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Adjuvant Treatment of Mediastinitis with Immunoglobulins after Cardiac Surgery: The ATMI Trial

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine 2002

Part of the book series: Yearbook of Intensive Care and Emergency Medicine 2002 ((YEARBOOK,volume 2002))

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Abstract

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.

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References

  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 90:4004–4013

    Google 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 1–13

    Google Scholar 

  3. Marshall JC (1999) Organ dysfunction as an outcome measure in clinical trias. Eur J Surg Suppl 584:62–67

    Article  PubMed  Google Scholar 

  4. Lefering R (1999) Biostatistical outcome evaluation using TISS-28. Eur J Surg Suppl 584:56–61

    Article  PubMed  Google 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 584

    Google Scholar 

  6. Kasatchkine MD, Kaveri SV (2001) Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 345:747–755

    Article  Google Scholar 

  7. Loop FD, Lytle BW, Cosgrove DM, et al (1990) Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 49:179–187

    Article  PubMed  CAS  Google Scholar 

  8. Ottino G, DePaulis R, Pansini S, et al (1987) Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2579 consecutive operative procedures. Ann Thorac Surg 44:173–179

    Article  PubMed  CAS  Google Scholar 

  9. Scarr MG, Gott VL, Townsend TR (1984) Mediastinal infection after cardiac surgery. Ann Thorac Surg 38:415–423

    Article  Google Scholar 

  10. Marggraf G, Splittgerber FH, Knox M, et al (1999) Mediastinitis after cardiac surgery — epidemiology and current treatment. Eur J Surg 584:12–16

    Article  Google Scholar 

  11. Solomkin JS (1999) Microbiology and antibiotic treatment: discussion forum on a study protocol on adjuvant treatment of mediastinitis with immunoglobulin (Pentaglobin®) after cardiac surgery (ATMI). Eur J Surg Suppl 584:43–44

    Article  PubMed  Google 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 9:60–62

    Google 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 29–41

    Google Scholar 

  14. Sibbald WI, Vincent IL (1995) Round table conference on clinical trials for the treatment of sepsis. Intensive Care Med 21:184–189

    Article  PubMed  CAS  Google Scholar 

  15. Lorenz W, Neugebauer E, Pilz G, et al (1994) Methodology of clinical trials in sepsis-introduction. Theor Surg 9:10–11

    Google Scholar 

  16. Schein M, Assalia A (1994) The role of planned reoperations and laparotomy in severe intraabdominal infection: is a prospective randomized tdgagadgarial possible? Theor Surg 9:38–42

    Google Scholar 

  17. Troidl H, McKneally MF, Mulder DS, et al (1997) Surgical Research. Basic Principles and Clinical Practice, 3rd edn. Springer, New York

    Google Scholar 

  18. Neugebauer E, Troidl H (1995) Consensus methods as tools to assess medical technologies. Surg Endosc 9:481–482 (Abst)

    PubMed  CAS  Google Scholar 

  19. Neugebauer E, Troidl H, Kum CK, et al (1995) The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements. Surg Endosc 9:550–563

    CAS  Google Scholar 

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Neugebauer, E., Marggraf, G., Lefering, R. (2002). Adjuvant Treatment of Mediastinitis with Immunoglobulins after Cardiac Surgery: The ATMI Trial. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 2002. Yearbook of Intensive Care and Emergency Medicine 2002, vol 2002. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56011-8_13

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  • DOI: https://doi.org/10.1007/978-3-642-56011-8_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-43149-7

  • Online ISBN: 978-3-642-56011-8

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