Lead levels of Culex mosquito larvae inhabiting lead utilizing factory.

OBJECTIVE: To determine lead level primarily in Culex quinquefasciatus (Cx. quinquefasciatus), and Culex gelidus (Cx. gelidus) larvae inhabiting lead consuming factories, and to putatively estimate eco-toxicological impact of effluents from the firms. METHODS: Third instars larvae were sampled by standard dipping method and lead concentrations in the larvae and their respective surrounding factory aquatic environments were determined through standard atomic absorption spectrophotometry (AAS). RESULTS: Cx. quinquefasciatus was the most abundant species followed by Cx. gelidus. The levels of lead were higher in the Cx. quinquefasciatus (1.08-47.47 µg/g), than in the wastewaters surface (0.01-0.78 µg/mL) from the factories or closer areas around factories. Other species were not reaching the criteria for lead determination. CONCLUSIONS: The Cx. quinquefasciatus larvae can bio-accumulate the metal and can potentially serve as a biomarker of lead contamination, to complemente conventional techniques.

[Massive gastrointestinal hemorrhage from the jejunum caused by Dieulafoy's lesion]. / Massiv gastrointestinal blødning fra jejunum forårsaget af Dieulafoys laesion.

A 54-year old woman was admitted to the hospital because of massive haematochezia. Emergency surgical exploration was performed and by a simple method the source of bleeding was localized and treated. We discuss one of the major problems in all GI-bleeding that lies in establishing the diagnosis. With localization in the small bowel the problem is even bigger because this part of the bowel isn't examined by conventional endoscopy. This case-story should be a reminder of the small bowel as a source of bleeding when conventional upper and lower endoscopy does not reveal the bleeding source.

[The effect of prednisolone on the systemic response and wound healing after colonic surgery]. / Effekten af prednisolon på det systemiske respons og sårheling efter colonkirurgi.

To study the effect of preoperative treatment with a single high-dose of glucocorticoid on the systemic and immunological response, wound healing, and convalescence after colonic surgery, thirty patients were double-blind randomized to receive either methylprednisolone 30 mg/kg intravenously 90 minutes prior to induction of anaesthesia (group 1, n = 12), or to receive placebo (group 2, n = 12). Six patients were excluded from the study. Assessments of pain, pulmonary function, convalescence, various injury and wound-healing factors were done until 10 days after surgery. Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activation was significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effect on collagen accumulation. It is concluded that treatment with a single high dose of glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.

[Metoprolol prevents myocardial ischemia during endoscopic retrograde cholangiopancreatography]. / Metoprolol forebygger myokardieiskaemi under endoskopisk retrograd kolangiopankreatikografi.

The aim of our study was to evaluate the effect of metoprolol on the occurrence of myocardial ischaemia during endoscopic cholangiopancreatography. Thirty-eight (2 x 19) patients scheduled for endoscopic cholangiopancreatography received either metoprolol 100 mg or placebo two hours before endoscopy. During endoscopy, arterial oxygen saturation was measured by continuous pulse oximetry, and the electrocardiogram was monitored continuously with a Holter tape recorder. Myocardial ischaemia was defined as an ST segment deviation > 1 mV from baseline. Heart rate during endoscopy was significantly lower in the metoprolol group compared with the placebo group (p = 0.0002). Twenty-one patients (16 placebo versus five metoprolol, p = 0.0008) developed tachycardia (heart rate > 100/min) during the procedure. A total of eleven patients (ten placebo versus one metoprolol, p = 0.003) developed myocardial ischaemia during the procedure, and myocardial ischaemia was always related to increases in heart rate. In conclusion, metoprolol prevented myocardial ischaemia during endoscopic cholangiopancreatography, probably through a heart rate lowering effect. Thus, tachycardia seems to be a key pathogenic factor in the development of myocardial ischaemia during endoscopy.

Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma.

BACKGROUND: Laparoscopic techniques have been evaluated for many operations, but retrospective and prospective studies have failed to show these techniques to be superior to open operations in all patients with colorectal disease. This study compares laparoscopic and open colonic resection in a randomized fashion with special reference to outcome, complications and immunomodulation. METHODS: The clinical course, assessment of convalescence parameters, immunofunction and pathological evaluation of the operative specimen were compared in 34 patients with colonic adenocarcinoma. The patients were randomized to either laparoscopic surgery (group 1, n = 18) or open surgery (group 2, n = 16). As five patients were excluded the number of patients was 15 in group 1 and 14 in group 2. RESULTS: Patients in group 1 were discharged earlier (P < 0.05) and suffered less pain (P < 0.01 at rest, P < 0.05 during coughing and mobilization). Surgery was equally radical in the two groups. Intraoperative bleeding, postoperative reduction in pulmonary function, and level of fatigue were identical in the two groups. The immunodepression was more pronounced in patients in group 1 (P < 0.01). CONCLUSION: Laparoscopic colonic resection is an acceptable and safe alternative to open procedures; the differences between the two techniques are not marked.

Effect of prednisolone on the systemic response and wound healing after colonic surgery.

OBJECTIVE: To study the effect of preoperative treatment with a single high-dose glucocorticoid on the systemic and immunologic responses, wound healing, and convalescence after colonic surgery. DESIGN: Double-blind, placebo-controlled, randomized trial. SETTING: Department of surgery in a university hospital. PATIENTS: Thirty patients scheduled for open colonic resection; 6 patients were excluded from the study (N = 24). INTERVENTIONS: Patients were randomized to either of 2 treatment regimens: methylprednisolone sodium succinate 90 minutes before induction of anesthesia and epidural analgesia (group 1, n = 12), or placebo 90 minutes before anesthesia and epidural analgesia (group 2, n = 12). MAIN OUTCOME MEASURES: Assessments of pain, pulmonary function, convalescence, and various injury and wound-healing factors were done several times until 10 days after surgery. RESULTS: Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activations were significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effects on collagen accumulation. CONCLUSION: Treatment with a single high-dose glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.

Impalpable breast lesions diagnosed by mammography: incidence of histologically confirmed malignancy.

OBJECTIVE: To evaluate the suitability of currently applied mammographic criteria for the early diagnosis of subclinical tumours by comparing radiological findings with the final histological diagnosis. DESIGN: Open study. SETTING: District hospital, Denmark. SUBJECTS: 151 Women who underwent needle biopsy of 161 occult breast lesions that had been diagnosed by mammography during the period 1986-90. INTERVENTIONS: Definitive operation if frozen section at the time of needle biopsy indicated malignancy. Radiographic examination of the specimen ensured that the abnormal area had been excised. MAIN OUTCOME MEASURES: Correlation of mammographic and histological findings. RESULTS: Eight foci showed carcinoma in situ and 33 invasive carcinoma; 10 of the 33 had lymph node metastases. Foci with mammographic masses had a significantly higher risk of malignancy than those without (25/70, 37%, compared with 8/91, 17%, p = 0.005). Spiculated foci with clustered calcifications had the highest risk of malignancy (6/11, 54%). 16/87 foci in women less than 50 years old contained malignant disease compared with 25/74 in women aged 50 or more (p = 0.04). A fifth of the frozen sections contributed nothing to the diagnosis. The incidence of malignant disease in impalpable lesions of a quarter is similar to the reported incidence in palpable mammary tumours, but metastases at the time of diagnosis are appreciably less common (30% compared with 50%). CONCLUSION: The currently applied mammographic criteria are particularly helpful to patients under the age of 50.

Double blind randomised controlled trial of effect of metoprolol on myocardial ischaemia during endoscopic cholangiopancreatography.

OBJECTIVE: To evaluate the effect of metoprolol, a beta adrenergic blocking drug, on the occurrence of myocardial ischaemia during endoscopic cholangiopancreatography. DESIGN: Double blind, randomised, controlled trial. SETTING: University Hospital. SUBJECTS: 38 (two groups of 19) patients scheduled for endoscopic cholangiopancreatography. INTERVENTIONS: Metoprolol 100 mg or placebo as premedication two hours before endoscopy. MAIN OUTCOME MEASURES: Heart rate, arterial oxygen saturation by continuous pulse oximetry, ST segment changes during endoscopic cholangiopancreatography (an ST segment deviation > 1 mV was defined as myocardial ischaemia), electrocardiogram monitored continuously with a Holter tape recorder. RESULTS: All patients had increased heart rate during endoscopy compared with rate before endoscopy, but heart rate during endoscopy was significantly lower in the metoprolol group compared with the placebo group (P = 0.0002). Twenty one patients (16 placebo, 5 metoprolol; P = 0.0008) developed tachycardia (heart rate > 100/min) during the procedure, and 11 patients (10 placebo, 1 metoprolol; P = 0.003) developed myocardial ischaemia. One patient in the placebo group had an acute inferolateral myocardial infarction. In the 10 other patients with signs of myocardial ischaemia during endoscopy the ST deviation disappeared when the endoscope was retracted. In all patients myocardial ischaemia was related to increases in heart rate, and 10 of the 11 patients had tachycardia coherent with myocardial ischaemia. CONCLUSIONS: Metoprolol prevented myocardial ischaemia during endoscopic cholangiopancreatography, probably through lowering the heart rate. Thus, tachycardia seems to be a key pathogenic factor in the development of myocardial ischaemia during endoscopy.

[Late recurrence of stomach cancer in a patient treated with a H2 receptor antagonist]. / Sent recidiv af cancer ventriculi hos en patient i H2-receptorantagonistbehandling.

We report a case where a patient developed recurrence of an adenocarcinoma of the stomach ten years after primary surgery. Besides the late recurrence, the case is interesting as the patient participated in a trial investigating the effect of cimetidine on survival after gastric cancer and received cimetidine for two years after surgery. Considering the well documented anti-tumour and immunomodulating effects of histamine type-2 receptor antagonists, it might be interesting to examine the effect on survival after surgery for gastric cancer in patients receiving prolonged treatment with such an antagonist.

Adverse events with continuous doxapram infusion against late postoperative hypoxaemia.

OBJECTIVE: A randomized double-blind controlled trial of doxapram versus placebo against late postoperative hypoxaemia was planned to include 40 patients (2 x 20). RESULTS: After inclusion of 18 patients a serious adverse event was encountered with development of a brain stem infarction in a 90-year-old woman receiving doxapram. At this point the randomization code was broken and we decided to terminate the trial. Three of nine patients receiving doxapram had had an adverse event whereas none of the patients receiving placebo had adverse events (P = 0.2). In the 18 patients studied, there was an insignificant trend towards higher mean oxygen saturation in the doxapram group, and a significantly higher minimum oxygen saturation and reduced number of hypoxaemic events on the first postoperative night. CONCLUSION: Although these preliminary data on the effect of doxapram on postoperative hypoxaemia seem promising, further studies on the effect of continuous nocturnal postoperative doxapram infusion on levels of arterial oxygen saturation should be postponed until more knowledge about the pharmacokinetics of doxapram in this particular clinical situation has been gathered.

The effect of vagotomy on human gastroesophageal sphincter pressure in the resting state and following increases in intra-abdominal pressure.

The effect of surgical isolation and extrinsic denervation of the distal 5 to 7 cm of the human esophagus on resting gastroesophageal sphincter pressure and its response to graded increases of external abdominal compression was determined in 89 patients with duodenal ulcer. Fasting serum gastrin concentration also was measured. No significant changes in resting sphincter pressure were obtained before and after vagotomy of various types: parietal cell vagotomy, selective gastric vagotomy plus drainage, and selective gastric vagotomy plus precise antrectomy. No correlation between resting sphincter pressure and fasting serum gastrin concentration was found in any of the groups studied. The increase in gastroesophageal sphincter pressure was similar to the increase in intragastric pressure after 10, 20, and 30 mm Hg of external abdominal compression and was unchanged after all types of vagotomies. These results suggest that (1) extrinsic innervation of the lower esophageal sphincter in humans does not regulate the resting tone of the sphincter; (2) extrinsic "mechanical" influence does not play any role in the maintenance of resting pressure; (3) the effect of increased abdominal pressure is a pure mechanical effect, is unchanged after vagotomy, and therefore is not regulated by external neural reflex.

Gastroesophageal reflux in duodenal ulcer patients before and after vagotomy.

Gastroesophageal reflux was investigated in 80 patients with duodenal ulcer by analysis of symptomatology and the acid reflux test. Resting gastroesophageal sphincter pressure (GESP) and postvagotomy reduction in basal and pentagastrin stimulated gastric acid secretion were also studied. Reflux symptoms were present in 40% of the patients, and this incidence was significantly reduced two months after vagotomy. In patients studied late after operation reflux symptoms were still less frequent than before operation, but not significant. After vagotomy, no significant changes in the fasting GESP or in gastroesophageal reflux as determined by the pH glass electrode were demonstrated. Thus, the decrease in reflux symptoms may be explained by the significant reduction in gastric acid secretion. Denervation of the cardia and the lower esophagus does not influence GESP or gastroesophageal reflux.