Articles: sepsis.
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Fifteen critically ill patients with sepsis, 12 of whom had significant pulmonary dysfunction develop, were investigated with regard to changes in pulmonary capillary pressure, in serum oncotic pressure and on roentgenograms of the chest. It could not be shown that the pulmonary edema, which is a major characteristic of the septic lung lesion, was due to changes only in oncotic and hydrostatic pressures. ⋯ A significant relationship was found which consisted of increasing severity of the lung lesion, decreasing serum oncotic pressure and increasing pulmonary pressure. When patients with sepsis require resuscitation with fluids, the administration of moderate amounts of albumin along with monitoring of pulmonary capillary pressure appears to be a rational approach to therapy.
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To determine the pathway used for activation of complement component C3, serum levels of components C1, C4, C2, C3, C5, C6, and C9 and two properdin factors, properdin and factor B, were measured in 42 patients with gram-negative bacteremia, in 19 of whom shock subsequently developed. Mean levels of the classical components C1, C4, and C2 in bacteremic patients in whom shock subsequently developed did not differ significantly (p greater than 0.05) from those of patients with uncomplicated bacteremia. ⋯ Taken together, these findings are consistent with activation of C3 and the terminal complement sequence, C5-C9, occurring primarily by the properdin pathway, in patients with gram-negative bacteremia eventuating in shock. Biologically active products released during activation of C3-C9 may contribute to the development of shock.
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Septicemia caused by contaminated infusion fluid is a newly appreciated hazard of intravenous infusion therapy. Microorganisms of the tribe Klebsielleae (Klebsiella, Enterobacter, and Serratia) have predominated in these infections. Members of this tribe found to possess a selecive ability over common non-Klebsielleae microbial pathogens to proliferate rapidly in commerical parential fluids contaning clucose at room temperautre. ⋯ Five Candida albicans strains frew only very slowly (31.3 organisms/ml). Even with concentrations exceeding 10-6 organisms/ml, microbial presence was never visibly detectable. The significant increases in cases of nosocomial spticmia caused by Klebsiella, Enterobacter, and Serratia in recent years might be attribuatble in part to fluid-related spesis accompanying the expanding use of parenteral therapy.