lewis-x-antigen and Sepsis

The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.. Neutrophilic granulocytes (NG) were enumerated histopathologically in 147 periprosthetic membranes obtained from aseptic and septic revision surgery, using periodic acid-Schiff (PAS) stains and CD15 immunohistochemistry. Cell numbers were correlated with the results of microbiological culture and the clinical diagnoses. Using receiver-operating characteristics, an optimized threshold was found at 23 NG in 10 high-power fields (HPF). Using this threshold, histopathological examination had a sensitivity of 73% and specificity of 95% when compared with microbiological diagnosis (area under the curve 0.881), and a sensitivity of 77% and specificity of 97% when compared with clinical diagnosis (area under the curve 0.891).. We therefore recommend a counting algorithm with a threshold of > or =23 NG in 10 HPF (visual field diameter 0.625 mm) for the histopathological diagnosis of septic endoprosthesis loosening. If the enumeration of NG is difficult in conventional haematoxylin and eosin-stained slides, CD15 immunohistochemistry should be performed, whereas the PAS stain has not proven to be helpful.

Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cell Count; Diagnosis, Differential; Female; Hip Prosthesis; Humans; Immunohistochemistry; Knee Prosthesis; Lewis X Antigen; Male; Middle Aged; Neutrophils; Prosthesis Failure; Prosthesis-Related Infections; Reoperation; Sepsis; Staining and Labeling

In vivo determination of protein synthesis in immune cells reflects metabolic activity and immunological activation. An intravenous injection of endotoxin to healthy volunteers was used as a human sepsis model, and in vivo protein synthesis of T lymphocytes and leucocytes was measured. The results were related to plasma concentrations of selected cytokines, peripheral cell counts and subpopulations of immune cells. The subjects (n = 8 + 8) were randomized to an endotoxin (4 ng/kg) or a saline group. In vivo protein synthesis was determined twice: before and 1-2.5 h after the endotoxin/saline injection. Protein synthesis decreased in isolated T lymphocytes, but increased in leucocytes. Plasma levels of TNF-alpha, IL-8, IL-6, IL-1 ra and IL-10 were elevated, whereas IL-2 and IFN-gamma, produced predominantly by T lymphocytes, did not change in response to endotoxin. Neutrophils increased, whereas lymphocytes and monocytes decreased 2.5 h after the endotoxin injection. Flow cytometry revealed a drop in total CD3+ T lymphocytes and CD56+ natural killer cells, accompanied by an increase in CD15+ granulocytes. In summary, in vivo protein synthesis decreased in T lymphocytes, while the total leucocyte population showed a concomitant increase immediately after the endotoxin challenge. The changes in protein synthesis were accompanied by alterations in immune cell subpopulations and in plasma cytokine levels.

Topics: Adult; CD3 Complex; CD56 Antigen; Cytokines; Endotoxins; Humans; Killer Cells, Natural; Leukocyte Count; Leukocytes; Lewis X Antigen; Male; Neutrophils; Protein Biosynthesis; Sepsis; T-Lymphocytes

1. Total parenteral nutrition is associated with a high incidence of septic complications. This may be partly due to neutrophil dysfunction induced by the parenteral nutrition. 2. Neutrophil adhesion molecule expression and the expression of CD11b in response to stimulation with formylmethionyl-leucyl-phenylalanine and lipopolysaccharide were determined before and after 24 h of lipid-containing parenteral nutrition. Eighteen adult patients referred for parenteral nutrition were studied. 3. There was no change in the expression of neutrophil L-selectin (CD62L), CD11a, CD11b, CD11c or CD15. Neutrophil response to stimulation with formylmethionyl-leucyl-phenylalanine and lipopolysaccharide as determined by CD11b expression was unaffected by parenteral nutrition. 4. This study has shown no evidence of parenteral nutrition-induced neutrophil dysfunction.

Topics: Adult; Aged; Aged, 80 and over; Cell Adhesion Molecules; Female; Flow Cytometry; Humans; Integrin alphaXbeta2; L-Selectin; Lewis X Antigen; Lipids; Lipopolysaccharides; Lymphocyte Function-Associated Antigen-1; Macrophage-1 Antigen; Male; Middle Aged; N-Formylmethionine Leucyl-Phenylalanine; Neutrophils; Parenteral Nutrition, Total; Sepsis; Stimulation, Chemical