title: The effect of laparoscopy on the IGF system in patients diagnosed with acute cholecystitis.
abstract: OBJECTIVE
  IGFs and IGF binding proteins in the circulation are subject to modulation by a number of catabolic states including inflammation, trauma and surgery. We sought to determine the impact of laparoscopy on the IGF system in patients diagnosed with acute cholecystitis.
  
  
  METHODS
  The components of the IGF system, cortisol, glucose and insulin concentration in both the serum and urine of patients were compared to those from a healthy group of subjects. An additional comparison was made between pre- and post-laparoscopically assisted patients.
  
  
  METHODS
  Thirty patients diagnosed with acute cholecystitis and 81 matched controls were included in the study.
  
  
  METHODS
  Radioimmunoassays were used to determine the IGF-I, IGF-II, insulin and cortisol concentrations. The concentration of IGFBP-3 was measured using an immunoradiometric assay. The GOD-PAP method was used to determine the glucose concentration. Gel filtration chromatography was performed to calculate the IGF binary/ternary complex ratio. The amount of sialic acid in IGFBP-3 was determined by affinity chromatography. The presence of IGFBPs in serum was determined by both immunoblotting and ligandblotting.
  
  
  RESULTS
  The concentrations of circulating IGF-I, IGF-II and IGFBP-3 were significantly reduced in pre-operative patients compared to healthy subjects. No further reductions were observed post-laparoscopy. Immunoblotting and ligandblotting demonstrated a decreased amount of IGFBP-3 in both pre- and post-operative patients compared to healthy subjects. Increased levels of IGFBP-2 and IGFBP-1 were observed in pre-operative patients compared to healthy subjects, but laparoscopy did not cause further elevation. No alteration in the IGF binary/ternary complex ratio was witnessed between any of the study groups. A significant increase in the sialic acid content of IGFBP-3 was seen in both patient groups when compared to healthy subjects. The level of urinary cortisol was significantly increased in post-operative patients, whereas the urinary IGF-I concentration was decreased compared to healthy subjects.
  
  
  CONCLUSIONS
  Our results indicate that acute cholecystitis causes several significant changes in the circulating IGF system. Laparoscopy, however, does not aggravate such changes, but elevates urinary cortisol.
authors.affiliation: Institute for the Application of Nuclear Energy-INEP, University of Belgrade, Belgrade, Serbia. ivona@inep.co.yu
authors.forename: Ivona
authors.initials: I
authors.lastname: Baricević
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.forename: Vesna
authors.initials: V
authors.lastname: Malenković
authors.forename: Olgica
authors.initials: O
authors.lastname: Nedić
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D041881:Cholecystitis, Acute / Q000097:blood* / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D007328:Insulin / Q000097:blood; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood* / Q000652:urine; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007335:Insulin-Like Growth Factor II / Q000032:analysis; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013002:Somatomedins / Q000032:analysis*; D018709:Statistics, Nonparametric
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006854:Hydrocortisone; D007328:Insulin; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II; D013002:Somatomedins