The effect of surgery on levels of some plasma proteins

[Stress-metabolism after myocardial infarction-demonstrated by means of the behaviour of plasma proteins with short half-life (author's transl)]

The kinetics of plasma proteins with short half-life during stress-metabolism in patients after myocardial infarction with and without clinical complications and after angina pectoris were compared. The acute-phase proteins alpha1-antitrypsin, C-reactive protein (CRP), fibrinogen, haptoglobin, and the transport proteins prealbumin and transferrin were analyzed with the method of radial immunodiffusion. Whereas angina pectoris doesn't influence the protein kinetics, one can recognize after myocardial infarction a continuous increase of the acute-phase proteins to maxima between the 3rd and 5th day after the attack. Parallel to these changes, the transport proteins decrease with subsequent increase. The changes, which are similar to those seen after surgical trauma, are dependent on the severity of illness, and can be used as prognostic parameters. During stress metabolism, the concentrations of the proteins depending on nutrition, prealbumin and transferrin, are modified by the type and severity of stress, and by nutritional influences. The mechanisms of these changes and the consequences for their use as diagnostic parameters are discussed.

Acute-phase proteins from the liver and enzymes from myocardial infarction; a quantitative relationship

In 14 patients with acute myocardial infarction (M.I.) not having any other disease, the possible quantitative relationship between enzymes from M.I. and changes in concentration of acute phase reactants coming from the liver were studied. The patients were followed up until 1 1/2 years after M.I. and comparison of baseline-protein values took place using a control group of 18 healthy individuals. Quantitation of protein changes was done by planimetric determination of the area under the concentration curve and by taking peak values. The myocardial infarction was quantitatively estimated by mathematical analysis of the time course of alpha-hydroxybutyrate dehydrogenase (alpha-HBDH) plasma concentrations and by taking peak values. A quantitative relationship with enzymatic infarct size was found for haptoglobin, alpha1-acid glycoprotein, alpha1-antitrypsin, C-reactive protein, fibrinogen and E.S.R. Albumin and transferrin did not show a negative quantitative relationship with enzymatic infarct size. Humoral factors originating from the site of tissue injury and evoking in proportion a positive acute phase reaction by the liver are probably the basis for this observed quantitative relationship.

Liver reaction to tissue injury: do therapeutic measures trigger the acute phase reaction?

In 30 healthy people we investigated the hypothesis that therapeutic measures trigger the acute phase reaction. In order of severity we analyzed: (1) the effects of an intramuscular injection of 2.5 ml 0.14 molar NaCl (6 patients), (2) the effects of an indwelling venous catheter for 24 h (7 patients), and for 72 h (8 patients), (3) the effects of cardiac catheterization (arterial and venous catheterization) carried out in 9 patients. In clinical investigations of the acute phase reaction, an intramuscular injection and a 24- or 72-h indwelling catheter, brought in by venipuncture, are acceptable because they do not provoke an acute phase reaction. A venous cutdown associated with an arterial puncture is not acceptable because this injury evokes a positive acute phase reaction. This was also observed in two patients who developed phlebitis during a 24-h indwelling venous catheter. Only a positive acute phase reaction was found, not a negative one.

An Experimental Study on the Pathogenesis of Postoperative Hypoalbuminaemia1

This paper reports a study in the rat of the changes in the plasma albumin level following laparotomy, and their correlation with the concentrations of extravascular albumin in the area of the operation wound and in the liver.

SUMMARY

The pathogenesis of postoperative hypoalbuminaemia remains a controversial and poorly understood topic. In the present study the changes in the plasma albumin level following laparotomy have been investigated by immunological methods and correlated with the concentrations of extravascular albumin in the operation wound site and in the liver. There was a fall in the plasma albumin level, accompanied by an increase in the extravascular albumin concentration at the laparotomy wound site, with no alteration in the concentration of albumin in the liver. This work confirms that postoperative hypoalbuminaemia is due to accumulation of albumin in the wound site. Increased capillary permeability is suggested as a cause of the excessive loss of plasma albumin into the surgically injured site. The role and subsequent fate of the extravascular albumin in the wound area are also discussed.

Effect of endotoxin on plasma albumin and fibrinogen synthesis rates in rabbits as measured by the [14C] carbonate method

1. Rates of synthesis of plasma albumin and fibrinogen were measured by the [(14)C]carbonate method in normal rabbits and in animals that received a single intravenous injection of Shigella endotoxin 14-48hr. earlier. 2. The accuracy of the method was improved by introducing refinements into procedures for measuring (14)C radioactivities associated with both urea and proteins that are lost from the plasma during the synthesis interval. 3. The synthesis interval (time between injecting carbonate and measuring specific radioactivities of protein guanidine carbon in plasma) can be shortened with advantage to 3-4hr. 4. Injection of endotoxin markedly decreased the fractional rate of loss in the first few hours of injected radioiodine-labelled fibrinogen and to a smaller extent of similarly labelled albumin from the plasma. The absolute rate of synthesis of fibrinogen was increased in endotoxin-treated rabbits by more than 400% compared with normal animals, and the rate of synthesis of albumin was increased by about 60%.