Epinephrine and endotoxin tolerance differentially modulate serum cytokine levels to high-dose lipopolysaccharide challenge in a murine model.

BACKGROUND: The epinephrine tolerance state has been demonstrated to increase survival in endotoxic shock and was claimed to have cross-tolerance with endotoxin tolerance. With use of these data, we aimed to determine the effect of epinephrine and endotoxin tolerance on major cytokine levels in a lipopolysaccharide challenge in mice. METHODS: Epinephrine tolerance was induced by beginning with a low dose and gradually increasing to a lethal dose. Endotoxin tolerance was induced by injecting saline solution for 4 days and lipopolysaccharide 1 mg/kg on the fifth day. After these procedures, saline solution or 20 mg/kg lipopolysaccharide was injected into animals. Peak serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 1 beta, interleukin 6 (IL-6), interleukin 10 (IL-10), and interleukin 12 (IL-12) were assayed. RESULTS: The lipopolysaccharide injection increased the levels of all the cytokines in the control and epinephrine-tolerant animals. TNF-alpha, IL-6, and IL-10 levels were lower in endotoxin-tolerant animals compared with controls. Epinephrine-tolerant animals had higher levels of TNF-alpha, IL-6, and IL-12 than the controls did. CONCLUSION: Epinephrine tolerance primes for an exaggerated release of TNF-alpha, IL-6, and IL-12 in response to lipopolysaccharide challenge, suggesting anti-inflammatory and immunosuppressive effects by epinephrine. The anti-inflammatory effect was not mediated through increased IL-10 release. Endotoxin tolerance selectively modulated cytokine release.

Surgical treatment of hydatid disease of the liver.

The records of 100 consecutive cases of hydatid disease of the liver that were treated surgically were reviewed to determine the complications and the results of different surgical procedures applied. Of those, 74% had single cyst and in 70% the disease was confined to the right lobe of the liver. Marsupialization and omentoplasty were the most commonly used techniques, followed by cystectomy, tube drainage, and cystojejunostomy. Infection in the remaining cavity was the most common postoperative complication. The complication rates were higher in marsupialization and tube drainage when compared with omentoplasty and cystectomy. Omentoplasty and cystectomy led to a shorter hospitalization period. All of the patients who underwent omentoplasty or cystectomy had good results whereas only 28.1% of those on whom marsupialization was done and 27.3% of the patients who underwent tube drainage had good results. The overall mortality was 3%.

Factors affecting postoperative mortality in abdominal trauma.

Records of 345 patients in whom laparatomies were performed because of blunt and penetrating abdominal trauma were reviewed retrospectively with respect to factors affecting mortality. One hundred and twenty-eight patients had blunt abdominal trauma (Group I), 114 patients had gunshot wounds of the abdomen (Group II), and 103 patients had stab wounds of the abdomen (Group III). Mortality rates were 14.8%, 12.3% and 1.9% in groups I, II and III respectively. The presence of head trauma especially if accompanied by hypotension in group I, and the presence of chest trauma (hemothorax and/or pneumothorax) and hypotension (less than 90 mmHg) in group II were associated with a high mortality rate (p less than 0.05). Of the two patients who died in group III, one had septic shock due to massive intestinal necrosis and the other had hemorrhagic shock due to multiple organ injury and bleeding from an injured internal thoracic artery as the cause of death.

Adrenalin tolerance does not prevent bacterial translocation in a murine burn model.

Burn injury causes mesenteric vasoconstriction and bacterial translocation. Since catecholamines are powerful vasoconstrictors and elevated immediately after burn injury, we hypothesised that adrenaline tolerance might decrease burn-induced mesenteric vasoconstriction and bacterial translocation. Adrenaline tolerance was developed in Swiss albino mice. Adrenaline tolerant and control animals were subdivided into sham-burn and burn subgroups. 24 h after sham-burn or burn injury, specimens were obtained for microbiological evaluation. Also, in a separate group of adrenaline tolerant and control animals, superior mesenteric blood flow was measured. Burn injury increased bacterial translocation rate in both control (P = 0.001) and adrenaline tolerant groups (P = 0.0351). The caecal bacterial level increase was significant after burn injury in control groups (P = 0.0004) but was not significant in adrenaline tolerant animals (P = 0.743). Mesenteric blood flow was decreased significantly by burn injury in both control and adrenaline tolerant animals (P < 0.00001). The results showed that catecholamines do not mediate postburn mesenteric vasoconstriction or bacterial translocation.

[Prophylactic use of antibiotics in biliary tract and stomach surgery (author's transl)]. / Safra yollari ve mide cerrahisinde profilaktik antibiyotik uygulamasi.

115 patients undergoing elective surgery on biliary tract (80 patients), and stomach (35 patients) for duodenal ulcer were divided into three groups: some received prophylactic antibiotics, cephalothin sodium or sulfamethoxazole trimethoprim and some received none. The antibiotics were started preoperatively and continued postoperatively for three days. The wound infection rate was reduced from 7.1% in the control group to 2.3% in patients treated with cephalothin sodium and 3.2% in sulfamethoxazole trimethoprim treated group. In patients who had biliary tract surgery, the wound infection rate was reduced to 3.3% and 0% with cephalothin sodium and sulfamethoxasole-trimetoprim respectively from 10% in the control group. Only one patient who had gastric surgery who received sulfamethoxasole-trimetoprim prophylactically, developed wound infection postoperatively. The difference between the groups was not statistically significant (p > 0.05). However the wound infection rate was higher in patients who had positive bile culture (p < 0.05).

Side-to-side choledochoduodenostomy in the management of choledocholithiasis.

Sixty patients with choledocholithiasis (either single or multiple stones of the biliary tree) were treated with lateral choledochoduodenostomy. Of these cases 83.3% were followed up for from 1 to 7 years. Only 1 patient developed cholangitis, which responded well to conservative treatment. The other cases have been asymptomatic following surgery. The diameter of the common bile duct is not an important problem in constructing a functional anastomosis.

Experimental study of the effect of adrenaline tolerance on intestinal ischaemia-reperfusion.

BACKGROUND: Adrenaline tolerance improves survival in animal models of shock. The purpose of this study was to determine the effects of adrenaline tolerance on intestinal ischaemia-reperfusion in a mouse model. METHODS: Adrenaline tolerance was developed by injecting intravenous adrenaline, gradually increasing the dose to 2 mg/kg over 5 days. In experimental animals the superior mesenteric artery was clamped for 120 min and then released. Evans blue dye was given intravenously to all animals to quantify pulmonary microvascular injury. Some 60 min after clamp release, the animals were killed and the effects of reperfusion assessed on tissue samples. RESULTS: Evans blue dye concentrations were significantly higher in animals with intestinal ischaemia-reperfusion than in those having sham intestinal ischaemia-reperfusion or in adrenaline-tolerant mice having intestinal ischaemia-reperfusion or sham ischaemia-reperfusion (P< 0.01). Malonyldialdehyde levels increased significantly in the lung in the intestinal ischaemia-reperfusion group compared with those in the sham ischaemia-reperfusion group (P< 0.001 for liver, lung and small intestine), whereas there was no difference in adrenaline-tolerant animals. There was no significant change induced by adrenaline tolerance in myeloperoxidase levels in any organ. CONCLUSION: Adrenaline tolerance reduced the lung permeability caused by intestinal ischaemia-reperfusion. Catecholamines may play a role in free radical generation induced by ischaemia-reperfusion.

Effects of adrenaline or endotoxin tolerance states on mesenteric blood flow in endotoxaemia.

BACKGROUND: Endotoxic shock is associated with release of catecholamines as well as decreased mesenteric vascular perfusion, which is thought to cause remote organ injury. Adrenaline tolerance was reported to decrease mortality in endotoxic shock and have cross-tolerance with endotoxin tolerance. Our aim was to investigate the effect of these two tolerance conditions on the lipopolysaccharide (LPS)-induced decrease in mesenteric blood flow (MBF). METHODS: Adrenaline tolerance was developed by injecting 0.03 mg/kg adrenaline to Swiss-albino mice, gradually increasing the dose to 2 mg/kg over 5 days. Endotoxin tolerance was developed by injecting saline for 4 days and LPS 1 mg/kg at the fifth day. Control animals were injected with saline for 5 days. At 72 h after completion of injections, half of the animals in each group were challenged with saline and the other half with 20 mg/kg LPS, at 0 h. Mesenteric blood flow was measured at 4 and 24 h. RESULTS: Neither endotoxin nor adrenaline tolerance prevented an LPS-induced decrease in MBF. CONCLUSION: A low dose of LPS prior to a higher dose does not prevent an LPS-induced decrease in MBF and may actually prime for a decrease. Also, catecholamines are not primary mediators of LPS-induced decreases in MBF.