Correlations of serum potassium fluctuations with body temperature after major surgery.

We have observed an association between hypothermia and hypokalemia in a number of postoperative patients. In order to analyze the incidence and consequences of this correlation, 108 patients undergoing major operations were prospectively studied. Rectal temperature, serum and urinary potassium, arterial blood gases, blood glucose, and routine monitoring were analyzed.

Human medullary thyroid carcinoma in tissue culture; secretion of calcitonin and carcinoembryonic antigen.

Monolayer cultures of medullary thyroid carcinoma (MTC) cells were prepared from 5 patients with familial and 4 with sporadic MTC. Basal calcitonin (CT) release decreased rapidly during 17 days in culture. Addition of extra calcium (2 mmol/l) or dibutyryl cyclic AMP (dBcAMP, 3 mmol/l) increased CT release in all investigated cultures (p less than 0.

Total parenteral nutrition in critically ill surgical patients: fixed vs tailored caloric replacement.

In critically ill patients accurate measurement of total energy expenditure (TEE) is possible by means of continuous indirect calorimetry. Since in many ICUs the necessary equipment is not available, the Harris-Benedict formula (HB) is frequently used to calculate TEE. Supplemental application of a clinical correction factor (HBc) has been advised.

Differential effects of the imidazole derivatives etomidate, ketoconazole and miconazole and of metyrapone on the secretion of cortisol and its precursors by human adrenocortical cells.

The direct effects of etomidate, ketoconazole, miconazole and metyrapone were investigated on the secretion of cortisol and its precursors by dispersed cells from the adrenal cortex of a normal individual and four patients with Cushing's syndrome. The drugs interfered with adrenocorticotropic hormone-stimulated cortisol secretion in a dose-dependent way. Desoxycortisol concentrations in the medium were increased after the addition of metyrapone and low doses of etomidate but were suppressed with higher doses of etomidate.

Calculation versus measurement of total energy expenditure.

In acutely ill patients both hypo- and hyperalimentation must be avoided by adjusting caloric intake to total energy expenditure (TEE). We determined the discrepancy between basal energy expenditure (BEE) calculated from the basic Harris-Benedict formula and TEE measured by continuous indirect calorimetry in a heterogeneous group of mechanically ventilated surgical patients. We also compared the accuracy of TEE calculated from the corrected Harris-Benedict formula or estimated by intermittent indirect calorimetry to that of TEE measured by continuous indirect calorimetry.

Secretion of adrenocorticotropin, beta-endorphin and calcitonin by cultured medullary thyroid carcinoma cells. Effects of synthetic corticotropin-releasing factor and lysine vasopressin.

The present study was performed to investigate the potential of human medullary thyroid carcinoma (MTC) cells to secrete ACTH, beta-LPH/beta-EP. In addition, these studies might shed further light on the possible synthesis of a common precursor molecule for calcitonin (CT), ACTH and beta-LPH/beta-EP. MTC tissue was obtained from 10 patients (6 familial, 4 sporadic) without clinical and biochemical signs of Cushing's syndrome.

A nonelemental versus an elemental diet for early postoperative enteral feeding by needle catheter jejunostomy.

In a prospective randomised study the use of an elemental versus a nonelemental diet for early postoperative enteral feeding by needle catheter jejunostomy was investigated. After extensive gastrointestinal surgery, 25 patients received an elemental and 24 patients a nonelemental diet. The incidence of diarrhoea, the effects of the feeding and the costs were evaluated.

Unexpected hypopotassemia after multiple blood transfusions during an operation.

A series of 226 patients undergoing major surgery was studied to asses the influence of the volume of transfused donor blood on the postoperative serum potassium level. Patients with a low serum potassium and with impaired renal function preoperatively and patients receiving medication capable of reducing the total body potassium were excluded from the study. Laboratory studies included complete blood count, electrolyte value measurements, serum creatinine, BUN, glucose, acid-base balance as well as urinalysis.

Artifacts in the assessment of metabolic gas exchange.

In mechanically ventilated patients metabolic gas exchange recordings are frequently influenced by routine patient therapy. In this study the influence of such artifacts is investigated and a method for automatic detection and suppression proposed. This method reduced the influence of artifacts on diurnal oxygen and carbon dioxide exchange from up to 10% to a maximum of 1%.

A comparison of the effects of two somatostatin analogues in a patient with an external pancreatic fistula.

In a 30-year-old man, a total external pancreatic fistula developed after enucleation of an insulinoma of the head of the gland. The output of the fistula was reduced to some extent by total parenteral nutrition. Much greater reductions of volume were noted during short-term administration of two somatostatin preparations, SMS 201-995 and Somatofalk, for 1 week consecutively.

Intragastric prostaglandin E2 and the prevention of gastrointestinal hemorrhage in ICU patients.

The effects of intragastric prostaglandin E2 (PGE2) on the occurrence of acute GI hemorrhage in intensive care patients were investigated in a prospective, double-blind, placebo-controlled study. Ninety patients with two or more risk factors (major surgery, multiple trauma, respiratory insufficiency, renal insufficiency, jaundice, hypotension, peritonitis, sepsis) were randomized for treatment with either PGE2 (0.5 mg) or placebo, administered every 4 h via a nasogastric tube.

The influence of preoperative jaundice, biliary drainage and age on postoperative morbidity and mortality after pancreatoduodenectomy and total pancreatectomy.

Details are given of the postoperative course of 56 patients after pancreatoduodenectomy, and 11 after total pancreatectomy. The main indication was adenocarcinoma (56 cases). The most serious complication was leakage from the pancreatojejunostomy, which occurred in nine patients and was fatal in seven of these (10%).

Optimal hemotherapy in elective surgery.

The transfusion incidence and the crossmatch/transfusion ratio are expected to provide objective guidelines for hemotherapy in elective surgery. For those surgical procedures which rarely require hemotherapy an ABO Rh-D typing and an antibody screening test without a crossmatch were recommended as preoperative tests. For surgical procedures with a moderate to high transfusion incidence it is suggested that the number of units to be crossmatched preoperatively should be equal to the average number of units transfused for that procedure in the past.

Elective cricothyroidotomy.

Cricothyroidotomies instead of tracheostomies were performed in 61 adult patients over a period of two years. The indications were as for tracheostomy. The majority of the patients had severe trauma, respiratory problems and sepsis.

Design and validation of an automatic metabolic monitor.

A self-calibrating fully automatic instrument for the measurement of oxygen consumption, carbon dioxide production and the respiratory quotient of mechanically ventilated patients has been developed. The instrument is based on commercially available conventional oxygen and carbon dioxide gas analysers and a domestic natural gas volumetric flow meter. The distribution of the different gas flows, i.

Clinical judgment versus delayed hypersensitivity skin testing for the prediction of postoperative sepsis and mortality.

In 59 patients operated upon for malignant disease of the gastrointestinal tract, skin testing with recall antigens was compared with assessments based upon clinical judgment alone for prediction of risk of postoperative septic complications. Clinical judgment alone could identify patients with a significantly increased risk for postoperative sepsis and mortality. Prediction based upon clinical judgment is superior to prediction based upon delayed hypersensitivity skin testing.

A close correlation between the amount of met-enkephalin-immunoreactivity and epinephrine in adrenal pheochromocytoma tissue from patients with Sipple's syndrome.

The concentration of epinephrine, norepinephrine, dopamine, met-enkephalin-, ACTH-, calcitonin- and somatostatin-like immunoreactivity (IR) were determined in the extracts of 9 adrenal pheochromocytomas from 7 patients. Six of these patients had Sipple's syndrome. There was a close correlation between the amounts of met-enkephalin-IR and of epinephrine present in the tumor tissue (p less than 0.

Different sensitivity to adrenocorticotropin of dispersed adrenocortical cells from patients with Cushing's disease with macronodular and diffuse adrenal hyperplasia.

A patient with Cushing's syndrome and low plasma ACTH levels had a unilateral adrenal mass (diameter, 3 cm), which proved to consist of adenomatous hyperplasia. Dispersed adrenocortical cells prepared from this mass responded to ACTH with a maximal increment in cortisol release of more than 400%. Five months after operation Cushing's syndrome recurred.

Primary hyperparathyroidism and pancreatitis.

Frequently a causal relationship between hyperparathyroidism (HPT) and pancreatitis has been defended. Bess et al. queried the existence of any causality.

Results of adrenalectomy with various surgical approaches in the treatment of different diseases of the adrenal glands.

In a retrospective study, the impact of the various possible approaches for adrenalectomy were analyzed in 90 patients undergoing 120 adrenalectomies in one or two operations. The posterior approach proved to be the best tolerated procedure as expressed by the shortest operation time (less than 60 minutes) and the lowest blood loss (less than 100 milliliter). The number of opiate injections required was the lowest with this operation and the ambulation earliest (on the first postoperative day).