization and extracorporeal resection with end-to-end anastomosis was performed employing a biofragmentable anastomotic ring. In two patients laparoscopy discovered peritoneal carcinomatosis. One patient was operated using conventional surgery. Intestinal segments with an average length of 21.3 cm were removed, with a mean of 13.5 lymph-nodes per patient, 70.3% of which had metastasis. Eleven of the 12 resection lines were tumor-free (91.6%). Hospital stay averaged 7.8 days, and mean survival has been 4.5 months. Only two patients, those with peritoneal carcinomatosis, had post-operative complications. If an appropriate patient selection is followed: cancer of the colon with hepatic metastasis and no peritoneal spread, laparoscopic surgery is a reliable and effective treatment for advaned cancer of the colon.

[Effect of growth hormone and parenteral nutrition on the catabolic phase following major digestive surgery]. / Efecto de la hormona del crecimiento y la nutrición parenteral sobre la fase catabólica tras cirugía digestiva mayor.

The purpose of the present study was to determine if the administration of a biosynthetic human growth hormone (bGH) was able to enhance the efficacy of total parenteral nutrition (PN). Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided in two groups. Group I (n = 20) treated only with PN and Group II (n = 18) treated as in Group I plus bGH (4 UI/daily). Our study shows that the administration of bGH produces a significant increase in serum levels of growth hormone and Somatomedin-C. It also caused a positive nitrogen balance from the first 24 hours on (p less than 0.01). In Group II on day 12 after operation a statistically significant increase in transferrin (p less than 0.05), albumin (p less than 0.01) and total proteins (p less than 0.02) was observed. Our study suggest that the administration of bGH produces, perhaps through Somatomedin-C as mediator, an increase in protein synthesis.

[Xanthogranulomatous cholecystitis]. / Colecistitis xantogranulomatosa.

Ten cases of xanthogranulomatous cholecystitis are presented, 5 women and 5 men, from a total of 439 cholecystectomies (2.2%). In 50% of cases the clinical course was consistent with acute cholecystitis; in 30%, gallbladder cancer was suspected preoperatively; and in 70% of cases cancer was suspected during surgery but intraoperative biopsies showed no malignancy. Definitive pathological findings included early carcinoma of the gallbladder in two patients, and a cholecystocolic fistula in one patient. A perforated gallbladder was found in one patient. The incidence of postoperative septic complications was 18.1%, a figure that doubles that of elective biliary surgery in our hospital.

[Dextran and hemodilution in the prevention of postoperative venous thrombo-embolism (author's transl)]. / Le dextran et l'hémodilution dans la prévention de la thrombo-embolie postopératoire.

A retrospective study was made to evaluate the effects of two preventive measures on deep venous thrombosis. The first group consists of 147 patients operated upon for biliary tract disease and 118 operative at the hip. The prophylactic measures consisted of dextran and ASA. The second group comprises 52 patients who underwent biliary tract surgery and 40 a hip intervention. During the operation they were submitted to a moderate normovolemic hemodilution (Hemat. 27%) only. During the postoperative period this group received no other prophylactic measures or therapy except for routine physical therapy. This study suggests that moderate normovolemic hemodilution is the best prophylaxis for deep venous thrombosis. Indeed, in the first group 10% of those operated upon for biliary tract disease developed a deep venous thrombosis as detected by the fibrinogen-I 25 test and phlebography (0,68% massive lethal pulmonary embolism). The incidence was 37,2% after hip surgery (1,6% massive lethal pulmonary embolism). Of those operated with moderate normovolemic hemodilution no deep venous thrombosis was detected in the biliary surgery group and only 10% in the hip surgery group. None of them died of a pulmonary embolus. The mechanisms by which normovolemic moderate hemodilution prevents the development of deep venous thrombosis are discussed.

[Osteomyelography and pseudarthrosis of the leg]. / Ostéomyélographie et pseudarthroses de la jambe.

The authors have performed osteomedullography in 25 cases of tibial non-union. They conclude that a complete block at the fracture level is in favour of an established non-union. This technique can make it possible to differentiate between delayed bone union and non-union. It cannot be used in cases treated by intramedullary nailing.

[Prevention of thromboembolic disease and post-transfusional complications using normovolemic hemodilution in arthroplasty surgery of the hip]. / Prévention de la maladie thrombo-embolique et des complications post-transfusionnelles par l'hémodilution normovolémique en chirurgie arthroplastique de la hanche.

A prospective randomized study was conducted to evaluate the effect of moderate normovolemic haemodilution in arthroplastic surgery of the hip, to prevent postoperative deep vein thrombosis and the need for postoperative transfusion. The patients (n = 151) were divided into three groups: 48 patients received Dextran + Acetylsalicylic Acid as a prevention of the thromboembolic complications (Group I). 57 patients received a low dose of Heparin according to the Kakkar protocol (Group II). 52 patients were operated under Haemodilution (Group III). In Group I and II homologous blood transfusions were necessary in 83% of the cases, and in two cases posttransfusional hepatitis were observed. In Group III haemodilution avoided the use of homologous blood. Therefore of the three methods this study showed that haemodilution is the best way to prevent postoperative thrombo-embolism, significantly more effective than Heparin and Dextran, in arthroplastic hip surgery.

[The behavior of atherogenic indices under the effect of growth hormone in postoperative disease]. / Comportamiento de los índices aterogénicos bajo el efecto de la hormona de crecimiento en la enfermedad postoperatoria.

OBJECTIVE: It has been studied the effect of the growth hormone (GH) in the atherogenic indexes, during the postoperative period in 28 patients, operated for digestive surgery. METHOD: Patients were divided in: I) control group, patients without treatment, and II) treatment group, patients treated with 8 U.I. of GH during five days after the intervention. RESULTS: Results show that, while in the control group the atherogenic values increased to pathologic levels, in the treatment group, these values stabilized in the physiological limits. CONCLUSIONS: Thus, these results let conclude to the beneficial antiatherogenic effect of growth hormone in the postoperative disease.

[Fracture of the penis (author's transl)]. / Fracture de la verge.

We have made a bibliografic review on the base of a personal observation rare case of a traumatic rupture of the corpus cavernosum. Upon all-literature, we have study, the only were 18 cases until 1956 and 64 in 1977. Ours would be the 65th. In this report we talk about the etiopathogenesis and symptomatology of this process. We insist on the need of a early surgery to get a good haemostasia, emptying of the haematoma and as a result prevention of cicatrization sequels which would determine penis significant deformities with subsequent disturbances in the erection and normal intercourse.

[Treatment of distal venous thrombosis of the lower extremity with "moderated" doses of heparin]. / Tratamiento de las trombosis venosas distales de la extremidad inferior con dosis "moderadas" de heparina.

The effectiveness of a therapeutic protocol, using 15,000 to 22,500 IU/day of heparin by subcutaneous injection, to treat the distal postoperative vein thrombosis on the lower limb, was evaluated. The study was made on 427 patients, which were analyzed by the Fibrinogen I125 marked accumulation test, to give an early diagnostic and follow-up of their thrombosis (thrombus lysis, stabilization or expansion). Treatment made, showed its efficacy preventing from proximal expansion, as well as avoiding pulmonary embolism and postphlebitic syndrome. Its cost is lower than other therapeutic option's costs, and it doesn't extend the hospital stay.

Testicular-epididymal hemodynamics and inguinal hernia.

Testicular-epididymal hemodynamics is studied by ultrasonographic color velocity imaging (CVI) in patients with primary, uncomplicated inguinal hernias. This procedure allows more precision than any other known Doppler system in measuring hemodynamic parameters such as peak systolic and diastolic velocity, resistance index and pulsatility index. The results of the exploration of 480 arteries of various testicular vascular territories are compared with those obtained by other authors in young healthy individuals using color Doppler. This procedure shows that the hernia does not cause significant alterations in the arterial circulation of the testicle and epididymis.

[Shunt infection in hydrocephalus]. / Infektion der Ableitungssysteme beim Hydrozephalus.

Infection is a generally feared complication of liquor drainage. Shunt sepsis is reported in this paper with reference to 284 patients with liquor drainage. The rate of infection amounted to 9.1 percent. Therapeutic action included application of antibiotics, surgical valve removal, and delayed restitution. The mortality was as high as 29.4 percent. Chemoprophylaxis should begin in parallel with primary shunt implantation.

Modifications of cAMP in plasma and CSF after experimental brain injury.

A dynamic head injury produced by an unconstrained head impact was induced in 30 dogs, out of a total of 45; 15 constituted the control group. Where the energy absorbed by the dog's head is of 59,95 Joules primary brain damage is produced. If the energy absorbed is of 340.31 Joules a severe brain swelling with increase in ICP takes place, leading to the animal's death within 48-96 hours. In the group of animals with a primary brain damage there was no significant change in I.C.P. However, the concentration of cAMP in CSF rose significantly, and this rise continued for 48 hours after impact. In the group of animals with severe secondary brain damage ICP rose significantly from the first post-injury control onwards. The concentration of cAMP in CSF increases significantly after the trauma, but reaches sub-normal levels 48 hours after impact. The plasma concentration of cAMP, on the other hand, is not significantly altered in any of the three groups. The modifications of cAMP in CSF could, in our opinion constitute a good guide for the assessment of the degree of brain damage.