J. N. Thompson

Peritoneal fibrinolytic activity and intra-abdominal adhesions

The mechanisms leading to reduction of peritoneal fibrinolytic activity in conditions that are associated with the formation of intra-abdominal adhesions were studied. Tissue plasminogen activator was found, by antibody inhibition techniques, to be the activator of fibrinolysis in homogenates of control peritoneum (n = 6). Homogenates of control (n = 10) and inflamed peritoneum (n = 10) were analysed. Plasminogen activating activity was much lower in inflamed peritoneum (median 0.07 IU/cm2) than in control tissue (median 12.0 IU/cm2) (p less than 0.001). Levels of tissue plasminogen activator and alpha 2-antiplasmin were similar in both control and inflamed tissue. Plasminogen activator inhibitor-1, not detectable in control peritoneum, was present in inflamed tissue and might be the reason for the reduction in functional fibrinolytic activity.

The Peritoneal Cytokine Profile in Acute Peritonitis

Cytokines are polypeptides produced mainly by activated leukocytes in response to infection and injury, including surgical trauma. Within the peritoneal cavity they are produced by resident mononuclear phagocytes [1] and mesothelial cells [2]. Peritoneal cytokines mediate the local inflammatory changes that occur after surgery and are also partly responsible for the immunological and systemic acute phase responses to surgery [3].

Cytokine Response to Elective Surgery: A Possible Mechanism for Intraperitoneal Adhesion Pathogenesis

Cytokines are biologically active mediators of the immune and acute phase responses to inflammation [1]. The main actions of cytokines occur locally and influence a number of processes, including wound healing, debridement of dead tissues and control of infection, all of which may lead to subsequent scarring and adhesion formation. In addition, the local production of cytokines probably contributes to the systemic disturbance observed following surgery [2]. Within the peritoneal cavity, they are produced by mononuclear phagocytes [3] and mesothelial cells [4]. Previous studies have measured cytokines in peritoneal fluid and plasma following surgery [5–8], but the correlation of systemic with intraperitoneal cytokine concentrations has been poorly documented. The aim of this study was to investigate the intraperitoneal and systemic cytokine responses in patients undergoing elective laparotomy. The results of this study have been reported in brief elsewhere [7].