Septic thrombosis of the internal jugular vein: Lemierre's syndrome revisited

OBJECTIVES/HYPOTHESIS Study of the clinical evolution of a primary ear, nose, and throat infection complicated by septic thrombophlebitis of the internal jugular vein. STUDY DESIGN Retrospective case-control study. PATIENTS AND METHODS From 1998 to 2010, 23 patients at our institution were diagnosed with a septic thrombosis of the internal jugular vein. Diagnostics included microbiologic analysis and imaging such as computed tomography, magnetic resonance imaging, and ultrasound. Therapy included broad-spectrum antibiotics, surgery of the primary infectious lesion, and postoperative anticoagulation. The patients were retrospectively analyzed. RESULTS The primary infection sites were found in the middle ear (11), oropharynx (8), sinus (3), and oral cavity (1). Fourteen patients needed intensive care unit treatment for a mean duration of 6 days. Seven patients were intubated, and two developed severe acute respiratory distress syndrome. An oropharynx primary infection site was most prone to a prolonged clinical evolution. Anticoagulation therapy was given in 90% of patients. All 23 patients survived the disseminated infection without consecutive systemic morbidity. CONCLUSION In the pre-antibiotic time, septic internal jugular vein thrombophlebitis was a highly fatal condition with a mortality rate of 90%. Modern imaging techniques allow early and often incidental diagnosis of this clinically hidden complication. Anticoagulation, intensive antibiotic therapy assisted by surgery of the primary infection site, and intensive supportive care can reach remission rates of 100%. LEVEL OF EVIDENCE 3b. Laryngoscope, 2014.

Arterial blood pressure targets in septic shock: is it time to move to an individualized approach?

Xu and colleagues evaluated the impact of increasing mean arterial blood pressure levels through norepinephrine administration on systemic hemodynamics, tissue perfusion, and sublingual microcirculation of septic shock patients with chronic hypertension. The authors concluded that, although increasing arterial blood pressure improved sublingual microcirculation parameters, no concomitant improvement in systemic tissue perfusion indicators was found. Here, we discuss why resuscitation targets may need to be individualized, taking into account the patient's baseline condition, and present directions for future research in this field.

Angiotensin II in septic shock.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

The function of the murine complement *C3a and *C5a anaphylatoxin receptors in endotoxemia, bacteremia and septic shock

The complement system functions as a major effector for both the innate and adaptive immune response. Activation of the complement cascade by either the classical, alternative, or lectin pathway promotes the proteolysis of C3 and C5 thereby generating C3a and C5a. Referred to as anaphylatoxins, the C3a and C5a peptides mediate biological effects upon binding to their respective receptors; C3a binds to the C3a receptor (C3aR) while C5a binds to the C5a receptor (C5aR, CD88). Both C3a and C5a are known for their broad proinflammatory effects. Elevated levels of both peptides have been isolated from patients with a variety of inflammatory diseases such as COPD, asthma, RA, SLE, and sepsis. Recent studies suggest that C5a is a critical component in the acquired neutrophil dysfunction, coagulopathy, and progressive multi-organ dysfunction characteristic of sepsis. The primary hypothesis of this dissertation was that preventing C3a-C3aR and C5a-C5aR mediated pro-inflammatory effects would improve survival in endotoxic, bacteremic and septic shock. To test this hypothesis, the murine C3aR and C5aR genes were disrupted. Following disruption of both the C3aR and C5aR genes, no abnormalities were identified other than the absence of their respective mRNA and protein. In models of both endotoxic and bacteremic shock, C3aR deficient mice suffered increased mortality when compared to their wild type littermates. C3aR deficient mice also had elevated circulating IL-1β levels. Using a model of sepsis, C3aR deficient mice had a higher circulating concentration of IL-6 and decreased peritoneal inflammatory infiltration. While these results were unexpected, they support an emerging role for C3a in immunomodulation. In contrast, following endotoxic or bacteremic shock, C5aR deficient mice experienced increased survival, less hemoconcentration and less thrombocytopenia. It was later determined that C5a mediated histamine release significantly contributes to host morbidity and mortality in bacteremic shock. These studies provide evidence that C5a functions primarily as a proinflammatory molecule in models of endotoxic and bacteremic shock. In the same models, C3a-C3aR interactions suppress the inflammatory response and protect the host. Collectively, these results present in vivo evidence that C3a and C5a have divergent biological functions. ^

Adolfo Garcé y Gerardo Uña (compiladores), Think Tanks y políticas públicas en Latinoamérica. Dinámicas globales y realidades regionales

Fil: Di Bello, Mariana Eva. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Adolfo Garcé y Gerardo Uña (compiladores), Think Tanks y políticas públicas en Latinoamérica. Dinámicas globales y realidades regionales

Fil: Di Bello, Mariana Eva. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Comparison of experimental and numerical sloshing loads in partially filled tanks

Sloshing describes the movement of liquids inside partially filled tanks, generating dynamic loads on the tank structure. The resulting impact pressures are of great importance in assessing structural strength, and their correct evaluation still represents a challenge for the designer due to the high level of nonlinearities involved, with complex free surface deformations, violent impact phenomena and influence of air trapping. In the present paper, a set of two-dimensional cases, for which experimental results are available, is considered to assess the merits and shortcomings of different numerical methods for sloshing evaluation, namely two commercial RANS solvers (FLOW-3D and LS-DYNA), and two academic software (Smoothed Particle Hydrodynamics and RANS). Impact pressures at various critical locations and global moment induced by water motion in a partially filled rectangular tank, subject to a simple harmonic rolling motion, are evaluated and predictions are compared with experimental measurements. 2012 Copyright Taylor and Francis Group, LLC.

Pitting Corrosion in Austenitic Stainless Steel Water Tanks of Hotel Trains

The water storage tanks of hotel trains suffered pitting corrosion. To identify the cause, the tanks were subjected to a detailed metallographic study and the chemical composition of the austenitic stainless steels used in their construction was determined. Both the tank water and the corrosion products were further examined by physicochemical and microbiological testing. Corrosion was shown to be related to an incompatibility between the chloride content of the water and the base and filler metals of the tanks. These findings formed the basis of recommendations aimed at the prevention and control of corrosion in such tanks. Se han detectado problemas de corrosión por picaduras en los depósitos de agua de trenes hotel. Para identificar las causas se llevó a cabo un detallado estudio metalográfico así como de la composición química de los aceros inoxidables austeníticos utilizados en su construcción. También se realizaron estudios fisicoquímicos y microbiológicos de los productos de corrosión. Se ha encontrado que los problemas de corrosión están relacionados con la incompatibilidad entre el contenido en cloruros del agua y los metales base y de aporte de la soldadura de los tanques. En base a estos hallazgos se proponen una serie de recomendaciones encaminadas a la prevención y control de la corrosión de dichos depósitos.

Development of a tanks line for waxing landing gear parts

The aim of this article is to define the technical specifications and to design the implementation of a line of tanks that would be used in the process of waxing and de-waxing large pieces. As it is based in a real case, it is also analyzed the process of dismantling the former installation that supported these functions. The origin of this project is due to a new rating for the maintenance of landing gears which makes the previous waxing line that was prepared to work on smaller aircraft?s pieces, no longer adequate to the current workflow and processes.