Metabolic responses to fructose-1,6-diphosphate in healthy subjects.

Fructose-1,6-diphosphate (FDP) is an important naturally occurring intracellular metabolite with a direct regulatory role in many metabolic pathways. The most important and widely studied of the FDP effects has been its regulation of glycolysis, particularly the enzyme that synthesizes FDP--phosphofructokinase (PFK). Since it was observed experimentally that FDP does indeed modulate carbohydrate metabolism, we investigated whether FDP would similarly enhance carbohydrate utilization in man. The study used indirect calorimetry and was open to healthy adults (N = 45) of either sex and above legal age. After a steady metabolic state was obtained, 5 g of FDP (10%) was infused into a brachial vein. In 10 subjects, glucose (5 g) or FDP (5 g) was sequentially infused. The rapid intravenous infusion of FDP produced a slight but significant decrease in heart and respiration rates (P < .05). A significant increase in the serum concentration of inorganic phosphate (P < .0001) and the intraerythrocytic concentration of adenosine triphosphate (ATP) (P < .01) was also observed. The FDP infusion produced a decrease in plasma cholesterol and triglycerides (P < .001 and P < .01, respectively). The indirect calorimetric data indicate that the infusion produced a highly significant increase in the respiratory quotient ([RQ] P < .0001) and the energy derived from carbohydrates (P < .0001) and a significant decrease in the energy derived from lipids (P < .0001). Glucose infusion did not cause changes in any of the parameters. These data indicate that carbohydrate metabolism is stimulated by FDP.

Diagnostic laparotomy for abdominal trauma. A university hospital experience.

Following the experience of World War II, exploratory laparotomy in all patients with penetrating abdominal trauma was deemed mandatory until 1960 when Shaftan reported his experience with selective laparotomy. In 1973, Nance et al. reported on selective observation of abdominal stab wounds. There seems to be little controversy over mandatory laparotomy for abdominal gunshot wounds. Blunt trauma is generally managed expectantly with the adjunctive use of peritoneal lavage, CT scanning, and serial examinations of the abdomen. Despite the selective approach and the use of adjunctive diagnostic methods, exploratory laparotomy continues to be the most accurate method used to diagnose the presence of intra-abdominal injury. In order to examine our experience with diagnostic laparotomy for trauma, both blunt and penetrating, a retrospective study of 494 consecutive patients undergoing exploratory laparotomy over the past 4 years was undertaken. Abdominal stab wounds were explored under local anesthesia, and, if found to penetrate the posterior fascia, laparotomy was accomplished. All patients with abdominal gunshot wounds underwent exploration. Exploratory laparotomy in patients with blunt abdominal trauma was mandated by clinical signs, positive peritoneal lavage, or positive CT scan. All patients with unexplained shock and/or signs of peritoneal irritation underwent urgent laparotomy. In this series of 494 patients, 99 or 20 per cent of the entire group had a negative exploration (30% for stab wounds, 16% for gunshot wounds, and 19% for blunt abdominal trauma). The morbidity for the negative laparotomy group was limited to five patients with postoperative atelectasis. There were no anesthesia complications, iatrogenic intraoperative injuries, or wound infections. There were five deaths but none were laparotomy-related.(ABSTRACT TRUNCATED AT 250 WORDS)

Lung carcinoma: survey of 2286 cases with emphasis on small cell type.

Lung carcinoma is the commonest major malignancy in men in the United States and its incidence is increasing rapidly in women. It is estimated that there will have been 117,000 new cases and 101,300 deaths in 1980. The 2286 patients with lung carcinoma admitted to the Hospital of the University of Mississippi from 1955 to 1980 were reviewed by decades of chronology and of life, with respect to age, cell type, sex and racial incidence. The greatest age incidence was in the sixth and seventh decades; cell types overall were epidermoid (45% of the patients), adenocarcinoma (12% of the patients), small (oat) cell (21% of the patients), and others (22% of the patients). There was a steady increase in the incidence of disease in females, adjusted for total hospital admissions, and a less certain increase among black patients. Twenty-eight per cent of 250 patients with small cell carcinoma so studied exhibited some feature of the paraneoplastic or paraendocrine syndromes. In 41 patients with small cell carcinoma treated with multiple drug chemotherapy, there was an overall response rate of 50% and an additional "stable disease" rate of 28%. Mean survival period in this group was 52 weeks, compared with 12 weeks in patients whose diseases went untreated. Clearly, definite progress is being made, not only in our knowledge of the biology of lung carcinoma, in general, but in the treatment of small cell carcinoma in particular.

Evisceration secondary to blunt trauma: occurrence through an incisional hernia.

We present a case of evisceration of the stomach, small bowel, and colon through an old incisional hernia in a 75-year old woman following blunt automobile trauma to the abdomen. Following routine surgical closure and debridement of excess skin the patient recovered uneventfully with no recurrence of the hernia.

Arterial surgery for arm ischemia. A survey of 136 patients.

A series of 136 patients with upper extremity ischemia requiring operative correction is presented. Causes of the ischemia included trauma, atherosclerosis, embolism, iatrogenic causes, radiation injury, and cervical rib syndrome. Operations included primary repair, various bypass grafts and embolectomy. Illustrative case reports are used to emphasize important points. The subclavian, axillary and brachial arteries have been considered separately. In general, ischemia of the arm caused by a discrete lesion is amenable to surgical correction with an excellent change of success.

Local anesthesia for mediastinoscopy: experience with 450 consecutive cases.

Mediastinoscopy has been widely applied in the evaluation of patients with suspected bronchogenic carcinoma over the past decade. Though there remain those who feel that such findings should not play a significant role in determining resectability, we have found a number of patients who have been saved from exploratory thoracotomy in obviously incurable situations. We have had a relatively high degree of success in the diagnosis of benign diseases. Wtih no mortality and a morbidity of 1.1%, we feel that mediastinoscopy under local anesthesia is applicable in many clinical circumstances in which the requirement for general anesthesia would preclude such evaluation. Though it is not necessary that local anesthesia be exclusively applied, we feel that our experience with over 450 cases in the last six years has demonstrated safety and efficacy in universal application of local anesthesia for cervical mediastinal exploration.

Blood flow distribution in dogs during hypothermia and posthypothermia.

Blood flow distribution in tissues of mongrel dogs during hypothermia was studied with radionuclide-tagged microspheres. The animals were cooled at 21 degrees C and rewarmed under thiamylal sodiuni anesthesia. During hypothermia, cardiac output fell to 20% of the control; the highest rate of blood flow relative to normothermic values was observed in the subendocardium of the left ventricle, and the lowest in the hypophysis. Each tissue showed specific reactions to hypothermia. During hypothermia the myocardial and brain-stem blood flows were about 40% of the control; almost all of the digestive tract, striated muscle, adrenal gland, and hypophysis blood flows were maintained at 20% or less of the control. After rewarming, cardiac output recovered to values significantly lower than control. The myocardium, brain, renal cortex, and striated and smooth muscle recovered to control levels; however, blood flow to the digestive organs, bronchial artery flow to the lung, and flow to the endocrine organs did not completely recover by 2 after rewarming.

Aortic and other arterial injuries.

Three hundred sixty arterial injuries in 353 patients are reviewed. They covered a wide spectrum of injuries and included 36 aortic injuries and 19 cases of carotid truama. The mortality rate of 12% was in large part due to aortic injuries. Shock was the predominant cause of death. Infection was the most frequent non-fatal complication. Pulmonary complications were surprisingly uncommon. With methods and techniques discussed in the paper, 90% satisfactory end results were achieved. The amputation rate was 6% where extremity injuries were involved.