pituitrin and Intestinal-Obstruction

Topics: Animals; Hypothalamus; Ileal Diseases; Intestinal Obstruction; Male; Rats; Rats, Inbred Strains; Supraoptic Nucleus; Vasopressins

Topics: Abdomen; Autonomic Nervous System; Axons; Constipation; Cranial Nerves; Depression; Diabetic Neuropathies; Drug Interactions; Hallucinations; Humans; Hyponatremia; Hypotension, Orthostatic; Intestinal Obstruction; Muscular Atrophy; Nervous System Diseases; Neural Conduction; Norepinephrine; Pain; Paresthesia; Parkinson Disease; Peripheral Nervous System Diseases; Seizures; Vasopressins; Vincristine

Our objective was to determine the least invasive surgical procedure; to do this we compared postoperative pain, duration of ileus, and level of neurohormonal stress response after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). Postoperative recovery of patients was faster after LC than OC but comparison of the neurohormonal stress response after laparoscopic and open surgical procedures revealed conflicting results. Forty-one consecutive patients with noncomplicated gallstones were randomized for LC (N = 25) and OC (N = 16). The stress level was evaluated in patients before surgery by the Hamilton anxiety scale. Postoperative pain was assessed by a visual analogic scale (VAS) pain score and by the amount of analgesic drugs (propacetamol) administered, while the duration of ileus was determined by the delay between surgery and the time to first passage of flatus as well by the colonic transit time (CTT) measured by radiopaque markers. Plasma concentrations of anti-diuretic hormone (ADH), adrenocorticotropic hormone (ACTH), beta-endorphin (BE), neurotensin (NT), and aldosterone (Ald) were measured before and during surgery as well as 2 and 5 hr after the surgery (D0) and on the day following surgery (D1). Urinary cortisol (uCOR) and urinary catecholamine metabolites were assessed before surgery, during D0, and on D1. Patient characteristics, the duration of surgery, and the doses of anesthetic drugs were not different in LC and OC. In LC patients the VAS pain score and the doses of postoperative antalgics were lower (P < 0.05), the time to first passage of flatus was shorter (P < 0.001), and the CTT tended to be shorter (54 +/- 12 hr vs 81 +/- 17) compared to OC patients. Patients who required the highest doses of postoperative antalgics had the longest delay to first passage of flatus (P < 0.01). During surgery, all neurohormonal parameters increased compared to the preoperative period (P < 0.05), and only plasma NT concentrations were lower during LC than OC (P < 0.05). During the postoperative period, ACTH, BE, Aid, catecholamines, and uCOR concentrations were lower in LC than in OC (P < 0.05). Concentrations of hormonal parameters were higher when the duration of surgery increased (P < 0.05). A greater need for propacetamol to relieve pain was associated with a greater increase in BE, ACTH, and urinary catecholamine levels (P < 0.05-P < 0.005). When the time to first passage of flatus was delayed, levels of BE, ACTH, and catecholamine

Topics: Adrenocorticotropic Hormone; Analgesics; beta-Endorphin; Catecholamines; Cholecystectomy; Cholecystectomy, Laparoscopic; Female; Humans; Hydrocortisone; Intestinal Obstruction; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Stress, Physiological; Vasopressins

Multiorgan system failure due to hypotension and sepsis is an important cause of death in patients with bowel obstruction. We have investigated the pathophysiology of this entity in an animal model. After 5 days of bowel obstruction, blood flow in the superior mesenteric artery was measured with and without Pitressin and norepinephrine given in separate experiments. In controls, Pitressin in moderate dosages caused a substantial fall in gut blood flow, which was not seen in obstructed animals (blood flow reduction 52 percent vs. 11 percent in sham and obstructed animals respectively, P less than 0.01). Similarly, norepinephrine infusion had less of an effect on gut blood flow in obstructed animals (blood flow reduction 79 percent vs. 58 percent sham vs. obstructed animals (P less than 0.05). Thus, both agents had dose-related effects on gut blood flow, which was maintained at a higher level throughout the drug infusion periods in the bowel of obstructed animals, demonstrating that splanchnic flow is less responsive to vasoactive drug infusion under these experimental conditions. Because splanchnic vasoconstriction is an important feature of normal hemodynamic homeostasis, we suggest that these results may help explain some aspects of the pathophysiology of multiorgan failure caused or worsened by systemic hypotension seen in bowel obstruction.

Topics: Animals; Blood Pressure; Cardiac Output; Colonic Diseases; Female; Intestinal Obstruction; Male; Norepinephrine; Splanchnic Circulation; Swine; Vasopressins

Topics: Carcinoma; Diagnosis, Differential; Exudates and Transudates; Female; Humans; Hyponatremia; Intestinal Obstruction; Middle Aged; Myxedema; Osmolar Concentration; Pelvic Inflammatory Disease; Pelvic Neoplasms; Sodium; Thyroid Hormones; Vasopressins; Water Intoxication; Water-Electrolyte Balance

Topics: Angiotensin II; Bradykinin; Esophageal and Gastric Varices; Fibrinolysis; Humans; Intestinal Obstruction; Pancreatitis; Shock, Hemorrhagic; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adrenal Cortex Hormones; Adrenal Glands; Anuria; Blood Circulation; Blood Glucose; Cortisone; Desoxycorticosterone; Humans; Insulin; Intestinal Obstruction; Mortality; Pituitary Gland, Posterior; Secretory Rate; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Anemia; Appendectomy; Appendicitis; Blood Chemical Analysis; Child; Colonic Diseases; Hernia, Inguinal; Humans; Hypersplenism; Infant; Intestinal Obstruction; Intussusception; Jaundice; Jaundice, Obstructive; Megacolon; Osteomyelitis; Sinusitis; Surgical Procedures, Operative; Thrombosis; Vasopressins; Wilms Tumor

Topics: Adrenal Cortex Hormones; Aldosterone; Arginine Vasopressin; Electrolytes; Intestinal Obstruction; Metabolism; Physiology; Potassium Deficiency; Sodium Chloride; Vasopressins; Water; Water-Electrolyte Balance