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Berger M, Goedeke J, Hubertus J, Muensterer O, Ring-Mrozik E, von Schweinitz D, Lacher M. Physiological impact of pneumoperitoneum on gastric mucosal CO2 pressure during laparoscopic versus open appendectomy in children. J Laparoendosc Adv Surg Tech A 2011; 22:107-12. [PMID: 22168325 DOI: 10.1089/lap.2011.0400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Funded knowledge about the physiological impact of laparoscopic surgery in children is sparse. Although there are data on hemodynamic compromise after creation of a pneumoperitoneum in children, little is known about microcirculatory changes at the mucosa level. Therefore, the aim of this study was to assess gastric microcirculation by continuous gastric air tonometry in the setting of laparoscopic versus open appendectomy. PATIENTS AND METHODS Twenty children 5-17 years old undergoing laparoscopic and 7 children undergoing open appendectomy were included in the study. Gastric intramucosal CO(2) pressure (pCO(2)i) was measured under standardized flow and intraperitoneal pressure using continuous air tonometry (TONOCAP(®), Datex Ohmeda), and ΔpCO(2) (pCO(2)i - end-expiratory CO(2) pressure [pCO(2)e]) was obtained for the time course of surgery. RESULTS ΔpCO(2) increased significantly from the baseline value not only in the laparoscopic group but also in the open surgery group. Even though ΔpCO(2) was higher in the laparoscopic group at all time points, the overall increase in ΔpCO(2) for both groups was uniform. The largest differences were observed during the initial 20 minutes of the operation. The changes observed were exclusively due to an increase of pCO(2)i in relation to a constant pCO(2)e. DISCUSSION In the setting of a standardized, simple operation in an otherwise healthy child above the age of 5 years, our data suggest that the effect of a pneumoperitoneum on splanchnic perfusion is comparable to the compromise caused by open surgery. Further research must be obtained when evaluating the full impact of laparoscopy in children.
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Affiliation(s)
- Michael Berger
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Graça G, Duarte IF, Barros AS, Goodfellow BJ, Diaz S, Carreira IM, Couceiro AB, Galhano E, Gil AM. 1H NMR Based Metabonomics of Human Amniotic Fluid for the Metabolic Characterization of Fetus Malformations. J Proteome Res 2009; 8:4144-50. [DOI: 10.1021/pr900386f] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Gonçalo Graça
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Iola F. Duarte
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - António S. Barros
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Brian J. Goodfellow
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Sílvia Diaz
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Isabel M. Carreira
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Ana Bela Couceiro
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Eulália Galhano
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
| | - Ana M. Gil
- CICECO, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, QOPNAA, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal, Cytogenetics Laboratory and Center of Neurosciences and Cellular Biology, Faculty of Medicine, University of Coimbra, 3001-401 Coimbra, Portugal, and Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, 3000 Coimbra, Portugal
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Zangeneh F, Young WF, Lloyd RV, Chiang M, Kurczynski E, Zangeneh F. Cushing's syndrome due to ectopic production of corticotropin-releasing hormone in an infant with ganglioneuroblastoma. Endocr Pract 2004; 9:394-9. [PMID: 14583423 DOI: 10.4158/ep.9.5.394] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report the first recognized case of Cushing's syndrome due to a corticotropin-releasing hormone (CRH)-secreting ganglioneuroblastoma, which was found in an 18-month-old boy with hypertensive encephalopathy. METHODS The clinical, biochemical, and immunohistochemical characteristics of this rare syndrome are described, and the relevant literature is reviewed. RESULTS An 18-month-old boy with a history of recent weight gain was admitted because of sudden onset of right fixed esotropia and left facial palsy after episodes of emesis. Magnetic resonance imaging showed old left frontal lobe and right hypothalamic infarcts. The patient had generalized obesity, decelerated linear growth, hypertrichosis, hypertension (144/103 mm Hg), hypokalemia, and proteinuria. The 24-hour urinary excretion of free cortisol, catecholamines, and metanephrines was increased. The serum cortisol concentration after a 1-mg overnight dexamethasone suppression test (DST) was 53.7 mg/dL (normal, <5). The serum adrenocorticotropic hormone (ACTH) concentration was 7 pg/mL (normal, 10 to 60), and the CRH level was 439 pg/mL (normal, 24 to 40). An overnight high-dose DST (8 mg) failed to suppress serum cortisol; however, both cortisol and ACTH were responsive to ovine CRH stimulation. Despite discordant dynamic endocrine testing and negative somatostatin receptor scintigraphy, computed tomography showed a right 3.6- by 3.0-cm extra-adrenal retroperitoneal mass with central calcification extending 7 cm cephalocaudally. The patient underwent exploratory laparotomy, followed by chemotherapy. Findings on light microscopic and immunohistochemical examination of the retroperitoneal mass were consistent with a ganglioneuroblastoma that expressed CRH, pro-opiomelanocortin, and ACTH. CONCLUSION The evaluation of Cushing's syndrome is one of the most complex endocrine challenges. In this case, it was due to ectopic production of CRH by a ganglioneuroblastoma. Because most CRH-producing tumors also secrete ACTH, the ectopic production may represent a paracrine phenomenon in addition to an endocrine phenomenon. The ectopic CRH may also indirectly provoke pituitary ACTH secretion. This dual mechanism may explain the resistance of the tumor to feedback inhibition and a CRH-stimulation response indistinguishable from that observed in pituitary-dependent Cushing's syndrome.
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Affiliation(s)
- Farhad Zangeneh
- Division of Endocrinology, Diabetes, Metabolism, Nutrition and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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