Selective catheterization of hepatic, intestinal and adrenal veins with blood sampling for serotonin and catecholamine determination was evaluated regarding its use in the diagnosis, location and characterization of carcinoids and pheochromocytomas. Catheterization of intestinal veins via the transhepatic route and of the adrenal veins via the femoral and caval veins was performed in 49 patients without major complications. High pressure liquid chromatography with electrochemical detection was used to quantitate norepinephrine and epinephrine in plasma and serotonin in plasma and whole blood. Serotonin in plasma was also determined by an enzymatic procedure. In 30 patients with suspected or verified carcinoid tumors concentration of serotonin in tumor-draining veins was clearly elevated in all patients but one. In this patient, who previously had been treated with temporary liver dearterialization, the serotonin concentration in the hepatic vein was within the normal range in spite of the existence of liver metastases. Hyperserotoninemia was registered in one patient without detectable carcinoid tumor cells. In three patients determination of norepinephrine and epinephrine in adrenal venous blood diagnosed a hyperplasia and tumors in the adrenal medulla. In these cases angiography and computed tomography were negative. Microscopic analyses revealed serotonin in all carcinoids and substance P-like immunoreactivity in a large percentage of these tumors. PP-like and glucagon-like immunoreactivity were observed in two endocrine pancreatic tumors. In normal adrenal medulla and in adrenal medullary tumor tissue catecholamine fluorescence and enkephalin-like immunoreactivity were demonstrated. In the two pheochromocytomas ACTH-like, somatostatin-like and calcitonin-like immunoreactivities were identified. The technique with determinations of plasma serotonin and catecholamines in combination with selective catheterization is a useful investigation for the diagnosis, location and follow-up of patients with carcinoids and pheochromocytomas.

Adrenal Gland Neoplasms↗

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Halothane-induced intrahepatic portovenous shunting reduces hepatic microvascular sinusoidal perfusion during contrast angiographic procedures.

PURPOSE: Reduced intrahepatic perfusion that occurs during contrast angiography performed after administration of halothane anesthesia is thought to result from halothane-induced systemic hemodynamic alterations, such as reduced splanchnic blood flow, rather than intrahepatic microvascular alterations. The authors postulate that intrinsic hepatic effects caused by inhalational anesthetic agents rather than contrast materials, further reduce liver perfusion. MATERIALS AND METHODS: With use of dynamic video microscopy, intrahepatic microvascular flow rates and patterns, hepatic cord/sinusoidal diameters, portal venous pressure changes, and quantitative and qualitative Kupffer cell phagocytic activity were continuously recorded in isolated perfused rat livers before and during exposure to 1.5% halothane in O2/CO2, with and without the addition of iothalamate meglumine. RESULTS: Exposure of livers to halothane resulted in intrahepatic portovenous shunting secondary to obstruction to sinusoidal outflow, diminished sinusoidal perfusion, and a mean elevation in terminal portal venous pressure of 12.8 mm Hg. Kupffer cell phagocytic activity was reduced even when normalized for flow within sinusoids. None of these changes were attributed to use of contrast material. CONCLUSIONS: Alterations in hepatic blood flow during exposure to halothane result, in part, from increased intrinsic hepatic vascular resistance, sinusoidal outflow obstruction, and portovenous shunting, and not only from systemic hemodynamic changes. Iothalamate meglumine produced no microvascular alterations.

Anesthetics, Inhalation↗

PubMedDate not supplied

The effects of iodamide on the left ventricular function and on hemodynamics during angiocardiography: a comparison with metrizoate.

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Acetamides↗

PubMedDate not supplied

Embolization of the spleen for treatment of splenomegaly and hypersplenism in patients with portal hypertension.

Splenectomy in cases of hypersplenism involves significant risk of serious complications, including infection, hemorrhage, portal systemic thrombosis, and necrosis of the stomach or small bowel. Alternative procedures such as transcatheter embolization have been associated with a high frequency of splenic or subphrenic abscess, preventing clinical use. We used partial splenic embolization under careful antibiotic protection to successfully treat thrombocytopenia in 18 patients, most of whom had hypersplenism and splenomegaly secondary to portal hypertension. Of the 30 embolizations performed, the only serious complications encountered were abscess in two patients (who had almost total infarction) and four cases of splenic vein thrombosis. We investigated the possible effect of splenic embolization on portal venous pressure in three patients and found no pressure change.

Abscess↗

PubMedDate not supplied

Experimental hepatic artery embolization with Gelfoam powder. Microfil perfusion study of the rabbit liver.

After hepatic artery embolization with Gelfoam powder in five rabbits, two colors of Microfil (silicone rubber solution) were perfused into the aorta and the portal vein to study hepatic microcirculation under a dissection microscope. In three of the animals, many intrahepatic arterial branches and portions of the hepatic sinusoids were perfused with the arterial Microfil (orange color), whereas in the other two animals no orange Microfil was found in the liver. In the three animals, occlusions of the hepatic artery were random in distribution and often segmental, and arteries as small as 50 microns in diameter were involved. In the latter group, levels of arterial occlusion could not be evaluated. Microcollaterals developed through the capsular artery, peribiliary arterial plexus, and vasa vasora of the portal vein.

Animals↗