Journal of the Royal College of Surgeons of Edinburgh
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Sepsis and the systemic inflammatory response syndrome are common and represent a major factor in morbidity and mortality in intensive care units and the critically ill. The pathogenesis of these syndromes is becoming increasingly understood and it is hoped that this will result in improved outcome. However, novel treatments have so far failed to live up to the expectations following extensive and promising in vitro and in vivo animal studies. The aim of this review is to detail the currently used definitions of systemic inflammatory response syndrome, sepsis and septic shock and to present an overview of our current understanding of the pathophysiology which underline these conditions.
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J R Coll Surg Edinb · Dec 1997
Review Case ReportsAnaphylactic shock in a patient with ruptured hydatid liver cyst owing to trivial abdominal trauma.
A 16-year-old Libyan male was admitted to the Intensive Therapy Unit (ITU) of Zliten Central Hospital after he had been hit on the abdomen by a football, his main symptom was upper abdominal pain. The patient looked pale, was dyspnoeic and had an unrecordable blood pressure level. Abdominal examination revealed tenderness, guarding and rigidity all over the abdomen. ⋯ The patient received intravenous fluid, analgesia and oxygen by mask. Peritoneal lavage was performed and a small amount of sero-sanguineous fluid was expelled. After resuscitation measures his blood pressure rose and the patient was taken to the operation theatre for a laparotomy.
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A classification of cervical spine injuries based upon Dunn's concept of stable and unstable fractures is presented. The role of conservative treatment using Halo-body fixation is outlined along with the various approaches to the cervical spine and their method of ensuring stability.
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The metabolic response to critical illness is an integrated process producing profound changes to multiple systems. The altered metabolism of carbohydrates, lipids, and proteins in critically injured patients, and the crucial role of cytokine mediators such as tumour necrosis factor, interleukins, and interferons are described in detail. ⋯ The research on specifically enriched amino acid formulations with glutamine, branched-chain amino acids, and arginine solutions is reviewed with emphasis on both theoretical and clinical issues. The role of dietary lipids in the production of specific modulators of immunoresponsiveness and investigations focusing on metabolic modulation relating to nutritional support are summarized.