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Báo cáo y học: "Recently published papers: inflammation, elucidation, manipulation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về y học đề tài: Recently published papers: inflammation, elucidation, manipulation? | Critical Care August 2003 Vol 7 No 4 Bayley and Venn Commentary Recently published papers inflammation elucidation manipulation Justin Kirk-Bayley1 and Richard Venn2 1 Research registrar Anaesthesia and Intensive Care Worthing Hospital West Sussex UK 2Consultant Anaesthesia and Intensive Care Worthing Hospital West Sussex UK Correspondence Justin Kirk-Bayley jkb@orange.net Published online 3 July 2003 Critical Care 2003 7 282-284 DOI 10.1186 cc2347 This article is online at http ccforum.com content 7 4 282 2003 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X The search for the marker in sepsis and inflammation continues. Perhaps when we do find it we may be able to alter and influence the underlying pathophysiology of sepsis. Many reports from those who believe that this may lie in the hypothalamic-pituitary-adrenal axis have recently been published. Manglik and colleagues 1 looked into secondary adrenocortical insufficiency in patients who present with severe sepsis. Measuring maximal cortisol secretion after stimulation with adrenocorticotrophic hormone those investigators found that 9 of their population failed an adrenocorticotrophic hormone stimulation test. Four per cent had previously undiagnosed pituitary disease and 5 were suffering from sepsis-related adrenal dysfunction. They used absolute cortisol levels and not delta cortisol to define adrenocortical insufficiency but until we have an established definition for adrenocortical insufficiency in sepsis the studies will continue to yield disparate results. Looking at reduced endogenous steroid levels in sepsis Marx and coworkers 2 focused on the androgens dehydroepiandrosterone DHEA and its sulphated precursor DHEAS and looked at disparity between survivors and nonsurvivors from severe sepsis. The cortisol levels of survivors reached upper normal limits and decreased significantly toward late sepsis. However nonsurvivors had persistently lower cortisol levels but within the normal .