Günther Schlag - Böcker

The first Wiggers-Bernard Conference on shock, sepsis and organ failure, named after two outstanding scientists in shock research and experimental medicine, took an interdisciplinary approach to addressing three questions: whether multi-organ failure is a sequence of organ failures or a systematic disease; whether cellular events in trauma and sepsis are due to suppression, activation or both; and whether LPS or sepsis are necessary as mediators of organ failure. The topics discussed included humoral and cellular activation mechanisms, immuno-suppression, metabolic responses, and the source and action of endotoxin (including the release of cytokines, oxygen radicals and proteinases).

The second Wiggers Bernard conference took an interdisciplinary approach and addressed three topics with a view to gaining increased understanding of the development of the multi-organ failure syndrome. These were, gut as a source of organ failure; metabolic aspects of the liver in sepsis; and endothelium as a target in sepsis. Eighteen contributors addressed these questions from a number of directions, including operational mechanisms, metabolic response, source and action of endotoxin and endotoxin-derived mediators. This book of proceedings on internal medicine, infectious diseases and emergency medicine is intended for the use of specialists and clinicians in these fields as well as for anaesthetists and surgeons.

The Third Wiggers Bemard Conference took an interdisciplinary approach to examining the role of cytokines in the development of sepsis and multiple organ failure. Sixteen intemational experts examine the role of cytokines in Gram-positive and Gram-negative bacteremia and inflammatory processes such as lung inflammation. The contributions explore all aspects of two growth factors, interleukin I and interieukin VI, as far as these molecules trigger the pathological process. The intense discussions which followed each talk are also printed in the volume.

This first volume in the series Update and Future Trends in Fibrin Sealing presents various subjects in the field of wound healing on both a theoretical and clinical basis. Fibrin sealant plays an important role in the first stages of wound healing. Among the issues discussed is the relationship between biomaterials and other substances.

The use of fibrin glue in abdominal and pediatric surgery is established procedure. In recent years, further areas of application and other indications have been added to the list: high risk anastomosis, as a protective measure in vascular anastomosis (especially after liver transplantation), in the treatment of fistulas - in particular lymphatic fistulas. In pediatric surgery fibrin glue is used mainly in orthotopic liver transplantation and in operations involving the parenchymal organs such as liver, spleen, pancreas, and kidney.

In the field of orthopedic surgery, additional areas of application and new indications have been discovered for fibrin glue treatment, for example, hemostasis in pseudotumors in hemophilic patients or in torn ligaments, and in spongiosa transplantation, primarily when nonautologous bone material is being used, or to fill large defects. In maxillofacial surgery fibrin glue is mainly used for osseous contouring of the facial and frontal bones, for alveolar ridge augmentations in preprosthetic surgery, and for soft tissue reconstructions.

Recent experience with the use of fibrin sealant in neurosurgery, in particular in the treatment of rhinorrhea, preoperative tumor embolization, frontobasal and orbital reconstruction are discussed. Fibrin sealant has also been successfully applied in the reconstruction of brachial plexus. In ophthalmic surgery fibrin sealing has become routine in some forms of therapy as, for example, in cataract surgery. New indications have been added to the other well-known indications for fibrin sealing in ENT surgery, in particular in endoscopic and microscopic transnasal interventions. Endonasal decompression of the nervus opticus has become safer thanks to fibrin sealant.

Fibrin sealant is used for numerous indications in gynecology, especially for the McIndoe Operation and Cohn biopsy, the Marshall-Marchetti-Krantz-Hirsch-Stoll-Operation, urethrocysopexy, or in vitro fertilization for embryo transfer. The use of fibrin sealant in urology has also been extended, especially in operations of the spermatic cord, reconstruction of the urethra and closing of nephrotomies.

The last volume in the series Fibrin Sealing in Surgical and Nonsurgical Fields discusses various uses of fibrin glue in endoscopic surgery. During the last years fibrin sealant has been established in the treatment of gastrointestinal ulcers and esophageal fistulae.

This volume presents the influence of fibrin sealant on post-operative bleeding in cardiovascular surgery, in particular after re-operations and during heart transplantations. The application of fibrin sealant has also proved very useful in cardiomyoplasties. In thoracic surgery new indications such as percutaneous needle biopsy, treatment of large bullae and bronchus stump insufficiency have been added to the list.

The use of fibrin glue in surgery is an established procedure. In recent years further areas have been added to the list: face lifts, oncologic surgery, facial nerve repair in plastic surgery and the treatment of burns. As a new method, the application of cultured keratinocytes in a fibrin glue suspension is described.

At the Sixth Wiggers Bernard Conference, a group of scientists from various fields discussed new findings relating to nitric oxide synthase inhibitor in shock, sepsis, and organ failure. This meeting was dedicated to the presentation and discussion of positive and negative findings related to the use of NOS inhibitors, the issue of specific and non-specific inhibitors and the role of nitric oxide-oxygen radical interactions. Both experimental and clinical data were presented in the trauma and sepsis field. With appropriate dosing and timing the use of NOS inhibitors seems to be beneficial at least in severe sepsis situations, but some inhibitors and overdosing can be potentially dangerous.

At the Sixth Wiggers Bernard Conference, a group of scientists from various fields discussed new findings relating to nitric oxide synthase inhibitor in shock, sepsis, and organ failure. This meeting was dedicated to the presentation and discussion of positive and negative findings related to the use of NOS inhibitors, the issue of specific and non-specific inhibitors and the role of nitric oxide-oxygen radical interactions. Both experimental and clinical data were presented in the trauma and sepsis field. With appropriate dosing and timing the use of NOS inhibitors seems to be beneficial at least in severe sepsis situations, but some inhibitors and overdosing can be potentially dangerous.

A report on new findings involving the brain in traumatic and septic shock, and after brain injury. Adopting an experimental and clinical approach to treatment, the book presents specific results obtained from the encephalogram and from histopathological study with regard to the immunohistochemistry of toxic lipid peroxidant products. It also includes the latest results of clinical and experimental pathophysiology in inflammatory processes after traumatic brain injury and the therapeutic effects of hypertonic fluid therapy.

In this book current knowledge of the pathophysiology of shock, sepsis and multi organ failure is presented. The rapid progress which has been made and the results achieved in intensive care medicine are based on sound basic research, which is duly reflected in these chapters. Multiorgan failure is the foremost cause of postoperative and posttraumatic death and many complex mechanisms are involved. Only with a good foundation of basic research can abnormalities in the physiological, biochemical, and morphological course of shock be recognized and the necessary conclusions for treatment drawn. Therapy must proceed from profound knowledge of the multi variant physiological events in order to influence shock, sepsis and organ failure. Although numerous possibilities for therapy have arisen from pharmaceutical research in recent years, they are beyond the scope of this book and are not discussed here. To gain a better understanding of the pathophysiological events it was necessary to examine and to describe different models that simulate and reproduce these events. Here we describe the causative agents (shock) and the consequences (sepsis, organ failure) in two main sections, divided on the basis of their pathophysiology.