ABSTRACT
This study is to investigate the effects of phenytoin sodium, lidocaine (sodium channel blockers), propranolol (beta-adrenergic receptor antagonist), amiodarone (drugs prolonging the action potential duration) and verapamil (calcium channel blockers) on arrhythmia of mice induced by Bufonis Venenum (Chansu) and isolated mouse hearts lethal dose of Chansu. Arrhythmia of mice were induced by Chansu and then electrocardiograms (ECGs) were recorded. The changes of P-R interval, QRS complex, Q-T interval, T wave amplitude, heart rate (HR) were observed. Moreover, arrhythmia rate, survival rate and arrhythmia score were counted. Isolated mouse hearts were prefused, and the lethal dose of Chansu was recorded. Compared with control group, after pretreatment with phenytoin sodium, broadening of QRS complex and HR were inhibited, and the incidence of ventricular arrhythmia was reduced dramatically, while survival rate was improved; the isolated mouse hearts lethal dose of Chansu was increased significantly. After pretreatment with lidocaine, the prolongation of P-R interval and broadening of QRS complex were inhibited, and the incidences of ventricular arrhythmia were reduced dramatically, while survival rate was improved; the isolated mouse hearts lethal dose of Chansu was increased significantly. After pretreatment with propranolol, prolongation of P-R interval, broadening of QRS complex, prolongation of Q-T interval and HR were inhibited, and the incidences of both supraventricular and ventricular arrhythmias were reduced dramatically, while survival rate was improved. After pretreatment with amiodarone, HR was inhibited, the incidences of ventricular tachycardia were reduced dramatically. Lastly, after pretreatment with verapamil, the prolongation of P-R interval and Q-T interval were inhibited and the incidences of both supraventricular and ventricular arrhythmias were reduced dramatically; the isolated mouse hearts lethal dose of Chansu was reduced significantly. In in vivo experiments, phenytoin sodium was most effective against the mice arrhythmias induced by Chansu while cautious use of verapamil for Chansu inducing arrhythmia should be noted. It is also concluded that mice ventricular arrhythmias induced by Chansu might be most closely related to sodium channel, supraventricular arrhythmias might be related to beta-adrenergic receptor, and calcium channel plays an important role in conduction block. In in vitro experiments, phenytoin sodium was most effective, followed by lidocaine and propranolol, and amiodarone had no obvious effect and verapamil reduced the lethal dose of Chansu.
ABSTRACT
Objective To explore the diagnosis and surgical management experience of appendiceal carcinoid. Methods The clinical data of 32 patients with appendiceal carcinoid from 1978 to 1998 were retrospectively analyzed. Results 26 patients (26/32, 81 25%) manifested the sign and symptom of appendicitis, and 6 patients (6/32, 18 75%) with carcinoid were incidentally discovered. The tumors were less than 1cm in diameter in 25 patients, between 1 and 2 cm in 4 patients, and larger than 2 cm in 3 patients. Tumor invasion was confined to the appendix in 29 patients, involved in the mesoappendix in 2 patients, and one patient had local lymphonodus metastasis. Three carcinoid patients with tumor lymph-nodes metastasis in the mesoappendix underwent secondary right hemicolectomy, 2 patients underwent appendicocecostomy, and 27 patients underwent appendectomy. The follow-up was performed in 28 patients, and all patients remained free of tumor recurrence and metastasis. Conclusion Appendiceal carcinoid was rare, and most of the patients manifested the sign and symptom of appendicitis. Appendiceal carcinoid of less than 1 cm diameter could be adequately managed by appendectomy alone. Appendiceal carcinoid in basis of the appendix could be adequately managed by appendicocecostomy. The treatment approach for tumors of 1 to 2 cm in diameter was still controversial. The right hemicolectomy should be performed in the patients with larger than 2 cm in diameter tumors.