The results of grapevine breeding in the Republic of Moldova – in context of climatic and socio-economic challenges

The results achieved in Republic of Moldova in using the potential of grapevine Gene pool over the past 40 years are significant: new varieties for diverse utilisation, designed for complex biological resistance to stress factors, for reduced pressing on the environment and for excellent capabilities for ecological agriculture. Breeding programs resulted in modernization of assortment – were created more than 80 new varieties for table and wine grapes, most of them with advanced biological resistance, and 32 varieties were included in actual assortment and other are in the process of testing. An important feature of this assortment is presence of seedless varieties, well adapted to our geographical area. According to their characteristics (resistance, quality, productivity), created seedless varieties are not only a pioneering for the assortment of the Republic of Moldova, but for the entire Euro-Asian region. New seedless varieties and perspective elites manifest an increased percentage of buds started in vegetation after the wintering. High fertility, medium to large and very large grapes, accumulation of sugars and total acidity in must favourably for consumption of fresh grapes or for technological processing, suitability for long-term storage and transportability for some of them, denote their high productive and qualitative potential.

Circadian input kinases and their homologs in cyanobacteria: evolutionary constraints versus architectural diversification

The circadian input kinase A (cikA) gene encodes a protein relaying environmental signal to the central circadian oscillator in cyanobacteria. The CikA protein has a variable architecture and usually consists of four tandemly arrayed domains: GAF, histidine kinase (HisKA), histidine kinase-like ATPase (HATPase_c), and a pseudo-receiver (REC). Among them, HisKA and HATPase_c are the least polymorphic, and REC is not present in heterocystic filamentous cyanobacteria. CikA contains several conserved motifs that are likely important for circadian function. There are at least three types of circadian systems, each of which possesses a different set of circadian genes. The originally described circadian system (kaiABC system) possesses both cikA and kaiA, while the others lack either only cikA (kaiABC (Delta)) or both (kaiBC). The results we obtained allowed us to approximate the time of the cikA origin to be about 2600-2200 MYA and the time of its loss in the species with the kaiABC (Delta) or kaiBC system between 1100 and 600 MYA. Circadian specialization of CikA, as opposed to its non-circadian homologs, is a result of several factors, including the unique conserved domain architecture and high evolutionary constraints of some domains and regions, which were previously identified as critical for the circadian function of the gene.

[Laparoscopic segmental pancreas resection and pancreatic cystadenoma]

Aside from location, the complex anatomic relationships and advanced laparoscopic skills needed in selected cases of laparoscopic pancreas surgery have increased. We report a 55-year-old woman with cystic adenoma in the area of the corpus who was treated with complete laparoscopic corpus resection while preserving the head and tail of the pancreas and the spleen. The patient was placed in lithotomy position. Four trocars were placed. After opening the bursa, the pancreas showed a 6x6x6-cm, well-bordered, cystic tumor in the corpus. Tail and head of the pancreas were free of tumor and seemed inconspicuous. After exploration of the v. porte and v. lienalis, the healthy tissue in the head area of the pancreas was divided with the linear stapler. Preparation continued in the direction of the pancreatic tail while preserving the v. lienalis. After reaching the healthy pancreas in the tail region, the tumorous segment was resected. The resected pancreas segment was placed in an endobag until removal over a slightly widened trocar incision above the symphysis. The tail segment was anastomized in situ end-to- side with the first jejunum loop behind the Treitz's ligament. There was no postoperative complication, and the postoperative course was observed. The patient returned to normal activity within 10 days after operation. Retaining high surgical standards and preserving the healthy pancreas tissue and laparoscopic anastomosis, laparoscopic surgery in cases of benign tumors of the distal pancreas is possible with all the patient benefits of minimally invasive surgery.

Adaptive role of increased frequency of polypurine tracts in mRNA sequences of thermophilic prokaryotes

The mechanism of an organism's adaptation to high temperatures has been investigated intensively in recent years. It was suggested that the macromolecules of thermophilic microorganisms (especially proteins) have structural features that enhance their thermostability. We compared mRNA sequences of 72 fully sequenced prokaryotic proteomes (14 thermophilic and 58 mesophilic species). Although the differences between the percentage of adenine plus guanine content of whole mRNAs of different prokaryotic species are much lower than those of guanine plus cytosine content, the thermophile purine-pyrimidine (R/Y) ratio within their mRNAs is significantly higher than that of the mesophiles. The first and third codon positions of both thermophiles and mesophiles are purine-biased, with the bias more pronounced by the thermophiles. Thermophile mRNAs that display the highest R/Y ratio (1.43-1.69) are those of the ribosomal proteins, histone-like proteins, DNA-dependent RNA polymerase subunits, and heat-shock proteins. Within mesophilic prokaryotes and five eukaryotic species, the R/Y ratio of the mRNAs of heat-shock proteins is higher than their average over coding part of the genome. Polypurine tracts (R)(n) (with n > or = 5) are much more abundant within the thermophile mRNAs compared with mesophiles. Between two sequential pure-purinic codons of thermophile mRNAs, there is a rather strong tendency for the occurrence of adenine but not guanine tracts. The data suggest that mixed adenine.guanine and polyadenine tracts in mRNAs increase the thermostability beyond the contribution of amino acids encoded by purine tracts, which highlights the importance of ecological stress in the evolution of genome architecture.

[Technique of right laparoscopic hemicolectomy]

Patho-anatomic feature such as easy mobilisation of the colon segment on mesocolon, technically easy approach to the central lymphovascular pedicle, and the possibility of relative uncomplicated salvage and anastomosis warrant including this method in the procedures of modern colorectal surgery. Mobilisation from the vascularisized mesenterial bridges in a window technique, transection of the ileocolic lymphovascular pedicle, lateral and proximal mobilisation of ileocoecum, colon ascendance, right flexure and proximal transversum. After enlargement of one trocar incision the exteriorized colon is resected and an extracorporeal anastomosis is performed in the standard manner. With this standardized method, right hemicolectomy is easy, practicable, and repeatable and can be done with all the advantages of minimally invasive surgery.

Laparoscopic inguinal hernia repair

BACKGROUND

We performed a prospective study to evaluate the safety and efficacy of laparoscopic hernia repair in our hospital.

METHODS

A total of 2500 consecutive laparoscopic transabdominal hernia repairs (TAPP) were performed in 1952 patients. Their average age was 59 years. We used a mesh. 12 x 15cm.

RESULTS

The average operating time was 32 mins. We had a recurrence rate of 1.04%. There were 89 complications (3.56%). Three were bladder injuries, one of which necessitated conversion to an open laparotomy. Three of 38 hematomas required open exploration. Three patients were reoperated because of nerve irritation. An incarcerated trocar hernia occurred in six cases. There was one wound infection at the umbilical incision. There were no infections or incompatibility reactions at the mesh. The complication rate declined over time. At the same time, the rate of recurrence decreased as we acquired more experience in laparoscopic hernia repair.

CONCLUSION

Laparoscopic hernia repair can be performed safely, with low rates of recurrences and few complications are low. This technique achieves good results combined with the benefits of minimal invasive procedures.

[Endoscopic parathyroidectomy. Surgical technique in primary hyperparathyroidism]

We report our experience and technique of endoscopic removal of parathyroid adenomas in case of primary hyperparathyroidism. Scintigraphy, MRI scan and cervical ultrasound enable exact diagnosis and therefore exact localisation and placement of the three 5 mm trocars for endoscopic operation. The placement of the optic and the function trocars depends on the localisation of the adenoma. The free room to work in is created between thyroid and neck muscles and supported by insufflated CO2 with a pressure of 12 mm Hg. After the adenoma is taken out through an incision above the jugulum. With this technique we operated upon 3 patients successfully. Benefits for the patients seem to be a less painful postoperative course with minimal blood loss because of the exact exploration of the adenoma with minimal invasion of the surrounding tissue.

Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study

PURPOSE

The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on oncologic follow-up in particular.

METHODS

A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers between May 1991 and September 1997. Surgical and pathologic data were recorded in an anonymous registry database and analyzed by type of resection. Standard procedures were sigmoid or left colectomy, anterior resection, abdominoperineal resection, and right hemicolectomy. Follow-up information included incidence of local, distant, and port site recurrence and cancer-related death.

RESULTS

A total of 399 patients (212 females) with a mean age of 66.6 years underwent laparoscopic curative resections (sigmoid resection, 89; left colectomy, 11; anterior resection, 157; abdominoperineal resection, 102; right hemicolectomy, 40). Conversion was necessary in 6.3 percent (n = 25). Complications requiring reoperation occurred in 9 percent (n = 35). Complications that were treated conservatively occurred in 27.6 percent (n = 110). Thirty-day mortality was 1.8 percent (n = 7). First bowel movements resumed on the third postoperative day; patients did not use analgesics after a mean of five days. Mean postoperative hospitalization was two weeks. According to International Union Against Cancer classification, 147 patients had Stage I cancer, 35 had Stage II cancer, and 217 underwent curative resection for Stage III cancer. Mean number of lymph nodes resected was 12.1. At a mean follow-up of 30 months, one port site recurrence was documented. No local recurrence was observed after curative resection of Stage I colorectal cancer. Of 399 patients, local recurrence occurred in 6 patients (Stage II, 2; Stage III, 4), and distant metastases were documented in 25 patients (Stage I, 3; Stage II, 3; Stage III, 19). The highest incidence of cancer-related death occurred after abdominoperineal resection (4.9 percent).

CONCLUSION

To assess the role of laparoscopic colorectal surgery for the cure of cancer objectively, prospective randomized trials are necessary.

[Laparoscopic gastric banding in morbid obesity]

Laparoscopic "Gastric Banding" is a modern, minimally invasive technique to induce significant weight loss in morbidly obese individuals. If performed according to the established principles of elective surgery, the procedure has to be classified as a serious offer to a specific group of patients, who have, as yet, been confronted with the option of futile conservative therapies or irreversible interventions in the gastrointestine. The technique comprises the laparoscopic placement of a silicone band below the cardia, connected to a port-system. By the hourglass-like segmentation of the stomach a "pouch" and an artificial "stoma" (outlet) is created, with the effect of decreasing food intake and--psychologically intended--inducing an early feeling of satiety. The complexity of the pathogenetic impulses leading to severe nutritional obesity requires a serious risk/benefit appreciation with multidisciplinary responder-analyse. Apart from the main indications like overweight, patient history and obesity-associated disorders it is indispensable to include the psychological status of the patient and his capability of compliance into the decision-finding. With the inflatable inner surface of the band connected to the access port, the system is designed to permit postoperative regulation of the therapeutic outcome by percutaneous stoma size adjustment without further surgery. The placement of the band as well as the specific anatomical conditions of extremely obese patients involve severe risks such as primary organ lesions, post-operative pouch dilatation or "slippage" by herniation of the gastric wall. Therefore the technical performance of the implantation demands a high level of experience and practical knowledge of abdominal laparoscopic procedures. It is to assume, that prospective validation to establish operation standards will have a critical look to the modification of the surgical procedure, the size of the implant, the pouch and the stoma.

[Laparoscopic hernia repair of recurrent hernias]

Successful treatment of recurrent inguinal hernias is still a problem, in spite of the availability of several different methods. We present our experience with laparoscopic TAP repair, which was performed in 154 patients with 168 recurrent inguinal hernias after traditional anterior repairs. Our results show an acceptable complication rate (5.4%, n = 9) and a low re-recurrence-rate (1.8%, n = 3), combined with the benefit of the minimal access technique, so that this procedure can be recommended in recurrent inguinal hernia repair.

[Technique of laparoscopic pancreatocysto-jejunostomy]

Usually the development of a pancreatic pseudocyst in the course of pancreatitis is followed by surgical intervention. In case of operation an internal drainage is preferred to an external according to general experience. We have developed a simplified technique of pancreatocysto-jejunostomy without Braun- or Roux-Y-anastomosis. Here we present our surgical strategy in the laparoscopic technique.

[Prevention of thromboembolism in minimal invasive interventions and brief inpatient treatment. Results of a multicenter, prospective, randomized, controlled study with a low molecular weight heparin]

A prospective, randomised, controlled clinical trial was carried out in order to elucidate the incidence of venous thromboembolism in selected patients undergoing laparoscopic cholecystectomy and other types of minimally invasive surgery, as well as to show safety and efficacy of a low-molecular-weight heparin (LMWH) in the prevention of post-operative venous thromboembolism. Seven hundred and eighteen patients were randomly allocated to one of two groups: One group received physical measures for prevention of deep-vein thrombosis, i.e. graduated elastic stockings (n = 359). The second group also received graduated elastic stockings and, additionally, a LMWH (reviparin sodium, Clivarin) s.c. once daily (n = 359). For safety reasons, with respect to the untreated control group, patients with three or more risk factors for venous thromboembolism were not included into the trial. Diagnosis for DVT was systematically done by duplex scan. In this, rather artificial low-risk selection the overall incidence of thromboembolic events was surprisingly low: five cases of suspected pulmonary embolism, confirmed by scintigraphy in one case only, and one patient with phlebographically confirmed calf vein thrombosis. The use of reviparin for prevention of venous thromboembolism was safe and convenient--the rate of post-operative bleeding complications was 2.3% in the LMWH group, even lower than in the control group (3.2%). The real incidence of venous thromboembolism in patients undergoing laparoscopic cholecystectomy remains unclear. Further trials with unselected patients are needed.

[Laparoscopy-assisted colorectal surgery. Early outcome in benign and malignant diseases--a prospective study of 120 patients]

We present our results with laparoscopic-assisted colorectal surgery in 120 patients during the time from January 1993 to September 1996. The types of procedures cover almost the whole spectrum of colorectal surgery. They included hemicolectomies, signmoid resections, low anterior resections, Hartmann closures, proctocolectomies and rectopexies. 127 patients were subjected to laparoscopic operation, 7 needed conversion to open surgery (7% conversion rate). Average operation time was 145 +/- 58 min, length of postoperative stay 12 +/- 4 days. Oral food intake was started at the second day postoperatively without major problems. We observed perioperative complications in 21 cases (17%). There were 5 anastomotic leaks, 4 wound infections, 1 pneumothorax and 2 postoperative bleedings, 4 patients had clinical signs of prolonged bowel paralysis, 2 patients died as a consequence of anastomotic leaks, 2 of other reasons. In the postoperative period we saw a marked faster recovery and a lower complication rate compared to our conventionally operated patients and postoperative pain was less. In cases of malignant disease no rise in rate of recurrence was observed during follow-up (average 18 months) compared to open surgery. Until the results of long-term studies are published laparoscopic procedures should still be restricted to early tumor stages and palliative procedures.

[Robot arm in laparoscopic surgery]

Currently laparoscopic surgery is limited by several factors. One of them is the precise handling of optics. Up to now, in our hospital 52 laparoscopic operations have been done with a voice-controlled robot arm to handle the optics in gallbladder, stomach, large bowel and hernia operations. The visual field is determined by the surgeon. In all cases handling of the robot arm was precise and the voice response exact and without technical problems. Twenty-nine operations were done by one operator as "solo surgeries". In 20 further cases there was one assistant. A robot arm can be used successfully without problems by any laparoscopic surgeon in any operating theater.

[Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation]

Given an indication for surgery in patients with chronic pancreatitis, such as distal common bile duct obstruction, duodenal stenosis, or dilated pancreatic duct with stones and congestion, the surgeon must decide the type of operation to perform. A duodenopancreatectomy, the Whipple procedure, is widely considered to be the gold standard. It is highly effective in relieving pain and eliminating the structural abnormalities noted above. Duodenum-preserving resection of the head of the pancreas (DPRHP) seems to be an attractive alternative to pancreaticoduodenectomy (PD) in the treatment of chronic pancreatitis. In a clinical prospective randomized trial the efficiency of both operative methods was investigated. Between 7/1987 and 12/1993 43 patients were randomly assigned to undergo either a Whipple procedure (n = 21) or DPRHP (n = 22). Data on postoperative course, mortality, and postoperative morbidity were compiled. As concerns long-term results, postoperative hormonal status (insulin, neurotensin, cholecystokinin, gastrin) was checked, basal and stimulated with a standardized meal, using standard hormonal assay kits. All patients with PD survived, whereas one with DPRHP died from peritonitis. Patients with DPRHP had a significant more rapid convalescence (16.5 vs. 21.7 days). The range for postoperative follow-up is from 36 months to 5.5 years. In the DPRHP group 18 patients are in good condition. Two had diabetes and one developed carcinoma. In the PD group one died from hepatic coma, 14 are in good condition and 6 developed diabetes. All gained body weight with an average of 6.4 vs. 4.9 kg, DPRHP vs. PD. A difference between DPRHP and PD was obvious for the postoperative hormonal status. Results are satisfactory in both groups. For patients with DPRHP however, we see a quicker convalescence and a significant benefit as concerns postoperative hormonal status.

[Laparoscopic pancreatocystojejunostomy without entero-entero-anastomosis]

The gradual enlargement of a persistent pancreatic pseudocyst generally requires intervention. When the decision to carry out an operative procedure is made, preference should be given to internal rather than external drainage. We have developed a simple technique in which the pseudocyst is approached directly, to make a pancreatico-cystojejunostomy, which does not require a Braun- or Roux-en-Y anastomosis. We present our laparoscopic method, which opens up new possibilities in the treatment of pancreatic pseudocysts.

[Prevention of thromboembolism in surgery--results of a survey in West German hospitals]

In 1990 a questionnaire on methods for prevention of deep venous thrombosis (DVT) and pulmonary embolism (LE) was mailed to 940 surgical centers in West Germany (FRG). The return rate was 60% or 564 answers, covering about 1,200,000 operations/year. The results are as follows: (1) Physical therapeutic measures (early mobilisation, elastic stockings) and drug administration are routinely used in all centers. The duration of prophylaxis is 3-8 days in 36% of centers, up to mobilisation in 31%, 9-16 days after operation in 17% and until demission in 16%. (2) A single drug regime is employed in 60% of centers (49% standard heparin, 9% low molecular heparin in combination with DHE) 40% of centers use all three drugs without clear cut guidelines concerning the indications. (3) The reported rates of thromboembolic complications diagnosed by clinical criteria are 0.55 +/- 0.62% for DVT and 0.22 +/- 0.29% for fatal or nonfatal LE. There is no evidence from the analysed data that the drug regimes influences the clinical outcome.

CONCLUSION

The need for administration of drugs prevent DVT is widely accepted. A polypragmatic approach seems to be effective. However, standardized regimes for defined clinical conditions are desirable.

Role of octreotide in the prevention of postoperative complications following pancreatic resection

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Liposarcoma of the esophagus

Presented here is a report on an unusual liposarcoma of the esophagus. A 66-year-old-woman was treated successfully by surgical excision without removal of the esophagus. Thirty months after surgery and radiation she presented with neither complaint nor recurrence.

[Effect of somatostatin on basal and stimulated exocrine pancreatic secretion after partial duodenopancreatectomy. A clinical experimental study]

In a prospective trial 30 patients underwent pancreaticoduodenectomy (Whipple operation) for cancer. They were randomly assigned to receive Somatostatin (SST) (n = 15) or not (n = 15). SST was started at laparotomy with 250 micrograms/h and given over a period of 5 days. A small catheter, which was placed into the duct of the pancreatic remnant, gave access to the pancreatic juice. Volume, amylase, lipase and protein as well as bicarbonate outputs were analyzed. As regards endocrine function, insulin and glucagon plasma levels were measured. The nitrogen balance was calculated. A stimulation test was done on the fifth postoperative day. Six patients (3/3) were assessed as drop-outs. A significant reduction was found for volume, amylase, lipase, protein and bicarbonate with SST, this effect lasting for two days. Lipase however was reduced significantly for 5 days. Pancreatic exocrine function was reduced as well after stimulation, if SST was given. Insulin and glucagon were inhibited with SST, the latter more effectively. We found a positive nitrogen-balance as early as on the second postoperative day in the SST-group, whereas without SST this did not occur before the fourth postoperative day. This findings were significant on the third and fourth postoperative day. The inhibitoric effects of SST, which are demonstrated by our laboratory investigations, conform very well with a more favorable clinical course and a reduction of perioperative morbidity and mortality.

Morphometry and function of islet cells after different forms of drainage at pancreatic transplantation in rats

The survival of endocrine cells of the islets is crucial for a successful transplantation of the pancreas in the treatment of diabetes mellitus. In the present investigation, we compared the effect of four techniques of whole pancreas transplantation in rats on the endocrine cells of islets of Langerhans. Impairment of the endocrine function of the pancreas with a decrease in the k value was seen after 6 months in the group with duct ligation, and after 12 months in the groups with latex and ethibloc occlusion. An open pancreatic duct maintains a more stable endocrine function than in duct-ligated or occluded grafts. Fasting plasma insulin and somatostatin were elevated in transplanted rats. Whichever method of transplantation we chose, the cell ratio remained unchanged compared with the control group, even after 12 months. Therefore, only intact islet architecture enables a normal endocrine pancreatic function.

[Subtotal adrenalectomy versus autotransplantation of the adrenal cortex--an alternative procedure in bilateral adrenalectomy in MEN II?]

Complete loss of steroid production is a very remarkable effect of total adrenalectomy. This is the reason why attempt was made to preserve some adrenal cortex function in cases with bilateral adrenalectomy. Till now successful autografting of adrenal cortex has been reported only in cases with Cushing's syndrome. We now report on two cases with MEN II syndrome, in whom autografting into the rectus muscle was done successfully. In order to compare results, data on two patients with subtotal adrenalectomy are given. Outcome was similar. In all 4 cases function of adrenal cortex was demonstrated by scintigraphy and by blood chemistry. In one case with autotransplantation and in another with subtotal resection, the remaining adrenal tissue showed response to ACTH. Provided more experience, in our opinion subtotal adrenalectomy and adrenal autotransplantation in cases of MEN II syndrome might turn out to prove as equivalent procedures.

Postischemic liver damage in rats: effect of some therapeutic interventions on survival rate

The aim of this paper is to elucidate the cause of death after 90 min of normothermic partial (2/3) ischemia of the liver and to examine the effects of glucagon, somatostatin, insulin, prednisolone and oral administration of polymyxin B (PB). The animals 24 hr after partial ischemia for 90 min were divided into two groups; namely, animals with normal appearance and those with moribund state. There were no significant differences in the plasma level of S-GOT, S-GPT, amino acids, NH3 or insulin, or in morphometrically estimated volume ratio of necrotic hepatocytes between the two groups of rats. The blood glucose level, however, was significantly decreased (31 +/- 28 mg/100 ml, n = 6) in the moribund rats with a higher incidence of positive Limulus gelation tests as compared with the rats with normal appearance (149 +/- 19, n = 5). The 1-day and 1-week survival rates of the animals were 42/62 (69%) and 32/61 (53%), respectively. A glucagon injection (1.5 mg/kg, after ischemia) was effective to elevate the 1-day survival rate (14/14), but failed to increase the 1-week survival rate (11/14). On the other hand, a somatostatin injection (100 micrograms/kg, after ischemia) or PB treatment (15 mg/kg/day x 5-9, before ischemia) succeeded to increase the 1-week survival rate (20/22 p less than 0.01 and 17/17 p less than 0.01, respectively), although no significant amelioration in transaminase levels or volume ratio of necrosis was demonstrated. It could be seen that a moribund state after partial ischemia was accompanied by severe hypoglycemic shock, and that the injection of somatostatin after ischemia or the annihilation of gram-negative bacteria by means of oral administration of polymyxin B before ischemia prevented the occurrence of the hypoglycemic shock.

Atropine depresses release of neurotensin and its effect on the exocrine pancreas

In this study the effect of 10 and 20 micrograms . kg-1 . h-1 atropine sulfate on release and pancreatic effects of neurotensin was studied in 4 dogs. Neurotensin plasma levels rose significantly when a liquid fat preparation was infused intraduodenally. This rise was almost completely abolished by simultaneous infusion of atropine. Atropine further suppressed basal and fat-stimulated output of pancreatic volume, protein, and bicarbonate; it also reduced pancreatic secretion stimulated by an intravenous infusion of low doses (2.5 to 20 pmol . kg-1 . min-1) neurotensin. The effect of higher doses (80 and 240 pmol . kg-1 . min-1 of neurotensin was less affected. As neurotensin plasma levels in contrast to normal oral feeding did not rise after sham feeding, our findings suggest that release and action of neurotensin may at least in part be dependent on a cholinergic, non-cephalic mechanism.

Effect of neurotensin on exocrine pancreatic secretion in dogs

The effects of various doses of synthetic neurotensin on exocrine pancreatic secretion were investigated in dogs prepared with pancreatic fistulae. Increasing doses of neurotensin infused intravenously caused a dose-dependent stimulation of exocrine pancreatic secretion. Plasma neurotensin levels determined with a radioimmunoassay kit for neurotensin were significantly correlated to the amount of neurotensin infused. Significant stimulation of exocrine pancreatic secretion was observed when 2.5 pmol kg-1 min-1 neurotensin were infused. This dose resulted in neurotensin plasma levels comparable to those observed after a meal. Combined infusions of neurotensin and the cholecystokinin analogue cerulein had synergistic effects on pancreatic bicarbonate output and raised the HCO-3:protein ratio. These observations suggest that neurotensin may play a role in the early phase of postprandial stimulation of exocrine pancreatic function.

[Tumors of the sacrococcygeal region (author's transl)]

In the world literature is reported about 584 tumors of the sacrococcygeal region, 484 of them are analysed exactly. The symptoms of the various tumors are about the same, pain and nerval irritation were seen in the most cases. Rectal-digital examination mostly leads to diagnosis. Computertomography is of special diagnostic value since some years. Because of the localisation of the tumor therapy often is difficult. Operation is the only way to remove the tumor and should be done so radically as possible. Radiation therapy may induce malignant degeneration. Adjuvant chemotherapy till now is without of any any effect. In the paper we report about the very seldom malignant meningeoma of the sacrum, in the literature we could not find any other case. Besides this and the 584 cases of the literature there is reported about 4 other own cases of sacrococcygeal tumors, one neurofibroma and three giant cell tumors of the Os sacrum.

[Giant cell tumors of the sacrum (author's transl)]

In connection with our observations of three patients with giant-cell tumors of the sacrum a description of this disease is given reviewing the 51 cases which have been published world-wide. As other tumors of the sacrococcygeal region the giant-cell tumor has no significant symptoms which would allow a differential diagnosis. Pain in the sacral region often radiating to both legs is the predominant symptom. Surgical intervention is the treatment of choice. To obtain a complete excision of the tumor with minimal damage to nervous structures the abdominal, sacral or abdomino-sacral route is recommended by several authors. The prognosis is dubious because a total removal is usually not feasable, and there is a high risk of recurrence and malignant degeneration.