Blood cytokine levels rise even after minor surgical trauma

The exact changes in cytokine production and clinical implications of the increased cytokine levels following operative trauma remain unclear. In this study, systemic production of a spectrum of cytokines, including IL1 alpha, IL1 beta, IL6, IL8, IL10, and IFN gamma, was examined in patients undergoing minor elective operative trauma. The levels of IL1 receptor antagonist (ra) and IL6 soluble receptor (sR) were also determined. Although there were no changes in IL1 alpha and IL1 beta plasma levels during the entire observation period, there was a significant rise in IL1 ra level in all patients between postoperative day 1 and postoperative day 14. A significant increase in the IL6 plasma level was seen on days 1, 3, and 7 after surgery and an increase in the IL6 sR level was observed on postoperative days 10 and 14. Interestingly, the IL8 plasma values had risen significantly on days 1 and 3 following the operation. In some patients, an elevation in IL10 plasma level was noted on days 1 and 3 postsurgery. Results demonstrated that even a minor surgical procedure such as cholecystectomy with uneventful wound healing was followed by an appearance in the blood circulation of significant levels of cytokines between day 1 and day 14 after surgery. These observations point to the necessity of searching for methods of down-regulating the systemic cytokine effects after surgical trauma for the routine postoperative management.

Comparative analysis of immunological reconstitution induced by vascularized bone marrow versus bone marrow cell transplantation

We have reported previously that vascularized bone marrow transplantation (VBMT) in an orthotopic hind limb graft brings about complete repopulation of bone marrow cavities in lethally irradiated syngeneic recipients within 10 days. Intravenous infusion of an equivalent volume of bone marrow cell suspension was evidently less effective. The purpose of this study was to investigate the reconstitution of immunocompetent compartments of lethally irradiated syngeneic rats after VBMT. Lewis rat hind limbs were transplanted orthotopically into irradiated recipients. Ten days after irradiation and bone marrow transplantation, bone marrow, mesenteric lymph nodes, and sera from rats were harvested. Mesenteric lymph node lymphocytes were analyzed. The responsiveness for mesenteric lymph node lymphocytes (MLNL) to mitogens and cell proliferation in the presence of sera and bone marrow cell (BMC) culture supernatants were measured. Our studies have shown that vascularized bone marrow transplantation brings about rapid replenishment of lymphoid organs of lethally irradiated syngeneic recipients. The repopulating subsets are fully responsive to mitogens. Sera from reconstituting rats had no effect on the proliferation of mature lymphocytes. Intravenous infusion of a number of BMC in suspension equivalent to that grafted in hind limb transplant was less efficient in reconstitution of lymphoid tissue.

[Personal experience with simultaneous transplantation of pancreas segment and kidney]

Between February 1988 and December 1994, 25 patients underwent simultaneous kidney and segmental pancreatic transplantation. Diabetes type I with the end-stage renal disease secondary to the diabetic nephropathy was the indication for this procedure. The original method of the four vascular anastomoses was introduced to prevent early pancreatic graft thrombosis. The cross section of the pancreatic segment was anastomosed to Roux--en Y loop in 80% cases and in 20% ductal occlusion with Ethiblock was performed. One-year survival rate for kidney and the pancreas was 81% and 57% and five - years survival rate 57% and 42%, respectively. One - year and five - year survival rate for the patients was 72% and 68%, respectively. The most serious complication leading to the graft removal was intrapancreatic abscess. Sepsis was the main cause of the death among transplant patients.

Diminished integrin expression on granulocytes from renal allograft recipients

Integrin (beta 2 subunit of the LEU-CAM family, CD18) expression on peripheral blood and urinary granulocytes was studied in renal allograft recipients. Circulating granulocyte CD18 expression was normal except for patients with CMV infection. In contrast, the majority of patients with urinary tract infection had low numbers of CD18+ cells collected from urine, and the same abnormality could also be observed in approx. 50% of non-infected recipients. These disturbances were associated with transplantation, as no such deficits were seen in the infected non-transplant patients or patients with glomerular diseases on immunosuppression. Short culture of granulocytes with immunosuppressants did not diminish integrin expression. Deficient granulocyte integrin expression, especially in urinary tract, may be associated with increased susceptibility to infection in renal transplant recipients, although immunosuppression alone could not be incriminated as a sole factor responsible for this deficit.

Laser-Doppler versus fluorometry in the postoperative assessment of a cutaneous free flap

To find the optimal means for monitoring the vascularity of a cutaneous free flap in the postoperative period, we have experimentally compared laser-Doppler velocimetry and fluorometry. Using the rat groin model, five groups were evaluated: 1. flap isolation without division of the pedicle vessels (island flap); 2) flap isolation, division, and repair of the pedicle artery and vein (free flap); 3) flap isolation, with ligation of the pedicle artery immediately or 1 hour later; 4) flap isolation, with ligation of the pedicle vein immediately or 1 hour later; 5) flap isolation, with ligation of the pedicle artery and vein immediately or 1 hour later. The laser-Doppler processes the signal by combination of the root mean square and differential amplification. The fluoroscan gives an index in relation to the fluorescence of a control area. The results obtained with both methods correlated well with findings in clinical situations. However, the laser-Doppler readings were more rapid and sensitive than those with fluorometry. We suggest that laser-Doppler velocimetry is a superior means of monitoring the vascular status of a free tissue transfer or digital replant.

Gastric stress ulcer of the rat: relative contribution of the pyloric sphincter, HCO3- bile reflux and mucosal blood flow

Gastric ulceration has been induced after stress, combining 24 h of fasting and 48 h of restraint in 9 groups of 20 rats with or without a pyloroplasty or a pylorojejunostomy combined with atropine and gastric infusion of NaHCO3 or taurocholic acid. After death or sacrifice at 48 h, ulcer index and blood in the jejunum were determined. Gastric mucosal blood flow was measured semi-continuously by a laser Doppler velocimeter. There were 45% deaths after 48 h of restraint alone, and 70% in the group combining pylorojejunostomy with taurocholic acid. Mortality was lower (p less than or equal to 0.01) pylorojejunostomy alone and more significantly so (p less than or equal to 0.001) when associated with NaHCO3. There was no death when NaHCO3 and atropine were combined with restraint. The mucosal blood flow increased significantly during the first 12 h of restraint in the taurocholic acid group. Both groups with NaHCO3 had mucosal blood flows similar to the controls. Gastric acid and gastric emptying, mucosal ischemia and bile reflux are joint factors inducing gastric stress ulcer. The 100% survival and the low ulcer index after a treatment by atropine and gastric infusion of NaHCO3 suggest that these well-known drugs should be used more frequently.

A new laser Doppler interface for the continuous measurement of the rat gastric mucosal blood flow

The laser Doppler system (LD) has been proposed for a tissue blood flowmetry. However, its accuracy is dependent on the pressure and direction of the laser probe. Therefore, we have devised a new interface for the measurement of the gastric mucosal blood flow in rats keeping the probe constant in pressure and direction. This interface is a small cylinder with one end fixed upon the gastric serosa and the other end fixed externally upon the skin. The laser probe adjusts exactly in direction and pressure inside this button. The LD apparatus processes two shifted beams with a differential amplification and a root mean square. It delivers an index (LDI) from 0 to 10. This interface was tested in 3 groups of rats, comparing the mucosal (open stomach) with the serosal gastric LDI and the same serosal LDI with a 133Xe washout flow. Finally, the interface was used in control and restrained rats. The gastric serosal LDI was found to be similar to the mucosal LDI. The correlation between the LDI and the 133Xe washout flow was good, with a coefficient of 0.9. Finally, the LDI of the gastric mucosal blood was significantly different in control and stressed rats. This new interface makes the LD more reliable for the monitoring of gastric mucosal flowmetry. It has the same accuracy as the xenon washout and additionally it is simpler, cheaper and may be repeated or even be used continuously.