Parallel changes of atrial natriuretic factor and catecholamines during surgery for pheochromocytoma.
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Biomedical subjects
Publications and source records attributed to E Collard.
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This study reports a double-blind evaluation of a new formulation of lormetazepam for sublingual administration, given as a premedicant in 48 female patients undergoing minor gynecological procedures. Both patient's and nurse's assessments for anxiety and sedation were recorded at different times. Anxiolysis and sedation were present 30 minutes after administration of the drug as reported by the patient with a peak effect at 45 minutes. Nurses reported significant differences in sedation only, but already present at 30 minutes after premedication. The memory test showed no persistent effect of the benzodiazepine one day after surgery.
During recovery, our patient presented an acute upper airway occlusion. After the removal of the airway obstruction, he developed a massive bilateral pulmonary edema with an acute hypoxemia. Hemodynamic measures following this incident show that mean and wedged pulmonary pressures are in the normal ranges. Several cases, associating acute upper airway obstruction, massive bilateral pulmonary edema and low or normal filling pressures, have been reported in literature. Three mechanisms have been postulated to explain this phenomenon; a dramatic increase of the negativity of the interstitial pulmonary pressure, a significative augmentation of the after-load and the hypoxic pulmonary reflex vasoconstriction.
A 59-year-old woman, after complete recovery from an episode of drug-induced agranulocytosis, was found to sustain a chronic absence of recognizable mature and immature eosinophils in blood and bone marrow during a follow-up period of 8 years. Her bone marrow and peripheral blood cells cultured in vitro were able to produce normal numbers of eosinophil colonies. The present disorder was thus not caused by a lack of EO-CFU-C, nor by a defect in EO-CSA, nor by an immunologically mediated mechanism acting on mature or immature eosinophils or on EO-CSA producing cells. It is suggested that the marrow was not able to differentiate normally along the eosinophil pathway, possibly owing to a microenvironmental defect or, less likely, an intrinsic stem cell defect.
The fractional production rate of CLL lymphocytes, certainly in the peripheral blood and possibly in the lymph nodes, is often lower than normal. On the other hand, the absolute production in CLL blood and in lymph nodes seems to be considerably increased in most cases. Arguments for an increased lymphocyte life span in CLL, although fragmentary and dispersed, exist. The blood CLL lymphocytes, as normal lymphocytes, exchange rapidly with an extravascular pool of lymphocytes. However, recirculation of lymphocytes--from blood to blood via the lymph node and the thoracic duct--does not proceed normally in CLL. Whether this is related to the B nature of the CLL lymphocyte, to the leukaemic nature of the CLL lymphocyte or to mechanical factors--crowding of the extravascular pool--is still debatable.
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We studied changes of atrial natriuretic factor (ANF) and catecholamines in three patients with pheochromocytoma occurring in the familial syndrome of multiple endocrine neoplasia type IIa. Previous studies have suggested a stimulating effect of catecholamines on ANF release. In pheochromocytoma, we observed normal basal ANF levels despite increased catecholamine secretion. In contrast, a rise in plasma ANF was observed when a hypertensive paroxysm occurred. Also during surgery, dissection of pheochromocytoma led to a rise in plasma ANF and catecholamines associated with an increase in blood pressure (in the 3 cases) and in pulmonary artery pressure (in 2 cases). We concluded that chronic elevation of basal catecholamines are without effect on plasma ANF but that manipulation of pheochromocytoma leads to a stimulation of ANF release, possibly mediated by either a direct effect of endogenously released catecholamines and/or an increase in atrial pressure.
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