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1/2. Staghorn calculus endotoxin expression in sepsis.

    Staghorn calculi are infrequent and generally are infected stones. Struvite or apatite calculi are embedded with gram-negative bacteria, which can produce endotoxin. sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. We present a child with an infected staghorn calculus who developed overwhelming sepsis and died after percutaneous stone manipulation. Endotoxin assay of stone fragments demonstrated an extremely high level of endotoxin despite low colony bacterial culture growth. This is the first reported case in which endotoxin was demonstrated in stone fragments from a child who died of severe sepsis syndrome after percutaneous staghorn stone manipulation.
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keywords = endotoxin
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2/2. Masking of the symptoms of esophageal and bowel perforation by combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone.

    sepsis is usually treated with surgical drainage, antibiotics, oxygenation optimization and volume resuscitation. Recent monoclonal and polyclonal anti-bodies have been used to treat sepsis by neutralizing the endotoxins and cytokines found in septic patients. This method does not significantly reduce mortality except in certain sub-populations of the treatment groups. We introduced a combination approach for sepsis treatment. This adjuvant therapy consists of polyclonal human immunoglobins together with infusion of low-dose hydrocortisone. This paper reports the results of this treatment in two different cases.
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keywords = endotoxin
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