RESUMO
In a series of 135 patients with severe surgical infections, we determined the sepsis score and the plasma level of the acute-phase proteins alpha-1-acid glycoprotein, alpha 1-antitrypsin, complement factor B, and C3. The initial sepsis score was a strong determinant of survival: in survivors it was significantly lower than in nonsurvivors. Only 8% of patients with a sepsis score above 20 survived. At the onset of severe sepsis, the plasma levels of all four acute-phase proteins were significantly lower in nonsurvivors. A significant elevation of C3a levels in the plasma of both surviving and nonsurviving patients indicated marked consumption of complement components in all patients with severe sepsis. A linear equation was developed to predict survival: sepsis index of survival (SIS) % = 121 + 0.26 (complement factor B) + 0.36 (alpha-1-acid glycoprotein)-6 (sepsis score). Based on our analysis, at the onset of severe sepsis, an SIS of 50% or more can correctly predict 88% of survivors and an SIS less than 50% can correctly predict 86% of nonsurvivors several days in advance of clinical outcome.
Assuntos
Infecções Bacterianas/sangue , Adulto , Infecções Bacterianas/mortalidade , Infecções Bacterianas/fisiopatologia , Complemento C3/análise , Fator B do Complemento/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Orosomucoide/análise , Prognóstico , alfa 1-Antitripsina/análiseRESUMO
A review of the literature on pancreatic trauma and its treatment in the light of recent experience is presented. The incidence, mechanism, classification, diagnosis, treatment and complications of pancreatic trauma are discussed. A case of pancreatic transection after blunt abdominal trauma is described.
Assuntos
Traumatismos Abdominais , Pâncreas/lesões , Ferimentos não Penetrantes , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Feminino , Seguimentos , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/cirurgiaRESUMO
Lymphoceles are a well-known complication of renal transplantation, with incidence rates up to 18%. The management of symptomatic lymphocele remains controversial. We report the case of a lymphocele which was successfully drained into the peritoneal cavity using laparoscopic surgery.
Assuntos
Drenagem/métodos , Transplante de Rim/efeitos adversos , Laparoscopia , Linfocele/cirurgia , Feminino , Humanos , Linfocele/diagnóstico por imagem , Linfocele/etiologia , Pessoa de Meia-Idade , UltrassonografiaRESUMO
The measurement of selected anthropometric, biochemical and immunological variables, and clinical judgment can be used to assess nutritional state. Nutritional assessment has three main aims: to define the type and severity of malnutrition; to identify high risk patients; to monitor the efficacy of nutritional support. The problems associated with the various methods to assess the nutritional state and the applications of nutritional assessment in clinical practice are presented and discussed.