Jejunal limb obstruction caused by a cholesterol stone 15 years after a total gastrectomy and 20 years after a cholecystectomy: report of a case

We present herein the rare case of a 74-year-old woman found to have jejunal limb obstruction caused by a cholesterol stone 15 years after a total gastrectomy with Roux-en-Y anastomosis, and 20 years after a cholecystectomy. The patient complained of repeated episodes of upper abdominal distress on three separate occasions over a period of 20 months, and jejunal limb obstruction was diagnosed by abdominal computed tomography scanning and (99m)Tc scintigraphy. Surgery revealed a stone incarcerated in the jejunal limb, where the anastomosis had become slightly stenotic. The removed stone was 3.5 cm in diameter and was subsequently demonstrated to be a cholesterol stone by chemical analysis. This report is thought to be the first to describe jejunal limb obstruction caused by a gallstone incarcerated in the jejunal limb after a total gastrectomy in a patient with a history of cholecystectomy.

Gastrointestinal stromal tumors treated by laparoscopic surgery: report of three cases

Three cases of gastrointestinal stromal tumors (GIST) were treated by a laparoscopic wedge resection of the stomach. The tumor characteristics were confirmed to be nonepithelial, nonlymphomatous, nonmyogenic, and nonneurogenic gastrointestinal neoplasms with an uncertain origin which were CD34-positive and actin- and S-100-negative. The malignant potential was estimated based on the mitotic figures and growth rates. The results suggest that laparoscopic surgery is an adequate strategy for gastric submucosal tumors including GIST, and also indicates this technique to be a curative, safe, and minimally invasive procedure for both diagnosis and treatment.

The effect of FR167653 on pulmonary ischemia-reperfusion injury in rats

BACKGROUND

A novel synthesized organic compound, FR167653, has been characterized as a potent suppressant of interleukin-1 and tumor necrosis factor-alpha. We designed this experimental study to evaluate the effect of FR167653 on ischemia-reperfusion injury of the rat lung.

METHODS

Following general anesthesia, the left bronchus, pulmonary artery and vein were clamped for 1 hour. FR167653 was administered continuously beginning 30 minutes before the onset of ischemia and extending for 2 hours after reperfusion. Thirty-eight Wistar rats were divided into 4 groups according to the dose of FR167653 at the rate of 0.1, 0.05 and 0.025 mg/kg/hr in each group. After the optimal dose was obtained from the result of 1-week survival rate, the group with the optimal dose was compared with a control group by using such parameters as arterial oxygen saturation (SaO(2)), arterial oxygen tension (PaO(2)), cytokines, the expression of p38 MAP kinase and histologic study.

RESULTS

Survival rate of the group received FR at the rate of 0.1 mg/kg/hr (FR0.1 group) was best among the 4 groups. SaO(2) levels and PaO(2) levels after 2-hour of reperfusion were significantly (p < 0.05, respectively) higher in the FR0.1 group than in the control group. After 2-hour reperfusion, IL-1 beta was lower in the FR0.1 group than in the control group, and the expression of p38 MAP kinase was reduced in the FR0.1 group compared with the control group. In histologic study after 2-hour of reperfusion, alveolar damage with edema and interstitial thickening localized along the alveolar duct were observed in the control group, whereas these findings were remarkably less evident in the FR0.1 group.

CONCLUSIONS

We concluded that FR167653 ameliorates ischemia-reperfusion injury of the lung and may inhibit the production of proinflammatory cytokines by means of the inhibition of p38 MAP kinase.

Matrix metalloproteinase expression in cultured human gastric wall fibroblasts--interactions with Helicobacter pylori isolated from patients with ulcers

BACKGROUND

Matrix metalloproteinases (MMPs), enzymes capable of degrading collagens and other extracellular matrix components, have been implicated in gastric ulcer formation. However, the effect on MMP expression of Helicobacter pylori, also implicated in these lesions, has not been studied to our knowledge.

AIM

To seek links between H. pylori and MMP expression likely to affect gastric ulcer formation. After fibroblasts from human gastric wall were cocultured with H. pylori. concentrations of MMP-1 and -2 in the medium were determined by enzyme-linked immunosorbent assays.

RESULTS

Whereas MMP-1 was not detected in media from fibroblasts or H. pylori culture alone, MMP-1 was detected in cocultures (P<0.01). Similar amounts of MMP-2 were detected in medium from fibroblasts cultured alone and with H. pylori. No MMP-2 production by H. pylori cultured alone was detected.

CONCLUSIONS

MMP-1 appears to be important in gastric ulcer pathogenesis, and MMP-1 induction by H. pylori may impede gastric ulcer healing.

Activation of matrix metalloproteinase-2 in head and neck squamous cell carcinoma: studies of clinical samples and in vitro cell lines co-cultured with fibroblasts

We undertook this present study to investigate the activation of matrix metalloproteinase-2 (MMP-2) in human head and neck squamous cell carcinomas (HNSCC) tissues and cell lines. Gelatinolytic activities of active MMP-2 were significantly higher in carcinoma samples than in normal portions. Furthermore, the activation ratio of proMMP-2 significantly correlated with cervical lymph node metastasis. In vitro studies revealed an HNSCC cell line, HEp-2, to produce neither the pro form nor the active form of MMP-2, but human fibroblasts were found to produce proMMP-2. However, coculture of HEp-2 cells with fibroblasts resulted in the production of not only proMMP-2 but also activeMMP-2 in the culture medium. Northern blot analysis revealed a stronger expression of membrane-type 1 matrix metalloproteinase (MT1-MMP),which is a specific activator of MMP-2, mRNA in HEp-2 cells than in fibroblasts. These results suggest the activation of proMMP-2 as an important event in the process of HNSCC metastasis. They also suggest MMP-2 is secreted in its pro form by stromal fibroblasts surrounding the cancer cells and activated by MT1-MMP localized on the cancer cells.

[The validity of the sentinel node concept in gastrointestinal cancers]

Although the sentinel node concept has been validated and clinically applied to breast cancer and malignant melanoma, its clinical significance in other solid tumors has not been thoroughly investigated. With regard to gastrointestinal (GI) cancers in particular, our surgeons have been cautious because of the high frequency of skip metastasis and the complicated lymphatic system in the GI tract. We would like to emphasize that so-called skip metastasis has been defined according to anatomic classification of regional lymph nodes and that the lymphatic drainage route must be patient or lesion specific. To test the validity and feasibility of this concept in GI cancers, we have established a radio-guided intraoperative sentinel node navigation system using preoperative endoscopic submucosal injection of radioactive tracer followed by intra-operative gamma-probing. In 131 patients with GI cancers (esophagus: 22, stomach: 71, colorectum: 38), the detection rate of sentinel nades was 91% and overall diagnostic accuracy of lymph node metastasis by sentinel node status was 97%. Initial results suggest further investigation of this procedure as an accurate staging and a minimally invasive approach to early GI cancers.

Laparoscopic wedge resection of gastric submucosal tumors

Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors (SMTs) of the stomach can be resected using laparoscopic techniques. Between 1993 and 1997, laparoscopic wedge resection was performed in 34 patients with an SMT of the stomach. The tumors ranged from 8 to 60 mm in diameter. All surgical margins were clear. The average operative time was 131 minutes. Most of the patients began eating on the first postoperative day and were discharged within 5 to 7 days. Histopathologic examination of the tumors showed gastrointestinal stromal tumor (n = 14), ectopic pancreas (n = 7), leiomyosarcoma (n = 4), schwannoma (n = 3), carcinoid (n = 2), leiomyoma (n = 2), an inflammatory lesion caused by parasites (n = 1), and cyst (n = 1). No recurrences were observed over the 5-year follow-up period. A solid SMT of the stomach larger than 20 mm in diameter can be treated using laparoscopic wedge resection.

Beneficial effects of novel nitric oxide donor (FK409) on pulmonary ischemia-reperfusion injury in rats

BACKGROUND

Nitric oxide (NO) seems to play an important role in tissue injury during reperfusion of the lung. FK409 is the first spontaneous NO donor that increases plasma guanosine 3':5'-cyclic monophosphate. It is reported that FK409 prevented myocardial infarction following occlusion and reperfusion in rat coronary arteries. In this study, we evaluated the effects of FK409 on pulmonary ischemia-reperfusion injury in an in situ warm ischemia model of rats.

METHODS

Animals were divided into 2 groups: the FK409 study group that was administered FK409 (0.4 mg/kg) before reperfusion and the control group, administered a saline vehicle only. Following a thoracotomy, the bronchus, pulmonary artery and vein were separately clamped for 1 hour. Arterial oxygen tension (PaO2), arterial oxygen saturation (SaO2), and endothelin-I (ET-I) were measured after 2 hours of reperfusion. Histologic and immunohistochemical studies were performed; polymorphonuclear neutrophils (PMNs) were counted after 2 hours of reperfusion.

RESULTS

PaO2, SaO2, ET-I after 2 hours of reperfusion and the 7-day survival rate were significantly (p < 0.05) better in the FK409 group than the control group. Histologic damage was reduced in the FK409 group compared with the control group. PMN infiltration was also significantly (p < 0.05) lower in the FK409 group than in the control group.

CONCLUSION

FK409 seems to protect against ischemia-reperfusion injury of the lung. This effect may be related to a homeostatic effect on pulmonary vascular beds and prevention of PMN sequestration.

Dependence of estrogenic activity on the shape of the 4-alkyl substituent in simple phenols

The ability of certain chemicals to mimic the effects of natural steroid hormones and their potential to disrupt the delicate balance of the endocrine system in animals has attracted much interest in recent years. Alkylphenolic chemicals have been reported to be weakly estrogenic. Estrogen receptor (ER) binding is primarily the result of interaction of the receptor with both a phenolic residue, and a hydrophobic pharmacophore. We have prepared and screened various phenols having a bulky 4-alkyl group, which may interact hydrophobically with the receptor, for estrogenic activity by using a previously described reporter gene assay employing COS-1 cells transfected with rat ER alpha-expression plasmid and an appropriate reporter plasmid. Some of the tested compounds, such as 4-(1-adamantyl)phenol and 4-cycloalkylphenols, exhibited much more potent activity than the typical estrogenic alkylphenol, 4-tert-octylphenol.

Dihydropyrimidine dehydrogenase and messenger RNA levels in gastric cancer: possible predictor for sensitivity to 5-fluorouracil

We investigated the correlation between tumor sensitivity to 5-fluorouracil (5-FU) and enzymatic activities of thymidylate synthetase (TS) and dihydropyrimidine dehydrogenase (DPD) in human gastric cancer specimens. Forty-one patients with advanced gastric cancer gave informed consent and were enrolled in the study. Biopsy specimens of gastric cancer were obtained preoperatively through gastrofiberscopy and used to determine TS and DPD messenger RNA (mRNA) levels. TS and DPD enzyme activity and mRNA levels were also measured in resected tumor tissue samples obtained after surgical resection. TS and DPD activity were measured using the TS-binding assay and a radioenzymatic assay, respectively, while mRNA levels were measured by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), with co-amplification of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as an internal standard. 5-FU sensitivity of resected tumor specimens was measured by the tetrazolium-based colorimetric assay (MTT assay). Both TS and DPD mRNA levels correlated well between biopsied and resected tumor specimens. A statistically significant correlation was also observed between mRNA levels in biopsied specimens and enzymatic activities in resected specimens. DPD levels significantly correlated with 5-FU sensitivity, such that high DPD activity and high DPD mRNA levels resulted in low sensitivity to 5-FU. In contrast, no correlation was observed between TS activity or TS mRNA levels and 5-FU sensitivity. We conclude that tumor DPD mRNA level, as assessed from biopsy specimens obtained by gastrofiberscopy, may be a useful indicator in predicting tumor sensitivity to 5-FU in patients with gastric cancer.

Hemodynamic effects of alpha-human atrial natriuretic polypeptide on patients undergoing open-heart surgery

BACKGROUND

A cardiac hormone, alpha-human atrial natriuretic polypeptide (alpha-hANP), acts as a vasodilator and a diuretic by activating cyclic GMP formation. We studied the hemodynamic effects of continuous intravenous infusion of alpha-hANP on patients undergoing open-heart surgery.

METHODS

A total of 15 patients, including 7 with CABG, 4 with AVR, 2 with CABG plus AVR, and 2 with AVR plus MVR were involved in the study. They underwent open-heart surgery in our institute between July 1996 and April 1997. The mean age of patients was 68 years, ranging from 63 to 77. A dosage of 0.05 microg/kg/min of alpha-hANP was administered to all patients on postoperative day 1. Hemodynamics and blood and urine samples were measured at the following times: 2 hours before continuous intravenous infusion of alpha-hANP, 0, 1, 2, 3, 6, 12 and 24 hours after continuous intravenous infusion. We concomitantly measured urine volume and the plasma concentration of alpha-hANP.

RESULTS

The plasma concentration of alpha-hANP increased sufficiently after the beginning of continuous intravenous infusion without any side effects, and the urine volume increased too. The administration of alpha-hANP induced a decrease in central venous pressure, pulmonary capillary wedged pressure and the pulmonary vascular resistance index. Systemic vascular resistance index and cardiac output remained unchanged.

CONCLUSIONS

It is useful for the management of patients with associated volume overload following open-heart surgery because the administration of alpha-hANP decreases preload and facilitates satisfactory urination.

Carbon dioxide insufflation aids video-assisted thoracic surgery in a young child

A 3-year-old girl with pectus excavatum successfully underwent exploration using video-assisted thoracic surgery. A complete pericardial defect was identified. The lung was kept totally collapsed during the procedure using low-flow (1 L/min), low-pressure (7 mmHg) carbon dioxide insufflation. This technique is expected to be a safe adjunct to thoracoscopic procedures in infants and small children.

Thymidylate synthetase and dihydropyrimidine dehydrogenase levels in gastric cancer

The measurement of thymidylate synthetase (TS) and dihydropyrimidine dehydrogenase (DPD) enzymatic activities and mRNA levels in tumors may be useful in predicting tumor sensitivity to 5-fluorouracil (5-FU). Forty-one patients with advanced gastric cancer gave informed consent and were enrolled in this study. Biopsy specimens of gastric cancer were obtained preoperatively through gastrofiberscopy and used to determine TS and DPD mRNA levels. We also measured TS and DPD enzymatic activities and mRNA levels in surgically resected gastric cancer samples, as well as in adjacent normal gastric mucosa. TS and DPD activities were measured using the TS-binding assay and a radioenzymatic assay, respectively, while mRNA levels were measured by semi-quantitative reverse transcription-PCR (RT-PCR) co-amplified with glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as an internal standard. In resected tumor specimens, TS and DPD activities ranged from 7.1 to 176.6 fmol/mg protein and from 3.6 to 99.8 pmol/min/mg protein, respectively, while TS and DPD mRNA levels ranged from 0.50 to 21.12 and from 0.014 to 7:22, respectively. There were no significant correlations between TS/DPD levels and other clinicopathological factors, except for low DPD mRNA levels in undifferentiated carcinoma. Both TS activity and mRNA levels were significantly higher in tumor tissues compared to normal adjacent mucosa. In contrast, there was no significant difference between tumoral and non-tumoral DPD activity, although tumor tissue showed significantly lower DPD mRNA levels than non-tumoral tissue. High tumoral TS mRNA levels in preoperative biopsy specimens from patients with stage III/IV was associated with poor survival outcome after surgery compared with patients with low tumoral TS mRNA levels. In contrast, DPD levels had no influence on prognosis. We conclude that high tumoral TS levels and low tumoral DPD mRNA may indicate the selective cytotoxicity of 5-FU on gastric cancer, and that tumoral TS mRNA levels may be a prognostic factor for patients with stage III/IV gastric cancer.

Chemosensitivity testing of primary tumor cells from gastric cancer patients with liver metastasis can identify effective antitumor drugs

The liver metastasis of gastric carcinoma is resistant to conventionally available treatment. Twenty patients with liver metastasis of gastric cancer were treated by arterial drug infusion using a reservoir and seven cases were treated with systemic chemotherapy. The resected primary gastric cancer specimen was used for chemosensitivity assay with 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl-2H tetrazolium bromide (MTT) endpoint, and the patients were treated without reference to the results of the chemosensitivity assay. The mean survival period was assessed according to the histology of the primary lesion, the grade of liver metastasis and, the presence of peritoneal dissemination. No significant differences were observed in the primary tumor histology and grade of liver metastasis, but the survival period of the patients with liver metastasis and peritoneal dissemination was significantly shorter than that of the patients without peritoneal dissemination. Nine patients were treated with drugs that were effective in the chemosensitivity assay, and their responses included two complete responses and two partial responses; these patients showed a significantly prolonged survival period compared with patients treated with drugs that were not effective in the assay. The chemosensitivity assay is useful for evaluating the effectiveness of antitumor agents against liver metastasis of gastric cancer.

Chemosensitivity test is useful in evaluating the appropriate adjuvant cancer chemotherapy for stage III non-scirrhous and scirrhous gastric cancers

A total of 183 cases with gastric cancer was retrospectively analyzed in terms of their chemosensitivity as determined by the 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay and their survival rates after surgery. After the patients were stratified into scirrhous or non-scirrhous carcinoma groups, they were tested for stage III or IV gastric cancer. In these four cohorts, the patients were categorized into sensitive and insensitive groups determined by the MTT assay. The sensitive group was treated with at least one drug that had been shown to be effective in the MTT assay, and the insensitive group was given a drug that had been shown to be ineffective in the MTT assay. In stage III gastric cancer, the sensitive group showed a favorable survival compared to the insensitive group in scirrhous and non-scirrhous carcinoma, while this difference was diminished in stage IV gastric cancer. There were no survival benefits in the sensitive group in stage III gastric cancer, when they were not treated with adjuvant cancer chemotherapy. These results suggested that MTT assay would be useful in evaluating the appropriate adjuvant cancer chemotherapy for stage III scirrhous and non-scirrhous gastric cancer.

[Establishment of alpha-fetoprotein producing human rectal cancer cell line (RKK-YK) and its features]

We succeeded in establishing a rectal cancer cell line RKK-YK from the primary lesion in a patient with rectal cancer. It took 36.2 hours for duplication. We were able to transplant the RKK-YK cell line to nude mice at a transplantation rate of 50%. The transplanted tumor exhibited histological features similar to those of the primary lesion. Cancer cells with two different degrees of differentiation, in which features of moderately differentiated adenocarcinoma and well-differentiated adenocarcinoma were observed together, were established. The levels of the tumor markers (CEA, CA19-9 and AFP) were elevated in the supernatant of the culture solution and the serum of the nude mice over time course. In the immunohistological examination of the transplanted tumor, anti-CEA, anti-CA19-9 and anti-AFP antibodies were positively stained. Molecular biological analysis revealed nor point mutation or deletion in K-ras gene exon 1 and 2, p53 gene exon 5 to 11 or MCC.

Interferon gamma increases the antitumor activity of mitomycin C against human colon cancer cells in vitro and in vivo

A combined antitumor activity of mitomycin C (MMC) and interferon gamma-1a (IFN-gamma) was evaluated to be synergistic by the 3-(4, 5-dimethylthiazol-2yl)-2,5-diphenyl-2H tetrazolium bromide assay and human tumor xenografts/severe combined immunodeficient (SCID) mouse system using colon cancer cell lines. The experimental metastasis of WiDr cells in SCID mouse was inhibited by MMC and IFN-gamma with their synergism. Intracellular uptake of MMC in WiDr cells in vitro was significantly increased by IFN-gamma, suggesting the mode of synergism of these agents. This model may also partly explain the antitumor activity of combined MMC, 5-fluorouracil and interleukin-2 treatment on hepatic metastasis of colon cancer.

Dihydropyrimidine dehydrogenase activity and messenger RNA level may be related to the antitumor effect of 5-fluorouracil on human tumor xenografts in nude mice

We investigated the correlation between tumor sensitivity to 5-fluorouracil (5-FU) and the enzymatic activity and mRNA levels of thymidylate synthetase (TS) and dihydropyrimidine dehydrogenase (DPD) using human tumor xenografts in nude mice. Three gastric carcinoma xenografts (SC-1-NU, St-4, and H-111), two colon carcinoma xenografts (Co-4 and Col-3-JCK), one pancreatic carcinoma xenograft (PAN-3-JCK), and one breast carcinoma xenograft (MX-1) were inoculated into nude mice. When the resultant tumors reached 100-300 mg, 5-FU was administered i.p. at a dose of 60 mg/kg in a schedule of three times every 4 days, and the antitumor activity of 5-FU was evaluated as the relative mean tumor weight in treated mice compared to control mice. Xenografts were also inoculated into untreated nude mice. When tumors weighed 200-300 mg, tumor tissues were resected for measurement of tumoral TS and DPD. TS and DPD activities were detected by the TS-binding assay and a radioenzymatic assay, respectively. mRNA levels were measured by semiquantitative reverse transcription-PCR, with glyceraldehyde-3-phosphate dehydrogenase coamplified as an internal standard. TS and DPD activities ranged from 84.7 to 775.5 fmol/mg protein and from not detectable to 79.7 pmol/min/mg protein, respectively. TS and DPD mRNA levels ranged from 0.51 to 9.90 and from not detectable to 0.93, respectively. The enzymatic activities of TS and DPD were correlated with observed mRNA levels. DPD levels were significantly correlated with 5-FU sensitivity, with high DPD activity and high DPD mRNA level resulting in low sensitivity to 5-FU. In contrast, no correlation between TS level and 5-FU sensitivity was observed. Tumoral DPD activity and DPD mRNA level may be useful indicators in predicting the antitumor activity of 5-FU.

[A case of esophageal cancer with excellent response to oral UFT treatment]

The patient was an 83-year-old Japanese male with the chief complaint of difficulty in swallowing. On Feb. 24, 1997, he was referred to our hospital under suspicion of esophageal cancer. X-P revealed an image of a protrusion at Im-Iu having a long diameter of 6 cm. Endoscopy revealed that the esophageal lumen was nearly completely obstructed due to the presence of an irregularly-shaped tumor. The pathological finding of biopsized specimen was a squamous cell carcinoma. Thus, this case was diagnosed as esophageal cancer, but surgery was deemed inappropriate due to the patient's advanced age. Accordingly, on March 12, treatment was started with oral administration of UFT-E granules (Tegafur, 450 mg/day). Initially, the patient was unable to ingest even liquids, but beginning around May the blockage of the esophagus disappeared. Endoscopic examination performed in June revealed that the tumor had shrunk to a about 1 cm in diameter. Although tumor tissue remained, the tumor was observed to have undergone further reduction in size at 6 months after the start of chemotherapy. Moreover, the patient gained weight. This is considered to be a very rare case of an excellent response of esophageal cancer to oral administration of only UFT agents.

Sealing effect of rapidly curable gelatin-poly (L-glutamic acid) hydrogel glue on lung air leak

BACKGROUND

Air leak is a problem commonly occurring in lung and thoracic operations. In this study, a rapidly curable hydrogel glue was prepared as the seal for lung air leak.

METHODS

Mixing an aqueous solution of gelatin and poly(L-glutamic acid) with a water-soluble carbodiimide produced a hydrogel. The sealing effect on the air leak wound of rat lung was compared with that of conventional fibrin glue.

RESULTS

The gelatin-poly(L-glutamic acid) hydrogel glue was solidified as rapidly as the fibrin glue, and was significantly more effective in sealing the lung air leak than the fibrin glue. Approximately 80% of the lungs treated with the hydrogel glue exhibited no air leak at the lung pressure of 50 cm H2O. Urea addition could prevent spontaneous gelatination of the mixed solution at room temperature and did not affect the hydrogel sealing effect. The bonding strength of the hydrogel glue both with and without urea to the lung tissue was significantly higher than that of the fibrin glue.

CONCLUSIONS

We concluded that this strong lung adhesion of the gelatin-poly(L-glutamic acid) hydrogel glue resulted in its superior sealing effect.

Impaired lung oxygenation in acute aortic dissection

BACKGROUND

In the early phase after the onset of acute aortic dissection, oxygenation impairment often occurs. However, the etiology and clinical course of this phenomenon have not been established. We examined the serial changes of oxygenation, inflammatory reaction and laboratory data in patients with acute aortic dissection.

METHODS

Nine patients (DeBakey type I; 4, type II; 3 and type IIIb; 2), aged 46 to 82 years were included in this study. All patients were managed in the intensive care unit, and systolic arterial pressure was maintained at around 110 to 120 mm Hg. Oxygenation was impaired in all patients, three (33%) of whom required mechanical ventilatory support.

RESULTS

Pleural effusion was observed in eight (89%) of nine patients. Respiratory index was 0.98+/-0.19 (mean +/-SEM) at the time of admission, and elevated to 1.59+/-0.35, 1.58+/-0.21, 1.60+/-0.28 respectively, at day 1, 2 and 3. Oxygenation index was 318+/-34 at the time of admission, and decreased to 271+/-34, 255+/-19, 263+/-26, respectively, at day 1, 2 and 3. These values recovered to normal after day 4. The increase of white blood cells and high fever (>38 degrees C) continued until day 3. Platelet counts recovered after day 4. The serum bilirubin level was highest (2.0+/-0.5 mg/dl) at day 3, and decreased gradually after day 4. In two recent patients whose serum interleukin-8 (IL-8) was measured, IL-8 levels increased according to the impaired oxygenation or aneurysmal enlargement. Impaired oxygenation, inflammatory changes, platelet consumption and bilirubin elevation continued until day 3 and resumed normal levels after day 4.

CONCLUSIONS

These changes may be due to hemolysis, consumption coagulopathy or inflammation associated with acute aortic dissection. IL-8 elevation may be associated with aneurysmal enlargement and these phenomena.