The vitamin E derivative, EPC-K1, suppresses inflammation during hepatic ischemia-reperfusion injury and exerts hepatoprotective effects in rats.

BACKGROUND: An important component of postoperative management includes alleviation of hepatic ischemia-reperfusion (I/R) injury, which commonly results from liver surgery. EPC-K1 is a hydroxyl radical scavenger reported to have mitigating effects on I/R injury in many organs. This study evaluates the effects of EPC-K1 on hepatic I/R injury. MATERIALS AND METHODS: Rats were injected subcutaneously with either EPC-K1 (100 mg/kg) or saline. The hepatic artery and left branch of the portal vein were clamped for 45 min under general anesthesia. Indicators of liver function, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH), and of liver tissue damage were evaluated after 6h and 24h of reperfusion. Serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and high-mobility group box 1 (HMGB1) protein were measured, and apoptosis was quantified via caspase 3/7 activity and TUNEL assay. RESULTS: AST, ALT, and LDH levels increased significantly as a result of hepatic I/R injury, but were attenuated by EPC-K1 administration. Histologic findings revealed that normal structure of the hepatic parenchyma was maintained in rats pretreated with EPC-K1. TNF-α, IL-6, and HMGB1 levels rose significantly after reperfusion, together with activation of the inflammatory response. However, EPC-K1 administration suppressed levels of inflammatory markers and attenuated the inflammatory response. Moreover, EPC-K1 administration prevented apoptosis as determined by inhibition of caspase 3/7 activity and a decrease in apoptotic cells. CONCLUSIONS: Results demonstrate that EPC-K1 inhibits the inflammatory response and suppresses apoptosis during hepatic I/R injury. This suggests that EPC-K1 has hepatoprotective effects, and may be a valuable and novel therapeutic agent in the clinical setting.

[Control of postoperative nausea and vomiting by preventive administration of dexamethasone].

BACKGROUND: Postoperative nausea and vomiting (PONV) are the most frequent side effects after anesthesia. Patients with persistent PONV continue to be impaired in performing their normal daily activities. We studied the controlling effect of dexamethasone (4 mg) before the induction of general anesthesia in the prevention of PONV. METHODS: Ninety-one patients were divided into respiratory surgery group (dexamethasone N=22, none N=23) and gynecology group (dexamethasone N=22, none N=24), respectively. Dexamethasone group received dexamethasone 4 mg before the induction of general anesthesia. PONV and antiemetic requirements were recorded. RESULTS: In the dexamethasone group (respiratory surgery, gynecology), the incidences of PONV during the initial 24 hour postoperative period were 36.4% (N=8), and 18.2% (N=4), respectively. In the none group, the incidences were 43.5% (N=10), and 41.7% (N=10), respectively Antiemetic requirements were 22.7% (N=5), 9.1% (N=2), 39.1% (N=9), and 20.1% (N=5), respectively (NS). In gynecology group, in almost all the patients droperidol was used in epidural anesthesia. Combination of dexamethasone and droperidol may have greater antiemetic action than a single drug. CONCLUSIONS: Combination therapy with dexamethasone and droperidol may reduce PONV in patients undergoing surgery.

[The effect of operating time of PMX-DHP on decrease of platelets].

BACKGROUND: Recently, it is said that long-term PMX-DHP is beneficial for severe septic shock. Decrease in platelets, however, is one of the problems of PMX-DHP. We retrospectively examined the effect of operating time of PMX-DHP on decrease of platelets. METHODS: Forty-nine subjects were divided into three subgroups by their operating times of PMX-DHP. In short (S) group, the operating time was below 4 hours, and the group comsisted of 13 subjects. Intermediate (I) group with operating time of 4-12 hours, had 15 subjects. And long (L) group with operating time of 12-24 hours, had 21 subjects. Rate of decrease of platelets was compared between these subgroups. RESULTS: Decreased rate of platelets of each sub-group is as follows; S group showed 16.7 +/- 28.4%, I group showed 25.5 +/- 28.1%, and L group showed 23.7 +/- 30.3% respectively. And there were no significant differences between these subgroups. CONCLUSIONS: Decreased rate of platelets was around 20% as previously reported and constant regardless of duration of operating times of PMX-DHP. Long-term PMX-DHP within 24 hours is practically safe in case of severe septic shock.