Articles: sepsis.
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To review the evolution and development of mortality risk prediction methods as they have been applied to the management of septic patients. ⋯ Severity of illness scoring systems are widely used in critically ill patients. However, their use in patients with sepsis has largely been limited to a means of stratification in clinical trials. As newer sepsis therapies become available, it may be possible to use such systems for refining their indications, and monitoring their utilization. Finally, as the databases supporting the systems increase in size and complexity, it may be possible to utilize them in clinical decision-making.
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The pathophysiological effects of severe sepsis, septic shock and related syndromes result from tissues damaged by the uncontrolled production of the mediators of inflammation. Early deaths are related primarily to the acute effects of the systemic inflammatory response. ⋯ Monoclonal antibodies and other immunotherapies have been developed against bacterial products, cytokines and other mediators involved in this systemic inflammatory response. Immunotherapies may improve outcome in the critically ill with sepsis if used early and as part of the therapeutic regimen of antimicrobial agents and intensive care support.
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Rev Gastroenterol Peru · Jan 1995
Review Comparative Study[Intra-abdominal sepsis: surgical management].
Intraabdominal sepsis is a frequent clinical disorder in inpatients with severe consequences as septic shock and multisystem organic failure. It starts with the presence of germs or toxins from the abdominal cavity either intra or retroperitoneal. Pathophysiology is not yet totally understood. ⋯ Treatment is based in the administration of antibiotics, nutritional support, ventilatory and hemodynamic aids. The keystone of the management is surgery. This review details the main technics and strategies of the surgeon in the operative room.
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Editorial Review
Tumor necrosis factor in sepsis: mediator of multiple organ failure or essential part of host defense?
Tumor necrosis factor-alpha (TNF) exerts numerous influences which, in association with severe infection, subserve both detrimental as well as beneficial host responses. The current review addresses recent insights into the structure and function of this pleiotropic cytokine, with a particular emphasis upon cellular and organ system consequences of sepsis-induced TNF activity. A comparison of responses elicited by endotoxin or TNF administration are discussed as are mechanisms of endogenous TNF regulation, such as soluble receptors, anti-inflammatory cytokines, and counter-regulatory responses. A review of past and future clinical strategies for altering TNF activity during sepsis is also provided.