Perforación colónica y sepsis fulminante asociada a Clostridium septicum como presentación de un cáncer de colon / Colonic perforation and sepsis associated with Clostridium septicum as clinical presentation of colon cancer

Resumen La asociación entre algunas infecciones bacterianas y cáncer de colon está bien documentada. La más descrita es la infección por Streptococcus bovis. Otra bacteria relacionada a neoplasias intestinales es Clostridium septicum. Presentamos el caso clínico de un varón de 62 años que consultó por dolor abdominal, diarrea y fiebre. Se realizó una tomografía computada de abdomen y pelvis que evidenció un engrosamiento de las paredes del ciego con una aparente solución de continuidad en su borde libre. En una laparotomía exploradora se confirmó la presencia de peritonitis y perforación cecal, siendo sometido a una hemicolectomía derecha e ileostomía terminal. El estudio histopatológico reveló la presencia de un adenocarcinoma de tipo células en anillo de sello asociado a isquemia. Los hemocultivos fueron positivos a C. septicum. El paciente falleció por una sepsis fulminante.

Abstract The association between some bacterial infections and colon cancer is well documented. The most described is Streptococcus bovis infection. Another bacteria related to intestinal neoplasms is Clostridium septicum. We present the case of a 62-year-old man who consulted for abdominal pain associated with diarrhea and fever. A computed tomography scan of the abdomen and pelvis was performed, which revealed thickening of the cecum walls with an apparent break in continuity at its free edge. An exploratory laparotomy was performed which confirmed the presence of peritonitis and cecal perforation. A right hemicolectomy and terminal ileostomy were performed. The histopathological study revealed the presence of signet ring cell type adenocarcinoma associated with ischemia. The blood cultures results demonstrated the presence of C. septicum. The patient died due to fulminant sepsis.

The research of the clinical effect for high-dose ulinastatin small on the SIRS and patients with MODS / 中国基层医药

Objective To study the clinical effect of large dose ulinastatin on patients combined SIRS and MODS.Methods 120 patients in ICU were randomly divided into two groups,each 60 cases,the control group using conventional standard treatment,the observation group in the control group on the basis of the 12h after the operation started on intravenous injection of large dose ulinastatin,observe two groups of patients after treatment with cytokine content and duration of hospital stay,mortality rate and APACHE Ⅱ score after treatment.Results The two groups before treatment TNFα,IL-6,IL-8 and APACHE Ⅱ score difference is not big,after treatment,48 h,72 h,two groups of patients with TNFα,IL-6,IL-8 were decreased,and the observation group decreased greater than the control group (t =8.46,8.72,8.68,10.38,7.83,9.26,all P ＜ 0.05),after treatment the observation group APACHE Ⅱ score,mortality,average time of hospitalization were significantly lower than those of the control group,there was statistical significance(t =9.58,x2 =10.28,t =9.17,all P ＜ 0.05).Conclusion High dose ulinastatin on inflammatory cytokines have obvious inhibition effect,can reduce the surgical risk in patients with APACHE Ⅱ score and mortality,shorten the treatment time of patients.

História natural da sepse: [revisão] / Natural story of the sepsis: [review]

A interação hospedeiro, agente e antimicrobiano é fundamental na evolução favorável ou não das septicemias. Além disso, o uso adequado dos antimicrobianos é o principal elemento capaz de propiciar o controle e a resolução da doença em pacientes clínicos e nos pacientes cirúrgicos tem também papel relevante na evolução do quadro. Boa parte das septicemias em pacientes com estado grave deve-se a infecções adquiridas nos hospitais. Assim, destaca-se não só a necessidade do seu tratamento precoce, como a utilização de práticas que previnam seu surgimento, com consequente diminuição da morbidade e mortalidade causadas por esse grupo de doenças.

The interaction of host, agent and antimicrobial is a paramount basis for the favorable evolution of sepsis or not. Moreover, adequate use of antimicrobials is the main element capable of controlling and curing the illness in clinical patients. In surgical patients, it also plays an important role in the evolution of the picture. Since a good part of sepsis in seriously ill patients is acquired in hospitals, not only the necessity of treatment of the illness, but also the need for clinical practices that prevent its development are pointed out, with consequent reduction of serious illness and death caused by this group of infections.

The Efficacy of Early Goal-directed Therapy in Septic Shock Patients in the Emergency Department: Severe Sepsis Campaign / 대한구급학회지

BACKGROUND: Early goal-directed therapy (EGDT) has been used for patients with severe sepsis and septic shock in the emergency department (ED). In 2003, international management guidelines for severe sepsis and septic shock were developed under the auspices of the Surviving Sepsis Campaign (SSC); however, EGDT based on the SSC was not fully evaluated in the ED. The purpose of this study was to evaluate the efficacy of EGDT based on the SSC in the ED in Korea. METHODS: We randomly assigned patients who arrived at our ED in septic shock to receive EGDT before admission to the intensive care unit between May 2007 and July 2007, and we retrospectively assigned patients in septic shock to receive standard therapy between May 2006 and July 2006. The in-hospital mortality for 24 hours and 28 days, the MODS, SAPS II, and APACHE II scores were obtained and compared between the study groups. RESULTS: Of the 60 enrolled patients, 30 were assigned to EGDT and 30 were assigned to standard therapy. There was no significant difference between the groups with respect to the baseline characteristics. In-hospital mortality at 28 days was 13% in the group assigned to EGDT as compared to 40% in the group assigned to standard therapy (p = 0.020) and in-hospital mortality at 24 hours was 0% and 13%, respectively (p = 0.038). CONCLUSIONS: EGDT provides significant benefits with respect to outcome in patients in septic shock.

Relationship between Toll-like receptor 2 on polymorphonuclear neutrophil and postoperative systemic inflammatory response syndrome in patients undergoing orthotopic liver transplantation / 中华麻醉学杂志

Objectlve investigate the role of Toll-like receptor 2 (TLR2) on polymorphonuclear neutrophil (PMN) during perioperative period in the development of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing orthotopic liver transplantation (OLT).Methods Twenty patients (18 male and 2 female, aged 33-58 yr and weighing 52-73 kg) with ASA Ⅲ or Ⅳ (NYHA Ⅱ or Ⅲ )undergoing OLT were studied. Blood samples were collected from the central vein for determination of TLR2 expression on PMN and plasma TNF-α, IL-1β and IL-8 concentrations before induction of anesthesia (T1, baseline), at 25 min of anhepatic phase (T2), 3 h (T3) and 24 h after beginning of reperfusion of the allograft (T4). The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme linked immunosorbant assay (ELISA). The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIRS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992.Results Ten patients developed SIRS within 7 days after operation. There was no significant difference in Child-Turcotte-Pugh (CTP) scores between the two groups. Compared with non-SIRS group, the TLR2 expression on PMN and the serum IL-1β concentration were significantly increased at T4 and the serum IL-8 concentration was significantly increased at T3 in SIRS group.There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group ( r= 0.607, P ＜0.05).Conclusion The expression of TLR2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.

Effects of inhalation of isoflurane on plasma and pulmonary levels of IL-1β and IL-10 in rats / 中华麻醉学杂志

Objective To investigate the effects of inhalation of isoflurane (Iso) on pulmonary and systemic inflammatory response through the changes in the plasma and pulmonary levels of IL-1β and IL-10 in rats. Methods Thirty-two adult male Wistar rats were randomly divided into 4 groups (n=8 each): group control (group C), group Iso-4 h, group Iso-8 h and group R. Group C inhaled air only. Group Iso-4 h and Iso-8 h inhaled in 40% O2 + 1.5% Iso for 4 and 8 h respectively. Group R inhaled 40% O2 + 1.5% Iso for 8 h and then withdrew and only inhaled 40 % O2 for 2 h. Blood samples were taken from femoral artery for measurement of plasma concentrations of IL-1β and IL-10 by ELISA. Then the rots were sacrificed to collect bronchoalveolar lavage fluid (BALF) for measurement of IL-1β and IL-10 concentrations. The right lung tissues were obtained for determination of the expression of IL-1β mRNA and IL-10 mRNA by RT-PCR. Results The BALF concentration of IL-1β and IL-1β mRNA expression in lung tissues were significantly higher in group Iso-4 h, and the concentrations of plasma and BALF IL-1β and IL-10, and the expression of IL-1β mRNA and IL-10 mRNA in lung tissues were significantly higher in group Iso-8 h than in group C (P<0.05), but there were no significant differences in the concentrations of plasma and BALF IL-1β and IL-10 and expression of IL-1β mRNA and IL-10 mRNA in lung tissues between group R and group C (P>0.05). The plasma and BALF IL-10 concentrations and IL-10 mRNA expression in lung tissues were significantly higher in group Iso-8 h than in group Iso-4 h (P<0.05). The concentrations of plasma and BALF IL-1β and IL-10 and expression of IL-1β mRNA and IL-10 mRNA in lung tissues were significantly lower in group R than in group Iso-8 h (P<0.05). Conclusion Isollurane inhalation can induce transient pulmonary and systemic inflammatory response in rats.

Risk factors for development of SIRS in patients after off-pump coronary artery bypass grafting / 中华麻醉学杂志

Objective To determine the risk factom for the development of systemic inflammatory response syndrome(SIRS)in patmnts after off-pump coronary artery bypass grafting(OPCABG).Methods Sixty NYHA Ⅰ or Ⅱ patients,aged 46-73 yr,weighing 54-110 kg,undergoing OPCABG,were studied.Blood samples from intemal iugular vein were taken for determination of the plasma concentrations of IL-6 and IL-10 at 4 h after the surgery by ELISA.SIRS 8COre W88 performed during 24 h after the surgery.The patients were divided into 2 groups:SIRS group(S,SIRS 8core≥2)and non-SIRS group(U,SIRS score<2).Factors including age,sex,weight,percentage of mononuclear cells,concentration of hemoglobin,time of operation,left ventricular ejection firction,whether using proteinase inhibitor or not during surgery and plasma concentrations of IL-6 and IL-10 at 4 h after surgery were reccorded.The risk factors were identified by logistic regression analysis.Results Logistic analysis indicated that percentage of mononuclear cells,concentration of hemoglobin,the plasma concentrations of IL-6 and IL-10 were closely related with the development of SIRS in patients after 0PCABG(P<0.05),Y=0.155+0.52 X1+0.39 X2+0.76X1-0.79X,Conclusion The percentage of mononuclear cells,concentration of hemoglobin,and plasma concentrations of IL-6 and IL-10 after surgery Call be the risk factors for the development of SIRS in patients after OPCABG.

Effects of Dachengqi Decoction on Systemic Inflammatory Response Syndrome in Mice / 广州中医药大学学报

[Objective] To investigate the mechanism of Dachengqi Decoction (DCD) in treating systemic inflammatory response syndrome ( SIRS). [ Methods ] Mouse models induced by zymosan A were administered with DCD orally. Serum endotoxin level was detected by limulus assay and TNF-? and IL-6 levels by radioimmunoassay 6, 12 and 24 hours after medication. [Results] Serum levels of endotoxin, TNF-? and IL-6 were increased in SIRS mice. After treatment with DCD, serum endotoxin level was decreased at the 6th and 12th hour ( P

Therapeutic Effect of Spleen-strengthening,Lung-clearing and Phlegm-resolving Therapy for Chronic Obstrustive Pulmonary Disease Complicated with Systemic Inflammatory Response Syndrome and Its Influence on Nuclear Factor ?B Expression / 广州中医药大学学报

Objective To investigate the therapeutic effect of spleen-strengthening,lung-clearing and phlegm-resolving herbs for the treatment of acute attack of chronic obstrustive pulmonary disease(COPD) complicated with systemic inflammatory response syndrome(SIRS),and to observe their effect on nuclear factor ?B(NF-?B)expression level.Methods Sixty qualified patients differentiated as deficiency of spleen and lung,phlegm-heat accumulating the lung were equally randomized into two groups:the control group received routine western medical treatment including oxygen inhalation,antibiotics and bronchodilator,and the treatment group received Chen Xia Liujunzi Decoction and Weijing Decoction,which have the actions of strengthening spleen,clearing lung,and resolving phlegm,one dose per day,for 7 days.The changes of clinical symptoms and signs,blood gas parameters and NF-?B expression level were observed.Results After treatment,clinical symptoms and signs such as cough,expectoration,dyspnea,shortness of breath,and wheeze were relieved in both groups(P

Nuevas consideraciones fisiopatológicas sobre el síndrome de respuesta inflamatoria sistémica relacionada con la sepsis

El shock séptico constituye una de las primeras causas de morbilidad y mortalidad en las unidades de cuidados intensivos y forma parte de los estadios evolutivos la respuesta inflamatoria sistémica (SRIS) en relación con la infección, que fueron modificados por Jaffari para su aplicación en la edad pediátrica. Está relacionado con la exposición del organismo a agentes exógenos y/o mediadores endógenos, que producen una inadecuada perfusión hística con alteración en el consumo de oxígeno, en la permeabilidad vascular y la aparición de trastornos hemodinámicos que comprometen la vida del paciente. Se considera que el mediador central en el shock séptico es el factor de necrosis tumoral-a(FNT- a), aunque también responden de forma descontrolada otras citocinas, los polimorfonucleares, el sistema de contacto, el fibrinolítico, el de la coagulación, así como otras sustancias endógenas. El conocimiento de su fisiopatología hace posible el diagnóstico y tratamiento precoz, sobre todo en los grupos de riesgo, y la reducción de la mortalidad en las unidades de terapia intensiva por esta afección.

The septic shock is one of the first causes of morbidity and mortality in intensive care units, and the systemic inflammatory response syndrome (SIRS) is a part of the evolutive stages related to the infection, that were modified by Jaffari for its application in the pediatric age. Septic shock is related with the organism exposition to exogenous agents, and/or endogenous mediators that produce an inadequate histic perfusion with alteration in oxygen consumption, in vascular permeability, and the presentation of hemodynamic disorders that compromise the patient's life. It is considered that the main mediator in septic shock is the tumoral necrosis factor - (TBF- ), although other cytosines also reply in an uncontrolled fashion, the polymorphonuclears, the contact system, the fibrinolytic, the coagulation one, as well as other endogenous substances. Knowing the physiopathology of septic shock renders possible the diagnosis and an early treatment, specially in the risk groups, and the decrease of the mortality by this affection in the intensive care units.

Effect of propofol on changes in cytokines in rats with systemic inflammatory response syndrome / 中华麻醉学杂志

Objective To investigate the effect of different doses of propofol on cytokines-tumor necosis factor-? (TNF-?), interleukin-6 ( IL-6 ), interlenkin-8 ( IL-8 ), during systemic inflammatory response syndrome (SIRS) .Methods Fifty-six male Wistar rats weighing 190-220g were anesthetized with intraperitoneal 2.5% pentobarbital 30mg.kg-1 . The animals were randomly divided into 4 groups of 14 animals each: group A received intraperitoneal saline 10ml.kg-1 followed by intravenous infusion of saline (2ml.h-1 ); group B received intraperitoneal LPS 1mg.kg followed by intravenous infusion of saline(2ml.h-1 ) ; in group C propofol was infused iv at 75?g.kg-1.min for 4h after intraperitoneal LPS injection; in group D propofol was infusion iv at 150?g.kg-1 .min-1 for 4h after intraperitoneal LPS injection. Blood samples were taken before experiment and 1, 2, 3, 4h after saline or propofol infusion for determination of serum TNF-? (cytotoxin stain method) and IL-6, IL-8 (ELISA) concentration.Results Serum concentrations of TNF-?, IL-6 and IL-8 induced by LPS increased significantly in group B as compared with those in group A. Propofol decreased the level of cytokines and delayed the peak values of TNF-? and IL-8. Conclusion Propofol used in the early stage of SIRS has some protective efficacy.

Mechanism of systemic inflammatory response syndrome induced by EC DNA / 中国病理生理杂志

AIM: To investigate whether the bacterial DNA participates in SIRS and its possible mechanism. METHODS: Escherichia coli genomic DNA (EC DNA) was extracted and purified from Escherichia coli 25922 by alkaline lysis method. Mortality of mice challenged with EC DNA and the changes of TNF-? and IL-6 in rat serum were observed. ANA-1 cells were cultured in vitro, after the cells were stimulated by different concentrations of EC DNA and LPS, the level of TNF-? and IL-6 in supernatant were tested. Meanwhile,expression of TLR9 and TLR4 on cell surface was measured. Activation of NF-?B was also observed. RESULTS: The lethal effect of EC DNA on mice with an obvious dose-effect relationship was observed. The death happened within 24 hours. Calf thymus DNA and DNase I-treated EC DNA did not lead to mice to die. The changes of serum TNF-? and IL-6 in rats induced by EC DNA and LPS were similar, but TNF-? peak level of EC DNA group appeared 1 hour earlier than that of LPS group. In vitro, large amount of TNF-? and IL-6 were released from ANA-1 cells stimulated by EC DNA. High expression of TLR9 and TLR4 was observed on surfaces of THP-1 cells. In particularly, LPS induced strong activation of NF?B. The results suggested other pathway possibly took part in the signal transduction inducea by EC DNA. CONCLUSION: EC DNA has the abilities to lead to death of mice, and induces serum TNF-? and IL-6 level to increase in rats and ANA-1 cells to release cytokines in vitro. High expression of TLR9 and TLR4, strong activation of NF-?B may be its important molecular mechanism, but other pathway probably exists to play an important role.

Altered thyroid hormone levels in patients with systemic inflammatory reaction syndrome / 中华内分泌代谢杂志

The patients with systemic inflammatory reaction syndrome had high possibility to get euthyroid sick syndrome, which happened more frequently and severely in patients with multiple organ dysfunction syndrome, reflecting that inflammation or cytokines may affect the hypothalamic- pituitary-thyroid axis.

THE EVOLUTION AND PROGRESS IN OUR UNDERSTANDING OF SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN DYSFUNCTION SYNDROME / 解放军医学杂志

Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis'. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.

TRANSMEMBRANE SIGNALTRANSDUCTION OF ENDOTOXIN AND TIS ROLE IN THE DEVELOPMENT OF UNCOTROLLED SYSTEMIC INFLAMMATORY RESPONSE / 解放军医学杂志

The uncontrolled inflammatory response is commonly seen and plays an important role in the pathogenesis of post traumatic complications. Bacterial endotoxin or lipopolysaccharide (LPS) is one of the most potent mediators in inducing uncontrolled inflammatory response.Several LPS associated receptors have been identified on the surface of monocytes/macrophages, which are shown to be initial factors to recognize LPS and trigger inflammatory response. Scanvenger receptor (SR), CD14and toll like receptor4 (TLR4)act as high affinity or sensitive LPS receptorS. SRhas been shown to be responsibe for clearance and neutralization of LPS by macrophages,whereas CD14 and TLR4have been foand to be important receptors mediating cell activation induced by LPS. TLR2, ? 2 integrin and L selectin have been considered to be low affinity LPSreceptors, and they may play an important catalytic role in LPS induced pro inflammatory and anti inflammatory responses as "secondary LPS receptors". In addition, TLR4 might be the receptor pathway through which LPS could activate blood endothelial cells. Down regulation of defense receptors such as SR and up regulation of excitatory receptors such as CD14, TLR4, and TLR2might be an important mechanism to turn monocytes/macrophages into effector cells (release of pro and anti inflammatory mediators) during the course of infection. Further investigation of transmembrane LPS signaltransduction mechanisms. might help discover some novel strategies for effective control or modulation of uncontrolled inflammatory response.