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Alterations in the mononuclear cell populations in the blood circulation are among the most characteristic changes after surgical trauma. They reflect changes in the hematopoietic compartment which develop following surgery. The process of mobilization and differentiation of the hematopoietic population is regulated by cytokines known as growth factors for stem and progenitor cells (SCF, IL-1, IL-3, IL-6, IL-1L, TNF, CSFs). Our question was whether operative trauma resulted in the release of the hematopoietic progenitor cells to the blood circulation and an increase in the blood level of cytokines participating in hematopoiesis. The studies were carried out in patients with chronic cholelithiasis, undergoing elective open cholecystectomy under general anesthesia. An increase in the frequency of circulating CD34+ hematopoietic progenitor cells was seen between days 3 and 7 after surgery. Moreover, a significant increase in the percentage of immature cells of myeloid lineage (CD13+, CD14+, CD33+) was seen on the 1st and 3rd postoperative days. This could be the result of an expansion of the total bone marrow cell number after surgery and a subsequent release of these cells into the blood circulation. The changes in blood cell populations were accompanied by an increase in IL-6 on days 1, 3, and 7 following surgery, in IL-6sR on days 10 and 14 and in IL-8 on days 1 and 3. No significant changes in IL-1alpha, IL-1beta, IL-3 and IL-11 were noted. A small rise in GM-CSF was noted in few patients on the 3rd and 7th postoperative days. It is known that IL6 is involved in hematopoiesis, that the IL6-IL-6sR complex may induce both proliferation and differentiation of hematopoietic progenitor cells and that IL8 possesses progenitor cell mobilization properties. The appearance of hematopoietic progenitor cells in the blood following surgery may represent a process for the expansion of the immune cell pool after trauma and maintaining of the reserves at a certain level.

The in vitro interleukin-1 (IL-1) and interleukin-2 (IL-2) production and IL-2 receptor (IL-2-R) expression by peripheral blood mononuclear (PBM) cells were examined in patients undergoing elective cholecystectomy. The IL-1 production by monocytes stimulated with a lipopolysaccharide (LPS) did not change on day +1 but increased by 57.5% on day +3 (p less than 0.05) after surgery, and was normalized on days +5 and +7. The IL-1 production by PBM cells stimulated by LPS increased by 97.6% on day +1 (p less than 0.05) and 109.5% on day +3 (p less than 0.05) after surgery, and became normalized on days +5 and +7. The IL-2 level in PBM cell supernatants stimulated with phytohemagglutinin (PHA) decreased by 45.2% on day +1 (p less than 0.05), 33.3% on day +3 (p less than 0.05), 32.3% on day +5 (p less than 0.05) and returned to the preoperative values on day +7. The IL-2-R expression on PHA-stimulated lymphocytes increased from 60.4 +/- 4.8% preoperatively to 67.2 +/- 1.9% on day +1 (p less than 0.05) but was again within the preoperative values on days +3, +5 and +7. In order to detect the described changes, stimulation with PHA had to be used. This indicates that simple surgical trauma produces subthreshold activation of blood immune cells. The cells enter the 'response alert' stage which can be measured after stimulation with lectins.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of operative trauma on the quantity and proportion of cooperating mononuclear cells in peripheral blood of patients with stage 0 uterine cancer who underwent hysterectomy was studied using monoclonal antibodies. The percentage of OKM1+ cells (monocytes) had increased on day 1 by 12.4%, on day 3 by 24.8%, and had returned to normal by day 7. The percentage of large OKIa1+ cells (expressing Ia antigen) on day 1 was increased by 186.9%, while on day 3 it had returned to a normal level. There was a decrease on day 1 of the number and percentage of OKT3+ cells (all T lymphocytes) by 17.4%, OKT4+ cells (helper/inducer cells) by 27.9%, OKT8+ cells (suppressor/cytotoxic cells) by 24.6%, and small OKIa1+ cells by 49.4%. The number and percentage of T lymphocytes remained below the preoperative level throughout the observation period. However, the number of helper cells had increased significantly on day 5, while suppressor cells remained below the preoperative level during the entire observation period. The rising ratio of OKT4+/OKT8+ cells reflected the kinetics of recovery of the helper over the suppressor cell population.