Alcohol, injury, and cellular immunity.

A sequential, prospective analysis of humoral and cellular immune function was performed on 20 burn patients with injuries involving >/=45% total body surface area. Infected patients had significantly worse neutrophil bactericidal activity against Staphylococcus aureus 502A than did noninfected patients. Chemotaxis of neutrophils correlated poorly with infection although chemotaxis was frequently abnormal. The opsonic index of serum was depressed early after the burn but returned to nearly normal values by the fourth to the fourteenth postburn day. There was no difference between infected and noninfected patients. Serum levels of IgG, properdin and C3, while initially low, remained within the normal range after the ninth postburn day in both groups. Factor B levels rose rapidly during the first three weeks after injury to more than double normal levels in many patients. Suggestive evidence for consumption of opsonic protein occurred with five of 19 episodes of bacteremia. The responsiveness of isolated lymphocytes to PHA was normal. However, patients' sera were shown to significantly inhibit the responsiveness of normal lymphocytes to PHA. Analysis of immunologic profiles for individual patients indicates that abnormalities of neutrophil function are the most important acquired defect predisposing patients to the development of bacteremia following major thermal injury; abnormalities of opsonic action play a secondary but important role.

A Sequential, Prospective Analysis of Immunologic Abnormalities and Infection Following Severe Thermal Injury

Post-traumatic immunosuppression is due to activation of suppressor t cells

The serum from 109 traumatized patients was examined for immunosuppressive activity which might explain diminished host immune responsiveness following operative or accidental injury. Twenty-eight fo 31 (90%) severely tralmatized patients, 25 of 60 (42%) moderately traumatized patients, and 0 of 18 minimally traumatized patients developed serum which suppressed the response of normal human lymphocytes to phytohemagglutinin. The degree and duration of serum immunosuppressive activity paralleled the severity of the clinical course but did not correlate with serum cortisol or barbiturate levels. Suppressive sera were not cytotoxic. The immunosuppressive factor(s) was contained in a low molecular weight (less than 10,000 daltons) peptide fraction and was present in 5--10 times the amount recoverable from normal serum. By size and activity the trauma serum factor resembled immunoregulatory alpha globulin, a naturally-occurring serum inhibitor of T-lymphocyte reactions. Thus, depressed immunoreactivity following trauma may be due in part to high concentrations of an endogenous immunosuppressive polypeptide.

Association of a circulating immunosuppressive polypeptide with operative and accidental trauma.

It is becoming increasingly important for anaesthetists to acquaint themselves with the immunological implications of anaesthetic practice. Not only do occasional patients suffer immunologically-mediated adverse reactions to anaesthetic drugs, but all patients may have reduced resistance to infection and malignancy as a result of exposure to anaesthesia and surgery. In addition, it is possible that the immunological consequences of occupational exposure to traces of anaesthetic gases may predispose operating room personnel to malignant disease. It is intended, in this paper, to review these three aspects of anaesthesia, surgery and immunology, but before doing so, it seems apposite to summarise briefly relevant immunological concepts. Those interested in a more detailed revision of basic immunology are referred to the excellent short texts available.1r2

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1978.tb12415.x

Anaesthesia, surgery and immunology.

Cell-mediated immunity after thermal injury.

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Cell-mediated immunity after thermal injury.