S. Nistrup Madsen

Influence of Epidural Analgesia on the Catecholamine and Cyclic AMP Responses to Surgery

The effects of neurogenic block on plasma concentrations of adrenaline, noradrenaline and cyclic AMP were studied. Eighteen patients were subjected to surgery of moderate or minor extent under enflurane anesthesia with or without epidural analgesia. The results show that adrenaline secretion during surgical stress is a response to neurogenic stimuli, since the increase found in patients subjected to hysterectomy under general anesthesia is blocked by the addition of epidural analgesia. Furthermore, plasma adrenaline after neurogenic block is comparable with adrenaline levels during minor surgical stress.

Thyroid adenylate cyclase stimulating immunoglobulins in thyroid diseases.

The occurrence of serum immunoglobulins with capacity to stimulate thyroid adenylate cyclase (TSAb) was studied in seventy‐two healthy volunteers and 120 unselected patients with various thyroid diseases. A high frequency of TSAb (82.5%, P>0.00006) was found in Graves’disease, while TSAb was present only in 13–20% of serum from patients with nontoxic nodular goitre, nontoxic diffuse goitre, toxic adenoma, toxic nodular goitre and myxoedema. These patients had low level of TSAb compared to patients with Graves’disease. In patients with Graves’disease there was no correlation between the level of TSAb and hormonal status except serum triiodothyronine (rs=0.29, P<0.05), and no relation with eye involvement or presence of microsomal thyroid antibodies was found.

Influence of Morphine Anaesthesia on the Endocrine‐Metabolic Response to Open‐Heart Surgery

Twelve patients scheduled for aortic valve replacement during extracorporal circulation were randomly allocated to either morphine anaesthesia or fluroxene anaesthesia. Morphine in a total dose of 4 mg/kg was administered bcforc skin incision. At the start of extracorporal circulation all patients received 25 g glucose intravascularly. The endocrine‐metabolic response to surgery, as expressed by changes in plasma ACTH, cortisol, insulin, growth hormone, cyclic adenosine ‐3′, ‐5′‐monophosphate (cyclic AMP), glucose, free fatty acids, blood b‐hydroxy‐butyrate and cumulative nitrogen balance was measured before and during anaesthesia and surgery, and on the first five post‐operative days.

L-thyroxine treatment of diffuse non-toxic goitre evaluated by ultrasonic determination of thyroid volume.

The effect of a daily dose of 150 μg 1‐thyroxine for one year was studied in forty‐five patients with diffuse non‐toxic goitre. Thyroid volume was evaluated by ultrasonic scanning. A decrease in the median value of the thyroid volume of about 20% was found after 3 months of therapy and no further change in the median value was observed in the following 9 months of treatment. About 50% of the patients showed a response to therapy and about 30% obtained normal size of the thyroid gland. Median value of the thyroid volume returned to pretreatment value 3 months after thyroxine therapy was stopped.