Comportamento do fator de necrose tumoral e da proteína C reativa em hepatectomia simultânea com colectomia em ratos

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Abstract

OBJETIVO: Observar o comportamento do fator de necrose tumoral-a (TNFalfa) e da proteína C reativa (PCR) em cirurgias simultâneas de fígado e intestino. MÉTODO: Para este objetivo foi desenvolvido um modelo experimental, no qual foram operados quarenta ratos da raça Wistar, divididos em quatros grupos: grupo controle, grupo 1 com ratos submetidos à hepatectomia a 70%, grupo 2 com ratos submetidos à colectomia e grupo 3 com cirurgia simultânea de hepactetomia e colectomia. Em todos os grupos foram dosados TNFalfa e PCR uma hora após o procedimento. Os animais foram mortos em seguida. RESULTADOS: Os valores encontrados mostraram alteração nas dosagens desses elementos nos diversos grupos, sendo que no grupo 3 houve aumento significativo do TNFalfa e queda de PCR. CONCLUSÃO: Quanto mais complexo se tornou o ato cirúrgico os níveis sangüíneos de TFNalfa aumentaram e os níveis sangüíneos da PCR diminuíram significativamente.

Translated abstract

BACKGROUND: The aim of this experimental study was to observe the behavior of Tumor Necrosis Factor and C-Reative Protein in simultaneous colectomy plus hepatectomy. METHODS: In this experimental model, 40 Wistar rats underwent surgery. They were divided into four groups: the control group; group 1, rats submitted to hepatectomy to 70%; group 2, rats submitted to colectomy; and group 3, rats submitted simultaneously to both procedures: hepatectomy plus colectomy. In all groups, TNF and PCR were collected one hour after the surgical procedure. The animals were killed afterwards. RESULTS: The dosage of these elements showed values with some alterations in all groups. Group three showed a significant increase of TNFalpha and decrease of PCR. CONCLUSION: The more complex became the surgical act the blood levels of TFNalpha have increased and the levels of the PCR decreased significantly.

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Multiple organ failure. Pathophysiology and potential future therapy.

Edwin A. Deitch (1992)

Multiple organ failure (MOF) has reached epidemic proportions in most intensive care units and is fast becoming the most common cause of death in the surgical intensive care unit. Furthermore, in spite of the development of successive generations of new and more powerful antibiotics and increasing sophisticated techniques of organ support, our ability to salvage patients once MOF has become established has not appreciably improved over the last two decades. Clearly, new therapeutic strategies aimed at preventing or limiting the development of the physiologic abnormalities that induce organ failure are needed to improve survival in these critically ill patients. Based on our rapidly increasing knowledge of the mechanisms of MOF and the fruits of molecular biology, a number of new therapeutic approaches are in various stages of development. To effectively use these new therapeutic options as they become available, it is necessary to have a clear understanding of the pathophysiology of MOF. Thus, the goals of this review are to integrate the vast amount of new information on the basic biology of MOF and to focus special attention on the potential therapeutic consequences of these recent advances in our understanding of this complex and perplexing syndrome.

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Initiation of acute phase response and synthesis of cytokines.

A Koj (1996)

A variety of injuries, such as bacterial infection or ischemic tissue necrosis, induce systemic acute phase reaction expressed as fever, leukocytosis, release of several hormones, activation of clotting, complement and kinin forming pathways, and drastic increase of synthesis of certain plasma proteins. The reaction is triggered by 'alarm molecules', including free radicals, which activate several stress-sensitive protein kinases (ERK, p38, JNK) in macrophages and other responsive cells. These kinases phosphorylate, usually in a multi-step cascade, transcription factors belonging primarily to C/EBP, NF-kappa B and AP-1 families. Active transcription factors after translocation to nucleus interact with responsive elements in the gene promoters of acute-phase cytokines: tumor necrosis factor-alpha, interleukin-1 and interleukin-6. Enhanced transcription of these genes is usually followed by rapid translation and precursor protein processing leading to the release of biologically active cytokines. Fine tuning of the acute phase response appears to be regulated at all stages: primary signals, kinase cascades, transcription factors, mRNA stability and translation, cytokine precursor processing, secretion and bioavailability. This makes possible designing of specific inhibitors of cytokine synthesis as potential therapeutic drugs.

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Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma.

David Bolton, G Fuhrman (2000)

To define the long-term outcome and treatment complications for patients undergoing liver resection for multiple, bilobar hepatic metastases from colorectal cancer. A retrospective analysis of 165 consecutive patients undergoing liver resection for metastatic colorectal cancer was performed. Patients were divided into a simple hepatic metastasis group, consisting of patients with three or fewer metastases in a unilobar distribution, and a complex hepatic metastases group, consisting of patients with four or more unilobar metastases or at least two bilobar metastases. The 5-year survival rate was 36% for the simple group and 37% for the complex group. Multivariate analysis revealed that the number of hepatic segments involved by tumor and the maximum diameter of the largest metastasis correlated significantly with the 5-year survival rate. The surgical death rate was 4.9% for the simple group and 9.1% for the complex group; this difference was not significant. Multivariate analysis revealed that extended lobar resection and concomitant colon and hepatic resection were significant and independent predictors of surgical death. The combination of extended lobar resection and concomitant colon resection was used significantly more frequently in the complex group than in the simple group. Resection of complex hepatic metastases, as defined in this study, results in a 5-year survival rate of 37% and confers the same survival benefit as does resection of limited hepatic metastases. The surgical death rate for this aggressive approach is significantly higher if extended lobar resections are necessary and if concomitant colorectal resection is performed. Patients who have complex hepatic metastases at the time of diagnosis of the primary colorectal cancer and who would require extended hepatic lobectomy should have hepatic resection delayed for at least 3 months after colon resection.

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Author and article information

Contributors

Hamilton Luiz Xavier Funes: Role: ND

Rita de Cássia Martins Alves da Silva: Role: ND

Renato Ferreira da Silva: Role: ND

Antonio Pelosi de Moura Leite: Role: ND

Fabiana Longui Segantini: Role: ND

Sueli Calvi: Role: ND

Journal

Journal ID (publisher): rcbc

Title: Revista do Colégio Brasileiro de Cirurgiões

Abbreviated Title: Rev. Col. Bras. Cir.

Publisher: Colégio Brasileiro de Cirurgiões (Rio de Janeiro )

ISSN: 1809-4546

Publication date (Print): April 2005

Volume: 32

Issue: 2

Pages: 94-99

Affiliations

[1 ] Faculdade de Medicina de São José do Rio Preto

[2 ] FAMERP

[3 ] Faculdade de Medicina de São José do Rio Preto

[4 ] FAMERP

[5 ] Universidade Estadual Paulista Brazil

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Publisher ID: S0100-69912005000200010

DOI: 10.1590/S0100-69912005000200010

SO-VID: 34ca899d-620c-42c2-b079-b0a8334e7c95

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http://creativecommons.org/licenses/by/4.0/

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Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-6991&lng=en

Comportamento do fator de necrose tumoral e da proteína C reativa em hepatectomia simultânea com colectomia em ratos Translated title: Behavior of the tumor necrosis factor and C-reactive protein in simultaneous hepatectomy plus colectomy in rats

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Most cited references 48

Multiple organ failure. Pathophysiology and potential future therapy.

Initiation of acute phase response and synthesis of cytokines.

Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma.

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