pituitrin and Intestinal-Perforation

Topics: Anesthesia; Diverticulum, Colon; Humans; Hypotension; Intestinal Perforation; Male; Middle Aged; Norepinephrine; Postoperative Complications; Receptors, Adrenergic; Sepsis; Sympathomimetics; Vasoconstrictor Agents; Vasopressins

In this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery. The use of such high doses of vasopressin for this type of shock is not described in the literature.. A 49-year-old white woman with grade III obesity, Crohn's disease, and an intestinal perforation presented with refractory septic shock. Initially, a low dose of vasopressin was used. Then, the dosage was increased to 0.4 U/minute; in the literature, this is defined as "salvage therapy." This therapy consists of an initial load followed by a continuous infusion of hydrocortisone.. The significant increase in her cardiac index and stroke volume index resulted in an improvement in peripheral resistance, gas exchange, and urine output and a decrease in her heart rate, interleukin-6 level, and tumor necrosis factor-α level. The administration of high doses of vasopressin and corticosteroids was demonstrated to be safe for the immune system, to reduce the systemic inflammatory response, and to have direct cardiovascular effects. Further studies are required to examine the use of vasopressin as an initial vasopressor as well as its use in high dosages and in combination with corticosteroids.

Topics: Acute Disease; Anti-Inflammatory Agents; Crohn Disease; Drug Therapy, Combination; Female; Humans; Hydrocortisone; Ileocecal Valve; Intestinal Perforation; Middle Aged; Obesity, Morbid; Shock, Septic; Tomography, X-Ray Computed; Vasoconstrictor Agents; Vasopressins

After induction of cecal perforation, 20 anesthetized sheep were randomized to be treated, when arterial blood pressure fell below 75 mm Hg, with vasopressin (fixed dose of 0.02 U/minute), norepinephrine (0.5-5 microg/kg/minute titrated to maintain mean arterial pressure between 75 and 85 mm Hg), vasopressin + norepinephrine (vasopressin at fixed dose 0.01 U/minute plus norepinephrine titrated as for norepinephrine only group), or no vasopressor (Ringer's lactate [control]). Mean arterial pressure was well maintained in all treatment groups. Superior mesenteric arterial blood flow was significantly lower in the vasopressin + norepinephrine group than in the vasopressin group. Vasopressin alone or combined with norepinephrine limited the increase in blood lactate concentration and ileal PCO2-gap compared with control and norepinephrine groups. Urine output was higher in the vasopressin group than in control and norepinephrine groups. Survival time was longer in the vasopressin (30 +/- 6 hours) and vasopressin + norepinephrine (30 +/- 3 hours) groups than in the norepinephrine group (20 +/- 1 hours, p < 0.05) and in all treatment groups than in the control group (17 +/- 2 hours, p < 0.05). Tissue injury was less severe in the vasopressin and vasopressin + norepinephrine groups than in the others. In this clinically relevant model of septic shock due to peritonitis, vasopressin administration (alone or with norepinephrine) can prolong survival.

Topics: Animals; Blood Pressure; Carbon Dioxide; Cecum; Ileum; Intestinal Perforation; Isotonic Solutions; Lactates; Mesenteric Arteries; Norepinephrine; Proportional Hazards Models; Random Allocation; Ringer's Lactate; Sheep; Shock, Septic; Splanchnic Circulation; Statistics, Nonparametric; Survival Rate; Vasoconstrictor Agents; Vasopressins

A patient with perforated appendicitis developed progressive vasodilatory shock which was complicated by perioperative acute myocardial infarction. Cardiovascular support included dopamine infusion, and later, intra-aortic balloon counterpulsation balloon pump and noradrenaline and dobutamine infusion. Vasopressin was introduced as a final attempt to reverse the refractory shock and was associated with recovery. The experience with this case suggests that vasopressin may be a valuable adjunct to the treatment of catecholamine-resistant vasodilatory shock.

Topics: Adrenergic alpha-Agonists; Adrenergic beta-Agonists; Aged; Appendicitis; Cardiotonic Agents; Dobutamine; Dopamine; Humans; Infusions, Intravenous; Intestinal Perforation; Intra-Aortic Balloon Pumping; Intraoperative Complications; Male; Myocardial Infarction; Norepinephrine; Recovery of Function; Shock; Vasoconstrictor Agents; Vasodilation; Vasopressins

The current state of endoscopic polypectomy of the large intestine is analysed. The indications for this treatment and the main complications arising (haemorrhages, perforations, colonic rupture) are evaluated with details of possible treatment and/or prevention. The connections with histology and surgery are also discussed. Finally, the treatment and follow-up of cancerised rectocolonic polyps are discussed in detail.

Topics: Arginine Vasopressin; Electrocoagulation; Epinephrine; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Intestinal Perforation; Intestinal Polyps; Intestine, Large; Laser Therapy; Postoperative Complications; Rupture; Vasopressins

A case of solitary cecal ulcer with major hemorrhage followed by perforation after treatment with intra-arterial vasopressin in a patient with end-stage renal failure is presented. Though vasopressin has been used with success in the treatment of colonic hemorrhage, caution should be applied in patients with a bleeding cecal ulcer as the vasoconstriction produced by vasopressin may cause perforation in an area whose blood supply is already compromised.

Topics: Cecal Diseases; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Perforation; Kidney Failure, Chronic; Middle Aged; Radiography; Ulcer; Vasopressins

Topics: Abortion, Criminal; Abortion, Legal; Adult; Amniocentesis; Amnion; Amniotic Fluid; Female; Humans; Hydatidiform Mole; Hypernatremia; Hypertonic Solutions; Intestinal Perforation; Maternal Mortality; Oxytocin; Postoperative Complications; Potassium; Pregnancy; Punctures; Sodium; Surgical Wound Infection; Uterine Hemorrhage; Uterine Rupture; Vasopressins; Water-Electrolyte Balance