RESUMEN
PURPOSE: High-energy gamma probes have recently become commercially available, developed for (18)F-FDG probe-guided surgery. The radiation received by the staff in the operating room might limit the use of it, but has never been determined. We therefore wanted to measure the absorbed staff doses at operations where patients had received a preoperative injection of (18)F-FDG. METHODS: Thirty-four patients with different cancers (breast cancer, melanoma, gastrointestinal cancers, respectively) were operated. At every operation the surgeon was monitored with a TLD tablet on his finger of the operating hand and a TLD tablet on the abdomen. The surgeon and anaesthesiologist were also monitored using electronic dosimeters placed in the trousers lining at 25 operations. RESULTS: The dose rate to the surgeon's abdominal wall varied between 7.5-13.2 microSv/h, depending on tumour location. The doses to the anaesthesiologists and the finger doses to the surgeon were much lower. About 350-400 MBq, i.e. ca. eight times higher activities than those used in the present study are supposed to be necessary for guiding surgery. It can be calculated from the body doses measured that a surgeon can perform between 150-260 h of surgery without exceeding permissible limits for professional workers. CONCLUSIONS: The radiation load to the operating staff will generally be so small that it does not present any limitation for FDG-guided surgery. However, it is recommended to monitor the surgical staff considering that the surgeon may be exposed to other radiation sources, and since the staff often includes women of child-bearing age.
Asunto(s)
Fluorodesoxiglucosa F18/análisis , Personal de Salud/estadística & datos numéricos , Exposición Profesional/estadística & datos numéricos , Monitoreo de Radiación/métodos , Servicio de Cirugía en Hospital/estadística & datos numéricos , Cirugía Asistida por Computador/estadística & datos numéricos , Adulto , Anciano , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiofármacos/análisisRESUMEN
The antral hormone gastrin is synthesized by processing progastrin into different peptides that stimulate gastric secretion. The effect on acid secretion depends mainly on the metabolic clearance rate of the peptides, but some of them may differ in potency and maximum acid output at similar concentrations in plasma. Sulfated and nonsulfated gastrin-6 are the smallest circulating bioactive gastrins in humans. Their effect and metabolism have now been investigated in nine normal subjects and compared with nonsulfated gastrin-17, a main product of progastrin. Maximum acid output after stimulation with gastrin-17, sulfated gastrin-6, and nonsulfated gastrin-6 were 28.3 +/- 2.0, 24.5 +/- 2.0 (P < 0.02), and 19.3 +/- 2. 3 (P < 0.05) mmol H(+)/50 min, respectively, and the corresponding EC(50) values were 43 +/- 6, 24 +/- 2 (P < 0.01), and 25 +/- 2 (not significant) pmol/l. The half-life of gastrin-17 was 5.3 +/- 0.3 min, the metabolic clearance rate (MCR) was 16.5 +/- 1.3 ml. kg(-1). min(-1), and the apparent volume of distribution (V(d)) was 124.3 +/- 9.6 ml/kg. The half-lives of sulfated and nonsulfated gastrin-6 were 2.1 +/- 0.3 and 1.9 +/- 0.3 min, the MCRs were 42.8 +/- 3.7 and 139.4 +/- 9.6 ml kg(-1) min(-1) (P < 0.01), and the V(d) were 139.0 +/- 30.5 and 392.0 +/- 81.6 (P < 0.01) ml kg(-1). All pharmacokinetic parameters differed significantly from gastrin-17 (P < 0.01). We conclude that gastrin 6 has a higher potency but a lower efficacy than gastrin-17. The efficacy of gastrin-6 is increased by tyrosine O-sulfation, which also enhances the protection against elimination.
Asunto(s)
Ácido Gástrico/metabolismo , Gastrinas/farmacocinética , Fragmentos de Péptidos/farmacocinética , Sulfatos/farmacocinética , Adulto , Cromatografía en Gel , Femenino , Mucosa Gástrica/metabolismo , Gastrinas/sangre , Humanos , Masculino , Fragmentos de Péptidos/sangre , Antro Pilórico/metabolismo , Sulfatos/sangreRESUMEN
Renal handling of postprandial and intravenously administered gastrin was investigated in anaesthetised pigs. The fractional extraction of postprandial carboxyamidated and glycine-extended gastrin in the kidneys was 0.21 +/- 0.01 and 0.16 +/- 0.02, but the respective urinary clearance comprised only 0.57 +/- 0.03 and 0.44 +/- 0.05% of the GFR (P < 0.02). The respective total body clearance of carboxyamidated and glycine-extended gastrin-17 (gastrin-17 and gastrin-17Gly) during continuous infusion was 22.9 +/- 1.5 and 19.6 +/- 1.4 mL kg-1 min-1 (NS), and the renal fractional extraction of the peptides was 0.31 +/- 0.03 and 0.29 +/- 0.05, respectively. The kidneys accounted for 8% of total body clearance of gastrin-17. Renal filtration rate of gastrin-17 exceeded renal extraction rate (9.739 +/- 0.487 vs. 6.407 +/- 0.321 pmol min-1). Urinary clearance of gastrin-17 and gastrin-17Gly amounted only 0.91 +/- 0.16 and 0.13 +/- 0.03%, respectively, of the GFR (P < 0.01), but urinary excretion rate correlated with the filtered amount of the peptides (r = 0.93, P < 0.01). Neither was a renal plasma threshold recorded nor was a Tm value for tubular uptake or degradation of gastrin achieved in spite of supraphysiological plasma levels of the peptides. The results indicate that filtered gastrin is almost completely removed in the renal tubules, primary by metabolism although part of the absorbed peptides may be returned to the circulation in intact form. The process for uptake or metabolism has a high capacity but varies with the molecular form of gastrin.
Asunto(s)
Gastrinas/orina , Hormonas/orina , Túbulos Renales/metabolismo , Animales , Transporte Biológico , Cromatografía en Gel , Gastrinas/administración & dosificación , Tasa de Filtración Glomerular , Hormonas/administración & dosificación , Túbulos Renales/efectos de los fármacos , Radioinmunoensayo , PorcinosRESUMEN
OBJECTIVE: To assess the accuracy of frequency-volume charts recorded by patients with voiding symptoms by comparing self-reported voiding data with the volumes of urine collected in same period. PATIENTS AND METHODS: The study comprised 18 patients (median age 63 years, range 20-80) and lasted 3 days, during which the patients recorded their fluid intake and voided volumes, and collected 24 h urine samples. RESULTS: The recorded volumes exceeded or underestimated the collected volume in 49% and 51%, respectively, of the samples, but the agreement between the accumulated daily voiding volumes on the charts and the volumes collected was acceptable. The median difference between volumes recorded on the charts and collected as samples was 100 (0-1450) mL per 24 h or 10 (0-117) mL per voiding (not significant). The median daily variation of creatinine in the urine was 1.1 (0.1-9.4) mmol (not significant), indicating that the 24 h collection periods were respected. CONCLUSION: Recordings on frequency-volume charts are valid and useful in the investigation of patients with voiding symptoms.
Asunto(s)
Registros Médicos/normas , Trastornos Urinarios/fisiopatología , Micción/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Recolección de Datos/métodos , Ingestión de Líquidos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Participación del Paciente , Presión , Sensibilidad y Especificidad , Trastornos Urinarios/diagnóstico , OrinaRESUMEN
In anaesthetized pigs, clearances of 51Cr-EDTA (EDTA) and endogenous creatinine were compared with renal clearance of inulin measured during constant infusion after bolus injection. Creatinine was determined by enzymatic (Kodak Ektachem) as well as conventional (Jaffé) methods. In saline-loaded pigs, renal clearance of constantly infused EDTA was 97.0 +/- 6.7 mL min-1 and identical to the clearance of inulin (94.1 +/- 9.1 mL min-1). There was good agreement between individual clearances. The extraction fractions of the two markers were indistinguishable (0.26 +/- 0.02 and 0.28 +/- 0.03, respectively). In other experiments the clearance of EDTA calculated from the first 4 h of the time course of the plasma concentration after single injection was 64.4 +/- 3.7 mL min-1, correlating well with inulin clearance (63.0 +/- 1.2 mL min-1). When calculated only from the monoexponential phase of the disappearance curve ('slope clearance'), significantly higher results were obtained (+33%, P < 0.001). Renal clearance of EDTA after single injection was 7.5 +/- 1.5 mL min-1 (approximately 12%) lower than inulin clearance (P < 0.001). Values of creatinine clearances determined by the two analytical methods showed a poor agreement with inulin clearance. It is concluded that, in pigs, glomerular filtration rate may be estimated by the clearance of EDTA using constant infusion or single injection of EDTA and that the renal clearance of endogenous creatinine is a less useful a measure of GFR.
Asunto(s)
Quelantes , Creatinina/metabolismo , Ácido Edético , Pruebas de Función Renal/métodos , Animales , Quelantes/farmacocinética , Radioisótopos de Cromo , Creatinina/sangre , Creatinina/orina , Ácido Edético/farmacocinética , Femenino , Tasa de Filtración Glomerular/fisiología , PorcinosRESUMEN
BACKGROUND: The physiologic role of the colon as an endocrine organ is not clear. We therefore studied the enteroinsular axis in patients with ulcerative colitis after colectomy. METHODS: The subjects included 11 patients with a conventional ileostomy, 10 patients with an ileoanal reservoir, and 10 normal controls. The concentrations of glucose, insulin, gastric inhibitory peptide (GIP), and glucagon-like peptide-I (GLP-I) were measured in plasma during an oral glucose test. RESULTS: The peak level of glucose and peak levels and area under the curve (AUC) of insulin and GIP were higher in patients (P < 0.05). Neither the peak level nor the AUC of GLP-I differed between patients and controls, but time to peak level was four times longer in patients with an ileoanal reservoir (P < 0.05). CONCLUSION: Colectomy seems to affect the enteroinsular axis, leading to hyperinsulinemia and an impaired glucose tolerance. Moreover, patients with an ileoanal reservoir have a slower GLP-I response after intake of glucose.
Asunto(s)
Colectomía , Polipéptido Inhibidor Gástrico/metabolismo , Glucagón/metabolismo , Insulina/metabolismo , Mucosa Intestinal/metabolismo , Fragmentos de Péptidos/metabolismo , Precursores de Proteínas/metabolismo , Adulto , Glucemia/metabolismo , Colitis Ulcerosa/cirugía , Femenino , Polipéptido Inhibidor Gástrico/sangre , Glucagón/sangre , Péptido 1 Similar al Glucagón , Prueba de Tolerancia a la Glucosa , Humanos , Ileostomía , Insulina/sangre , Secreción de Insulina , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/sangre , Proctocolectomía Restauradora , Precursores de Proteínas/sangreRESUMEN
Glycine-extracted gastrins are the immediate precursors of the bioactive carboxyamidated gastrins. The effect on gastric acid secretion and the pharmacokinetics of glycine-extended gastrin-17 were studied in 8 normal subjects. The elimination in plasma after bolus injection was biexponential, the half-lives being 4.1 +/- 0.2 and 21.8 +/- 0.9 min, and clearance and apparent volume of distribution being 7.9 +/- 0.6 ml/kg/min and 69.5 +/- 2.7 ml/kg, respectively. Infusion of the peptide at three consecutive dose rates did not stimulate gastric acid secretion, although plasma concentrations reached supraphysiological levels. Nor did glycine-extended gastrin-17 influence submaximal acid secretion induced by amidated gastrin-17. In contrast to amidated gastrins, the concentration of glycine-extended gastrins in peripheral venous plasma did not increase significantly after a meal. The postprandial rise in amidated gastrin was unaffected by concomitant infusion of glycine-extended gastrin-17. A reduction in glycine-extended gastrin-17 concentrations in plasma during constant-rate infusion of the peptide was observed after a protein meal (p < 0.05). This reduction was reflected by an increase in glycine-extended gastrin-17 is without immediate effect on gastric output in man. The postprandial increase in clearance might be due to increased splanchnic blood flow with subsequently increased peptide elimination.
Asunto(s)
Ácido Gástrico/metabolismo , Mucosa Gástrica/metabolismo , Gastrinas/farmacocinética , Adulto , Cromatografía en Gel , Femenino , Humanos , Infusiones Intravenosas , MasculinoRESUMEN
A rare case of a tubular breast adenoma in a 13-year-old pregnant girl is presented. The tumor which developed during pregnancy measured 10 x 8 x 4 cm, was well demarcated and could be totally removed.
Asunto(s)
Adenoma , Neoplasias de la Mama , Complicaciones Neoplásicas del Embarazo , Adenoma/patología , Adolescente , Neoplasias de la Mama/patología , Femenino , Humanos , Embarazo , Complicaciones Neoplásicas del Embarazo/patologíaRESUMEN
Eight patients presented parathyroid cancer between 1963 and 1990. There were seven women and one man with a median age of 55.5 years (range 34-81). At admission the median serum calcium concentration was 3.75 mmol/l (range 3.0-5.0), and four patients presented with a hypercalcaemic crisis. Six patients had a pathological bone resorption and five had reduced kidney function or urinary stones. All cases were treated by en bloc resection of the tumour and affected adjacent structures. One patient with a local lymph node metastasis died after seven months, and one in whom it was impossible to remove the tumour died after 14 months. Two patients had recurrences three and nine years after the operation, respectively. The first was treated with mithramycin, but died 33 months later, the other was reoperated on and was still normocalcaemic 2-9 years after diagnosis.
Asunto(s)
Neoplasias de las Paratiroides/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/patología , PronósticoRESUMEN
In order to investigate hepatic clearance of vasoactive intestinal polypeptide we measured its concentration in blood from the common carotid artery, right atrium and portal vein during orthotopic liver transplantation in six pigs. Just after laparotomy we found a significantly higher concentration of vasoactive intestinal polypeptide in portal plasma compared to that of the right atrium (p less than 0.05). This difference was soon eliminated by a fall in portal concentration, and, apart from fluctuations in portal concentration, no significant gradient between portal and atrial blood was recorded during the remaining part of the operation. When portal concentrations exceeded 30 pmol/l, the median reduction after transhepatic passage was 29% (range 16.8%-63.9%), while portal concentrations less than 30 pmol/l had a median reduction of only 6.3% (range 1.4%-16.5%) (p less than 0.05). No gradient between right atrial and systemic arterial blood was recorded. We suggest that a concentration-dependent clearance of splanchnic vasoactive intestinal polypeptide takes place in the porcine liver.
Asunto(s)
Trasplante de Hígado/fisiología , Hígado/metabolismo , Péptido Intestinal Vasoactivo/metabolismo , Animales , Arterias Carótidas/química , Atrios Cardíacos/química , Vena Porta/química , PorcinosRESUMEN
Microscopic hematuria is a well-known finding in several patients with acute appendicitis. We present a case of long-standing, painless gross hematuria as the only symptoms of an appendicular abscess.
Asunto(s)
Absceso/diagnóstico , Apendicitis/diagnóstico , Hematuria/etiología , Perforación Intestinal/diagnóstico , Absceso/complicaciones , Absceso/patología , Adulto , Apendicitis/complicaciones , Apendicitis/patología , Diagnóstico Diferencial , Humanos , Perforación Intestinal/complicaciones , Perforación Intestinal/patología , Masculino , Rotura Espontánea , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria , UrografíaRESUMEN
The results of completion angiography after acute thromboembolectomy with a Fogarty balloon catheter were evaluated. There were 62 patients (median age 72 years, range 44-92 years) and completion angiograms were made in 44 of them (71%). Incomplete runoff was demonstrated in 26 patients (59%) and rethromboembolectomy or vascular reconstruction was made in 18 cases (41%) under the same anaesthesia, while additional vascular surgery was technically impossible in 8 patients (18%). Supplementary surgery resulted in radiological improvement in 56% of operated cases. Reocclusion rate after 6 months was 50% in patients without patent tibials compared to 15% in patients with two or three patent tibial arteries (P less than 0.05). Eighteen patients had no completion angiograms after thromboembolectomy and 5 (28%) required early reoperation due to ischaemia. Completion angiograms are advocated in all cases of acute thromboembolectomy before the patient leaves the operating table.
Asunto(s)
Angiografía , Tromboembolia/cirugía , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Periodo Intraoperatorio , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Pronóstico , Reoperación , Tromboembolia/diagnóstico por imagenRESUMEN
The diagnostic reliability of currently accepted gross pathologic signs in patients with ulcerative colitis and Crohn's disease of the large intestine was evaluated. Of 198 patients who had colectomy or proctocolectomy because of inflammatory bowel disease, 52% had ulcerative colitis and 37% had Crohn's disease, 11% were indeterminable according to histologic evaluation of the surgical specimens. Cobblestone mucosa was most common in Crohn's disease (P less than 0.001) and pseudopolyposis in ulcerative colitis (P less than 0.01), but there was considerable overlap. Strictures and skip lesions occurred in both diseases with a similar incidence. It is concluded that the differential diagnosis between ulcerative colitis and Crohn's disease of the large intestine should not be made from macroscopic examination of the resected specimens.
Asunto(s)
Colitis Ulcerosa/patología , Colon/patología , Enfermedad de Crohn/patología , Diagnóstico Diferencial , Femenino , Humanos , Mucosa Intestinal/patología , MasculinoRESUMEN
Six cases of psoas abscess complicating Crohn's disease are presented. The most common manifestations were weight loss, pain, fever and a palpable mass in the flank or iliac fossa. CT-scan confirmed the diagnosis. The treatment of choice in this condition is either laparotomy with drainage and primary resection of affected bowel or initial ultrasound-guided percutaneous drainage followed by early resection of the affected bowel.
Asunto(s)
Absceso/etiología , Enfermedad de Crohn/complicaciones , Miositis/etiología , Absceso/diagnóstico , Absceso/cirugía , Adulto , Bacteroides fragilis/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Humanos , Persona de Mediana Edad , Miositis/diagnóstico , Miositis/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Output from gastrointestinal fistulae to the skin was measured in five patients during total parenteral nutrition and restricted oral intake. Supplemental infusion of somatostatin during six days caused a significant reduction in discharge in all patients compared to the pretreatment level, but none of the fistulae closed as a result of the treatment. Somatostatin may be considered an adjuvant drug to parenteral nutrition and restricted oral intake in the conservative treatment of external fistulae from the gastrointestinal tract.
Asunto(s)
Fístula/tratamiento farmacológico , Fístula Intestinal/tratamiento farmacológico , Enfermedades de la Piel/tratamiento farmacológico , Somatostatina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Duodenales/tratamiento farmacológico , Enfermedades Duodenales/terapia , Fístula/terapia , Humanos , Fístula Intestinal/terapia , Enfermedades del Yeyuno/tratamiento farmacológico , Enfermedades del Yeyuno/terapia , Persona de Mediana Edad , Fístula Pancreática/tratamiento farmacológico , Fístula Pancreática/terapia , Nutrición Parenteral Total , Enfermedades de la Piel/terapiaRESUMEN
A retrospective study is presented of 297 patients operated upon for perforated benign gastric ulcer in Denmark from 1975 to 1984. Male:female ratio was 0.9:1, mean age 64.2 years. The numbers of gastric and prepyloric perforations were almost equal (156:141), but gastric perforations were more frequent in elderly women and prepyloric perforations in younger men. Simple closure was performed in 83 per cent of the patients, gastric resection in 14 per cent and simple closure and vagotomy in 3 per cent. The postoperative mortality rate was 21 per cent and was related to the high proportion of elderly patients with concurrent diseases and delayed treatment.
Asunto(s)
Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica Perforada/mortalidad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Estómago/cirugía , Úlcera Gástrica/mortalidad , Úlcera Gástrica/cirugía , VagotomíaRESUMEN
Sixteen patients were treated for gastrocolic fistula arising as a complication of peptic ulcer (11 cases), colonic perforation (2), gastric cancer (1), colonic cancer (1) or pancreatitis (1). The predominant symptoms were diarrhoea, weight loss and abdominal pain. Barium meal and barium enema were the most reliable means of diagnosis, and no fistula was gastroscopically demonstrable. A one-stage en bloc resection of the involved gastrocolic region was performed in eight cases. Other operations were simple excision (3), gastric resection with closure of the colonic wall (2) and colectomy with closure of the gastric wall (2). In one case cure was achieved with cimetidine, without surgical intervention. Four patients died postoperatively and two had recurrence of fistula.
Asunto(s)
Enfermedades del Colon/cirugía , Fístula Gástrica/cirugía , Fístula Intestinal/cirugía , Adulto , Anciano , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/etiología , Femenino , Fístula Gástrica/diagnóstico , Fístula Gástrica/etiología , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiología , Masculino , Persona de Mediana EdadRESUMEN
A 40-year-old woman with Crohn's disease had a cutaneous fistula discharging only during menstruation. Surgical exploration showed a tubocutaneous fistula. Such fistula is extremely rare without prior surgery of the reproductive organs. Discharge during menstruation was the salient feature in most reported tubocutaneous fistulas. Resection of the fistula and salpingectomy is the treatment of choice.