ABSTRACT
Hypersecretion following villous adenomatosis of the rectum is demonstrated by two single case studies. Both patients exhibited a secretory diarrhea with a 2.000-2.500 and 1.000 ml daily stool volume respectively, resulting in severe and life-threatening (first patient) loss of water and electrolytes. With increasing stool volume, rising concentrations of Na and Cl were observed in the stool and approached plasma levels. Consecutively the potassium concentration decreased to values between 15 and 23.4 mmol/l in the first severe case and to 28 and 31 mmol/l in the patient with the lowest stool volume. Elevated PG-E2 concentrations in the fluid moiety of the stool (up to 13.3 ng/ml and 0.98 ng/ml respectively) as well as the response to treatment with Indomethacin support the idea of a PG-E2 induced pathological loss of water and electrolytes. While 100 mg Indomethacin/day led to cessation of symptoms in the less severe case, even 400 mg Indomethacin/day were not able to reduce the massive rectal water loss in the first most severe patient to less than 1,000 ml/day. Surgical removal of villous adenoma showing hypersecretory activity is the only promising therapy. In case of inoperability, denial of surgical intervention or just for palliative treatment prior to surgery we recommend the inhibition of PG-synthesis with Indomethacin.
Subject(s)
Adenoma, Villous/complications , Diarrhea/etiology , Rectal Neoplasms/complications , Water-Electrolyte Imbalance/etiology , Adenoma, Villous/therapy , Aged , Aged, 80 and over , Combined Modality Therapy , Diarrhea/therapy , Fatal Outcome , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Male , Middle Aged , Rectal Neoplasms/therapy , Recurrence , Water-Electrolyte Imbalance/therapyABSTRACT
The ph-changes of cerebral spinal fluid were measured following subarachnoid injection of bupivacaine 0.5% with and without adrenaline (1:200,000) during the three hours after the start of anaesthesia. At the same time drug precipitation was not detected. The ph-changes however, were pronounced but not enough to cause disturbances of the homoeostatic milieu. Especially no significant differences related to adrenaline were be found. The authors recommend bupivacaine 0.5% with and without adrenaline for spinal anaesthesia.
Subject(s)
Bupivacaine/pharmacology , Cerebrospinal Fluid/drug effects , Aged , Anesthesia, Spinal/methods , Epinephrine , Female , Humans , Hydrogen-Ion Concentration , Injections, Spinal , Male , Middle AgedABSTRACT
Clinical experiences of 5001 subarachnoid blocks using isobaric bupivacaine 0.5%, with and without adrenaline, for surgery are reported. The clinical results are satisfactory and no neurological sequelae are known to the authors. In vivo studies of C.S.F. after subarachnoid injection of bupivacaine 0.5% in an isobaric solution showed no changes in pH or precipitation. According to these results the authors see no contraindication in the use of bupivacine 0,5% for subarachnoid injection. The use of higher concentrations (e.g. 1%), however, can not be recommended.
