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장폐쇄에서 나타나는 장점막 손상의 진단에서 내독소의 유용성
이정은(Jeong-Eun Lee),염차경(Cha-Kyong Yom),박재정(Jae-Jung Park),한기환(Ki-Hwan Han),허정원(Jung-Won Huh),성순희(Sun-Hee Sung),정구용(Ku-Yong Chung) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.2
Purpose: The treatment outcome of an intestinal obstruction depends on the early recognition and emergent operation of a strangulated intestinal obstruction. Endotoxin is a lipopolysaccharide component of the cell wall of gram negative bacteria that normally exist in the intestinal lumen. When a strangulated obstruction occurs, the endotoxin passes transluminally into the peritoneal cavity and blood stream. A disruption of the mucosal barrier is an important putative cause in this pathogenesis. This study investigated the relationship between the endotoxin level and progress of an intestinal obstruction to a strangulated obstruction. Methods: 25 adult male Sprague-Dawley rats (200∼250 g) were divided into 3 groups, the control group, simple obstruction group, and closed loop obstruction group. An intestinal obstruction was induced using a silk tie. Blood samples and obstructed bowel wall specimens were obtained at 24, 48 and 72 hours after surgery. The endotoxin and IL-6 levels were examined, and all specimens were reviewed by a pathologist for mucosal damage after H-E staining. Results: In the obstruction groups, dilated bowel loops at the proximal end of the obstruction site was identified but there were no ischemic changes. The endotoxin and IL-6 levels were similar regardless of the obstruction types and times. There were no differences between the three groups in the degree of mucosal damage. However, according to the endotoxin level, the groups with an endotoxin level <0.2 EU/㎖ showed mild mucosal damage. The severity of mucosal damage increased with increasing endotoxin level. Conclusion: There is a positive relationship (r2=0.673, P-value=0.002) between the endotoxin level and mucosal damage. This suggests the possibility of using endotoxin as a predictive factor for the detection of mucosal injury in an intestinal obstruction. However, a larger scale will be needed to confirm the statistical significance.
박재정(Jae Jeong Park),정구용(Ku-Yong Chung),이정은(Jeong-Eun Lee),염차경(Cha-Kyong Yom),이재길(Jae-Gil Lee),안형준(Hyung Joon Ahn),오세관(Sei-Kwan Oh),성순희(Sun-Hee Sung),강병철(Byung-Chul Kang),한기환(Ki-Hwan Han) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.5
Purpose: We designed a pig to canine liver xenotransplantation model to study the diverse immunologic and hemodynamic consequences that follow xenotransplantation and hyperacute rejection. Methods: The animals were divided into two groups: the cobra venom factor and Gadolinium chloride treatment group (CVF+Gd group) (3 cases) and the control group (3 cases). The donor pig"s whole liver was harvested, and then the harvested pig"s whole liver was transplanted into a dog after the dog underwent left hepatectomy. After reperfusion of the graft, blood samples were taken 20, 40 and 60 minutes after reperfusion, and the liver, lung and kidney tissues were taken 1 hour after reperfusion. Results: In the control group, the grafts showed a patchy hypoperfused liver surface and it felt rubbery solid compared to the CVF+Gd group. The serum total protein, albumin, fibrinogen and platelets decreased abruptly and there were no significant differences between the two groups. The serum PT, PTT and FDP were increased in both groups and the CVF+Gd group showed a more obtuse slope than the control group. We could not find any intravascular pathologic changes on the microscopic findings of the graft. Only scant intravascular fibrin deposition was found. Hepatocellular vacuolization and sinusoidal dilatation were also found. There were patches of necrosis without any zonal distribution, intrasinusoidal neutrophil sequestration and interstitial hemorrhage. These findings were milder in the CVF+Gd group. Conclusion: The pig to canine partial auxiliary liver xenotransplantation model is feasible and it is a good model before starting to perform pig to primate liver xenotransplantation. In the CVF+Gd group, pathologic findings like patch hepatocyte necrosis etc. were less severe. As there were no corresponding vascular pathologic findings, these findings are not the direct effect of CVF and gadolinium treatment, and so other factors like Ischemiareperfusion injury should be considered.