Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Complement fragments (C3, C3d, C5a), thromboxane B2 (TxB2), 6-keto-PGF1 alpha and immunoreactive trypsin (IRT) were measured in 98 patients at risk of developing the adult respiratory distress syndrome (ARDS): 53 multiple trauma, 28 abdominal surgery and 17 acute pancreatitis. Sixty-five of these patients developed ARDS: 30 multiple trauma, 19 abdominal surgery and 16 acute pancreatitis patients. Forty of the 65 ARDS patients and 9 out of the 33 non-ARDS patients died. Mean value of the C3d to C3 ratio was abnormal in both ARDS and non-ARDS patients. C5a-like activity was detected in 70 out of the 98 patients (49 ARDS and 22 non-ARDS patients). TxB2 abnormal values (greater than 100 pg . ml-1) were found in 70% of the patients, especially when sepsis occurred. No correlation could be made between abnormal 6-keto PGF1 alpha values and ARDS or sepsis. The mean peak IRT value was 675 micrograms . 1(-1) for ARDS patients and 274 micrograms . 1(-1) for non-ARDS patients (p less than 0.05). A firm correlation was also measured between IRT and sepsis (p less than 0.01). C5a-like activity was regularly detected soon after injury, while TxB2 and IRT tend to appear later in patients developing ARDS. Neither C3d/C3, nor C5a-like activity, nor TxB2, nor IRT are specific markers of ARDS, since they also appeared in severely ill patients who did not develop ARDS.
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PMID:Biochemical pathways of acute lung injury. 387 73

The value of ERCP was studied in 25 patients with pancreatic pseudocysts. There were no episodes of sepsis; however, acute pancreatitis developed in one patient for an overall complication rate of 4 percent. Results of ERCP were positive in 24 of the 25 patients (96 percent), with filling of the pseudocyst in 17 and pancreatic ductal obstruction in 7. Biliary tract abnormalities were found in seven patients and included common bile duct strictures in four, bile duct dilatation in two, and cystic duct obstruction in one. ERCP also detected six pseudocysts not diagnosed by ultrasonography, five of which were small and resolved with nonoperative therapy. ERCP is a safe diagnostic procedure for patients with pancreatic pseudocysts and may provide important information about coexistent biliary tract disease not otherwise available. It is also sufficiently sensitive to detect small pseudocysts that otherwise would be missed.
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PMID:Endoscopic retrograde cholangiopancreatography in the management of pancreatic pseudocysts. 390 81

This study set out to investigate the alteration of amino acid (AA) and protein metabolism in patients with malnutrition, sepsis, acute pancreatitis and liver diseases. The results showed that in preoperative patients with malnutrition or protein catabolism (decreased levels of plasma proteins, increased urea production rate) the postoperative complications were significantly increased. An increased postoperative infusion of branched chain AA did not improve postoperative nitrogen retention nor plasma protein syntheses in patients with colon or rectum CA. Patients with sepsis or acute pancreatitis had drastically reduced levels of total muscular free AA, mainly due to a fall in muscle glutamine. In septic patients also the hepatic levels of free AA were decreased. These changes of AA metabolism found in clinical situation were not always reflected by results found in experimental rat models (sepsis, pancreatitis, burn injury). The parenteral administration of a synthetic dipeptide containing glutamine and alanine decreased the muscular decrease of glutamine and alanine and increased the hepatic uptake of these two AA in a catabolic dog model. In critically ill patients changes in amino acid and protein metabolism lead to a protein catabolic situation. Urea production rate and muscle glutamine levels seem to be closely related to the prognosis of catabolic patients.
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PMID:[Amino acid and protein metabolism in critically ill patients]. 393 9

Pancreatic abscess has become the most common cause of death from acute pancreatitis. Since computed tomography (CT) permits noninvasive imaging of the peripancreatic anatomy, the relationship of early CT findings to late pancreatic sepsis has been evaluated in 83 patients with acute pancreatitis. Pancreatic abscesses developed in 18 patients and were responsible for five of the six deaths in this study. Initial CT findings were graded: A = normal, in 12 patients; B = pancreatic enlargement alone, in 19; C = inflammation confined to pancreas and peripancreatic fat, in 17; D = one peripancreatic fluid collection, in 12; and E = two or more fluid collections, in 23. The incidence of pancreatic abscess in grades A and B was 0%; in grade C, 11.8%; in grade D, 16.7; and in grade E, 60.9%. The severity of pancreatitis was also graded by previously reported prognostic signs as "mild" (0-2 signs) in 56 patients, "moderate" (3-5 signs) in 22, and "severe" (greater than or equal to 6 signs) in five patients. The incidence of abscesses in mild disease was 12.5%; in moderate, 31.8%; and in severe, 80%. Fluid collections on CT resolved spontaneously in 19 of 35 (54.3%) patients. Abscess developed in two patients with no fluid collections on initial CT study. No abscess occurred in 31 patients with CT grades A or B, and in one of 22 patients (4.5%) with CT grade C or D and less than three positive prognostic signs. Among 30 patients with CT grade E or CT grade C or D and three or more positive prognostic signs, 17 (56.7%) developed abscesses. All deaths were in patients with five or more positive prognostic signs. Early imaging of the pancreas by CT identifies a group of patients with increased risk of pancreatic abscess. Identification of this group is improved further by use of early objective prognostic signs.
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PMID:Computed tomography and the prediction of pancreatic abscess in acute pancreatitis. 399 37

The appearance of the adult respiratory distress syndrome (ARDS) during the course of acute illness is believed to result, in part, from intrapulmonary neutrophil sequestration and degranulation induced by circulating inflammatory mediators. To evaluate the role of complement-neutrophil interactions in the pathogenesis of ARDS in man, 34 patients suffering from intra-abdominal sepsis (seven), multisystem trauma (15), or acute pancreatitis (12) were serially studied with regard to neutrophil migratory responses to C5a and F-Met-Leu-Phe, lysosomal content of beta-glucuronidase and lysozyme, and simultaneously obtained plasma levels of immunoreactive C3adesArg and C5adesArg. Nineteen patients developed ARDS. In these patients, plasma C3adesArg levels obtained within 72 hours of admission to the hospital were elevated to 305 +/- 35 ng/ml compared with 145 +/- 16 ng/ml for patients who did not develop ARDS (p less than 0.0005). C5adesArg levels were not elevated in either group. In vitro studies showed that neutrophils from normal persons were able to clear all of the C5a/C5adesArg generated in up to 5% zymosan-activated serum, while no clearance of C3adesArg was identified. Patient migratory responses could be divided into three groups based on their initial (less than 72 hour) samples: (1) hyperresponsive to both N = formyl-methionyl-leucyl-phenylalanine (FMLP) and C5a, (2) specifically deactivated to C5a, and (3) deactivated to both C5a and FMLP. Patients in the latter two groups developed ARDS. Enzyme content of neutrophils from patients who developed ARDS showed a substantial fall in beta-glucuronidase and lysozyme levels. The finding of elevated plasma C3a levels and deactivation of migratory response to C5a support the contention that complement activation had occurred in these patients and that their neutrophils had been exposed to C5a/C5adesArg in vivo. The finding of nonspecific migratory dysfunction associated with lysozymal enzyme loss, a circumstance not reproducible in vitro by C5a exposure, suggests that other stimuli produced degranulation of neutrophils made hyperresponsive by prior exposure to C5a.
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PMID:Complement activation and clearance in acute illness and injury: evidence for C5a as a cell-directed mediator of the adult respiratory distress syndrome in man. 400 15

We measured amino acid concentrations in plasma and skeletal muscle of three groups of patients with acute hemorrhagic pancreatitis: (a) patients without secondary organ lesions, (b) patients also suffering from kidney damage, and (c) patients in whom the pancreatitis was accompanied by sepsis and multiple organ failure. In all three groups, especially the third group, the amino acid concentrations in both plasma and muscle were below normal. Glutamine was only 14% of normal in muscle tissue of the third group. Onset of renal insufficiency was indicated by increasing values for 3-methylhistidine and cystathionine; multiple organ failure, by increased concentrations of methionine and phenylalanine in plasma. The low amino acid concentrations of patients with acute pancreatitis can be explained as a combined effect of semistarvation and hypercatabolism. Changes in the plasma concentrations of amino acids did not reflect necessarily the concentrations in muscle tissue.
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PMID:Amino acid concentrations in plasma and skeletal muscle of patients with acute hemorrhagic necrotizing pancreatitis. 401 35

The reported mortality due to pancreatic abscesses after acute pancreatitis has been 30 to 50%, a statistic that has remained unchanged for decades. This is a report of 45 patients treated over 10 years, showing a dramatic improvement in survival during that period. They represent 2.5% of admissions at the Massachusetts General Hospital for acute pancreatitis. The identifiable antecedents included alcohol (38%), gallstones (11%), and surgical trauma (16%), or were unknown in 24%. Computerized tomography (CT) was clearly the best means of specific diagnosis (unequivocal evidence in 74%, suggestive in 21%). Treatment in 44 patients was surgical debridement and catheter drainage, and in one it was resection of the pancreatic head. Multiple abscesses were present at the first operation in 21 patients. Seven had second drainage procedures for additional abscesses. In the first 5 years (1974-1978), 10 of 26 patients died (38%). In the second 5 years (1979-1983), one of 19 died (5%) (p less than 0.01). Postoperative complications (84%) included wound hemorrhage (9 of 26 vs. 1 of 19), systemic sepsis (7 of 26 vs. 1 of 19), pancreatic fistula (14/45, 13 of which closed spontaneously), colonic perforation (4), duodenal perforation (2), and gastric perforation (1). The causes of death were renal and respiratory failure with sepsis (7), hemorrhage (3), and pulmonary emboli (1). Analysis of the findings shows in the second 5-year period more frequent use of CT to certify the diagnosis of pancreatic abscess earlier, a more aggressive attitude producing earlier surgical intervention, and more extensive drainage and debridement of associated necrotic tissue. Transcatheter arterial embolization was used successfully to control postoperative hemorrhage from the abscess cavity. CT-guided percutaneous catheter drainage was used occasionally for drainage of recurrent abscesses. Neither open packing of major pancreatic abscesses nor lavage of the abscess cavity, as recently advocated, was necessary.
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PMID:Improved survival in 45 patients with pancreatic abscess. 405 96

Colonic necrosis is a rare complication of peripancreatic sepsis following acute pancreatitis. Three patients with colonic necrosis associated with extensive retroperitoneal suppuration are reported. The pathogenesis of this syndrome may be explained by the tendency of pancreatic abscesses to extend widely in the retroperitoneum. Management is discussed, emphasizing the need for an aggressive surgical approach and multiple operations.
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PMID:Colonic necrosis in acute pancreatitis. A complication of massive retroperitoneal suppuration. 406 56

The purpose of this study is to elucidate the pathophysiology of the acute pancreatitis and set up the criteria for assessing the severity of this disease. One hundred and fifty seven cases of acute pancreatitis were treated at the First Surgical Department of Tokyo University Hospital and its affiliated hospitals. They consisted of 24 severe cases, 76 moderate cases, and 57 mild cases according to our classification. In early stage ten parameters, namely, abnormalities of white cell count, platelet count, hematocrit, lactic acid dehydrogenase, blood urea nitrogen, serum calcium, base excess, PaCO2 and fasting blood glucose and age within 24 hours after admission and X-ray CT scan within 48 hours as early prognostic signs, enabled us to predict severe, moderate, or mild pancreatitis. More than 4 weeks later than the onset of acute pancreatitis, X-ray CT scan, white blood cell count, elevation of serum FDP level, endotoxemia and fall of plasma opsonic index served as good indicators to evaluate the severity of abdominal sepsis. In experimental pancreatitis, CH50 and opsonic index were remarkably decreased at 6 and 12 hours after induction of acute pancreatitis. As the above results, determination of early prognostic signs immediately after onset and late prognostic signs 3-4 weeks after onset is very important to evaluate and manage the acute pancreatitis patients.
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PMID:[Pathophysiology and prognosis of acute pancreatitis--early and late prognostic signs]. 408 48

alpha 2-macroglobulin is probably the most important of the antiproteases in plasma. In this study, the relationships of plasma alpha 2-macroglobulin to the clinical features of acute pancreatitis as well as to plasma levels of other antiproteases, immunoglobulins, and immunoreactive trypsin, were investigated in 55 patients with acute pancreatitis. The mean level of alpha 2-macroglobulin in 395 plasma samples from the patients was 2.12 g/liter compared with 2.41 g/liter in 29 healthy subjects and 2.93 g/liter in 17 patients with septicemia. Plasma levels were lower in 12 patients with severe pancreatitis than in 43 with mild attacks, and the lowest levels in three fatal attacks were less than half the mean of the normal range. Lowest levels were recorded at a mean time of 3 days after admission in the patients with mild attacks, at 5 days after admission in the patients with severe attacks, and 9 days after admission in those with fatal attacks. In contrast, plasma levels of the alpha 1-proteinase inhibitor antichymotrypsin and C-reactive protein increased to above normal levels during the attack, significantly more so in severe compared with mild attacks. Plasma levels of IgA, IgG, and IgM remained within the normal range or were increased. In patients with severe pancreatitis, plasma levels of immunoreactive trypsin remained elevated for longer than in those with mild attacks although there was little initial difference in the levels. These data suggest that decreasing levels of alpha 2-macroglobulin during the course of acute pancreatitis are due to a specific mechanism and unrelated, for the most part, to any generalized effect of pancreatitis on protein synthesis. The formation of rapidly cleared complexes between alpha 2-macroglobulin and active proteases is the most tenable explanation for the depletion of plasma levels, but the clinical significance of the changes remains unclear.
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PMID:Relation of alpha 2-macroglobulin and other antiproteases to the clinical features of acute pancreatitis. 619 93


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