Surgical stress increases renal glutathione content via increased glucocorticoid, and resistance to subsequent oxidative injury in the rat: significant link between endocrine response and cell defense system under the stress.
(9/974)
Systemic and nonspecific stress response effects on the cellular defense mechanism were studied in the male rat kidney. Two days after laparotomy-induced surgical stress, rats showed increased serum corticosterone and renal cortical reduced glutathione (GSH). Rats were then injected s.c. with mercuric chloride (HgCl2) to oxidatively injure renal tubuli. Increased serum creatinine levels indicated that laparotomy pretreatment lessened renal damage. To study the effects of the activated pituitary-adrenal axis on renal cortical GSH content and vulnerability to subsequent oxidative injury, rats were injected s.c. with ACTH on two consecutive days. ACTH administration increased both corticosterone and aldosterone. These rats showed increased, dose-dependent renal cortical GSH content, i.e., controls (n=7): 1.25 +/- 0.23 micromol/g tissue, daily dose of 10 microg/100 gBW (n=7): 1.53 +/- 0.24 micromol/g tissue, and daily dose of 40 microg/100 gBW (n=7): 2.31 +/- 0.23 micromol/g tissue. Rats receiving daily doses of 40 microg of ACTH/100 gBW acquired resistance to oxidative injury, indicated by serum creatinine levels: controls (n=6), 22 +/- 4 micromol/L; HgCl2 (n=6), 145 +/- 88 micromol/L; ACTH and HgCl2 (n=6), 37 +/- 11 micromol/L. Morphological evidence indicated that ACTH pretreatment in HgCl2-injected rats prevented renal tissue from inflammatory cell infiltration but not from tubular degeneration. Cellular GSH content of LLC-PK1 cells, porcine renal-tubule-derived culture cells, increased significantly in incubation with dexamethasone or aldosterone, suggesting that adrenal steroids directly stimulate renal cell GSH. We demonstrated that stress or ACTH administration activates the defense mechanism in the kidney via increased GSH. This stress-activatable defense system may therefore indicate a connection between endocrine stress response and the cellular defense mechanism. (+info)
Laparotomy versus no laparotomy in the management of early-stage, favorable-prognosis Hodgkin's disease: a decision analysis.
(10/974)
PURPOSE: To perform a decision analysis that compared the life expectancy and quality-adjusted life expectancy of early-stage, favorable-prognosis Hodgkin's disease (HD) managed with and without staging laparotomy, incorporating data on treatment outcomes of HD in the modern era. METHODS: We constructed a decision-analytic model to compare laparotomy versus no laparotomy staging for a hypothetical cohort of 25-year-old patients with clinical stages I and II, favorable-prognosis HD. Markov models were used to simulate the lifetime clinical course of patients, whose prognosis depended on the true pathologic stage and initial treatment. The baseline probability estimates used in the model were derived from results of published studies. Quality-of-life adjustments for procedures and treatments, as well as the various long-term health states, were incorporated. RESULTS: The life expectancy was 36.67 years for the laparotomy strategy and 35.92 years for no laparotomy, yielding a net expected benefit of 0.75 years for laparotomy staging. The corresponding quality-adjusted life expectancies for the two strategies were 35.97 and 35.38 quality-adjusted life years (QALYs), respectively, resulting in a net expected benefit of laparotomy staging of 0.59 QALYs. Sensitivity analysis showed that the decision of laparotomy versus no laparotomy was most heavily influenced by the quality-of-life weight assigned to the postlaparotomy state. CONCLUSION: Our model predicted that on average, for a 25-year-old patient, proceeding with staging laparotomy resulted in a gain in life expectancy of 9 months, or 7 quality-adjusted months. These results suggest that a role remains for surgical staging in the management of early-stage HD. (+info)
Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.
(11/974)
We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed. (+info)
Technical note: development of a transcervical oocyte recovery procedure for sheep.
(12/974)
An oocyte recovery procedure was developed and evaluated to determine whether a transcervical embryo recovery procedure is feasible with our method, which includes estradiol-17beta (E2) and oxytocin (OT) treatments, for dilating the cervix in ewes. On d 6 of an estrous cycle, oocytes were recovered either transcervically or with a laparotomy procedure. In the laparotomy group, ovulation rate was determined during the procedure and was used to calculate the percentage ofoocytes recovered. The laparotomy procedure was a standard uterine flush, and 12 mL of PBS was used to flush each uterine horn. In the transcervical group, the ovaries in each ewe were evaluated ultrasonically to determine ovulation rate. For transcervical recovery, 100 microg of E2 were injected i.v. on d 5 to increase cervical OT receptors, and 100 USP units of OT were injected i.v. 10 to 12 h later to dilate the cervix. Approximately 25 min after OT, ewes were placed in dorsal recumbency in a Commodore cradle, and a modified Foley catheter was passed through the cervix and into the uterus for injection (80 to 210 mL) and aspiration of PBS. The PBS was aspirated with a vacuum pump. The percentage of PBS recovered was greater (P<.01) at laparotomy than with the transcervical procedure (85.8 vs. 36.2%). Despite that difference, oocyte recovery did not differ significantly between the two groups (67% for laparotomy vs. 50% for transcervical; [oocytes recovered/number of corpora lutea] x 100), and there was no evidence that the transcervical procedure damaged the oocytes; the zona pellucida remained intact around all of the oocytes. In conclusion, a procedure that includes E2-OT-induced cervical dilation, passage of a modified Foley catheter into the uterus, and incremental infusion and aspiration of media through the catheter can be used to recover oocytes transcervically from ewes. This procedure may make transcervical embryo recovery feasible for sheep. (+info)
Estradiol-17 beta-oxytocin-induced cervical dilation in sheep: application to transcervical embryo transfer.
(13/974)
Experiments were conducted to determine whether exogenous estradiol-17beta (E2) and oxytocin (OT) can be used to improve transcervical (TC) embryo transfer (ET) procedures for sheep. Our concerns that the E2-OT treatment may alter luteal function prompted Exp. 1, in which 32 ewes were assigned to treatments in a 2x2 factorial array. On d 7 after onset of estrus, ewes received i.v. either 100 microg of E2 or diluent; 12 h later, ewes received i.v. either 400 USP units of OT or saline. To monitor luteal function, progesterone was measured in jugular blood collected from d 7 to 18. The treatments did not affect progesterone concentrations. Two trials were conducted in Exp. 2. In Trial 1, ewes were assigned to one of three treatments: TC transfer with E2-OT treatment to dilate the cervix, laparoscopic ET with E2-OT treatment, or laparoscopic ET with an equivalent diluent that did not dilate the cervix. In Trial 2, ewes were assigned to treatments in a 2x2 factorial array: TC or laparoscopic ET on d 6; E2-OT treatment for cervical dilation or diluents on d 6. Transferred embryos were recovered on d 12 in Trial 1 and d 14 in Trial 2, evaluated morphologically for development, and scored. Treatments did not affect the percentage of transferred embryos recovered. However, mode of transfer decreased (P<.01) the mean embryo development score. The E2-OT treatment increased (P<.01) the development score of embryos transferred transcervically, indicating that cervical dilation may improve the chances of embryos surviving after TC transfer. In conclusion, E2-OT treatment did not affect luteal function, and the E2-OT treatment can be used to enhance the success of TC embryo transfer in sheep. (+info)
Elective repair of type IV thoraco-abdominal aortic aneurysms; experience of a subcostal (transabdominal) approach.
(14/974)
OBJECTIVE: preoperative pulmonary function has been shown by univariate analysis to be an independent predictor of outcome following Crawford Type IV thoraco-abdominal aortic aneurysm repair. The aim of this study was to determine if outcome had been improved by the introduction of a subcostal approach for the elective repair of these aneurysms. METHODS: 39 patients studied (19 subcostal, 20 thoracolaparotomy) all operated on between 1993 and 1998 by a single surgeon using a standard technique. No significant difference in median age (69 years) or weight (64 kg vs. 69 kg) between the two groups. RESULTS: preoperative co-morbidities, pulmonary function and predictors of respiratory failure did not vary significantly between the two groups, despite a trend towards greater respiratory, cardiac and renal disease in the subcostal group. Preoperative median pulmonary function in both groups was 80% of that predicted for age, sex and height. The subcostal approach did not significantly reduce blood loss (3500 ml vs. 4500 ml) or anaesthetic time (255 min vs. 253 min). Overall 30 day mortality was 10.2%. The rate of re-operation was significantly higher in the subcostal group (21% vs. 0%, p=0.05). No differences were observed in intensive care unit stay, total hospital stay or respiratory complications, despite earlier extubation of the subcostal group (47% vs. 10% extubated at 12 h, p=0.01). CONCLUSION: the introduction of a subcostal approach for type IV thoraco-abdominal aneurysm repair in selected "high risk" patients has been associated with an unacceptably high rate of complications requiring early re-operation. We feel that this relates to the problems inherent in the introduction of a new technique and reduced exposure in patients of inappropriate body habitus. The predicted benefit to pulmonary function is realised in shorter intubation times, but has not translated into earlier recovery or improved outcome. Operation duration and blood loss have not been significantly reduced. Based on these outcomes, we do not currently recommend the general adoption of this approach in all type IV repairs. We will continue to evaluate this approach in patients with poor pulmonary function and a suitable body habitus. (+info)
Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis.
(15/974)
OBJECTIVE: To compare the long-term functional results of ileorectal anastomosis (IRA) with those of ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP). SUMMARY BACKGROUND DATA: In patients with FAP, hundreds of colorectal adenomas develop, and the patient will die of colorectal cancer if left untreated. The surgeon must choose between colectomy with IRA and restorative proctocolectomy with IPAA. One factor crucial to decision making is the functional outcome after either procedure. To date, studies on this issue have reported conflicting results and have been based on small series of patients. METHODS: To assess various functional variables, a questionnaire was sent to 323 patients with FAP who underwent either IRA or IPAA and who were registered at the Netherlands Foundation for the Detection of Hereditary Tumors. The overall response rate was 86%; the responders comprised 161 patients who underwent IRA and 118 patients who underwent IPAA. RESULTS: Patients who underwent IRA scored significantly better for daytime and nighttime stool frequency, soiling, occasional passive incontinence, flatus and feces discrimination, stool consistency, and need for antidiarrheal medication. There was no difference with regard to perianal irritation, episodes of bowel discomfort, or dietary restrictions. The functional results according to the aggregate score of the Gastro-Intestinal Functional Outcome Scale, where the items specified above were integrated (0 indicating a poor and 100 a good overall function), were significantly better in patients with an IRA (74.5) than in patients with an IPAA (66.0) (p < 0.01). CONCLUSION: The functional outcome after IRA is significantly better than after IPAA. On the basis of these results, IRA might still be considered in patients with a mild phenotypic expression of the disease in the rectum. (+info)
Outcome of postchemotherapy surgery after treatment with methotrexate, vinblastine, doxorubicin, and cisplatin in patients with unresectable or metastatic transitional cell carcinoma.
(16/974)
PURPOSE: The role of postchemotherapy surgery for patients with metastatic transitional cell carcinoma (TCC) is controversial. We retrospectively analyzed our experience with patients who underwent postchemotherapy surgery after methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy to assess an impact on long-term survival. PATIENTS AND METHODS: This report is based on the retrospective analysis of 203 patients with unresectable primary tumors or metastatic TCC, previously reported in five trials of M-VAC chemotherapy. Fifty patients underwent postchemotherapy surgery for suspected or known residual disease. Characteristics of patients selected for surgery, results of surgery, and the impact of surgery on survival were assessed. RESULTS: In 17 patients, no viable tumor was found at postchemotherapy surgery, pathologically confirming a complete response to chemotherapy. Three patients had unresectable residual TCC. In 30 patients, residual, viable TCC was completely resected, which resulted in a complete response to chemotherapy plus surgery. Ten (33%) of these 30 patients remained alive at 5 years, similar to results observed for patients who attained a complete response to chemotherapy alone (41%). Analysis by baseline extent of disease suggested that patients with unresectable primary tumors or with metastases restricted to lymph node sites were most likely to survive for 5 years. CONCLUSION: Postchemotherapy surgical resection of residual cancer may result in 5-year disease-free survival in some patients who would otherwise succumb to disease. Optimal candidates include patients whose prechemotherapy sites of disease are restricted to the primary or lymph node sites and who have a major response to chemotherapy. (+info)