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1.
Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy 总被引:1,自引:0,他引:1
Aoife M. Ryan Aine Hearty Ruth S. Prichard Aileen Cunningham Suzanne P. Rowley John V. Reynolds 《Journal of gastrointestinal surgery》2007,11(10):1355-1360
Objective Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma
and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute
albumin level on the first postoperative day was of value in predicting in-hospital complications.
Methods A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and
2005 was performed. Patients who had pre and postoperative (days 1, 3, and 7) serum albumin levels measured were included
in the study. Patients were subdivided into three postoperative albumin categories <20 g/l, 20–25 g/l, >25 g/l. Logistic regression
analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level.
Results Patients with an albumin of less than 20 g/l on the first postoperative day were twice as likely to develop postoperative
complications than those with an albumin of greater than 20 g/l (54 vs 28% respectively, p < 0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome (22
vs 5%, p < 0.001), respiratory failure (27 vs 8%, p < 0.01) and in-hospital mortality (27 vs 6% (p < 0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications
(odds ratios, 0.89: 95%; confidence intervals, 0.83–0.96; p < 0.005). In addition, albumin <20 g/l on the first postoperative day was associated with the need for further surgery and
a return to ICU.
Conclusion Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative
risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes. 相似文献
2.
H. Inaba M.D. J. Sato H. Uchida M. Sakurada T. Ohwada T. Mizuguchi 《Acta anaesthesiologica Scandinavica》1988,32(5):374-378
Fluctuating PEEP (F-PEEP) is a newly developed PEEP in which end-expiratory pressure (EEP) is periodically changed within a certain range. In a dog model with unilateral lung injury induced by the introduction of hydrochloric acid, F-PEEP in which the EEP was periodically changed from 0.5 to 1.5 kPa at periods of 6 min, and conventional PEEP (C-PEEP) with an optimized EEP of 1.0 kPa, were each applied for 30 min. F-PEEP produced a significantly greater improvement of PaO2 and intrapulmonary shunt (QS/QT) than C-PEEP, and at the low EEP phase, the greatest improvement accompanied by an increased dynamic compliance and a large cardiac output was obtained. These results suggest that F-PEEP provides a useful mode of artificial ventilation for the treatment of unilateral lung injury. 相似文献
3.
Hayato Funiu Rei Kondo Kaori Sakurada Yasuaki Kokubo Shinya Sato Shinjiro Saito Hiroyuki Orita Shigeki Hirooka Takamasa Kayama 《Brain and nerve》2006,58(3):257-261
We encountered a rare case of unilateral internal carotid arterial defect complicated with anterior communicating aneurysm and subclavian artery aneurysm. The patient was a 56-year-old man in whom cerebral angiography and 3D-CTA revealed defects in the right internal carotid artery and the right carotid canal, and an unruptured aneurysm in the anterior communicating artery. In addition, the patient was also found to have an unruptured aneurysm in the right subclavian artery. As both the aneurysms were considered to have a high risk of rupture and such subclavian aneurysms were likely to cause an embolism, radical surgery was performed for each aneurysm. The postoperative course was uneventful, and the patient was discharged without ambulatory limitations. Although the defect in the internal carotid artery is a relatively rare vascular deformity, the incidence of cerebral aneurysm is about 30% in such cases due to the marked hemodynamic stress involved. On the other hand, there have been only two previous case reports of internal carotid arterial defect complicated with a subclavian aneurysm. Moreover, there have been no previous reports of internal carotid arterial defect complicated with both an intracranial aneurysm and a subclavian aneurysm, as observed in the present case. Thus, this case was very rare and is reported here. 相似文献
4.
T Sakurada R Kuribayashi H Aida K Seki Y Goto Y Shibata A Meguro R Hayashi I Yamagishi T Abe 《[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai》1992,40(9):1700-1706
In order to complete operations without blood transfusion we have chosen means of preoperative autologous blood saving and intraoperative autotransfusion, but we have not always achieved our purpose. We examined 29 patients (13 patients without blood transfusion and 16 with blood transfusion) to analyze the determinant factors as to whether open heart surgery without blood transfusion may be indicated or not, according to the quantification theory (type II) and to examine the possibility to apply the maximum surgical blood order schedule (MSBOS) for the open heart surgery by the quantification theory (type I). The analysis of determinant factors revealed hematocrit (Ht) value before saving of blood (more than 40%) as the best contributor of possibility of non-blood transfusion surgery, followed by the amount of blood loss during operation (less than 600 ml), the amount of saving blood (more than 800 ml), body weight (less than 70 kg), calculated Ht value on the beginning of cardiopulmonary bypass (CPB) (more than 24%), CPB time (less than 120 minutes) and the amount of postoperative blood loss (less than 600 ml). The prospective using blood volume at the operation was precisely calculated by the values of 4 preoperative factors, that is, the amount of saving blood, calculated Ht value on the beginning of CPB, CPB time and body weight. Therefore it is important to increase the amount of preoperative saving blood and decrease the amount of surgical bleeding in order to perform operations without blood transfusion, and is possible to apply the MSBOS for the open heart surgery. 相似文献
5.
Yoichi Kikuchi Taku Sakurada Masato Suzuki Tomoyasu Hirano Katsuyuki Kusajima 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(8):375-378
Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocar-dial revascularization because
of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial
treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need
of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment
of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case
of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels
coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass. 相似文献
6.
7.
J K Sakurada A Maury W M Tamashiro P M Araújo I J Camargo H A Rangel 《Research in immunology》1992,143(2):157-164
To verify whether anti-Trypanosoma-cruzi-proteinase antibodies are able to play a role in the development of Chagas' disease, CBA/J and C57BL/6 mice were immunized with purified proteinase fractions: antibody production was studied and passive immunization experiments were carried out. No significant differences were observed in the titre, isotype composition and specificity of the antibodies produced by the mouse strains. Immune sera produced in one strain was able to protect mice of both strains, provided that the challenge did not exceed the number of parasites corresponding to 30-fold the LD50. The data presented suggest that anti-proteinase antibodies may play a role in immunoprotection. 相似文献
8.
Ikegaya H Iwase H Zheng HY Nakajima M Sakurada K Takatori T Fukayama M Kitamura T Yogo Y 《Journal of virological methods》2005,126(1-2):37-43
Recently genotyping of JC virus (JCV) DNA in renal tissue was reported to be useful to identify the geographic origin of unidentified cadavers. In the above study, autopsied tissue samples without storage or stored in a frozen state were used. This study examined JCV DNA sequence modifications caused by formalin-fixation, in an attempt to elucidate whether formalin-fixed, paraffin-embedded tissue samples can also be used to determine the genotypes of JCV DNA in the kidney. In four cases, a 610 bp typing region of the JCV genome was PCR-amplified from renal tissues stored for 1 year in three different states: frozen at -80 degrees C [Amaker, B.H., Chandler, F.W., Huey, L.O., Colwell, R.M., 1997. Molecular detection of JC virus in embalmed, formalin-fixed, paraffin-embedded brain tissue. J. Forensic Sci., 1157-1159], formalin-fixed, paraffin-embedded [Ault, G.S., Stoner, G.L., 1992. Two major types of JC virus defined in progressive multifocal leukoencephalopathy brain by early and late coding region DNA sequences. J. Gen. Virol. 73, 2669-2678], and soaked in 5% formalin [Baksh, F.K., Finkelstein, S.D., Swalskey, P.A., Stoner, G.L., Ryschkewitsch, C.F., Randhawa, P.R., 2001. Molecular genotyping of BK and JC virus in human polyomavirus-associated interstitial nephritis after renal transplantation. Am. J. Kidney Dis. 38 (2), 354-365]. The amplified fragments were cloned, and the resultant clones were sequenced. In frozen samples, single sequences ('original' sequences) were detected in all cases. In formalin-fixed, paraffin-embedded samples, not only the original sequences but also those with 1-6 base substitutions were detected. From formalin-soaked samples, the original sequences and those with 1-5 and 10-13 substitutions were detected. The genotyping of JCV DNA was not hampered by the presence of 1-6 substitutions, but a shift in JCV genotypes was observed in sequences with 10-13 substitutions. Thus, it was concluded that the genotypes of JCV DNA in the kidney can be determined only with specimens stored in a frozen state or formalin-fixed for a short time. 相似文献
9.
S. Sakurada O. Shido N. Sugimoto K. Fujikake T. Nagasaka 《Pflügers Archiv : European journal of physiology》1994,429(2):291-293
Rats were subjected to an ambient temperature (Ta) of 33°C for ca. 5 h during the last half of the dark phase for 5, 14 or 28 consecutive days (heat-exposed rats, HE), while control rats were kept at a constant Ta of 24°C. After the heat exposure schedule, the levels of hypothalamic temperature (Thy) as an index of body core temperature in the HE were significantly lower than those of the controls for 2–4 h in the last half of the dark phase. The low levels of Thy persisted during the specific period for 1, 3 and 6 days after the end of the 5-, 14- and 28-day heat exposure schedules, respectively. These results confirm that, in rats subjected to daily heat exposure for ca. 5 h at a fixed time per day, their Thy falls during the period when the rats were previously exposed to heat, and suggest that the duration of the specific Thy change observed after completing the heat exposure schedule depends on the length of the heat exposure schedule. 相似文献
10.
M Imamura H Fujimoto S Hashino T Fukuhara M Kobayashi M Kasai K Sakurada T Miyazaki 《Immunobiology》1990,180(4-5):441-457
When we analyzed the in vivo efficacy of cytokine administration in murine allogeneic bone marrow chimeras, mitogen-induced responses to ConA, PHA, LPS, or PWM were increased by the in vivo administration of human recombinant granulocyte colony-stimulating factor (rG-CSF), human recombinant interleukin 2 (rIL-2), or WEHI-3B conditioned medium (CM). Furthermore, we found increased alloreactive mixed lymphocyte reactions (MLRs) against donor and/or host type alloantigens in spleen cells from (BALB/c----C3H/He) chimeras, although cytotoxic activity against BALB/c or C3H/He target cells was not detected in spleen cells from these chimeras. Since no significant increase of T cells or Ia positive cells was observed, some functional activation, rather than changes in the cell count, appeared to relate to increase immunoreactivity. An increased IL-2 production in spleen cells from chimeras injected with cytokine was observed shortly after the cessation of cytokine administration. Thereafter, an IL-2 production in these chimeras decreased around 45 days after bone marrow transplantation and then recovered nearly to the control level. An increased IL-2 responsiveness was also observed in spleen cells from these chimeras. These findings suggest that the in vivo administration of rG-CSF as well as rIL-2 or WEHI-3B CM (IL-3) can modulate the immunoreactivity in chimeras via the network of immune systems. 相似文献