Abstract. This study was performed on patients (n = 18) suffering from strictly defined hyperdynamic septic shock. Plasma faclors (C-reactive protein, acid al-glycoprotein, fibri nogen, fibrinopeptide A, fibrinogen-fibrin split products, factor XIII, antithrombin III, complement factors C3 and C4, interet-trypsin-inhibitor and CtrmacrogJobulin) measured during hyperdynamic septic shock were highly abnormal. The actjvation and consumption of dotting, fibrinolytic and complement factors due to systemspeeific proteinases (such as thrombokinase or plasminogen aetivators) seemed to be intensified by the nonspecific proteolytic activity of granuloeytic proteinases probably released by the action of endotoxins. Possible therapeutie measures {o maintain the endogeneous defenee meehanism against enhaneed proteolysis during septic shoek are diseussed.

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Endotoxemia in dogs was induced by a slow intravenous infusion of E. coli endotoxin for 2 h. Thereby, a significant decrease was observed in the plasma levels of several clotting, fibrinolysis and complement factors. The changes were studied over an experimental period of 14 h and checked for statistical significance by three-way analysis of variance. Application of the broad-spectrum proteinase inhibitor aprotinin (Trasylol®) from bovine organs clearly lowered the endotoxin-induced decline of the plasma proteins studied. By intravenous application of a specific granulocytic proteinase inhibitor (Bow-man-Birk inhibitor from soybeans), the endotoxin-induced reduction of the plasma proteins was prevented in a similar manner. It can be concluded that at least some of the pathobiochemical mechanisms observed in clotting, fibrinolysis and complement systems during endotoxemia are not only caused by a severe consumption reaction but also by unspecific proteolytic degradation due to neutral granulocytic proteinases.

Chylous ascites, due to a lymphangiomyomatosis and resistant to conservative therapy, occurred in a 30 year-old female. A distinct subjective and clinical improvement could be attained with the aid of a peritoneo-venous anastomosis employing a Denver-Shunt. With the preconditions that the implantation is correct and that it is reliably managed, we regard the Denver-Shunt system as a recommendable approach to the treatment of chylous ascites not controllable by conservative measures.

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