Objectives Plasma proinflammatory, anti-inflammatory cytokine, and soluble tumor necrosis factor (TNF) receptor concentrations were examined in hospitalized patients after abdominal and thoracoabdominal aortic aneurysm (TAAA) repair, with and without left atrial femoral bypass. Changes in plasma cytokine concentrations were related to the duration of visceral ischemia and the frequency rate of postoperative, single, or multiple system organ dysfunction (MSOD). Design Prospective, observational study. Setting Two academic referral centers in the United States and The Netherlands. Patients We included 16 patients undergoing TAAA repair without left atrial femoral bypass, 12 patients undergoing TAAA repair with left atrial femoral bypass, and nine patients undergoing infrarenal aortic aneurysm repair. Measurements and Main Results Timed, arterial blood sampling for proinflammatory and anti-inflammatory cytokine and soluble TNF receptor concentrations (p55 and p75), and prospective assessment of postoperative single and MSOD. Plasma appearance of TNF-α, interleukin (IL)-6, IL-8, and IL-10 peaked 1 to 4 hrs after TAAA repair, and concentrations were significantly elevated compared with infrarenal abdominal aortic aneurysm repair (p < .05). Left atrial femoral bypass significantly reduced the duration of visceral ischemia (p < .05) and the systemic TNF-α, p75, and IL-10 responses (p < .05). Plasma TNF-α concentrations >150 pg/mL were more common in patients with extended visceral ischemia times (>40 mins). Additionally, patients with early peak TNF-α concentrations >150 pg/mL and IL-6 levels >1,000 pg/mL developed MSOD more frequently than patients without these elevated plasma cytokine levels (both p < .05). Conclusions Thoracoabdominal aortic aneurysm repair results in the increased plasma appearance of TNF-α, IL-6, IL-8, IL-10, and shed TNF receptors. The frequency and magnitude of postoperative organ dysfunction after TAAA repair is associated with an increased concentration of the cytokines, TNF-α, and IL-6 and the increased plasma levels of these cytokines appear to require extended visceral ischemia times.
The in vivo effects of interieukin-6 (IL-6) and dexamethasone (Dex) on amino acid transport in rat liver were studied employing hepatic plasma membrane vesicles (HPMVs). Adult rats were treated with Dex (0.5 mg/kg) and subsequently with varying concentrations if IL-6 (10, 50, or 150 $uMg/kg). The HPMVs were prepared by Percoll density gradient centrifugation. The activities of System A, System N and System Y4 transport proteins were evaluated by tritiated uptake of their respective amino acids (methyl-aminoisobutyric acid [MeAIB], glutamine, and arginine). System A activity was increased in response to low doses of IL-6. Dex alone increased System A and had an additive effect to enhance transport in response to IL-6. System N was stimulated by higher doses of IL-6 in a dose-dependent manner. Dexamethasone had no effect by itself on System N activity but worked synergistically to enhance the effect of IL-6 even at low doses. System Y+ activity was increased by Dex but IL-6 did not alter arginine transport. Kinetic analysis of the increases in System A and N showed the increases to be related to an increase in the Vmax (maximal transport velocity) for the carrier with no significant change in Km, carrier affinity We conclude that IL-6 and glucocorticoids work in a coordinated fashion to enhance hepatic amino acid uptake.
The development of current concepts in the treatment of breast diseases during the last 100 years is well documented in the Transactions of the Southern Surgical Association. Fellows of the SSA have been on the cutting edge of these developments and chose the SSA as the forum to describe and debate their new observations.
Objective: To evaluate the efficacy of preoperative radiotherapy (RT) and chemoradiation (CRT) followed by transanal excision (TAE) for rectal adenocarcinoma. Methods: Thirty-two patients were treated between July 1988 and April 2004 and followed from 2 to 123 months (median, 27 months). Results: The 3-year outcomes were: locoregional control, 79%; distant metastasis-free survival, 80%; cause-specific survival, 88%; and overall survival, 75%. Outcomes were better for patients with T1-T2 tumors and those who experienced a complete response to preoperative RT or CRT. Two patients (6%) had chronic RT proctitis after treatment. Conclusion: A select subset of patients with T2/T3 tumors will experience similar outcomes after preoperative RT or CRT and TAE compared with radical proctectomy. Reliably predictive clinicopathologic features to define this subgroup would best be elicited in the context of large prospective randomized trials, as would the optimal combination and schedule of systemic agents delivered in conjunction with preoperative RT. Patients who experience a complete response (cCR) after preoperative CRT are excellent candidates for TAE; those with less than a cCR have a less-favorable prognosis and are probably better treated with a low anterior resection or abdominal-perineal resection.
