Two Cases of Severe Sepsis Treated by Operation and Endotoxin Eliminating Therapy

Hidekazu Todoroki, Aiichiro Higure, Takahisa Nagata, Kohji Okamoto, Naoki Nagata, Hideaki Itoh

Department of Surgery I, University of Occupational and Environmental Health

Endotoxin is an important pathogenetic factor in severe sepsis via the release of various mediators. We experienced two cases of severe sepsis treated effectively by surgery and endotoxin-eliminating therapy using a polymyxin B-immobilized fiber column. In case 1, the patient was a 62-year-old woman, who was suffering from complicating septic shock and failure of three organs due to rectal perforation. In case 2, the patient was a 60-year-old woman, who was also suffering from complicating septic shock and from failure of six organs due to acute cholecystitis and acute obstructive suppurative cholangitis. Endotoxin-eliminating therapy was given twice to these patients postoperatively, resulting in improvement in the organs. The interleukin-6 and -8 concentrations in the plasma were decreased and the leukocyte count improved soon after endotoxin-eliminating therapy. We therefore concluded that when one performs endotoxin-eliminating therapy for severe sepsis, changes in the interleukin-6, -8 concentrations in the plasma and leukocyte count will furnish much information for the proper timing and number of endotoxin-eliminating treatments for severe sepsis.

Key words
sepsis, endotoxin eliminating therapy, multiple organ dysfunction

Reprint requests
Hidekazu Todoroki Department of Surgery I, University of Occupational and Environmental Health
1-1, Isegaoka, Yahatanishi-ku, Kitakyushu, 807 JAPAN

Accepted
September 11, 1996

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