Articles: sepsis.
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Mayo Clinic proceedings · Oct 1994
Case ReportsThe clinical spectrum of critical illness polyneuropathy.
To describe the entity of critical illness polyneuropathy and review our experience with six cases. ⋯ Polyneuropathy in critically ill patients may be a cause of severe generalized limb weakness and occurs in the setting of a sepsis syndrome. The long-term outcome is good in patients who recover from the underlying critical illness. Compression neuropathies may be a cause of permanent sequelae.
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Critical care medicine · Oct 1994
Relationships between plasma cytokine concentrations and leukocyte functional antigen expression in patients with sepsis.
To determine the relationships between cytokine concentrations and alterations in leukocyte functional antigen expression in sepsis. ⋯ These findings suggest that the expression of specific functional molecules on peripheral blood leukocytes is variably related to the net production of certain monokines in sepsis.
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The purpose of this study was to determine the mortality rate in 527 critically ill patients with multiple organ failure (MOF), treated in our ICU between August, 1986 and January, 1992, and to compare it with the results obtained in a group of patients studied who had been treated between October, 1978 and July, 1986. The relationship between the mortality rate and each type of organ failure and the extent of organ system involvement was also investigated. ⋯ The mortality rate of patients with the failure of two organs in the present study was significantly lower than that found in those in the previous study. Although artificial organ mechanical life support technology other than that for patients with renal failure is still unsatisfactory, these results suggest that the prognosis of patients with MOF is improving.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Role of interleukin-1 and the therapeutic potential of interleukin-1 receptor antagonist in sepsis.
Clinical trials of anticytokines in sepsis have not been as straightforward as had been anticipated from results in animal models of sepsis and the role of cytokines in sepsis is now in question. Retrospective analysis of the results of a phase III trial of interleukin-1 (IL-1) receptor antagonist suggests that sepsis-induced adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), renal dysfunction, and shock are valuable markers of patients in whom IL-1 is a pathogenic mediator and in whom IL-1ra can reduce mortality. A re-examination of the effects of IL-1ra in animal models of sepsis supports the validity of this analysis. A new phase III clinical trial will confirm or disprove the hypothesis that IL-1 is a mediator of pathology, and IL-1ra is a valuable therapy for sepsis complicated by ARDS, DIC, renal dysfunction, or shock.
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In part 2 author pays attention to new findings on treatment of sepsis and septic shock. He emphasizes facts which are of immediate importance for clinical practice and therapy. Possibilities of immunomodulating therapy (monoclonal antibodies, immunoglobulins) are described in detail.