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Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction
Örebro University, Department of Clinical Medicine.
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2004 (English)In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 187, no 3, p. 372-377Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cytokine response is an important factor in the development of shock and organ failure. The aim of this study was to investigate intraperitoneal (peritoneal) and venous (systemic) postoperative cytokine release after major surgery.

METHODS: Major abdominal surgery was performed in 19 patients. Preoperative systemic measurements and postoperative systemic and peritoneal measurements of C-reactive protein (CRP) and the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-6), and IL-10 were performed.

RESULTS: Significantly higher TNF-alpha, IL-6, and IL-10 peritoneal values were recorded compared with systemic values, whereas peritoneal CRP was significantly decreased. CRP increased significantly over time, whereas postoperative values of IL-6, IL-10, and peritoneal TNF-alpha decreased. Systemic TNF-alpha was constant over time, but values after emergent abdominal surgery showed a more extensive response. An additional effect of surgery and emergent abdominal disease was seen in increased TNF-alpha and IL-10 levels.

CONCLUSIONS: Compared with systemic cytokines, peritoneal cytokines respond extensively after major surgery, indicating that measurement of peritoneal cytokines is a more sensible method to determine postoperative inflammatory reaction. A normal postoperative course is characterized by decreasing levels of peritoneal cytokines.

Place, publisher, year, edition, pages
2004. Vol. 187, no 3, p. 372-377
National Category
Medical and Health Sciences Surgery
Research subject
Medicine; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-3153DOI: 10.1016/j.amjsurg.2003.12.019PubMedID: 15006565OAI: oai:DiVA.org:oru-3153DiVA, id: diva2:137177
Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Intraperitoneal microdialysis: technique and results
Open this publication in new window or tab >>Intraperitoneal microdialysis: technique and results
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Microdialysis has recently developed from a laboratory research method of animals to a useful clinical tool to evaluate parameters suggesting tissue ischemia. It is now used in neurosurgery, plastic surgery and liver transplantation.

Shock and multiple organ failure after surgery are rare but serious complications with a high mortality rate and splanchnic ischemia is an early and important step in this development. Splanchnic ischemia is leading to increased permeability of the intestinal mucosa and to activation of macrophages. Subsequent release of inflammatory mediators like cytokines initiates shock, which may result in multiple organ failure and death. The importance of splanchnic hypoxia/ischemia is investigated in these five studies in relation to activation of cytokines (intraperitoneal and systemic) during a normal recovery and in case of surgical complications after major gastrointestinal surgery.

Postoperatively the metabolic substances, glucose, pyruvate, lactate and glycerol were analysed and the LP ratio was calculated using microdialysis intraperitoneally and subcutaneously. Two studies are focused on the activation of the immunologic system by measurement of the cytokines TNF-, IL-6 and IL-10 and the relationship between LP ratio and the cytokines. Three studies are describing the performance of intraperitoneal microdialysis, different responses depending on the site of measurement, the difference between intraperitoneal and subcutaneous measurements and normal values in postoperative gastrointestinal surgery. Patients with clinical complications are described separately.

No adverse effects of the intraperitoneal measurement technique were seen. An increase of the intraperitoneal LP ratio and decrease of glucose were in several cases preceding clinical complications. Intraperitoneal LP ratio, glucose and cytokines were higher in the abdominal cavity compared to subcutaneous and systemic measurements in a normal postoperative recovery. An intraperitoneal correlation between TNF-a and the LP ratio was found. Intraperitoneal concentrations of the cytokines and the LP ratio were decreasing in parallel during a normal postoperative recovery.

The intraperitoneal inflammatory response is higher, during a normal postoperative recovery as well as in patients suffering from complications, compared to systemic findings, emphazising the importance of the gastrointestinal tract as the source of early immunological reactions postoperatively. IPM enables safe and sensitive analysis of glucose, pyruvate, lactate and glycerol from the intraperitoneal organs measured in the intraperitoneal fluid.

Measurement of the LP ratio with microdialysis seems to detect early splanchnic hypoxia/ischemia that correlates to the intraperitoneal inflammation. IPM may have a future as an important clinical tool for monitoring patients at risk of developing postoperative surgical complications.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2004. p. 61
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 2
Keywords
kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-73 (URN)91-7668-395-8 (ISBN)
Public defence
2004-06-11, B-husets aula, Universitetssjukhuset, Södra Grev Rosengatan, Örebro, 10:00
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Supervisors
Available from: 2004-06-08 Created: 2004-06-08 Last updated: 2017-10-18Bibliographically approved

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