Arch Surg Chicago
-
Comparative Study
Multiple-organ failure. Generalized autodestructive inflammation?
As multiple-organ failure (MOF) has been generally associated with sepsis, the importance of bacterial sepsis was evaluated retrospectively in 55 trauma and 37 intra-abdominal-sepsis patients with MOF. The severity of MOF was graded, and an analysis was made of day of onset, incidence, severity, sequence, and mortality of organ failures. ⋯ It is concluded that sepsis is probably not the essential cause of MOF. Instead, an alternative hypothesis is presented involving massive activation of inflammatory mediators by severe tissue trauma or intra-abdominal sepsis, resulting in systemic damage to vascular endothelia, permeability edema, and impaired oxygen availability to the mitochondria despite adequate arterial oxygen transport.
-
In each of four patients with suspected thoracic outlet syndromes, the transaxillary approach to resection of the first thoracic and cervical ribs resulted in severe and permanent damage to the brachial plexus. The most severe sequela was causalgia. ⋯ Two patients suffered severe psychological depressions, with one committing suicide. Current enthusiasm with transaxillary rib resections in cases of thoracic outlet syndrome should be tempered by the possibility of severe and permanent injury to the brachial plexus and intractable causalgia.