The patterns of endocrine response to surgical stress during different types of anesthesia and surgery in man.

The authors studied 123 patients undergoing minor (varicectomy) or major (cholecystectomy) surgery under diethyl ether, halothane, enflurane or hydroxydione anesthesia. The goal was to investigate the effects of emotional tension, anesthesia and surgical trauma, as well as glucose load, on the patterns of endocrine response under standardized clinical settings. The endocrine response (growth hormone, cortisol, insulin) was not modified significantly by emotional stress and the anesthetics used.

In vitro study of hormone degradation by heart-lung machine with bubble oxygenator.

In the present experiment with heart-lung machine set in a closed system in vitro, the blood containing increased levels of hormones was circulated at 30 degrees C for 90 min and at 37 degrees C for 30 min; a fraction of the priming perfusate was studied in parallel at the same temperatures in an incubator. The level of growth hormone decreased gradually to a mean of 76% at 30 degrees C and no further decrease was found at 37 degrees C. The mean insulin level fell within 30 min to 32% and no substantial further changes were observed during the remaining period of study; re-warming failed to produce significant additional changes.

The effects of open heart surgery on growth hormone, cortisol and insulin levels in man. Hormone levels during open heart surgery.

Plasma growth hormone, cortisol, insulin and blood glucose concentrations were measured intra- and postoperatively in ten patients who underwent open heart surgery with moderate hypothermia. Diazepam-ketamine anaesthesia for 10-20 min failed to precipitate any significant alterations in the levels of measured hormones and blood glucose. In the pre-bypass period of surgery, an increase in cortisol and a slight elevation in growth hormone levels was observed; insulin level showed no change in spite of marked hyperglycaemia.

Surgical, infectious and thromboembolic complications of central venous catheterization.

The authors have analysed the incidence of specific complications in a series of 420 intracaval catheters placed in 388 patients, using six transcutaneous puncture techniques: supraclavicular and infraclavicular subclavian, external and internal jugular, antecubital and brachiocephalic approaches. Strict and moderate criteria were used to evaluate the frequency of complications. Using strict criteria, the lowest rate of surgical complications (5%) was found with the antecubital and external jugular approach, followed by infraclavicular (6.

Venepuncture, catheterization and failure to position correctly during central venous cannulation.

The authors analyse the incidence of puncture, catheterization and failures of positioning in a series of 420 central venous catheterizations performed in 388 patients, using six transcutaneous approaches: supraclavicular and infraclavicular subclavian, external and internal transjugular, antecubital and brachiocephalic. Puncture failures were recorded at 7.9% per 36 failures from 456 attempts, catheterization failures at 5.

Alpha-adrenergic control of growth hormone release during surgical stress in man.

The mechanisms involved in the initial release of growth hormone (GH) during cholecystectomy have been studied after the administration of phentolamine in saline and in isotonic glucose, and after the administration of 10% glucose. Infusion of these substances was started 10 min before and terminated 30 min after skin incision. The serum GH levels 30 min after skin incision in a nontreated control group were raised to 14.

Inadvertent thoracic duct catheterization during transjugular central venous cannulation. A case report.

An aberrant placement of a central venous catheter into the upper part of the thoracic duct with loop formation in the left innominate vein was observed on catheterizing via the left internal jugular vein. The misplacement, which did not have any deleterious effects, was caused by the atypical insertion site of the thoracic duct at the dorsocaudal wall of the left innominate vein and, possibly, by its incompetent closing valve. The stiffness of the nylon catheter used may also have been a contributory factor.

Misplacement and loop formation of central venous catheters.

Exact placement is an essential prerequisite for long-term use of a central venous catheter. Reported data show an extremely wide range of catheteral misplacements: from less than 1% to more than 60%. Some approaches appear to be less advantageous than others, but the highest rates of misplacement occur in the cubital, external jugular and saphenous veins.

Transient psychological syndrome following diazepam therapy for tetanus.

Two cases of transitory reversible pathopsychological changes associated with diazepam therapy in tetanus are described. The psychopathology developed owing to an abrupt discontinuance of diazepam or to a sudden reduction of its dosage. The reinstitution of diazepam in low doses and the administration of regulators of cerebral metabolism resulted in a progressive normalization of the psychological state.

Respiratory failure as a seizure phenomenon. A case report.

Recurrent acute respiratory failure in an epileptic subject is described. The first episode of respiratory failure occurred while the patient was having frequent epileptic fits and was probably secondary to cerebral oedema with temporal herniation. The second occurred suddenly after 27 days during which the patient had been free from seizures.