Publications (6)1.86 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Surgery for esophageal cancer is one of the most invasive treatments in gastrointestinal surgery. The aim of this study was to analyze perioperative kinetics of coagulation-fibrinolytic states in comparison with cytokines in order to investigate biological responses to surgical stress in patients undergoing esophagectomy. Serum or plasma samples of 20 patients with esophageal cancer who had undergone esophagectomy were collected during the perioperative period. Serial concentrations of cytokines (IL-6, IL-8, IL-10), PMN-E, and coagulation-fibrinolytic agents (TAT and PIC) were measured and analyzed. There were significant increases in concentrations of both inflammatory and anti-inflammatory cytokines during the operative and postoperative courses. TAT and PIC levels also increased significantly intra- and postoperatively. The TAT/PIC ratio was elevated simultaneously with a predominance of inflammatory cytokines over anti-inflammatory ones. In addition to the profile of cytokines, the TAT/PIC ratio seems to be a sensitive and useful indicator in evaluating biological responses to surgical stress.
- [Show abstract] [Hide abstract] ABSTRACT: Endotoxin-induced liver failure is characterized by necrosis and apoptosis of hepatocytes. The aim of this study was to establish the relation of the time-course of hepatic parenchymal cell apoptosis and necrosis in a murine endotoxin shock model and to characterize the role of the gene products of Bcl-2 and Bax in endotoxin-mediated hepatocellular apoptosis. Male Wistar rats were treated with 5 mg/kg body weight endotoxin, and the necrosis and apoptosis of hepatocytes were assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining and enzyme-linked immunosorbent assay for DNA fragmentation. Furthermore, Bcl-2 and Bax were analyzed by Western blotting. Endotoxin treatment led to liver dysfunction, and increased hepatic parenchymal cell apoptosis. Necrotic changes in hepatic tissues were found after the appearance of apoptosis. The apoptotic index increased up to 12 hours after endotoxin treatment. Western blot analysis revealed that the apoptosis was accompanied by a decrease of Bcl-2 protein and a relative increase of Bax protein. The apoptotic index decreased at 24 hours after the treatment synchronously with an increase in the ratio of Bcl-2 and Bax. These results demonstrate a significant role of hepatocellular apoptotic processes in the later development of necrosis in the liver. The kientics of this apoptosis are directly proportionate to the disturbed ratio of Bcl-2 and Bax.
- [Show abstract] [Hide abstract] ABSTRACT: Postoperative delirium has in recent years been a common complication which can interfere with the recovery of patients after surgery. Unfortunately there is still no medical procedure available which can completely prevent the occurrence of postoperative delirium. Haloperidol is a psychopharmacological agent that has been used to treat the delirium and agitation, especially in geriatric patients. To assess the effectiveness and safety of the use of haloperidiol for the reduction of postoperative delirium, we performed a randomized, comparative clinical study in which 78 patients who underwent gastrointestinal surgery received either 5 mg of haloperidol intravenously postoperatively at 21:00 for 5 consecutive days, or normal saline with the same schedule. Postsurgical evaluation revealed the incidence of postoperative delirium to be only 10.5% (4 of 38 patients) in the group receiving haloperidol treatment, compared to 32.5% (13 of 40 patients) in the saline treatment group. No significant neuroleptic side effects were seen in any of the patients. These results suggest that daily postoperative administration of haloperidol can reduce the occurrence of postoperative delirium safely.
- [Show abstract] [Hide abstract] ABSTRACT: We encountered a rare case of primary sclerosing cholangitis (PSC) localized in the intrahepatic bile duct (IHBD) (B7). A 71-year-old man was fond to have an abnormal mucosa in the stomach at a medical examination visited our hospital and was diagnosed with gastric cancer by an upper GI seies. At the same time, ultrasonography and a CT scan revealed dilation of the IHBD (B7). Endoscopic retrograde cholangiography did not indicate IHBD (B7) and PTC revealed dilatation and stenosis of IHBD (B7). Distal partial gastrectomy and posterior segmentectomy of the liver were performed with the diagnosis of gastric cancer and a suspicion of hepatolithiasis or cholangiocelluler carcinoma. The surgical specimen showed dilatation and stenosis of IHBD (B7), and no tumor formation or stone. Histological examination revealed periductal fibrosis with infiltration of inflammatory cells. We made the final diagnosis of intrahepatic localized PSC. To the best of our knowledge, this is the first of an intrahepatic localized PSC in our country. Surgical resection should be performed for the localized type of PSC, because of progress of this disease and its rare combination with cholangiocellular carcinoma.
TTJ, Tottori, Japan
- Faculty of Medicine