title: Surgical stress reduces mortality from endotoxin shock.
abstract: OBJECTIVE
  Surgical stress has been considered a preliminary to multiple organ failure through what has been termed a "two-hit" mechanism. Recent evidence, however, suggests that such stress has a beneficial influence in reducing endotoxin [lipopolysaccharide (LPS)]-mediated lethality. This study has been an effort to clarify whether and how LPS-mediated septic shock is prevented by a previous insult with mild (laparotomy) or severe (hepatectomy) surgical stress.
  
  
  METHODS
  LPS was injected intraperitoneally into mice after two-thirds hepatectomy or laparotomy only. Survival rates, and protein and messenger RNA (mRNA) levels for tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured.
  
  
  RESULTS
  Most of the unoperated control mice died within 3 days after the LPS challenge. Mortality following LPS injection was reduced after laparotomy only or hepatectomy (P<0.05). A significant reduction in the mortality was observed from 2 days to 7 days after laparotomy only, and from 2 days to 4 weeks after hepatectomy. Correspondingly, the increase in the serum levels of TNF-alpha and IL-6 induced by the LPS injection was partially impaired by either laparotomy only or hepatectomy at an early (2 days) postoperative stage (P<0.05). At a later (7 days) stage, however, the serum level of IL-6 and its mRNA level in the spleen were elevated after the LPS challenge more quickly in the hepatectomy group than in the unoperated control group ( P<0.05).
  
  
  CONCLUSIONS
  Surgical stress reduces LPS-induced lethality through biphasically regulating the levels of TNF-alpha and IL-6 production.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
authors.forename: Keitarou
authors.initials: K
authors.lastname: Kamei
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Keiya
authors.initials: K
authors.lastname: Aono
authors.forename: Izumi
authors.initials: I
authors.lastname: Nakashima
mesh_terms: D000199:Actins / Q000097:blood; D000818:Animals; D004195:Disease Models, Animal; D006498:Hepatectomy / Q000009:adverse effects*; D015850:Interleukin-6 / Q000097:blood; D007813:Laparotomy / Q000009:adverse effects*; D008070:Lipopolysaccharides / Q000009:adverse effects; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D012772:Shock, Septic / Q000139:chemically induced / Q000378:metabolism* / Q000401:mortality*; D013312:Stress, Physiological / Q000209:etiology* / Q000378:metabolism*; D015996:Survival Rate; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D000199:Actins; D015850:Interleukin-6; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha