Glucagon-induced changes in plasma thyroid hormone concentrations in healthy dogs resemble "euthyroid sick syndrome".

We recently demonstrated that glucagon infusion induced a decline in T3 and a rise in rT3 in anesthetized dogs. These changes in T3 and rT3 may be attributed, at least in part, to anesthesia itself, since general anesthesia is known to cause lowering of T3 and an elevation in rT3 during the perioperative period. Therefore, to eliminate the contribution, if any, of anesthesia to these changes in T3 and rT3, we assessed plasma glucose, T3 resin uptake (T3RU), T4, free T4, T3 and rT3 concentrations following intravenous glucagon (0.5 mg) or normal saline (0.5 ml) administration at frequent intervals for 3 h in 6 conscious dogs fasted for 16 h. No significant alterations were noted in T4, free T4, and T3RU levels during either study. However, glucagon infusion alone induced a significant fall in T3 (0.33 +/- 0.06 in nmol/l vs -0.03 +/- 0.03 nmol/l with normal saline; p less than 0.01) and marked elevations in glucose (3.66 +/- 0.22 mmol/l vs 0.61 +/- 0.11 nmol/l with normal saline, p less than 0.001) and rT3 concentrations (0.11 +/- 0.02 nmol/l vs 0.005 nmol/l; p less than 0.001). Furthermore, the integrated responses of T3 and rT3 as assessed by cumulative changes and areas under the curves were markedly greater during glucagon infusion when compared with saline administration (p less than 0.01 for all comparisons). Since the elevations in levels of stress hormones known to ensue during anesthesia do not occur during a conscious resting state, we believe that hyperglucagonemia may be a major contributor of thyroid hormone alterations observed in several euthyroid sick states, not associated with stress, and may enhance these changes during euthyroid sick syndrome associated with stressful crises. Finally, these changes may be attributed to altered metabolism of iodothyronines in peripheral tissues as reflected by lowered T3/T4 and increased rT3/T4 ratios.

Necrotizing fasciitis.

Early recognition of necrotizing fasciitis is the key to successful treatment. However, initial presentation of this disease is variable. In this case report, the first clinical evidence was a gram stain of the deep surface of the superficial fascia.

Barium peritonitis.

Perforation of the gastrointestinal tract during the course of barium contrast examination represents a lethal circumstance if untreated. The reported mortality of barium peritonitis in collected series is approximately 50 per cent. The authors' personal experiences with seven cases of barium peritonitis are presented for review and analysis. Aggressive fluid resuscitation, broad-spectrum antibiotics, early operative intervention, and lavage are important factors in increasing patient survival. Depending upon the operative findings, appropriate surgical procedures may include closure, resection, or exteriorization of the site of perforation. Adequate nutritional support must be maintained. Selected cases may require or permit only supportive, nonoperative therapy. Following these principles of management, survival was achieved in six of the authors' seven patients. Of paramount concern in any discussion of this entity is its prevention. Predisposing procedures and conditions are detailed. Careful attention to the particulars of the technical features of barium contrast studies may obviate some occurrences. Barium enemas through a colostomy require particular care. The use of a water-soluble contrast medium, rather than barium, may be appropriate in certain clinical settings.

Vagotomy and drainage procedure for duodenal ulcer: The results of seventeen years' experience.

During the 10 years prior to January, 1968, 455 duodenal ulcer patients were operated upon at the University of Florida affiliated hospitals. The early results were reported in 1969. The present study is a followup of the same patients now 7 to 17 years after vagotomy and drainage. Twenty-four per cent were lost to followup. The ulcer recurrence rate was 5.8 per cent. All the recurrent ulcers that were not gastric in location (4.9%) occurred within 5 years after the original operative procedure with a mean of 2.6 years. The gastric ulcers (0.9%) occurred at a much later date with a mean of 6 years. It is concluded that vagotomy and gastric drainage is a satisfactory modality of therapy for duodenal ulcer. It can be accomplished with an acceptable morbidity and mortality and the long-term recurrence rate is low. If recurrences due to incomplete vagotomy do not occur within 5 years, they are unlikely to recur.

Serum gastrin and secretin levels after the Exalto-Mann-Williamson procedure.

The Exalto-Mann-Williamson procedure produces peptic ulceration in nearly 100% of experimental animals but the mechanism is unknown. To investigate the possible hormonal role of the gastric acid hypersecretion seen after this procedure, we investigated preoperative and postoperative serum gastrin and secretin concentrations. There was no significant change in serum gastrin; however, serum secretin concentrations increased to 2 1/2 times the preoperatve value, most likely secondary to the enhanced secretion of gastric acid. These data do not suppport the theory that alterations in circulating secretin or gastrin levels are responsible for the gastric acid hypersecretion following the Exalto-Mann-Williamson operation.

Immediate oophorectomy and adrenalectomy in the treatment of stage III breast carcinoma. A ten year follow-up study.

One hundred twenty-two patients with state III breast carcinoma had radical mastectomy with or without adjunctive radiation therapy, chemotherapy, or steroids. Thirteen randomly selected persons in the group had immediate bilateral oophoroadrenalectomy. Survival ranged from 10 to 147 months (median, 68.0) with seven of thirteen patients (53.8 per cent) alive five years and three of thirteen (23.0 per cent) alive ten year or longer. No statistical difference in survival or disease-free intervals with respect to menopausal status was observed in the nine patients of this group who died. One hundred and nine patients treated by conventional therapy without endocrine ablation had shorter five year (37.6 per cent) and ten year (15.6 per cent) survival intervals. The difference in survival intervals was statistically significant at p smaller than 0.01. This study suggests that immediate endocrine ablation may prolong survival in patients with stage III breast carcinoma.

The effect of vagal stimulation on gastrin release and acid secretion.

Canines with vagally innervated fundic pouches and chronic esophageal fistulas were subjected to sham feeding experiments during which pouch acid output and peripheral serum gastrin levels were measured. These dogs then underwent construction of vagally innervated antral pouches. The sham feeding experiments were repeated after recovery. Preoperatively sham feeding provoked a substantial increase in acid output accompanied by a small serum gastrin increase which did not achieve statistical significance. After creation of the innervated antral pouches, sham feeding evoked an acid secretory response similar to control values. Serum gastrins, however, increased nearly 500 percent in response to sham feeding. Our data support the concept that direct vagal stimulation of the parietal cell mass is the major mechanism by which sham feeding increased acid secretion.