Relations among circulating monocytes, dendritic cells, and bacterial translocation in patients with intestinal obstruction.
BACKGROUND
Little evidence is available regarding the relations among circulating monocytes, dendritic cells (DCs), and bacterial translocation (BT) in patients with intestinal obstruction.


METHODS
We investigated alterations in DCs in mesenteric lymph nodes (MLNs), circulating immune cells (white blood cell, lymphocyte, and monocyte counts), and BT to MLNs in 21 patients undergoing abdominal surgery because of intestinal obstruction. We also examined whether BT correlated with the development of perioperative systemic inflammatory response syndrome (SIRS) and postoperative septic complications.


RESULTS
BT subsequent to intestinal obstruction was observed in 7 (33%) patients. Preoperative circulating immune cell counts were significantly lower in BT-positive patients than those in BT-negative patients. The presence of preoperative SIRS was also significantly related to BT-positive status. A preoperative monocyte count <290/mm(3) was the best predictive factor for BT in MLNs during intestinal obstruction: sensitivity 85.7%; specificity 92.3%; positive and negative predictive values 85.7% and 92.9%, respectively. The area under the receiver operating characteristic curve was 0.944. The expression of S-100 protein-positive DCs in MLNs significantly increased in BT-positive patients.


CONCLUSIONS
A significant inverse correlation was observed between the circulating monocyte count and the ratio of DCs among all cells in MLNs (r(2)= 0.259). Postoperative septic complications were 3.3 times more common in BT-positive patients than in BT-negative patients. A significant increase in the expression of DCs in MLNs was observed in patients with BT subsequent to intestinal obstruction. Our findings suggested that a low monocyte count (<290 /mm(3)) and the presence of preoperative SIRS might be useful factors for predicting BT in patients with intestinal obstruction.
Shiomi
Hisanori
H
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
Shimizu
Tomoharu
T
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan. tomoharu@belle.shiga-med.ac.jp.
Endo
Yoshihiro
Y
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
Murata
Satoshi
S
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
Kurumi
Yoshimasa
Y
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
Uji
Yoshitaka
Y
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
Tani
Tohru
T
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
D000368:Aged; D000465:Algorithms; D018988:Bacterial Translocation; D015169:Colony Count, Microbial; D003713:Dendritic Cells / Q000166:cytology*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D008198:Lymph Nodes / Q000382:microbiology; D018655:Lymphocyte Count; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000382:microbiology*