Alterations in function and phenotype of monocytes from patients with septic disease--predictive value and new therapeutic strategies.

Recently we described the predictive value of the proportion of HLA-DR+ peripheral blood monocytes for the clinical outcome of septic disease in immunosuppressed patients (allograft recipients) and surgical patients mostly with peritonitis as septic focus (following perforation of gastrointestinal tract). The experiments described here show that the loss of HLA-class II antigen expression and other phenotypical abnormalities of monocytes from septic patients with fatal outcome are associated with functional defects (antigen presentation, formation of reactive oxygen species, cytokine secretion). The picture of phenotypical and functional defects of monocytes was termed "immunoparalysis" (leading parameter: loss of HLA-DR antigen expression less than 20%).

[Prognosis of acute dialysis dependent renal failure].

In a retrospective study of 116 patients with acute renal failure treated by hemodialysis the prognostic value of various clinical data was evaluated by discriminant analysis. With a letality of 73.6% the patient survival was dependent on the frequency of associated organ disorders.

[Factors influencing the duration of function of arteriovenous vascular anastomoses in hemodialysis].

The function of an arterio-venous vascular access is influenced by vascular material, hemodynamics, blood coagulation and technique and number of punctures. By careful intraoperative handling, optimal postoperative care and treatment of the vascular access during and after hemodialysis the functional duration may be influenced effectively. The technique of puncture, the puncture cannula and the skill of the "puncture" are of great importance.