[Possibilities and limits of interventional therapy in necrotizing pancreatitis]

We present a new technique for minimal invasive radiological assisted necrosectomy (MIRAN) for infected necrosis in acute pancreatitis. We describe how to place volumic catheters for fragmentation and extraction of necrotic material. In addition a new technique is described for minimal invasive occlusion of selected pancreas tail to avoid fistulas. In 26 patients with infected necrosis of the pancreatic region, 12 patients (46.2%) could be healed by MIRAN alone. 5 patients (19.2%) could be satisfactory treated with a combination of MIRAN and operative necrosectomy. 9 patients (34.6%) died, 5 of them postoperatively. In 7 cases death followed multiple organ failure/dysfunction syndrome. 12 (71%) of 17 patients with the aim of curative treatment could be satisfactory treated with MIRAN. 2 other patients (12%) received additional surgery, 3 patients died (17%), 2 of them without any other treatment. The advantages of MIRAN are reduced trauma, general anaesthesia is not necessary, no difficult surgical preparation is necessary, no limits for additional therapy, reduced damage of neighbouring organs and vital pancreatic tissue as well as avoiding splenectomy.

[Clinical and immunohistoenzymatic investigations in patients with vasomotor and perennial allergic rhinitis]

The aim of our study was evaluation of the results of clinical examination in patients with vasomotor and perennial allergic rhinitis and assessment of number of blood vessels, nerve fibres and mast cells on the basis of immunohistoenzymatic examination. There were 42 patients examined aged from 18 to 50 and divided into three groups: I--16 patients with vasomotor rhinitis and II--14 patients with perennial allergic rhinitis and III--12 patients (control) with nasal septum deviation. On the basis of the patient's history data, clinical otorhinolaryngologic examination and active anterior rhinomanometry the patients were qualified to bilateral inferior turbinectomy. The nasal mucosa removed during surgery underwent immunohistoenzymatic examination using the monoclonal antibody against the tryptase of mast cells (MCT company, DAKO), the endothelin of blood vessels (EC - DAKO) and the neurospecific enolase (NSE - DAKO). In examined groups of patients with vasomotor and perennial allergic rhinitis and control group similar escalation of clinical symptoms expressed by means of points index were stated. In immunohistoenzymatic studies the differences in mean number of blood vessels and nerve fibres between examined groups were not statistically significant, however statistically significant difference concerned higher number of mast cells patients with vasomotor rhinitis in comparison to perennial allergic rhinitis.

Pattern generation for walking and searching movements of a stick insect leg. I. Coordination of motor activity

During walking, the six legs of a stick insect can be coordinated in different temporal sequences or gaits. Leg coordination in each gait is controlled and stabilized by coordinating mechanisms that affect the action of the segmental neuronal networks for walking pattern generation. At present, the motor program for single walking legs in the absence of movement-related coordinating intersegmental influences from the other legs is not known. This knowledge is a prerequisite for the investigation of the segmental neuronal mechanisms that control the movements of a leg and to study the effects of intersegmental coordinating input. A stick insect single middle leg walking preparation has been established that is able to actively perform walking movements on a treadband. The walking pattern showed a clear division into stance and swing phases and, in the absence of ground contact, the leg performed searching movements. We describe the activity patterns of the leg muscles and motoneurons supplying the coxa-trochanteral joint, the femur-tibial joint, and the tarsal leg joints of the middle leg during both walking and searching movements. Furthermore we describe the temporal coordination between them. During walking movements, the coupling between the leg joints was phase-constant; in contrast during searching movements, the coupling between the leg joints was dependent on cycle period. The motor pattern of the single leg generated during walking exhibits similarities with the motor pattern generated during a tripod gait in an intact animal. The generation of walking movements also drives the activity of thoraco-coxal motoneurons of the deafferented and de-efferented thoraco-coxal leg joint in a phase-locked manner, with protractor motoneurons being active during swing and retractor motoneurons being active during stance. These results show that for the single middle leg, a basic walking motor pattern is generated sharing similarities with the tripod gait and that the influence of the motor pattern generated in the distal leg joints is sufficient for driving the activity of coxal motoneurons so an overall motor pattern resembling forward walking is generated.

Artificial indoor streams as a method to investigate the impact of chemicals on lotic communities

The potential hazard of chemicals on aquatic communities are generally evaluated by standardised single-species bioassays. Safety assessment is based on results gained from organisms adapted to lentic systems and biological interactions in ecosystems are neglected. While lotic communities are often at first in contact with chemicals, it is astonishing that microcosms with lentic communities are mainly used as a bridge between laboratory bioassays and outdoor aquatic systems. Hence, we established five artificial indoor streams to simulate abiotic factors of small rivers. The closed-circuit system was filled with nutrients added to tap water. Washed pebbles were used as sediment. The dynamics of a simple biocoenoses consisting of aufwuchs, Lumbriculus variegatus Asellus aquaticus and Gammarus fossarum was investigated. The dynamic of aufwuchs and periphyton was determined as dry weight and chlorophyll-a, respectively and qualitatively by pigment pattern. The abundance of different developmental stages of L. variegatus was determined at the end of the experiment as well as the population dynamics of G. fossarum and A. aquaticus. Survival rates of gammarids and juveniles per female were investigated and data were used for modelling the population dynamics. The experiment was carried out to investigate the performance of the established artificial streams and the developed approaches to investigate effects of chemicals on a basic lotic community. The prime reason to establish this approach was to close a gap between complex artificial stream systems and laboratory single species tests to assess the impact of chemicals on the aquatic environment.

Intramuscular versus surface electromyography of the diaphragm for determining neuromuscular blockade

We determined the neuromuscular blockade of 0.2 mg. kg(-1) mivacurium at the diaphragm by using two new methods of electromyographic (EMG) monitoring and compared it with acceleromyography of the orbicularis oculi (OO) and the corrugator supercilii (CS) muscle. After the induction of anesthesia in 15 patients undergoing gynecologic laparoscopic surgery, evoked EMG responses at the diaphragm were obtained by using skin electrodes at the back of the patient, placed lateral to T12/L1 or L1/L2, and a laparoscopically applied wire electrode inserted into the dorsolateral portion of the diaphragm. Acceleromyography at the right OO and the left CS was performed. The facial and phrenic nerves were stimulated transcutaneously (onset: every 10 s, offset: every 15 s, single twitch stimulation). Lag and onset time, peak effect, and clinical duration (time to reach 75% of control value and time to reach 90% of control value) were measured and the results were compared by using analysis of variance; P < 0.05 showed significant difference. Pearson's correlation test and the Bland-Altman test were used to compare the two diaphragmatic monitoring methods. Mean peak effects of >98% were reached at all sites. Onset times at diaphragm (skin, IM) were significantly (P < 0.005) shorter than at the CS or OO (100 +/- 14 s and 98 +/- 16 s vs 147 +/- 39 s, 185 +/- 38 s) without being statistically different between OO and CS. There was a good correlation of lag, onset time, time to reach 75% of control value, and time to reach 90% of control value (r = 0.8, 0.9, 0.8, and 0.75; P < 0.01) between the two diaphragmatic methods. Mean difference and limits of agreements are -2 +/- 15 s, 1 +/- 21 s, -1 +/- 2.3 min, and -2 +/- 3.4 min. We showed a shorter onset and clinical duration at the diaphragm in comparison with CS and OO. Two methods of EMG of the diaphragm correlated well and showed good comparability. The novel method of surface diaphragmatic EMG at the patient's back may be useful during routine clinical anesthesia.

Interaction of MyoD family proteins with enhancers of acetylcholine receptor subunit genes in vivo

The myogenic determination factors (MDFs) are transcriptional activators that target E boxes in many muscle-specific promoters, including those of the genes coding for the subunits of the acetylcholine receptor. It is not known, however, if in vivo a given E box in a transcriptionally active gene is occupied, either uniquely by one MDF or randomly by all MDFs. We have analyzed expression of MDF and acetylcholine receptor subunits in cultured mouse muscle cells and, using chromatin immunoprecipitation, have determined which individual MDFs reside at promoters of several receptor subunit genes. We find that before fusion, C2C12 cells express myf-5, MyoD, and myogenin, all of which take up residence at promoters of all subunits except epsilon. At this stage, herculin is present in limited amounts and is detected mainly at the gamma and delta subunit genes. On myotube formation, herculin reaches high levels; concomitantly, the epsilon subunit gene becomes a common MDF target and begins to be expressed. In general, any MDF protein that is expressed also is present on transcriptionally active receptor genes; transcriptional activity of target genes correlates with occupancy by MDF, in particular, herculin.

[Air endotamponade in 52 vitrectomies due to proliferative diabetic retinopathy--retrospective comparison with 40 vitrectomies without endotamponade]

BACKGROUND

In patients with proliferative diabetic retinopathy rebleeding after pars plana vitrectomy is one of the most common complications. We tried to reduce the rate of that complication by using an air endotamponade.

PATIENTS AND METHODS

The following study is a retrospective comparison of 2 patient groups both after pars plana vitrectomy due to proliferative diabetic retinopathy. Group 1 was managed with air as endotamponade (n = 52, mean age 61.2 years), group 2 without any endotamponade (n = 40, mean age 59.4 years). Classification of the proliferative diabetic retinopathy as described by Kroll et al. [5] in both groups: 23 and 29 patients with stage A resp., 24 and 10 patients with stage B resp., 5 and 1 patient with stage C respectively.

RESULTS

77% of group 1 patients had an increase os vision by mean of 4.8 vision steps, in 70% of the group 2 patients vision increased by mean of 7.2 vision steps. Complications in both groups as follows: Rebleeding within 14 days 15% vs. 33%, development of secondary glaucoma in 9.6% and 17.5% resp., revitrectomy within 14 days were necessary in 3.8% resp. 2.5% of the patients, later revitrectomy in 13.5% vs. 42.5% of all patients.

SUMMARY

Air endotamponade turned out to be appropriate to reduce the rate of postoperative vitreous rebleeding after pars plana vitrectomy due to proliferative diabetic retinopathy. We found no increase of secondary glaucoma or cataract.

Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles

We simultaneously determined the neuromuscular blocking effect of mivacurium 0.2 mg kg(-1) at five muscles in 20 women undergoing gynaecological surgery. Evoked electromyographic responses were obtained using surface electromyography (EMG) at the adducting laryngeal muscles, the diaphragm (lateral to vertebrae T12/L1 or L1/L2) and the adductor pollicis muscle and acceleromyographic (AMG) responses were measured at the orbicularis oculi and the corrugator supercilii muscle. Onset time and times for the first twitch response (T1/T0) to return to 25, 75 and 90% at the adducting laryngeal muscles and the diaphragm were significantly (P<0.005) shorter than at the adductor pollicis, the corrugator supercilii or the orbicularis oculi muscles (mean (SD) onset time: 89 (26) s and 78 (17) s to 202 (45) s, 152 (41) s, 194 (40) s; T1/T0=25%: 10.4 (1.5) and 11.4 (1.2) min versus 20.5 (3.9), 15.9 (3.3), 16.3 (3.7) min; T1/T0=90%: 15.5 (1.6) and 16.1 (1.6) min versus 27.4 (4.6), 21.5 (3.8), 23.3 (5.1) min). Onsetand clinical duration of neuromuscular block at the larynx and the diaphragm after mivacurium 0.2 mg kg(-1) are shorter than in the peripheral muscles. Monitoring of neuromuscular block in the diaphragm was successfully used in all patients.

Arterial blood pressure following different types of urinary stone therapy. Presented at the 8th European Symposium on Urolithiasis, Parma, Italy, 1999

OBJECTIVE

Several studies reported increased blood pressure (BP) values following extracorporeal shock wave lithotripsy (ESWL) treatment of renal stones. It is unclear, however, whether this is due to ESWL, since nephrolithiasis itself increases the relative risk of developing hypertension. Therefore we prospectively studied the BPs of stone patients undergoing different types of treatment.

METHODS

252 stone patients (63% males, 37% females, median age 44.3, range 11.7-86.4 years) participated. 168 suffered from uretral stones: 50 underwent ESWL; 40 ureteroscopy, and 78 patients passed stones spontaneously (SP). 84 had renal stones: 60 underwent ESWL; 8 percutaneous nephrolithotomy/open surgery, and 16 no treatment. Systolic (SBP) and diastolic (DBP) BP were measured according to Riva-Rocci prior to, immediately after, and 3, 6, 12, 18 and 24 months after stone therapy.

RESULTS

Immediately after SP, SBP decreases, whereas after active stone treatment increases (highest after ESWL) in SBP were seen. DBP was unchanged. During the further follow-up, a gradual increase in BP was observed in all groups. At 24 months in all groups, regardless of the stone location and type of treatment, SBP and DBP were significantly higher than the pretreatment levels (p = 0.000). There was no a difference between renal and ureteral stones, or between the ESWL treatment and the other groups.

CONCLUSION

Renal stone disease itself rather than the type of treatment significantly increases SBP and DBP during a follow-up period of 24 months. The underlying mechanisms remain to be elucidated.

Effect of intrathecal administration of serotonin in chronic pain models in rats

The present study examined the effects of intrathecal (i.t.) administration of 5-hydroxytryptamine (5-HT; 0.1-100 microg) on mechanical hyperalgesia associated with neuropathic pain (chronic constriction of the sciatic nerve model and diabetic model) and inflammatory pain (carrageenan and polyarthritic models) in rats. Results demonstrated that the hyperalgesia observed in the mononeuropathic and diabetic rats was attenuated by 5-HT; the active dose, however, was 100- to 1000-fold higher than that required in normal rats, and was moderately effective. In the two experimental models of inflammatory pain, 5-HT was not markedly or similarly active. In the carrageenan model, 5-HT at the highest dose was only weakly effective whereas in the polyarthritic model it was inactive. Together, these results show that 5-HT has antinociceptive effects in several rat pain models, except in the model of diffuse pain (polyarthritic rats). Its antinociceptive effects in these models, however, are slight and differ from those observed in normal rats.

A chlorinated amide and piperidine alkaloids from Aloe sabaea

Phytochemical investigations of Aloe sabaea afforded a new chlorinated amide, N-4'-chlorobutylbutyramide, and the toxic piperidine alkaloids coniine, gamma-coniceine and the quarternary N,N-dimethylconiine. This is the first report of the occurrence of a chlorinated compound in the Aloeaceae family.

Indole alkaloid biosynthesis in Catharanthus roseus: new enzyme activities and identification of cytochrome P450 CYP72A1 as secologanin synthase

The molecular characterization of CYP72A1 from Catharanthus roseus (Madagascar periwinkle) was described nearly a decade ago, but the enzyme function remained unknown. We now show by in situ hybridization and immunohistochemistry that the expression in immature leaves is epidermis-specific. It thus follows the pattern previously established for early enzymes in the pathway to indole alkaloids, suggesting that CYP72A1 may be involved in their biosynthesis. The early reactions in that pathway, i.e. from geraniol to strictosidine, contain several candidates for P450 activities. We investigated in this work two reactions, the conversion of 7-deoxyloganin to loganin (deoxyloganin 7-hydroxylase, DL7H) and the oxidative ring cleavage converting loganin into secologanin (secologanin synthase, SLS). The action of DL7H has not been demonstrated in vitro previously, and SLS has only recently been identified as P450 activity in one other plant. We show for the first time that both enzyme activities are present in microsomes from C. roseus cell cultures. We then tested whether CYP72A1 expressed in E. coli as a translational fusion with the C. roseus P450 reductase (P450Red) has one or both of these activities. The results show that CYP72A1 converts loganin into secologanin.

Hepatitis C virus genotypes in Estonia

Distribution of hepatitis C virus (HCV) geno(sub)types among 215 Estonian patients hospitalized with acute or chronic hepatitis and with HCV RNA-positive sera was investigated. For genotyping, both multiplex PCR with subtype-specific primers of the core region and RFLP analysis of cDNA of the 5' NCR region were used. These two methods permitted a correct characterization of genotypes, a more truthful characterization of mixed infections, and combined use of single-tube performances. They revealed, respectively, 200 and 202 (93.0% and 93.9%) HCV-positive samples of sera, subtype 1a- 0.9% and 0.9%, 1b- 56.3% and 64.2%, 3a- 13.9% and 22.3%, 2a- 6.5% and 5.6%, type 4 0.5% and 0%, mixed infections- 13.5% and 0%, and unidentified- 1.4% and 0.9%. In the majority of cases (84.7%) both methods gave completely or partially concordant results; in mixed infections, as determined by subtype-specific PCR, only one subtype was revealed by the RFLP method. In the remaining 15.3% of the cases (Ohno- 7.0%, RFLP- 8.3%) only one of the methods was positive. The epidemiological analysis of the dynamics of the subtypes' relative participation may indicate increasing 3a and decreasing 1b subtype infection during recent years.

Cigarette smoke enhances ethanol-induced pancreatic injury

Alcohol induces pancreatic ischemia, but the mechanisms promoting pancreatic inflammation are unclear. We investigated whether cigarette smoke inhalation is a cofactor in the development of ethanol-induced pancreatic injury. Cigarette smoke was administered to anesthetized rats alone or in combination with intravenous ethanol infusion. Control animals received either saline or ethanol alone. Pancreatic capillary blood flow and leukocyte-endothelium interaction in postcapillary venules were evaluated by intravital microscopy. Leukocyte sequestration was assessed by measurement of myeloperoxidase activity in pancreatic tissue, and pancreatic injury evaluated by histology. Ethanol decreased pancreatic blood flow progressively over 90 minutes (p < 0.001 vs. baseline), but neither leukocyte-endothelium interaction nor leukocyte sequestration was altered. Cigarette smoke alone reduced pancreatic blood flow temporarily (p < 0.01 vs. baseline) and increased leukocyte-endothelium interaction (roller p < 0.001, sticker p < 0.01 vs. baseline). Cigarette smoke potentiated the impairment of pancreatic capillary perfusion caused by ethanol, and both the number of rolling leukocytes and myeloperoxidase activity levels were increased compared to ethanol or nicotine administration alone (p < or = 0.05 and p < or = 0.01, respectively). This study demonstrates that ethanol induces pancreatic ischemia and that cigarette smoke leads to both temporary pancreatic ischemia and minimal leukocyte sequestration. Cigarette smoke potentiates the amount of pancreatic injury generated by ethanol alone. Smoking therefore seems to be a contributing factor in the development of alcohol-induced pancreatitis in the rat model.

Clinical experiences with a new semi-quantitative solid phase immunoassay for rapid measurement of procalcitonin

A self-developing solid-phase immunoassay (B.R.A.H.M.S. PCT-Q, B.R.A.H.M.S.-Diagnostica GmbH, Hennigsdorf, Germany) has recently become available for the semi-quantitative and rapid measurement of procalcitonin (PCT). In this study we examined the validity of this assay at daily clinical routine conditions at five different hospitals in a prospective study. After development of the assay (200 microl plasma, 30 minutes incubation), PCT levels were categorized into four groups (< 0.5 microg/l; > or = 0.5-< 2 microg/l; > or = 2-< 10 microg/l; > or = 10 microg/l) according to the provided reference scale. Samples from patients with suspected elevation of PCT of different etiology (n=237) were read by various analyzers and compared with the results of the Lumitest PCT (B.R.A.H.M.S.-Diagnostica GmbH, Hennigsdorf, Germany). A total of 74.7% of measurements were categorized according to the results of the LumitestPCT, 24.5% were read within the next lower or higher category. Using a +/- 10% range at the reference concentrations (20% at 0.5 microg/l), 82.7% of samples were correctly categorized and 16.4% within the next categories. Using a cut-off value of 2.0 microg/l, 92.0% (94.1% for +/- 10%) of the results were correctly categorized. The semi-quantitative solid phase immunoassay allows a rapid, simple and semi-quantitative measurement of plasma PCT. The validity of the test results and its ease of use are sufficient to support acute diagnostic decisions. However, for the follow-up of PCT concentrations and routine daily measurements, the quantitative luminometric assay should be preferred, when available.

[The intra-arterial calcium stimulation test in site diagnosis for surgical therapy of insulinoma]

BACKGROUND

Approximately 10% of all insulinomas--the most common neuroendocrine pancreatic tumor--occur in multiple sites of the pancreas (e.g., multiple endocrine neoplasia type I) and rarely as islet cell hyperplasia. Malignant insulinomas appear in 10% to 15% of cases. For these special groups and for patients with a reoperation preoperative localization of the tumour is advisable. With current imaging technology, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and somatostatin receptor scintigraphy (SRS), localization of insulinomas is often inadequate.

METHODS

In this study we report our results using intra-arterial calcium-stimulated venous blood sampling (ASVS) to localize and guide the management of insulinomas for patients with a reoperation because of recurrent insulinomas or persistent hyperinsulinism, for patients with malignant neoplasm and for patients with a previous abdominal operation.

RESULTS

For all three cases the insulinomas were correctly localized by the ASVS in contrast to the preoperative imaging studies.

CONCLUSIONS

Our experience and a review of the current literature demonstrate that ASVS is a highly accurate (sensitivity > 90%) and a safe method for preoperative localization of insulinomas. For patients with a reoperation ASVS is recommended and the extensive use of other costly preoperative methods should be avoided.

Transjugular intrahepatic portosystemic shunt. Experiences at a liver transplantation center

OBJECTIVE

Transjugular intrahepatic portosystemic shunt (TIPS) placement is an established therapy for portal hypertension that leads to variceal bleeding or refractory ascites. We present experiences of the role of TIPS at a liver transplantation center.

MATERIAL AND METHODS

One hundred and ten patients were referred to the Radiological Department for TIPS placement. One of the 110 patients had recurrent cirrhosis after liver transplantation with refractory ascites. Function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. Shunt insufficiency was supposed when the blood flow velocity within the stent tract was under 50 cm/s and was an indication for TIPS revision.

RESULTS

TIPS was placed in 101 patients. After TIPS placement, 10 patients underwent liver transplantation. While waiting for the new liver, none of them developed variceal rebleeding, ascites or other complications of portal hypertension. Two of the 101 patients had episodes of rebleeding. The frequency of patients undergoing TIPS revision within the first year after TIPS placement was 67.5%, within the second year 38.0% and within the third year 24.4%. The revisions led to sufficient reduction of the portosystemic pressure gradient.

CONCLUSION

In some liver transplant candidates, TIPS can be useful in minimizing the risk of complications of portal hypertension during the waiting time for a liver transplantation. TIPS can be monitored by Doppler US and revised if occlusion occurs.

Constituents of Eulophia petersii

The isolation of five known phenanthrenes and a mixture phytosterols from roots of Eulophia petersii is reported.

Surface vs intramuscular laryngeal electromyography

PURPOSE

To compare surface and intramuscular laryngeal electromyography (EMG) with adductor pollicis muscle EMG after 0.1 mgxkg(-1) cisatracurium.

METHODS

This prospective study included ten patients undergoing surgery with risk of damage to the recurrent laryngeal nerve (RLN). The tracheas were intubated after fentanyl/propofol without the aid of muscle relaxation. A surface laryngeal electrode was attached to the tube and placed amidst the vocal cords; two straight needles were inserted endoscopically into the left lateral cricoarytenoid muscle. Single twitch stimulation of the left RLN (0.1 Hz) was performed transcutaneously; skin EMG of the left adductor pollicis muscle was performed at 0.1 Hz. After supramaximal stimulation for 10 min, 0.1 mgxkg(-1) cisatracurium was injected. Lag, onset time and peak effect were measured and compared.

RESULTS

Good correlation (r = 0.9, 0.8, P < 0.005) and good comparability of the two methods of laryngeal EMG (mean difference and limits of agreement: 0 +/- 28 sec for lag time, -2 +/- 84 sec for onset time) was shown. The mean surface laryngeal lag and onset times were 67 +/- 22 sec and 198 +/- 72 sec, compared with the adductor pollicis muscle (98 +/- 30 sec and 242 +/- 59 sec) at P < 0.01. Peak effects at larynx (92 +/- 9%) and adductor pollicis muscle (95 +/- 3%) were similar.

CONCLUSION

Surface laryngeal EMG is comparable to intramuscular laryngeal EMG to determine degree and onset of the neuromuscular blockade. Increasing muscle relaxation does not cause the surface electrode to lose contact with the vocal cords and therefore underestimate onset time and peak effect.

Influence of gastrointestinal hormones on tumor microcirculation of experimental pancreatic cancer in the rat

BACKGROUND/AIMS

Gastrointestinal hormones influence the microcirculation in the normal pancreas. In the present study, we studied the effect of cerulein and somatostatin on pancreatic cancer microcirculation after orthotopic and nonorthotopic tumor implantation.

METHODS

In 36 male Lewis rats (150-180 g) induction of a ductlike pancreatic cancer was achieved by intrapancreatic or intraperitoneal tumor fragment interposition between two inert transparent polymethyl methacrylate plates. After 4 weeks, intravital microscopy of the tumor microcirculation was performed in a temperature-controlled immersion chamber. The animals received 5 microg/kg cerulein or 3 mg/kg somatostatin for 1 h intravenously. The erythrocyte velocity in normal pancreatic capillaries or in tumor vessels was measured.

RESULTS

The erythrocyte velocity in the capillaries of the normal pancreas was 1.01 +/- 0.11 mm/s at baseline and increased to 1.64 +/- 0.09 mm/s after cerulein stimulation (p = 0.007). Pancreatic cancer vessels demonstrated no increase in erythrocyte velocity after orthotopic (baseline 0.95 +/- 0.14 mm/s, after 1 h 0.86 +/- 0.13 mm/s; n.s.) and nonorthotopic tumor implantation (baseline 0.91 +/- 0.12 mm/s, after 1 h 0.95 +/- 0.14 mm/s; n.s.) after cerulein stimulation. Somatostatin decreased the erythrocyte velocity both in normal pancreas (baseline 0.87 +/- 0.02 mm/s, after 1 h 0.60 +/- 0.07 mm/s; p = 0.01) and in pancreatic cancer (baseline 0.85 +/- 0.20 mm/s, after 1 h 0.63 +/- 0.18 mm/s; p = 0.02) after orthotopic tumor implantation. There was no effect of somatostatin after nonorthotopic tumor implantation (baseline 0.90 +/- 0.10 mm/s, after 1 h 0.88 +/- 0.14 mm/s; n.s.).

CONCLUSION

These data suggest that pancreatic cancer microcirculation lacks physiological blood flow control by stimulatory hormones, in contrast to the normal pancreas.

Comparison of succinylcholine with two doses of rocuronium using a new method of monitoring neuromuscular block at the laryngeal muscles by surface laryngeal electromyography

We compared the onset of neuromuscular block with succinylcholine (1 mg kg-1) and two doses of rocuronium (0.6 and 0.9 mg kg-1) at the adductor pollicis muscle using electromyography (EMG) and acceleromyography (AMG), and at the adductor laryngeal muscles with a new electromyographic method using a disposable surface electrode attached to the cuff of a tracheal tube. At the larynx, the mean (+/- SD) time to 90% block and the onset time of succinylcholine (38 +/- 15 and 47 +/- 19 s, respectively) were significantly shorter (P < 0.01) than for rocuronium 0.6 mg kg-1 (92 +/- 42 and 106 +/- 38 s) and rocuronium 0.9 mg kg-1 (52 +/- 31 and 64 +/- 30 s). We found that, with comparable degrees of neuromuscular block, the onset time of succinylcholine at the adductor pollicis was significantly shorter (P < 0.01) than for rocuronium 0.6 mg kg-1 and 0.9 mg kg-1 (EMG, 80 +/- 39 vs 145 +/- 48 s and 99 +/- 31 s; AMG, 90 +/- 39 vs 124 +/- 53 s and 106 +/- 38 s). Clinical duration at the adductor pollicis (AMG) was significantly longer (P < 0.01) for both rocuronium groups than for succinylcholine (T4:T1 = 0.7, 54 +/- 18 and 77 +/- 21 vs 8 +/- 6 min). The surface laryngeal electrode proved non-invasive, easy to use and reliable in measuring onset of the neuromuscular block at the larynx.