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PubMed · 11345859

[Septic shock].

Abstract

Septic shock is the most severe systemic inflammatory response to infection. Despite recent progress in prevention and critical care therapy, this syndrome is the most common cause of death in intensive care units. Major advances have been realized recently in the understanding of septic shock. Cellular receptors involved in bacterial recognition have been identified as Toll-like receptors. After bacterial challenge, these receptors become activated and initiate in septic shock patients a biphasic immunological response associated with coagulation disorders. Genetic variability among humans and their predisposition towards pathologic inflammatory responses have also been demonstrated. These current views on the pathophysiological aspects of septic shock open new therapeutic perspectives which should change the prognosis of this syndrome.

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BibTeXRIS

A Veinstein, A Wernet, J P Mira. 2001-03-31. [Septic shock].. https://pubmed.ncbi.nlm.nih.gov/11345859/

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Prosthetic patch infection after carotid endarterectomy.

OBJECTIVES AND DESIGN: prospective audit of the management and outcome of prosthetic patch infection after carotid endarterectomy (CEA) at Leicester Royal Infirmary plus review of the literature. RESULTS: 8/936 CEA patients (0.85%) developed a prosthetic patch infection. Responsible organisms included MRSA (n=3), Staphylococcus epidermidis(n=2), haemolytic Streptococcus (n=1), Staphylococcus aureus(n=1) and Pseudomonas (n=1). Early wound complications preceded 4/5 infections presenting within 9 weeks of surgery. In addition to systemic antibiotics and debridement, management included patch removal and: (i) carotid ligation (n=3), vein patch repair (n=1), vein bypass (n=3). One patient had antibiotic irrigation of the in-situpatch. No patient died, one suffered a disabling postoperative stroke and two had temporary cranial nerve injuries. Including this series, a literature review identified 43 prosthetic patch infections, 91% culturing Staphylococci or Streptococci. Cumulative freedom from perioperative stroke/death or re-infection was 65% at 2 years. Patients treated by patch excision and autologous venous reconstruction had the best outcome with a cumulative freedom from perioperative stroke/death or re-infection of 91% at 2 years. CONCLUSION: prosthetic patch infection after CEA is rare. This study emphasises the importance of close surveillance of early wound complications. Surgical decision-making, especially the safety of carotid ligation, was facilitated by access to transcranial Doppler.

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