ABSTRACT
Recently we described the predictive value of the proportion of HLA-DR+ peripheral blood monocytes for the clinical outcome of septic disease in immunosuppressed patients (allograft recipients) and surgical patients mostly with peritonitis as septic focus (following perforation of gastrointestinal tract). The experiments described here show that the loss of HLA-class II antigen expression and other phenotypical abnormalities of monocytes from septic patients with fatal outcome are associated with functional defects (antigen presentation, formation of reactive oxygen species, cytokine secretion). The picture of phenotypical and functional defects of monocytes was termed "immunoparalysis" (leading parameter: loss of HLA-DR antigen expression less than 20%). Interferon-gamma as well as GM-CSF normalized in vitro the surface antigen expression on monocytes derived from septic patients with "immunoparalysis". However, sera from patients with "immunoparalysis" prevented the cytokine-mediated effects on HLA-DR antigen expression. The inhibitory activity in septic sera was not dialysable. In order to remove such factors we started a plasmapheresis study in septic patients selected for "immunoparalysis". The preliminary data of this clinical trial suggest an improved survival rate.
Subject(s)
HLA-DR Antigens/analysis , Monocytes/immunology , Sepsis/immunology , Antibodies, Monoclonal , Antigen-Presenting Cells/immunology , Biomarkers/blood , Cells, Cultured , Critical Care , Cytokines/biosynthesis , Female , HLA Antigens/analysis , Humans , Male , Phenotype , Plasmapheresis , Prognosis , Reference Values , Sepsis/therapyABSTRACT
Changes of the renal function of a three-phase course originate from the application of hypertonic infusions. The first phase is characterized by a copious osmotic diuresis and the decrease of the re-absorption of osmotic free water. The second phase shows a lower osmotic diuresis and the re-absorption of osmotic free water attains the values before the beginning of the infusion. The third phase produces a urine time volume like before the infusion, however, the re-absorption of osmotic free water exceeds the starting-value. A biphasic course with isotonic electrolyte infusion is opposed to the three-phase course with osmotic load. Changes of the osmolarity in plasma and urine is to be recommended in order to take it into consideration more in the clinical practice.
