Plasma histamine levels in patients in the course of several standard operations: influence of anaesthesia, surgical trauma and blood transfusion

A prospective controlled clinical trial was conducted on changes in plasma histamine and catecholamine levels during 5 standard operations. This communication, as the first part of the trial, deals only with the feasibility of such a trial and the changes in plasma histamine levels. Elevated histamine concentrations corresponding to histamine-release responses of greater than 1 ng/ml occurred in 8 of 25 operations. In an explorative analysis these responses were associated with distinct phases of anaesthesia or the surgical procedure. Blood transfusion carried the risk of infusion of "free histamine" into the patient--especially when administered under pressure. Since during operations "free histamine" enters the circulation with a rather high incidence and may cause harmful effects, premedication with H1-+H2-receptor antagonists seems worth consideration

Symptomloses und kompliziertes Ulcus pepticum als extreme Erscheinungsform der Ulcuskrankheit: Konsequenzen für die Wahl zwischen konservativer und chirurgischer Therapie [Symptomless and complicated peptic ulcer as an extreme clinical form of ulcer disease: consequences for choice between conservative and surgical therapy].

Asymptomatic recurrent ulcers following drugs and surgical therapy are true failures of treatment (Visick IV). Several types of bias at present do not allow any conclusion whether medical treatment and maintenance increase the rate of ulcer complications. The mechanisms of action for medical treatment with cimetidine and operative treatment with SPV are similar, but not identical. Bad compliance and incomplete vagotomies mainly account for success of mutual exchange between the two types of therapy. Using a decision tree with mortality as outcome recommendations are developed for a step-wise therapeutic concept in peptic ulcer patients

Sample taking problems in measuring actual histamine levels of human gastroduodenal mucosa: specific and general relevance in clinical trials on peptic ulcer pathogenesis and selective proximal vagotomy.

Changes in histamine storage in the oxyntic mucosa of duodenal ulcer patients and their reversal by vagotomy and the histamine H2-antagonist cimetidine supported the hypothesis that histamine could be a causal factor in peptic ulcer pathogenesis. The specificity of these findings was impaired by problems in biopsy taking, however, and in the preparative steps before measuring the actual histamine contents in all parts of the gastric mucosa and in the duodenum. A prospective trial was carried out in 190 patients to identify these sources of bias and to overcome them by appropriate study designs. Usually a direct correlation was found between weight of biopsy and mucosal histamine content. This problem was solved by selecting a biopsy forceps producing smaller variations in sample size, by limiting the time of cold ischaemia to four to five minutes only and by taking three biopsy specimens for each single histamine value. The actual histamine content of mucosal biopsies remained constant for about four to five minutes only. The 'disappearance' rate was faster in control subjects than in duodenal ulcer patients. Hence by variation of the cold ischaemia time any artefacts of differences between mucosal histamine levels in controls and duodenal ulcer patients could be produced. Using the optimised sample taking procedure mucosal histamine contents of several gastric regions and the duodenal bulb were measured in 24 patients with duodenal ulcer, after selective proximal vagotomy without drainage and in control subjects without any stomach disease (randomised controlled trial). The histamine content was lower in all parts of the upper gastrointestinal tract in duodenal ulcer patients than in controls and was raised again in all regions after selective proximal vagotomy. As the most likely hypothesis it is suggested that vagal reflexes with afferent fibres coming from the oxyntic mucosa stimulate histamine release in duodenal ulcer patients by efferent peptidergic neurones to all parts of the stomach and the duodenum where the ulcer lesion is situated