Dysregulation of atrial natriuretic factor in hypertension-prone man

To evaluate the hypothesis of an atrial natriuretic factor (ANF) deficiency in hypertension-prone humans, we investigated plasma ANF and other variables in 116 white offspring of normotensive parents (ONorm) or essential hypertensive parents (OHyp). Ten ONorm and 10 OHyp, all men matched for age and body habitus, were studied after 4 days of low (70 mmol/day) and high (350 mmol/day) dietary sodium intake. After mild sodium restriction, plasma ANF did not differ between ONorm and OHyp (9.7 +/- 0.7 vs. 9.0 +/- 1.3 fmol/L). On high sodium intake, plasma ANF increased in ONorm, but not in OHyp (to 18.3 +/- 1.7 vs. 11.7 +/- 1.7 fmol/L; P less than 0.001). On the other hand, acute responses of plasma immunoreactive ANF (irANF) to saline loading or a norepinephrine-induced rise in blood pressure did not differ significantly between 8 ONorm and 8 OHyp. Fifty-one additional ONorm and 45 OHyp were evaluated during liberal sodium intake. Groups were further subdivided according to whether 24-h urinary sodium excretion was 91 mmol/m2 or less (modest salt intake) or more than 91 mmol/m2 (high salt intake). Twenty-four-hour urinary sodium was similar in the 26 ONorm and 21 OHyp on a modest salt intake (121 +/- 6 vs. 116 +/- 9 mmol) and in the 25 ONorm and the 24 OHyp on a high salt intake (226 +/- 10 vs. 221 +/- 9 mmol). However, compared with ONorm, plasma irANF in OHyp was slightly lower on modest sodium intake (7.7 +/- 0.7 vs. 5.3 +/- 0.7 fmol/L; P less than 0.05) and markedly reduced on high sodium intake (15.0 +/- 1.3 vs. 8.0 +/- 1.3 fmol/L; P less than 0.001). Moreover, the slope of the relationship between plasma irANF and 24-h urinary sodium was flatter in OHyp than in ONorm (z test = 2.4). We postulate a new endocrine syndrome characterized by a relative plasma ANF deficiency during high sodium intake in some hypertension-prone humans. This functional defect becomes apparent during chronic, rather than acute, stimulation of ANF release. It occurs as a familial disturbance and may potentially predispose to the development of hypertension.     

Safety of Gastric Resections During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis

Background  Cytoreductive surgery (CRS) including gastric resection combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve the prognosis of selected patients with peritoneal surface malignancies. Perioperative morbidity of this aggressive treatment strategy is high; however, overall mortality can be low in specialized centers. The aim of this study was to assess the safety of gastric resections with anastomosis during CRS and HIPEC. Methods  Between 2005 and 2008, 204 patients underwent CRS and HIPEC at our tertiary referral centre. Of these, 37 procedures (male/female 24/13, median age 55 years) included gastric resections. The clinical data of all patients were introduced into a database and analyzed with respect to the morbidity associated with the gastric resections. Results  Of all patients included, 16 had pseudomyxoma peritonei, 11 gastric carcinoma, 4 ovarian carcinoma, 3 malignant peritoneal mesothelioma, and 3 colon carcinoma. Twenty-seven patients had previous surgery (n = 22) and/or systemic chemotherapy (n = 18). Fifteen total gastrectomies, 3 subtotal gastrectomies, 12 distal gastrectomies, and 7 gastric wedge resections were performed during CRS. The overall postoperative morbidity was 45%; main surgical complications were pancreatitis (n = 6), abdominal abscess (n = 4), bile leakage (n = 2), and digestive fistula (leakage of ileorectostomy and small bowel perforation) (n = 2). However, no complications occurred at the site of the esophageal anastomosis (n = 15), gastric anastomosis (n = 15) or gastric suture (n = 7). No patient died postoperatively during the hospitalization period. Conclusions  CRS in combination with HIPEC is associated with high postoperative morbidity; however, anastomosis following total or subtotal gastrectomy is safe in experienced centers. No leakages related to gastric resections occurred in this high-risk patient group. Pompiliu Piso and Przemyslaw Slowik have contributed equally to this study.     

Pre- and post-transplant care: nursing management of the renal transplant recipient: part 2

This is the second article in a three part continuing education series on renal transplantation which addresses the specialised knowledge and skills required in order to prepare a patient admitted to hospital for renal transplantation and then how to care for that patient afterwards. The first article in this series addressed patient health and well-being while waiting for a renal transplant. The third article will look at the long-term care of kidney recipients.     

Rare diaphragmatic complications following cytoreductive surgery and HIPEC: report of two cases

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proven to be an effective treatment modality for selected patients with peritoneal surface malignancies. The most common surgical complications after CRS and HIPEC are anastomotic leakage, intestinal obstruction and peripancreatitis. This case report presents two patients with early and late postoperative diaphragmatic hernia after CRS and HIPEC. One patient that initially had pseudomyxoma peritonei complained of persistent chest pain and dyspeptic disorder after peritonectomy and HIPEC and underwent reoperation due to a left diaphragmatic hernia containing the splenocolic flexure. The other patient had gastric cancer and peritoneal carcinomatosis and developed anastomotic leakage of the transverse colon anastomosis and pleural empyema. Stripping of the diaphragm is often performed during CRS, sometimes combined with diaphragmatic resection. A herniation through a diaphragmatic defect is rarely diagnosed during either the early or late postoperative period. Direct suture of the defect or closure with synthetic or biological tissue are possible surgical techniques for repair with a good prognosis.     

Peritonealkarzinose bei gastrointestinalen Malignomen

Peritoneal carcinomatosis is defined as the seeding of malignant cells in the peritoneum. In primary peritoneal carcinomatosis, the cancer cells originate from the peritoneum itself, whereas they spread from another solid tumor in secondary peritoneal carcinomatosis. Amongst tumors of gastrointestinal origin, metastases from colorectal cancer are the most common, although the incidence in gastric cancer (30?%) is higher. The best method for diagnosis is computer tomography of the abdomen (with intravenous, oral, and rectal administration of contrast agent). Systemic chemotherapy is significantly less effective in patients with peritoneal metastases than in patients with metastases in solid organs (e.?g. liver). Carefully chosen patients can be treated with cytoreductive surgery (CRS) in combination with intraabdominally applied hyperthermic intraperitoneal chemotherapy (HIPEC). The prognosis is highly dependent on the histology of the primary tumor as well as the extent of peritoneal seeding; the life expectancy can be between a few months and several years.     

A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*

BACKGROUND:

Currently, no tumor‐node‐metastasis (TNM) staging system exists for patients with diffuse malignant peritoneal mesothelioma (DMPM). The primary objective was to formulate a clinicopathological staging system through the identification of significant prognostic parameters.

METHODS:

Eight international institutions with prospectively collected data on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy contributed to the registry. Two hundred ninety‐four patients had complete clinicopathological data and formed the basis of this staging project.

RESULTS:

Peritoneal cancer index (PCI) was categorized into T₁ (PCI 1‐10), T₂ (PCI 11‐20), T₃ (PCI 21‐30), and T₄ (PCI 30‐39). Twenty‐two patients had positive lymph nodes (N₁) and 12 patients had extra‐abdominal metastases (M₁). The survival for patients with T₁ (PCI 1‐10) N₀ M₀ was significantly superior to the other patients. This group of patients is therefore designated as Stage I. The survival of patients with T₂ (PCI 11‐20) and T₃ (PCI 21‐30), in absence of N₁ or M₁ disease, was similar. This group of patients was categorized as Stage II. The survival of patients with T₄ (PCI 30‐39), N_1, and/or M₁ was similarly poor. This group of patients was therefore categorized as Stage III. Three prognostic factors were independently associated with survival in the multivariate analysis: histological subtype, completeness of cytoreduction, and the proposed TNM staging. The 5‐year survival associated with Stage I, II, and III disease was 87%, 53%, and 29%, respectively.

CONCLUSIONS:

The proposed TNM staging system resulted in significant stratification of survival by stage when applied to the current multi‐institutional registry data. Cancer 2011. © 2010 American Cancer Society.     

Stentgraftimplantation bei Erkrankungen der Aorta ascendens

The endovascular deployment of stent graft in the ascending aorta was proposed for inclusion in the benefit catalogue of the Austrian Federal Ministry of Health. The efficacy and safety of this intervention was unclear, and therefore a systematic review was performed to support evidence-based decision making. Detailed searches for English- or German-language articles published between 2002 and 2008 were performed in a number of electronic databases. Internal validity of studies was judged by two authors independently. A total of 11 case reports but no prospective studies were identified through literature search. The case reports showed the technical feasibility of this intervention but allow no conclusions about its efficacy and safety. Therefore the endovascular deployment of stent graft in the ascending aorta must be considered as experimental and its inclusion in the benefit catalogue cannot be recommended.     

Neuroendokrine Tumore des Magens Chirurgische Therapie und Prognose

Gastric carcinoid tumors are rare lesions characterized by hypergastrinemia that arise from enterochromaffin-like (ECL) cells of the stomach. A classification system distinguishing three types of gastric carcinoid tumors has been proposed: 1) tumors related to chronic atrophic gastritis, 2) tumors associated with Zollinger-Ellison syndrome, and 3) sporadic lesions. It is apparent that hypergastrinemia-associated gastric carcinoids show a rather benign biological behavior. Normogastrinemic sporadic lesions, on the other hand, require an aggressive surgical management. We report seven patients with gastric neuroendocrine tumors (“carcinoids”), who underwent surgical treatment in our department between 1988 and 2000. Surgical therapy included total gastrectomy with D2 lymphadenectomy in two cases with type I tumors and for one patient with type III tumor. One patient with a type II tumor was treated by distal subtotal gastrectomy and another by antrectomy. A local excision was performed on one patient with type I tumor. After a mean follow-up of 8 years, 5 of 7 patients are alive without recurrence.     

蜂胶对大鼠实验性胃溃疡的作用

用５种大鼠胃溃疡模型观察了蜂胶乙醇提取液的抗溃疡作用，并探讨其机理。实验结果，蜂胶乙醇提取液能对抗幽门结扎型溃疡的形成（Ｐ＜０．０１），降低胃中的总酸度（Ｐ＜０．０５）和胃蛋白酶活性（Ｐ＜０．０１），还能对抗应激型（Ｐ＜０．０１）、酒精型（Ｐ＜０．０５）和消炎痛型（Ｐ＜０．００１）溃疡的形成，并促进醋酸型溃疡的愈合（Ｐ＜０．０１）。