Untersuchungen zum Verlauf von hämodynamischen und gasanalytischen Parametern während der isolierten hyperthermen Extremitätenperfusion mit Tumornekrosefaktor α und MelphalanRoland Georgieff1121.1131.1.11.1.2141.1.31.2151621733.13.1.13.1.2183.2193.33.4203.4.1169#47213.4.1.1189#4476#413.4.222188#243.4.33.4.3.123140#23135#2483#45199#682489#4588#47253.53.5.126#203#453.5.227167#47#261#24121#43232#24121#41#93#4328179#24165#47207#25##229#25172#473.6293.730314324.13334448#37935448#379438#37936448#379438#37937429#3794.2384.2.139448#379404.2.2504#355414.2.3448#3794.34224#254.443563#41744604#8754.54546604#881475485.1495.2505.35152535.4545.55.6555657658 LITERATURVERZEICHNIS59606162636465 Abkürzungsverzeichnis91011 ANHANG66533#37767573#42368562#42969533#37770571#45971562#37772DANKSAGUNG LEBENSLAUF7374EIDESSTATTLICHE ERKLÄRUNGdeInhaltsverzeichnisHilfe LITERATURVERZEICHNIS 1 Klopp C.T.,Alford T.C., Bateman J.: ractional intra-arterial cancer chemotherapy with methyl-bis-amine hydrochloride. Ann Surg. 1950, Bd. 132, S.811-832, 2 Sullivan R.F., Jones R., Schnabel T.G., Shorey J.M.: The treatment of human cancer with intra-arterial nitrogen mustard utilizing a simplified catheter technique. Cancer. 1953, Bd. 6, S.121-134, 3 Ryan R.F., Krementz E.T., Creech O., Winblad J.N., Chamblee W., Cheek H. : Selected perfusion of isolated viscera with chemotherapeutic agents using extracorporal circuit. Surg Forum. 1957, Bd. 8, S.158-161, 4 Creech O., Krementz E.T., Ryan R.F., Winblad J.N.: Chemotherapy of cancer: regional perfusion utilizing an extracorporal circuit. Ann Surg. 1958, Bd. 148, S.616-631, 5 Cavaliere R., Ciocatto E.C., Giovanella B.C., Heidelberger C., Johnson R.O., Margottini M. et al.: Selective heat sensitivity of cancer cells. Biochemical and clinical studies. Cancer. 1967, Bd. 20, S.1351-1381, 6 Stehlin J.S., Giovanella B.C., Delpolyi P.D., Muenz L.R., Anderson R.F.: Results of hyperthermic perfusion for melanoma of the extremities. Surg Gynecol Obstet. 1975, Bd. 140, S.339-348, 7 Eggermont A.M., Schraffordt Koops H., Klausner J.M., Kroon B.B., Schlag P.M., Lienard D. et al: Isolated limb perfusion with tumor nekrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. Ann Surg. 1996, Vol 224, No 6, S.756-765, 8 Thompson J.F., Hunt J.A., Shannon K.F., Kam P.C.: Frequency and duration of remission after isolated limb perfusion for melanoma. Archives of Surgery. 1997, Vol 132, No 8, S.903-907, 9 Lienard D., Ewalenko P., Delmotte J.J., Lejeune F.J. : High-dose recombinant tumor necrosis factor alpha in combination with interferon gamma and melphalan in isolation perfusion of the limbs for melanoma and sarcoma. J Clin Oncol. 1992, Vol. 10, S.52-60, 10 Lienard D., Eggermont A.M., Schrafford Koops H., Kroon B.B., Rosenkaimer F., Autier P. et al : Isolated perfusion of the limb with high-dose tumor necrosis factor alpha, interferon-gamma and melphalan for melanoma stage III. Results of a multi-centre pilot study. Melanoma Res. 1994, Vol. 4, S1, S.21-26, 11 Frater-Schröder M., Risau W., Hallmann R., Gautschi P., Böhlen P. : Tumor necrosis factor type alpha, a potent inhibitor of endothelial cell growth in vitro, is angiogenic in vivo. Proc Natl Acad Sci USA. 1987, Vol. 84, S.5277-5281, 12 Sato N., Goto T., Haranaka K., Satomi N., Nariuchi H., Mano-Hirano Y. et al: Actions of tumor necrosis factor on cultured vascular endothelial cells: morphologic modulation, growth inibation, and cytotoxity. J Natl Cancer Inst. 1986, Vol. 76, S.1113-1121, 13 Stolpen A.H., Guinan E.C., Fiers W., Pober J.S.: Recombinant tumor necrosis factor and immune interferon act singly and in combination to reorganze human vascular endothelial cell monolayers. Am J Pathol. 1986, Vol. 23, S.16-24, 14 Kettelhack C., Robaye B., Morandini R., Mosselmans R., Ghanem G., Lejeune F.: Induction of apoptosis in human endothelial cells by TNF and interferon-gamma. Annals of Hematology 67. 1993, S.156, 15 Pober J.S., Cotran R.S.: Cytokines and endothelial cell bioogy. Physio Rev. 1990, Vol. 70, S.427-451, 16 Lejeune F., Lienard D., Eggermont A., Schrafford Koops H., Rosenkaimer F., Gerain J. : Rationale for using TNF alpha and chemotherapy in regional therapy of melanoma. J Cell Biochem. 1994, Vol.56, S.52-61, 17 Olieman A.F., van-Ginkel R.J., Hoekstra H-J., Mooyaart E.L., Molenaar W.M., Koops H.S.: Angiographic response of locally advanced soft-tissue sarcoma following hyperthermic isolated limb perfusion with tumor necrosis factor. Ann Surg Oncol. 1997, Vol. 4, No 1, S.64-69, 18 Bone R.C.: ACCP/SCCM consensus conference: Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992, Vol 20, S.864-874, 19 Sablotzki A., Dehne M., Welters I. et al.: Alterations of the cytokine network in patients undergoing cardiopulmonary bypass. Perfusion. 1997, 12, S.393-403, 20 Nathan N., Denizot Y., Cornu E. et al.: Cytokine and lipid mediator blood concentrations after coronary artery surgery. Anesth Analg. 1997, 85, S.1240-1246, 21 Toft P., Tonnesen E., Zülow I. et al.: Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass. Scand Cardiovasc J. 1997, 31, S.91-95, 22 Hensel M., Volk T., Döcke W.D. et al.: Hyperprocalcitoninemia in patients with noninfectious SIRS and pulmonary dysfunction associated with cardiopulmonary bypass. Anesthesiology. 1998, 89, S.93-104, 23 Zwaveling J.H., Maring J.K., Clarke F.L., van Ginkel R.J., Hoekstra H.J.: High plasma tumor necrosis factor concentrations and a sepsis-like syndrome in patients undergoing hyperthermic isolated limb perfusion with recombinant TNF- alpha, interferon-gamma and melphalan. Critical Care Med. 1996, Vol. 24, No 5, S.765-770, 24 Zwaveling J.H., Maring J.K., Moshage H., van Ginkel R.J., Hoekstra H.J., Schrafford Koops H. et al: Role of nitric oxide in recombinant tumor necrosis factor alpha induced circulatory shock: a study in patients treated for cancer with isolated limb perfusion. Critical Care Med. 1996, Vol. 24, No 11, S.1806-1810, 25 Fawcett W.J., Hill S., Sheldon J., Williams T.R., Thomas J.M., Riches P.: Hemodynamic changes and circulating recombinant tumor necrosis factor-alpha concentrations in a patient undergoing isolated limb perfusion. Critical Care Med. 1993, Vol. 21, S.796-800, 26 Sigurdsson G.H., Nachbur B., Lejeune F.J.: Anesthesoilogists` Management of Isolated Limb Perfusion with High-dose Tumor Necrosis Factor alpha. Anesthesiology. 1993, 79, S.1433-1437, 27 Lejeune F.J., Lienard D., Eggermont A.M. et al.: Isolation perfusion with rTNFalpha, rINFgamma + melphalan for in transit metastases of malignant melanoma. Update of a pilot study. European Journal of Cancer. 1993, 29, S.117, 28 Vaglini M., Belli F., Ammatuna M. et al.: Treatment of primary or relapsing limb cancer by isolation perfusion with high-dose alpha-tumor nekrosis factor, gamma-interferon and melphalan. Cancer. 1994, 73, S.483-492, 29 Fraker D.L., Alexander H.R., Andrich M.P., Rosenberg S.A.: Treatment of patients with melanom of the extremity using hyperthermic isolated limb perfusion with melphalan, tumor necrosis factor, and interferon-gamma: results of a tumor necrosis factor dose-escalation study. J Clin Oncol. 1996, 14, S.479-489, 30 Wieberdink J., Benckhuysen C., Braat R.P., Van Slooten E.A., Olthuis G.A. : Dosimetry in isolation perfusion of the limbs by assessement of perfused tissue volume and grading of toxic tissue reactions. Eur J Cancer Clin Oncol. 1986, S.1819-1826, 31 Eggimann P., Chiolero R., Chassot P.-G. et al: Systemic and hemodynamic effects of recombinant tumor necrosis factor alpha in isolation perfusion of the limbs. Chest. 1995, 107, S.1074-1082, 32 Goris R.J.A.: MODS/SIRS: result of an owerhelming inflammatory response?. World J Surg. 1996, 20, S.418-421, 33 Nathens A.B., Marshall J.C.: Sepsis, SIRS and MODS: what's in a name?. World J Surg. 1996, 20, S.386-391, 34 Ganz W., Swan H.J.C.: Measurement of Blood Flow by Thermodilution. American Journal of Cardiolgy. 1972, Vol. 29, S.241-245, 35 Assman R., Heidelmeyer C.F., Trampisch H.J., Mottaghy K.,Verprille A., Sandmann W., Falke K.J.: Right ventricular function assessed by thermodilution technique during apnea and mechanical ventilation. Crit Care Med. 1991, 6, S.810-817, 36 Yelderman M.: Continuous cardiac Output by thermodilution. Int Anaesthesiol Clin. 1993, Vol. 31, No. 3 , S.127-140, 37 Jacquet L., Hanique G., Glrieux D., Matte P., Goenen M.: Analysis of the accuracy of continuous thermodilution cardiac output measurement. Comparision with intermittent thermodilution and Fick cardiac output measurement. Intensive Care Medicine. 1996, Vol. 22, S.1125-1129, 38 Fick A.: Über die Messung des Blutquantums in den Herzventrikeln. Sitzungsbericht der Physikalisch Medizinischen Gesellschaft Würzburg. 1870, S.16f, 39 Weyland A.,Weyland W., Sydow M., Weyland C., Kettler D.: Inverses Ficksches Prinzip im Vergleich zu Messungen der Sauerstoffaufnahme aus respiratorischen Gasen. Anaesthesist. 1994, S.658-666, 40 Thews G: Lungenatmung. Hrsg.: Schmidt R.F., Thews G.: Physiologie des Menschen. Band 1. 26

Berlin, Heidelberg, New York

, Springer Verlag, 1995 S.565-590, 41 Wells J.C.K., Fuller N.J.: Precision and accuracy in a metabolic monitor for indirect calorimetry. European Journal of Clinical Nutrition. 1998, Vol. 52, S.536-540, 42 Scheeren T.W.L., Krossa M., Meriläinen P., Arndt J.O.: Error in measurement of oxygen cabon dioxide concentration by the Deltatrac II metabolic monitor in the presence of desflurane. British Journal of Anaesthesia. 1998, Vol. 80, S.521-524, 43 Bland J.M., Altman D.G.: Statistical methods for assesing agreement between two methods of clinical measurement. Lancet. 1986, 2, S.307-310, 44 Nunn J.F.: Pulmonary oxygen consumption. Intensive Care Med. 1996, 22, S.275-276, 45 Light R.B.: Intrapulmonary oxygen consumption in experimental pneumococcal pneumonia. J Appl Physiol. 1988, Vol. 64, S.2490-2495, 46 Omlor G., Molter G., Meessen S., Gross G., Seyfert U., Feifel G.: Kardiozirkulatorische Nebenwirkungen der hyperthermen Extremitätenperfusion. Langenbecks Arch Chir. 1993, 378, S.17-20, 47 Harpole D.H., Clements F.M., Quill T., Wolfe W.G.: Right and left ventricular performance during and after abdominal aortic aneurysm repair. Ann Surg. 1989, 209, S.356-362, 48 Nunn J.F.: Non respiratory functions of the lung. Hrsg.: Nunn J.F.: Applied respiratory physiology. Band 1. 4

London, Boston

, Butterworth-Heinemann, 1993 S.306-317, 49 Hensel M., Kox W.J.: Increased Intrapulmonary Oxygen Consumption in Mechanically Ventilated Patients with Pneumonia. Am J Respir Crit Care Med. 1999, 160, S.137-143, 50 Shomaker W.C., Montgomery E.S., Kaplan E. et al: Physiologic patterns in surviving and nonsurviving shock patients. Arch Surg. 1973, 106, S.630 ff, 51 Royston D.: Systemic inflammatory responses to surgery whith cardiopulmonary bypass. Perfusion. 1996, 11, S.177-189, 52 Gosh S., Latimer R.D., Gray B.M., Harwood R.J., Oduro A: Endotoxin induced organ injury. Crit Care Med. 1993, Vol 21, S.19-24, 53 Gerain J., Lienard D., Ewalenko P., Lejeune F.J. : High serum levels of TNF-alpha after its administration for isolation of the limb. Cytokine. 1992, Vol. 4, S.585-591, 54 Thom A.K., Alexander H.R., Andrich M.P., Barker W.C., Rosenberg S.A., Fraker D.L. : Cytokine levels and systemic toxity in patients undergoing isolated limb perfusion with high-dose tumor necrosis factor, interferon-gamma and melphalan. J Clin Oncol . 1995, Vol. 13, S.264-273, 55 Sorkin P., Abu-Abid S., Lev D., Gutman M., Aderka D., Halpern P. et al: Systemic leakage and side effects of tumor necrosis factor alpha administered via isolated limb perfusion can be manipulated by flow rate adjustment. Arch Surg. 1995, Vol. 130, S.1079-1084, 56 Menasche P., Haydar S., Peynet J., Du Buit C., Merval R., Bloch G., Pivnica A.: A potential mechanism of vasodilatation after warm heart surgery: the temperature dependent release of cytokines. J Thorac Cardiovasc Surg. 1994, 107, S.293-299, 57 Butler J., Rocker G.M., Westaby S.: Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1993, Vol.55, S.552-559, 58 Chenoveth D.E., Cooper S.W., Hugli T.E., Stewart R.W., Blackstone E.H., Kirklin J.W. : Complement activation during cardiopulmonary bypass. N Engl J Med. 1981, Vol 304, S.497, 503. 59 Cremer J., Martin M., Redl H., Bahrami S., Abraham C., Graeter T., Haverich A., Schlag G., Borst H.G. : Systemic inflammatoric response syndrom after cardiac operations. Ann Thorac Surg. 1996, Vol. 61, S.1714-1720, 60 Gillinov A.M., Bator J.M., Zehr K.J., Redmond J.M., Burch R.M., Ko C., Winkelstein J.A., Stuart R.S., Baumgartner W.A., Cameron D.E.: Neutrophil adhesion molecule expression during cardiopulmonary bypass whith bubble and membran oxygenators. Ann Thorac Surg. 1993, Vol.56, S.847-853, 61 Menasche P.: The inflamatory response to cardiopulmonary bypass and its impact on postoperative myocardialfunktion. Curr Opin Caardiol. 1995, 10, S.597-604, 62 Lehmann A., Zeitler C., Thaler E. et al.: Comparison of two different anesthesia regimes in patients undergoing aortocoronary bypass grafting surgery: sufentail-midazolam versus remifentanil-propofol. J Cardiothorac Vasc Anesth. 2000, 4, S.416-420, 63 Hogue C.W., Browdle T.A., O'Leary C. et al.: A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesth Analg. 1996, Vol 83, S.279-285, 64 Neuhof H., Wolf H.: Method for continuosly measured oxygen consumption and cardiac output for use in critically ill patients. Crit Care Med. 1978, Vol.6, S.155-161, 65 Connors A. F., Speroff T., Dawson N.V., Thomas C., Harrel F.E. et al.: The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996, 276, S.889-897, 66 Third European Consensus Conference in Intensive Care Medicine. Tissue hypoxia: How to detect, how to correct, how to prevent. Societe de Reanimacion de Langue Francaise. The American Thoracic Society. European Society of Intensive Care Medicine. Am J Respir Crit Care Med. 1996, Vol. 154, S.1573-1578, 67 Pulmonary artery catheter consensus conference: Consensus statement. Crit Care Med. 1997, S.910-925, 68 Parker M.M., Peruzzi W.: Pulmonary artery catheters in sepsis/septic shock. New Horiz. 1997, S.228-232, 69 Nunn J.F., Makita K., Royston B.: Validation of oxagen consumption measurements during artificial ventilation. J Appl Physiol.. 1989, Vol. 67, S.2129-2134, 70 Loer S.A., Scheeren T.W., Tarnow J.: How much oxygen does the human lung consume?. Anesthesiology. 1997, S.532-637, 71 Douglas C.G., Haldane J.S.: The regulation of the general circulation rate in man. J Physiol. 1922, Vol.56, S.69-100, 72 Scheeren T.W.L., Schwarte L.A., Arndt J.O.: Metabolic regulation of cardiac output during inhalation anaesthesia in dogs. Acta Anaesthesiol Scand. 1999, Vol. 43, S.421-423, 73 Scheeren T. W.: Beziehung zwischen Herzminutenvolumen und Sauerstoffverbrauch bei Inhalationsanästhesien und unter dem Einfluß von Katecholaminen. Anaesthesiol Intensivmed-Notfallmed-Schmerzther. 2000, Bd. 35 , S.214-219, 74 Bihari D., Smithies M., Gimson A., Tinker J.: The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med. 1987, 317, S.397-403, 75 Hayes M.A., Timmins A.C., Yau E.H., Palazzo M., Watson D., Hinds C.J.: Oxygen transport patterns in patients with sepsis syndrom or septic shock: influence of treatment and relationship to outcome. Crit Care Med. 1997, S.926-936, 76 Rhodes A., Malagon I., Lamb F.J., Newman P., Grounds R.M., Bennett E.D.: Failure to increase oxygen consumption is a predictor of mortality in septic patients. Intensiv Care Med. 1996, Vol. 22, S.274ff, 77 Archie J.: Mathematic Coupling of Data. Ann. Surg. 1981, Vol.193, No. 3, S.296-303, 78 Ronco J.J., Fenwick J.C., Tweeddale .G. et al.: Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA. 1993, 270, S.1724-1730, 79 Wysocki M., Besbes M., Roupie E. et al.: Modification of oxygen extraction ratio by change in oxygen transport in septic shock. Chest. 1992, 102, S.221.226, 80 Vermej C.G., Feenstra B.W., Adrichem W.J., Bruining H.A.: Independent oxygen uptake and oxygen delivery in septic and postoperative patients. Chest. 1991, 99, S.1438-1441, 81 Friedman G., de Backer D., Shala M., Vincent J.L.: Oxygen supply depency can characterize septic shock. Intensive Care Med. 1998, 24, S.118-123, 82 de Boisblanc B.P.: Oxygen consumption in the intensive care unit: Indirect calorimetry is the way to go, but where?. Crit Care Med. 1998, Vol. 26 No. 7, S.1153-1154