PMID- 12390392
OWN - NLM
STAT- MEDLINE
DCOM- 20021202
LR  - 20151119
IS  - 0007-1323 (Print)
IS  - 0007-1323 (Linking)
VI  - 89
IP  - 11
DP  - 2002 Nov
TI  - Granulocyte colony-stimulating factor but not peritoneal lavage increases 
      survival rate after experimental abdominal contamination and infection.
PG  - 1457-64
AB  - BACKGROUND: The value of peritoneal lavage for intra-abdominal contamination and 
      infection has never been proven scientifically. In contrast, the stimulation of 
      host defence mechanisms with cytokines such as granulocyte colony-stimulating 
      factor (G-CSF) has appeared promising in recent clinical trials. METHODS: Clinic 
      modelling randomized trials (CMRTs), which model the complexity of the clinical 
      reality, were used in rats in which peritoneal contamination and infection (PCI) 
      was produced with human stool bacteria. The following groups were compared: trial 
      1, intraoperative peritoneal lavage with saline versus taurolin (18 rats per 
      group); trial 2, no lavage versus saline lavage versus saline lavage plus 
      subcutaneous administration of G-CSF (18 rats per group); trial 3, lavage with 
      saline versus no lavage (30 rats per group). The primary endpoint was mortality 
      at 120 h. Secondary endpoints were the phagocytic activity of granulocytes, and 
      systemic and peritoneal cytokine levels. RESULTS: In trial 1 lavage with taurolin 
      was not superior to that with saline (five of 18 versus eight of 18 animals 
      survived; P = 0.32). In trial 2, six of 18 animals having no lavage and three of 
      18 receiving saline lavage survived. The combination of lavage and G-CSF 
      increased the number of animals surviving to 11 of 18 (P < 0.05). Lavage combined 
      with G-CSF stimulated granulocyte phagocytic activity (P < 0.01) and reduced the 
      levels of interleukin (IL) 6 (P < 0.01) and tumour necrosis factor alpha (P < 
      0.05) in peritoneal fluid, as well as plasma levels of IL-6 (P < 0.05) and IL-10 
      (P < 0.01). In trial 3, survival was not significantly different in animals 
      having lavage (14 of 30) and no lavage (19 of 30) (P = 0.14). CONCLUSION: In 
      these CMRTs of intra-abdominal contamination and infection, peritoneal lavage was 
      not beneficial, but when lavage was combined with subcutaneous administration of 
      G-CSF mortality was reduced and the local and systemic cytokine response was 
      downgraded. Results from these CMRTs were used directly to define the trial 
      conditions of a randomized clinical trial with G-CSF. Peritoneal lavage is not 
      recommended.
FAU - Bauhofer, A
AU  - Bauhofer A
AD  - Institute of Theoretical Surgery, Philipps University Marburg, Germany. 
      bauhofer@mailer.uni-marburg.de
FAU - Stinner, B
AU  - Stinner B
FAU - Kohlert, F
AU  - Kohlert F
FAU - Reckzeh, B
AU  - Reckzeh B
FAU - Lorenz, W
AU  - Lorenz W
FAU - Celik, I
AU  - Celik I
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Br J Surg
JT  - The British journal of surgery
JID - 0372553
RN  - 0 (Thiadiazines)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 143011-72-7 (Granulocyte Colony-Stimulating Factor)
RN  - 1EQV5MLY3D (Taurine)
RN  - 451W47IQ8X (Sodium Chloride)
RN  - 8OBZ1M4V3V (taurolidine)
SB  - IM
MH  - Abdomen/*surgery
MH  - Animals
MH  - Granulocyte Colony-Stimulating Factor/*therapeutic use
MH  - Male
MH  - Peritoneal Lavage/*methods
MH  - Random Allocation
MH  - Rats
MH  - Rats, Wistar
MH  - Sodium Chloride/therapeutic use
MH  - Surgical Wound Infection/*prevention & control
MH  - Survival Analysis
MH  - Systemic Inflammatory Response Syndrome
MH  - Taurine/*analogs & derivatives/therapeutic use
MH  - Thiadiazines/therapeutic use
MH  - Tumor Necrosis Factor-alpha/metabolism
EDAT- 2002/10/23 04:00
MHDA- 2002/12/03 04:00
CRDT- 2002/10/23 04:00
PHST- 2002/10/23 04:00 [pubmed]
PHST- 2002/12/03 04:00 [medline]
PHST- 2002/10/23 04:00 [entrez]
AID - 2227 [pii]
AID - 10.1046/j.1365-2168.2002.02227.x [doi]
PST - ppublish
SO  - Br J Surg. 2002 Nov;89(11):1457-64. doi: 10.1046/j.1365-2168.2002.02227.x.