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Response of the endothelium to trauma and sepsis. Adherence, cytokine effects and procoagulatory response.

Trauma and sepsis induced organ dysfunction is the result of an overwhelming inflammatory response, in which the endothelium plays a central role. Within the mediator cascade reactions involve thrombin, histamine induced endothelial "stimulation" and endotoxin/cytokine induced endothelial "activation" in the endothelial/leukocyte interactions. Adherence events beyond the physiological degree lead to endothelial damage, increase of permeability and result in organ dysfunction. Activated endothelial cells are further involved in cytokine production and they are important actors in the procoagulatory/anticoagulatory balance. The homeostasis is disturbed in the systemic inflammatory response, which leads to a procoagulant state of the endothelium and severe coagulation disorders.