Document Detail

Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS)
MedLine Citation:
PMID:  8849154     Owner:  NLM     Status:  MEDLINE    
Our current understanding of sepsis and multiple organ dysfunction needs to be revised, as the uniformly negative results of new therapies for these disorders suggest. Previous theories for the pathogenesis of these conditions are incomplete; reasons for this include the following. First, the surrogate models that have been used to study these disorders are not analogous to the clinical situation. Second, patients who have less severe manifestations of these diseases are often overlooked. And third, patients' preexisting conditions have not been taken into account. Considerable new evidence indicates that, in addition to a massive proinflammatory reaction, a compensatory anti-inflammatory response contributes to the onset of these disorders. At a local site of injury or infection and during the initial appearance of pro- and anti-inflammatory mediators in the circulation, the beneficial effects of these mediators outweigh their harmful effects. Only when the balance between these two forces is lost do these mediators become harmful. Sequelae of an unbalanced systemic proinflammatory reaction include shock, transudation into organs, and defects in coagulation. An unbalanced systemic compensatory anti-inflammatory response can result in anergy and immunosuppression. The proinflammatory and anti-inflammatory forces may ultimately reinforce each other, creating a state of increasingly destructive immunologic dissonance.
R C Bone
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of internal medicine     Volume:  125     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1996-10-24     Completed Date:  1996-10-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  680-7     Citation Subset:  AIM; IM    
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
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MeSH Terms
Immune Tolerance
Multiple Organ Failure / immunology*,  physiopathology
Systemic Inflammatory Response Syndrome / immunology*,  physiopathology
Comment In:
Ann Intern Med. 1996 Oct 15;125(8):690-1   [PMID:  8849156 ]

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