THE CONCEPT AND DIAGNOSIS OF MULTIPLE SYSTEMS ORGAN FAILURE

Authors
Citation
Zy. Sheng et Hm. Yang, THE CONCEPT AND DIAGNOSIS OF MULTIPLE SYSTEMS ORGAN FAILURE, Chinese medical journal, 107(8), 1994, pp. 563-569
Citations number
NO
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medicine, General & Internal
Journal title
ISSN journal
0366-6999
Volume
107
Issue
8
Year of publication
1994
Pages
563 - 569
Database
ISI
SICI code
0366-6999(1994)107:8<563:TCADOM>2.0.ZU;2-F
Abstract
There are still controversies concerning the concept and diagnosis of multiple systems organ failure (MSOF), since the term does not precise ly define its true nature, and its differential diagnosis with other i rrelevant clinical conditions, such as senile dysfunction of organs, a gonal state, etc, remains unclarified. Our studies on both human burn patients and rat model by means of electron spin resonance (ESR) showe d that there was an excessive generation of free oxygen radicals resul ting in lipid peroxidation of cell membrane of various tissues. The in testine seemed to be particularly sensitive to hypoperfusion-reperfusi on injury, as diamine oxidase activity of the ileum was lowered and tr anslocation of bacteria occurred, indicating failure of intestinal muc osal barrier function. Concomitant determinations of plasma endotoxin (LPS) and tumor necrosis factor alpha (TNFa) levels showed significant elevation, especially in patients who finally developed MSOF. The dat a suggested that intestinally derived bacteria and / or LPS exacerbate the systemic responses initiated by ischemia reperfusion injury and t he presence of large amounts of devitalized tissue. Early diagnosis is important inorder to improve the prognosis. However, current criteria of diagnosis for MSOF do not conduce to an early diagnosis, as they o nly describe the end stage manifestations, while our therapeutic strat egy should be directed against different levels of initiators, systemi c mediators, and effectors of injury. Therefore, it is important to em phasize the role of septic responses in the development of the syndrom e. We propose that the name of the syndrome be changed to ''sepsis wit h organ dysfunction'' or ''mediator injury of organs''.