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[The change of polymorphonuclear elastase releasing from ischemic skeleton muscles after reperfusion]
1Second Department of Surgery, Yamagata University, School of Medicine, Japan.
Abstract:
This report evaluates the activity of Polymorphonuclear Elastase (PMNE), after reperfusion of the skeleton muscles during the infra-renal abdominal aortic aneurysmal surgery. We studied the following data to prevent post-operative complications of acute arterial occlusion: the change of PMNE and alpha 1-AT and the effect of Ulinastatin (U)-the inhibitor of PMNE. Twenty surgical cases of the abdominal aortic aneurysms were used in the study. Ten cases of non-U-treated served as group I, 10 cases of U-treated served as group II. PMNE level, in group I, showed a value of 233.7 +/- 34.8 micrograms/l pre-clump and 848.0 +/- 110.3 micrograms/l after releasing the clamp 2 hours later (p < 0.001). In group II, pre-clamping value was 204.8 +/- 21.0 and a relative low value of PMNE (416.7 +/- 36.6 micrograms/l) 2 hours later after releasing the clamp compared with group I. In group I, consistently positive correlations were found between the duration of clamping time and the value of PMNE. This study shows that PMNE increases statistically after re-perfusion of the skeleton muscle. U shows a significant inhibition of PMNE increasing. U may prevent further damages of the visceral organs after operation of acute arterial occlusion.
Insights
Polymorphonuclear Elastase (PMNE) significantly increases after skeletal muscle reperfusion during aortic aneurysm surgery. Ulinastatin (U) effectively inhibits this PMNE increase, potentially preventing post-operative organ damage.
Area of Science:
- Vascular Surgery
- Biochemistry
- Pharmacology
Background:
- Abdominal aortic aneurysm surgery involves muscle reperfusion, leading to potential complications.
- Polymorphonuclear Elastase (PMNE) is implicated in post-reperfusion injury.
- Alpha 1-antitrypsin (alpha 1-AT) is a known inhibitor of PMNE.
Purpose of the Study:
- To evaluate the activity of PMNE after skeletal muscle reperfusion in infra-renal abdominal aortic aneurysm surgery.
- To investigate the effect of Ulinastatin (U), a PMNE inhibitor, on PMNE levels and post-operative complications.
Main Methods:
- A study involving 20 patients undergoing abdominal aortic aneurysm surgery.
- Patients were divided into two groups: Group I (non-Ulinastatin treated) and Group II (Ulinastatin treated).
- Measurements of PMNE levels were taken before and 2 hours after reperfusion, with correlation analysis to clamping time.
Main Results:
- PMNE levels significantly increased from pre-clamping to post-reperfusion in Group I (233.7 to 848.0 µg/l, p < 0.001).
- Group II showed a significantly lower increase in PMNE post-reperfusion (204.8 to 416.7 µg/l) compared to Group I.
- A positive correlation was observed between clamping duration and PMNE levels in Group I.
Conclusions:
- Skeletal muscle reperfusion during aortic surgery leads to a statistically significant increase in PMNE.
- Ulinastatin demonstrates significant inhibition of PMNE activity.
- Ulinastatin may serve as a protective agent against visceral organ damage following acute arterial occlusion surgery.