- Email: [email protected]
Serum IL-6 as a prognostic indicator in surgical patients
0.11 Serum patients
IL-6 as a prognostic
indicator
in surgical
Contml oKa4 Non-OK(u Nbalance(mgld) 256ft4 226t14 Mu&AA: Gluianxc L54+0.21 4.32tO.34 GlUt&lllne 3ut1.7 36.6i3.7 LWWAA GkJhlllC 5.15+0.29 4.46t0.36 Glutaltllne 15.6fO.9 14.4r1.4 IntestmeAA GM&c 5.44to.79 11.46kO.88 GlUtaflllIle 2.11 3.62+0.50
A.M. Cruickshank, H.G. Bums andA. Shenkin Departments of Biochemistry and Surgery, Glasgow Royal Infirmary, Scotland Introduction: Serum IL-6 rises post-operation, the increase being related to the severity of surgical trauma.
co.29
Trauma OKGA Non.OKOA 257+13 177+9 6.01+0.43 5.17+0.35 42.4t3.0 26.212.0 5.64*0.35 4.61t0.33 16.4+2.0 14.4t1.1 4.93to.59 7.93t1.25 1.66~0.15 2.69tO.46
Significant improvements in N balance and AA levels are evident due to adjuvant OKGA.
Aim: To assess the value of serum IL-6 in predicting the development of complications post-operation.
0.13
Method: Timed venous blood samples were collected from surgical patients. Sera were analysed for IL-6 (mouse B cell hybridoma stimulation assay) and C-reactive protein (CRP - fluorescence polarisation immunoassay).
Glucose-insulin-potassium
in hypoxic shock
Allan Engquist and Stig Nistrup Ho/megaard Dept. ofAnesthesia and Internal Medicine, Bispebjerg and Herlev Hospitals, Copenhagen, Denmark Glucose-insulin-potassium (GIK) or hypertonic glucose have been advocated in states of cellular hypoxia to stimulate anaerobic pathways of metabolism and thus improve myocardial performance, organ functions, and survival. The purpose of the present investigation was to study the possible beneficial cardiovascular and metabolic effects of hypertonic glucose and supraphysiologic dose of insulin during hypoxemia in a standardized sublethal hypoxic and normocapnic dog model (Pa02 3.3-4.7 kPa, PaC02 4.96.1 kPa). Methods: Twenty-five dogs were randomized to receive either glucoseinsulin-potassium (GIK) (glucose 509, insulin 66Ou, potassium 20mmol) or glucose-potassium (GK) (glucose 509, potassium 20mmol). The following variables were measured: systolic time intervals (STI), cardiac output, aotiic, pulmonary arterial, and wedge pressures, epinephrine, norepinephrine, cortisol, cyclic AMP, glucose, lactate, pyruvate, inorganic phosphate, electrolytes, hemoglobin and hematocrit. Results: Forty percent of the animals receiving either GlKor GK succumbed afler a mean hypoxic period of 38.5 min. Furthermore, 680 units of insulin had essentially no effect on the measured variables during hypoxemia. Of the variables measured only heart rate, pulmonary arterial and wedge pressures, plasma catecholamines, cyclic AMP, phosphate and potassium showed prognostic significance. The highly significant correlation between epinephrine, norepinephrine and cyclic AMP indicates that the cause of death was not due to malfunctioning of the catecholamine stimulated receptors. The findings support the view that provision of substrate during severe hypoxemia is deleterious.
Results: 21 patients were studied: 7 undergoing moderate intra-abdominal surgery; 7 undergoing major colorectal surgery; 5 undergoing vascular surgery; 2 undergoing extensive vascular surgery. IL-6 rose in all patients peaking within 12 hours of incision. 6 patients developed complications post-operation (infections, respiratory problems). Of these, 5 showed no decrease in IL-6 between 12 and 24 hours post-incision, whereas in the uncomplicated controls IL-6 values did fall. Patients wfih complications had higher (p < 0.01, Mann Whitney U test) IL-6 concentrations (median, (range), 226% (1291000%)) than controls undergoing similar surgery (67% (26100%)) at 24 hours post incision, although CAP levels were similar in the two groups (60% (33-96%) and 70% (31-100%) respectively). By 46 hours, complicated patients did have higher @ = 0.05, Mann Whitney U test) CAP concentrations than controls (95% (56-1449/a) and 68% (25-100%) respectively).
Conclusion: Serum IL-6 24 hours post-operation may be of use in identifying patients liable to develop clinical complications. Results are expressed as percentage of maximum control value.
l
0.12 Altered tissue amino acid (AA) levels in traumatized, growing rats due to L-ornithine-a-ketoglutarate (OKGA) supplemented oral diet M. Jeevansndam, M.R. A/i and W.R. Schiller Trauma Center, St. Joseph’s HospitalandMedical USA
Center, Phoenix, Arizona,
0.14 The impact of substrate infusion on tissue 02 extraction patterns during TPN in sepsis
Hypoaminoacidemia and unique patterns of tissue AA levels are known characteristics of severe injury. Since conventional nutritional supports were unable to reverse the catabolic effects in the early “flow” phase of severe injury, organ or tissue specific nutritional supports are needed. The potential use of OKGA. a precursor complex of glutamine in normalizing the AA levels in traumatized, growing rats are investigated. One group of male Sprague-Dawley rats (159 f 4g), adapted to dark-light cycle, was anesthetized and subjected to bilateral femur fracture and another group (Control), was only anesthetized. All rats were provided water but not food for 2 days. This resuited in 13 f 2% loss of body weight. On the third day, feeding was started and continued to 7 days. Traumatized as well as control rats were randomized between 2 isonitrogenous liquid diets (1) control diet (no. F1259, Bio-Serv, 6.5gN and 1000 kcal/l); (2) test diet (control diet from which 2.3% N was replaced by OKGA). Daily weight, voluntary dietary intake and urinary output data were collected. On day 7 the animals were sacrificed. Tissues of forelimb, muscle, liver and intestine were excised and AA contents were determined. Selected results (u moVg dry tissue, Mean 2 SEM, n = 6 for each group) are:
I. Giovannini, C. Chiada, G. Boldrini and M. Castagnero lstitufo diclinica Chirurgica (Chairman: Prof. F. Crucitti), Cenfro distudioper la Fisioparo/ogia de//o Shock CfVR, Roma, Italy In order to investigate the changes in 02 extraction patterns related to glucose, fat and amino acid infusion, 80 septic patients received 285 simultaneous measurements of Oz consumption (vOz, m!Imin/m’$, cardiac output (CO, UminIm~ and total body and lower limb O2 extraction fractions (02Ex, LO*Ex). The changes in total body and lower limb respiratory quotients (RQ, LRQ), in hemoglobin concentration (Hb), and in O2 tension at 50% Hb-02 saturation (Pso)were also taken into account together with the infusion rates of glucose, fat and amino acids (GIR, FIR, AAIR, g/Kq/24h). Mean + SD values for all pts were: VO, = 153 + 50, CO = 4.3 + 2.1,02Ex = 0.30? 0.09, and LO@ = 0.40 + 0.17, withGIR = 6.5,? 3.2, FIR = 0.8 f 0.2 (only for pts receiving fat) and AAIR = 1 .l + 0.5. Regression analysis showed that OnEx and L02Ex were inversely related to CO (r’ = 0.30, p i 0.01 for both). At any given CO, O*Ex and L02Ex were directly related to AAIR and FIR, which explained an additional 9% of the variability of OnEx and L02Ex 4
IL-6 as a prognostic
indicator
in surgical
Contml oKa4 Non-OK(u Nbalance(mgld) 256ft4 226t14 Mu&AA: Gluianxc L54+0.21 4.32tO.34 GlUt&lllne 3ut1.7 36.6i3.7 LWWAA GkJhlllC 5.15+0.29 4.46t0.36 Glutaltllne 15.6fO.9 14.4r1.4 IntestmeAA GM&c 5.44to.79 11.46kO.88 GlUtaflllIle 2.11 3.62+0.50
A.M. Cruickshank, H.G. Bums andA. Shenkin Departments of Biochemistry and Surgery, Glasgow Royal Infirmary, Scotland Introduction: Serum IL-6 rises post-operation, the increase being related to the severity of surgical trauma.
co.29
Trauma OKGA Non.OKOA 257+13 177+9 6.01+0.43 5.17+0.35 42.4t3.0 26.212.0 5.64*0.35 4.61t0.33 16.4+2.0 14.4t1.1 4.93to.59 7.93t1.25 1.66~0.15 2.69tO.46
Significant improvements in N balance and AA levels are evident due to adjuvant OKGA.
Aim: To assess the value of serum IL-6 in predicting the development of complications post-operation.
0.13
Method: Timed venous blood samples were collected from surgical patients. Sera were analysed for IL-6 (mouse B cell hybridoma stimulation assay) and C-reactive protein (CRP - fluorescence polarisation immunoassay).
Glucose-insulin-potassium
in hypoxic shock
Allan Engquist and Stig Nistrup Ho/megaard Dept. ofAnesthesia and Internal Medicine, Bispebjerg and Herlev Hospitals, Copenhagen, Denmark Glucose-insulin-potassium (GIK) or hypertonic glucose have been advocated in states of cellular hypoxia to stimulate anaerobic pathways of metabolism and thus improve myocardial performance, organ functions, and survival. The purpose of the present investigation was to study the possible beneficial cardiovascular and metabolic effects of hypertonic glucose and supraphysiologic dose of insulin during hypoxemia in a standardized sublethal hypoxic and normocapnic dog model (Pa02 3.3-4.7 kPa, PaC02 4.96.1 kPa). Methods: Twenty-five dogs were randomized to receive either glucoseinsulin-potassium (GIK) (glucose 509, insulin 66Ou, potassium 20mmol) or glucose-potassium (GK) (glucose 509, potassium 20mmol). The following variables were measured: systolic time intervals (STI), cardiac output, aotiic, pulmonary arterial, and wedge pressures, epinephrine, norepinephrine, cortisol, cyclic AMP, glucose, lactate, pyruvate, inorganic phosphate, electrolytes, hemoglobin and hematocrit. Results: Forty percent of the animals receiving either GlKor GK succumbed afler a mean hypoxic period of 38.5 min. Furthermore, 680 units of insulin had essentially no effect on the measured variables during hypoxemia. Of the variables measured only heart rate, pulmonary arterial and wedge pressures, plasma catecholamines, cyclic AMP, phosphate and potassium showed prognostic significance. The highly significant correlation between epinephrine, norepinephrine and cyclic AMP indicates that the cause of death was not due to malfunctioning of the catecholamine stimulated receptors. The findings support the view that provision of substrate during severe hypoxemia is deleterious.
Results: 21 patients were studied: 7 undergoing moderate intra-abdominal surgery; 7 undergoing major colorectal surgery; 5 undergoing vascular surgery; 2 undergoing extensive vascular surgery. IL-6 rose in all patients peaking within 12 hours of incision. 6 patients developed complications post-operation (infections, respiratory problems). Of these, 5 showed no decrease in IL-6 between 12 and 24 hours post-incision, whereas in the uncomplicated controls IL-6 values did fall. Patients wfih complications had higher (p < 0.01, Mann Whitney U test) IL-6 concentrations (median, (range), 226% (1291000%)) than controls undergoing similar surgery (67% (26100%)) at 24 hours post incision, although CAP levels were similar in the two groups (60% (33-96%) and 70% (31-100%) respectively). By 46 hours, complicated patients did have higher @ = 0.05, Mann Whitney U test) CAP concentrations than controls (95% (56-1449/a) and 68% (25-100%) respectively).
Conclusion: Serum IL-6 24 hours post-operation may be of use in identifying patients liable to develop clinical complications. Results are expressed as percentage of maximum control value.
l
0.12 Altered tissue amino acid (AA) levels in traumatized, growing rats due to L-ornithine-a-ketoglutarate (OKGA) supplemented oral diet M. Jeevansndam, M.R. A/i and W.R. Schiller Trauma Center, St. Joseph’s HospitalandMedical USA
Center, Phoenix, Arizona,
0.14 The impact of substrate infusion on tissue 02 extraction patterns during TPN in sepsis
Hypoaminoacidemia and unique patterns of tissue AA levels are known characteristics of severe injury. Since conventional nutritional supports were unable to reverse the catabolic effects in the early “flow” phase of severe injury, organ or tissue specific nutritional supports are needed. The potential use of OKGA. a precursor complex of glutamine in normalizing the AA levels in traumatized, growing rats are investigated. One group of male Sprague-Dawley rats (159 f 4g), adapted to dark-light cycle, was anesthetized and subjected to bilateral femur fracture and another group (Control), was only anesthetized. All rats were provided water but not food for 2 days. This resuited in 13 f 2% loss of body weight. On the third day, feeding was started and continued to 7 days. Traumatized as well as control rats were randomized between 2 isonitrogenous liquid diets (1) control diet (no. F1259, Bio-Serv, 6.5gN and 1000 kcal/l); (2) test diet (control diet from which 2.3% N was replaced by OKGA). Daily weight, voluntary dietary intake and urinary output data were collected. On day 7 the animals were sacrificed. Tissues of forelimb, muscle, liver and intestine were excised and AA contents were determined. Selected results (u moVg dry tissue, Mean 2 SEM, n = 6 for each group) are:
I. Giovannini, C. Chiada, G. Boldrini and M. Castagnero lstitufo diclinica Chirurgica (Chairman: Prof. F. Crucitti), Cenfro distudioper la Fisioparo/ogia de//o Shock CfVR, Roma, Italy In order to investigate the changes in 02 extraction patterns related to glucose, fat and amino acid infusion, 80 septic patients received 285 simultaneous measurements of Oz consumption (vOz, m!Imin/m’$, cardiac output (CO, UminIm~ and total body and lower limb O2 extraction fractions (02Ex, LO*Ex). The changes in total body and lower limb respiratory quotients (RQ, LRQ), in hemoglobin concentration (Hb), and in O2 tension at 50% Hb-02 saturation (Pso)were also taken into account together with the infusion rates of glucose, fat and amino acids (GIR, FIR, AAIR, g/Kq/24h). Mean + SD values for all pts were: VO, = 153 + 50, CO = 4.3 + 2.1,02Ex = 0.30? 0.09, and LO@ = 0.40 + 0.17, withGIR = 6.5,? 3.2, FIR = 0.8 f 0.2 (only for pts receiving fat) and AAIR = 1 .l + 0.5. Regression analysis showed that OnEx and L02Ex were inversely related to CO (r’ = 0.30, p i 0.01 for both). At any given CO, O*Ex and L02Ex were directly related to AAIR and FIR, which explained an additional 9% of the variability of OnEx and L02Ex 4