Biomedical subjects

R Frasko

Publications and source records attributed to R Frasko.

11 recordsLinked to original sources

PubMed2002

[Percutaneous electrogastrography in the perioperative period in laparoscopic and classical cholecystectomy and in laparoscopic nonadjustable gastric banding].

Percutaneous electrogastrography (EGG) is a non-invasive measuring method of gastric myoelectrical activity. We measured myoelectrical activity patients after laparoscopic cholecystectomy (16 patients), after laparotomic cholecystectomy (9 patients) and after gastric bandage (14 patients). We used a Microdigitrapper (Medtronic) and data were analysed with a spectral analysis and Fournier's transformation. We measured 24 hours and 5 hours before operation procedure and 24 and 48 hours after operation. After operative procedure we compared results with healthy voluntaries. Bradygastria was found in most frequent cases in early postoperative period. Physiologic conditions were renewed in laparoscopic operative procedure in first day, after laparotomic operation in second day after operation.

Adult↗

PubMed2002

[Cytokines and soluble cytokine receptors in the perioperative period].

UNLABELLED: The common basis of systemic inflammatory response to surgical trauma is the activation of cytokine cascade, accompanied by the release of soluble cytokine receptors. The main cytokine axis stimulates the release of acute phase proteins (APP) form liver, modulates metabolic pathways and hormonal responses. The aim of this study was to assess characteristic changes in levels of pro- and anti-inflammatory cytokines in early post-op stages after a major intraabdominal surgery and to compare the results with dynamic changes in APP levels. The results will form a basis of evaluation of diagnostic value of certain cytokines and APP in post-operative complications. SUBJECTS AND METHODS: Subjects fell into three categories: 1--patients after colonic resection for colorectal carcinoma I. and II. grade (N = 20), 2--patients after hemipancreatoduodenectomia (N = 17) and 3--control group of 18 healthy subjects. The levels of following parameters were measured between from one day before to three days after surgery: tumour necrosis factor-alpha, interleukin (IL)-1 beta, IL-1ra, IL-2, IL-6, IL-8, IL-10, soluble IL-2 receptors, C reactive protein (CRP) and alpha1-antitrypsin (AAT). RESULTS: Measured parameters exhibited different dynamic changes in reaction to surgical trauma, according to their roles in immune reaction. Main pro-inflammatory cytokines culminated within 24 hours from the onset of surgery, marked elevations were noted in IL-1ra and the soluble IL-2 receptor. Both measured APP were rising until he 72nd hour post surgery, and their rise was markedly delayed compared to cytokines. The extent of immune reaction as measured by the amplitude of changes in both types of surgery was similar in most measured parameters, apart from marked difference in IL-2R. We also noted significant correlation of plasma levels of IL-6 and IL-1ra. CONCLUSIONS: Surgical trauma as any other significant painful stimulus activates the pro-inflammatory cytokine axis with secondary response of APP. The release or pro-inflammatory cytokines, i.e. TNF-alpha, IL-1, IL-6 and IL-8 is synchronized with the release of antagonistic mediators (i.e. IL-1ra, IL-10, IL-2 and IL-6 soluble receptors), who precede the acceleration of APP production and thus modulate its extent. The evaluation of relationships between pro- and anti-inflammatory factors with regard to prognosis is confounded by unclear interpretation of their changes. The maximum effect of cytokines takes place at local autocrine and paracrine level and systemic levels do not reflect this. This is how we explain minimal changes in plasma levels of IL-1 beta and IL-2, despite their key role as initiators of cytokine cascade. In order to increase their diagnostic value the use a series of measurements is advocated in combination with other clinical and laboratory parameters of inflammation, such as the levels of acute phase proteins.

Adult↗

PubMed2002

[Procalcitonin in the diagnosis of postoperative complications].

UNLABELLED: The dynamic changes in levels of procalcitonin (PCT), as well as other cytokines and acute phase proteins (APP) in post-operative stages reflect the systemic immune response, integrating perioperative infectious and non-infectious stimuli. This study evaluates PCT in context of 16 other inflammatory parameters in patients with different types of infectious post-operative complications. It analyses the specificity and sensitivity of PCT, cytokines and APP and their relationships during systemic inflammatory response. SUBJECTS AND METHODS: The study involved the following groups of patients: those with confirmed bacterial sepsis, fulfilling the SIRS criteria (N = 28), those with limited infectious site at the wound (N = 16), those with post-operative pneumonia (N = 15) and a control group of N = 25. In 24-hour interval we assessed plasma levels of: PCT, TNF-alpha, IL-1 beta, IL-1ra, IL-6, IL-8, sIL-2R and a spectrum of APP. RESULTS: PCT in patients with wound infection (1.4 +/- 0.31 ng/ml) and in those with pneumonia (0.7 +/- 0.30 ng/ml) does not rise above levels expected in uncomplicated post-op course (1.7 +/- 0.04 ng/ml), but it differs significantly in comparison to healthy controls (0.2 +/- 0.07 ng/ml). Initial levels of PCT as well as their maximum levels were significantly different in septic patients compared to other groups (p < 0.001). According to specificity and sensitivity tests PCT is the most significant marker for diagnosis of sepsis as opposed to uncomplicated post-operative course (AUC 0.91, CI 0.82-1.0). CONCLUSION: Individual inflammatory parameters vary in sensitivity and specificity to causative stimulus. PCT when compared to major cytokines and APP reacts sensitively mainly to systemic stimuli accompanying bacterial infection, notably endotoxin. It is characterized by markedly lower sensitivity to non-bacterial stimuli (trauma of surgery) or localized bacterial inflammations. It is this behaviour that makes it a useful diagnostic tool in post-op courses. Unlike other parameters, PCT allows with sufficient sensitivity and specificity single-test diagnosis of initial sepsis.

Biomarkers↗

PubMed2001

Leptin as an acute phase reactant after non-adjustable laparoscopic gastric banding.

BACKGROUND: Leptin is a hormone that regulates food intake; its concentrations are elevated in the majority of obese individuals. During inflammation, plasma leptin is usually increased and may contribute to the anorexia and cachexia of infection. The purpose of this study was to characterize the dynamics of circulating leptin in the early postoperative period in relation to the acute phase response in extremely obese patients undergoing laparoscopic non-adjustable gastric banding (LNAGB). We compared plasma leptin changes with 4 proinflammatory cytokines and BMI. METHODS: The prospective study was performed on 18 patients with 3rd degree obesity. Plasma concentration of leptin, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1, soluble IL-2 receptor (sIL-2R), and IL-6 were estimated before operation and 24, 48, and 72 h after NALGB. RESULTS: We demonstrate statistically significant elevation of plasma leptin concentration (32.2 +/- 10.2 micrograms/l) 24 h after operation compared with preoperative status (18.4 +/- 5.2 micrograms/l, p < 0.05). There was diminished correlation of plasma leptin and BMI in this period. Leptin levels +48 and +72 h after banding quickly returned to preoperative levels. The regression coefficient was the highest for leptin and TNF-alpha 24 h after surgery (r = 0.40, p < 0.05), and for leptin and IL-6 24 h after surgery (r = 0.29, p < 0.05). There was no significant correlation between leptin and IL-1 and between leptin and sIL-2R respectively. CONCLUSIONS: During the non-infectious stress response (as with abdominal surgery), leptin shows itself as an acute phase reactant. Proinflammatory cytokines can be the main regulatory factors of leptin in this period. Significant correlation between leptin and TNF-alpha (similarly demonstrated by other authors in models of bacterial inflammation) indicates that TNF-alpha can be a crucial regulator of leptin generation in the early postoperative period.

Acute-Phase Reaction↗

PubMed2001

[Dynamics of leptin plasma levels after abdominal surgical procedures].

UNLABELLED: In addition to its basic role as regulator of the amount of body fat and food intake leptin plays a part also as an acute phase reactant. A rise of the leptin level during this period may be associated with anorexia and cachexia in relation to general inflammatory manifestations. The objective of the present study was to characterize the dynamics of the leptin concentration in patients after intraabdominal surgery. PATIENTS AND METHODS: The prospective study was implemented in a group of 16 men subjected to planned surgery--resection of colorectal carcinoma. The plasma leptin concentration (RIA), TNF alpha, IL-beta. IL-6, sIL-2R (ELISA), CRP, alpha-1-antitrypsin, alpha-1-acid glycoprotein and ceruloplasmin (nephelometry) were assessed before surgery and then +24, +48 and +72 hours after the beginning of the operation and compared with concentrations in healthy subjects. RESULTS: Plasma leptin concentrations culminate +24 hours after surgery and in this stage they do not correlate with the BMI. Within 48 hours the concentration reaches rapidly normal levels. TNF alpha, IL-6 and sIL-2R reach maximal levels 24-48 hours after the onset of surgery with a subsequent slow decline. All acute phase proteins (APP) have prolonged dynamics with an elevation within +72 hours. A significant correlation was proved between the leptin concentration and TNF alpha 24 hours after surgery (r = 0.43, p < 0.05) and between leptin and IL-6 24 hours after surgery (r = 0.32, p < 0.05). CONCLUSION: The dynamics of the plasma leptin concentration during the postoperative period differ from the typical development of early indicators of the systemic inflammatory response--cytokines as well as from the dynamics of APP. Leptin elevation during this period may contribute to anorexia of patients after major surgery. However, rapid normalization of the level within 48 hours after surgery indicates however that leptin is involved also in other, so far unspecified factors with an anorectic action.

Abdomen↗

PubMed2001

[Leptin--a new acute phase reactant].

Leptin, 16 kDa protein and the product of the Ob gene was discovered six years ago and characterized as a fat cell hormone which maintains via specific receptors in the hypothalamus by a feedback mechanism the energy balance and body weight. Research conducted during the last three years detected further properties of this protein which include it, in addition to its basic role in mammalian metabolism, also among acute phase reactants. Leptin is as to its structure, pattern of the receptor and the postreceptor transduction mechanism close to the group of cytokines of interleukin 6, in particular the granulocytic colony stimulating factor. During infectious and non-infectious inflammatory reactions leptin synthesis is stimulated by a combination of inflammation promoting cytokines. The mechanism of induction is not known so far but the majority of investigations proves an indirect stimulating effect of the tumour necrosis factor and interleukin 1, depending on non-specified cytokines of the second stage. Investigations of cell lines and animal experiments provided evidence of some local and systemic effects of leptin which may play a physiological part in the acute phase reaction. Leptin mediates at least partly the anorectic effect of the tumour necrosis factor and interleukin 1 during inflammation. Synergically with bacterial antigens it activates macrophages, enhances their phagocytic capacity and stimulates secretion of pro- and anti-inflammatory factors from macrophages. Leptin stimulates neovascularization, it has a stimulating effect on precursors of white blood cells and potentiates the effect of erythropoietin on red blood cells. It is obviously an essential factor for T-lymphocyte proliferation and development. The authors discuss also the role of leptin in the modulation of the hypothalamo-pituito-adrenal stress axis. Leptin is a factor of the inflammatory mediator network, probably essential for an adequate course of the inflammatory defence reaction.

Acute-Phase Proteins↗

PubMed2001

[Percutaneous electrogastrography in the perioperative period in laparoscopic gastric banding at the First Surgical Clinic of the General Faculty Hospital in Prague].

Percutaneous electrogastrography (EGG) is a method which makes non-invasive follow-up of the myoelectric gastric activity possible. The authors present the results of assessment of the myoelectric gastric activity during the perioperative period in patients undergoing, at the First Surgical Clinic General Faculty Hospital, laparoscopic non-adjustable gastric banding. The data were recorded using a Microdigittrapper and evaluated using spectral analysis and Fourier's transformation. The authors mention also briefly conditions which must be met to ensure the study, and the physiological and pathophysiological background of the method. In 14 patients the ECG record was made 24 hours prior to surgery and then 5 hours, 24 and 48 hours after surgery on fasting and after a fluid bolus. The assembled results of the dynamics of perioperative changes on the EGG were compared with results obtained in a group of healthy volunteers. The most frequent finding during the early postoperative period was bradygastria, the return to preoperative values occurred on average 48 hours after surgery. Percutaneous electrogastrography is a non-invasive method which can provide the surgeon during the early postoperative period with information on myoelectric gastric activity.

Adult↗

PubMed2001

Serum leptin levels in septic men correlate well with C-reactive protein (CRP) and TNF-alpha but not with BMI.

Leptin, an adipocyte-derived signaling factor, is a member of the IL-6 cytokine family. However there is no direct evidence of leptin stimulation of the acute phase protein (APP) synthesis which is typical for all other IL-6-like factors. The purpose of this study was to characterize the dynamics of circulating leptin in relation to ten APPs. We used postoperative septic patients as a model of cytokine network hyperstimulation and intensive APP reaction. The prospective study was performed on 22 patients with proven postoperative intraabdominal sepsis after large abdominal surgery. Plasma levels of leptin, TNF-alpha, IL-1beta, soluble IL-2 receptor (sIL-2R), IL-6 (ELISA analysis) and ten APPs (nephelometric analysis) were estimated. We have demonstrated a statistically significant elevation of plasma leptin concentrations in the septic group compared with healthy subjects (p<0.001). The correlation of plasma leptin and BMI during postoperative sepsis was diminished. The regression coefficient was the highest for leptin and CRP (r=0.48, p<0.05), and for leptin and alpha-1-antitrypsin (r=0.46, p<0.05) in the septic group. There was significant correlation between TNF-alpha and leptin (r=0.47, p<0.05) and between IL-6 and leptin (r=0.45, p<0.05) in septic patients. No significant correlation was found between leptin and "negative" APP and between leptin and IL-1beta. Leptin has thus been shown as an acute phase reactant with a potential hematopoietic, immunomodulatory and hepatocyte stimulating activity during the infectious and non-infectious stress response. The significant correlation between leptin and CRP and leptin and alpha-1-antitrypsin indicates that leptin can participate in APP synthesis regulation during a systemic inflammatory response.

Adult↗

PubMed2001

[Differences in the dynamics of leptin and cortisol during the non-infectious stress reaction].

UNLABELLED: Leptin is a hormone and acute phase reactant with multiple effects during both rest and inflammatory period. Effects of leptin in acute phase response cover a modulation of hypothalamo-pituitoadrenal (HPA) axis, too. In our study we evaluate the dynamics of leptin and glucocorticoid acute changes in model situations of infectious and non-infectious inflammatory reaction. PATIENTS AND METHODS: This study was realized on a group of patients 1--after operation of carcinoma coli (16 persons), 2--after laparoscopic non-adjustable gastric banding (13 persons), and patients 3--with development of postoperative intraabdominal sepsis (22 persons). Plasma levels of leptin, ACTH, cortisol, TNF-alpha, IL-6, C reactive protein (CRP), and alpha1-antitrypsin (AAT) were measured from -7 to +3 day related to surgery or 2nd day after a day when signs of sepsis were occurred. RESULTS: All tested parameters responded to surgical trauma with elevation 12 h after operation except leptin that elevated +24 h after surgery. Maximal levels of measured parameters were found 12 h after surgery (for cortisol), 24 h after surgery (for leptin, TNF-alpha, IL-6), or 36 h after operation (for CRP and AAT). Maximal levels of cortisol after a resection of coli or maximal levels of leptin after laparoscopic gastric banding fall to septic range. Other parameters in uncomplicated postoperative period significantly differed from septic levels on p < 0.01. There wasn't found statistically significant correlation between leptin and cortisol or between leptin and ACTH in all groups. DISCUSSION AND CONCLUSION: The elevation of leptin in postoperative period and during sepsis reflects a different regulation of this protein in rest period and during systemic inflammatory response. The inhibitory effect of leptin to HPA axis during stress response was documented in vitro, however, its physiological importance is not clear, yet. Our study didn't prove a statistically significant relation between plasma cortisol and leptin. The different dynamics of leptin and cortisol after surgical trauma shows that both factors have own specific regulation.

Acute-Phase Reaction↗

PubMed2000

[Cytokines in the diagnosis of peritoneal inflammation].

Early diagnosis of peritoneal inflammation in the initial stage with equivocal clinical manifestations is not always simple. At present there are in the literature many new laboratory indicators which to a different extent describe the inflammatory process. In the present paper the authors focused attention on the practical importance of the use of cytokines in the diagnosis of peritoneal inflammations. They compare the diagnostic impact of clinical examination as compared with assessed plasma concentrations of inflammation promoting cytokines. The authors maintain that the diagnosis of secondary peritonitis is based on the clinical examination of the patient. Elevated values of PCT or IL-6 can support this clinical conclusion. In postoperative peritonitis dynamic investigation of cytokines is important. The diagnosis of tertiary peritonitis is based on laboratory findings.

Biomarkers↗

PubMed2000

[Postoperative immunosuppression--a physiological process and source of complications. Minireview].

Postoperative immunosuppression reflects non-specific neurohumoral stress responses to surgical trauma. Surgical stress in the early stage is characterised by a dysbalance of the adrenocortical response, the index of the formation of glucocorticoids and dehydroepiandrosterone is shifted to the glucocorticoids. This non-specific hormonal response has an impact on the balance between TH1 and TH2 lymphocyte response. Inhibition of the TH1 response occurs, the clinical reflection of which is a decline of cell-mediated immunity. Postoperative immunosuppression and dysbalance of cell-mediated and humoral immunity are physiological processes, part of the neurohumoral stress response to surgical trauma. Its potential pathological consequences, although proved so far only experimentally, make it on the one hand an important factor for evaluation of the risk of postoperative complications and on the other hand a possible of object of therapeutic intervention in oncological or high risk patients.

Adjuvants, Immunologic↗