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- Fant, F., et al.
(författare)
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Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy
- 2013
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Ingår i: British Journal of Anaesthesia. - Oxford, USA : Oxford University Press. - 0007-0912 .- 1471-6771. ; 110:5, s. 747-757
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropubic prostatectomy.Methods: Twenty-six patients were randomized to Group P (systemic opioid-based analgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction and maintenance of anaesthesia followed a standardized protocol. The following measurements were made perioperatively: plasma cortisol, glucose, insulin, C-reactive proteins, leucocyte count, plasma cytokines [interleukin (IL)-6, tumour necrosis factor (TNF)-alpha], and pokeweed mitogen-stimulated cytokines [interferon (IFN)-gamma, IL-2, IL-12p70, IL-10, IL-4, and IL-17]. Other parameters recorded were pain, morphine consumption, and perioperative complications.Results: Plasma concentration of cortisol and glucose were significantly higher in Group P compared with Group E at the end of surgery, the mean difference was 232 nmol litre(-1) [95% confidence interval (CI) 84-381] (P=0.004) and 1.6 mmol litre(-1) (95% CI 0.6-2.5) (P=0.003), respectively. No significant differences were seen in IL-6 and TNF-alpha at 24 h (P=0.953 and 0.368, respectively) and at 72 h (P=0.931 and 0.691, respectively). IL-17 was higher in Group P compared with Group E, both at 24 h (P=0.001) and 72 h (P=0.018) after operation. Pain intensity was significantly greater in Group P compared with Group E (P<0.05) up to 24 h.Conclusions: In this small prospective randomized study, thoracic epidural analgesia reduced the early postoperative stress response but not the acute inflammatory response after radical retrobupic prostatectomy, suggesting that other pathways are involved during the acute phase reaction.
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- Sundin, Johanna, 1982-, et al.
(författare)
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Increased number of double positive CD3+ CD8+ CD4+ lamina propria T lymphocyte in gut mucosa of post infectious IBS patients compared to healthy controls
- 2012
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Ingår i: Neurogastroenterology and Motility. - : Wiley-Blackwell. - 1350-1925 .- 1365-2982. ; 24:Suppl. 2, s. 104-105
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Irritable bowel syndrome (IBS) developed after a gastroenteritis is denoted post infectious IBS (PI-IBS) and is thought to represent a specific patho-physiological entity. Naive CD8+CD45RA+cytotoxic T lymphocytes recognize antigen derived from intracellular bacteria and viruses. Naive CD4+CD45RA+helper T lymphocytes are activated by the antigen from extracellular microorganisms with the help of antigen-presenting cells. Activated CD4+CD45RO+helper T lymphocytes help phagocytes to kill microbes and activate naive B lymphocytes.Aim: To characterize subsets of mucosal lymphocytes in PI-IBS with flow cytometry analysis as a lead in identifying new therapeutic methods.Methods: 5 PI-IBS patients and 6 healthy individuals were recruited. We performed a distal colonoscopy without bowel cleansing or other preparation. Lamina propria lymphocytes (LPL) and intra-epithelial lymphocytes (IEL) were isolated from sigmodal biopsies and sub classified by CD3, CD4, CD8, CD45RO and CD45RA with flow cytometry.Results: We observed a significant deference (P < 0.01, two-tailed Mann–Whitney test) in double positive CD3+CD8+CD4+LPL between PI-IBS patient and healthy controls. We also observed a trend towards increased frequency of CD3+CD4+LPL in PI-IBS patients. Additionally, PI-IBS patients showed an increased frequency of CD3+CD8+LPL and IEL. The proportion of memory / activated CD45RO+CD4+LPL was higher in PI-IBS patients, and its proportion of the CD8+population was lower compared with the healthy controls. On the contrary the proportion of naive CD45RA+CD4+LPL was lower in PI-IBS patients compared with healthy controls. However, we found no differences in the distribution naı¨ve / activated CD4+ and CD8+IEL between PI-IBS patients and healthy controls.Conclusion: The difference in double positive (DP) CD3+CD8+CD4+LPL seen between PI-IBS patient and healthy controls is consistent with findings of increased number DP T cells in target organs in immuno-inflammatory conditions. Our analysis revealed that the normal gut has a greater variation in the prevalence of CD3+CD4+and CD4+CD45RO+LPL than that of PI-IBS patients. These findings confirm aberrant mucosal subsets of lymphocytes. However, more subjects need to be included in the study in order to draw firm conclusions.
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