title: Pulmonary hypertension and polymorphonuclear leukocyte elastase after esophageal cancer operations.
abstract: To evaluate the role of polymorphonuclear leukocyte (PMN) elastase in pulmonary impairment occurring after operation for esophageal cancer, 10 patients were randomized preoperatively into two equal groups. One group received a placebo infusion and the other, an infusion of the PMN elastase inhibitor ulinastatin. In the placebo group, the mean plasma PMN elastase level increased from 154 +/- 23 micrograms/L preoperatively to 449 +/- 56 micrograms/L at 6 hours postoperatively (p less than 0.01), whereas the mean plasma fibronectin concentration decreased from 490 +/- 70 micrograms/mL preoperatively to 265 +/- 81 micrograms/L on postoperative day 2 (p less than 0.01). The mean pulmonary vascular resistance increased markedly from 151 +/- 24 dynes.s.cm-5.m-2 preoperatively to 284 +/- 76 dynes.s.cm-5.m-2 at 6 hours postoperatively (p less than 0.01). In the group given ulinastatin, 150,000 units every 12 hours from the start of the operation, the mean PMN elastase value at 6 hours postoperatively was lower (275 +/- 66 micrograms/L; p less than 0.01) and the fibronectin level on postoperative days 1 and 2, higher (p less than 0.05). A lower pulmonary vascular resistance was noted into day 2 (p less than 0.05). Our results suggest that PMN elastase may participate in the development of postoperative pulmonary impairment.
authors.affiliation: First Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Murakami
authors.forename: K
authors.initials: K
authors.lastname: Ishida
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
authors.forename: K
authors.initials: K
authors.lastname: Saito
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D005353:Fibronectins / Q000097:blood; D006023:Glycoproteins / Q000494:pharmacology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000201:enzymology / Q000209:etiology*; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects / Q000201:enzymology*; D010196:Pancreatic Elastase / Q000502:physiology*; D011183:Postoperative Complications / Q000209:etiology*; D014361:Trypsin Inhibitors / Q000494:pharmacology; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D005353:Fibronectins; D006023:Glycoproteins; D014361:Trypsin Inhibitors; D010196:Pancreatic Elastase; C028665:urinastatin