title: Inflammatory response in patients with malignant obstructive jaundice.
abstract: OBJECTIVE
  Surgery in patients with malignant obstructive jaundice is associated with increased risks for postoperative septic complications. The aim of this study was to investigate the inflammatory and the local cellular immune response in patients accepted for surgery because of tumours in the hepatic-pancreatic-biliary (HPB) tract.
  
  
  METHODS
  Patients with obstructive jaundice (group HPB(+)) were compared with those without (HPB(-)). Patients undergoing surgery for benign abdominal disorders served as controls. Obstructive jaundice was present in 18 out of 33 HPB patients. Preoperatively, blood was analysed for bacteria, endotoxins and cytokines (TNF-alpha, IL-6 and IL-10). At operation, mesenteric lymph nodes (MLNs) were excised for bacterial cultures using standard microbiological techniques, and immunohistochemistry, using antibodies CD4 and CD8 (mainly staining T lymphocytes), CD68 (macrophages), and anti-caspase-3 (to determine the rate of apoptosis).
  
  
  RESULTS
  Bacterial translocation was not demonstrated in any of the patients. Increased preoperative concentrations of endotoxins were found in group HPB(+). The number of macrophages and the rate of apoptosis in MLNs were increased in jaundiced patients, while the number of T lymphocytes was decreased.
  
  
  CONCLUSIONS
  Malignant obstructive jaundice causes increased blood concentrations of endotoxins and cytokines, an increased number of macrophages in MLNs, a higher rate of apoptosis in MLNs, but a decreased number of T lymphocytes in MLNs. The lymphocyte depletion is probably due to the increased rate of apoptosis, and might reduce the ability of jaundiced patients to eradicate infection.
authors.affiliation: Department of Surgery, University Hospital, Uppsala, Sweden. mikael.ljungdahl@akademiska.se
authors.forename: Mikael
authors.initials: M
authors.lastname: Ljungdahl
authors.forename: Johanna
authors.initials: J
authors.lastname: Osterberg
authors.forename: Ulrika
authors.initials: U
authors.lastname: Ransjö
authors.forename: Lars
authors.initials: L
authors.lastname: Engstrand
authors.forename: Ulf
authors.initials: U
authors.lastname: Haglund
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D001419:Bacteria / Q000302:isolation & purification; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes; D016207:Cytokines / Q000097:blood; D004067:Digestive System Neoplasms / Q000150:complications*; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D041781:Jaundice, Obstructive / Q000209:etiology / Q000276:immunology* / Q000382:microbiology / Q000473:pathology; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D013601:T-Lymphocytes / Q000473:pathology
chemical_list: D016207:Cytokines; D004731:Endotoxins