Chirurgische Maßnahmen zur Elimination von Endotoxin

  • D. Berger
Part of the Klinische Anästhesiologie und Intensivtherapie book series (KAI, volume 45)

Zusammenfassung

Die diffuse eitrige Bauchfellentzündung, in ihrer systemischen Auswirkung als abdominelle Sepsis klinisch bekannt, stellt noch heute eine Erkrankung mit sehr ungünstiger Prognose dar. Trotz entscheidender chirurgischer und intensivmedizinischer Fortschritte beträgt die Sterblichkeit noch 20–40% (Goegler u. Meckes 1989).

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Literatur

  1. Berger D, Beger HG (1991 a) Neue Aspekte zur Pathogenese und Behandlung der Sepsis und des septischen Schocks. Chirurg 62: 783–788Google Scholar
  2. Berger D, Beger HG (1991 b) Interaction of endotoxin and endotoxin-binding proteins. Postgrad Surg 3: 174–181Google Scholar
  3. Berger D, Beger HG (1992) Pathophysiologische Grundlagen der Peritonitistherapie. Chirurg 63: 147–152PubMedGoogle Scholar
  4. Berger D, Kitterer WR Beger HG (1990 a) Are the serum levels of endotoxin-binding proteins reliable predictors of complications in the course of peritonitis? Eur J Clin Invest 20: 66–71CrossRefGoogle Scholar
  5. Berger D, Schleich S Seidelmann M Beger H (1990 b) Correlation between endotoxin-neu-tralizing capacity of human plasma as tested by the limulus-amebocyte-lysate-test and plasma protein levels. FEBS 277: 33–36CrossRefGoogle Scholar
  6. Berger D, Schleich S, Seidelmann M, Beger HG (1991) Demonstration of an interaction between transferring and lipopolysaccharide — an in vitro study. Eur Surg Res 23: 309–316PubMedCrossRefGoogle Scholar
  7. Berger D, Schmidt UM, Seidelmann M, Beger HG (1993) Incidence and pathophysiological relevance of postoperative endotoxemia. J Invest Surg (in press)Google Scholar
  8. Broome A, Hansson L, Lundgren F, Smedberg S (1983) Open treatment of abdominal septic catastrophies. World J Surg 7: 792–796PubMedCrossRefGoogle Scholar
  9. Cuevas P, Fine J (1972) Role of intestinal endotoxin in death from peritonitis. Surg Gynecol Obstet 134: 953–957PubMedGoogle Scholar
  10. Deitch EA, Berg D (1987) Endotoxin but not malnutrition promotes bacterial translocation of the gut flora in burned mice. J Trauma 27: 161–166PubMedCrossRefGoogle Scholar
  11. Deitch EA, Winterton J, Li M, Berg R (1987) The gut as a portal of entry for bacteremia. Role of protein malnutrition. Ann Surg 205: 681–692Google Scholar
  12. Deitch EA, Ma WJ, Ma L, Berg RD, Specian RD (1989) Endotoxin-induced bacterial translocation: a study of mechanisms. Surgery 106: 292–299PubMedGoogle Scholar
  13. Deitch EA, Specian RD, Berg RD (1991) Endotoxin-induced bacterial translocation and mucosal permeability: role of xanthine oxidase, complement activation, and macrophage products. Crit Care Med 19: 785–791PubMedCrossRefGoogle Scholar
  14. Dominioni L, Dionigi R, Zanello M, Chiaranda M, Acquarolo A, Ballabio A, Sguotti C (1991) Effects of high-dose IgG on survival of surgical patients with sepsis scores of 20 or greater. Arch Surg 126: 236–240PubMedGoogle Scholar
  15. Dumont AE, Maas WK, Iliescu H, Shin RD (1986) Increased survival from peritonitis after blockade of transdiaphragmatic absorption of bacteria. Surg Gynecol Obstet 162: 248–252PubMedGoogle Scholar
  16. Edmiston CE, Goheen MP, Kornhall S, Jones FE, Condon RE (1990) Fecal peritonitis: microbial adherence to serosal mesothelium and resistance to peritoneal lavage. World J Surg 14: 176–183PubMedCrossRefGoogle Scholar
  17. Farthmann EH, Schöffel U (1990) Principles and limitations of operative management of intraabdominal infections. World J Surg 14: 210–217PubMedCrossRefGoogle Scholar
  18. Flegel WA, WOlpl A, Männel DM, Northoff H (1989) Inhibition of endotoxin-induced activation of human monocytes by human lipoproteins. Infect Immung 57: 2237–2245Google Scholar
  19. Goegler H, Meckes P (1989) Peritonitis, septischer Schock and Endotoxin — eine tierexperimentelle Studie. ( Peritonitis, septic shock and endotoxin — an animal experiment study ). Z Exp Chir Transplant Kunstfiche Organe 22: 159–167Google Scholar
  20. Kleine HO, Beger HG (1988) Endotoxinelimination durch intra-and postoperative Lavage bei diffuser bakterieller Peritonitis. Langenbecks Arch Chir [Suppl] 2: 654–656Google Scholar
  21. Kleine HO, Friedrich J, Oeschger R (1990) Das chirurgische Vorgehen bei bakterieller Peritonitis — Steigerung der Therapieeffizienz durch intraoperative Lavage and durch konti nuierliche geschlossene postoperative Peritoneallavage. Chir Gastroenterol 6: 147–155Google Scholar
  22. Leiboff AR, Soroff HS (1987) The treatment of generalized peritonitis by closed postoperative peritoneal lavage. A critical review of the literature. Arch Surg 122: 1005–1010Google Scholar
  23. McCabe WR, DeMaria A, Berberich H, Johns MA (1988) Immunization with rough mutants of Salmonella minnesota. Protective activity of IgM and IgG antibody to the R595 ( Re chemotype) mutant. J Invest Dis 158: 291–300Google Scholar
  24. Pearson FC, Dubczak J, Weary M, Bruszer G, Donohue G (1985) Detection of endotoxin in the plasma of patients with gramnegative bacterial sepsis by the Limulus amoebocyte lysate assay. J Clin Microbiol 21: 865–868PubMedGoogle Scholar
  25. Polk HC, Fry DE (1980) Radical peritoneal debridement for established peritonitis. The results of a prospective randomized clinical trial. Ann Surg 192: 350–355Google Scholar
  26. Rietschel ET Brade L, Schade U et al. (1990) Bacterial lipopolysaccharides: relationship of structure and conformation to endotoxic activity, serological specificity, and biological function. Adv Exp Med Biol 256: 81–99PubMedGoogle Scholar
  27. Rush BF jr, Sori AJ, Murphy TF, Smith S, Flanagan JJ jr, Machiedo GW (1988) Endotoxemia and bacteremia during hemorrhagic shock. The link between trauma and sepsis? Ann Surg 207: 549–554PubMedCrossRefGoogle Scholar
  28. Schedel I, Dreikhausen U, Nentwig B, Höckenschnieder M, Rauthmann D, Balikcioglu S, Coldewey R, Deicher H (1991) Treatment of Gramnegative septic shock with an immunoglobulin preparation: a prospective, randomized clinical trial. Crit Care Med 19: 1104–1113PubMedCrossRefGoogle Scholar
  29. Schottmüller H (1914) Wesen and Behandlung der Sepsis. Verh Dtsch Ges Inn Med 31: 257–280Google Scholar
  30. Steinberg D (1979) On leaving the peritoneal cavity open in acute generalized suppurative peritonitis. Am J Surg 137: 216–220PubMedCrossRefGoogle Scholar
  31. Teichmann W, Wittmann DH, Andreone PA (1986) Scheduled reoperations ( Etappenlavage) for diffuse peritonitis. Arch Surg 121: 147–152Google Scholar
  32. Teng NNH, Kaplan HS, Hebert JM, Moore C, Douglas H, Wunderlich A, Braude I (1985) Protection against gram-negative bacteremia and endotoxemia with human monoclonal IgM antibodies. Proc Natl Acad Sci 82: 1790–1794PubMedCrossRefGoogle Scholar
  33. Tokyay R,. Zeigler ST, Heggers JP, Loick HM, Traber DL, Herndon DN (1991) Effects of anesthesia, surgery, fluid resuscitation, and endotoxin administration on postburn bacterial translocation. J Trauma 31: 1376–1379CrossRefGoogle Scholar
  34. Winchurch RA, Thupari JN, Munster AM (1987) Endotoxemia in burn patients: levels of circulating endotoxins are related to burn size. Surgery 102: 808–812PubMedGoogle Scholar
  35. Ziegler EJ, Fisher CJ jr, Sprung CL et al. (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibodiy against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group [see comments]. N Engl J Med 324: 429–436PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1993

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  • D. Berger

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