[Vipoma of the pancreas. Apropos of a case and review of the literature]

Pancreatic endocrine tumors are uncommon; of this type of tumors, the Verner-Morrison's syndrome, WDHA or vipoma is diagnosed very rarely. The present paper is a report of a pancreatic vipoma in a 60 year-old female; she presented with watery diarrhea, facial flushing, hypokalemia, hypochlorhydria, metabolic acidosis and reversible renal failure; these are the usual manifestations of the syndrome. The diagnosis was made on the basis of radiological imaging, CAT and arteriography as well as the finding or elevated levels of vasoactive intestinal peptide (VIP). The surgical resection of the tumor was followed by the remission of the symptoms and normalization of the plasmatic levels of VIP. It is necessary to recognize this type of tumors because the only way to achieve a curative surgical resection is after an early diagnosis.

[Endoscopic sclerotherapy of esophageal varices with 80% alcohol. Experience with 46 cases]

We are presenting the results obtained by endoscopic sclerotherapy with 80% alcohol in fifty-five patients with upper GI bleeding caused by esophageal varices, with or without active bleeding at the moment of the endoscopic study. We obtained control of bleeding in 83.64% with a recurrence of bleeding of 16.36% during the first 15 days. At the same period of time we obtained a 16.36% mortality rate. In the forty six patients that concluded sclerotherapy, decrease in size of the varices occurred in 89.79% and eradication was obtained in 6.11% of the patients. We observed three types of complications: esophageal ulcers in 100% of the cases which healed in a period of three weeks. Retrosternal pain of short duration, in 45.65%, this pain appears when the sclerosant substance is injected. Esophageal stenosis in 5.45% which were treated with dilatations. Our conclusion is that 80% alcohol is an effective and safe sclerosant substance in the management of acute bleeding of esophageal varices and in the prevention of the immediate recurrence, but has the disadvantage of a great number of local complications.

Comparative evaluation of aloe vera in the management of burn wounds in guinea pigs

An experimental study was designed using Hartley guinea pigs, who received full-thickness burns covering 3 percent of their body surface area by direct contact with a hot plate. A total of 40 animals were equally divided among four modalities of closed burn wound management as follows: group I: silver sulfadiazine (Silvadine); group II: aloe vera gel extract (Carrington Dermal Wound Gel); group III: salicylic acid cream (aspirin); and group IV: plain gauze occlusive dressing only. The dressings were changed daily, and the size and appearance of each burn wound were recorded until complete healing. On the sixth postburn day, quantitative burn wound cultures were made. The average time to complete healing in the control group was 50 days, and the only significant difference was found in the aloe vera-treated animals, which healed on an average of 30 days (p less than 0.02). Wound bacterial counts were effectively decreased by silver sulfadiazine (p = 0.015) and by aloe vera extract (p = 0.015). From our data it appears that aloe gel extracts permit a faster healing of burn wounds.

Modification of catecholamine and prostaglandin tissue levels in E. coli endotoxin-treated rats

Epinephrine and norepinephrine adrenal levels were depleted in Escherichia coli endotoxin-treated (10 mg/kg) male Wistar rats from 504 +/- 203 to 119 +/- 77 ng/mg in control and from 200 +/- 97 to 123 +/- 66 ng/mg wet wt, respectively. However dopamine increased from 4.2 +/- 1.9 to 14.9 +/- 3.4 ng/mg. After endotoxin administration, norepinephrine content in peripheral organs, heart 1.27 +/- 0.19 ng/mg, spleen 1.52 +/- 0.59 ng/mg, liver 0.15 +/- 0.05 ng/mg, and kidney 0.24 +/- 0.09 ng/mg wet wt. decreased by 34, 36, 47, and 18%, respectively. Indomethacin treatment kept the catecholamine levels constant in endotoxic rats, but naloxone had no effect. PGF2 alpha tissue levels (12.0 +/- 10.1 pg/mg protein in spleen and 1.85 +/- 0.6 pg/mg protein in liver) were increased twofold by endotoxin treatment: PGE2 content in spleen and liver 0.5 +/- 0.2 pg/mg protein and 2.3 +/- 1.9 pg/mg protein, respectively, increased by only 27 and 26%. In the kidneys of endotoxin-treated animals, PGF2 alpha and PGE2 levels were lower than in control. Indomethacin treatment decreased PGF2 alpha and PGE2 and increased the norepinephrine content in the same organs. It is suggested that prostaglandins play a participative role in the control of norepinephrine tissue levels in endotoxemia.

Somatostatin in the treatment of severe upper gastrointestinal bleeding: a multicentre controlled trial

To evaluate the effectiveness of somatostatin versus combined cimetidine and pirenzepine in the treatment of upper gastrointestinal (GI) bleeding of peptic origin, a multicentre controlled, prospective, randomized and double blind trial has been undertaken in 60 subjects. Strict selection criteria were followed. All subjects were diagnosed by endoscopy during the first 18 h after admission. Endoscopic stigmata of recent haemorrhage were also evaluated. Sixty-five per cent of the subjects presented with severe upper GI bleeding (blood pressure less than or equal to 100 mmHg, pulse rate greater than or equal to 110, haematocrit less than or equal to 30 per cent), and in 71.6 per cent stigmata were found. Thirty patients (Group 1) received a somatostatin infusion (250 micrograms/h continuously during 120 h) and 30 patients (Group 2) received cimetidine (200 mg IV every 4 h for 5 days) and pirenzepine (10 mg IV every 8 h for 5 days). Both groups were homogeneous for sex, age, backgrounds, bleeding source, grade of bleeding (moderate or severe) and presence or not of stigmata. Bleeding stopped in 27 subjects of Group 1 (90 per cent and in 20 subjects of Group 2 (66.67 per cent) (P less than 0.05, chi 2 test). The time until the bleeding stopped was significantly shorter in patients of group 1 (3.44 +/- 0.53 h) than in patients of group 2 (8.12 +/- 1.94 h) (P less than 0.05, Mann-Whitney U test). The number of blood units required for Group 1 (2.26 +/- 0.35) was significantly lower than the one required for Group 2 (3.90 +/- 0.51) (P less than 0.005, Wilcoxon test). Significant differences were not observed between the two groups regarding cross-over subjects, re-bleeding, surgery (P = 0.0635, Fisher's exact test) and hospital stay. The mortality of the trial was 5 per cent. There was no toxicity during somatostatin, cimetidine or pirenzepine infusion. In conclusion, somatostatin was more effective than cimetidine plus pirenzepine in the control of severe upper GI bleeding of peptic origin, with a lower interval time to stop bleeding and reduced transfusion requirements.

Lipid metabolism in pregnancy. Perfusion of liver in pregnant rats

Livers of pregnant or nonpregnant rats were perfused, and incorporation of 14C-acetate into lipids was studied. Total lipids were extracted from samples of perfusion medium, taken at the entrance and exit from the liver, at different time intervals, and from the liver homogenates at the end of the experiment. Time-course of the incorporation of 14C-acetate into different lipid classes from perfusion medium and liver tissue was compared for pregnant and nonpregnant rats. Radioactivity incorporation into circulant FFA and TG was higher in the control rats than in the pregnant animals. Contrariwise, there was a high incorporation of labelled fatty acids into phosphoglycerides in pregnant rats. There was an increase of unsaturated fatty acids of large carbon chain (24 : 1 and 22 : 6) in the perfusion media of pregnant liver. Moreover, the percentages of labelled fatty acids 16 : 1, 18 : 1 and 18 : 0 were higher in pregnant rats than in controls.

Chemoimmunotherapy with Corynebacterium parvum in acute myelocytic leukemia

The purpose of this study is to see if immunotherapy with C. parvum and prevention of central nervous system relapse with intrathecal methotrexate can prolong duration of complete remission and survival as well as avoid central nervous system relapse. For induction, three weekly I.V. injections of vincristine and Daunorubicin were given with daily prednisone orally, followed by 5-day courses of Cytosine Arabinoside and 6-mercaptopurine. The patients were randomized to chemotherapy or chemoimmunotherapy. Maintenance consisted of vincristine, Daunorubicin, and prednisone one week every odd month, and a 5-day course of Cytosine Arabinoside and 6-mercaptopurine every even month. Every week, the chemoimmunotherapy group also received, without chemotherapy, one injection of C. parvum 4 mg, subcutaneously. All patients received five weekly injections of intrathecal methotrexate 13 mg/m2 right after complete remission was achieved. Out of 181 evaluable cases, 80 (44%) achieved complete remission, 45 were randomized to chemotherapy, and 35 to chemoimmunotherapy. In the chemoimmunotherapy group 32/35 relapsed, and in the chemotherapy group 36/45. Median duration of complete remission and survival were: for group chemotherapy, 8 and 15 months; for group chemoimmunotherapy, 5 and 10 months. This difference is not significant. Intrathecal methotrexate was given to all patients. Six patients (7%) had central nervous system leukemia at the time of the first injection. None had central nervous system relapse after prevention with intrathecal methotrexate. This method seems useful in preventing central nervous system relapse in patients with acute myeloblastic leukemia, but does not seem to prolong complete remission.

Comparison of two combination chemotherapy regimens for multiple myeloma: methyl-CCNU, cyclophosphamide, and prednisone versus melphalan and prednisone

Of 139 evaluable and previously untreated patients with multiple myeloma, 67 received methyl-CCNU-cyclophosphamide-prednisone (group A) and 72 received melphalan-prednisone (group B); 48% and 33% respectively had good responses and the overall response rates (good plus partial) were 75% and 65% for groups A and B respectively. The survival curves for both groups of patients were similar, with a median survival of 32 months. At 36 months, 70% of those patients who obtained good response were alive, 29% of those with partial response were alive, and 13% of those with no response were alive. The clinical staging system described by Durie and Salmon shows a good prognosis for stage I patients, with 80% remaining alive at 48 months, while the survival curves for stage II and III patients were similar, with 33% and 28% respectively remaining alive at 48 months. The combination of methyl-CCNU-cyclophosphamide-prednisone is not more effective in terms of response rate or duration of survival than melphalan-prednisone.

[Value of liver biopsy in the diagnosis of cholestatic jaundice]

50 patients with cholestatic jaundice were studied with liver biopsy and fine needle transhepatic cholangiography. In 36 cases there was obstruction of the extrahepatic bile ducts. Rest of the cases had normal bile ducts. These findings were compared with those of the liver biopsy. When there is portal inflammation, bile pigment intracellular, cholangitis and bile plugs associated there was obstruction in 99 per cent of cases. A concluded that cholangiography should precede biopsy in cholestatic jaundice.

Protection of organs during experimental ischemia

Cell death complicating ischemia has profound local or systematic effects on the organism. We have tried to protect the small intestine and severed extremities from the effects of ischemia by using various drugs and techniques. Occlusion of the superior mesenteric artery for 1.5 hours in anesthesized, fed rats had a 97 per cent mortality. This was improved by pretreatment with methylprednisolone and amplicillin given together. Histologic preservation was seen in treated survivors. Chlorpheniramine, diphenylhydantion and methylprednisolone or amplicillin given alone had little, if any, effect. In dogs, reimplantation of severed extremities subjected to a 1.5 to two hour warm ischemic period resulted in toxic systemic picture, and 100 per cent mortality. This was improved by perfusion with Collins solution and postoperative injection of methylprednisolone. The incidence of gangrene was decreased. The judicious use of some drugs and preservation techniques may protect organs and the organism from the consequence of ischemia.

A reversed jejunal segment interposition as feeding gastrostomy

Permanent feeding gastrostomies are needed for prolonged alimentation in some patients with foregut obstruction. The usual gastric flap or tube may be limited in patients with previous gastric surgery or with a small stomach. In these patients, interposition of a short, vascularized jejunal segment between the anterior wall of the stomach and the outside may be valuable. Periodic intubation is easy. Tested initially in dogs and then applied to selected patients, we have not seen ulcers, regurgitation, soiling, pain, or other complications.