Histamine release in the course of elective conventional cholecystectomy in aged patients: Problems in defining release in relation to specific intraoperative events

The effectiveness of an H₁ ⁻+H₂-prophylaxis against perioperative acute pseudoallergic reactions in which histamine is involved, and against postoperative complications the incidence of which may be increased by these reactions, was the central problem of a randomized trial in 162 aged patients during elective conventional cholecystectomy. As main endpoint it was planned to use the systemic histamine release reaction, as it already had been defined for the conscious and anaesthetized human subject. However, it had to be reassessed and redefined for the intraoperative period after improvement of the plasma histamine assay and new findings about stress-induced histamine release and the kinetics of histamine release during certain phases of operation.

Intraoperative release is, at present, defined solely as an increase of plasma histamine values after a particular action (phase of operation). It includes criteria concerning plasma histamine changes either in comparison to the base value before surgery or to the preceding value before the last surgical action. Histamine elevations must exceed the last value by more than 3 standard deviations of the analytical error (i.e. 200% if value <0.25 ng/ml and 40% above). Basic requirements for the histamine assay (quality control), correct sample taking and appropriate preparation have to be fulfilled over the whole trial period. When these criteria were applied to the 162 patients an overall incidence of histamine release during cholecystectomy of 55.6% was found with 9.7–20% during an individual phase of operation. The data of this study, performed under routine conditions, with a sufficient number of patients with elevated risk and event controlled plasma histamine values, lead to a better understanding of intraoperative histamine release, its incidence and extent.

     

Histamine release in conventional versus minimally invasive surgery: Results of a randomised trial in acute cholecystitis

Inflammation Research -     

180例老年腹腔镜胆囊切除术的临床分析

目的 探讨腹腔镜胆囊切除术(LC)在治疗老年胆囊结石中的临床价值。方法 回顾分析老年组180例围手术期的处理，特别是对并存有心血管系统、呼吸系统、糖尿病、肝硬化、急性胆源性胰腺炎等疾病的诊治，以及对手术时机、适应证的选择等，与同期非老年组840例临床资料作统计学分析。结果 172例(95．7％)LC成功，8例中转开腹手术，22例术中心率失常，33例术中出现血压升高或大幅度波动，4例术后引流管短暂胆汁漏，8例术后出现肺部感染。本组病例恢复好，无死亡。结论 虽然老年组LC风险相对较非老年组大，只要重视围手术期处理和监护，把握手术时机和合适的适应证，LC对老年人同样是安全并能获得满意的疗效。     

Histamine release test in the diagnosis of human hydatidosis

An evaluation of the use of the histamine release test (HRT) in the diagnosis of human hydatidosis is presented. This technique, which makes it possible to evaluate directly IgE dependent immediate hypersensitivity by measuring the histamine released from leucocytes (basophils) after antigenic challenge, was compared with the detection of serum specific IgE by the radio-allergosorbent test (RAST), and with the determination of serum specific IgE by the enzyme-linked immunosorbent assay (ELISA). Of the 54 patients with hydatidosis, all were positive according to HRT, 42 according to RAST and 47 according to ELISA. No false positive results were obtained by HRT in 43 patients with parasitosis other than hydatidosis, however, of these 43, 10 resulted in false positives according to RAST and five according to ELISA. It is concluded that HRT is more sensitive and more specific than RAST and ELISA.     

人嗜碱性粒细胞在不同刺激物作用下的组胺释放能力

目的:研究蛋白酶激活受体2(PAR2)激动剂和肝素等,对嗜碱性粒细胞组胺释放的影响。方法:用Ficoll进行密度梯度离心分离外周血单个核细胞(PBMC)。经Hank’s平衡盐溶液(HBSS)重新悬浮后进行嗜碱性粒细胞激发实验,用酶联免疫试剂盒来检测组胺的水平。结果:浓度为10mg/L胰蛋白酶可引起嗜碱性粒细胞释放组胺,其作用强度较抗IgE抗体、钙离子载体(CI)及P物质等为弱。PAR2特异性激动肽SLIGKVNH2对嗜碱性粒细胞没有明显的激活作用,但抗IgE抗体、CI、FMetLeuPhe(FMLP)、C5a及P物质可引起嗜碱性粒细胞显著的组胺释放。肝素、C5和腺苷在试验浓度内未引起组胺释放,但肝素可显著增加C5a和P物质诱导的组胺释放。结论:胰蛋白酶、抗IgE抗体、CI、FMLP、C5a及P物质均可诱导嗜碱性粒细胞显著地释放组胺。PAR2激动肽SLIGKVNH2不能引起组胺释放,肝素可增加P物质和C5a引起的组胺释放,具有放大嗜碱性粒细胞激活信号的作用。     

十二指肠镜联合腹腔镜手术治疗老年胆囊结石合并胆总管结石124例

目的探讨十二指肠镜联合腹腔镜续贯治疗老年患者胆囊结石合并肝外胆管结石的疗效。方法回顾分析2010年1月至12月246例老年患者（年龄大于等于60岁）胆囊结石合并肝外胆管结石的临床资料,按手术方式的不同分为微创组和传统手术组。微创组（n=124）采用十二指肠镜下内镜乳头括约肌切开术（EST）取石再行腹腔镜胆囊切除术（LC）,传统手术组（n=122）采用传统开腹胆囊切除术胆总管切开取石T管引流术,对比两组住院时间、并发症和结肠功能恢复时间等。结果微创组与传统手术组比较,住院时间短、并发症低和术后结肠功能恢复时间短,差异均有明显的统计学意义（P〈0．01）;两组手术时间无统计学差异（P〉0．05）。结论十二指肠镜联合腹腔镜续贯治疗老年胆囊结石合并肝外胆管结石具有微创、安全、疗效良好等优点。     

Postpartum depression: in relation to life events and patterns of coping

Summary The purpose of this study was to estimate the prevalence of postpartum depression (PPD) and its relationship with life events (LE) and patterns for coping. We performed a cross-sectional study of 113 women, on the 10^th day of puerperium, at the Obstetric Clinic of the São Paulo University Medical School. The study was based on the following: Pitt (1967) and Stein (1980) Scales, Beck Depression Inventory (1961), Holmes and Rahe Schedule of Recent Events (1967), Folkman and Lazarus Ways of Coping (1985) and questionnaire of social-demographic and obstetric data. Logistic regression was performed to calculate prevalence of PPD and its association with several risk factors. The significance level was defined at 5%. The prevalence of PPD was 15.9% (IC 9.7% to 24.0%). According to the multivariate analyses, the variables of coping with distancing, number of children and ethnic origin were significant. There were no association between PPD and LE. The depressed puerperal women have a low educational level, greater number of children and resort to inadequate coping strategies, such as distancing. This pattern of coping might be an etiological factor of the PPD as well as a reaction to their difficult life environment.     

Histamine release during the induction of anesthesia with propofol in allergic patients: A comparison with the induction of anesthesia using midazolam-ketamine

OBJECTIVE: A prospective randomized controlled study was performed for patients with a history of allergy to evaluate the effect of the induction of anesthesia with propofol against histamine release, skin reactions, hemodynamic changes and other clinical symptoms, while also comparing these parameters during the induction of anesthesia with midazolam-ketamine for patients with a history of allergy. SUBJECTS: We examined 40 patients undergoing oral surgery, who had a history of allergy and/or the percentage of eosinophils in the leukocytes was more than 3%. METHODS: Forty patients were randomly allocated into two groups and thus received either midazolam-ketamine (M-K group, n = 20) or fentanyl-propofol (propofol group, n = 20) for the induction of anesthesia. Venous blood samples (4 ml each) were obtained before induction as a control and at 0.5, 1, 3, 5 minutes after the administration of each induction agent, and then furthermore at 0.5, 1, 3, 5 minutes after tracheal intubation in order to measure the plasma histamine level by using the HPLC post-label system. In addition, the blood pressure and heart rate were also simultaneously recorded. Skin reactions were also evaluated by two anesthesiologists. RESULTS: The incidence of 50% histamine release during the induction of anesthesia with propofol occurred in 15% of the patients with a history of allergy. Sixteen patients out of 20 (80%) showed a decrease in the systolic blood pressure after the administration of propofol without any evidence of histamine release. The incidence of 50% histamine release, skin reactions and an increase in the heart rate between the two groups were not statistically significant after the administration of each anesthetic agent. Moreover, some patients also demonstrated histamine release after tracheal intubation. Hemodynamic changes after tracheal intubation showed a similar tendency in both groups. No significant difference was observed regarding the incidence of histamine release, skin reactions and hemodynamic changes between both groups after tracheal intubation. CONCLUSIONS: Propofol was found to show a similar incidence of histamine release during the induction of anesthesia using midazolam-ketamine, and thus was also found to be a useful induction agent against histamine release for patients with a history of allergy when hydroxizine was used as a premedication.     

Histamine release test in comparison to standard tests in diagnosis of childhood allergic asthma.

An allergen-specific histamine release test (HR) was investigated in 93 children with a history of extrinsic asthma and suspected allergy to house dust mite or fungi. For both allergy groups the correlations between HR and the bronchial provocation test were better than those between the inhalation test and prick test or RAST. It is concluded that, especially in childhood where performance of a bronchial provocation should be avoided because of its potential risk and required hospitalization, the HR test can represent a significant diagnostic aid.     

Histamine and mast cell distribution in the gastrointestinal wall of the rat: comparison between germ-free and conventional rats

The distributions of histamine and mast cells in the intestinal mucosa have been studied in conventional (CV) and germ-free (GF) rats. Both distributions do not appear to be uniform throughout the gastrointestinal tract. The presence of digestive microflora influences these distributions: more histamine and mucosal mast cells are present in the small intestine of CV than in GF rats. Paradoxically the opposite is observed in the large intestine. Differences in mast cell counts in the crypt area of the small intestine (higher in CV than in GF rats) confirm the role of microflora on crypt cell proliferation due to a mild chronic inflammation. In the large intestine, however, the microflora appears to have a more complex influence and could act indirectly on histamine turnover.     

腹腔镜胆囊切除对患者生存质量与医疗效率影响的研究

目的比较腹腔镜手术（LC）与开腹手术（OC）行胆囊切除术的患者生存质量的差异，阐析腹腔镜手术的医疗效率。方法采用GIQI生存质量指标测定40例腹腔镜胆囊切除术及40例开腹胆囊切除术患者在术前及术后2、5、10、16周的生存质量值。结果LC组和OC组术前平均GLQI指数分别为110分和109分（P〉0.05）。Lc组患者术后2周时的GLQI指数为108分，下降不明显（P〉0.05），手术5周以后，GLQI指数和主观症状、躯体生理功能状态、心理情绪状态各方面均显著高于术前（P〈0．05）。OC组患者术后2周时GLQI指数为101分，降幅明显（P〈0．05），术后5周时GLQI指数为108分，恢复至术前水平（P〉0．05），手术10周以后，GLQI指数和上述3项分值均明显超出术前水平（P〈0．05）。手术10周内，LC组GLQI指数显著高于OC组（P〈0．05）。结论腹腔镜胆囊切除手术较开腹手术更有利于患者术后恢复，能提高生活质量和医疗效率。