In ischemic stroke, plasma cytokines and catecholamines were not predictors of neurological outcome at 1 month. In hemorrhagic stroke, high levels of IL-6 in the early phase indicated a poor neurological outcome.
FasL, which is expressed mainly on activated lymphocytes, can induce apoptosis (programmed cell death) of cells which express Fas. Fas/FasL interaction is primarily beneficial in maintaining immunological and physiological homeostasis by eliminating unnecessary cells. Dysregulation of the interaction, however, leads to tissue damage. We investigated how Fas/FasL levels changed after major surgery. The major aim of this study was to elucidate the involvement of the Fas/FasL system in postoperative inflammation. The investigation involved 10 patients admitted to the intensive care unit after surgery. Although the percentage of Fas+ cells and the amount of Fas expression tended to increase, there was no significant difference between pre- and post-operative samples. In contrast, the levels of FasL mRNA were dramatically up-regulated after operation. Post-operative C-reactive protein (CRP) levels increased and correlated well with FasL levels (r=0.91, P<0.01). Lymphocyte counts decreased after operation and were inversely proportional to FasL levels (r=0.58, P < 0.05). These results suggest that the enhanced FasL expression is likely to be related to systemic inflammatory responses induced during the perioperative period. FasL up-regulation may be involved in the aggravation of tissue damage, including lymphocytopenia, in the early post-operative period.
Background:Hyperbilirubinaemia is a common occurrence in patients who are admitted to intensive care units (ICUs) after major surgery, and it is associated with high mortality. We investigated the incidence of hyperbilirubinaemia after two major types of thoracic surgery: open-heart surgery and oesophagectomy. In order to identify the risk factors associated with hyperbilirubinaemia after major surgery, we compared the incidence after open-heart surgery with that after oesophagectomy.Results:Hyperbilirubinaemia was detected in 51% of the open-heart surgery patients (n = 133) and in 64% in the oesophagectomy group (n = 74). The incidence of hyperbilirubinaemia was significantly related to the duration of surgery (P< 0.05). In the open-heart surgery group, duration of surgery was 465 ± 24 min for the patients without hyperbilirubinaemia and 571 ± 26 min for the patients with hyperbilirubinaemia. In the oesophagectomy group, the procedure durations were 415 ± 17 min and 493 ± 20 min, respectively. The overall mortality rate was 8% in the open-heart surgery group; the rate was 12% in those with hyperbilirubinaemia, but 5% in those without hyperbilirubinaemia. No members of the oesophagectomy group died, with or without hyperbilirubinaemia. Infection significantly affected both the occurrence of hyperbilirubinaemia and mortality in the open-heart surgery group. In the subgroups from the open-heart surgery group, 5% (three out of 65) of those without hyperbilirubinaemia (or evidence of infection) died; of the patients with hyperbilirubinaemia, 3% (one out of 38) of those without infection died and 23% (seven out of 30) with detected infection died.Conclusion:After open-heart surgery and oesophagectomy, approximately half of the patients studied had higher levels of serum total bilirubin. Time spent in surgery was significantly related to the occurrence of hyperbilirubinaemia. Infection significantly affected mortality and total bilirubin levels after open-heart surgery. Control of infection plays a crucial role in the prevention of hyperbilirubinaemia and in reducing mortality.
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