Articles: sepsis.
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Comparative Study
The role of septic complications in aortic aneurysm surgery.
Out of 229 patients operated due to abdominal aortic aneurysms, 51 (22.3%) had prolonged (> 120 hours) postoperative intensive care stay. The mortality rate in this group was 27% representing 46% of the total mortality. ⋯ Reoperations, time for ventilatory support, incidence of renal failure and dialysis, gastrointestinal complications and mortality were all frequent in patients with septic postoperative complications as compared to those with non-septic complications, the latter mainly of cardiovascular origin. Signs of organ dysfunction should raise a suspicion of a septic complication and prompt insertion of diagnostic procedures and therapeutic interventions are necessary in order to minimize morbidity and mortality.
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To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients. ⋯ The attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden.
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The effects of administering total parenteral nutrition (TPN) supplemented with the dipeptide of L-alanyl-L-glutamine (Ala-Gln) on gut structure, barrier function, and protein metabolism were investigated in septic rats. Sepsis was induced by the continuous intraperitoneal administration of endotoxin via a miniosmotic pump. Twenty-three rats were divided into two groups and fed parenterally for 5 days. ⋯ The intestinal mucosal weight and villous height were significantly greater in the Ala-Gln group than in the control group. Pathological derangement of the mucosal structure was more marked in the control group than in the Ala-Gln group. These results suggest that TPN supplemented with Ala-Gln preserves the gut structure without decreasing the nitrogen balance under septic conditions.
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Clinical Trial Controlled Clinical Trial
Repeated administration of a F(ab')2 fragment of an anti-tumor necrosis factor alpha monoclonal antibody in patients with severe sepsis: effects on the cardiovascular system and cytokine levels.
In an uncontrolled clinical trial the effects of repeated administration of the F(ab')2 fragment of a murine monoclonal anti-tumor necrosis factor alpha (TNF alpha)-antibody (MAK 195F) on cytokine levels and the cardiovascular system were studied in 20 patients with severe sepsis. Patients were treated with a total of 11 single dosages of the anti-TNF alpha-antibody intravenously over 5 days using either 1 mg/kg (n = 10) or 3 mg/kg (n = 10). ⋯ Comparison of our data with recent data from phase I or II trials using a complete murine monoclonal anti-TNF alpha-antibody suggest that the F(ab')2 fragments of the murine monoclonal anti-TNF alpha-antibody may be of similar efficacy. Definitive conclusions, however, with respect to improvement of mortality and improvement of the cardiovascular system, await the results of larger ongoing placebo-controlled trials.