Factors Relating to Coagulation, Fibrinolysis and Hepatic Damage After Liver Resection

A survey of the blood of twenty-two patients who had undergone hepatic resection was performed. Serum levels of α-2 plasmin inhibitor-plasmin complex initially decreased from 1.58 ± 0.31 μg/ml on the preoperative day (PREOP), to 0.92 ± 0.14 μ/ml on the first postoperative day (POD 1), and then increased to 3.13 ± 0.92 μg/ml on the seventh postoperative day (POD 7) (mean ± SE)). Thrombin-anti-thrombin III complex (14.2 ± 4.3 ng/ml on PREOP and 26.0 ± 4.1 ng/ml on POD 7 (mean ± SE)) and D-dimer (335 ± 96 ng/ml on PREOP and 1859 ± 258 ng/ml on POD 7 (mean ± SE)) increased in the early postoperative stage. The level of 6-keto-prostaglandin F1α increased after the operations (from 13.2 ± 1.8 pg/ml on PREOP to 37.8 ± 12.8 pg/ml on POD 7 (mean ± SE)). The level of thromboxane B-2 decreased at first, and then gradually increased and returned to its preoperative level on POD 7 (144.7 ± 43.8 pg/ml on PREOP, 57.6 ± 27.5 pg/ml on POD1 and 152.5 ± 58.4 pg/ml on POD 7 (mean ± SE)). Superoxide dismutase activity increased at first, and then gradually decreased, postoperatively (2.8 ± 0.5 NU/ml on PREOP, 4.8 ± 0.8 NU/ml on POD1 and 2.6 ± 0.3 NU/ml on POD 7 (mean ± SE)). That is, biodefensive reactions which protect patients against the shift to disseminated intravascular coagulation (DIC) were inferred with by the increase in antiplatelet aggregation, despite the activation of coagulation and fibrinolytic mechanisms after hepatic resection

Use of salivary cortisol and cortisone in the high and low dose synacthen test

CONTEXT: Salivary cortisone reflects serum cortisol levels, is more sensitive than salivary cortisol at lower values of serum cortisol and is non-invasive. OBJECTIVE: To investigate the relationship between serum cortisol and salivary cortisol and cortisone following low and high-dose synacthen. DESIGN AND SETTING: Prospective pharmacodynamic studies in clinical research facilities. PARTICIPANTS AND INTERVENTION: 35 dexamethasone-suppressed, healthy adult males underwent an intravenous synacthen test: N=23 low-dose (1mcg), N=12 high-dose (250mcg). Paired serum and salivary samples were taken at 15 sampling points over 120 minutes. MAIN OUTCOME MEASURE: Serum cortisol and salivary cortisol and cortisone were analyzed for correlations and by a mixed effects model. RESULTS: At baseline the correlation between serum cortisol and salivary cortisol was weak with many samples undetectable (r=0.45, NS), but there was a strong correlation with salivary cortisone (r=0.94, p<0.001). Up to 50 minutes following synacthen the correlation coefficient between serum cortisol and salivary cortisol and cortisone was <0.8, but both had a stronger correlation at 60 minutes (salivary cortisol r=0.89, p<0.001, salivary cortisone r=0.85, p<0.001). The relationship was examined excluding samples in the dynamic phase (baseline to 60 minutes). Salivary cortisol and cortisone showed a close relationship to serum cortisol. Salivary cortisone showing the stronger correlation: Salivary cortisol r=0.82, p<0.001, salivary cortisone r=0.96, p<0.001. CONCLUSION: Following synacthen, both salivary cortisol and cortisone reflect serum cortisol levels but there is a lag in their rise up to 60mins. The results support further research for possible future use of a 60min salivary cortisone measurement during the synacthen test

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Desmopressin, ovine CRH, and low-dose ACTH tests: tools for the study of the hypothalamic-pituitary-adrenal axis in premenopausal rheumatoid arthritis patients.

none8Foppiani L; Sulli A; Prete C; Sessarego P; Piredda S; Seriolo B; Cutolo M; Giusti M.Foppiani, L; Sulli, Alberto; Prete, C; Sessarego, P; Piredda, S; Seriolo, Bruno; Cutolo, Maurizio; Giusti, M