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During sepsis, lipopolysaccharide released by gram-negative bacteria induces activation of inflammatory pathways resulting in organ dysfunction and failure. Extracorporeal therapies that remove this molecule and support organ function are useful in critically ill patients in ICUs. Today, blood purification therapies such as high-volume hemofiltration, polymyxin B hemoperfusion, and coupled plasma filtration adsorption are easy to perform. According to the reconciliation of the three sepsis theories and thanks to the removal of lipopolysaccharide (the first inflammatory stimulus) from the blood, we can provide an effective and useful extracoporeal therapy for this clinical condition.

Adrenomedullin (AM), inducing a potent and powerful hypotensive activity caused by dilatation of resistance vessels, has elicited interest for its cardiovascular actions. AM is secreted from various cell type, including vascular endothelial and smooth muscle cell. AM plasma levels are increased in various cardiovascular diseases as heart failure and hypertension and may be involved in pathophysiological changes in cardiovascular diseases.

The sepsis is a bacterial invasion of the organism producing many manifestations which are able to amplify themselves. In the United States of America there are 100,000 death per year and the incidence is among 300,000-500,000 cases. The major surgery in the elder (especially if it is in emergency) has a great percental of risk because the preoperative study isn't often complete. Fever, agitation, panting, bullation, abdominal splinting, enteroplegia, are signals of evolving inflammatory situation. Moreover there are disorders of biochemical values: leukocytosis, thrombocytopenia, increased levels of VES, PCR, amylase and biliribinaemia. The more common radiological examinations are the straight radiography of abdomen and horax, abdomen ultrasonography, CT or MRI. In the last years pro-calcitonin, interleukin-6 , C-reactive protein, and nitric oxide from endothelial and muscularis cells have been evaluated as prognostic factors in the septic shock.

The paper describes a case of meningococcal sepsis and septic shock treated with Ceftriazone, Dexamethosone, plasma and heparin. It was observed that contrary to other hematological parameters, ESR levels remained high for one month after the suspension of antibiotic therapy and complete clinical recovery. The authors relate this alteration of ESR values to the administration of plasma during the acute phase of the disease.

After a short notice on the relations between the endotoxine and lipydic metabolism the AA. refer on the inquiry on 60 animals divided in three groups according to the dosis of the injected endotoxin. The dosis were 0.010-1-5 mg of the lypopolisaccaride from E. coli O-127; seven animals were appointed as controls. In the all animals were examined proofs of blood after 4, 12, 24, 36, 48, 60 and 72 hours from the start of experience. The total lipids, the triglycerides, the phospholypids, the NEFA, the free and esterified cholesterol were doses. The data of lethality and the value of determinations of the single fractions obtained were registered. In the all experienced animals, independently from the injected dosis, an independently from the injected dosis, an increase of the lypidic fractions was remarked: the free fatty acids were the first to rise, suived by triglycerides and phospholypids and denn by the two fractions of cholesterol. The highest dosis of endotoxine have comported a blok in the esterification of cholesterol. This early and persistent hiperlypemie can be caused initially by increased incretion of catecolamine.

After an short bibliographic records in the relation between the endotoxine and lipydic metabolism, the AA. expose an inquiry on the rabbit. Ten rabbits (weight 2500-3000 g) were traited with 10 U.E. (haemolitic units) of streptococcal toxine (1/10 of DL50 for the rabbit). A conspicous increase of all the fractions examined, was remarked in all traited animals. The total lipids and the triglycerides reached the biggest value at 24 hours. Even the two fractions of cholesterol have increased, but the biggest concentration was at 48 hours. An hypotesis of interpretation can be that the streptococcal toxine produce the modification of lipidemic outline with the iperincretion of catecolamine, as in first phase of all toxinfections processes.

The AA. have studied the effects provoques by alpha staphylococcal toxin in the lipidemic panel of the rabbit. Of 15 rabbits, five were injected with 0.25 emolitic units (U.E.) five with 1 U.E. and five ad control. The blood from heart was frequently with drawed and examined. In the animals traited with lowest dosis of toxin, the two fractions of cholesterol have increased with the maximum at the last control (96 hours). With a quadruple dosis of toxin increased also the total lipids and triglyceridis with the maximum at 48 hours. Remarked after all the different behaviour of the two fractions of cholesterol at the various dosis. The AA. conclude that the staphylococcal toxin provoque at low dosis only the modification on the cholesterol but at greater dosis also of the triglycerids and phospholipidis.