The pulmonary vasoconstrictor response to the unilateral administration of 7% oxygen was studied in 10 anaesthetized dogs in which the lungs were mechanically ventilated. The distribution of blood flow between the two lungs was measured continuously by recording the radioactivity in the mixed expired gas from each lung during the infusion i.v. of xenon-133. Infusions of nitroglycerine and sodium nitroprusside which produced the same decrease in mean aortic pressure produced similar decreases in hypoxic pulmonary vasoconstriction. The reduction in arterial PO2 during unilateral hypoxia was greater when the hypoxic vasoconstrictor response was depressed by drugs than it was during the control periods, although mixed venous PO2 was unchanged. It is concluded that both drugs may cause hypoxaemia by increasing the blood flow to alveoli with a low ventilation/perfusion ratio.

No abstract

Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged as an alternative for patients with bilobar colorectal liver metastasis and a small future liver remnant (FLR). In cases of extensive disease, ALPPS can be performed, leaving only one segment of the liver as FLR. We describe a case of monosegmental ALPPS using segment 4 as FLR. In conclusion, ALPPS should be reserved for a selected group of patients. Monosegmental ALPPS is feasible, but should be performed by hepatobiliary surgeons in specialized centers.

Background: Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. Aim: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. Methods: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. Results: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. Conclusions: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.

Objective: the aim of this study was to assess the values of hemodynamic, gasometric and electrolytic parameters, in rabbits submitted to controlled hemorrhagic shock, using an experimental model for catheterization of right carotid artery and jugular vein. Methods: fourteen male California rabbits were submitted to intramuscular anesthesia, and medium cervicotomy was performed for catheterization of right carotid artery and right jugular vein. The animals were bled to a mean arterial pressure of 40mmHg and were maintained at this level, by further blood withdrawal, during 20 minutes, followed by 15 minutes of resuscitation using lactated Ringer's solution and remaining shed blood volume (3:1) to mean arterial pressure equal 80mmHg, and 120 minutes of reperfusion. Arterial blood gas, serum lactate and electrolytes (sodium and potassium) samples were measured at baseline, hemorrhagic shock, at the time of resuscitation, and at the time of reperfusion (30, 60, 90 and 120min). Results: the mean of initial values of hemodynamic parameters were-MAP=82.3mmHg, RR=51.4breaths/min, HR=141.5beats/min; gasometric parameters-pH=7.358, PaCO 2 =46.6mmHg, PaO 2 =271.9mmHg, HCO 3-=25.0mmol/L, base deficit=1.5mmol/L, serum lactate=2.6mmol/L; electrolytic parameters-Na + =131.7mEq/L and K + =3.4mEq/L. Conclusions: this study presents a reproducible model of hemorrhagic shock in Californian rabbits, which describes the progressive hemodynamic and metabolic changes that reflect the changes seen frequently in the clinical situation, besides offers a model to assess novel therapeutics interventions in a controlled setting.

No abstract

Objective: to determine, using a systematic review of meta-analysis studies, whether or not, remote alcohol and smoke are significant risk factors for late-onset Alzheimer's disease. Methods: using a meta-analysis statistics model, 12 case-control studies (6 for alcohol /6 for smoke) published on Medline from 1984 until 1999 which evaluated the interaction between those factors and Alzheimer's disease were investigated. Mantel-Haenszel adjusted odds ratio (OR) and 95% confidence intervals were calculated in stratified data. Epi Info statistical software was used to determine p-value with significant level at 0.05. Results: the studies showed that a prior history of alcohol abuse wasn't associated with late-onset of dementia due to Alzheimer's disease (OR=0.98; 95%CI 0.63 to 1.52; and p-value=0.996). And the other studies showed that a prior history of tabagism wasn't considered as a risk factor for AD (OR=0.70; 95%CI 0.57 to 0.85; and p-value= 0.0004). Conclusions: In this study alcoholism wasn't considered as a risk factor for AD .On the other hand , in people who had the smoke habit, chances of late-onset Alzheimer's development were reduced in 30%. In that case, tabagism was considered as a protector factor for AD.

Colorectal liver metastasis (CRLM) is the most common lesion diagnosed in the liver worldwide and new therapies have been proposed over the last decades. On the leading edge of these therapies, radiofrequency ablation (RFA) has been increasingly applied for treatment these lesions. The procedure can be done by percutaneous approach guided by CT, or during open or laparoscopic surgery. Although findings in preliminary reports suggest that this procedure is both safe and effective, only a few studies have been published. We present a 69-year-old female, previously submitted to two hepatic resections and one RFA for treatment of CRLM, who developed an abdominal wall recurrence due to neoplastic seeding after RFA procedure. In the published literature thus far, some risk factors have been associated with neoplastic seeding following RFA, like subcapsular location, multiple electrode placements, multiple RFA treatments and poor tumor differentiation grade. Technical features like access through normal liver substance and tract needle ablation may play a role in mitigating the risk of this complication. Although it seems to be a safe procedure, only a few retrospective papers have been published its rare complications and outcomes. Nevertheless, patients with localized disease may benefit from surgical resection.