Efficacy of an extracorporeal endotoxin adsorber system during hyperdynamic porcine endotoxemia.

BACKGROUND: Endotoxemia is a crucial factor in the pathogenesis of sepsis. Elimination of endotoxin is aimed at the reduction of sepsis-related morbidity and lethality. The objective of this study was to examine the impact of an endotoxin adsorber on hemodynamics, O(2) exchange and metabolism during resuscitated porcine endotoxemia. METHODS: Twenty pigs were randomized into 2 intervention groups (n = 7 each) and 1 control group (n = 6). Endotoxemia was induced by continuous intravenous application of lipopolysaccharide for 8 h. Adsorber therapy was started at the same time as the induction of endotoxemia or 2 h later. An extracorporeal hemoperfusion device using immobilized human serum albumin for endotoxin adsorption was used. RESULTS: Hemodynamic, metabolic and acid-base parameters, as well as the kinetics of interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor-alpha, were characteristic for endotoxic shock. Endotoxin plasma levels were low (arterial, hepatic and portal vein). None of the parameters were significantly influenced by the adsorber system. CONCLUSION: Despite typical clinical signs of endotoxemia, the adsorber system had no significant effect on hemodynamic, metabolic and acid-base parameters during endotoxic shock. The reasons for the absence of an effect are elusive; however, failure of the method per se or exceeded capacity of the adsorber cannot be excluded.

Discrimination of HIV-1 and HIV-2 infection based on recombinant immunoblots.

Recombinant polypeptides representing various parts of structural proteins of HIV-1 and HIV-2 were expressed in E. coli. Fragments of the transmembrane proteins gp41 of HIV-1 (HTLV-IIIB) and gp38 of HIV-2 (LAV-2 ROD) proved to be highly antigenic in the immunoblot test system. Each protein was found to be suitable for detection and differentiation of antibodies in sera of patients infected with HIV-1 or HIV-2. Sera of 100 patients from West-Germany, which were confirmed as positive for HIV-1 antibodies, reacted clearly with the HIV-1 recombinant antigen (fpOE-6); no or only weak immune reactions were seen when the analogous recombinant HIV-2 antigen (fpOE-T) was used in the same immunoblot test. An inverse reaction pattern was found with 7 sera from Africa which, by conventional means, were proved to be HIV-2 antibody positive. These sera specifically reacted with the homologous HIV-2 fusion protein and no or only weakly stained bands were identified on the analogous strip with the HIV-1 antigen (fpOE-6).

[Oxygen therapy in diving accidents]. / Sauerstofftherapie nach Tauchunfall.

Diving accidents represent a departure from the routine practice of emergency physicians. The incidence of non-fatal diving accidents is reported as 1-2 per 10,000 dives. Apart from adequate intravenous hydration, oxygen is the only medication with a proven effect in the treatment of diving accidents. After a typical diving accident, administration of oxygen at an inspired concentration (F(I)O(2) 1.0) as high as possible is recommended. Many divers bring along their own oxygen administration systems to the diving sites and these are often better suited for the treatment of diving accidents than the oxygen systems of many emergency responders. Pressure regulators supplying low constant flow oxygen, nasal prongs and inhalation masks are inappropriate. When using artificial ventilation bags with face masks, an oxygen flow of at least 15 l/min should be used. Demand regulators are simple to use and able to deliver a F(I)O2 of 1.0. Their ease of use has earned them high marks in the emergency management of diving accidents and their similarity to standard diving equipment has also aided relatively widespread acceptance. Circulation breathing systems are more technologically complex oxygen delivery systems which permit CO2 absorption and re-breathing at low oxygen flow. In contrast to the demand modules, the likelihood of mistakes during their usage is higher. In diving accidents, the administration of normobaric oxygen, already begun in the field, is the most important therapy and should not be interrupted. Presented with an inadequate supplemental oxygen supply, the inspired oxygen concentration should not be decreased, rather the duration of the oxygen administration should be reduced. Hyperbaric oxygen therapy should be the mainstay of further treatment.