Articles: sepsis.
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Clinical and experimental evidence confirms that delivery of nutrients via the gastrointestinal tract reduces septic morbidity in critically injured patients. Early enteral feeding seems to maintain mucosal integrity and to support the gut as an important immunologic organ that may affect other areas of the body. There is increasing evidence to suggest that specific nutrients are especially beneficial in maintaining intestinal host-defense function in times of critical illness and injury.
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Septic shock is the major cause of treatment-related death in patients with acute myelogenous leukaemia (AML) undergoing intensive chemotherapy. Interleukins (IL)-1 beta, -6, -8, and tumour necrosis factor alpha (TNF-alpha) have been implicated as mediators of septic shock, with circulating leucocytes being considered a major source for their release. However, plasma cytokine levels of leucocytopenic patients with evolving sepsis have not been studied. ⋯ IL-1 beta was detected in less than 5% of all samples. Cytokine concentrations were unrelated to leucocyte counts and markers of neutrophil or monocyte activation (elastase and neopterin levels, respectively). We conclude that cytokine release associated with evolving septic shock in patients with AML does not depend on circulating leucocytes.
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Meningococcal septicaemia is a severe systemic illness which has an overall mortality of 15 per cent. It differs from meningococcal meningitis in clinical presentation, treatment, complications and prognosis. Skin and extremity loss are particular problems seen in meningococcal septicaemia. ⋯ We also discuss some of the pathophysiology behind skin necrosis. A popular view at present is that endotoxin from the cell wall of Neisseria meningiditis initiates the release of vasoactive cytokines by the host. High levels of interleukin-1 and interleukin-6 have been associated with a greater likelihood of fatality.