Surgical infections
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Surgical infections · Jan 2001
Comparative StudyHemorrhagic shock resuscitation with a low molecular weight starch reduces neutrophil-endothelial interactions and vessel leakage in vivo.
The polymorphonuclear neutrophil (PMN) has been implicated in the pathogenesis of endothelial cell (EC) damage and organ injury following hemorrhagic shock. Pentastarch (PTS), a low substituted medium molecular weight (MW) colloid, improves hemodynamics in hypovolemic shock and cardiac surgery. No data exist comparing the immunomodulation of PTS and Ringer's lactate (RL) on the activation of PMN in hemorrhagic shock in vivo. ⋯ 10% pentastarch reduces RL-associated EC-PMN interactions and vessel leakage following hemorrhagic shock. These results support the use of low MW starches to resuscitate hemorrhagic shock, potentially reducing PMN-mediated tissue injury.
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Surgical infections · Jan 2001
Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection.
It is well documented that tertiary peritonitis is associated with different microbiological flora and worse outcomes than secondary peritonitis. It is unknown, however, if these differences can be explained simply by the nosocomial nature of tertiary peritonitis and underlying severity of illness. ⋯ We were unable to demonstrate, when compared to secondary peritonitis, that tertiary peritonitis is a significant independent predictor of mortality when other variables are taken into account. This suggests that the high mortality associated with tertiary peritonitis is more a function of the patient population in which it occurs than the severity of the pathologic process itself.
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Surgical infections · Jan 2001
Catheter materials affect the incidence of late blood-borne catheter infection.
Adherence of bacteria and subsequent catheter-related infections (CRI) are greatly enhanced by the fibrin sheath that develops on indwelling catheters. Since the infection rate of catheters without fibrin sheaths is low and the fibrin sheath mediates bacterial adherence, catheter material is not thought to affect the incidence of late catheter-related infection. ⋯ Catheter material does affect the incidence of catheter-related infection even when catheters are coated with a fibrin sheath. This difference may relate to a difference in the fibrin sheath itself as it forms on different catheter materials.
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Surgical infections · Jan 2001
ReviewNitric oxide synthase inhibition as therapy for sepsis: a decade of promise.
Inhibition of nitric oxide synthase (NOS) has held promise as a novel and important therapeutic target for sepsis for over a decade. However, the question as to whether an inhibitor of NOS will prove to be efficacious in human septic shock remains unanswered. ⋯ A better understanding of the effects of NOS and its inhibitors is needed as is an understanding of the underlying pathophysiology of sepsis. Moreover, a nontoxic, short-acting, titratable, specific inhibitor of NOS2 has yet to be identified and tested. Until then, efforts should be designed to describe more completely the role of NO in the pathophysiology of sepsis.