Läkartidningen
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There are some sex differences in the perception of defined noxious stimuli, with females being more sensitive than males in both rodents and humans. Using imaging techniques gender differences of the brain were recently demonstrated in neurophysiological response and pain perception to heating of the skin. ⋯ Since the details of the mechanisms which govern the biological differences between the sexes in health and disease are largely unknown there is scope for additional studies. It is anticipated that such research will reveal new important gender related data which will elucidate the background to a number of ailments and contribute to the development of better and/or quite new treatments of different patients, e.g. patients with chronic pain syndromes.
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Anaemia is common in intensive care and its causes multifactorial. Blood transfusion is not without risks and the efficacy of stored blood to increase tissue oxygenation has been questioned. ⋯ There is also evidence for a benefit with the use of leucocyte reduced transfusions. With exception for patients with ongoing bleeding, instabile angina, myocardial infarction or COPD during weaning, a restrictive regime with a haemoglobin concentration between 70-90 seems to be without risks.
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Human recombinant activated protein C (Xigris) represents a new concept in adjuvant therapy for patients with severe sepsis. In the large randomized controlled trial on which the registration is based, 28 day mortality was significantly reduced by 6.1% from 30.8% in the placebo group to 24.7% in the treatment group. ⋯ Until further data becomes available from ongoing studies, we recommend that treatment be restricted to those patients for whom benefit has been shown in the clinical trial, i.e. adult patients with septic shock and at least one additional sign of organ dysfunction as defined in the study. Patients with septic organ dysfunctions with a longer duration than 24 h were not evaluated in the study.
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Comment Review
[Septic shock--a condition with great potential for improvement. Management and therapy].
There is a recent focus upon treatment of septic shock, related to the publication of a number of interesting studies during the last two years. These studies indicate that patient outcome can be improved, provided care is organized so as to optimize and expedite initial treatment of the patient in septic shock. ⋯ These "new" therapies are presented in a total context with a temporal perspective. It is suggested that emergency sepsis teams be instituted at hospitals.