Granulocytosis induced by increasing sympathetic nerve activity contributes to the incidence of acute appendicitis

Since the incidence of acute appendicitis seems to vary with weather, we investigated the underlying mechanism. When 112 patients who had undergone appendectomy were classified into three groups according to atmospheric pressure at the time of onset, gangrenous cases (high infiltration of granulocytes) were much greater in frequency than catarrhal cases (no infiltration of granulocytes) at high pressure, At low pressure, the situation was the reverse. The variation of granulocytes and lymphocytes in the blood as related to atmospheric pressure and heart rate was examined in healthy donors. Granulocytosis was seen with increased sympathetic activity (high heart rate) at high pressure, whereas lymphocytosis was seen with increased parasympathetic activity (low heart rate) at low pressure. Taken together with the results from patients, in which gangrenous cases showed granulocytosis in the blood as well as in the appendix while catarrhal cases showed lymphocytosis in the blood and appendix, it is presumed that granulocytosis induced by increased sympathetic activity might be related to the onset of gangrenous appendicitis. Experimental results using human and mouse materials indicated that catecholamines induce granulocytosis via their adrenergic receptors. Even in gangrenous cases, bacteria were not detected in the vicinity of granulocytes in the appendix by electron microscopy. The present results seem to shed important light on the etiology of suppurative diseases.