| Co-Investigator(Kenkyū-buntansha) |
SITOH Tkuroh Fukushima medical university, school of medicine, instructor, 医学部, 助手 (20305361)
HOSHINO Yutaka Fukushima medical university, school of medicine, instructor, 医学部, 助手 (30295414)
TERASHIMA Schinya Fukushima medical university, school of medicine, Assistant Professor, 医学部, 講師 (80264547)
GOTOH Mitsukazu Fukushima medical university, school of medicine, Professor, 医学部, 教授 (50162160)
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| Research Abstract |
Four patients who underwent subtotal esophagectomy were classified into 2 groups : a control group(n=2) and a steroid group(n=2) in which patients were intravenously administered 250mg of methylprednisolone 2 hours before surgery. Specimens such as serum, pleural effusion, ascites, tracheal washings, and bile juice from jejunal feeding tube were collected on postoperative days (POD) 1, 3, 5, 7, 10, 30 and the levels of IL-6, IL-10, PGE2, and IAP were measured in individual specimens. IL-6, as an inflammatory cytokine, of which levels in serum, ascites and bile juice showed highest vales on POD 1 and then rapid decrease in both group. Only levels of pleural IL-6 were significantly lower in the steroid group than in controls. (mean value : 8000 and 29000pg/ml, individually). The levels of tracheal washings showed highest value on POD 5. IL-10, as an anti-inflammatory cytokine, of which levels in serum, pleural effusion, ascites, and bile juice showed highest vales on POD 1 (mean value :
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40, 130, 120, and 40 pg/ml, individually) and then rapid decrease in both group. The levels of tracheal washings showed highest value (360pg/ml) on POD 5. PGE2, as an immunosuppressive parameter, of which levels in serum showed highest value of 150pg/ml on POD 3, and the levels in pleural effusion and bile juice showed highest value of 450 and 1800pg/ml on POD1 and then rapid decrease in both group. The levels of ascites and tracheal washings showed highest value of 550 and 1300 pg/ml on POD 5 in both group. In these specimens the levels of IL-6, IL-10 and PGE2 revealed elevation early in the postoperative state and then rapid decrease without tracheal washings, but only tracheal washings revealed elevation on POD 5. The levels of IAP in serum, pleural effusion and ascites were maintained high values of 800μg/ml from POD1 in both group, but in tracheal washings and bile juice remained low value less than 100 μg/ml. In conclusions we revealed that 1. the inflammatory responses are different in individual organs, 2. steroid administration before operation makes the level of pleural IL-6 decrease but not makes immunosuppressive state worse, 3. the IAP which represents poor prognosis in high levels over 560μg/ml for esophageal cancer patients, maintains high levels in serum and pleural effusion, and it is supposed the strong immunosuppressive state to be continued after esophageal resection. Less
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