Surgical infections
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Surgical infections · Jan 2003
Comparative StudySublethal hemorrhage induces tolerance in animals exposed to cecal ligation and puncture by altering p38, p44/42, and SAPK/JNK MAP kinase activation.
We have shown that SLH induces tolerance to endotoxin in vivo and in vitro, and is associated with alterations in MAP kinase (p38, p44/42, and SAPK/JNK) activation and TNF production. This study investigates the effect of sublethal hemorrhage (SLH) on cecal ligation and puncture (CLP) polymicrobial sepsis and examined the effect of the bioflavinoid, curcumin, a MAP kinase inhibitor, on this relationship. ⋯ SLH induces tolerance to CLP. This tolerance is dependent on early MAP kinase activation, since the survival benefit is reversed by curcumin. Decreases in tissue cytokine levels and neutrophil infiltration are potential mechanisms by which SLH induces tolerance to CLP (polymicrobial sepsis), attenuates acute lung injury, and improves survival.
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Surgical infections · Jan 2003
Comparative StudyLower levels of whole blood LPS-stimulated cytokine release are associated with poorer clinical outcomes in surgical ICU patients.
In vitro pretreatment of human monocytes with lipopolysaccharide (LPS) induces "endotoxin tolerance" with blunted TNF and IL-6 release to rechallenge with LPS. The pro-inflammatory cytokines TNF and IL-6 are important mediators in sepsis. A high IL-6 concentration has been used as a marker of infection severity, but IL-6 may also have beneficial effects as an acute-phase protein. We sought to address two questions: (a) What is the relationship between TNF and IL-6 release? (b) Is the clinical outcome different for intensive care unit (ICU) patients with ex vivo characteristics of endotoxin tolerance (low levels of ex vivo LPS-stimulated cytokine release)? ⋯ The data suggest that ICU patients with characteristics of endotoxin tolerance (low LPS-stimulated cytokine release capacity) have significantly poorer clinical outcomes. Ex vivo LPS-stimulated whole blood cytokine production may be useful to identify ICU patients with severe sepsis.
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Surgical infections · Jan 2003
Influence of the TNF-alpha and TNF-beta polymorphisms upon infectious risk and outcome in surgical intensive care patients.
Tumor necrosis factor-alpha (TNF-alpha) is a well-documented central inflammatory mediator in sepsis. Specific polymorphisms of the TNF-alpha and TNF-beta genes (TNF2 and LTA + 250, respectively) have been suggested to correlate with higher mortality in septic shock. This study sought to determine whether these polymorphisms of the TNF-alpha and -beta genes are associated with an increased risk of infection in an at-risk surgical intensive care population. ⋯ The presence of the A allele at these polymorphic sites did not predispose critically ill surgical patients to either infection or septic shock.
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Surgical infections · Jan 2003
Reclassification of urinary tract infections in critically ill trauma patients: a time-dependent analysis.
Successful treatment of urinary tract infections (UTIs) in the trauma ICU requires early recognition and timely, appropriate antibiotic therapy. We evaluated the incidence and microbiology of UTIs stratified by days post-admission and risk factors. ⋯ Escherichia coli was the most common pathogen in all nosocomial infection categories. Increased age, gender, and obesity, in addition to catheter-days, were significant risk factors for UTI in trauma patients. Specific risk factors may predispose patients to pathogens that are not ordinarily covered by usually-chosen antibiotic therapy.
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Surgical infections · Jan 2003
Appendicitis: selective use of abdominal CT reduces negative appendectomy rate.
Recent literature supports the use of CT for all patients with right lower quadrant pain to improve diagnostic accuracy and reduce hospital cost. Our current practice at a large teaching hospital is to use CT only for patients whose diagnosis remains in question after a thorough history, physical examination, and focused laboratory assessment. In consideration of a more liberal use of CT for right lower quadrant pain, we reviewed our experience with selective CT and the effect this has had on our practice, paying particular attention to perforation rate and negative appendectomy rate. ⋯ Selective use of CT scan in patients presenting with right lower quadrant pain is helpful in reducing the incidence of nontherapeutic appendectomy.