[Functions of circulating and intra-abdominal polymorphonuclear leukocytes during human secondary peritonitis].
BACKGROUND
Aim of the study was to characterize different functions of circulating and emigrated, intra-abdominal polymorphonuclear leukocytes (cPMNs, ePMNs) during human secondary peritonitis.


METHODS
In patients (n=25) with diffuse secondary peritonitis circulating and emigrated PMNs were characterized intra- and until 96 h postoperatively. Patients were allocated to two different groups, e. g. patients with septic complications (shock, organ failure, n=11) and patients without complications (n=14) during peritonitis. In addition a control group of patients (n=10) with abdominal surgery but without peritonitis was investigated. The lucigenin- and luminol-enhanced chemiluminescence was used to determine extra- and intracellular oxygen radical generation of PMNs. Besides spontaneous oxygen radical generation of PMNs, stimulated radical production was investigated after the addition of ionophores A23 187 and C3-coated zymosan. Phagocytosis by PMNs was characterized with opsonized E. coli bacteria and fluorescence-activated cell analysis.


RESULTS
Especially patients with complicated peritonitis had strong and long-lasting changes of PMNs functions. The toxic and tissue-destroying production of extracellular oxygen radicals by circulating PMNs was enhanced (e. g., A23 187 - stimulated oxygen radical generation 433 +/- 89 cpm/cPMNs (peritonitis with complications) versus 90 +/- 30 cpm/cPMNs (peritonitis without complications) versus 110 +/- 44 cpm/cPMNs (controls), p < 0.05). Phagocytosis (58 +/- 9 % (ePMNs, peritonitis with complications) versus 81 +/- 6 % (ePMNs, peritonitis without complications) versus 82.2 +/- 1.6 % (ePMNs, controls), p < 0.05) and phagocytosis-associated intracellular oxygen radical generation (8.23 +/- 1.6 x 10(3) cpm/ePMNs (peritonitis with complications) versus 25.2 +/- 5.2 x 10(3) cpm/ePMNs (peritonitis without complications) versus 11.7 +/- 2.8 cpm x 10(3) cpm/ePMNs (controls) p < 0.05) were suppressed.


CONCLUSIONS
Not for all patients with peritonitis does it seem favourable to modulate PMNs-functions. If immunomodulation would be able to down-regulate exaggerated functions of circulating PMNs and to up-regulate the suppressed functions of emigrated PMNs patients with complicated peritonitis might benefit from this therapy.
Holzer
K
K
Klinik für Allgemein- und Gefässchirurgie, Universitä tsklinik Frankfurt/Main.
Richter
A
A
Konietzny
P
P
Schübel
F
F
Wilhelm
K
K
Henrich
D
D
D003082:Colectomy; D005609:Free Radicals; D005743:Gastrectomy; D006801:Humans; D016209:Interleukin-8 / Q000378:metabolism; D008163:Luminescent Measurements; D009102:Multiple Organ Failure / Q000276:immunology; D009504:Neutrophils / Q000276:immunology*; D010537:Peritoneum / Q000276:immunology; D010538:Peritonitis / Q000276:immunology*; D011183:Postoperative Complications / Q000276:immunology*; D011379:Prognosis; D017382:Reactive Oxygen Species / Q000378:metabolism; D012772:Shock, Septic / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D005609:Free Radicals; D016209:Interleukin-8; D017382:Reactive Oxygen Species; D014409:Tumor Necrosis Factor-alpha
Untersuchungen zu Funktionen zirkulierender und intraabdominaler polymorphkerniger Leukozyten bei Patienten mit sekundärer Peritonitis.