The ␤ 2 integrin CD11b plays a central role in inflammation and the systemic inflammatory response syndrome (SIRS). The CD11b molecule activates in two ways: the density of membranebound CD11b up-regulates and the molecule undergoes a conformational change that confers adhesiveness to counter-receptors. We studied the kinetics of CD11b activation in patients with SIRS. We found a significantly diminished CD11b activation in response to tumor necrosis factor ␣ (TNF-␣). This affected all circulating polymorphonuclear neutrophils (PMN) and was an intrinsic property of the cells and not due to antagonism by soluble TNF-␣ receptors or loss of cellular receptors for TNF-␣. Diminished responsiveness correlated with the severity of organ failure and lasted for months in some patients but had no impact on mortality. We speculate that reduced CD11b responsiveness in SIRS contributes to the high risk of recurrent infection, but that it may also be protective against excessive PMN activation within the vascular space.

P Pu ur rp po os se e: : Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.C Co on nc cl lu us si io on ns s: : It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors. MNIOTIC fluid embolism (AFE) is a rare life-threatening complication unique to pregnancy. AFE has a mortality rate of 61 to 86% and accounts for approximately 10% of all maternal deaths in the United States. 1,2 AFE has a variable presentation, ranging from mild degrees of organ dysfunction to cardiovascular collapse, coagulopathy and death. 1,2 AFE usually presents at term during labour. 3 In this report, we present a patient in her second trimester of pregnancy who developed sudden hypoxic respiratory failure followed by cardiopulmonary arrest and coagulopathy following dilatation and evacuation (D & E) for intra-uterine fetal demise. Objectif