In order to elucidate the relationship between secretory pathway and processing for precursor molecule of peptide hormones, we performed immunoelectron microscopic studies to localize POMC-derived peptides in mouse cultured L cells (fibroblasts without secretory granules) and in mouse AtT20 cells (ACTH secreting pituitary tumor cells with secretory granules) which had been transformed with human POMC gene. From the electron microscopic localization patterns, L42 cells were considered to serve as a model of constitutive pathway without processing of POMC, and A53 cells were considered to serve as a model of transgranular (regulated) pathway with processing of POMC. Immunoblotting supported these interpretations.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

Involvement of soluble adhesion molecules in acute pancreatitis.

The relationship between inflammatory cytokines and adhesion molecules in cases of acute pancreatitis was studied. Twenty-five patients were divided into three groups based on the severity of their disease as rated by the Ranson score. They were also divided into two groups according to the presence or absence of the complications of the multiorgan dysfunction syndrome (MODS) and the prognosis. As the severity of acute pancreatitis increased, the plasma levels of TNF-alpha, slCAM-1, sE-selectin, and sVCAM-1 also increased. The levels of all of these soluble adhesion molecules were significantly higher in the MODS-complicated group than in the non-MODS-complicated group. The levels of TNF-alpha, slCAM-1, and sVCAM-1 were significantly higher in patients who eventually died than in patients who survived. Significant correlations were observed between the levels of TNF-alpha and slCAM-1, between those of TNF-alpha and sVCAM-1, and between the levels of slCAM-1 and sVCAM-1. These results suggest that inflammatory cytokines stimulate the expression of adhesion molecules on the vascular endothelium and that mediators, including these adhesion molecules, are closely involved in the pathogenesis of acute pancreatitis. The plasma levels of these soluble adhesion molecules reliably reflected the severity of the disease.

Acute Disease↗

PubMedDate not supplied

Perioperative serum procalcitonin concentrations in patients with acute aortic dissection.

We investigated the perioperative serum procalcitonin (PCT) concentrations in 5 consecutive patients who underwent surgery for acute aortic dissection (2 men, 3 women; mean age 72 +/- 9 years, age range 52-81 years). Surgery used cardiopulmonary bypass with deep hypothermic circulatory arrest. Blood samples were taken prior to surgery, upon arrival in the intensive care unit, and 6, 12, 18, 24, and 48 h after intensive care unit arrival. Prior to surgery, the PCT level was 4.2 +/- 3.4 (range 0.8-8.3) ng/ml. The PCT increase was greatest at 24 h (5.8 +/- 4.5 ng/ml). Preoperatively, the C-reactive protein concentration was 8.0 +/- 8.3 (range 0.9-23.8) mg/dl, and the white blood cell count was 8.5 +/- 3.1 x 10(3). C-reactive protein continued to increase at 48 h, while the white blood cell count peaked at 24 h. In spite of no symptoms of infectious diseases or septicemia, all patients had a significant preoperative PCT elevation. This finding may have something to do with the specific preoperative condition of acute aortic dissection. However, more clinical investigation is needed to clarify the PCT changes during and after surgery for acute aortic dissection.

Acute Disease↗

PubMedDate not supplied

Recurrence after thoracoscopic surgery for spontaneous pneumothorax.

AIM: The purpose of this study was to examine the cause and risk of recurrence after thoracoscopic surgery for spontaneous pneumothorax. METHODS: A total of 204 patients under 60 years of age who underwent axillary thoracotomy and 139 patients who underwent thoracoscopic surgery were compared. In addition, among the patients who underwent thoracoscopic surgery, recurrent and non recurrent cases were reviewed and compared. RESULTS: Postoperative recurrence rate was significantly higher among the thoracoscopic surgery group. There were some significant differences between the recurrent and non recurrent cases in the Brinkman index, the duration from the onset of pneumothorax to the initial consultation, and the number of patients who had past history of pneumothorax. The recurrence rate was higher in patients with an air leak in the chest drainage tube before operation than in patients without an air leak. CONCLUSIONS: Appropriate training under supervision of experienced surgeons is necessary for minimizing complications and procedure failures. A history of heavy smoking or an air leak in the chest drainage tube before surgery may be an index of recurrence after surgery.

Adult↗

PubMedDate not supplied

The role of video-assisted thoracic surgery for the treatment of lung cancer: lung lobectomy by thoracoscopy versus the standard thoracotomy approach.

Our objective was to evaluate the usefulness, safety, validity and benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 24 patients with clinical NO stage I primary non-small-cell lung cancer compared with 30 patients who underwent a conventional thoracotomy. There were no significant differences in the intra-operative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group, but in this VATS' experience, patients had less postoperative pain. Numbers and distributions of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We can confirm that the safety and validity of VATS are virtually identical to those of the standard thoracotomy approach in the lobectomy. However, the former technique causes less discomfort to patients and requires a shorter recovery period of laboratory data and IL-6 concentrations in thoracic drainage fluid. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important and special training is needed.

Aged↗

PubMedDate not supplied

Plasma type II phospholipase A2 levels in patients with acute pancreatitis.

Changes in the blood levels of type II phospholipase A2 (PLA2) were investigated over time in patients with acute pancreatitis from an early stage after manifestation of the disease. The serum level of type II PLA2 at the first examination and the maximum level during the course of illness were both correlated with the severity of the disease. Serum levels of type II PLA2 were significantly higher in patients with acute pancreatitis complicated by multiple organ failure (349.1 +/- 146.6 ng/ml) than in those with acute pancreatitis not complicated by multiple organ failure (66.9 +/- 50.1 ng/ml). The serum levels of type II PLA2 were also significantly higher in patients who eventually died (316.8 +/- 150.5 ng/ml) than in those who survived (148.9 +/- 167.9 ng/ml). There was a significant correlation between the serum levels of type II PLA2 and those of TNF-alpha during the course of illness (r = 0.8037, p < 0.0001). The serum levels of type II PLA2 reliably reflected the severity of acute pancreatitis even in the early stages of the disease. These results suggest that type II PLA2 may be closely involved in the pathophysiology of acute pancreatitis.

Acute Disease↗

PubMedDate not supplied

The effects of immune globulin on endotoxemia.

Ten patients (mean age, 40 years; 2 women) with endotoxemia received 2.5 gm of immune globulin daily for 4 days or 5 gm daily for 2 days. In all patients, plasma endotoxin levels decreased to normal levels (< or = 9.8 pg/ml) within a mean of 3.2 days after starting immune globulin treatment, and body temperatures decreased to < 37 degrees C within 4.5 days. In 10 antibiotic-treated (control) patients with endotoxemia who did not receive immune globulin, plasma endotoxin levels declined to normal levels in 6 and their body temperatures dropped to normal levels within 5.0 days; no changes in body temperature were noted in the 4 patients whose plasma endotoxin levels did not decrease.

Adult↗

PubMedDate not supplied

Treatment of endotoxemia with low-dose intramuscular injections or oral administration of polymyxin B.

Thirty patients with sepsis received 50,000 U of polymyxin B intramuscularly per day (n = 22) or 3 million U orally per day (n = 8). Plasma endotoxin levels were measured by the Endospecy test after treating the plasma with a new perchloric acid method. Plasma endotoxin levels were reduced to normal values (less than 9.8 pg/ml) in all the injected patients within two days and in all the orally treated patients within three days. Clinical symptoms were also ameliorated. No treatment side effects were reported. It is concluded that polymyxin B is a safe and effective treatment against endotoxemia.

Administration, Oral↗

PubMedDate not supplied

Inhibitory effects of ulinastatin on the production of cytokines: implications for the prevention of septicemic shock.

The study was designed to determine whether ulinastatin can be used as a biological response modifier for the prevention of septicemic shock. Monocytes from heparinized blood of three healthy volunteers were incubated with 0.125 or 1.25 U/ml of ulinastatin, and then endotoxin (Escherichia coli lipopolysaccharide) was added at concentrations of 0.1, 1.0, and 10.0 micrograms/ml. A dose-dependent increase in the production of tumor necrosis factor alpha, interleukin-1 alpha, and interleukin-1 beta was noted after endotoxin stimulation. Production of these cytokines was inhibited by the addition of ulinastatin in a dose-dependent manner. The results indicate that ulinastatin could be useful in the prevention of septicemic shock.

Cytokines↗

PubMedDate not supplied

Evaluation of IPM/CS in gram-negative bacillus infections: use of an endotoxin-specific assay.

The subjects were 26 patients hospitalized with severe trauma or burns. Twice daily for seven to 14 days, 1 gm of IPM/CS (a 1:1 combination of imipenem and cilastatin sodium) was administered by intravenous drip infusion to each patient. Clinical outcome was rated excellent in nine patients, good in 12, and fair in five. Bacteria, isolated in 21 of the 26 patients, were eliminated in 18 and decreased in three. Mean endotoxin levels, assessed by the Endospecy method, were reduced from 167.8 pg/ml before treatment to 5.1 pg/ml after treatment. No treatment side effects were noted.

Adult↗

PubMedDate not supplied

Levels of soluble adhesion molecules and cytokines in patients with septic multiple organ failure.

Multiple organ failure (MOF) is a common complication of sepsis or septic shock. In this condition, it is believed that activated neutrophils adhere to the vascular endothelium and induce various mediators and tissue damage, leading to organ damage. We investigated the plasma levels of inflammatory cytokine activating neutrophils, soluble adhesive molecules, and endotoxin in 8 patients with septic MOF, 15 patients with sepsis but without MOF, and in 5 patients with MOF unrelated infection. The soluble intercellular adhesion molecule-1 (sICAM-1) concentration in sepsis-complicated groups was significantly higher than that in the multiple organ failure (MOF) group without infection. Of sepsis-complicated groups, the sICAM-1 value in the MOF group was significantly higher than that in the sepsis group without MOF. In sepsis-complicated groups, both soluble endothelial-leukocyte adhesion molecule-1 (sELAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) concentrations were significantly higher than those in the MOF group without infection. However, there was no significant difference between the septic MOF group and the sepsis group without MOF. In patients showing high levels of soluble adhesion molecule, prognosis was poor, and the concentration of soluble adhesion molecules rapidly decreased during recovery from MOF. It is speculated that endotoxin and inflammatory cytokines damage vascular endothelium as well as various other cells and produce, a large number of adhesion molecule, especially in patients with septic MOF, causing leakage of adhesion molecules into blood.

Adult↗