atrial-natriuretic-factor and Esophageal-Neoplasms

Endothelin-1 (ET-1) and human atrial natriuretic peptide (hANP) are known as vasoactive substances. In the present study, an attempt was made to evaluate the mode by which these substances are secreted in patients having severe surgical stress. Plasma ET-1 and hANP concentrations were measured in 15 patients with esophageal carcinoma who underwent subtotal esophagectomy via right-thoraco-ventrotomy (EC group) and 10 patients with gastric carcinoma who underwent total gastrectomy via ventrotomy (GC group). The volume of intraoperative hemorrhage was significantly larger and operation time was significantly longer in the EC group than in the GC group. Plasma ET-1 concentration in the EC group increased remarkably on the first operative day (1st POD), whereas that in the GC group did not. Plasma levels of hANP in both the EC and GC groups gradually increased until they peaked on the 2nd POD. The increment of plasma hANP secretion for the EC group was significantly higher than that for the GC group on the day of the operation, suggesting that ET-1 stimulated hANP in the EC group. Plasma hANP levels reached their peak values on the 2nd POD and returned to the preoperation level on the 5th POD, while PCWP did not change significantly after the surgery. Since this discrepancy between the postoperation patterns of PCWP and hANP cannot be explained by changes in the circulating blood volume, hANP secretion may be regulated by certain factors in addition to the left ventricular pressure experienced by patients receiving heavy operation stress, such as those in the EC group.

Topics: Atrial Natriuretic Factor; Endothelins; Esophageal Neoplasms; Esophagectomy; Female; Gastrectomy; Homeostasis; Humans; Laparotomy; Male; Middle Aged; Stomach Neoplasms; Stress, Physiological; Thoracotomy; Water-Electrolyte Balance

We investigated postoperative changes in immunoreactive plasma endothelin (ET-1) concentrations using a highly specific and sensitive radioimmunoassay developed for this purpose. The patients were divided into two groups: 10 patients underwent subtotal-esophagectomy by combined right thoracotomy and celiotomy (EC-group), and an other 10 underwent total gastrectomy via celiotomy only (GC-group). Before operation, plasma ET concentrations in both groups were within the normal range. After operation, the mean plasma ET-1 concentration in the EC group was significantly higher than the preoperative concentration (p less than 0.01). But in the GC-group, there were no significant change. A significant correlation existed between the change in plasma ET-1 concentration and the amount of intraoperative hemorrhage (p less than 0.05). Additionally in the EC group, a significant correlation existed between plasma ET-1 concentrations after operation and the change in the atrial-natriuretic-peptide (ANP) concentration during operation (p less than 0.05). There was no correlation between ET-1 concentrations and blood pressure. We believe that the increase in the ET-1 concentration was attributable to endothelial cell injury and may increase ANP secretion. We speculate that the plasma ET-1 concentration may be a reliable index of surgical stress.

Topics: Adult; Aged; Amino Acid Sequence; Atrial Natriuretic Factor; Blood Loss, Surgical; Endothelins; Esophageal Neoplasms; Esophagectomy; Female; Gastrectomy; Humans; Male; Middle Aged; Molecular Sequence Data; Postoperative Period; Radioimmunoassay; Stomach Neoplasms

Topics: Atrial Natriuretic Factor; Endothelins; Esophageal Neoplasms; Gastrectomy; Humans; Peptides; Postoperative Period; Stomach Neoplasms; Vasopressins

The present study examined the effects of subtotal oesophagectomy through a right thoracal and abdominal approach, on the postoperative water-electrolyte metabolism and cardio-pulmonary function of patients with thoracic oesophageal carcinoma. The primary water balance, total sodium intake, urinary NAG index, free-water clearance (CH2O), oxygen diffusion function of the lungs to aerate blood (DLO2-Index), and alpha-human atrial natriuretic polypeptide (alpha-hANP) were measured perioperatively until the seventh day. Subjects were divided by age according to whether they were older or younger than 70 years into 2 groups. In both groups, no change was observed in the primary water balance, total sodium intake, urinary NAG index or CH2O. However, all of the patients in the older group exhibited significantly higher alpha-hANP values than those in the control group, and the DLO2-Index was also higher in the former subjects during the first 3 days following surgery. It may be concluded that alpha-hANP is a hormone of considerable importance as it is secreted in large amounts in response to increased stress on the cardio-pulmonary system and serves to normalize the water balance causing this extra load.

Topics: Acetylglucosaminidase; Age Factors; Aged; Atrial Natriuretic Factor; Esophageal Neoplasms; Humans; Middle Aged; Postoperative Care; Sodium, Dietary; Water-Electrolyte Balance

The present study examined the influence of subtotal esophagectomy through r-thoracal and abdominal approach on plasma atrial natriuretic polypeptide (ANP) and postoperative cardiopulmonary function using the Swan-Ganz Catheter in patients with thoracic esophageal cancer. The cardiac output (CO), left ventricular stroke work index (LVSWI), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), and plasma atrial natriuretic polypeptide levels (ANP) were measured during the perioperative period till the 3rd day. Subjects were divided into 2 groups by preoperative PVR values, those over 100 dynes.sec.cm-5 (PVR group), and those less than 100 dynes.sec.cm-5 (N group). Significant correlations were observed between ANP and CO (r = -0.63, P = 0.028), PVR (r = 0.66, P = 0.018), LVSWI (r = -0.71, P = 0.0009) and SVR (r = 0.71, P = 0.009) at 3 hours after operation. And the correlations between ANP and CO (r = 0.54, P = 0.049), PVR (r = -0.69, P = 0.019) and LVSWI (r = 0.65, P = 0.031) were observed on the 2nd POD. Moreover, the patients indicating high PVR values preoperatively showed significantly higher PVR values than those seen in the N group during the postoperative days. Postoperative complications were significantly seen in the PVR group. Primary water and sodium balance tended to be the higher accumulation in the PVR group than those of the N group, and the cardiovascular parameters in the PVR group revealed hypodynamic characteristics in the early period after the operation. With these results, it is suggested that perioperative fluid therapy and respiratory management should be performed more strictly in the PVR group.

Topics: Adult; Aged; Atrial Natriuretic Factor; Esophageal Neoplasms; Esophagus; Female; Heart; Humans; Lung; Male; Middle Aged; Postoperative Period

For the purpose of evaluation of the water-electrolyte metabolism in upper GI tract surgery, I measured alpha-human atrial natriuretic polypeptide (alpha-hANP) and other parameters of twenty-eight patients daily for seven days after operation. The subjects were divided in four groups as follows; 6 r-thoracal and abdominal esophagectomy (r-TA group); 4 l-thoracoabdominal total gastrectomy (1-TA group), 8 abdominal total gastrectomy (TMR group) and 10 partial gastrectomy (PMR group). Plasma alpha hANP levels in r-TA group were significantly higher than those in PMR group on the first, second, third and seventh postoperative days (p less than 0.05). Furthermore, those in 1-TA group were also significantly higher compared to those in PMR group on the second and seventh postoperative days (p less than 0.05). Significant correlation between plasma alpha hANP level and water balance was detected in transabdominal groups (TMR, PMR). However, this correlation was not found in thoracoabdominal groups (r-TA, l-TA). There was no correlation among alpha hANP level, heart rate and blood pressure. Serum and urinary Na/K ratio was lower in r-TA group, l-TA group, TMR group, and PMR group in descending order. Consequently, plasma alpha hANP level plays an important role in water-electrolyte metabolism during the perioperative period. A good group of the dynamic status of the secretion of alpha hANP levels might be a very useful index for the evaluation of the magnitude of surgical stress.

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Blood Pressure; Esophageal Neoplasms; Female; Heart Rate; Humans; Male; Middle Aged; Peptide Fragments; Postoperative Period; Stomach Neoplasms; Water-Electrolyte Balance