Adjuvant Treatment of Mediastinitis with Immunoglobulins after Cardiac Surgery: The ATMI Trial
Immunoglobulins constitute an innovative product group with a wide spectrum of clinical use. Intravenous immunoglobulin (IVIG) solutions containing IgG in a concentration of 95% or more were introduced in the fifties primarily for the treatment of patients with humoral immunodeficiencies. In primary and secondary humoral immunodeficiencies, intravenously administered immunoglobulins replace the natural immunoglobulins and subsequently maintain the natural function of the humoral immune system. In addition, since 1981, there has been a rapid expansion of use in autoimmune diseases, in particular T-cell- and B-cell-mediated chronic neuroinflammatory diseases. The administration of high-dose IVIG is now accepted for various immune-mediated neuropathies, e.g., in the treatment of Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor-neuropathy. Furthermore the National Institutes of Health (NIH) consensus conference in 1990 set up a list of indications for which there was sufficient evidence to justify IVIG application: idiopathic thrombocytopenic purpura, hypogammaglobulinemia in chronic lymphatic leukemia patients, allogenic bone-marrow transplantation, and Kawasaki syndrome. The use of IVIG in the treatment of several inflammatory disorders is a more recent trend. Potential for the clinical use of immunoglobulins has been shown for inflammatory diseases/syndromes such as rheumatoid arthritis, immunovasculitis, dermatomyositis, sepsis, and others.
KeywordsIdiopathic Thrombocytopenic Purpura Discussion Forum Chronic Inflammatory Demyelinating Polyneuropathy Data Monitoring Committee Sternal Dehiscence
Unable to display preview. Download preview PDF.
- 1.Hures V, Kasatchkine MD, Vassilev T, et al (1997) Pooled normal human polyspecific IgM contains neutralizing anti-idiotypes to IgG autoantibodies of autoimmune patients and protects from experimental autoimmune disease. Blood 90: 4004–4013Google Scholar
- 2.Marshall JC (1994) Infection and the host septic response contribute independently to adverse outcome in critical illness: implications for clinical trials of mediator antagonism. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer, Heidelberg, pp 1–13Google Scholar
- 5.Neugebauer E, Marggraf G, Lefering R (1999) Immunoglobulins in inflammation: Consensus-assisted protocol development and discussion forum of the ATMI trial. Eur J Surg Suppl 584Google Scholar
- 12.Neugebauer E (1994) Multicentre trials in sepsis and septic shock–necessary prerequisites elaborated on the trial of supplement immunoglobulin treatment of Pilz et al. Theor Surg 9: 60–62Google Scholar
- 13.Opal SM (1996) Criticism of clinical trials in sepsis and organ dysfunction. In: Gullo A (ed) Sepsis and Organ Failure, Vol 4. APICE, Trieste, pp 29–41Google Scholar
- 15.Lorenz W, Neugebauer E, Pilz G, et al (1994) Methodology of clinical trials in sepsis-introduction. Theor Surg 9: 10–11Google Scholar
- 16.Schein M, Assalia A (1994) The role of planned reoperations and laparotomy in severe intraabdominal infection: is a prospective randomized trial possible? Theor Surg 9: 38–42Google Scholar
- 17.Troidl H, McKneally MF, Mulder DS, et al (1997) Surgical Research. Basic Principles and Clinical Practice, 3rd edn. Springer, New YorkGoogle Scholar