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

The efficiency of vancomycin hydrochloride in the treatment of septicemia due to polyresistant aureus staphylococcus is illustrated by the observation of a patient affected with a necrotic and hemorrhagic acute pancreatitis and post-operative septicemic syndrome, which has been cured after a one-month treatment with a daily dose of two grammes. The vancomycin hydrochloride, because of its potential toxicity on the kidneys and cochlea should be reserved to the treatment of major staphylococcic infections. It could be prescribed either alone or in association, with a mean daily dose of 30 milligrammes a kilo, slowly administered by intravenous way. The side effects are prevented by adjusting the doses in case of renal insufficiency and by controlling the serous concentrations in case of a long continued treatment.
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PMID:[Septicemia due to polyresistant Staphylococcus aureus (author's transl)]. 625 90

The complement (C) system evolved as a beneficial antimicrobial system. However, when activated during extracorporeal perfusion as with haemodialysis or cardiopulmonary bypass modest pulmonary dysfunction associated with granulocyte aggregation and embolization can occur. When C activation is massive and prolonged, as with severe sepsis, trauma, or acute pancreatitis, severe pulmonary damage which is recognized as shock lung, or adult respiratory distress syndrome, may occur. Since ulcerating atherosclerotic plaques can also activate C, a mechanism by which myocardial infarcts may extend during the first few hours after infarction is also implied. Therapeutic ramifications of these conclusions are evident. Thus, high doses of corticosteroids or of nonsteroidal anti-inflammatory agents such as ibuprofen share the ability to prevent aggregation and embolization of stimulated granulocytes to patent vessels downstream and also inhibit their production of toxic oxygen radicals. These properties suggest the use of these agents in myocardial infarction and shock states, particularly shock lung, and appropriate clinical trials are awaited with interest.
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PMID:Complement-mediated leucoembolization: a mechanism of tissue damage during extracorporeal perfusions, myocardial infarction and in shock--a review. 635 25

Experimental evidence has shown that pancreatic blood flow is severely diminished during acute pancreatitis, but it is unclear whether a decrease in blood flow is a critical event in the evolution of complications of this disease. When an episode of edematous pancreatitis is complicated by necrosis of part of the gland, there is a risk of both acute and chronic complications, including sepsis, hemorrhage, and abscess. One of the questions that remains is whether the decreases in blood flow alluded to are primary or secondary causes. If primary, treatments that preserve pancreatic blood flow during pancreatitis might have a salutary effect on observed morbidity and mortality. This study determined whether two vasoactive drugs, oxidopamine (6-hydroxydopamine) and dihydroergotamine tartrate, given prior to experimentally induced pancreatitis in rats, affected observed mortality. After oxidopamine treatment, rats had a higher survival rate and greater pancreatic blood flow than untreated controls. The association of greater pancreatic blood flow and reduced mortality did not exclude other possible effects of oxidopamine treatment but was consistent with the hypothesis that vasoactive therapy may have a role in this disease.
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PMID:Vasoactive drugs in acute pancreatitis. 642 6

Total parenteral nutrition (TPN) was given to 121 patients admitted with severe pancreatitis (73), chronic pancreatitis (23), or pancreatic malignancy (25) over 104 months. No adverse effects on the pancreas were detected from the TPN, including the provision of intravenous (IV) fat. Nutritional status was maintained or improved in all groups, including patients undergoing surgical procedures and those experiencing marked stress. No significant impact on the clinical course of pancreatitis was observed, although the death rate in acute pancreatitis (15.2%) and complicated pancreatitis (18.5%) compares favorably with other published series where early surgical intervention was undertaken. There was an increased risk of catheter-related sepsis in patients with complicated pancreatitis (14.8%) and with chronic pancreatitis (17.4%). No increase septic risk was seen in patients with acute pancreatitis or pancreatic malignancy. Eighty-two per cent of patients with acute pancreatitis required an average of 87 units of insulin per day while 78% of patients with chronic pancreatitis required an average of 54 units per day. In summary, TPN proved to be safe, effective, and well-tolerated in those patients with disorders of the pancreas.
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PMID:Total parenteral nutrition in pancreatic disease. 643 52

The efficacy of antibiotics given prophylactically in cases of acute pancreatitis is controversial. The authors carried out a retrospective review of 528 cases of pancreatitis seen between 1955 and 1980 and noted a marked increase in the number of septic complications and in the mortality related to sepsis. In most cases, infection was due to organisms sensitive to the antibiotics used, suggesting that they are not effective in preventing sepsis. The authors suggest a new approach to prophylactic administration of antibiotics, based on bioactive tissue levels in pancreatitis.
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PMID:Prophylactic use of antibiotics in pancreatic sepsis: a 25-year reappraisal. 649 50

Nine cases of acute pancreatitis due to parasites in the common bile duct (Ascaris lumbricoides 4, Clonorchis sinensis 5) are reported. Eight cases were discovered at laparotomy and one at postmortem. The indications for operation were worsening pancreatitis, sepsis or cholangitis. Decompression of the biliary system and removal of parasites resulted in the recovery of the eight cases operated upon. In endemic areas, all patients with acute pancreatitis should be screened for parasites. Antibiotics and/or antihelminthics should be given if they are found. Surgery is necessary for those with worms causing biliary or pancreatic obstruction who do not respond.
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PMID:Severe acute pancreatitis caused by parasites in the common bile duct. 653 Jul 10

Colonic involvement should be suspected in patients with severe acute pancreatitis, especially in the following clinical settings: plain abdominal radiographs suggesting bowel ischemia, colonic obstruction, acute lower gastrointestinal hemorrhage, gram-negative septicemia, enteric bacteria on Gram stain or culture of peritoneal fluid, and feculent abdominal drainage from a previously drained pancreatic abscess. Intraoperatively, the pancreas should be widely drained and the fecal stream diverted. Colonic hemorrhage and nonviable bowel require immediate resection. Broad-spectrum antibiotic administration and vigorous nutritional support also are required in these critically ill patients. Although proximal diversion and pancreatic diversion alone may suffice, colonic resection may be required later for persistent obstruction or fistulization, but in a more elective setting. Colonic anastomoses should be performed only when pancreatic inflammation and associated sepsis have resolved completely.
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PMID:Colonic complications of acute pancreatitis and pancreatic abscess. 663 61

Three patients with severe liver and renal failure admitted to the Infectious Diseases Department of the Alessandria for suspected leptospirosis in the second half of 1979 are presented. In one case, the agent responsible was Leptospira icterohaemorrhagiae AB Wjnberg strain, in another Gram-negative sepsis, and in the third acute pancreatitis associated with serious Escherichia coli infection. An account is given of the peritoneal dialysis technique that led to successful resolution of the serious liver and renal failure.
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PMID:[Possibilities and current technics of dialysis in leptospirosis with severe renal damage]. 667 99

The plasma complement system evolved as a beneficial antimicrobial mechanism. However, this system can be activated chaotically in such situations as extracorporeal perfusion, trauma, sepsis, or acute pancreatitis. When so activated, the complement component C5a may aggregate granulocytes and cause leukoembolization; it is suggested that such leukoembolization is an important, previously unsuspected mechanism of tissue damage. In addition, toxic oxygen species, such as superoxide, that are produced by granulocytes that have been triggered by C5a can damage the endothelium, an event that may, if it occurs in the lungs, contribute to the development of the adult respiratory distress syndrome (ARDS). Hence the previously empiric use of high doses of corticosteroids in treating shock states, particularly in cases of the ARDS, may have a physiologic basis since very high concentrations of such drugs have been shown to inhibit both superoxide production and granulocyte aggregation.
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PMID:Complement-induced vascular leukostasis. Its role in tissue injury. 689 56

The complement system evolved as a beneficial antimicrobial system. However when activated during extracorporeal perfusion, as with hemodialysis or cardiopulmonary bypass, modest pulmonary dysfunction associated with granulocyte aggregation and embolization can occur. When complement activation is more massive and prolonged as with severe sepsis, trauma and acute pancreatitis or during infusions of amniotic fluid or other lipid-rich suspensions, severe pulmonary damage which we often recognize as shock lung may occur. Therapeutic ramifications of these conclusions are evident. Thus, high doses of corticosteroids (or of non-steroidal anti-inflammatory agents, such as ibuprofen--herein not discussed) have the ability to prevent aggregation and embolization of stimulated granulocytes to patent vessels downstream and also inhibit their production of toxic oxygen radicals. These beneficial properties suggest the use of these agents may be appropriate in shock states, particularly shock lung or during suspected amniotic fluid infusion. Appropriate clinical trials to substantiate this suggestion are awaited with interest.
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PMID:Tissue damage caused by activated complement and granulocytes in shock lung, post perfusion lung, and after amniotic fluid embolism: ramifications for therapy. 696 80


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