Nihon rinsho. Japanese journal of clinical medicine
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We outline the epidemiology of the systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis among intensive care unit (ICU) patients in Japan. One survey conducted in the ICU of a university hospital suggested that the prevalence of SIRS reached 84% among all ICU patients, and that about 8% of patients with SIRS progressed to severe sepsis. ⋯ Moreover, a graded severity was noted from SIRS to sepsis and severe sepsis, with total in-hospital mortality of 6%, 20% and 63%, respectively. Thus, every effort should be made to decrease the risk of sepsis in ICU patients.
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The concept of systemic inflammatory response syndrome (SIRS) was introduced in 1992 to define and objectively diagnose sepsis. Over the last decade, the definition of sepsis has been used for inclusion criteria of multicenter trials to develop innovative therapies of sepsis. With the recent understanding of the pathogenetic mechanisms of sepsis, many drugs have been tested, but only two drugs (activated protein C and neutrophil-elastase inhibitor) have been approved for clinical use in sepsis or SIRS. Further understanding of basic pathophysiology of SIRS and sepsis holds promise to develop a new therapeutic strategy to improve survival of patients with SIRS and sepsis.
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Severe acute pancreatitis is a disease associated with high mortality, causes of which are multiple organ failure(MOF) in the early course and the development of bacterial infections in the later course. Inflammatory response leading to organ failure continues to be one of the major problem after acute pancreatitis. ⋯ We have to clarify the mechanism of immunological suppression in the development of bacterial infections in severe acute pancreatitis. It is important that the elucidation of key mediators in MOF and the mechanism of immune suppression in the development of bacterial infection could be improved by the prognosis of severe acute pancreatitis.
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Acute pancreatitis is a disease with a wide variety of pathophysiologies, ranging from mild to severe condition. In about 80% to 90% of cases, acute pancreatitis presents as a mild inflammation with low morbidity and mortality, self-reversing to normal condition within 3-4 days. However, the natural course of severe pancreatitis progresses into SIRS and necrosis of the pancreas and its surrounding tissue. ⋯ For those events, the evidences were collected by a systemic search of MEDLINE and Japan Centra Revues Medicina. And then practical recommendations were also graded and introduced to provide a framework for clinitians to manage acute pancreatitis as a guideline. This paper described a part of those recommendations.