STUDY OBJECTIVE: To determine the effect of intravenous administration of prostaglandin E1 (PGE1) in inducing controlled hypotension during general anesthesia. DESIGN: Randomized, prospective study. SETTING: Inpatient surgery at a university hospital. PATIENTS: 57 ASA physical status I and II patients scheduled for total hip replacement. INTERVENTIONS: In 29 patients undergoing total hip replacement, PGE1 (0.11 +/- 0.03 micrograms/kg/min) was infused to induce hypotension during general anesthesia with enflurane, isoflurane, or sevoflurane in nitrous oxide and oxygen. In another 28 patients, the control group, normotensive anesthesia was performed for the same procedure. MEASUREMENTS AND MAIN RESULTS: Systolic blood pressure decreased significantly (p < 0.01) from 136 +/- 22 mmHg to 93 +/- 10 mmHg during PGE1 infusion, although heart rate did not change significantly. Arterial hemoglobin oxygen saturation showed a mild but significant decrease (p < 0.05) during PGE1 infusion. Blood loss (480 +/- 132 ml) and blood transfusion (280 +/- 260 ml) during surgery were significantly less in patients with hypotensive anesthesia (p < 0.01 and p < 0.05, respectively) than in patients with normotensive anesthesia (667 +/- 326 ml and 468 +/- 395 ml, respectively). Blood loss and blood transfusion after surgery were similar in both groups. In the recovery room or surgical ward, 3 of 29 patients with hypotensive anesthesia needed rapid blood transfusion because of moderate hypotension. The volume of urine during surgery was significantly less (p < 0.05) in the control group. Two patients developed mild phlebitis at the site of the PGE1 infusion, but there were no serious side effects. CONCLUSION: These data suggest that PGE1 can be used safely to induce hypotension, thereby reducing blood loss during total hip replacement with general anesthesia.

Alprostadil↗

PubMedDate not supplied

Fibroblast growth-stimulating activity in bronchoalveolar lavage fluid of patients with pulmonary sarcoidosis.

Increased fibroblast growth-stimulating activity (FGA) was found in bronchoalveolar lavage fluid (BALF) from sarcoidosis patients. For evaluation of the significance of FGA in disease activity and the pathophysiology of sarcoidosis, the FGA levels were compared with data on cellular analysis of BALF, serum angiotensin-converting enzyme (S-ACE) activity and chest radiograms. The FGA level was significantly higher in sarcoidosis patients with parenchymal involvement (radiological stages II and III) than in those without parenchymal involvement (radiological stage I). The FGA was positively correlated with albumin and fibronectin concentrations in BALF. However, it was not significantly correlated with the ratio of CD-4 + to CD-8 + T-lymphocytes in BALF or the S-ACE level, which are known to be useful in evaluating the disease activity of sarcoidosis. These results indicate that the diagnostic value of FGA is different from that of the lymphocyte subpopulations in BALF and S-ACE, and is useful in estimating the extent of parenchymal involvement in sarcoidosis.

Adult↗

PubMedDate not supplied

Metastatic pancreas cancer from the thyroid; clinical imaging mimicking non functioning islet cell tumor.

A case of pancreatic metastasis from thyroid cancer resected seven years previously is presented. Pancreatic metastases of thyroid cancer are rare. The radiological features of the tumor are described and the diagnostic implications of pancreatic metastases are discussed.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

Intraoperative ultrasonic imaging of coronary artery and saphenous vein grafts in coronary bypass surgery.

The intraoperative evaluation of native coronary atherosclerotic lesions and the anastomotic status of saphenous vein grafts were made using two-dimensional echography. Ultrasonic imaging was performed with a linear cross-sectional ultrasonograph and a high-frequency wide-brand microtransducer. In animal experiments, the lumens of the left main trunk and other major branches of coronary arteries of mongrel dogs were clearly visualized; the stenotic portion created by external constriction of the left anterior descending artery was also recognized in this manner. In the clinical application, 30 patients who required coronary artery this manner. In the clinical application, 30 patients who required coronary artery bypass grafting were examined during surgery. Intraluminal status of the left main trunk and proximal to mid portion of the other major coronary arteries were visualized satisfactorily. Stenotic portions detected by preoperative coronary cine-angiography were recognized. It was concluded that intraoperative echo coronary arteriography provides adequate information on the target coronary artery before the incision is made and that evaluation of anastomotic status is possible.

Animals↗