Correlating functional staging to effective treatment of acute surgical illness.
BACKGROUND
Proinflammatory and anti-inflammatory events may eventually trigger host response, which acting via a broad spectrum of complex biological processes and molecular interactions may either enhance or resolve the symptoms of acute surgical illness (ASI). Staging the sequence of biological events that take place at the cellular level during the development of ASI may provide leads to effective stage-specific treatments. In line with the hypothesis that proper timing of therapeutic intervention may be crucial to the management of the disease, we have attempted in this review to correlate functional staging to effective treatment of ASI.


METHODS
The present report proposes a conceptual synthesis on the biogenesis and treatment of ASI that is based on known molecular and cellular aspects of human inflammatory sequence and patient data from clinical trials. It also introduces proper timing of therapeutic intervention as a potentially important determinant for the successful outcome of the disease process.


CONCLUSIONS
Progress in understanding the biogenesis of ASI did not result in successful therapeutic developments as yet. The challenge ahead should be a better understanding of the dynamics of the various processes and regulators in appropriate animal and clinical models of ASI, in order to properly intervene and direct effective therapies for the benefit of critically ill patients.
Nomikos
I N
IN
Department of Surgery, Athens University School of Nursing, Athens, Greece. jnomikos@cc.uoa.gr
Vamvakopoulos
N C
NC
D000208:Acute Disease; D017209:Apoptosis / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D009102:Multiple Organ Failure / Q000503:physiopathology*; D009504:Neutrophils / Q000502:physiology; D015398:Signal Transduction / Q000502:physiology