Sepsis and infection are the major enemies of the intensive care patient in whom immunological defenses are severely impaired. This major problem is thefocus of attention in this book, based on the presentation of the First International Congress on the Immune Consequences of Trauma, Shock, and Sepsis, which is one of the first attempts to exchange ideas on the state-of-the-art in this area of immunology. Both basic and clinical research, including new centres of attention, are described. The growing role of immunology in medicine opens new avenues to the under- standing of trauma and sepsis and will allow the design of novel therapeutic approaches.

Over two decades an abundance of knowledge has been accumulated focus ing on the understanding of the molecular and cellular pathomechanisms of stressful conditions like systemic inflammation and sepsis. We have learned that there is a clear correlation between the magnitude of the inciting traumatic event and the degree of inflammatory dysbalance. The immunoinflammatory disintegration comprises a simultaneous col lapse of the otherwise very smoothly balanced pro- and antiinflammatory vectors of cytokine regulation. Most recently, we understood that it is predominantly the dysregulation of antiinflammatory mediators that plays a pivotal role for the phenomenon of trauma-induced depression or paralysis of cell-mediated immune responses. The substantial intellectual and logistic investments of numerous investi gators towards understanding the biology of sepsis inevitably lead us towards a rewarding status in terms of reaching spheres of clinical relevance. From the evolutionary collection of a multitude of ex-vivo and in-vivo immuno mechanistic parameters, some were found to represent most significant bio logical markers to support the clinician to characterize better the severity of inflammatory illness and to predict outcome. Chapter one of this book, authored by G. Grass and E.A.M. Neugebauer, analyses elegantly our current knowledge on the assessment of the immuno logical status in terms of risk and prognosis of sepsis.

Inflammation in itself is not to be considered as a disease . . . and in disease, where it can alter the diseased mode of action, it likewise leads to a cure; but where it cannot accomplish that solitary purpose . . . it does mischief - John Hunter, A Treatise on the Blood, ITfIlammation, and Gunshot Woundr (London, 1794)1 As we reached the millennium, we recognized the gap between our scientific knowledge of biologic processes and our more limited clinical capabilities in the care of patients. Our science is strong. Molecular biology is powerful, but our therapy to help patients is weaker and more limited. For this reason, this book focuses on the problems of multiple organ failure (MOF), multiple organ dysfunction syndrome (MODS), and systemic inflammatory response syndrome is, patients who have severe injuries; require major, (SIRS) in high-risk patients, that overwhelming operations; or have serious illnesses requiring intensive care; patients who have diseases elsewhere, in other organs or systems, that limit their capabilities to survive a new insult; and patients who are elderly or at high risk for sepsis or other complications. These are the patients who need our help. They need the advances in science, in molecular biology, immunology, pathophysiology, biochemistry, genetics, high technology, and other areas of maximum support at the bedside. These advances could potentially have the greatest impact on improving patient care.

This book presents a unique overview of all aspects of host defense alterations under stressful conditions. It is based on the most important contributions given at the "2nd International Congress on the Immune Consequences of Trauma, Shock, and Sepsis-Mechanisms and Therapeutic Approaches," which was held in Munich under the auspices of the most distinguished scientific societies involved in this field (Society of Critical Care Medicine, European Society of Intensive Care Medicine, Societe Internationale de Chirurgie, Surgical Infection Society, Surgical Infection Society Europe, European Society for Surgical Research, International Society for Burn Injury, American Association for the Surgery of Trauma, and National Institutes of Health). Since the first conference of this kind in 1988, new information from basic studies and clinical trials has provided exciting and novel insights into the immune dysfunctions accom panying trauma, shock, and sepsis. The volume is divided into 18 parts presenting the structural background of trauma-induced alterations of immune and imflammatory mechanisms as well as the currently discussed therapeutic interventions designed to restore or maintain normal host defenses following major injury. Introducing the general theme of the book is a summary of the essential keystones of trauma and sepsis-related immune deficits. Discussions of the progress in trauma care brought through better understanding of the cell biology of injury and of the major clinical factors that influence host defense integrity in operative medicine provide a setting for understanding the wide array of detailed information that is presented thereafter.