Protective effect of ischemic postconditioning against hepatic ischemic reperfusion injury in rat liver

PURPOSE: The efficiency of ischemic postconditioning (IPC) was evaluated in a rat model of ischemic liver. Concentration of survivin of liver tissue correlated with the degree of antiapoptosis, so survivin was estimated to evaluate the efficiency of IPC on ischemic reperfusion (IR) injury. METHODS: Twenty-four healthy rats were divided to three groups (SHAM, IR, and IPC). Rats in the SHAM group displayed no change during 3 hours. Rats in the IR group were ischemic within 1 hour of clamping the left hepatic artery and left portal vein. Reperfusion for 2 hours was then done. IPC group, intermittent 2, 3, 5, and 7 minutes of reperfusion followed by 1 hour of warm ischemia. Two-minute reocclusion was done after each reperfusion. Rat sera were analyzed for AST and ALT, and Western blot analysis of rat liver tissue of rats evaluated malondialdehyde (MDA) and survivin. RESULTS: MDA in the liver tissue of rats in the IR and IPC group were significantly high than in the liver tissue of the SHAM group (P = 0.003 and P = 0.008, respectively). Survivin was higher in the IPC group than in the SHAM and IR groups (P = 0.021 and P = 0.024, respectively). CONCLUSION: IPC could not prevent lipid oxidation in liver cell mitochondria, but did aid in the regeneration of ischemic injured liver cells. The results indicate that IPC can suppress the apoptosis of liver cells and reduce reperfusion injury of liver tissue.

The Role of Prophylactic Gastrojejunostomy in Unresectable Periampullary Cancer / 한국간담췌외과학회지

PURPOSE: It was reported that 25% to 75% patients with a periampullary cancer were found to be unresectable after exploratory surgery. The aim of this study was to evaluate the role of a prophylactic gastrojejunostomy in patients with an unresectable periampullary cancer. METHODS: During January 1999 to April 2004, a prophylactic gastrojejunostomy (GJ group) or no gastrojejunostomy (non-GJ group) was carried out for an unresectable periampullary cancer without a gastric outlet obstruction in 42 patients. The clinicopathological characteristics, postoperative complications and time survival were evaluated retrospectively. RESULTS: Of the 42 patients, a prophylactic gastrojejunostomy was performed in 24 cases. There were no immediate postoperative deaths in both groups, and the postoperative morbidity rate was similar in both groups (GJ group 10% vs non-GJ group 7%). There were no differences in the mean postoperative hospital stay (GJ group 29.5 days vs non-GJ group 26.8 days) and mean survival (GJ group 7.5 months vs non-GJ group 8.1 months) between the two groups. In the 5 of the non-GJ group (27%), a postoperative gastric outlet obstruction had developed. The median interval time between the initial exploration and the postoperative gastrojejunostomy was 4.1 months. CONCLUSION: Although a small number of patients developed a postoperative gastric outlet obstruction in the non-GJ group, the prophylactic gastrojejunostomy did not increase the number of postoperative complications or the length of hospitalstay. However, several patients who did not received the prophylactic gastrojejunostomy developed a duodenal obstruction. Furthermore they needed a prophylactic gastrojejunostomy. These results suggest that a prophylactic gastrojejunostomy is a necessary and feasible procedure for patients with an unresectable periampullary cancer without duodenal obstructive symptoms.