1. Plasma concentrations of noradrenaline and adrenaline were measured in 11 anaesthetized patients during normocapnia, hypocapnia and hypercapnia. Hypocapnia was produced by deliberate hyperventilation and hypercapnia by adding carbon dioxide to the inspired gas mixture. 2. With a median (range) arterial partial pressure of carbon dioxide of 4.7 (4.2-5.2) kPa, the median (range) plasma concentration of noradrenaline was 0.41 (0.12-0.94) nmol/l and of adrenaline was 0.15 (0.05-0.31) nmol/l. 3. With an arterial partial pressure of carbon dioxide of 2.6 (2.2-3.3) kPa, there was no change in the plasma concentration of noradrenaline [0.37 (0.12-0.86) nmol/l] or that of adrenaline [0.16 (0.05-0.32) nmol/l]. 4. However, with an arterial partial pressure of carbon dioxide of 10.4 (7.6-13.2) kPa, there were significant increases in the plasma concentrations of both noradrenaline [1.13 (0.79-2.05) nmol/l, P < 0.01] and adrenaline [0.67 (0.20-2.92) nmol/l, P < 0.05]. 5. This is the first demonstration in man that respiratory acidosis causes an increase in plasma concentrations of catecholamines.
Seventy-nine consecutive patients underwent elective laparotomy for symptomatic hepatocellular carcinoma between 1986 and 1992. In the first 4 years, 51 patients received liver resection without intraoperative ultrasonography. In the subsequent 2 years, ultrasonography was performed during operation on 28 patients; three were found to have inoperable tumours. The technique located tumours in two patients and changed the extent of liver resection in another two. Eight of 51 patients (16 per cent) who had the parenchymal transection plane determined clinically had histological evidence of tumour infiltration of the resection margins, compared with none of 25 in whom the plane was determined by ultrasonography. This difference was significant (P = 0.034). The use of intraoperative ultrasonography improved patient survival, although this was not statistically significant. The median survival of patients with adequate resection margins was 9.2 months, compared with 3.9 months in those with inadequate margins. Intraoperative ultrasonography is useful in surgery for hepatocellular carcinoma.
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