Quantitative assessment of the effects of 'inodilators' on the myocardium in patients without primary cardiac insufficiency after coronary surgery: Part II--Enoximone

Twelve patients undergoing routine coronary artery surgery received a bolus injection of 1.5 mg/kg enoximone between 8 and 18 hours and again between 18 and 48 hours after operation. No patient showed clinically manifest myocardial heart failure. The haemodynamic and cardiodynamic response to enoximone was quantified over a 30 minutes period following injection. Local myocardial developed force increased by 24 +/- 7% after the first and by 12 +/- 6% after the second injection. The rate of myocardial contraction increased by 50 +/- 14% and 15 +/- 10%, respectively, and relaxation increased by 35 +/- 14% and 22 +/- 19%. There was a decrease in total peripheral resistance of 38.8 and 42.9%, and an increase in heart rate of 11 and 15%. The mean arterial pressure showed small reductions from 73 (+/- 3.7) to 67 (+/- 2.6) mmHg for the first dose and from 83 (+/- 3.1) to 78.4 (+/- 2.8) mmHg for the second. Central venous and pulmonary artery pressures were essentially unaltered. The substantial positive inotropic effect of enoximone has been shown to match its peripheral vasodilatory activity, so that in the normovolaemic patient there is a clinically insignificant small fall in mean arterial pressure.

Quantitative assessment of the effects of 'inodilators' on the myocardium in patients without primary cardiac insufficiency after coronary surgery: Part I--Amrinone

The positive inotropic and peripheral vasodilating effect of amrinone has been measured in 20 patients without manifest cardiac insufficiency during the early (8-18 h postoperative) and late (18-48 h postoperative) recovery phase after coronary surgery. On conclusion of the surgical intervention first the aortocoronary bypass flow was compared during dobutamine and amrinone administration. It increased by 88% with amrinone and by 19% with dobutamine. Then a needle force probe was implanted in the myocardium. Directly measured local myocardial force increased not significantly by 3.5% after the first and by 5.1% after the second bolus injection of 2 mg/kg amrinone. The rate of myocardial contraction increased by 18.7% and 12%. The rate of relaxation decreased by 5.3% after the first and increased by 15% after the second injection. Mean pulmonary arterial pressure fell from 18.5 to 15.5 mmHg and from 19.7 to 17 mmHg. Cardiac output increased by 23% after the first and by 20% after the second injection. Heart rate rose from 88 to 99 bpm and from 86 to 94 bpm. Total peripheral resistance fell from 1,035 to 706 dyn*s*cm-5 and from 1,036 to 819 dyn*s*cm-5. The systolic arterial pressure fell from 132 to 116 mmHg after the first injection and did not change after the second injection. Amrinone was found to be a powerful peripheral vasodilator with a mild positive inotropic action. The variations in the effects between the early and late recovery phases mainly reflect a progressive haemodynamic stabilization with a decreasing tendency toward hypotensive disregulation. Careful consideration has to be paid to a properly balanced filling of the vascular system before administering amrinone.

[The value of Gardnerella-vaginalis-culture in bacterial-vaginitis- score-confirmed bacterial vaginosis]

The relative value of a semiquantitative Gardnerella vaginalis culture for the diagnosis of bacterial vaginosis (BV) was studied in 113 women attending a STD clinic. The standard diagnosis of BV was based on the BV score, which is a 10-point grading system to evaluate gram-stained vaginal samples objectively and reproducibly. The sensitivity of G. vaginalis culture for the diagnosis of BV was 28%, while the specificity was 89%. The positive and the negative predictive values were 50% and 76% for G. vaginalis culture in our population. Our data suggest that G. vaginalis culture cannot be recommended for the routine diagnosis of BV. However, G. vaginalis culture will detect asymptomatic women with high vaginal colonization with G. vaginalis. Further studies are needed to find whether these women are at risk of developing BV.

Indomethacin and the stress response to hysterectomy

The influence of indomethacin on the surgical stress response was evaluated in a double-blind study of 20 patients, scheduled for abdominal hysterectomy. The patients were randomly allocated to treatment with either indomethacin, 0.8 mg/kg i.v. preoperatively followed by 100 mg rectally 8-hourly for 3 days (Group I), or placebo (Group P), in both cases supplemented with nicomorphine as needed. Thiopentone was used for induction of anaesthesia, followed by nitrous oxide, enflurane, suxamethonium, and pancuronium. In both groups a significant increase in blood glucose and serum cortisol was seen postoperatively. Twenty-four hours later the values had almost returned to baseline. No differences were found between the absolute increases in the two groups. In both groups the serum concentrations of C-reactive protein, haptoglobin, and orosomucoid increased after an initial small decrease. We conclude that pathways involving prostaglandin synthesis play only a minor role in eliciting the postoperative hyperglycaemic, hypercortisolaemic, and acute phase protein response.

Indomethacin as an analgesic after hysterectomy

The influence of indomethacin on the need for postoperative analgesics was investigated in a double-blind study of 41 patients scheduled for abdominal hysterectomy. The incidence of side effects was evaluated. The patients were randomly allocated to treatment with either indomethacin, 0.8 mg/kg i.v. preoperatively, followed by 100 mg rectally 8-hourly for 3 days (Group I), or placebo (Group P), in both cases supplemented with nicomorphine as needed. Thiopentone was used for induction of anaesthesia, followed by nitrous oxide, enflurane, suxamethonium, and pancuronium. The average nicomorphine requirement during the study was 14.0 mg/24 h lower in Group I than in Group P. The pain score values were slightly lower in Group I when resting, but similar on movement. A significant increase in perioperative blood loss was found in Group I. Beginning the indomethacin treatment with a preoperative i.v. bolus seems to offer few advantages compared to a purely postoperative regime and may increase the risk of bleeding complications.

Administration of a terpene mixture inhibits cholesterol nucleation in bile from patients with cholesterol gallstones

Patients with cholesterol gallstones referred to elective cholecystectomy were randomly assigned prior to operation to no treatment (n = 14), treatment with one capsule t.d.s. (n = 12) or two capsules t.d.s. (n = 11) of a terpene mixture (Rowachol). Patients with pigment stones (n = 7) or no biliary tract disease (n = 5) were also studied. Lipid composition, presence of cholesterol monohydrate crystals, and nucleation time were determined in gallbladder bile aspirated during surgery. Cholesterol saturation was similar in the different groups. Crystals were present in all cholesterol gallstone patients without treatment and in none of the controls. In one of the patients treated with one capsule and four of the patients treated with two capsules crystals could not be detected. The terpenes prolonged nucleation time from 2.8 to 5.8 days (one capsule; P less than 0.05) and to 9.5 days (two capsules; P less than 0.001), respectively; but nucleation did not occur in seven controls. Although the mechanism by which the terpene mixture inhibits the formation of cholesterol crystals in bile was not determined, the findings suggest that the terpene mixture might be a useful agent for a clinical trial to test whether they will prevent recurrence of gallstones after medical dissolution.

[Is the postmenopausal-age-at-death variable a fitness-maximizing reproductive strategy?]

On the basis of the complete 18th century vital statistics available for 811 women from Ostfriesland (Germany), an attempt is made to examine the relationship between the postmenopausal age at death and the reproductive behaviour (reproductive effort and reproductive management). Although reproductive activities appeared to have a basically life-shortening effect in the population under study, this was independent of the amount of reproductive effort. The positive correlation reported in the literature to exist between the number of (surviving) children and the age at death was confirmed in our analysis; and it can partly be explained by the interference of another relationship, i.e. between the age at the last parturition and longevity. This correlation is interpreted as an expression of fitness-maximizing reproductive management. To this belongs the idea that the existence of unmarried children, i.e. the sub-optimal social position of one's descendants, had a life-lengthening effect on the women investigated. Whereas the effects found are largely statistically significant, they are on the whole very minor, so that we may surmise that only a small part of the total variance of the postmenopausal age at death can be interpreted as an expression of an adaptive reproductive strategy.

[Scintigraphy in the diagnosis of intestinal hemorrhage]

13 patients with gastrointestinal hemorrhage underwent a scintigraphic examination to localize the bleeding. In 6 patients Tc-99m labeled red blood cells, in 7 patients Tc-99m sulfur colloid were used. Scintigraphy could demonstrate an intestinal bleeding in ten patients, in whom the conventional examinations, and among them 7 abdominal angiographies had failed. 5 of them had to be operated after that, whereby the scintigraphic findings were verified. One of the three patients with negative scintigraphy had to undergo an operation because of continuous bleeding. The methods of scintigraphy and their indication in gastrointestinal hemorrhage are discussed.

[Results of percutaneous transhepatic bile duct drainage]

Significant reduction in serum bilirubin levels was obtained in 90.7% of 75 patients on whom percutaneous transhepatic biliary drainage had been carried out, either immediately before operation or as a prolonged palliative procedure. The technical requirements, complications, mortality rate and length of stay in hospital are less than following palliative surgery.

Observations on the interaction between adult group members, group members without rearing experience and infants in the common marmoset, Callithrix jacchus

This study describes the reactions of adult, rearing-experienced members of three Callithrix jacchus families to interactions between animals without rearing experience and infants. The direct involvement of adult group members in situations in which inexperienced animals interact with infants decreases as the infants become older. Inexperienced animals will approach infants more seldom, if adult, rearing-experienced animals are nearby. Adult, rearing-experienced members of the group display primarily noninteractive behavior. This is especially true when no physical contact has taken place between an inexperienced animal and the infant, or if contact was initiated by the infant. Most of the dissociative reactions were observed in the context of competition for objects and play activity. However, there was a similarly high percentage of associative behavior towards inexperienced animals during play activity. In the episodes observed, the adult, rearing-experienced animals displayed mainly taking care behavior towards the infant but never any dissociative behavior. The following points appear to be of significance for the way adult, rearing-experienced members of the group behave: spatial distance between inexperienced animal and infant; which party was the initiator of the interaction; the level of experience already acquired by the animals without previous rearing experience, and the level of maturation of the infant.

[Intrathoracic-extrapleural esophageal replacement with gastroplasty]

We carried out replacement of the oesophagus by transposing the stomach in 87 patients, 64 with carcinoma of the oesophagus. There is an immediate operative mortality of 20-30%, but this is followed by a relatively low morbidity, which is well demonstrated radiologically (stricture at the anastomosis, which can be mechanically dilated, about 22%; external fistula with a tendency to spontaneous closure about 25%; ectasia of the thoracic stomach, 15-25%). Average survival time is eight to ten months. There is a 24% risk of post-operative pulmonary oedema and daily chest x-rays are indicated.

Modification of the bone marrow toxicity of cis-diamminedichloroplatinum(II) in mice by diethyldithiocarbamate

It has been shown that cis-platinum-induced nephrotoxicity in rats can be inhibited by diethyldithiocarbamate (DDC). We report here the bone marrow protective properties of DDC in hybrid (C57BL X BALB/c) mice exposed to single and fractionated doses of cis-platinum. Relatively nontoxic doses of DDC afford maximum protection, using that dose of cis-platinum that would result in the death of 50% of the mice within 9 days as an end point (dose-limiting gut toxicity in mice), when injected 0.5 to 2 hr following i.p. cis-platinum treatment. Survivals of colony-forming units in spleen, nucleated bone marrow cells, and peripheral white blood cell were used to assess the bone marrow protective properties of DDC following both single and fractionated doses of cis-platinum. A dose modification factor of 3.2 (based on colony-forming units in spleen survival) was obtained when DDC (1000 mg/kg) was injected into mice 0.5 hr after graded doses of cis-platinum. When fractionated doses of cis-platinum were used (6 mg/kg on Days 0, 10, 20, and 30), the survival of colony-forming units in spleen was markedly enhanced if the animals were rescued with DDC 0.5 hr following each cis-platinum dose. When bone marrow cellularity was measured immediately before and 2 days after each dose of cis-platinum, a similar pattern of depression and recovery was noted whether DDC was present or not; however, the depression was less marked in mice rescued with DDC. When peripheral white blood cell counts were monitored, the nadir and recovery were similar in the presence or absence of DDC; however, recovery occurred sooner in the animals that had received DDC. Our data support the ability of DDC to modify the bone marrow toxicity of cis-platinum in normal mice. Experiments are in progress in tumor-bearing animals exploring the differential protection afforded by DDC between bone marrow and tumor.

[Primary tumors of the mesentery and greater omentum]

Diseases of mesentery and greater omentum are commonly the result of lymph node metastases from an abdominal carcinoma, or lymph node involvement as part of a general lymphatic malignancy. Primary tumours are rare. Cysts occur predominantly in children. In addition, one may find mesenchymal benign or malignant tumours, which produce clinical symptoms at a later age. Plain abdominal films, barium meals and angiograms fail to show evidence of a space-occupying lesion, or produce only indirect signs. Only ultrasound or CT can demonstrate these tumours directly.

Enhancement of heat sensitivity and modification of repair of potentially lethal heat damage in plateau-phase cultures of mammalian cells by diethyldithiocarbamate

Diethyldithiocarbamate (DDC) is active both in vivo and in vitro in reducing the levels of enzymes such as superoxide dismutase (SOD) and glutathione peroxidase whose role in respiring cells is to remove toxic superoxide radicals and organic hydroperoxides. Although DDC, a copper-chelating agent, has been used to treat benign diseases, its potential as a heat sensitizer has not been fully explored. We have recently shown that the presence of 10(-3) M DDC for 2 hr causes a threefold reduction in the level of SOD in plateau-phase cultures of mammalian cells. At this concentration, the drug causes minimal toxicity but markedly affects both the shoulder and the slope of the heat survival curves. To explore another pathway of DDC sensitization, other than through reduced levels of SOD, we examined the repair of potentially lethal damage with and without DDC following exposure for 1 hr and 40 min at 43 degrees C. The repair, which progressed with a T 1/2 of about 10 hr, in either full medium or Hank's balanced salt solution (HBSS), in the absence of DDC, was completely blocked when DDC was added to the monolayers on completion of the heat exposure. DDC, in view of its ability to potentiate the effects of heat, is a potentially useful drug that could be used in an adjunctive setting with clinical hyperthermia.

[Echinococcus alveolaris--clinical manifestation, treatment and prognosis]

Life-cycle and endemic areas of Echinococcus alveolaris are described with reference to the autonomous character of this parasitosis. Especially human ways of infestation are shown with man's role as definitive host. The natural course of this parasitosis leads obligatory to lingering illness and death. Indication of exploratory laparotomy remains beyond doubt. Based on our own experience and corresponding with other authors importance of radical resection has to be propagated with reservation. Maintaining of the bile flow however is most important with regard to operative mortality, survival time and quality of life--even when performed as palliative surgical treatment. Adjuvant therapy with Mebendazol (Vermox) is considered to be helpful in improving the unfavourable prognosis of this parasitic disease.

Modification of the sensitivity and repair of potentially lethal damage by diethyldithiocarbamate during and following exposure of plateau-phase cultures of mammalian cells to radiation and cis-diamminedichloroplatinum(II)

Diethyldithiocarbamate (DDC), a chelating agent known to reduce levels of superoxide dismutase and glutathione peroxidase, appears to protect irradiated monolayers of mammalian cells when present for 1 hr before and during irradiation. To examine a possible cause of this modification, the repair of potentially lethal X-ray damage was examined with and without the presence of DDC in the medium overlying the cells postirradiation. Although little repair was seen in full medium alone when DDC was added to the full medium, the amount of repair was comparable to that seen under optimum repair conditions, that is, in Hanks' balanced salt solution. The t 1/2 of the repair process in Hanks' balanced salt solution or in full medium with DDC added was comparable and of the order of 1 to 1.5 hr. The cis-platinum sensitivity of the monolayers is significantly modified by the addition of DDC, and the nature of the modification is dependent upon the time at which the DDC is added to the cells following initiation of cis-platinum exposure. To investigate a possible reason for this protection by DDC, we examined the repair of potentially lethal cis-platinum damage in the cell monolayers. Minimal repair was noted in the presence of either Hanks' balanced salt solution or full medium, but when DDC was added to the full medium, the repair was tripled, and the t 1/2 of the repair process was approximately 2 hr. The ability of DDC to protect cells from exposure to both X-rays and cis-platinum, together with its augmentation of repair of potentially lethal damage following exposure to each, has broad clinical application and is being actively explored in tumor-bearing mice.

[Thymomas--clinico-pathologic aspects]

A collective of 38 patients with a thymoma, confirmed by microscopic investigation, was analysed retrospectively. 63% of them were female. In 27% of the cases the final diagnosis could be made by autopsy only. 56% of the operated patients lived half of their age-dependant expectation of life. The 5- and 10-year-survival rates amount 84% and 68%, respectively. Of the non-operated patients no one was alive 2.5 years after diagnosis. There was no consistent relationship between the different histologic structure of thymomas (degree of lymphocytic infiltration) and the clinical behaviour and the survival rate. All patients with "parathymic syndromes" were women. One case with pure red cell anemia (erythrophthisis) was associated with spindle-shaped epithelial thymoma. The incidence of myasthenia gravis did not depend on the histologic pattern of thymomas.

[The value of oral gastrografin in the diagnosis of ileus (author's transl)]

One hundred and thirty examinations with oral gastrografin were performed in 110 patients with obstructive symptoms, who did not require immediate operation. They consisted of 49 patients with mechanical ileus, eighteen patients with paralytic ileus and 63 patients with incomplete mechanical ileus. All patients with complete mechanical and three patients with paralytic ileus were investigated surgically and treated in this way. Small bowel transit time longer than five hours provides considerable certainty of complete mechanical ileus. The method has been tried for four years; it makes few demands on the patient and has practically no contra-indications, except for deranged electrolyte balance. In children, the amount of contrast medium should be limited and it should be diluted or an isotonic contrast medium should be used. The method provides definite differentiation between mechanical and functional obstruction. In patients with adhesions and recurrent incomplete obstruction, further laparotomies may be avoided in this way.

[The appendix stump insufficiency. Clinical appearance forms and treatment]

Early manifestation of insufficiency of the appendiceal stump appearing as a diffuse peritonitis with a septicemic general state has led to the death of 6 of 10 patients treated here. One has to suppose that these complications have additional unknown causes. Insufficiency of the stump, with or without necrosis of the cecum, can only be discovered with active procedures and than treated in the appropriate way. Each of these patients has been lost when there has been no courage for reintervention or even an excuse for providing intensive medical treatment with respiration aid and hemodialysis. As a rule, the fecal fistula appears during postoperative days 5-8 without diffuse peritonitis and should be treated in a conservative way; spontaneous fading away should be expected and operative occlusion should not be started before a 3 month interval.

[Radiological and clinical aspects of diaphragmatic injuries (author's transl)]

In experience of generally increasing frequency of diaphragmatic injuries, nowadays mostly caused by blunt body traumata in traffic accidents, a review is made about diagnostic and morphologic aspects outlining syndromal relations of 70 cases treated from 1950 until 1980 in the Department of Surgery of the Bonn University. Diaphragmatic tears following indirect (closed) trauma are surely more often associated with a transposition of abdominal organs (73%) than those secondary to direct (penetrating) wounds with an amount to 23%. In typical associated injuries like multiple rib fractures (29%, in relation to blunt injuries even 42%) and pelvic fractures (24% resp. 35%) diaphragmatic damage has to be investigated for if there is any doubtful abdominal or cardiorespiratory symptom. Especially in less symptomatic intervals roentgenographic methods come to use predominantly.

Thrombolysis by ultrasound

1. A new method of destroying thrombi in blood vessels by ultrasound and simultaneously removing them is reported. 2. Experiments were performed in twenty dogs with artificial thrombi in the iliac and femoral arteries and veins. The length of the thrombi ranged from 4 to 5 cm and the age from 12 h to 10 days. The unit used consisted of a generator, a frequency counter, an ultrasonic transducer with the hollow waveguide and a vacuum pump. For protection of the vessel wall the guide is surrounded by a plastic tube. The ultrasonic frequency is 26-5 kHz, the amplitude 25-30 micronm. The time needed to destroy the thrombus by ultrasound and suck out the thrombotic material ranged from 2-5 to 5 min. 3. To check side effects, experiments were performed in forty-four dogs. No significant changes were seen in the fibrinolytic system or microscopic structure of the vessel wall after ultrasound.

[Embolism by ultrasound-thrombolysis (author's transl)]

By ultrasound it is possible to destroy thrombi intravascular and remove them by a hollow flexible probe at the same time. Experiments were now performed in 6 dogs with 2-9 days old thromboses in the femoral or iliac veins, to detect embolisation during ultrasound-thrombolysis. Parameters were pulmonary angiograms and lung scans. Only in one dog with a floating thrombus in the iliac vein signs of pulmonary embolism were found after thrombolysis. The controls of the other 5 dogs were normal.

Tetrachloroanisol: a source of musty taste in eggs and broilers

Ingestion by hens and broilers of specific chloroanisols present in some wood shavings used in poultry cages can result in a musty taste in poultry products.