Elevated expression of inducible nitric oxide synthase and inflammatory cytokines in the alveolar macrophages after esophagectomy.
OBJECTIVE
To evaluate the role of inducible nitric oxide (NO) synthase (iNOS) and inflammatory cytokines in alveolar macrophages (AMs) after esophagectomy in the pathogenesis of acute lung injury.


METHODS
Prospective, exploratory, open-labeled clinical study.


METHODS
Intensive care unit and operating room in a university hospital.


METHODS
Thirteen patients receiving esophagectomy with carcinoma of the esophagus (postesophagectomy group), ten patients just before the surgery (preoperation group), and seven patents receiving surgery less invasive than esophagectomy (other surgery group) were selected.


METHODS
Bronchoalveolar lavage fluid (BALF) and blood samples were obtained from study groups.


RESULTS
The AMs in the BALF collected from each group were stained immunohistochemically with antibodies against iNOS, interleukin (IL)-6, and IL-8. The intensities of these expressions were determined by semiquantitative cytofluorometric system. NOx (NO2- + NO3-), IL-6, and IL-8 levels in the BALF and plasma were measured concurrently. The expressional intensities of iNOS, IL-6, and IL-8 in AMs obtained from the postesophagectomy group were maximal 24 hrs after the skin incision and significantly more evident than those from other groups. The IL-6, IL-8, and NOx levels in BALF and IL-6 and IL-8 levels in plasma in the postesophagectomy patients were also elevated. The intensities of iNOS and inflammatory cytokines expressions in AMs were closely related to postoperative respiratory failure.


CONCLUSIONS
The activation of topical alveolar macrophages may be involved in the pathogenesis of pulmonary complications in the postoperative period after esophagectomy.
Kooguchi
Kunihiko
K
Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Japan.
Kobayashi
Atsuko
A
Kitamura
Yoshihiro
Y
Ueno
Hiroshi
H
Urata
Yoji
Y
Onodera
Hideki
H
Hashimoto
Satoru
S
D000368:Aged; D001992:Bronchoalveolar Lavage Fluid; D004797:Enzyme-Linked Immunosorbent Assay; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015850:Interleukin-6 / Q000032:analysis* / Q000097:blood; D016209:Interleukin-8 / Q000032:analysis* / Q000097:blood; D016676:Macrophages, Alveolar / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis; D019001:Nitric Oxide Synthase / Q000032:analysis / Q000502:physiology*; D052247:Nitric Oxide Synthase Type II; D009609:Nitrous Oxide / Q000032:analysis; D011446:Prospective Studies
D015850:Interleukin-6; D016209:Interleukin-8; D009569:Nitric Oxide; C496319:NOS2 protein, human; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II; D009609:Nitrous Oxide