The phagocytic and metabolic functions of the reticuloendothelial system (RES) were tested in seven patients with advanced cirrhosis of the liver due to excessive ingestion of ethanol. 125I-labelled microaggregated human serum albumin was used as a test substance. A group of 13 volunteers served as controls. Liver and spleen scans were performed in all patients. Routine blood analyses were made, including seven different liver tests. The results show that both the phagocytic and the metabolic activity of the RES were hampered significantly in all these patients compared with the control group. The liver and spleen scan findings were all pathological, showing a good correlation with the RES function test. The blood test that correlated best with the RES function test was the prothrombin time, which was likewise abnormal in all patients. It is concluded that certain functions of the RES are hampered after prolonged ethanol ingestion and that the enhanced frequency of infections in patients with alcohol liver cirrhosis might partly be due to their impaired RES function.
Total parenteral nutrition (TPN) has been associated with an increased incidence of infection. To assess the hypothesis that TPN, and in particular one of its constituents, the rat emulsion Intralipid, might impair host defense, we investigated in vitro migration, bactericidal functions, and chemiluminescence of the neutrophil granulocyte in four patients with Crohn's disease, given TPN for up to 12 wk. No abnormal values were found during TPN, but both before and after, impaired migration was noted. Further, 10 volunteers were given 10% Intralipid (85 ml/h), and in blood samples obtained 2 h after discontinuation of the infusion, enhancements were recorded for migration stimulated with serum and the maximal chemiluminescence response (p less than 0.05, respectively). Thus, neither during TPN nor infusions of Intralipid were impairments of neutrophil migration or bactericidal functions noted, and it is suggested that other factors than effects on neutrophils must be sought to explain susceptibility to infection during TPN.
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