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Surgical Stress (surgical + stress)
Selected AbstractsSurgical stress and tumor behavior: Impact of ischemia-reperfusion and hepatic resection on tumor progression,LIVER TRANSPLANTATION, Issue 12 2007Michitaka Ozaki [source] Role of xanthine oxidase in small bowel mucosal dysfunction after surgical stressBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2000R. Anup Background The small intestine is highly susceptible to surgical stress even at remote locations. An earlier study using a rat model indicated that oxidative stress plays an important role in this process. The enzyme xanthine oxidase is an important source of free radicals in the small intestine. The role of this enzyme in intestinal damage after surgical stress was examined. Methods Rats pretreated with xanthine oxidase inhibitors were subjected to surgical stress by opening the abdomen and handling the intestine, as done during laparotomy. Enterocytes at various stages of differentiation were isolated and the protection offered by xanthine oxidase inhibitors against damage due to surgical stress was determined and compared with normal controls. Protection against ultrastructural changes to the mucosa, as well as mitochondrial function was examined. Results Surgical stress affected both the villus as well as crypt cells, causing increased superoxide generation, accompanied by increased activity of xanthine oxidase. Xanthine oxidase inhibitors ameliorated the increased superoxide generation, and protected against mitochondrial damage and ultrastructural changes in the intestine. Conclusion Surgical stress affects both the villus and crypt cell populations in the small intestine. The enzyme xanthine oxidase maybe an important mediator of surgical stress in the intestine. © 2000 British Journal of Surgery Society Ltd [source] Serum concentrations of high-mobility group box chromosomal protein 1 before and after exposure to the surgical stress of thoracic esophagectomy: a predictor of clinical course after surgery?DISEASES OF THE ESOPHAGUS, Issue 1 2006K. Suda SUMMARY., High-mobility group box chromosomal protein 1 (HMGB-1) has recently been shown as an important late mediator of endotoxin shock, intra-abdominal sepsis, and acute lung injury. However, its role in the systemic inflammatory response syndrome after major surgical stress, which may lead to multiple organ dysfunction syndrome, has not been thoroughly investigated. We hypothesized that serum HMGB-1 participates in the pathogenesis of postoperative organ system dysfunction after exposure to major surgical stress. A prospective clinical study was performed to consecutive patients (n = 24) with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy with three field lymph node resection between 1998 and 2003 at Keio University Hospital, Japan. Serum HMGB-1 concentrations were measured by enzyme-linked immunosorbent assay. Preoperative serum HMGB-1 levels correlated with postoperative duration of SIRS, mechanical ventilation, and intensive care unit stay. Three of the 24 patients had serious postoperative complications: sepsis in two, and acute lung injury in one. Serum HMGB-1 levels in patients without complications increased within the first 24 h postoperatively, remained high during postoperative days 2,3, and then decreased gradually by postoperative day 7. In patients with serious complications, serum HMGB-1 was significantly higher than that found in patients without postoperative complications at every time point except postoperative day 2. Preoperative serum HMGB-1 concentration seems to be an important predictor of the postoperative clinical course. Transthoracic esophagectomy induces an increase in HMGB-1 in serum even in patients without complications. Postoperative serum HMGB-1 concentrations were higher in patients who developed complications, and may be a predictive marker for complications in this setting. [source] Influence for testicular development and histological peculiarity in the testes of flutamide-induced cryptorchid rat modelINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2007Kentaro Mizuno Objectives: To investigate influence for the testicular development and to assess the usefulness as an animal model, cryptorchid rats were induced by exposure to flutamide during the fetal period and their testes examined histologically. Methods: Flutamide was injected into the abdomen of pregnant rats for 7 days from the 14th to 20th day of gestation. The male offspring in which cryptorchidism was observed at 28 days after birth were defined as the model rats. They were divided into four groups by dosage of flutamide (2.5 mg, 5 mg, 7.5 mg, 15 mg per day), and their testicular weight, spermatogenesis (modified Johnsen score), and germ cell apoptosis were examined histochemically at 10 weeks after birth. Results: The incidence of cryptorchidism including both unilateral and bilateral in the 2.5, 5, 7.5 and 15-mg flutamide groups was 58.3%, 81.9%, 93.6% and 91.0%, respectively. In the model rats, the undescended testes were located at the caudal end of the abdominal cavity, and these testes weighed less than the contra-descended testes in each group. Histologically, apoptotic cells were markedly increased, the seminiferous tubules were degenerated and disturbance of spermatid differentiation was observed in the undescended testes compared with the normal or contra-lateral descended testes. Conclusions: We found out that the incidence of undescended testes increased in a flutamide dose-dependent manner. The findings of histological examination were independent of the administrated dose of flutamide and it is suggested that exposure of the testes to abdominal temperature causes spermatogenic arrest with germ cell apoptosis. The present animal model indicates high incidence of above 90%, has no surgical stress and dose not require special techniques. We believe that the present model is a useful tool for the understanding of pathogenesis and treatment of cryptorchidism and further biological research into spermatogenesis. [source] Morphological Substrate of the Catecholaminergic Input of the Vasopressin Neuronal System in HumansJOURNAL OF NEUROENDOCRINOLOGY, Issue 12 2006B. Dudás It has been postulated that the stress response is associated with water balance via regulating vasopressin release. Nausea, surgical stress and insulin-induced hypoglycaemia were shown to stimulate vasopressin secretion in humans. Increased vasopressin release in turn induces water resorption through the kidneys. Although the mechanism of the stress-mediated vasopressin release is not entirely understood, it is generally accepted that catecholamines play a crucial role in influencing water balance by modulating the secretion of vasopressin. However, the morphological substrate of this modulation has not yet been established. The present study utilised double-label immunohistochemistry to reveal putative juxtapositions between tyrosine hydroxylase (TH)-immunoreactive (IR) catecholaminergic system and the vasopressin systems in the human hypothalamus. In the paraventricular and supraoptic nuclei, numerous vasopressin-IR neurones received TH-IR axon varicosities. Analysis of these juxtapositions with high magnification combined with oil immersion did not reveal any gaps between the contacted elements. In conclusion, the intimate associations between the TH-IR and vasopressin-IR elements may be functional synapses and may represent the morphological basis of vasopressin release modulated by stressors. Because certain vasopressin-IR perikarya receive no detectable TH innervations, it is possible that additional mechanisms may participate in the stress-influenced vasopressin release. [source] Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2005Tsung-Jen Huang Abstract The magnitude of the tissue damage from surgery impacts the trauma response. This response is proportional to the severity of surgical stress. Systemic cytokines are recognized as markers of postoperative tissue trauma. Microendoscopic discectomy (MED) recently has become popular for treating lumbar disc herniations, and is associated with favorable clinical outcomes compared with open discectomy (OD). This study postulates that MED is a less traumatic procedure, and therefore has a lower surgical stress response compared to OD. In this study, a quantitative comparison of the overall effects of surgical trauma resulting from MED and OD was performed through analyzing patient systemic cytokines response. From April, 2002 to June, 2003, 22 consecutive patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either intracanalicular MED (N = 10) or OD (N = 12). In this study, the Vertebroscope System (Zeppelin, Pullach, Germany) was used to perform the endoscopic discectomy procedure in all MED patients. Serum levels of tumor necrosis factor-, (TNF-,), Interleukin-1, (IL-1,), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were measured before surgery and at 1, 2, 4, 8 and 24h after surgery using an enzyme-linked immunosorbent assay. Serum C-reactive protein (CRP) was measured at the same time interval. The results showed the MED patients had shorter postoperative hospital stay (mean, 3.57 ± 0.98 vs. 5.92 ± 2.39 days, p = 0.025) and less intraoperative blood loss (mean. 87.5 ± 69.4 vs. 190 ± 115 ml, p = 0.042). The operating length, including the set-up time, was longer in the MED group (mean, 109 ± 35.9 vs. 72.1 ± 17.8 min, p = 0.01). The mean size of skin incision made for the MED patients was 1.86 ± 0.13cm (range 1.7,2.0cm); and 6.3 ± 0.98 cm for the OD patients (range 5.5,8cm), p = 0.001. The patients' pain severity of the involved limbs on 10-point Visual Analog Scale before operation in MED group was 7.5 ± 0.3 (range 6,9) and 8 ± 0.2 (range 7,9) in OD group, p = 0.17; and after surgery, 1.5 ± 0.2 (range 1,2) in MED group and 1.4 ± 0.1 (range 1,3) in OD group, p = 0.91. CRP levels peaked at 24h in both groups, and OD patients displayed a significantly greater postoperative rise in serum CRP (mean, 27.78 ± 15.02 vs. 13.84 ± 6.25mg/l, p = 0.026). Concentrations of TNF-,, IL-1,, and IL-8 were detected only sporadically. Serum IL-6 increased less significantly following MED than after OD. In the MED group, IL-6 level peaked 8 h after surgery, with the response statistically less than in the open group (mean, 6.27 ± 5.96 vs. 17.18 ± 11.60pg/ml, p = 0.025). A statistically significant correlation was identified between IL-6 and CRP values (r = 0.79). Using the modified MacNab criteria, the clinical outcomes were 90% satisfactory (9/10) in MED patients and 91.6% satisfactory (11/12) in OD patients at a mean 18.9 months (range 10,25) follow-up. Based on the current data, surgical trauma, as reflected by systemic IL-6 and CRP response, was significantly less following MED than following OD. The difference in the systemic cytokine response may support that the MED procedure is less traumatic. Moreover, our MED patients had achieved satisfactory clinical outcomes as the OD patients at a mean 18.9 months follow-up after surgery. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Increased Cortisol Response to Surgery in Patients With Alcohol Problems Who Developed Postoperative ConfusionALCOHOLISM, Issue 8 2004Akira Kudoh Background: Patients with alcohol problems often develop postoperative confusion and have impaired cortisol, ACTH, and norepinephrine. However, the relationship between neuroendocrine responses to surgical stress and postoperative confusion remains unclear in patients with alcohol problems. Methods: Plasma cortisol, ACTH, and norepinephrine concentrations during and after surgery in 30 patients with alcohol problems and 30 control patients who underwent lower abdominal surgery were measured before the induction of anesthesia, 15 and 60 min after skin incision, 60 min after the end of surgery, the next day, and the second day after the operation. Results: Plasma cortisol concentrations (21.2 ± 4.7 ,g·dl,1) of patients with alcohol problems before anesthesia were significantly higher than 15.6 ± 4.8 ,g·dl,1 of control patients. Plasma cortisol and ACTH responses to surgery in patients with alcohol problems were not significantly increased compared with preoperative values. The incidence of postoperative confusion was significantly higher in patients with alcohol problems than that of control patients (33% vs. 3%). Plasma cortisol concentrations (29.7 ± 7.0, 31.2 ± 6.6, 30.3 ± 8.0, and 28.4 ± 6.2 ,g·dl,1) 15 and 60 min after the skin incision, 60 min after the end of surgery, and the next day after operation in postoperatively confused patients with alcohol problems were significantly higher than those of nonconfused patients with alcohol problems (23.0 ± 5.8, 22.7 ± 4.1, 22.4 ± 7.2, and 21.9 ± 5.5 ,g·dl,1). Conclusion: The cortisol response to surgical stress increases in patients with alcohol problems who develop postoperative confusion, although cortisol response to surgical stress decreases in patients with alcohol problems without postoperative confusion. [source] Effect-site concentration of remifentanil attenuating surgical stress index responses to intubation of the tracheaANAESTHESIA, Issue 6 2010S. Mustola Summary Surgical Stress Index has been proposed for assessment of surgical stress and analgesia. It is a numeric index based on the normalised pulse beat interval and photoplethysmographic pulse wave amplitude. We determined the effect-site concentration of remifentanil for attenuation of Surgical Stress Index responses to intubation of the trachea. Thirty ASA 1,2 patients received either deep or normal anaesthesia and then target-controlled remifentanil. Burst suppression was maintained in the deep group and state entropy at 40,60 (scale 0,91) in the normal group. Mean (SD) effect-site concentrations of remifentanil attenuating responses in 50% of patients were 2.13 (0.25) ng.ml,1 and 3.05 (0.27) ng.ml,1 in deep and normal groups, respectively (p = 0.034). From probit analysis, EC50 and EC95 of remifentanil (95% CI) were 2.34 (1.97,2.71) ng.ml,1 and 3.19 (2.69,3.69) ng.ml,1 in deep group and 3.17 (2.67,3.67) ng.ml,1 and 3.79 (3.21,4.37) ng.ml,1 in the normal group, respectively. The values from probit analysis and up-and-down method did not differ significantly. [source] Histological and Histomorphometrical Alterations of the Periodontal Ligament in Gerbils Submitted to Teeth ExtractionANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2008M. M. Iyomasa Summary This study verified the effect of unilateral teeth extraction on the periodontal ligament in gerbils (Meriones unguiculatus). Ten adult male gerbils weighing about 50 g had induced occlusal alterations by upper left molar extractions while the other ten animals, only submitted to surgical stress, were considered as controls. The periodontal ligament was characterized by qualitative and quantitative analysis, histological description and histomorphometric quantification. Significant alterations were observed on the left side of the experimental group (P < 0.05), the hypofunctional region, when it was compared with the contralateral side and the corresponding region of the control group. Two months after occlusal alterations induced by unilateral teeth extraction, atrophic histological alterations and a decrease in the periodontal space on the ipsilateral side characterized the periodontal ligament. In this study it was possible to conclude that the gerbil can be used in experimental models attempting to correlate the periodontium's biological response to various mechanical stresses, as the periodontal ligament was shown to be highly sensitive to occlusal alterations. [source] The relationship of physical trauma and surgical stress to menstrual dysfunctionAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2000William W K. To SUMMARY To evaluate the incidence and pattern of menstrual dysfunction in reproductive age group women suffering acute musculoskeletal trauma, 198 women between 15 and 50 years of age admitted consecutively into an acute orthopaedic unit were recruited over a 6-month period. The patients were then followed up for 6 months with menstrual diaries to compare their menstrual pattern with their preadmission status. Excluding those with significant menstrual problems before admission, the menstrual pattern remained normal in 135 (68%) (EM), while 12 (6%) developed polymenorrhoea (PM), and 51 (25%) had oligomenorrhoea or amenorrhoea (OAM) within the 6-month observation. The three groups did not differ in their mean age, body mass index, parity or age of menarche, but previous cycle lengths were shortest in the PM group (25.4 days, SD 7.64) (p<0.05) and history of amenorrhoea in the previous one year was most common in the OAM group (p<0.025). Univariate analysis showed the incidence of moderate to major trauma, operative treatment, longer operative time, general anaesthesia, blood transfusion and immobilisation were significantly higher in the PM and OAM groups compared to the unchanged group (p<0.05). A logistic regression model showed that general anaesthesia and longer surgical operations remained significantly related to the development of menstrual dysfunction. We conclude that the pattern of menstrual dysfunction after acute orthopaedic trauma appeared to be dictated by the woman's pre-existing menstrual characteristics and the stress of surgical treatment. [source] Role of xanthine oxidase in small bowel mucosal dysfunction after surgical stressBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2000R. Anup Background The small intestine is highly susceptible to surgical stress even at remote locations. An earlier study using a rat model indicated that oxidative stress plays an important role in this process. The enzyme xanthine oxidase is an important source of free radicals in the small intestine. The role of this enzyme in intestinal damage after surgical stress was examined. Methods Rats pretreated with xanthine oxidase inhibitors were subjected to surgical stress by opening the abdomen and handling the intestine, as done during laparotomy. Enterocytes at various stages of differentiation were isolated and the protection offered by xanthine oxidase inhibitors against damage due to surgical stress was determined and compared with normal controls. Protection against ultrastructural changes to the mucosa, as well as mitochondrial function was examined. Results Surgical stress affected both the villus as well as crypt cells, causing increased superoxide generation, accompanied by increased activity of xanthine oxidase. Xanthine oxidase inhibitors ameliorated the increased superoxide generation, and protected against mitochondrial damage and ultrastructural changes in the intestine. Conclusion Surgical stress affects both the villus and crypt cell populations in the small intestine. The enzyme xanthine oxidase maybe an important mediator of surgical stress in the intestine. © 2000 British Journal of Surgery Society Ltd [source] Laparoscopic colonic surgery , mission accomplished or work in progress?COLORECTAL DISEASE, Issue 6 2006H. Kehlet Abstract Laparoscopic colonic resection may facilitate early postoperative recovery due to reduced surgical stress, pain and ileus. However, large randomised studies have only shown marginal improvements in outcome compared with open surgery, reporting a median hospital stay of about 5,7 days. Concomitant with these developments multimodal rehabilitation, which involves a revision of general postoperative care principles, improved pain relief with epidural analgesia and early oral nutrition and mobilization, has demonstrated greater improvements in recovery after open surgery, resulting in a median hospital stay of about 2,4 days. Recent single centre, randomised studies where laparoscopic and open colonic resection are combined with multimodal rehabilitation have not resolved the debate regarding which is the optimal operative technique. Therefore, new strategies are required to integrate laparoscopy with multimodal rehabilitation in order to establish its advantages, cost effectiveness and indications in specific groups of patients or colorectal procedures, thus justifying widespread application of the laparoscopic technique. [source] | |||||||||||||