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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Advances in medical technology and knowledge have influenced morbidity and mortality in surgically treated diseases. The authors have compiled four consecutive retrospective studies of demography, morbidity and mortality of patients with acute pancreatitis to summarize the experience from 1956 to 1985 at the Montreal General Hospital with 629 patients. The death rate has remained unchanged. Hypotension, gastrointestinal bleeding and respiratory failure have assumed lesser roles as major complicating factors. Renal failure and gram-negative aerobic pancreatic sepsis are the common causes of death. The last two reviews revealed that surgical debridement and drainage combined with appropriate biliary procedures salvaged two-thirds of the patients with sepsis. Deteriorating nutritional status, heralded by a fall of serum albumin level below 30 g/L, is associated with a poor prognosis. Interval cholecystectomy in patients with mild biliary tract pancreatitis is associated with a low death rate (0.01%).
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PMID:Acute pancreatitis--30 years' experience at a teaching hospital. 202 95

Infected pancreatic necrosis was diagnosed clinically and radiologically in a patient admitted for acute pancreatitis. As free gas in the pancreatic area was recognized, antibiotic therapy (ceftriaxone) was empirically introduced, while surgical drainage was being planned. After the second week, the patient rapidly started to improve, to the point that he could be discharged home without operation. Control CT-scans and general laboratory tests, at this phase and later on, confirmed a still enlarged gland but free of infection or ongoing inflammation. Cholelithiasis, which had been identified in an early ultrasound scan, was electively treated by cholecystectomy 2 mo after the onset of pancreatitis, in the absence of sepsis, and with uneventful recovery. This case illustrates the rare possibility of spontaneous regression of infected necrotic pancreatitis, without any type of operation or nonoperative drainage.
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PMID:Clinical regression of infected pancreatic necrosis. Case report. 151 60

Sixty-three patients with severe acute pancreatitis have been studied. Pancreatitis was associated with biliary tract disease in 23 patients (36.5%) and with alcoholism in 21 (33.3%). It occurred post-operatively in 9, and was associated with other conditions in 10. We evaluated the Ranson prognostic signs (RPS) with the appearance of complications. 36 patients (57.2%) had 3-4 RPS, 9 (30.2%) had 5-6 RPS and 8 (12.6%) had 7 or more RPS. Diagnostic laparotomy was performed in 11 patients (17.5%). 55 patients were operated one or more times due to failure of medical treatment and/or local and septic complications. The most frequent complications were pancreatic abscess (60.3%), sepsis (58.7%) and pulmonary insufficiency (52.4%). Renal failure occurred in 26 patients and 9 required dialysis. Of the patients with renal failure, 84.6% (22/26) had 4 or more RPS; 78.4% (29/37) of those with sepsis and 71.6% (27/38) of those with pancreatic abscess also had 4 or more RPS. The mean duration of hospitalization of survivors was 58 +/- 30 days. Overall mortality was 28.6%. We conclude that RPS are helpful to predict complications in patients with severe pancreatitis.
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PMID:[Acute severe pancreatitis. Analysis of mortality and morbidity]. 184 70

In patients with severe acute pancreatitis, the most important diagnostic goal is differentiation between the interstitial-edematous and the necrotizing type of acute pancreatitis. Surgical management in patients with proven necrotizing pancreatitis is indicated in patients who develop surgical acute abdomen, sepsis, shock syndrome, multisystemic organ failure syndrome, persistent or progressive despite maximum intensive care. The most appropriate procedure for surgical management of pancreatic necrosis is the careful removal of necrosis and preservation of vital pancreatic tissue. Necrosectomy supplemented by postoperative closed continuous lavage of the lesser sac is a procedure that offers the advantages of debridement of devitalized tissue only, and the non-surgical removal of necrotic tissue and bacterially and biologically active compounds. In comparison with a reoperation protocol, necrosectomy and continuous lavage reduce the reoperation rate as well as the need for tracheostomy. In a prospectively treated series of patients suffering from necrotizing pancreatitis, hospital mortality was 8.4% and the reoperation rate 27%. Any tissue becoming necrotic in the postoperative course of disease is rinsed with lavage fluid, thus obviating the need for repeated surgical reoperation in most patients. Local lavage is achieved by the insertion of two, in some cases five, large double-lumen tubus and the use of 8 liters (median) of lavage fluid per day.
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PMID:Operative management of necrotizing pancreatitis--necrosectomy and continuous closed postoperative lavage of the lesser sac. 185 69

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-edematous pancreatitis and necrotizing pancreatitis. In this respect, laboratory measures like CRP, LDH, and antiproteases, and the application of contrast-enhanced CT are highly sensitive methods. Surgical decision-making should be based on clinical, bacteriological and contrast-enhanced CT data. Persistent or progressive systemic or local organ complications occurring despite ICU treatment for a minimum of three days are indicators for surgical management of necrotizing pancreatitis. Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, or surgical acute abdomen should be treated surgically early in the course of the disease. The use of a major pancreatic resection for the surgical management of necrotizing pancreatitis should be excluded from treatment protocols. Carefully performed necrosectomy or debridement, in combination with continuous or repeatedly applied surgical evacuation techniques for necrotic tissue, bacteria, and biologically active compounds, has proved to be very effective in experienced treatment centers. Necrosectomy and postoperative continuous local lavage is a well-adapted, safe, and atraumatic procedure. It results in a hospital mortality of less than 10% in patients with necrotizing pancreatitis.
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PMID:Surgery in acute pancreatitis. 185 79

The variable clinical presentation and natural history of acute pancreatitis are illustrated by case reports, namely a case with a falsely positive diagnosis of biliary pancreatitis, a case with acute interstitial pancreatitis of biliary origin, a patient with early and severe late systemic complications and with sterile necrotizing pancreatitis necessitating operative debridements twice, a patient with acute pancreatogenic ascites and ARDS requiring drainage and respiratory supportive care, a patient with biliary pancreatitis and operation for necrotizing cholecystitis, with a further, late intervention for pancreatic abscess, and a patient with internal drainage for a pseudocyst, complicated by acute biliary pancreatitis due to cholesterolosis of the gallbladder. Modern clinico-pathological classification of acute pancreatitis and modern definitions of pancreatic sepsis are important for determining prognosis and adequate treatment.
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PMID:[Variable course in acute pancreatitis exemplified by case reports]. 186 65

Twenty patients with histologically verified carcinoid liver metastases underwent a total of 24 liver artery embolizations by means of interventional radiologic techniques. There were no deaths. The postembolization syndrome, consisting of fever, abdominal pain, nausea, and vomiting, occurred in all the patients. Severe complications were rare, the most serious being multiple hepatic abscesses with septicemia in one patient, septicemia in another, and mild acute pancreatitis in a third. All these three patients recovered without any sequels from the embolization, and none required surgical intervention. The hepatic abscesses were drained percutaneously, guided by ultrasound. Hepatic artery embolization seems justified in patients with disabling symptoms from the carcinoid syndrome, as long as alternative therapy with the same benefit but fewer complications is not available.
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PMID:Side effects and complications after hepatic artery embolization in the carcinoid syndrome. 187 48

The mortality rate for acute pancreatitis complicated by necrosis and infection has remained high in spite of progress made in supportive care. This is mostly related to development of multi-organ failure and overwhelming sepsis. Early diagnosis of necrosis and infection followed by correct management are essential for improving survival. Contrast-enhanced computed tomography with the adjunct of fine-needle aspiration is reliable in detecting necrosis and infection. Several surgical treatment modalities are discussed in the literature; however, the cornerstone for improved survival in patients with infected necrosis is adequate debridement and wide drainage. This can be achieved with any modality, provided that the patients are re-explored promptly if the septic status persists.
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PMID:Pancreatic necrosis and infection--an update on management. 188 9

The influence of total parenteral nutrition (TPN) was studied in 67 patients with severe acute pancreatitis having three or more criteria according to Ranson (mean +/- SD = 3.8 +/- 0.21). Although TPN has been reported to not be of benefit in the progress and severity of the disease, we have found that the time TPN is started is important in influencing the course of the disease and in the development of local complications, as well as in the mortality rate. Patients whose TPN was started within the first 72 hours of the disease had a 23.6% complication rate and 13% mortality, in comparison with patients whose TPN was started later in the course of the disease, who had a 95.6% complication rate (p less than 0.01) and a mortality rate of 38% (p less than 0.03). The nutritional status of the patients during TPN administration of 28.4 days was maintained either steady or was improved, as assessed by nitrogen balance, serum levels of transferrin (p less than 0.05), and albumin (p less than 0.05). The administration of fat solution, either to prevent essential fatty acid deficiency or to provide part of the caloric requirements, was found to cause neither clinical nor laboratory worsening of the disease. All pancreatic fistulae that developed during the course of the disease spontaneously closed in patients receiving TPN without operation in a mean period of 33.3 days, and all pseudocysts subsided in an average of 18.3 days. Those who died (overall mortality rate 24%) had had uncontrollable sepsis, which resulted in hypercatabolism and multiple system organ failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Total parenteral nutrition in severe acute pancreatitis. 157 3

116 patients admitted for acute pancreatitis were analysed. In 80% of patients presenting biliary pancreatitis cholecystectomy and bile duct exploration was the prevalent treatment, in 7.8% pancreatic necrosis was removed. Indications to operate on patients with non-biliary pancreatitis included enhancement of pancreatic inflammation revealed by computed tomography and multi-organ-failure or sepsis complicating the course of the disease (incidence of laparotomy 20.3%, incidence of necrosectomy 12.3%). According to this concept 2 out of 3 patients presenting partial pancreatic necrosis recovered without operation. Lethality of patients with acute necrotizing pancreatitis (6.9%) was accounted 25%, over-all mortality 6%. Methods used for classification of severity of acute pancreatitis (Mainz classification, Ranson criteria) turned out to be not reliable. Clinical staging of pancreatitis was not in accordance with intraoperative findings in 51.9% of cases. As a prerequisite for stage-dependent therapy new objective data to access severity and clinical course of acute pancreatitis have to be worked out.
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PMID:[The value of classification for therapy and prognosis of acute pancreatitis. Analysis of a patient sample of the Heidelberg Surgical University Clinic 1986-1989]. 191 47


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