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Oussaada SM, Kilicarslan M, de Weijer BA, Gilijamse PW, Şekercan A, Virtue S, Janssen IMC, van de Laar A, Demirkiran A, van Wagensveld BA, Houdijk APJ, Jongejan A, Moerland PD, Verheij J, Geijtenbeek TB, Bloks VW, de Goffau MC, Romijn JA, Nieuwdorp M, Vidal-Puig A, Ter Horst KW, Serlie MJ. Tissue-specific inflammation and insulin sensitivity in subjects with obesity. Diabetes Res Clin Pract 2024; 211:111663. [PMID: 38616042 DOI: 10.1016/j.diabres.2024.111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Obesity is associated with low-grade inflammation and insulin resistance (IR). The contribution of adipose tissue (AT) and hepatic inflammation to IR remains unclear. We conducted a study across three cohorts to investigate this relationship. The first cohort consists of six women with normal weight and twenty with obesity. In women with obesity, we found an upregulation of inflammatory markers in subcutaneous and visceral adipose tissue, isolated AT macrophages, and the liver, but no linear correlation with tissue-specific insulin sensitivity. In the second cohort, we studied 24 women with obesity in the upper vs lower insulin sensitivity quartile. We demonstrated that several omental and mesenteric AT inflammatory genes and T cell-related pathways are upregulated in IR, independent of BMI. The third cohort consists of 23 women and 18 men with obesity, studied before and one year after bariatric surgery. Weight loss following surgery was associated with downregulation of multiple immune pathways in subcutaneous AT and skeletal muscle, alongside notable metabolic improvements. Our results show that obesity is characterised by systemic and tissue-specific inflammation. Subjects with obesity and IR show a more pronounced inflammation phenotype, independent of BMI. Bariatric surgery-induced weight loss is associated with reduced inflammation and improved metabolic health.
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Affiliation(s)
- S M Oussaada
- Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - M Kilicarslan
- Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - B A de Weijer
- Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - P W Gilijamse
- Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - A Şekercan
- Amsterdam UMC Location University of Amsterdam, Department of Public Health, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - S Virtue
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - I M C Janssen
- Nederlandse Obesitas Kliniek, Departement of Science, Huis ter Heide, the Netherlands
| | - A van de Laar
- Spaarne Gasthuis, Department of Surgery, Haarlem, the Netherlands
| | - A Demirkiran
- Red Cross Hospital, Department of Gastrointestinal Surgery, Beverwijk, the Netherlands
| | - B A van Wagensveld
- NMC Royal Hospital, Department of Surgery, Abu Dhabi, United Arab Emirates
| | - A P J Houdijk
- Northwest Clinics, Department of Surgery, Alkmaar, the Netherlands
| | - A Jongejan
- Amsterdam UMC Location University of Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, the Netherlands
| | - P D Moerland
- Amsterdam UMC Location University of Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, the Netherlands
| | - J Verheij
- Amsterdam UMC Location University of Amsterdam, Department of Pathology, Amsterdam, the Netherlands
| | - T B Geijtenbeek
- Amsterdam UMC Location University of Amsterdam, Laboratory for Experimental Immunology, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Cancer Immunology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Immunology, Amsterdam, the Netherlands
| | - V W Bloks
- University Medical Center Groningen, Department of Paediatrics, University of Groningen, Groningen, the Netherlands
| | - M C de Goffau
- Amsterdam UMC Location University of Amsterdam, Department of Experimental Vascular Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Wellcome Trust Sanger Institute, Hinxton, UK; Amsterdam UMC, Tytgat Institute for Liver and Intestinal Research, Meibergdreef 9, Amsterdam, the Netherlands
| | - J A Romijn
- Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Amsterdam UMC Location University of Amsterdam, Department of Vascular Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - A Vidal-Puig
- MRC Metabolic Diseases Unit, University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - K W Ter Horst
- Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - M J Serlie
- Amsterdam UMC Location University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands; Section of Endocrinology, Yale School of Medicine, New Haven, USA.
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Abstract
Background Patients qualified for gastric bypass surgery have an enlarged and fatty liver. An essential step in gastric bypass surgery is elevation of the left liver lobe to expose the gastroesophageal junction. An enlarged and fatty liver complicates the surgical procedure and increases the risk for laceration of the liver. The aim of our study was to evaluate methods to reduce liver volume in patients prior to gastric bypass surgery. Methods A systematic literature search of multiple databases, including PubMed, EMBASE.com, and the Cochrane Library and a hand search of reference lists, was performed. We used the search terms morbid obesity and liver, including their synonyms and controlled terms. Inclusion criteria were as follows: patients with morbid obesity who qualified for bariatric surgery, the use of a preoperative treatment to reduce liver volume, and the use of imaging techniques before and after treatment. Results In total, 281 patients in 11 different studies were included. Preoperative diets reduced liver size by an average of 14 %, alternative methods including nutritional supplements, reduced liver size between 20 and 43 %, and an intragastric balloon by 32 %. Conclusions This review showed that nutritional supplements and intragastric balloon are more effective than low calorie diets in reducing liver volume prior to gastric bypass surgery. However, low calorie diet is the preferable method to reduce liver volume, considering the level of evidence and practical applicability. There is a need for well-designed randomized studies with sufficient power in order to confirm the effectiveness of preoperative methods to reduce liver volume.
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Affiliation(s)
- J van Wissen
- Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands. .,VU Medical Center, Amsterdam, The Netherlands. .,Trial Center Holland Health, Alkmaar, The Netherlands.
| | - N Bakker
- Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.,VU Medical Center, Amsterdam, The Netherlands.,Trial Center Holland Health, Alkmaar, The Netherlands
| | - H J Doodeman
- Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.,Trial Center Holland Health, Alkmaar, The Netherlands
| | - E P Jansma
- VU Medical Center, Amsterdam, The Netherlands
| | - H J Bonjer
- VU Medical Center, Amsterdam, The Netherlands
| | - A P J Houdijk
- Department of Surgery, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.,VU Medical Center, Amsterdam, The Netherlands.,Trial Center Holland Health, Alkmaar, The Netherlands
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Abstract
BACKGROUND Hip fracture surgery in elderly patients is associated with a poor postoperative outcome and a high mortality. Malnutrition is a frequent problem in elderly patients and may be associated with mortality after hip fracture surgery. The Mini Nutritional Assessment (MNA) is a valuable tool to identify malnourished patients and those at risk for malnutrition. OBJECTIVE To evaluate the association between the preoperative MNA score and mortality after surgery for hip fractures in elderly patients. METHODS Patients with a hip fracture and an indication for surgery were included in our study. This study was part of a randomized trial on the effect of taurine on postoperative outcome in elderly hip fracture patients. The MNA was assessed on admission before surgery. Length of stay, postoperative complications and mortality were documented. The association of the MNA score on postoperative outcome and mortality was analyzed using Cox regression analysis. RESULTS The one-year survival rate in 226 elderly hip fracture patients was 79%. In-hospital mortality rates and 1-year mortality were 27% and 46% in malnourished patients, 12% and 26% in patients at risk for malnutrition and 7% and 17% in well-nourished patients as assessed by MNA. CONCLUSION Preoperative malnutrition measured by the MNA is associated with mortality in elderly hip fracture patients.
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Affiliation(s)
- J van Wissen
- A.P.J. Houdijk, MD, PhD, Department of Surgery, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands, Tel: +31 72 5484444 pager 5383, Fax: +31 72 5482422 E:
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Olthof DC, Bun RJ, Dutrieux RP, Houdijk APJ. An unexpected finding in the resection specimen of a carcinoma of the oral cavity: A case report. Int J Surg Case Rep 2015; 19:55-9. [PMID: 26710330 PMCID: PMC4756081 DOI: 10.1016/j.ijscr.2015.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/01/2015] [Accepted: 12/13/2015] [Indexed: 11/11/2022] Open
Abstract
The occurrence of two synchronous, primary cancers is rare. Thyroid carcinoma is incidentally found in the resection specimen after surgery for head and neck cancer in 0.3–1.9% of the patients. A papillary thyroid carcinoma was found coincidentally in lymph nodes recovered after a ‘commando’ procedure for carcinoma of the oral cavity. A tailor made therapeutic approach of incidental thyroid gland carcinoma in head and neck cancer depends on prognosis and life expectancy.
Introduction The occurrence of two synchronous, primary cancers is rare. Thyroid carcinoma is incidentally found in the resection specimen after surgery for head and neck cancer in 0.3–1.9% of the patients. Presentation of case In this report, we describe the case of a 72-year-old patient in whom a primary (synchronous) papillary thyroid carcinoma was found coincidentally upon pathologic examination of lymph nodes recovered from the cervical neck lymph node dissection specimen after a ‘commando’ procedure for carcinoma of the oral cavity. Discussion and conclusion There is no gold standard concerning treatment of the incidentally discovered thyroid gland carcinoma. The decision to perform surgery depends on the life expectancy of the patient, whether the thyroid gland demonstrates clinical or radiologic lesions, the already completed treatment for the head and neck cancer and should always be adjusted to the specific patient.
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Affiliation(s)
- D C Olthof
- Department of Surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
| | - R J Bun
- Department of Head and Neck surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
| | - R P Dutrieux
- Department of Pathology, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands.
| | - A P J Houdijk
- Department of Surgery, Medical Center Alkmaar, Postbus 501, 1800 AM Alkmaar, The Netherlands; Trial Center Holland Health, Alkmaar, The Netherlands.
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van den Broek JJ, Poelman MM, Wiarda BM, Bonjer HJ, Houdijk APJ. Extensive cervicomediastinal hematoma due to spontaneous hemorrhage of a parathyroid adenoma: a case report. J Surg Case Rep 2015; 2015:rjv039. [PMID: 25935903 PMCID: PMC4417131 DOI: 10.1093/jscr/rjv039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Spontaneous extracapsular hemorrhage is a rare but potentially life-threatening manifestation of parathyroid gland adenomas. We present a case demonstrating that even in a patient with increased bleeding tendency due to anticoagulants, combined with compression of trachea and esophagus, conservative treatment can be successful.
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Affiliation(s)
- J J van den Broek
- Department of General Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - M M Poelman
- Department of General Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - B M Wiarda
- Department of Radiology, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - H J Bonjer
- Department of General Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - A P J Houdijk
- Department of General Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
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Cakir H, van Stijn MFM, Lopes Cardozo AMF, Langenhorst BLAM, Schreurs WH, van der Ploeg TJ, Bemelman WA, Houdijk APJ. Adherence to Enhanced Recovery After Surgery and length of stay after colonic resection. Colorectal Dis 2013; 15:1019-25. [PMID: 23470117 DOI: 10.1111/codi.12200] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 12/05/2012] [Indexed: 12/20/2022]
Abstract
AIM The Enhanced Recovery After Surgery (ERAS) programme is a multimodal approach to improve peri-operative care in colon surgery. The aim of this study was to report on the adherence to and outcomes of ERAS in the first years after implementation. METHOD Data of patients undergoing elective colon resections for malignancy in 2006 until 2010 were compared with patients receiving conventional care in 2005. Retrospective analysis was performed including length of stay (LOS), protocol adherence and complications. The predictive values of ERAS items and baseline characteristics on LOS and complications were analysed using univariate and multivariate analysis. RESULTS Length of stay (LOS) was significantly shorter in 2006 and 2007 (P ≤ 0.009 and P ≤ 0.004) but not in 2008 and 2009. The mean adherence rate to the ERAS items was 84.1% in 2006 and 2007 and 72.4% in 2008 and 2009 (P < 0.001). In 2005, 2008 and 2009 LOS was significantly shorter for laparoscopically operated patients than for patients with open resections (P < 0.002, P < 0.001 and P < 0.004 respectively). Multivariate analysis showed that age, laparoscopic surgery, removal of nasogastric tube before extubation, mobilization within 24 h after surgery, starting nonsteroidal anti-inflammatory drugs at day 1 and removal of thoracic epidural analgesia at day 2 were independent predictors of LOS. CONCLUSION Strict adherence to the ERAS protocol was associated with reduced LOS and improved outcome in elective colon surgery for malignancy. These benefits were lost when protocol adherence was lower. Embedding the ERAS protocol into an organization and repetitive education are vital to sustain its beneficial effects on LOS and outcome.
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Affiliation(s)
- H Cakir
- Department of Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
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Buijs N, Luttikhold J, Houdijk APJ, van Leeuwen PAM. The role of a disturbed arginine/NO metabolism in the onset of cancer cachexia: a working hypothesis. Curr Med Chem 2013; 19:5278-86. [PMID: 22963622 DOI: 10.2174/092986712803833290] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/16/2012] [Accepted: 08/27/2012] [Indexed: 11/22/2022]
Abstract
Cancer cachexia is a complex catabolic state in patients with a malignancy, associated with increased morbidity and mortality. This syndrome is characterized by a redistribution of the body's protein content and a subsequent muscle wasting. The aetiology of this syndrome seems multifactorial, but remains unclear. It is suggested that this catabolic state occurs in response to the alterations in immune interactions between tumor and host. The amino acid arginine and its derivate nitric oxide (NO) play various roles in anti-tumor immune response and the body's homeostasis. Glutamine is the precursor for arginine de novo synthesis and the most abundant amino acid in the body, mainly stored in skeletal muscle. Tumors develop a protection mechanism against the specific anti-tumor attack of the immune system by recruiting myeloid derived suppressor cells (MDSC). The MDSC deplete arginine levels and disturb NO production. We here hypothesize that the perturbation of the arginine/NO metabolism plays a significant role in the aetiology of cancer cachexia. Arginine/ NO metabolism is disturbed in patients with cancer. The body will try to correct this perturbation by mobilizing arginine and glutamine from muscles. The decreased arginine levels and the disturbed NO production activate several cascades, which in turn inhibit protein synthesis and promote proteolysis, leading to cachexia. Cachexia remains one of the most frequent and damaging opportunistic syndromes in cancer patients. In this review we will elaborate on a new hypothesised concept and the underlying mechanisms of this syndrome. New studies are essential to ground this hypothesis and to develop interventions to break through the pathological mechanisms underlying cachexia.
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Affiliation(s)
- N Buijs
- Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Boelens PG, Fonk JCM, Houdijk APJ, Scheper RJ, Haarman HJTHM, Meijer S, Van Leeuwen PAM, von Blomberg-van der Flier BME. Primary immune response to keyhole limpet haemocyanin following trauma in relation to low plasma glutamine. Clin Exp Immunol 2004; 136:356-64. [PMID: 15086402 PMCID: PMC1809027 DOI: 10.1111/j.1365-2249.2004.02447.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Severe trauma can lead to a compromised immune response, thereby increasing susceptibility to infections. Here we will study to what extent these early changes in the immune status upon trauma affect a primary immune response to keyhole limpet haemocyanin (KLH). Because glutamine is the preferred respiratory substrate for immune competent cells and known to be depleted after trauma, we studied the immune status and the primary sensitization in relation to the glutamine plasma concentration in a group of severe trauma patients [injury severity score (ISS) >17]. Trauma patients (n = 31) were sensitized with KLH within 12 h after trauma; plasma glutamine concentrations and immune parameters were determined, after which KLH-specific immune responsiveness was evaluated on days 9 and 14. Low plasma glutamine concentrations were found after trauma. Significantly elevated numbers of granulocytes and CD14-positive leucocytes were found, whereas the HLA-DR expression on CD14-positive cells was significantly lower in trauma patients than in healthy controls. Trauma did not change the in vitro proliferative capacity of lymphocytes when cultured with glutamine; however, when lymphocytes were cultured without glutamine, trauma resulted in lower proliferation than healthy controls. Phytohaemagglutinin-(PHA)-induced interferon (IFN)-gamma and interleukin (IL)-10 production was significantly lower after trauma, whereas IL-4 production was not affected. KLH sensitization following trauma resulted in poor skin test reactivity and low in vitro KLH-induced lymphocyte proliferation compared to controls. In contrast, the development of anti-KLH IgM, IgG, IgA, IgG1, IgG2, IgG3 and IgG4 production on days 9 and 14 following trauma was not different from that in healthy controls. Major trauma was associated with a reduced cell-mediated immune response, correlating with low plasma glutamine concentrations, while no effects of trauma were found on the development of a primary humoral immune response.
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Affiliation(s)
- P G Boelens
- Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands
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Van den Broek WT, Makay O, Berends FJ, Yuan JZ, Houdijk APJ, Meijer S, Cuesta MA. Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus. Surg Endosc 2004; 18:812-7. [PMID: 15216864 DOI: 10.1007/s00464-003-9173-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 11/07/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy. METHODS In this study, 25 laparoscopically assisted transhiatal esophagus resections were compared with a historical control group consisting of 20 open transhiatal esophagus resections. RESULTS Nine laparoscopically assisted resections (36%) were converted to open procedures. The operating time was longer in the laparoscopically assisted group (300 vs 257 min; p < 0.05), but laparoscopically assisted esophagus resection was associated with less blood loss (600 vs 900 ml; p < 0.05) and shorter intensive care unit stay (1 vs 2 days; p < 0.05). There were no differences in morbidity, mortality, and hospital stay. During a shorter follow-up time for the laparoscopic group (17 vs 54 months), 11 patients (44%) in the laparoscopically assisted group and 10 (50%) patients in the open group had recurrence of the disease. CONCLUSIONS Laparoscopically assisted transhiatal esophagus resection is a safe procedure with important advantages, as compared with the open procedure, such as less blood loss and shorter intensive care unit stay. At this point, the oncologic consequences are not clear.
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Affiliation(s)
- W T Van den Broek
- Department of Surgery, VU Medisch Centrum, Postbus 7057, Amsterdam, The Netherlands
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Prins HA, Houdijk APJ, Teerlink T, van Lambalgen A, Thijs LG, van Leeuwen PAM. Mild endotoxaemia during low arginine plasma levels reduces blood flow to the small intestine. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01544-5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
Arginine is the sole precursor in the generation of the vasodilating agent nitric oxide. Plasma levels of arginine are low in situations associated with endotoxaemia such as major trauma, sepsis and experimental obstructive jaundice. The aim of the study was to evaluate haemodynamics at low arginine plasma levels during low-grade endotoxaemia.
Methods
Rats were assigned randomly to receive (at t = 0 min) an intravenous infusion of 1·5 ml sodium chloride 0·9 per cent (SAL, n = 12) or 1·5 ml arginase solution (3200 units) (ASE, n = 17) over 20 min. After the SAL or ASE infusion, rats were randomly assigned to receive an intravenous endotoxin (lipopolysaccharide; LPS; 150 μg kg−1 in 1·0 ml 0·9 per cent sodium chloride) challenge (ASE-LPS, n = 10 and SAL-LPS, n = 6) or a control infusion of 1·0 ml 0·9 per cent sodium chloride (ASE-SAL, n = 7 and SAL-SAL, n = 6) at t = 30 min. Organ blood flow was measured at t = 270 min, using radiolabelled microspheres.
Results
At 270 min arginine plasma levels were lower in the ASE-treated rats (ASE-SAL versus SAL-SAL and ASE-LPS versus SAL-LPS, both P < 0·005). Cardiac output, mean arterial pressure and therefore total peripheral resistance were similar for all groups. In the LPS-treated animals (SAL-LPS and ASE-LPS) cardiac output was maintained by a higher heart rate compensating for the lower stroke volume. Organ blood flow to the small intestine and splanchnic blood flow were lower in the ASE-LPS-treated rats (both P < 0·05 compared with other groups). Total liver blood flow was similar for all groups; the lower splanchnic blood flow was compensated for by a higher hepatic arterial blood flow.
Conclusion
This study shows that low plasma levels of arginine do not influence organ blood flow while, during low-grade endotoxaemia, low arginine plasma levels result in reduced blood flow to the small intestine.
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Affiliation(s)
- H A Prins
- Department of Surgery, Free University Hospital, Amsterdam, The Netherlands
| | - A P J Houdijk
- Department of Surgery, Free University Hospital, Amsterdam, The Netherlands
| | - T Teerlink
- Department of Clinical Chemistry, Free University Hospital, Amsterdam, The Netherlands
| | - A van Lambalgen
- Department of Physiology, Free University Hospital, Amsterdam, The Netherlands
| | - L G Thijs
- Department of Medicine, Free University Hospital, Amsterdam, The Netherlands
| | - P A M van Leeuwen
- Department of Surgery, Free University Hospital, Amsterdam, The Netherlands
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