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18Th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium Critical Care 1998, Volume 2 Suppl 1 http://ccforum.com/supplements/2/S1 MEETING ABSTRACTS Open Access 18th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium. 17–20 March 1998 Published: 1 March 1998 These abstracts are available online at http://ccforum.com/supplements/2/S1 mean pulmonary arterial pressure increased at 42°C (P = 0.0115 and P = MEETING ABSTRACTS 0.0037), pulmonary vascular resistance only dropped little compared to systemic vascular resistance, left ventricular stroke work index even P001 dropped with increasing temperature, though showing no significant Hemodynamics in induced whole body hyperthermia difference. Values for mixed venous oxygen saturation did not vary T Kerner1, M Deja1, O Ahlers1, J Löffel2, H Riess2, P Wust3, D Pappert1, during therapy, pulmonary right-left shunt showed a temperature H Gerlach1 associated increase (P = 0.0323) to a maximum at 42°C. 1Abteilung für Anaesthesiologic und operative Intensivmedizin, Virchow- Conclusion: Under the procedure of sKMT cardiac function in patients, Charité der Humboldt-Universität zu Berlin, Deutschland; 2Abteilung für who do not have any pre-existing cardiac impairment, can be maintained Hämatologiel Onkologie, Virchow-Charité der Humboldt-Universität zu Berlin, almost unchanged, ie with normal right and left ventricular pressure, Deutschland; 3Abteilung für Strahlenklinik und poliklinik, Virchow-Charité der despite an increase in right ventricular stroke work Humboldt-Universität zu Berlin, Deutschland Acknowledegment: Supported by Deutsche Krebshilfe. Critical Care 1998, 2(Suppl 1):P001 Background: Whole body hyperthermia induced by radiative systems has been used in therapy of malignant diseases for more than ten P002 years. Von Ardenne and co-workers have developed the ‘systemiche Induced hyperthermia causes significant changes in lymphocytes Krebs-Mehrschritt-Therapic’ (sKMT), a combined regime including whole O Ahlers1, T Boehnke1, T Kerner1, M Deja1, D Keh1, J Löffel2, B Hildebrandt2, body hyperthermia of 42°C, induced hyperglycaemia and relative H Riess2, P Wust3, D Pappert1, H Gerlach1 hyperoxaemia with additional application of chemotherapy. This 1Abteilung für Anästhesiologie und operative Intensivmedizin (GD: Prof. Dr. concept has been employed in a phase I/II clinical study for patients KJ Falke),Virchow-Charitè der Humboldt-Universität, 13344 Berlin, with metastatic colorectal carcinoma at the Virchow-Klinikum since Deutschland; 2Abteilung für Hämatologie/Onkologie (GD: Prof. Dr. D. Huhn), January 1997. Virchow-Charitè der Humboldt-Universität, 13344 Berlin, Deutschland; Methods: The sKMT concept was performed eleven times under 3Strahlenklinik und -poliklinik (GD: Prof. Dr. h.c. R. Felix), Virchow-Charitè der intravenous general anaesthesia, avoiding volatile anaesthetics. Core Humboldt-Universität, 13344 Berlin, Deutschland temperatures of up to 42°C were reached stepwise by warming with Critical Care 1998, 2(Suppl 1):P002 infrared-A-radiation (IRATHERM 2000®). During the whole procedure blood glucose levels of 380–450 mg/dl were maintained as well as PaO2 Background: Changes in lymphocyte subpopulations are determined levels above 200 mmHg. Extensive invasive monitoring was performed under several clinical conditions eg during activation of the immune in all patients including measurements with the REF-Ox-Pulmonary system. Our aim was to analyze the influence of induced elevated body artery catheter with continuous measuring of mixed venous saturation temperatures on lymphocytes in patients without infections or other (Baxter Explorer®) and invasive monitoring of arterial blood pressure. physiological stimulators of the immune system. Therefore we examined Data for calculation of hemodynamic and gas exchange parameters blood of patients with metastatic colorectal carcinoma during whole were collected four times, at temperatures of 37°C, 40°C, 41.8–42°C and body hyperthermia of 42°C caused by infrared-A-radiation. This is used as ‘ ’ 39°C, during measurements FiO2 was 1.0 at all times. Fluids were given part of so called systemische Krebs-Mehrschritt-Therapie (sKMT), which in order to keep central-venous and Wedge pressure within normal was started as a phase I/II clinical study at Virchow-Klinikum in 1997. range during the whole procedure. Statistics were performed using the Methods: Lymphocyte subpopulations were investigated by flow- Wilcoxon Test. cytometry-analysis. Blood sampleswereobtainedbeforebeginningof Results: Statistically significant differences were found between heart therapy at 37°C, at 40°C, at the end of the plateau of 42°C and after therapy rate, cardiac index and systemic vascular resistance comparing data at at 37°C again. Time between investigations was about 2 h. Subpopulations 37°C and 42°C. Heart rate and cardiac index increased to a maximum at were natural killer cells, T-Cells, IL2-Receptor on T-Cells, T4-Cells and T8-Cells. 42°C (P < 0.0001) whereas systemic vascular resistance had its minimum Cell counts were compared by using a Wilcoxon rank sum test. at 42°C (P < 0.0001). Mean arterial pressure dropped with increasing Results: The number of lymphocytes per nl decreased significantly from temperature, differences were not significant. Calculation of stroke 37°C to 42°C (Fig. 1). This effect was mainly caused by a significant volume index and ventricular volumes showed only a slight decrease in decrease of the absolute T4-Cell count and a slight decrease of the T8- endsystolic volumes with increasing temperature, the resulting differences Cell count with a resulting significant decrease of T-Cells. In addition, IL2- in right ventricular ejection fraction were marginally significant (P = 0.038) Receptor expression on T-Cells, as a marker for activation, decreased comparing 42°C to baseline. Right ventricular stroke work index as well as significantly. In contrast, the number of natural killer cells per nl Critical Care 1998, Volume 2 Suppl 1 Page 2 of 60 http://ccforum.com/supplements/2/S1 Figures 1-3 (abstract P002) increased. Looking for changes in relation between lymphocyte subpopulations, we found a significant percentual decrease of T4-Cells P004 (Fig. 2), no percentual changes in T8-Cells but a significant percentual LPS does not induce changes in hepatocellular microtubule cytoskeleton increase of natural killer cells (Fig. 3). Effects were reversible and at the S Russwurm1, M Wiederhold1, KJ Böhm2, P Mühlig2, I Stonans1, E Unger2, last time-point at 37°C all examined parameters showed a tendency to K Reinhart1 the initial values. 1Department of Anesthesiology and Intensive Therapy, Friedrich-Schiller- Conclusions: Elevated body temperatures up to 42°C induce a change in University of Jena, 07740, Jena, Germany; 2Institute of Molecular lymphocytes which is similar to early responses of the immune system to Biotechnology e.V., Beutenbergstr, 11, 07745, Jena, Germany other stress situations or host response. For example natural killer cells Critical Care 1998, 2(Suppl 1):P004 are known to increase in the early phase after severe trauma, whereas the number of T4-Cells decreases in these patients. Thus, isolated Introduction: Lipopolysaccharides (LPS) are known to be involved in the induced hyperthermia in absence of infections or other physiological pathogenesis of septic shock and multiorgan failure. It has been demonstrated stimulators of the immune system seems to cause a kind of host that LPS may cause changes in monocyte cytoskeleton and directly influence response. It seems remarkable, that these effects were reversible in a very assemblation of isolated microtubuli. As liver failure is increasingly observed short time-period after decrease of temperature. during septic shock we estimated the influence of LPS on microtubule Acknowledgement: Supported by Deutsche Krebshilfe. cytoskeleton of cultivated hepatocytes and human blood monocytes. Methods: HepG2 cells, murine hepatocytes, or human monocytes (positive control) were incubated with LPS FITC labelled or unlabelled P003 (0.1–200 μg/ml) up to 48 h. After staining with antibodies to tubulin and Relationship between reactive hemophagocytic syndrome (RHS) and tau proteins cells were analysed by fluorescence and laser scan confocal multiple organ system failure (MOSF) microscopy. Activation of MAP-kinases was investigated by Western Blot F Gauvin, B Toledano, M David, J Lacroix using phosphospecific antibodies. Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal (Québec), Results: Immunofluorescence revealed that the cytoskeleton of Canada H3T 1C5 hepatocytes was not affected by LPS. Furthermore, no phosphorylation of Critical Care 1998, 2(Suppl 1):P003 MAP-kinases was found after LPS-incubation. Mouse hepatocytes and HepG2 cells did not accumulate FITC labelled LPS. In contrast, human Objective: To report two cases which show that severe RHS can be blood monocytes showed an accumulation of FITC-LPS, an activation of reversible, can be a cause of cytopenia in the ICU, and can be associated MAP-kinases and changes in microtubule cytoskeleton. with MOSF. In both cases, a bone marrow aspirate showed histiocytes, Conclusions: Our results might explain the frequently observed late hypocellularity of all cell lines, and hemo- and erythrophagocytosis. onset of liver failure during sepsis-syndrom. Further studies on possible Case reports: 1) A 3 year-old boy with Mucha-Haberman syndrome was protective factors in hepatocytes and the complex co-operation between admitted to the PICU for septic shock (Staphylococcus
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