Surgical infections
-
Surgical infections · Jan 2000
ReviewMultiple organ dysfunction syndrome: past, present and future.
In the past, our approach to multiple organ failure in the injured or critically ill surgical patient was driven by attempts to simplify a complex process. Early studies focused on uncontrolled invasive infection (sepsis) as the driving force of multiple organ dysfunction syndrome (MODS). However, some patients with adequately controlled infection and those without sepsis nevertheless develop MODS and signs of systemic inflammation. ⋯ A new paradigm suggests that, in the critically ill patient at risk for organ failure, an integrated process propagates an excessive systemic inflammatory response and/or an inadequate compensatory anti-inflammatory response. Future studies should examine the balance between these two processes at the level of the individual patient with organ failure. Careful stratification of individual patient responses to inflammatory stressors may be an essential step for creating better strategies for therapeutic interventions that can restore balance between the pro-inflammatory and anti-inflammatory processes in the critically ill patient and possibly prevent organ failure.
-
Surgical infections · Jan 2000
Biography Historical Article Classical ArticleEffect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. 1973.
-
Surgical infections · Jan 2000
ReviewMolecular biology of multiple organ dysfunction syndrome: injury, adaptation, and apoptosis.
Injury will equal or surpass communicable disease in the year 2020 as the number one cause of lost disability-adjusted life-years worldwide. The major cause of "late death" after trauma is organ dysfunction, commonly as a complication of shock or sepsis. The pathophysiology of injury-induced organ dysfunction is poorly characterized but has been linked to systemic inflammation as a result of infection (either obvious or occult) or massive tissue injury (systemic inflammatory response syndrome, SIRS). ⋯ We hypothesize that a complete understanding at the molecular level of the stress responses induced by injury will aid in the development of therapeutic strategies for treating MODS in the critically ill surgical patient. This paper reviews recent data from our Cellular Injury and Adaptation Laboratory relevant to our understanding of MODS pathophysiology, particularly as it relates to stress-induced cell death by apoptosis. Our data suggest that inhibition of stress-induced apoptosis may improve survival after severe injury.
-
Multiple organ failure (MOF) is currently the most common cause of late death after injury and surgery. The pathogenesis of MOF remains incompletely understood but in all likelihood results from a combination of dysregulated balance between inflammatory response and immune function, maldistribution of microcirculatory blood flow, and ischemia/reperfusion injury. ⋯ However, as recent clinical trials have shown, studies demonstrating an improvement in outcome from use of these therapeutic agents are difficult to design. The purpose of this article is to discuss the evolution, clinical course, and pathogenesis of MOF, to attempt to better define and quantitate MOF, and to describe recent studies aimed at identifying an at-risk study population for improved treatment and prevention strategies for MOF.
-
Surgical infections · Jan 2000
Comparative StudySurgeons and infectious disease specialists: different attitudes towards antibiotic treatment and prophylaxis in common abdominal surgical infections.
The role of medical infectious disease (ID) specialists in the treatment of surgical infections is increasing but no information is available regarding the therapeutic perception held by these non-surgeons treating surgical infections. The purpose of this study was to assess the attitude of the ID specialists towards antibiotic treatment and prophylaxis of common abdominal surgical infections and to compare it with that of surgeons "interested" in this field. ⋯ Medical ID specialists may overtreat common surgical infections with antibiotics. Surgical infections should be treated by surgeons.