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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John Butler Stephen Westaby Graeme M. Rocker Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Butler, J. Articles by Rocker, G. M. Search for Related Content PubMed PubMed Citation Articles by Butler, J. Articles by Rocker, G. M.

J Thorac Cardiovasc Surg 1994;107:1161
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Neutrophil elastase release and cardiopulmonary bypass

Department of Cardiothoracic Surgery
Oxford Heart Centre, John Radcliffe Hospital,
Oxford, United Kingdom^a

Reply to the Editor:

We appreciate the opportunity to reply to the letter from Gupta and associates in response to our recent manuscript. ¹ Several points merit discussion. Baseline levels of plasma elastase in our study are of a similar order of magnitude to other published reports detailed in a recent review, wherein preoperative values ranged from 89 to 490 ng/ml. ² In contrast, Gupta and colleagues quote their unpublished work and use a different assay producing a wider 2SD around a preoperative mean of 20 ng/ml. Direct comparison between two different laboratory techniques is not appropriate and we suspect the difference is indeed related to the method used.

Factorizing elastase levels is a simple but crude way to quantify the degree of neutrophil activation. We suspect that regional tissue injury is more likely to be due to increases in local absolute levels.

We cannot comment on their finding of a peak in plasma elastase at 7 days, but this later rise implicates triggering events beyond and not directly caused by the stimulus of contact with the extracorporeal circuit, or perhaps it reflects factors involved in clearance of the complex from the circulation, which are not understood.

The use of the Apache III score is of interest. The finding of a positive statistical relation between circulating inactive neutrophil elastase (peaking at day 7) and an overall score of morbidity has to be seen in context. In many units patients are discharged home within 7 postoperative days. We question the validity of the use of statistical rather than of biological significance in this setting.

References

1. Butler J, Parker D, Pillai R, Westaby S, Shale DJ, Rocker GM. Effect of cardiopulmonary bypass on systemic release of neutrophil elastase and tumor necrosis factor. J THORAC CARDIOVASC SURG 1993;105:25-30.
   
2. Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993;55:552-9.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John Butler Stephen Westaby Graeme M. Rocker Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Butler, J. Articles by Rocker, G. M. Search for Related Content PubMed PubMed Citation Articles by Butler, J. Articles by Rocker, G. M.