Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego
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Pol. Merkur. Lekarski · Jun 2000
Review[Disturbances of the neurohumoral regulation in patients in critical illness and post-resuscitation period].
Cardiac arrest (CA) is an extreme stressful situation accompanied by impairment of hypotalamichypophyseal axis resulting from many reasons, specially when cardio-pulmonary resuscitation (CPR) has been delayed or prolonged. The author compares dysfunction of the neurohormonal system, including the release of hypophyseal and adrenal hormones, atrial natriuretic hormone and endothelin in patients in critical illness as well as in those after cardiac arrest. Associated consequences for the maintenance of homeostasis in postresuscitation period have also presented.
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Pol. Merkur. Lekarski · Jan 2000
Review[The role of cytokines and reactive oxygen species in the pathogenesis of sepsis].
The role of cytokines and reactive oxygen species (ROS) in multiple and not fully explained pathogenesis of sepsis was presented. Close attention was paid to the contribution of inflammatory cytokines (TNF-alpha, IL-1, IL-6, IL-8) to the enhanced phagocyte-derived oxidative metabolism and the activation of respiratory burst. The pleiotropic interaction of these and the other cytokines creating so-called cytokine network was described, among other things in order to express the phagocytic and endothelial receptors. ⋯ The key role of ROS generated by the activated phagocytes during sepsis has been outlined; it is proposed that the hypermetabolic response to sepsis results from enhanced ROS generation and so-called oxidant stress is a consequence of the imbalance between their generation and detoxification. The consequences of the action of oxygen free radicals resulting in lipid peroxidation followed by host auto-injury were also described. At the end a possibility of immunotherapy of sepsis connected with the application of pentoxifylline (PTXF) as TNF-alpha inhibitor was recommended to take into consideration.
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Pol. Merkur. Lekarski · Dec 1999
Biography Historical Article[Heliodor Swiecicki: precursor of anesthesia with nitrous oxide in obstetrics].
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Procalcitonin (PCT), a 116 amino acid prohormon of calcitonin, is a novel diagnostic marker of severe bacterial infection. The aim of the study was to evaluate the diagnostic usefulness of serum procalcitonin concentration in severely sick patients admitted to the department of internal diseases. Fifty one patients were included into the study and divided into two groups: group A--36 severely sick patients with different medical problems without signs of bacterial infection; group B--15 patients with severe bacterial infection (sepsis--7 patients, pneumonia--6, pyelonephritis--1, peritonitis--1). ⋯ Serum PCT concentration measured by immunoluminometric assay was undetectable or low in control group (range 0.0-0.1 ng/ml) and group A (range 0.0-1.8 ng/ml). In group B (range 0.0-183 ng/ml) markedly elevated PCT levels were observed in all patients with sepsis, peritonitis and some patients with pneumonia. We conclude that high serum PCT level support the diagnosis of severe bacterial infection.
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Pol. Merkur. Lekarski · Nov 1999
Clinical Trial Controlled Clinical Trial[Clinical evaluation of amino acid solution].
Glutamine, a conditionally essential amino acid, is important for immune function. It is now being formulated for incorporation in to total parenteral nutrition (TPN). The aims of this study were to examine the effect of glutamine administration on clinical status, body composition, protein synthesis and immune function in critically ill patients with sepsis. ⋯ Patients receiving amino acid solution revealed improved nitrogen balance, body composition and body water distribution. Plasma proteins concentrations and immunological indices significantly increased during ten days TPN with Glamin. We confirm the beneficial effects of amino acid solution-supplemented TPN on nitrogen balance, plasma proteins, and immune status of critically ill patients.