Inflammatory response in patients with malignant obstructive jaundice.
Mikael Ljungdahl1, Johanna Osterberg, Ulrika Ransjö
1Department of Surgery, University Hospital, Uppsala, Sweden. mikael.ljungdahl@akademiska.se
Scandinavian Journal of Gastroenterology
|December 28, 2006
Summary
Malignant obstructive jaundice increases endotoxins and cytokines, leading to more macrophages and apoptosis but fewer T lymphocytes in mesenteric lymph nodes. This immune cell depletion may impair infection control in jaundiced patients.
Area of Science:
- Gastroenterology
- Immunology
- Surgical Oncology
Background:
- Obstructive jaundice, particularly malignant, elevates risks of postoperative septic complications.
- Hepatic-pancreatic-biliary (HPB) tract tumors often necessitate surgery, posing significant challenges.
Purpose of the Study:
- To investigate the inflammatory and local cellular immune responses in patients undergoing surgery for HPB tract tumors.
- To compare immune markers in patients with and without obstructive jaundice.
Main Methods:
- Compared patients with obstructive jaundice (HPB(+)) to those without (HPB(-)) and benign surgery controls.
- Analyzed preoperative blood for bacteria, endotoxins, and cytokines (TNF-alpha, IL-6, IL-10).
- Examined mesenteric lymph nodes (MLNs) for bacterial cultures, T lymphocytes (CD4, CD8), macrophages (CD68), and apoptosis (caspase-3).
Main Results:
- No bacterial translocation was detected in any patient group.
- Elevated preoperative endotoxin levels were observed in the jaundiced HPB(+) group.
- Jaundiced patients showed increased macrophages and apoptosis, but decreased T lymphocytes in MLNs.
Conclusions:
- Malignant obstructive jaundice is associated with increased endotoxins, cytokines, MLN macrophages, and MLN apoptosis.
- A decrease in T lymphocytes within MLNs was noted in jaundiced patients.
- This lymphocyte depletion, likely due to apoptosis, may compromise the immune system's ability to fight infection.
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