Clinical and experimental studies of the limulus test after digestive surgery

A chromogenic limulus test (Toxicolor test) revealed a transiently increased blood endotoxin level in some patients after digestive surgery. However, most showed no clinical signs of endotoxemia. The Endospecy test of these specimens, which reacts specifically with endotoxin, did not show a high value, while the Gluspecy test, which reacts specifically with (1-->3)-beta-D-glucan (glucan), did. These findings thus suggested that the gauze used for surgery contains a large amount of glucan. The intraperitoneal injection of this gauze-saline into rats results in a phenomenon similar to that observed in clinical studies. These findings suggested the involvement of substances other than endotoxin such as glucan in the postoperative positive-Toxicolor phenomenon. In addition, the Toxicolor test also showed a higher value in patients with liver cirrhosis than in those without. In an experimental study in rats, the liver cirrhosis group also showed a significantly high value. These results therefore suggest that the glucan clearance mechanism is impaired in the reticuloendothelial system in liver damage such as cirrhosis.