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Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. Faecal peritonitis was induced in pigs that were killed 8 h later and frontal cortex samples were taken immediately after death. The tissue was investigated using light and electron microscopy and compared with frontal cortex samples taken from sham-operated controls. Septic pigs had 49.5% more perimicrovessel oedema than sham pigs. However, the tight junctions between cerebral microvessel endothelial cells appeared morphologically intact in both septic and sham pigs. Sepsis also resulted in neuronal injury, disruption of astrocytic end-feet and swollen, rounded erythrocytes. These morphological changes may be sufficient to underlie the clinical features seen in septic encephalopathy.

Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. Faecal peritonitis was induced in pigs that were killed 8 h later and frontal cortex samples were taken immediately after death. The tissue was investigated using light and electron microscopy and compared with frontal cortex samples taken from sham-operated controls. Septic pigs had 49.5% more perimicrovessel oedema than sham pigs. However, the tight junctions between cerebral microvessel endothelial cells appeared morphologically intact in both septic and sham pigs. Sepsis also resulted in neuronal injury, disruption of astrocytic end-feet and swollen, rounded erythrocytes. These morphological changes may be sufficient to underlie the clinical features seen in septic encephalopathy.

A patient with severe acute respiratory distress syndrome requiring prolonged tracheal intubation and mechanical ventilation is described. Tracheal dilatation was noted to have occurred following an elective surgical tracheostomy. Eventually, the patient was successfully weaned from mechanical ventilation and the tracheostomy tube removed.

Simple measures such as counting of numbers of patients and fatalities, do not provide either adequate or comprehensive data with regards to the performance of an intensive care unit (ICU), due to the great variations in case mix which includes age, diagnoses, severity of acute illness and co-morbidities. Consequently, complex scoring systems have emerged. These systems and in particular the Acute Physiology, Age, Chronic Health Evaluation (APACHE) III were developed for intensive care units (ICU) for sone principal reason [1]. This was to predict the risk of death for admitted patients. Subsequently to these, various authors have used these systems, although they were not specifically designed for this purpose, to evaluate the efficiency, clinical effectiveness and quality of care within each unit [2–6].

This review program is utilized during the design of a nuclear power plant to insure separation between interdiscipline design for the Reactor Protection System (RPS) and Engineered Safeguard Systems (ESS). Color coded transparent drawings of the RPS and ESS are produced by each discipline. The separation is then reviewed by overlaying drawings of different disciplines on a light table. When this inspection shows that RPS or ESS elements have less than the established minimum separation, an analysis is performed to determine what, if any, design revision is necessary to insure proper separation. "Hazard" drawings are also made for determination of each type of potential hazard in each area of the plant. The review is a continuing process as the design progresses and is revised by any discipline. A complete writeup of apparent separation violations and resolution of the apparent violations is made for each stage of the separation review.