Multiple Organ Failure In Septic Patients.

Multiple organ failure (MOF) is the main cause of death in ICUs, especially affecting septic patients. It is strongly related to number of systems with failure, type of system involved, risk factors such as age, previous chronic diseases, delayed or inadequate resuscitation, persistent infection, immune suppression, and others. The prognoses is worse for patients rather than in elective or emergency surgical patients. The objective of this article is to provide data from our university teaching hospital ICU related to the incidence of septic patients, the distribution of MOF, and distribution of failure among each of the organs. The mortality rate, relationship between mortality and age, and mortality and types of organs affected were evaluated. The main bacterial causes of sepsis were also identified. A retrospective evaluation was done of 249 patients admitted to the ICU in a 4 month period during 1999. Fifty four patients had sepsis diagnosed by ACCS/SCCM criteria. There were 37 men and 17 women; 24 medical and 30 post-surgical patients (9 after elective surgery and 21 emergency patients). APACHE II score was calculated on admission and MOF, measured for the first five days, was diagnosed using Marshall and Meakins criteria. The statistical method used was non-parametric Mann-Whitney test, p61 years 13/19 (68%), died. There were 23 patients with positive bacterial culture. The most frequent bacteria found were: Pseudomonas aeruginosa (5), multiresistant Acinetobacter baumanii (3), Staphylococcus epidermidis (3), Enterobacter aerogenes (3), Klebsiella pneumoniae (2) and multiresistant Staphylococcus aureus (2). The mean value +/- SD of APACHE II (mortality risk) for survivors was 21 +/- 18 and for non-survivors 42 +/- 26 (p<0.001). We conclude that MOF due to sepsis in an ICU is frequent, with high mortality related to the number of failing organs, age and high APACHE II.5310311

Streptokinase In Severe Pulmonary Embolism [estreptoquinase No Tromboembolismo Pulmonar Grave]

Severe pulmonary embolism (PE) was treated with streptokinase in four patients, three men and one woman, age 38 to 72 (mean = 53 ± 14) years. Before the thrombolytic therapy, all patients had pulmonary angiogram and hemodynamic parameters analized. The drug was infused through the distal lumen of the Swan-Ganz catheter at the pulmonary artery trunk. The initial dosage was 250.000 units 'in bolus' and 100.000 units in 24 to 72 hours. The time interval between the symptoms and treatment had ranged from 2 hours to 5 days. The results are analized as follow: reduction on right atrial pressure, mean pulmonary pressure, pulmonary vascular resistance, an increase in the stroke volume and cardiac output. In two cases we observed total lysis, in one partial lysis and one patient died from severe form of PE and late infusion of SK. Reinfusion of the drug was necessary in one patient that had PE recurrence with reliable final result. Finally, no one had severe bleeding despite the use of the intrapulmonary catheter.61528729

Highlighting Intracranial Pressure Monitoring In Patients With Severe Acute Brain Trauma.

Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < or = 20 mm Hg.533 A39039

Semiquantitative Culture In Diagnosing Venous Catheter-related Sepsis.

Since Aubaniac (1) described the puncture of the subclavian vein in 1952, and specially after the standardization of parenteral nutrition by Dudrick et al. (11) in 1968, much has been published about complications caused by percutaneous central venous catheterization. Among the various complications provoked by this procedure, a very important one is "primary sepsis" or "catheter-related sepsis", both because of its frequency and because of the morbidity and mortality it causes (18,19). It is, however, difficult to diagnose this complication. The main difficulty lies in differentiating catheters that are really causing sepsis from those that, though showing "positive culture" do not cause bacteremia and are not responsible for the occasional signs of infection that a patient may show (6,7). This difficulty in diagnosing has led to the recommendation that all catheters suspected of causing sepsis be systematically removed. This procedure has the effect of exposing patients in serious condition and with limited venous access to the risks of new punctures. Usually these risks are unnecessary, since 75 to 90% of the catheters removed for this reason are not the real source of infection (3, 17, 19, 21, 22). In 1977, Maki et al. (18) proposed a semiquantitative catheter tip culture that showed considerable correlation with positive hemoculture for the same microorganisms; that is, capable of identifying which "positive catheters" were really causing sepsis. Subsequent research confirmed these results, showing that the semiquantitative catheter tip culture had specificity and sensibility over 80% (10, 15).(ABSTRACT TRUNCATED AT 250 WORDS)110522222

Influence of Al grain structure on Fe bearing intermetallics during DC casting of an Al-Mg-Si alloy

207 mm diameter direct chill (DC) cast billets of 6063 aluminium-magnesium-silicon (Al-Mg-Si) alloy were produced with various different primary aluminium (α-Al) grain structures including feathery-dendrites, equiaxed-dendrites and equiaxed-globular morphologies. To control the α-Al grain structure (grain morphology and grain size) an intensive shearing melt conditioning technique and Al-5Ti-1B grain refiner were used. For the first time, due to the variety of controlled microstructures produced in the DC billets, it was possible to study and determine the role of the α-Al grain structure on the iron (Fe) bearing intermetallics (Fe-IMCs). The size, shape and three dimensional (3D) inter-connectivity of the Fe-IMCs were observed to be affected by the modification of the primary α-Al grain morphology and grain size. Although both “αc-AlFeSi” and “β-AlFeSi” phases are present in all billets, β-AlFeSi phase is dominant in the billets with grain refiner addition while αc-AlFeSi is dominant in the billets without grain refiner. This suggests that the addition of Al-5Ti-1B grain refiner plays a more significant role in the intermetallic phase selection than the primary α-Al grain morphology or grain size

Benchmarking plant diversity of Palaearctic grasslands and other open habitats

Aims: Understanding fine-grain diversity patterns across large spatial extents is fundamental for macroecological research and biodiversity conservation. Using the GrassPlot database, we provide benchmarks of fine-grain richness values of Palaearctic open habitats for vascular plants, bryophytes, lichens and complete vegetation (i.e., the sum of the former three groups). Location: Palaearctic biogeographic realm. Methods: We used 126,524 plots of eight standard grain sizes from the GrassPlot database: 0.0001, 0.001, 0.01, 0.1, 1, 10, 100 and 1,000 m2 and calculated the mean richness and standard deviations, as well as maximum, minimum, median, and first and third quartiles for each combination of grain size, taxonomic group, biome, region, vegetation type and phytosociological class. Results: Patterns of plant diversity in vegetation types and biomes differ across grain sizes and taxonomic groups. Overall, secondary (mostly semi-natural) grasslands and natural grasslands are the richest vegetation type. The open-access file ”GrassPlot Diversity Benchmarks” and the web tool “GrassPlot Diversity Explorer” are now available online (https://edgg.org/databases/GrasslandDiversityExplorer) and provide more insights into species richness patterns in the Palaearctic open habitats. Conclusions: The GrassPlot Diversity Benchmarks provide high-quality data on species richness in open habitat types across the Palaearctic. These benchmark data can be used in vegetation ecology, macroecology, biodiversity conservation and data quality checking. While the amount of data in the underlying GrassPlot database and their spatial coverage are smaller than in other extensive vegetation-plot databases, species recordings in GrassPlot are on average more complete, making it a valuable complementary data source in macroecology