Glucocorticoid attenuates a decrease of antithrombin III following major surgery.
BACKGROUND
Major surgery, such as esophagectomy, activates inflammatory responses and the coagulation system, and this activation is characterized by release of inflammatory cytokines and a decrease in antithrombin-III (AT-III), respectively. Preoperative glucocorticoid administration has been reported to suppress circulatory cytokine levels after major surgery.


METHODS
A total of 28 patients underwent esophagectomy for esophageal carcinoma; 14 of them were given 10 mg/kg of methylprednisolone intravenously upon induction of anesthesia and 14 served as controls. Circulating levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), polymorphonuclear (PMN) elastase, thrombin-antithrombin III complex (TAT), AT-III, and albumin were measured before and immediately after the operation and on postoperative days (PODs) 1, 3, 5, and 7.


RESULTS
TNF-alpha, IL-6, and TAT levels significantly increased after esophagectomy in both groups. AT-III and albumin decreased to their minimum levels on POD 1 and POD 3, respectively. Methylprednisolone treatment effectively inhibited the increases in TNF-alpha and IL-6 and the decreases in AT-III and albumin, but did not inhibit the increases in PMN-elastase and TAT levels. There were significant correlations between AT-III, IL-6, and albumin levels.


CONCLUSIONS
These results suggest that methylprednisolone pretreatment attenuates the decrease in AT-III by reducing IL-6 production postoperatively.
Matsutani
T
T
First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Tokyo, Bunkyo-ku, 113, Japan.
Onda
M
M
Sasajima
K
K
Miyashita
M
M
D000368:Aged; D000990:Antithrombin III / Q000032:analysis*; D002277:Carcinoma / Q000601:surgery; D016207:Cytokines / Q000097:blood; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009994:Osmolar Concentration; D011184:Postoperative Period; D013997:Time Factors
D016207:Cytokines; D005938:Glucocorticoids; D018836:Inflammation Mediators; D000990:Antithrombin III; D019272:Leukocyte Elastase; D008775:Methylprednisolone