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We have developed an extracorporeal hemoadsorption cartridge, the PMX cartridge, to eliminate endotoxin from peripheral blood circulation. As an adsorbent, a polymyxin B covalently immobilized fiber (PMX-F) was developed. After the optimization of the condition of immobilization, fixed polymyxin B maintained its ability to adsorb endotoxin and its bactericidal activity. PMX-F could detoxify many kinds of endotoxin in vitro. Fixed polymyxin B was estimated to interact with the lipid A portion of endotoxin. Utilization of fibrous adsorbents enabled us to design the PMX cartridge with a large surface area and low blood pressure drop in the blood flow compartment and to apply it safely to the direct hemoperfusion procedure. In Japan, the PMX cartridge is now being clinically applied as one of the therapeutical interventions for sepsis, septic shock, and septic multiple organ failure. In multicenter clinical studies, the blood endotoxin level has been significantly decreased. Accompanied with elimination of endotoxin, hemodynamic abnormalities such as low blood pressure and low systemic vascular resistance were significantly improved. In more recent multicenter studies, the average number of failed organs; severity of illness score, such as Goris score; and vasopressor dosage were significantly decreased. The PMX cartridge is expected to be effective in the intervention for the treatment of septic shock. Endotoxin may be one of the therapeutical targets for the treatment of sepsis.

Early postoperative evaluation was prospectively performed in 35 gastric cancer patients after pylorus-preserving gastrectomy (PPG) between 1989 and 1991, comparing the results with those of 29 patients who underwent conventional distal gastrectomy (CDG). Surgical stress, including the duration of operation (149.0 +/- 4.3 minutes) and the total volume of bleeding at operation (97.0 +/- 11.2 g), was significantly less in the PPG patients. Early postoperative complications were seen in 31% after PPG and in 35% after CDG. The most frequent complication in PPG patients was remnant gastric stasis (23%). Endoscopy showed redness or erosion (or both) of the gastric remnant in 17% after PPG and in 81% after CDG. Bile regurgitation was demonstrated in 11% after PPG and in 62% after CDG. In PPG patients, the pyloric ring opened and closed during the examination. Gastric pH was 4.2 +/- 0.4 in PPG patients but was significantly lower in CDG patients. The resting gallbladder area, examined by ultrasonography, demonstrated no changes after PPG but was significantly enlarged after CDG (from 11.3 +/- 1.2 cm2 to 15.8 +/- 1.5 cm2 at 2 weeks). The percentage of the original resting gallbladder area at 20 minutes after injection of cerulein increased slightly in PPG patients but recovered thereafter, whereas in CDG patients it increased significantly (from 39.4 +/- 8.3% to 66.7 +/- 9.1% at 2 weeks). No gallstone formation was detected throughout the observation period after PPG, whereas after CDG it was detected in two patients at 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)