Masui. The Japanese journal of anesthesiology
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We investigated the correlation between the endogenous hormonal changes of pituitary-adrenal and pituitary-thyroid hormones and the prognosis of patients in multiple organ failure, and elucidated the mechanism of blunted thyrotropin (TSH) secretion by histological and immunocytochemical studies of anterior pituitary glands. ⋯ Decreased cortisol, low T4 levels and blunted TSH response to TRH correlated with mortality in MOF patients. Histological and immunocytological studies suggest that blunted TSH secretion is not caused by pituitary damages or TSH exhaustion but by disturbances in TSH secretion. This blunted TSH secretion is reversible and its improvement is an indicator of survival.
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The effect of intraoperative stored blood transfusion on the changes in plasma neutrophil elastase (PMN-E) was studied in packed red cell, and in the patients transfused with stored blood (400-1000 ml) during surgery (n = 22), compared with the control in patients who had not received transfusion (n = 6). PMN-E was measured as elastase.alpha 1-antitrypsin complex (EAC) and the effect of ulinastatin (UTI) treatment on EAC was also evaluated. ⋯ There was no significant correlation between transfusion volume and EAC (r2 = 0.44, P > 0.05) in patients with UTI treatment during blood transfusion. These results and increased H2O2 concentration of expired breath in the patient whose plasma EAC exceeded 1,000 micrograms.l-1, suggested PMN-E is released from triggered neutrophil by increased EAC.