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Polymicrobial sepsis induces organ changes due to granulocyte adhesion in a murine two hit model of trauma. 总被引:7,自引:0,他引:7
Martijn van Griensven Meryem Kuzu Maike Breddin Frederic B?ttcher Christian Krettek Hans-Christoph Pape Thomas Tschernig 《Experimental and toxicologic pathology》2002,54(3):203-209
INTRODUCTION: Polytrauma patients, who develop organ dysfunction, have often undergone multiple subsequent insults ("hits"). The sequence of organs that show a dysfunction mostly is lung, liver, kidney and heart. The aim of the present study was to investigate whether a second hit after trauma induces organ changes. Furthermore, it was of interest to identify possible pathogenic mediators such as polymorphonuclear granulocytes (PMN) and cytokines. For this purpose, a two hit model of systemic damage in mice was developed. Sepsis was induced by caecal ligation and puncture (CLP), which was preceded 48 hours by a femur fracture, the most common fracture of long bones in trauma patients. This fracture was combined with a haemorrhagic shock. METHODS: In both mouse groups studied, a standardized femur fracture was produced using a blunt guillotine device with a weight of 500 g. This was followed by a haemorrhagic shock with substitution of ringer's lactate after 1 hour. In the study group, CLP was induced by puncturing the caecum using a 21G needle. As a control, sham animals underwent a laparotomy without CLP. Both groups were sacrificed after 48 or 96 hours. Clinical parameters were investigated on a daily basis to evaluate the animals' status. Lung, liver and kidney morphology was studied by light microscopy. PMN adhesion was determined by counting the number of adherent PMN per 100 microm of endothelium. Serum levels of TNF-alpha were measured after 48 and 96 hours. RESULTS: In the group submitted to laparotomy, all animals survived. The induction of polymicrobial sepsis by CLP resulted in an 85% (34/40) mortality within 96 hours after surgery (p < 0.05). The induction of a polymicrobial sepsis resulted in a significantly steady worsening of the clinical situation compared to the sham animals (p < 0.05). Lung morphology demonstrated significant changes at the end of the experimental period after 96 h in the two hit group. The alveolar septa were thickened and in all lungs haemorrhagic foci were observed. The number of PMN adhering to the pulmonary endothelium significantly increased at 96 hours. Some of the liver specimens in the two hit group showed focal hydropic degeneration and PMN infiltration. No kidney pathology was observed. This result coincided with an increase in TNF-alpha serum levels. DISCUSSION: A new rodent model mimicking the situation in the polytraumatized patient was developed. Although the animals showed minimal organ manifestation, a high percentage died probably due to cytokinemia. Furthermore, the increased TNF-alpha levels may lead to increased adhesion of PMN in the lung venules. This adhesion developed four days after the second hit. This might be the initial step for the development of extensive lung lesions in later phases. This model represents the SIRS more than MODS. This is a model for devolopment of posttraumatic disease due to cytokinemia and less for chronic multiple organ dysfunction and failure. 相似文献
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Vanessa Rouzier Karine Severe Marc Antoine Jean Juste Mireille Peck Christian Perodin Patrice Severe Marie Marcelle Deschamps Rose Irene Verdier Sabine Prince Jeannot Francois Jean Ronald Cadet Florence D. Guillaume Peter F. Wright Jean W. Pape 《The American journal of tropical medicine and hygiene》2013,89(4):671-681
Successful and sustained efforts have been made to curtail the major cholera epidemic that occurred in Haiti in 2010 with the promotion of hygiene and sanitation measures, training of health personnel and establishment of treatment centers nationwide. Oral cholera vaccine (OCV) was introduced by the Haitian Ministry of Health as a pilot project in urban and rural areas. This paper reports the successful OCV pilot project led by GHESKIO Centers in the urban slums of Port-au-Prince where 52,357 persons received dose 1 and 90.8% received dose 2; estimated coverage of the at-risk community was 75%. This pilot study demonstrated the effort, community mobilization, and organizational capacity necessary to achieve these results in a challenging setting. The OCV intervention paved the way for the recent launching of a national cholera vaccination program integrated in a long-term ambitious and comprehensive plan to address Haiti''s critical need in water security and sanitation. 相似文献
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N. Enninghorst R. Peralta O. Yoshino R. Pfeifer H. C. Pape B. M. Hardy D. C. Dewar Z. J. Balogh 《European journal of trauma and emergency surgery》2011,37(6):559-566
The timing of fracture fixation in polytrauma patients has been debated for a long time. The decision between DCO (damage
control orthopaedics) and ETC (early total care) is a difficult dilemma. Overzealous ETC in haemodynamically compromised patients
with significant chest and head injuries can be detrimental. It has been shown, however, that early fracture fixation has
a trend towards better outcome in patients with less severe injuries. Delaying all orthopaedic surgery in critically injured
patients can be a safe alternative, but has several disadvantages like longer ICU stay and septic complications. The literature
shows equivocal evidence for both settings. This article will summarize the historical background and controversies regarding
patient assessment and decision making during the treatment of polytrauma patients. It will also give guidance for choosing
DCO versus ETC in the clinical setting. 相似文献
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The goals of the transition from pediatrics to adult medicine are to achieve the best possible health status and the greatest potential for the patients, but also to encourage their self-determination, decision-making ability, and capacity to communicate to ensure the highest degree of autonomy and joie de vivre possible. The process of transition must be initiated early and take into consideration chronological age, health status, physical maturity, and psychosocial aspects. To accomplish this, a transition team, an individually tailored transition plan, joint consultations as well as discussions and training concepts are necessary. An assessment of the transition success is important. Several promising approaches already exist, e.g., the transfer program ??Endlich Erwachsen?? (??Finally a Grown-up??) or computer-assisted training models such as??OTIS.?? Successful transition with a team consisting of pediatricians, internists, psychologists, social workers, and nurses is only sustainable when financing for these efforts is assured by the health insurance providers. For example, after kidney transplantation this strategy contributes to improved graft survival with longer independence from continuous renal replacement therapy. 相似文献
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