Articles: sepsis.
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 1985
Comparative Study Clinical Trial Controlled Clinical TrialFibronectin and other DIC-related variables in septic ICU patients receiving cryoprecipitate.
In a controlled study of fibronectin supplementation in sepsis, 11 ICU patients in septic shock were scheduled to receive either cryoprecipitate from 20-40 donors (n = 6) or 250-300 ml of stored plasma (n = 5) (two infusions over 24 h). We wanted to: compare some "conventional" DIC variables in the ICU (platelet count, prothrombin complex = NT, FDP) to additional variables: Fibronectin (Fn), fibrinogen (Fg), F V, FVIII R:Ag, F VIII:C activity, F XII, plasminogen (Plg), antiplasmin (AP), antithrombin (AT), kallikrein inhibiting activity (KI) and spontaneous proteolytic activity (SPA): study the effects of cryoprecipitate or plasma infusion on three variables. Samples were taken before the first infusion, and 24 and 48 h after. ⋯ Five patients were thrombocytopenic, and in these a pattern with low levels of Plg and AT was observed. Fn did not correlate well to the other variables measured. These results indicate a marked activation of coagulation and fibrinolysis in these severely ill patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 1985
Plasmapheresis in the treatment of severe meningococcal or pneumococcal septicaemia with DIC and fibrinolysis. Preliminary data on eight patients.
Plasmapheresis (50 ml fresh frozen plasma/kg body weight per session--total 9-11 liters) was performed within 36 hours of the onset of septicaemia in 7 patients (1 woman and 6 men, age 14-48 years). One 8 year old girl was treated with exchange blood transfusion (2 liters). All had symptoms of severe septic shock caused by Neisseria meningitidis (6) or by Streptococcus pneumoniae (2). ⋯ Persistent extreme values were observed in 2 patients that died, whereas coagulation/fibrinolysis parameters frequently improved during plasmapheresis and gradually (more than 6 days) returned to normal values in the survivors. Although plasmapheresis was largely successful and signs of DIC and fibrinolysis were normalized, 2 patients died and 1 survived with severe sequelae. Thus, it remains to accumulate more data to conclude if plasmapheresis is beneficial in the treatment of severe septic shock and DIC.
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An outbreak of 12 cases of infection occurred over a 9-month period in a Regional Referral Neonatal Intensive Care Unit. The pathogen was a gentamicin- and multiply-resistant Klebsiella oxytoca (K55), of high virulence. Seven of 10 neonates with septicaemia died, the majority within 24 h of the onset of infection. ⋯ There is evidence to suggest that in one case the infecting organism was acquired from a contaminated blood gas analyser. It is necessary to use incompatibility grouping and restriction endonuclease digestion for complete characterization of plasmids and their molecular weights. However, the finding that each isolate examined carried the same five plasmids as judged by co-electrophoresis on agarose gels, and expressed the same extent and degree of transferable antibiotic resistance provides evidence to suggest that this outbreak was due to spread of a resistant clone of K. oxytoca (K55).