The Effects of Gabexate Mesilate on the Ishemia-Reperfusion Injury in the Rabbit Liver

PURPOSE: Ischemia-reperfusion is an important pathologic process that leads to impairment of the liver after major surgery. Ischmia-reperfusion injury includes both hypoxia and an inflammatory response associated with reperfusion; the former is caused by the lack of microvascular perfusion and the latter is mediated by cytyokines and oxygen free radicals. In addition to inhibiting thrombin, plasmin, kalikrein, trypsin, and neutrophil elastase, gabexate mesilate also plays an important role in inhibiting cytokines and oxygen free radical production. The purpose of this study was to investigate the effects of gabexate mesilate on ischemia- reperfusion injury in the liver. METHODS: Twenty-four New Zealand white rabbits were divided into three groups. Clamping was not done in group A (n=8), although it was done in group B (n=8) and group C (n=8). Group C received intravenous infusion of gabexate mesilate (10 mg/kg/hr) continuously during the process of clamping. Serum alanine aminotrasferase (ALT) and purine nucleoside phophorylase (PNP) were measured immediately before clamping, following 30-minute ischemia, and after 60-minute reperfusion. Hepatic tissue adenosine triphophate (ATP), xanthine oxidase, and malondialdehyde (MDA) plus 4-hydroxyalcenals (4HA) were measured after reperfusion. RESULTS: Compared with group A, group B and group C demonstrated a significant increase in ALT and PNP levels following ischemia and reperfusion, as well as in xanthine oxidase and MDA plus 4HA levels following reperfusion. However, ATP levels showed no significant differences among the three groups. ALT levels were significantly lower in group C than in group B following reperfusion (P<0.01),although there was no significant differences in PNP levels between them. Xanthine oxidase and MDA plus 4HA levels were significantly lower in group C than in group B (P<0.05). The results suggest that gabexate mesilate inhibits an increase in ALT, xanthine oxidase, and MDA plus 4HA levels. CONCLUSION: Gabexate mesilate inhibits oxygen free radical production of xanthine oxidase, and results in a reduction of hepatic ischemia-reperfusion injury.

Functional Outcome of Surgical Management for Acute Lower Extremity Ischemia

PURPOSE: Despite simplification of operative techniques, high morbidity and mortality of patients presenting with acute lower extremity ischemia remain a challenge to the vascular surgeon. The purpose of this study is to assess the functional outcome of thromboembolectomy in acute lower extremity ischemia in addition to the technical success. METHOD: A retrospective review was conducted on 52 procedures in 42 patients presenting with acute lower extremity ischemia due to arterial thrombosis or embolism between Jan. 1992 and Feb. 2000, initially underwent thromboembolectomy. After initial thromboembolectomy, we assessed the functional outcome of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997. RESULT: There were 35 men and 7 women, the mean age was 64.5 years. Mortality rate was 16.7% and overall amputation rate was 16.7%, major and minor amputation rate were 28.5% and 4.8% respectively. Causes of acute lower extremity ischemia were embolic occlusion (26.9%), native arterial thrombosis (36.5%) and bypass graft thrombosis (36.5%). Underlying diseases were heart disease (48.1%), hypertension (23.1%), cerebrovascular accident (17.3%) and diabetes (11.5%). The sites of native arterial occlusion were aortoiliac (24.2%) and distal to femoral (75.8%). Clinical categories were grade I in 1.9%, IIa in 32.7%, IIb in 61.5% and III in 3.8%. The 1-month limb salvage rate was 61.9%. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 30.8%, +2 in 26.9%, +1 in 26.9%, 0 in 0.0%, +1 in 0.0%, +2 in 3.8% and +3 in 11.5%. CONCLUSION: Surgical approach to the management of acute lower extremity ischemia due to thromboembolism can achieve a significant rate of limb salvage. A new scale for gauging changes of clinical status in acute lower extremity ischemia is required to assess the functional outcome of the treatment of acute lower extremity ischemia.

The Effects of Topical Cooling in Ischemia-Reperfusion Injury of Rabbit Liver / 한국간담췌외과학회지

BACKGROUND: Major hepatic surgery often requires temporary occlusion of the portal triad in order to minimize intraoperative bleeding. The Occlusion of portal triad may induce hepatic ischemia-reperfusion injury. Hepatic hypothermia is intended to suppress hepatic metabolism by lowering the liver temperature, to reduce oxygen consumption, and to minimize ischemic damage to the liver. This study was undertaken to evaluate the effects of topical cooling following ischemia on the liver. METHODS: Twenty-four New Zealand white rabbits were divided into three groups; group A (n=8) received no clamping, group B (n=8) received only clamping, and group C(n=8) received topical cooling using ice slush during clamping. In group B and C, duration of ischemia was 30 miniutes and duration of reperfusion was 60 minutes. Serum alanine aminotransferase(ALT) and purine nucleoside phophorylase(PNP) were measured immediately before clamping, after 30-minute clamping, and after 60-minute reperfusion. Hepatic tissue adenosine triphosphate(ATP), xanthine oxidase, and malondialdehyde( MDA) plus 4-hydroxyalcenals(4HA) were measured after reperfusion. RESULTS: Group C was topically cooled and reached the lowest level of 23.3 degrees C after 20 minutes of cooling. The results showed that ALT levels were significantly lower in group C than in group B(p<0.01), but PNP levels showed no significant differences between them. ATP levels showed no significant differences among the three groups. Xanthine oxidase and MDA plus 4HA levels were significantly lower in group C than in group B(P<0.01). CONCLUSION: These results suggest that topical cooling has a protective effect on parenchymal cells by reduction of oxygen free radicals produced by xanthine oxidase.

Adventitial Cystic Disease of the Popliteal Artery: A case report

Adventitial cystic disease of the popliteal artery is a rare disorder that causes localized stenosis or occlusion by compression of the vessel lumen. The disease produces lower extremity claudication, typically in young and middle-aged men. We report a case of the adventitial cystic disease of the popliteal artery in a 55-year-old man with symptom of left calf claudication. Diagnosis was done by ultrasound, angiography, and magnetic resonance imaging. The patient was treated with resection of the diseased popliteal artery followed by interposition of saphenous vein graft. Postoperatively, the symptom and sign resolved completely.

Risk Factors Affecting Lymph Node Metastasis and Recurrence in Early Gastric Cancer

PURPOSE: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over 90%. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. MATENRIALS AND METHODS: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. RESULTS: Lymph node metastasis was observed in 26 patients (11.7%), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was 4.4%, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. CONCLUSION: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery.

A Study of the Quality of Life Following after Curative Surgery for Gastric Cancer

PURPOSE: The quality of life of patients who have undergone surgery for carcinoma of the esophagus, breast, or lung has been discussed, however, little is known of the results following radical surgery for gastric cancer. We evaluated the quality of life of patients who had undergone radical surgery for gastric cancer and clarified the factors that influenced the quality of life for patients with gastric cancer. METHODS: We surveyed one hundred and thirty seven patients without recurrence of disease or chronic diseases following gastrectomy for gastric cancer. A questionnaire based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 was used to analyse the correlations between six functional scales and nine symptom scales and stage, surgical methods, chemotherapy, and performance status by scoring system. RESULTS: The quality of life following gastrectomy was determined by the stage of the disease at surgery, the surgical method, the application of anticancer chemotherapy, and the patient's own performance status. Patients with more advanced stages had a lower quality of life, and those who underwent total gastrectomy were expected to have a lower quality of life than patients who received subtotal gastrectomy. However there were no differences in the quality of life between patients with gastrojejunostomy and gastroduodenostomy following subtotal gastrectomy. The severity of postoperative weight loss had no influence on the quality of life. Patients undergoing chemotherapy showed higher points in the symptom scale rather than the functional scale. The functional scale and the symptom scale both showed asignificant difference according to the patient's performance status as assessed by the surgeon after a survey of the patient. CONCLUSION: We consider the periodic evaluation of the quality of life following gastrectomy in patients with gastric cancer to be useful in obtaining information concerning the patient's postoperative course and in assessing the therapeutic efficiency of the patient.

Pathologic Review of the Rectal Villous Adenoma

Neoplastic polyps of colon are one of the most risky factors for colorectal cancer. Particularly villous adenomas have more malignant potential than other neoplastic polyps. The preoperative detection of malignant change in villous adenoma is very important to determine treatment modality of patients. We conducted that total twenty-four cases of villous adenoma who were diagnosed and treated at our institution between January 1990 and December 1995 were reviewed retrospectively. The peak incidence of age was 7th decades. And male to female ratio was 2 : 1. Size of the adenoma ranged from 1.2 to 10.7 cm with a mean diameter of 3.9 cm. Five cases(20.8%) were between 1 and 2 cm, 10(41.7%) between 2 and 4 cm, and 9(31.5%) greater than or equal to 4 cm. Location of the adenoma were 10 cases(41.7%) in upper rectum, 8(33.3%) in rectosigmoid, and 6(25.0%) in lower rectum respectively. Pathologic examination of the resected specimen were diagnosed 9(37.5%) as benign villous adenomas, 10(41.7%) as in situ carcinoma, and 5(20.8%) as invasive carcinoma. The diagnostic accuracy to detect in situ carcinoma or invasive carcinoma was endoscopic examination in 66.7 percent and digital examination in 86.7 percent. The grade of in situ carcinoma had not significantly relationship with the size of the adenoma on our study. However, invasive carcinoma was significantly related to adenoma size(P<0.05) as following results zero percent between 1 and 2 cm, 20 percent between 2 and 4 cm, and 33.3 percent greater than or equal to 4 cm. In conclusion, the larger villous adenoma has higher malignant potential, especially greater than or equal to 4 cm in size. Added, the clinical impression of the malignancy on digital examination can be more accurate than preoperative endoscopic examination on our study.