Tumor necrosis factor-alpha (TNF-alpha) has been implicated in the pathophysiology of the systemic inflammatory response syndrome (
- Dinarello C.A
- Gelfand J.A
- Wolff S.M
Anticytokine strategies in the treatment of the systemic inflammatory response syndrome.
JAMA. 1993; 269: 1829-1835
2). This syndrome is often associated with acute hepatic failure, in which TNF-alpha has also been reported to play a central role (
- Davies M.G
- Hagen P.-O
Systemic inflammatory response syndrome.
Br J Surg. 1997; 84: 920-935
3). The systemic use of TNF-alpha in cancer patients is limited by the high incidence of side effects, whereas the therapeutic effect of acceptable doses remains poor (
- Wang J.H
- Redmond H.P
- Watson R.W
- Bouchier-Hayes D
Role of lipopolysaccharide and tumor necrosis factor-alpha in induction of hepatocyte necrosis.
Am J Physiol. 1995; 269: 297-304
4). Only with TNF-alpha perfusion of isolated limbs is there both a good tumor response and tolerable systemic side effects after intensive wash-out of the TNF-alpha (
- Frei E
- Spriggs D
Tumor necrosis factor still a promising agent.
J Clin Oncol. 1989; 7: 291-294
5). Isolated liver perfusion with TNF-alpha is under investigation for the treatment of unresectable liver tumors (
- Eggermont A.M.M
- Koops H.S
- Klausner J.M
- et al.
Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas.
Ann Surg. 1996; 224: 756-765
6). Eight isolated liver perfusions with TNF-alpha have been performed at our institution. We describe our experience with a unique case of accidental high TNF-alpha release into the systemic circulation after insufficient wash-out.
- Fraker D.L
- Alexander H.R
- Thom A.K
Use of tumor necrosis factor in isolated hepatic perfusion.
Circ Shock. 1994; 44: 45-50
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- Anticytokine strategies in the treatment of the systemic inflammatory response syndrome.JAMA. 1993; 269: 1829-1835
- Systemic inflammatory response syndrome.Br J Surg. 1997; 84: 920-935
- Role of lipopolysaccharide and tumor necrosis factor-alpha in induction of hepatocyte necrosis.Am J Physiol. 1995; 269: 297-304
- Tumor necrosis factor.J Clin Oncol. 1989; 7: 291-294
- Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas.Ann Surg. 1996; 224: 756-765
- Use of tumor necrosis factor in isolated hepatic perfusion.Circ Shock. 1994; 44: 45-50
Published online: August 16, 2004
Accepted: June 8, 1998
Received in revised form: June 8, 1998
Received: April 6, 1998
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.