Articles: sepsis.
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Sepsis, shock, and resuscitation may result in various degrees of ischemia-perfusion injury that may produce widespread organ dysfunction through complex interactions and activation of host immunoinflammatory processes. As the pathophysiologic mechanisms of the inflammatory response are better defined, we may be able to modulate the generalized inflammatory state we know as sepsis and prevent the development of multiple organ failure syndrome. At present, however, the mainstay of therapy remains prompt resuscitation to eliminate regions of hypoperfusion and to limit as much as possible those factors that predispose to further organ injury while the source of inflammatory stimulation is being identified and controlled.
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Enferm. Infecc. Microbiol. Clin. · Aug 1991
Comparative Study[Usefulness of blood cultures from central venous catheters in the diagnosis of infection of the catheter tip].
Central venous blood cultures, obtained through catheters have been used for diagnosis of tip infections. We prospectively studied in a consecutive way two blood culture techniques. In a group of 23 cases, the first 5 ml of catheter solution was discarded, and in the second group of 41 cases the first 10 ml of catheter solution and blood were used. ⋯ Test validation showed for all cases, first and second groups respectively: sensitivity 60%, 50% and 62.5%; specificity 91.1%, 100% and 94.7%; positive predictive values 94.1%, 100% and 93.8%; negative predictive values 73.3%, 85% and 64%. This study had a limited utility in the diagnosis of central venous catheter tip infections. Our results show that the most sensitive technique is culture of initial samples obtained through the venous access, and that a cut-off lower than those used in previous studies should be used.
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A case of massive haemolytic anaemia in the course of a C. perfringens sepsis of hepatic origin is presented. The diagnosis was strongly suggested by the presence of intragranulocytic capsulated bacilli in a Giemsa stained peripheral blood smear. ⋯ The outcome was fatal and the patient died eight hours after admission. We review the aetiopathogenesis, diagnosis and therapy of haemolysis in Clostridium perfringens infections.
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Multicenter Study Clinical Trial
Supplemental immunoglobulin (ivIgG) treatment in 163 patients with sepsis and septic shock--an observational study as a prerequisite for placebo-controlled clinical trials.
In a multicenter observational study of 163 medical and surgical patients with a total of 173 episodes of sepsis or septic shock (Elebute sepsis score: 19.0 +/- 0.5), the effects of supplemental i.v. immunoglobulin (i.v. IG) treatment (unmodified polyvalent IgG pH 4.25, n = 123; for Pseudomonas sepsis, n = 50, Pseudomonas IgG) on multiple organ failure (MOF) were investigated by means of APACHE II score changes (pretreatment: 23.7 +/- 0.6). In 44% of the cases ("responders"), a prompt improvement in APACHE II score (defined as decrease greater than or equal to 4) was evident from day 0 to day 4 after onset of therapy, thus being in close time relationship to the i.v. ⋯ In a small-sized second comparative nonrandomized control group (n = 27, antibiotic treatment alone) of septic patients (Elebute: 14.7 +/- 1.0) with similar MOF severity (APACHE II: 23.6 +/- 1.4), the response rate (30%) was, though not statistically significant, lower by one-third. The optimal baseline score ranges for patient inclusion into future placebo-controlled randomized i.v. IG trials were found to be 20-35 for the APACHE II score and 12-27 for the Elebute score.