Antibiotics change contractility of guinea pig aorta and trachea to histamine after a short exposure to LPS.
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Animals↗
Biomedical subjects
B Stinner
Publications and source records attributed to B Stinner.
[The value of double contrast colon imaging in inadequate colposcopic diagnosis].
PURPOSE: Prospective evaluation of colon double-contrast enemas in patients with incomplete colonoscopy during routine examination. MATERIALS AND METHODS: From 1. February 1993 through 31. January 1994 we prospectively evaluated all patients undergoing a double-contrast barium enema following incomplete colonoscopy in the endoscopy unit of the Department of Surgery of the University Hospital Marburg. The examination was carried out using the typical double-contrast technique at least 24 h after colonoscopy. The results of the barium enema were correlated with the findings at colonoscopy with regard to completion of the diagnostic procedure and additional pathological findings. RESULTS: Of 448 colonoscopies 168 remained incomplete. Sixty patients underwent an additional double-contrast study of the colon. In 43 patients this study was sufficient to complete the diagnostic procedure. Unknown pathological diagnoses were found in 11 patients. In 2 patients an adenocarcinoma and in 9 patients polypoid lesions were detected. CONCLUSION: After incomplete colonoscopy a double-contrast barium enema should be performed to complete the diagnostic examination of the whole colon and to reveal unknown additional pathological findings.
Adenocarcinoma↗
Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia. Trial Group Mainz/Marburg.
Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were studied during a standardised induction of anaesthesia and preoperative loading of the circulation with either Ringer solution or Haemaccel-35, with or without antihistamine prophylaxis with dimetindene (H1) plus cimetidine (H2). Cardiorespiratory disturbances were graded as detectable, clinically relevant, or life-threatening from observers' records of the anaesthesia and the actions taken by the anaesthetists. Disturbances that were accompanied by significant rises in plasma histamine were further designated histamine-related, and those that were not were designated histamine-unrelated. Anaesthetists, observers, and designators were blinded to whether or not the patients had received antihistamines and to which solution was used for circulatory volume loading. Clinically relevant or life-threatening histamine-related disturbances occurred in 8% of the patients who after induction of anaesthesia received Ringer without antihistamines, in 26% of those who received Haemaccel without antihistamines, and in 2% or less of those who received antihistamines (p < or = 0.0001). There were 4 life-threatening histamine-related disturbances, all in patients who received Haemaccel without antihistamines (p < 0.01). Histamine-unrelated disturbances occurred in 16% overall, with no obvious effect of Haemaccel or antihistamines. The histamine-related disturbances under anaesthesia were remarkable for their severity (even with small rises in histamine concentrations), for the prevalence of bradycardia, and for the absence of skin signs. Their likelihood and severity were increased in patients with tumours. The results of the trial make a case for routine prophylaxis with antihistamines as part of anaesthetic management.
Adolescent↗
Perioperative nonspecific histamine release: a new classification by aetiological mechanisms and evaluation of their clinical relevance.
As a consequence of the performance of a randomized controlled clinical trial on perioperative histamine release and cardiovascular and respiratory disturbances, several types of increases in plasma histamine had to be distinguished instead of only two which existed at the beginning of the study: drug-induced allergic and pseudoallergic reactions. First of all, the new classification by aetiology (clinical epidemiology) was derived from a meta-analysis (secondary analysis) of the most recent literature. According to that histamine release in the perioperative period has several, different causes and is involved in several, different disease manifestations. A clear distinction (classification), however, is necessary if histamine release as an unwanted (adverse) effect has to be recognized, value judged according to its clinical relevance and therefore also prevented by histamine antagonists. Histamine release by neuro-endocrine and neuro-inflammatory mechanisms, cytotoxic histamine release and local, cytokine induced histamine release have been distinguished from pseudoallergic histamine release, but its functions are not yet clear. It has been analysed in prospective trials which used special clinical situations as models: patients on a normal ward or before and during upper GI endoscopy without premedication, but also in specific phases of laparoscopic cholecystectomy (trocar phase and dissection phase). Their existence in the clinical reality is now very likely, but new trials must investigate the pathophysiological effects such as in metabolism, coagulation, pulmonary haemodynamics (shunt volume) and gastric acid secretion. Histamine release by pseudoallergic mechanisms, however, was identified in the very vulnerable post-induction phase of anaesthesia up to skin incision. Its incidence was much higher than ever expected and its clinical relevance was demonstrated by the severity of reactions and the intervention strategies of the anaesthetists who were blinded concerning the type of the plasma substitute given and the prophylaxis with antihistamines. Pseudoallergic histamine release was clearly unwanted (adverse). Its occurrence in the other phases of anaesthesia has to be further evaluated in the tedious procedure of data analysis of the Mainz-Marburg-trial. The overall incidence of histamine release in the trial was so incredible high (72% of all patients, some of them with up to 4 episodes of histamine release) that a distinction between pseudoallergic (unwanted) and other types of histamine release (possibly less unwanted or even beneficial) is urgently needed. In the phase of steady state (maintenance) of anaesthesia the H1-(+)H2-prophylaxis was highly effective. Further analysis must show whether this is also the case during the phases of induction of anesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
[The initial results of the implantation of self-expanding nitinol stents into the esophagus in malignant dysphagia].
Nine patients (mean age 64, range 51-83 years), with dysphagia due to incurable malignant obstruction of the esophagus were treated by the introduction of 10 self-expanding metal endoprostheses (Nitinol stents). All cases were technically and functionally successful. In one patient the stent did not expand completely; it had to be removed and a second introduced. There were no other complications from the stent implantation. During the period of observation of 136 +/- 86 days one stent (11%) was reobstructed by tumor growing into the stent. Two patients died after 60 and 119 days, both with open stents. Early experience with the Nitinol stent indicates that good palliation of malignant dysphagia can be achieved with a much lower complication rate than results from tube implantation. The design and application system of the stent is capable of further improvement.
Aged↗
[Consequences of routine gastroscopy before cholecystectomy].
In a retrospective study of 610 patients the role of routine gastroscopy prior to cholecystectomy was investigated. The results demonstrated that only in a low incidence (11% of patients gastroscopied) relevant findings are present. However, most of these patients had a typical history. Therefore, despite risks, routine preoperative endoscopy prior to cholecystectomy should be performed only in patients with a history of upper abdominal pain or discomfort.
Adolescent↗
[Palliative endoscopic surgical measures in esophageal carcinoma. Indications, technical requirements and results].
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Carcinoma↗
Controlled clinical trials and cross-sectional studies with plasma histamine measurements and histamine receptor antagonists: solving the problem of preoperative H1- + H2-prophylaxis by asking new questions?
The problem of a preoperative histamine H1- + H2 - prophylaxis was tackled by a group of new studies including randomized controlled clinical trials and cross-sectional studies with plasma histamine measurements and administration of H1- + H2 - antagonists to a control group. The first study demonstrated serial histamine release in the induction of anaesthesia up to 4 times in a single patient. Basal plasma histamine levels in resting subjects fell below 100 pg/ml during the time necessary for preparation of the surgical patient. Hence, spikes of elevated plasma histamine concentrations corresponded to histamine release. Although this histamine release very often was less than 1 ng/ml plasma histamine, it created systemic reactions after atracurium. The cut-off point of 1 ng/ml for such anaphylactoid reactions does no longer exist, also lower plasma levels are of patho-physiological significance. The clinical signs of histamine release in the induction of anaesthesia vary from drug to drug. Sometimes tachycardia and hypertension produce the highest likelihood ratio, sometimes tachy- and bradycardia, but no changes in blood pressure as in the case of atracurium. It is concluded that the reasons why histamine release in anaesthesia and surgery is so much underreported and under-estimated include the present paradigms about plasma histamine levels and the "classical picture" of histamine release. Both are no longer valid and need a re-assessment.
Adolescent↗
[Making a surgical decision: indications conference].
One of the most important parts of a surgeon's education is learning to develop an adequate system of indications for a surgical procedure. In medical structures with a "one department--one boss system" the indication conference lends itself well to this. The day prior to surgery all information on the particular patient are presented and there is an analysis of risk and benefit of the planned procedure and a discussion on the type of procedure. Prerequisites are the presentation of all relevant information and clarity in the decision-making process including an open discussion on the basis of objective facts.
Diagnosis↗
[Stress ulcer or pneumonia: effect of prevention with H2 blockers on gastric juice pH].
In a study with 30 consecutive ventilated patients in a surgical ICU, the course of gastric pH was measured for 24 h. Cimetidine, 1.2 g per 24 h, was given to prevent stress bleeding. In the course of the evaluation period complete alkalization was found in only 4/30 patients (high responders); 10/30 patients showed no alkalization of gastric juice to above pH 4; and in 16/30 patients irregular pH changes were observed. These results suggest that the risk of developing pneumonia under this regimen will only be elevated in the high responder group. Although the alkalization of gastric juice was incomplete in our group, we saw no evidence of upper gastrointestinal bleeding. There is evidence that alkalization is not the only mechanism involved in successful prevention of bleeding.
Adult↗
Endocrine pancreatic carcinoma.
Endocrine carcinomas of the pancreas are rare, but they should be treated aggressively because they threaten the patient's life by both malignant growth and hormone excess. Resection for cure should be attempted, but is hardly ever possible. Debulking should be performed primarily in hormone-active tumours so that symptoms can be controlled by subsequent medical treatment; this can be directed against tumour growth and/or hormone production, and it can reduce stomach acid secretion in the gastrinoma syndrome. Surgery should be undertaken whenever possible since the patient's life can be considerably prolonged in most cases. Palliative surgery can reduce the patient's symptoms that may be caused by excessive hormone production and/or obstruction of the bile duct or the duodenum.
Adenoma, Islet Cell↗
The cardioplegic solution HTK: effects on membrane potential, intracellular K+ and Na+ activities in sheep cardiac Purkinje fibres.
The effects of the cardioplegic solution HTK on membrane potential (EM) and intracellular K and Na activities (aiK, aiNa) were studied in sheep cardiac Purkinje fibres by means of conventional and ion-selective microelectrodes. HTK contains (mM): Na 15, K 10, Ca 0, Mg 4, histidine 180. (1) In control conditions EM was -74.3 +/- 3.3 mV (n = 25), aiK was 116.4 +/- 4.1 mM (n = 7) and aiNa was 8.2 +/- 1.4 mM (n = 15). (2) Exposure to HTK led to a depolarization to -59.7 +/- 3.6 mV (n = 25) which exceeded by about 5-7 mV that induced in a Tyrode solution of 10 mM K and in a modified HTK solution supplemented by 2 mM Ca (n = 6). (3) Addition of 0.5 mM barium eliminated the difference in the steady-state depolarization. (4) HTK superfusion increased aiK to 120.1 +/- 4.4 mM (n = 7) and decreased aiNa to 3.9 +/- 0.9 mM (n = 15). (5) The decrease in aiNa was insensitive to amiloride (1 mM) and to external alkalization but was slightly increased by addition of 2 mM calcium. (6) When the calcium in Tyrode solution was lowered from 2.0 mM to 0.05 mM, aiNa hardly decreased during subsequent exposure to unmodified HTK and it increased in the presence of 0.1 mM dihydroouabain. We propose the hypothesis (1) that the difference in membrane depolarization between HTK and a 10 mM K-Tyrode is caused by a decrease in K conductance by the HTK solution and (2) that the aiNa decline mainly results from a coupled Ca influx via Na-Ca exchange due to a delayed washout of external calcium.
Animals↗
[Intraluminal leiomyoma of the trachea].
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Adolescent↗
[Maternal lipoproteins post partum. Qualitative and quantitative studies of the effect of lactation].
Quantitative and qualitative examinations of serum lipoproteins separated by use of discontinuous ultracentrifugation were performed in 17 lactating and 13 non-lactating healthy women 5 days and 5 weeks after delivery. In general a normalisation of the lipid parameters, which are increased during gestation, was observed during this period. Within 5 weeks after delivery all single parameters were in levels of normal non-pregnant women. A significant effect of lactation on the decrease of pregnancy-induced hyperlipoproteinemia after delivery could not be detected.
Adult↗
[Current aspects of a new staging classification of pancreatic cancer and its clinical consequences].
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Humans↗
Intracellular pH, Na+- and K+-activities at the onset of St. Thomas' cardioplegia: a study with ionselective microelectrodes.
Cellular edema and cardiac arrhythmias are often closely related to intracellular ionic alterations and, moreover, are an actual problem of clinical cardioplegia and ischemia of the heart. In order to investigate whether the clinically widely used cardioplegic solution of the St. Thomas' Hospital may predispose for these complications, membrane potential (EM), intracellular pH (pHi), and intracellular sodium and potassium activity (aiNa- and aiK) in sheep heart Purkinje fibres were directly measured by means of neutral-carrier ion-selective microelectrodes during equilibration of the fibres' extracellular space with the cardioplegic solution. The experimental temperature was 35 degrees C throughout. During control conditions under superfusion of a HEPES-buffered Tyrode solution EM was -74.4 +/- 5.1 mV (n = 39), pHi was 7.18 +/- 0.05 (n = 16), and aiNa and aiK were 7.6 +/- 1.4 mmol/l (n = 15) and 118.9 +/- 4.6 mmol/l (n = 15) respectively. Superfusing the Purkinje strand for 10 minutes with the cardioplegic St. Thomas' solution led to a depolarization to -57.3 +/- 4.7 mV (n = 21), a slight aiNa decrease to 6.7 +/- 1.6 mmol/l (n = 15; p less than 0.01; cardioplegic solution without procaine) and an increase of aiK to 127.1 +/- 4.4 mmol/l (n = 6; p less than 0.01). pHi needed 15 minutes to reach a steady state value of 7.25 +/- 0.05 (n = 9). The alterations on post-cardioplegic reperfusion with Tyrode solution were reversible within 15 minutes. Simulation of the clinical situation of ice-cold application of the solution by inhibiting the cellular Na/K pump via 0.1 mmol/l dihydroouabaine added to the St. Thomas' solution resulted in a marked increase of aiNa to 10.7 +/- 1.5 mmol/l (n = 6; p less than 0.01; no procaine) during cardioplegic superfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Acid-Base Equilibrium↗
Successful allotransplantation of microencapsulated parathyroids in rats.
Allotransplantation of parathyroid tissue in humans is desirable for treating long-term hypoparathyroidism (e.g., after inadvertent removal of parathyroid glands during thyroid surgery). Until now, parathyroid allotransplantation was not used clinically because its advantages were outweighted by the need of immunosuppression. To overcome the immunogenicity of the tissue to be transplanted, we employed the method of microencapsulation; first tried in islet cell transplantation for experimental allotransplantation of parathyroid tissue. We have been able to achieve long-term success in a rat model. After isolation and tissue culture, tissue pieces from parathyroid glands of 280 Lewis rats were encapsulated in barium alginate and grafted into hypocalcemic DA rats. From the 7th to the 90th day after transplantation the recipient rats (DA rats) showed a normal serum calcium concentration. This is the first report of successful long-term survival and function of microencapsulated allotransplanted parathyroid tissue.
Animals↗
Intracellular sodium activity and Bretschneider's cardioplegia: continuous measurement by ion-selective microelectrodes at initial equilibration.
Intracellular sodium activity (aiNa), intracellular pH (pHi) and membrane potential were directly and continuously measured in sheep cardiac Purkinje fibers using neutral carrier liquid membrane ion-selective microelectrodes. Changing the superfusing medium from normal Tyrode's solution to the cardioplegic solution "HTK" according to Bretschneider (6) a depolarization from -73.7 +/- 7.2 mV to -55.0 +/- 9.5 mV (n = 25), a decrease of aiNa from 9.1 +/- 1.9 mM to 4.0 +/- 1.4 mM (n = 25) and an intracellular acidification from pHi 7.18 +/- 0.06 to pHi 7.01 +/- 0.06 (n = 11, mean +/- S.D.) occurred at 35 degrees C. The decrease of intracellular sodium activity was not effected by replacement of K, Mg, or histidine by mannitol in the cardioplegic solution. Addition of 4 mM Ca somewhat enhanced aiNa decline. Inhibition of the sodium pump with the cardiac steroid dihydroouabain (10(-4) M) lowered the effect of "HTK" on intracellular sodium by approximately 35% (n = 5). Sodium decline was also sensitive to equilibration temperature, giving a Q10 of 1.54 for the initial decrease velocity (temperature range 20 to 35 degrees C), which is less than that found by other investigators for pure sodium pump activity. It is suggested that although the electrochemical sodium gradient remains inward throughout, sodium may leave myocardial cells on induction of Bretschneider's cardioplegia because of a reduction of inward fluxes by simultaneously increasing sodium pump activity, thus increasing Na efflux. Na/Ca exchange is assumed to be of minor importance and the Na/H exchange may be involved. With respect to the clinical application of the low Na and nominally Ca-free cardioplegic solution "HTK" lowering of intracellular sodium activity is interpreted as a factor minimizing the risk of a "calcium paradox" on reperfusion with Ca at serum levels, as well as a possible mechanism preventing early development of cellular edema.
Animals↗