Mortality In Infected Patients Research Articles

Tumor necrosis factor gene polymorphism and septic shock in surgical infection.

To evaluate the relationship of the genotype distribution of the tumor necrosis factor (TNF)-alpha polymorphism with regard to the plasma TNF-alpha concentration and the development of septic shock as well as mortality of infected patients in a surgical intensive care unit (SICU). A total of 112 postoperative critically ill infected patients were prospectively enrolled. SICU of a tertiary university-affiliated medical center. Patients who were consecutively admitted to the SICU because of surgical infection with sepsis. Blood sampling. Blood sample was obtained 24 hrs after intensive care unit (ICU) admission or within 2 hrs after the onset of septic shock to determine the plasma TNF-alpha level and to analyze the genotype of the biallelic polymorphism of the TNF-alpha. The allele frequency of the TNF2 in our infected ICU patients was 12%. Forty-two (37.5%) patients admitted fulfilled the criteria of septic shock during their ICU stay. Patients carrying the TNF2 allele were not more likely to develop septic shock, nor did they have a higher mortality rate. In the patients with septic shock, those carrying the TNF2 allele had a significantly higher mortality rate than those with the homozygous TNF1 genotype (92% vs. 62%, p < .05). In those who developed septic shock, the TNF2 allele was significantly associated with higher TNF levels. In patients admitted to SICU with surgical infection, the frequency of TNF2 allele was higher than in the general population. SICU patients with TNF2 allele did not show a higher incidence of developing septic shock, nor was there a higher baseline TNF-alpha level after infection. However, once septic shock had developed, the mortality rate was higher in those patients carrying the TNF2 allele.

Splenic Tissue Autotransplantation

Letters to the EditorSplenic Tissue Autotransplantation Bernd Domres, MD, Facharzt Ram N. Goel, FRCS, MD M. Heitham Schammut, and MD, Facharzt Robert R. ToussaintMD, Facharzt Bernd Domres Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , Ram N. Goel Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , M. Heitham Schammut Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , and Robert R. Toussaint Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1988https://doi.org/10.5144/0256-4947.1988.297aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionAsplenic patients are at an increased risk of overwhelming bacterial infection. It appears as pneumococcal sepsis in about 2% of splenectomized patients and may occur as late as 20 years after the splenectomy. Mortality in infected patients exceeds 50%, and this high mortality rate is related to the absent splenic functions. Therefore, we autograft removed ruptured spleen into an omentum pouch. This procedure does not extend the operation time more than 10 minutes.After removal of the ruptured spleen, its capsule is removed. The organ is shredded with sharp sterile device (of the type used in the kitchen to shred vegetables). The site of splenic implantation is important. It should be placed in an area that will drain into the portal venous system when neovascularization occurs. Implants function better in an omentum pouch than in a subcutaneous or peritoneal pouch. To avoid the main complications of the procedure (splenosis of the abdominal cavity or adhesions) the omental pouch should be sutured tightly so that it will not leak.We try to reimplant as much tissue of the ruptured spleen as possible. Research into splenic autotransplantation could prove that the minimum total weight of the grafted spleen should exceed 100 g, about a third of the total organ, to preserve satisfactory splenic function.Autotransplantation of ruptured spleen was performed in 49 cases. Eleven of the 49 patients died as a result of accompanying multiple injuries and not due to the splenectomy or autotransplantation.The progress of spleen regeneration in the omental pouch can be monitored by splenic scans, and postoperatively 30 patients were followed with regular thrombocyte counts, blood smears for RBC morphology such as Howell-Jolly bodies and pitted RBCs, and quantitative immunoelectrophoresis of IgM levels. After an initial increase in the numbers of thrombocytes, Howell-Jolly bodies, and pitted RBCs in the first 4 weeks, the levels returned to near normal after 8 weeks. The decreased IgM fraction returned to normal after 6 months.These results encourage us to continue autotransplantation of splenic tissue after splenectomy. Previous article Next article FiguresReferencesRelatedDetails Volume 8, Issue 4July 1988 Metrics History Published online1 July 1988 InformationCopyright © 1988, Annals of Saudi MedicinePDF download

An outbreak of antibiotic-resistant Salmonella enteritidis in Liberia, West Africa.

Between October 1980 and August 1982, 100 patients in the pediatric population at Curran Lutheran Hospital, Zorzor, Liberia were identified as having multiple drug-resistant Salmonella enteritidis serotype enteritidis. The illness usually presented as an enteric fever but also as meningitis, gastroenteritis, empyema, subcutaneous abscesses, chronic otitis media, or a combination of these conditions. Predisposing factors were young age and debilitation from malnutrition or measles. The mortality of infected patients was 27.8%. The organism was originally misidentified as a Citrobacter species because of a delayed reaction on lysine decarboxylase medium. Incubation of the medium for five days resulted in a positive reaction that identified the organism as a Salmonella species. The isolates were resistant to multiple antibiotics. Genes mediating resistance were located on a 120-megadalton conjugative plasmid. A cryptic nonconjugative 40-megadalton plasmid was also present in several isolates.