Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Sep;218(3):321–327. doi: 10.1097/00000658-199309000-00011

Translocation. Incidental phenomenon or true pathology?

A M Munster 1, M Smith-Meek 1, C Dickerson 1, R A Winchurch 1
PMCID: PMC1242972  PMID: 8373274

Abstract

OBJECTIVE: This study was conducted to determine if reduction of early postburn endotoxemia influences the cytokine cascade, clinical manifestations of sepsis, and mortality rate. SUMMARY BACKGROUND DATA: Translocational endotoxemia has been demonstrated postburn in animals and humans. Endotoxin is known to induce the cytokine cascade, which leads to the clinical manifestations of sepsis. Whether reduction of postburn endotoxemia could influence the induction of cytokines has not been demonstrated. METHODS: In a prospective, randomized study, 76 burn patients were given polymyxin intravenously or served as control subjects. Polymyxin B was given intravenously for 1 week postburn in doses designed to neutralize circulating endotoxemia. RESULTS: In the polymyxin group, there was a statistically significant reduction in the plasma endotoxin concentration. There was, however, no reduction in the sepsis score or the interleukin-6 levels, and no differences in mortality rates were seen between the two groups. CONCLUSIONS: Early postburn translocational endotoxemia can be treated with anti-endotoxin agents such as polymyxin B. This, however, does not influence the cytokine cascade or the mortality rate. The systemic inflammatory response syndrome is caused by cytokine induction from the injury and is unaffected by a reduction in the plasma endotoxin concentration.

Full text

PDF
321

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baue A. E. The horror autotoxicus and multiple-organ failure. Arch Surg. 1992 Dec;127(12):1451–1462. doi: 10.1001/archsurg.1992.01420120085016. [DOI] [PubMed] [Google Scholar]
  2. Bender B. S., Winchurch R. A., Thupari J. N., Proust J. J., Adler W. H., Munster A. M. Depressed natural killer cell function in thermally injured adults: successful in vivo and in vitro immunomodulation and the role of endotoxin. Clin Exp Immunol. 1988 Jan;71(1):120–125. [PMC free article] [PubMed] [Google Scholar]
  3. Bitterman H., Kinarty A., Lazarovich H., Lahat N. Acute release of cytokines is proportional to tissue injury induced by surgical trauma and shock in rats. J Clin Immunol. 1991 Jul;11(4):184–192. doi: 10.1007/BF00917424. [DOI] [PubMed] [Google Scholar]
  4. Bone R. C. Let's agree on terminology: definitions of sepsis. Crit Care Med. 1991 Jul;19(7):973–976. doi: 10.1097/00003246-199107000-00024. [DOI] [PubMed] [Google Scholar]
  5. Border J. R., Hassett J., LaDuca J., Seibel R., Steinberg S., Mills B., Losi P., Border D. The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU. Ann Surg. 1987 Oct;206(4):427–448. doi: 10.1097/00000658-198710000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Callery M. P., Kamei T., Mangino M. J., Flye M. W. Organ interactions in sepsis. Host defense and the hepatic-pulmonary macrophage axis. Arch Surg. 1991 Jan;126(1):28–32. doi: 10.1001/archsurg.1991.01410250032004. [DOI] [PubMed] [Google Scholar]
  7. Carter E. A., Tompkins R. G., Schiffrin E., Burke J. F. Cutaneous thermal injury alters macromolecular permeability of rat small intestine. Surgery. 1990 Mar;107(3):335–341. [PubMed] [Google Scholar]
  8. Chalfin D. B., Holbein M. E., Fein A. M., Carlon G. C. Cost-effectiveness of monoclonal antibodies to gram-negative endotoxin in the treatment of gram-negative sepsis in ICU patients. JAMA. 1993 Jan 13;269(2):249–254. [PubMed] [Google Scholar]
  9. Cheadle W. G., Hanasawa K., Gallinaro R. N., Nimmanwudipong T., Kodama M., Polk H. C., Jr Endotoxin filtration and immune stimulation improve survival from gram-negative sepsis. Surgery. 1991 Oct;110(4):785–792. [PubMed] [Google Scholar]
  10. Damas P., Ledoux D., Nys M., Vrindts Y., De Groote D., Franchimont P., Lamy M. Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg. 1992 Apr;215(4):356–362. doi: 10.1097/00000658-199204000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Deitch E. A. Intestinal permeability is increased in burn patients shortly after injury. Surgery. 1990 Apr;107(4):411–416. [PubMed] [Google Scholar]
  12. Deitch E. A., Maejima K., Berg R. Effect of oral antibiotics and bacterial overgrowth on the translocation of the GI tract microflora in burned rats. J Trauma. 1985 May;25(5):385–392. doi: 10.1097/00005373-198505000-00002. [DOI] [PubMed] [Google Scholar]
  13. Deitch E. A. Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg. 1992 Aug;216(2):117–134. doi: 10.1097/00000658-199208000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Deitch E. A., Winterton J., Li M., Berg R. The gut as a portal of entry for bacteremia. Role of protein malnutrition. Ann Surg. 1987 Jun;205(6):681–692. doi: 10.1097/00000658-198706000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Demling R. H., LaLonde C. Identification and modifications of the pulmonary and systemic inflammatory and biochemical changes caused by a skin burn. J Trauma. 1990 Dec;30(12 Suppl):S57–S62. doi: 10.1097/00005373-199012001-00014. [DOI] [PubMed] [Google Scholar]
  16. Guo Y., Dickerson C., Chrest F. J., Adler W. H., Munster A. M., Winchurch R. A. Increased levels of circulating interleukin 6 in burn patients. Clin Immunol Immunopathol. 1990 Mar;54(3):361–371. doi: 10.1016/0090-1229(90)90050-z. [DOI] [PubMed] [Google Scholar]
  17. Inoue S., Wirman J. A., Alexander J. W., Trocki O., Cardell R. R. Candida albicans translocation across the gut mucosa following burn injury. J Surg Res. 1988 May;44(5):479–492. doi: 10.1016/0022-4804(88)90152-7. [DOI] [PubMed] [Google Scholar]
  18. Jones W. G., 2nd, Minei J. P., Barber A. E., Rayburn J. L., Fahey T. J., 3rd, Shires G. T., 3rd, Shires G. T. Bacterial translocation and intestinal atrophy after thermal injury and burn wound sepsis. Ann Surg. 1990 Apr;211(4):399–405. doi: 10.1097/00000658-199004000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. LeVoyer T., Cioffi W. G., Jr, Pratt L., Shippee R., McManus W. F., Mason A. D., Jr, Pruitt B. A., Jr Alterations in intestinal permeability after thermal injury. Arch Surg. 1992 Jan;127(1):26–30. doi: 10.1001/archsurg.1992.01420010032005. [DOI] [PubMed] [Google Scholar]
  20. Meek M., Munster A. M., Winchurch R. A., Dickerson C. The Baltimore Sepsis Scale: measurement of sepsis in patients with burns using a new scoring system. J Burn Care Rehabil. 1991 Nov-Dec;12(6):564–568. [PubMed] [Google Scholar]
  21. Moore F. A., Moore E. E., Poggetti R. S., Read R. A. Postinjury shock and early bacteremia. A lethal combination. Arch Surg. 1992 Aug;127(8):893–898. doi: 10.1001/archsurg.1992.01420080027004. [DOI] [PubMed] [Google Scholar]
  22. Moore F. D., Jr, Socher S. H., Davis C. Tumor necrosis factor and endotoxin can cause neutrophil activation through separate pathways. Arch Surg. 1991 Jan;126(1):70–73. doi: 10.1001/archsurg.1991.01410250076012. [DOI] [PubMed] [Google Scholar]
  23. Munster A. M., Winchurch R. A., Thupari J. N., Ernst C. B. Reversal of postburn immunosuppression with low-dose polymyxin B. J Trauma. 1986 Nov;26(11):995–998. doi: 10.1097/00005373-198611000-00006. [DOI] [PubMed] [Google Scholar]
  24. Parry-Billings M., Baigrie R. J., Lamont P. M., Morris P. J., Newsholme E. A. Effects of major and minor surgery on plasma glutamine and cytokine levels. Arch Surg. 1992 Oct;127(10):1237–1240. doi: 10.1001/archsurg.1992.01420100099017. [DOI] [PubMed] [Google Scholar]
  25. Richardson R. P., Rhyne C. D., Fong Y., Hesse D. G., Tracey K. J., Marano M. A., Lowry S. F., Antonacci A. C., Calvano S. E. Peripheral blood leukocyte kinetics following in vivo lipopolysaccharide (LPS) administration to normal human subjects. Influence of elicited hormones and cytokines. Ann Surg. 1989 Aug;210(2):239–245. doi: 10.1097/00000658-198908000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rush B. F., Jr, Sori A. J., Murphy T. F., Smith S., Flanagan J. J., Jr, Machiedo G. W. Endotoxemia and bacteremia during hemorrhagic shock. The link between trauma and sepsis? Ann Surg. 1988 May;207(5):549–554. doi: 10.1097/00000658-198805000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Steffen E. K., Berg R. D., Deitch E. A. Comparison of translocation rates of various indigenous bacteria from the gastrointestinal tract to the mesenteric lymph node. J Infect Dis. 1988 May;157(5):1032–1038. doi: 10.1093/infdis/157.5.1032. [DOI] [PubMed] [Google Scholar]
  28. Ulich T. R., Guo K. Z., Remick D., del Castillo J., Yin S. M. Endotoxin-induced cytokine gene expression in vivo. III. IL-6 mRNA and serum protein expression and the in vivo hematologic effects of IL-6. J Immunol. 1991 Apr 1;146(7):2316–2323. [PubMed] [Google Scholar]
  29. Waage A., Halstensen A., Shalaby R., Brandtzaeg P., Kierulf P., Espevik T. Local production of tumor necrosis factor alpha, interleukin 1, and interleukin 6 in meningococcal meningitis. Relation to the inflammatory response. J Exp Med. 1989 Dec 1;170(6):1859–1867. doi: 10.1084/jem.170.6.1859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Winchurch R. A., Thupari J. N., Munster A. M. Endotoxemia in burn patients: levels of circulating endotoxins are related to burn size. Surgery. 1987 Nov;102(5):808–812. [PubMed] [Google Scholar]
  31. Wortel C. H., von der Möhlen M. A., van Deventer S. J., Sprung C. L., Jastremski M., Lubbers M. J., Smith C. R., Allen I. E., ten Cate J. W. Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels. J Infect Dis. 1992 Dec;166(6):1367–1374. doi: 10.1093/infdis/166.6.1367. [DOI] [PubMed] [Google Scholar]
  32. Xiao G. X., Chopra R. K., Adler W. H., Munster A., Winchurch R. A. Altered expression of lymphocyte Il-2 receptors in burned patients. J Trauma. 1988 Dec;28(12):1669–1672. doi: 10.1097/00005373-198812000-00010. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES