Effects of analgesic and surgical modality on immune response in colorectal cancer surgery.

BACKGROUND AND OBJECTIVE: Different surgical methods, anesthesia, and analgesia are known to modify the surgical stress response, especially in patients with malignancy. We compared the impact of patient-controlled intravenous (PCA) versus epidural analgesia (EDA) on tumor-related mucosal immune response in patients undergoing open or laparoscopic surgery for colorectal cancer. METHODS: In a University Hospital subgroup (n = 43) of a larger cohort (n = 235) of patients undergoing open or laparoscopic surgery for colorectal carcinoma randomized to PCA or EDA, colorectal tissues were stained for interleukin-10 (IL-10), tumor necrosis factor (TNF), and mast cell tryptase and then examined by immunofluorescence microscopy. RESULTS: More IL-10+-cells were found in patients undergoing open compared to laparoscopic surgery in the PCA (P < 0.05) and EDA group (P < 0.0005), respectively, and numbers of TNF+-cells were higher in the open surgery group who received PCA (P < 0.05). No differences in IL-10 or TNF expressions were detected between EDA/PCA within the open or laparoscopic surgery groups, respectively. Fewer mast cells were observed in patients undergoing laparoscopic compared to open surgery combined with PCA (P < 0.05). Within the open surgery group, EDA resulted in fewer mucosal mast cells compared to the PCA group (P < 0.05). CONCLUSIONS: The surgical method, rather than type of analgesia, may have higher impact on peri-operative inflammation. Laparoscopic surgery when combined with EDA for colorectal cancer caused a decrease in the TNF and IL-10 expression and mast cells. EDA seems to have an anti-inflammatory effect on cancer-related inflammation during open surgery.

A suspected case of systemic envenomation syndrome in a soldier returning from Iraq: implications for Special Forces Operations.

Upon returning to Denmark from a mission in Baghdad, Iraq, under Operation Iraqi Freedom, a 45-year-old Danish Special Forces soldier experienced serious and unexplainable symptoms after being stung by an arthropod. The soldier sought medical attention in an emergency department at a public hospital, where he was diagnosed with an allergic reaction to a wasp, bee, or mosquito sting, animals that are commonly found in Denmark. After a short period of observation, he was prescribed antihistamines and discharged. Within a few hours, the soldier developed severe symptoms consistent with a systemic envenomation. There is no proof of the existence of poisonous animals in Denmark that can cause such symptoms. On the basis of circumstantial evidence, an accidental importation of a venomous spider or scorpion by Danish Special Forces personnel might be the possible cause.