Endotoxemia after abdominal surgery.

et al. 1988

Self Cite

Effect of hepatectomy on the prognosis of cirrhotic rats prepared by oral administration of thioacetamide was studied from the standpoint of the reticuloendothelial function and energy metabolism of the liver. OK-432, a streptococcal preparation, was used to activate reticuloendothelial functions. Administration of OK-432 to cirrhotic rats prior to 70% hepatectomy significantly prevented the elevation of serum GOT, GPT and LDH, the prolongation of blood coagulation and the decrease of serum complement level. Hepatic ATP synthesis and RNA content were significantly increase by the use of OK-432. These findings suggest that activation of reticuloendothelial functions at the time of massive hepatectomy in cirrhotic rats may diminish hepatic injury, maintain serum complement level, and improve protein synthesis of the liver, massive hepatectomy ; reticuloendothelial function ; liver cirrhosis ; thioacetamideThe postoperative period of patients subjected to hepatectomy due to hepatocellular carcinoma associated with liver cirrhosis is frequently complicated with the episodes of multiple organ failure (MOF) such as liver failure, renal failure, respiratory failure and disseminated intravascular coagulation (DIC). It has been pointed out that deterioration in the clearance of toxic substances, due to a decreased reticuloendothelial function, is involved in the pathogenesis of these surgical complications. In order to investigate the significance of the activation of this function before massive hepatectomy, we performed 70% hepatectomy in cirrhotic rats that had been treated with OK-432 (Chugai Pharmaceutical Co., Tokyo) to activate the reticuloendothelial function and measured liver function tests, total hemolytic complement (CH50), hepatic energy metabolism and liver regeneration capacity.

Section: Discussionmentioning

confidence: 99%

Significance of activation of reticuloendothelial function after hepatectomy in cirrhotic rats.

et al. 1988

Self Cite

Section: Discussionmentioning

confidence: 99%

“…Postoperative endotoxemia is thought to be one of the precipitating factors for the occurrence of multiple organ failure in these patients (Nakagawa et al 1986), and has been conventionally treated with oral antibiotics directed against the intestinal flora. On the other hand, although cirrhotic patients have a suppressed blood endotoxin clearance (Nakagawa et al 1986), literatures reported about the potential usefulness of activation of the reticuloendothelial function for the purpose of reducing blood endotoxin levels are scanty. Since OK-432, which has been widely used as an immunoactivator in cancer patients, has thought to be an effective activator of the reticuloendothelial function (Nakagawa et al 1985), this was administered to patients with hepatocellular carcinoma associated with liver cirrhosis before and after hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Activation of reticuloendothelial function for prevention of endotoxemia after hepatectomy in cirrhotic patients.

et al. 1987

Self Cite

In order to prevent endotoxemia after hepatectomy in cirrhotic patients, we administered OK-432 before and after hepatectomy to activate the reticuloendothelial function and studied its effect on postoperative endotoxemia. In the cirrhotic group without OK-432 administration (7 patients), the value of endotoxin increased significantly after hepatectomy, compared to the cirrhotic group which received OK-432 administration (5 patients) and the non-cirrhotic group (12 patients), and the endotoxin level was still higher than the preoperative value even on the 14th day. On the other hand, the cirrhotic group with OK-432 administration and the non-cirrhotic group showed minimal increases of endotoxin levels at the first day, which returned to the preoperative values at the third day. Base on these findings, it is suggested that activation of the reticuloendothelial function bears substantial significance as one of the therapeutic modalities for prevention of endotoxemia after hepatectomy in cirrhotic patients. reticuloendothelial function ; endotoxemia ; liver cirrhosis ; hepatectomy As a possible pathogenic mechanism of endotoxemia after hepatectomy in cirrhotic patients, the decreased function of the reticuloendothelial system, particularly suppressed blood endotoxin clearance due to the diminished function of Kupffer cells, has been drawing increasing attention (Nolan 1981). In order to prevent endotoxemia after hepatectomy in cirrhotic patients, we activated the reticuloendothelial function applying OK-432 before and after hepatectomy and studied its effect on postoperative endotoxemia. PATIENTS and METHODSAs shown in Table 1, 12 patients with hepatocellular carcinoma associated with liver cirrhosis were subjected to this study. Of five patients whose reticuloendothelial function was activated by the administration of OK-432 (Chugai Pharmaceutical Co., Tokyo) (OK-432 group), three had a subsegmentectomy, and the other two, an anteroinferior

“…However, in cases undergone massive hepatectomy, where the reticuloendothelial function is markedly deteriorated, spillover of endotoxin into the systemic circulation might have a chance to impair various organs, finally reaching to MOF (Yajima et al 1985;Nakagawa et al 1986). In the present experiment, the blood endotoxin level after hepatectomy was markedly increased in the control group, however, in the group where the reticuloendothelial function was activated by OK-432, the rise of the blood endotoxin was slight.…”

Section: Discussionmentioning

confidence: 99%

The significance of activation of reticuloendothelial function on hepatectomy.

et al. 1987

Self Cite

The prognosis of patients after massive hepatectomy is poor in certain cases whose hepatic reserve, including reticuloendothelial function, is deteriorated. We administered OK-432 before 70% hepatectomy on rats to activate the reticuloendothelial function and studied its effect on postoperative course. The elevations in plasma endotoxin, GOT and GTP were attenuated, and the deterioration of the complement activity after hepatectomy was greatly improved by OK-432 treatment. The RNA content in the liver was significantly increased by OK-432 administration. These findings suggest that activation of the reticuloendothelial function at the time of massive hepatectomy enhances endotoxin clearance from blood and thereby contributes in lessening the magnitude of hepatic injury, maintaining the serum complement, and improving liver protein synthesis. massive hepatectomy ; reticuloendothelial function ; endotoxemia ; postoperative liver injury Massive hepatectomy sometimes induces postoperative multiple organ failure (MOF) such as liver failure, renal failure, respiratory failure, disseminated intravascular coagulation (DIC) and gastrointestinal bleeding. It has been pointed out that deterioration in the clearance of toxic substances, including endotoxin, due to a decreased reticuloendothelial function, is involved in the pathogenesis of these surgical complications. We, therefore, performed 70% hepatectomy in rats which had been treated with OK-432 (Chugai Pharmaceutical Co., Tokyo) to activate the reticuloendothelial function and evaluated the significance of the activation of this function from various aspects of blood endotoxin level, total hemolytic complement (CH50) and liver function tests, energy metabolism and regeneration of the liver. MATERIALS and METHODSMale Spraque-Dawley rats weighing 200 to 250 g were used in the present experiments.