thromboxane-b2 and Esophageal-Neoplasms

We have studied prospectively the clinical course and serum concentrations of thromboxane B2 (TxB2) and leukotriene B4 (LTB4) in patients developing adult respiratory distress syndrome (ARDS) after oesophagectomy. The clinical course was assessed according to a validated ARDS score, and intra- and postoperative measurements of TxB2 and LTB4 in pre- and post-pulmonary blood were performed in 18 patients undergoing oesophagectomy for oesophageal carcinoma and 11 control patients undergoing thoracotomy and pulmonary resection. Six of 18 patients undergoing oesophagectomy, but no control patient, developed ARDS. The ARDS score was highest on day 8 after operation. Only patients with ARDS had a significant postoperative increase in post-pulmonary, but not pre-pulmonary, TxB2 concentrations (P < 0.05 vs patients without ARDS). This study provides evidence that TxA2, originating from the lungs, was associated with the development of ARDS after oesophageal resection. In view of the high incidence of ARDS after oesophagectomy (10-30%), prophylactic treatment of patients undergoing oesophageal resection with clinically applicable thromboxane synthetase inhibitors may be warranted.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Esophageal Neoplasms; Esophagectomy; Female; Humans; Leukotriene B4; Male; Middle Aged; Postoperative Period; Prospective Studies; Respiratory Distress Syndrome; Risk Factors; Thromboxane B2

Studies on responses to surgical stress in blood coagulation and fibrinolysis, platelet counts and thromboxane B2 (TXB2) were carried out with 18 esophageal cancer patients who had undergone radical esophagectomy through right thoracotomy and reconstruction with gastric tube. Plasma levels were measured for the following for coagulation assessment: thrombin.antithrombin III complex (TAT), soluble fibrin monomer complex(SFMC), fibrinogen, antithrombin III, protein C and thrombomodulin. Selected fibrinolytic markers are: tissue plasminogen activator.plasminogen activator inhibitor 1 complex (tPA.PAI1C), plasminogen, alpha 2 plasmin inhibitor, plasmin. alpha 2 plasmin inhibitor complex(PIC), FDP and D-dimer. Peripheral venous blood samples were taken from the patients before the operation, immediately after the operation and on each of the first, second, third, seventh and fourteenth day after the operation. It was observed that TAT, SFMC, tPA.PAI-1C and TXB2 were remarkably altered immediately after the operation. This indicates that the major surgical stress significantly activated coagulation, fibrinolysis and platelets. Higher plasma levels of TAT compared to the pre-operation level was recorded for two weeks after the operation. Furthermore, in four cases, SFMC became positive during three to seven days after operation. These facts indicate that the activation of coagulation persisted during the days after operation. PIC began to increase from the 2nd to 3rd days after operation, reaching the maximum on the 7th day. Biphasic changes which peaked twice on the 1st and 7th days after operation were shown in plasma levels of FDP and D-dimer. These results indicate that the activation of fibrinolysis also persisted during the days after operation. The activation of coagulation and fibrinolysis may persist at least for two weeks after major surgical operation. Careful observation for the states of these systems was thought to be needed during the post-operative days, and the molecular markers could be useful to assess subclinical changes of these systems.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Blood Coagulation; Esophageal Neoplasms; Esophagectomy; Fibrinolysis; Humans; Male; Middle Aged; Platelet Count; Postoperative Period; Stress, Physiological; Thoracotomy; Thromboxane B2; Time Factors

To examine the effects of total thoracic esophagectomy on cardiorespiratory functions and the responses of the body to surgery, changes in the cardiorespiratory parameters and plasma concentrations of chemical mediators were examined before and after surgery in 21 mongrel dogs inflicted with 3 types of surgical damage. Group 1 underwent a simple thoracotomy, Group 2 an ablation around the thoracic esophagus and pulmonary hilus, and Group 3 a total thoracic esophagectomy with extended lymphnode dissection around the tracheobronchial region. In Group 3, lung resistance and extravascular lung water increased by 108 per cent and 83 per cent, respectively, while lung compliance decreased by 71 per cent. Among the cardiovascular parameters, pulmonary arterial pressure and pulmonary wedge pressure increased by 40 per cent and 89 per cent, respectively, these values being significantly higher in this group than in the other two groups. With regard to the plasma chemical mediators, renin-angiotensin-aldosterone, antidiuretic hormone, catecholamine, serotonin, histamine, and thromboxane B2 levels were significantly higher in Group 3 than in Group 1. The increase in thromboxane B2 was particularly notable in Group 3, being about 6,000 pg/ml 60 minutes after surgery. The results of this study showed how total thoracic esophagectomy lead to a marked deterioration in respiratory function caused by division of the pulmonary nerves and changes in plasma chemical medicator concentrations which induced constriction of the pulmonary vessels and/or increased the vascular permeability. The disturbance of pulmonary lymph flow due to surgical disruption of the lymphatic system also contributed to the deteriorated lung function.

Topics: Animals; Blood Gas Analysis; Dogs; Esophageal Neoplasms; Esophagus; Extravascular Lung Water; Hemodynamics; Lymph Node Excision; Postoperative Complications; Pulmonary Wedge Pressure; Renin-Angiotensin System; Respiratory Mechanics; Thromboxane B2