Document Detail

Inflammatory response in patients with malignant obstructive jaundice.
MedLine Citation:
PMID:  17190769     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Surgery in patients with malignant obstructive jaundice is associated with increased risks for postoperative septic complications. The aim of this study was to investigate the inflammatory and the local cellular immune response in patients accepted for surgery because of tumours in the hepatic-pancreatic-biliary (HPB) tract. MATERIAL AND METHODS: Patients with obstructive jaundice (group HPB(+)) were compared with those without (HPB(-)). Patients undergoing surgery for benign abdominal disorders served as controls. Obstructive jaundice was present in 18 out of 33 HPB patients. Preoperatively, blood was analysed for bacteria, endotoxins and cytokines (TNF-alpha, IL-6 and IL-10). At operation, mesenteric lymph nodes (MLNs) were excised for bacterial cultures using standard microbiological techniques, and immunohistochemistry, using antibodies CD4 and CD8 (mainly staining T lymphocytes), CD68 (macrophages), and anti-caspase-3 (to determine the rate of apoptosis). RESULTS: Bacterial translocation was not demonstrated in any of the patients. Increased preoperative concentrations of endotoxins were found in group HPB(+). The number of macrophages and the rate of apoptosis in MLNs were increased in jaundiced patients, while the number of T lymphocytes was decreased. CONCLUSIONS: Malignant obstructive jaundice causes increased blood concentrations of endotoxins and cytokines, an increased number of macrophages in MLNs, a higher rate of apoptosis in MLNs, but a decreased number of T lymphocytes in MLNs. The lymphocyte depletion is probably due to the increased rate of apoptosis, and might reduce the ability of jaundiced patients to eradicate infection.
Mikael Ljungdahl; Johanna Osterberg; Ulrika Ransjö; Lars Engstrand; Ulf Haglund
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Scandinavian journal of gastroenterology     Volume:  42     ISSN:  0036-5521     ISO Abbreviation:  Scand. J. Gastroenterol.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-27     Completed Date:  2007-03-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0060105     Medline TA:  Scand J Gastroenterol     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  94-102     Citation Subset:  IM    
Department of Surgery, University Hospital, Uppsala, Sweden.
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MeSH Terms
Aged, 80 and over
Bacteria / isolation & purification
CD4 Lymphocyte Count
CD8-Positive T-Lymphocytes
Cytokines / blood
Digestive System Neoplasms / complications*
Endotoxins / blood
Jaundice, Obstructive / etiology,  immunology*,  microbiology,  pathology
Lymph Nodes / microbiology,  pathology
Macrophages / pathology
Middle Aged
T-Lymphocytes / pathology
Reg. No./Substance:
0/Cytokines; 0/Endotoxins

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