M. I. Halliday

Host immune responses and intestinal permeability in patients with jaundice.

Systemic endotoxaemia is implicated in the development of complications associated with obstructive jaundice. The aims of these studies were to assess the systemic immune response to intervention in patients with jaundice and to compare the effects of surgical and non‐surgical biliary drainage on host immune function and gut barrier function.

The use of tonometry to predict mortality in patients undergoing abdominal aortic aneurysm repair

OBJECTIVE To assess the reliability of intramucosal pH (pHi) of the sigmoid colon, IL-6 concentration and the APACHE II score in predicting outcome in patients undergoing elective abdominal aortic aneurysm repair. DESIGN Prospective study. METHODS In 42 patients, measurements were made of the sigmoid pHi with the silicone tonometer and plasma IL-6 by enzyme linked immuno-sorbent assay (ELISA). The daily postoperative APACHE II scores were also calculated. In 29 patients a preoperative left ventricular ejection fraction was determined by gated radionuclide angiography. RESULTS Four out of 42 patients who were studied died. The lowest perioperative pHi, the peak postoperative IL-6 concentration and APACHE II scores were significantly different in the survivors in comparison to the non-survivors. In the non-survivors, the fall in pHi preceded the time of patients demise by at least 4 days. Significant correlations were observed between changes in pHi, IL-6 and APACHE II. Using receiver operating characteristic curves, pHi was shown to be the most predictive of mortality compared to the other variables. The simplicity, speed and practicality of using the tonometer adds to its superiority over the latter measurements. No relationship was found between ventricular ejection fraction, pHi and outcome. CONCLUSION Although the number of patients is small, these results support pHi as a valuable predictor of outcome and also suggest a role for the gut in initiating the IL-6 and physiological responses.

Circulating Tumour Necrosis Factor in Active Inflammatory Bowel Disease

Enteric bacteria and their products (endotoxins) have attracted attention as luminal antigens that may initiate or contribute to the enterocolitis and associated systemic illness of inflammatory bowel disease (IBD). It has been proposed that endotoxins originating from these intestinal flora cross the disrupted intestinal mucosal barrier of patients with IBD to enter the portal circulation [1]. If the hepatic capacity to eliminate endotoxins is exceeded, spillover into the systemic circulation occurs (Fig. 1). Systemic endotoxaemia has been demonstrated in ulcerative colitis and Crohn’s disease and shown to correlate positively with disease activity [1, 2].