MANAGEMENT OF MEDIASTINAL-ABSCESS-INDUCED SEPSIS AND SEPTIC SHOCK (CLINICAL CASE REPORT).

Infection of the mediastinum is typically polymicrobial in nature resulting from a disruption of normal mucosal and tissue barriers. Infection may result from a rupture of the esophagus or trachea or from surgical intervention. Medaistinal abscess is the most lethal form of mediastinitis. A case report is presented: sepsis - induced polyorganic insufficiency with underlying severe somatic pathological condition and violation of hemodynamics. Clinically the insufficiency of all the organic systems developed at the background of cardio-respiratory-cerebral insufficiency, with functional insufficiency of all the organ systems and violation of buffer system. With reasonable pathognomic and symptomatic treatment eradication of vicious circle was possible. The patient was discharged from the clinic with positive clinical-laboratory recovery. The condition was stable. Neurological status -contacted, adequate, with high capacity to work. The fistula on the anterior wall of the trachea as well as stoma were removed.

DYSFUNCTION OF VARIOUS ORGAN SYSTEMS INDUCED BY SEPSIS WITH UNDERLYING SEVERE MYELOMIC DISEASES AND PROSTATE CANCER (CASE REPORT).

A 65-year-old male patient, unconscious, was admitted into the clinic by the Ambulance. From the patient's medical history it was revealed that several hours before the admission in the clinic the following symptoms were present: shortness of breath, fever, hypotonia, consciousness inhibition, because of which emergency brigade was called and was brought by the Emergency Brigade. The history is loaded by chronic pathologies: myeloma disease, prostate cancer, ciliary arrhythmia, heart failure; received several courses of polichemotherapy, last ten days has been treated for pneumonia with antibiotics of ceftriaxone group in outpatient setting. It is also noteworthy that for the last three months dysfunction of musculoskeletal system with muscle weakness, restricted motion has been present. Clinically there was present dysfunction syndrome of several organs: disorder of function of several organs that required emergency intervention, recovery chance was very low, correlation with morbidity in PIRO was high. By investigation it is known, that as SIRS aggravates, and turns into septic shock, lethal index increases, especially when the underlying severe diseases are present. On basis of certain data we can conclude that the severity of the disease may have some compatibility with results, although it is alteration of further clinical status of initial stage that has the closest compatibility with results. Sepsis toward MODS experiences progress with lethal results. Mortality rate in the patients with acute respiratory deficiency increases from 50% to 80%. In most patients with sepsis syndrome, who have 3 or more organs damaged, lethality is more than 90%. In this certain case organ systems that are mostly involved in the process during the sepsis, are respiratory, blood, renal and cardiovascular systems, were all involved , in the mentioned case a reasonable symptomatic and pathognomic treatment and the appropriate measures led to the recovery of the above mentioned patient. Sepsis syndrome is developed when the balance between the substances that contribute to the inflammation and anti-inflammatory substances is violated. By the mentioned case there is sepsis - induced polyorganic insufficiency with underlying severe somatic pathological condition, with violation of hemodynamics. Clinically the insufficiency of all the organic systems developed at the background of cardio-respiratory-cerebral insufficiency, with functional insufficiency of all the organ systems and violation of buffer system. With reasonable pathognomic and symptomatic treatment eradication of vicious circle was possible. The patient was discharged from the clinic with positive clinic-laboratory recovery. The condition is stable. Neurological status -contact, adequate, with high capacity to work, and with an achievement of 2 year remission.

ALTERED MICROCIRCULATION IN SEPTIC SHOCK.

Retrospective data analysis of microcirculation in septic shock was conducted. Sepsis is characterized by a severe microvascular dysfunction that persists despite fluid resuscitation and leads to multi-organ failure even after normalization of hemodynamics in response to fluid resuscitation, vasopressors and the treatment of infection. Several clinical studies suggest that microcirculatory alterations in severe sepsis are stronger predictors of outcome than global hemodynamic variables. Microvascular dysfunction under septic shock is related to: increased capillary permeability that manifests as a breakdown of the microvascular endothelial barrier (factors which may contribute to capillary leak syndrome include endogenous proinflammatory cytokines, angiopoietin 2, vascular endothelial growth factor); arteriolar hyporesponsiveness to vasoconstrictors and vasodilators, the loss of adrenergic sensitivity and tone of smooth muscle cells lining the arterioles; loss of the anti-adhesive function of endothelial surfaces; decreased density of perfused capillaries (due to several contributing factors: decreased deformability of erythrocytes and neutrophils; activation of the clotting cascade with fibrin deposition and the formation of microthrombi; dysfunction of vascular autoregulatory mechanisms by nitric oxide; enhanced functional arteriovenous shunting of the microcirculation).