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

Two cases with a remarkable similarity in their clinical and histopathologic findings are reported. Both cases involved myocardial calcification found in biopsy material obtained after orthotopic heart transplantation. Myocardial calcification after heart transplantation so far has been described in only one case in the medical literature and thus appears to be a rare entity. Its occurrence is associated with a certain constellation of clinical situations, which include repeated episodes of acute rejection, temporary uremia, periods of septicemia, alcoholism, and cyclosporine and/or steroid therapy.
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PMID:Myocardial calcification after orthotopic heart transplantation. 266 79

Three mistakes are commonly made in managing metabolic disorders. 1. Oral fluids may be pushed to treat simple volume depletion. However, almost all fluids used for this purpose are sodium-poor and do not restore salt and water balance. 2. The physician may not be aware of common causes of hypophosphatemia, such as hyperventilation, sepsis, stress, use of antacids or diuretics, and alcoholism. If the patient is not monitored adequately, severe hypophosphatemia may develop with serious consequences. 3. Low serum bicarbonate levels may be attributed to metabolic acidosis only, when in actuality metabolic acidosis may coexist with respiratory alkalosis. Arterial blood gas studies differentiate the conditions and direct attention to the cause of respiratory alkalosis when present.
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PMID:Common mistakes in managing metabolic disorders. 318 62

The etiology, clinical presentation, and management of hypophosphatemia are reviewed. Phosphorus is a major intracellular anion and plays an important role in many biochemical pathways relating to normal physiologic functions. Approximately 60 to 90% of the 1 to 1.5 g of daily dietary phosphorus intake is absorbed, and of that amount, about two thirds is excreted in the urine. The overall incidence of hypophosphatemia is about 2 to 3% of all hospitalized patients. Factors associated with hypophosphatemia include phosphate-binding antacid therapy, nasogastric suction, liver disease, sepsis, alcoholism, and acidosis associated with diabetic ketoacidosis. Patients receiving parenteral nutrient solutions were also at higher risk for hypophosphatemia before the routine supplementation of these formulations with phosphate. Patients with hypophosphatemia may be asymptomatic or may experience weakness, malaise, anorexia, bone pain, and respiratory arrest. The major systems involved include the neuromuscular, hematologic, and skeletal systems. Phosphorus-containing products used to treat hypophosphatemia are a combination of monobasic and dibasic phosphate salts. Therefore, it is essential to calculate doses in millimoles rather than milligrams or milliequivalents to more accurately reflect the phosphorus concentration and to avoid potentially serious dosage errors. Normal daily requirements are readily maintained by dietary sources of phosphorus such as milk products or may be supplemented by phosphate-containing products administered orally or intravenously. Since phosphorus is a key factor in many organ systems, it is essential to monitor serum phosphorus concentrations in patients at risk for hypophosphatemia.
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PMID:Management of hypophosphatemia. 328 Feb 19

The group B streptococcus has been shown to be a major cause of meningitis in the newborn and an occasional cause of endocarditis and sepsis in postpartum women. Little attention has been devoted to this organism as a cause of bacterial endocarditis. Twelve patients with group B streptococcal endocarditis were seen at The Presbyterian Hospital, New York, NY, between 1974 and 1985. There were seven women, five men. Ages ranged from 32 to 81 years. Serious underlying disease was present in all - diabetes mellitus in seven, carcinoma in three (bladder in two, and breast in one), alcoholism in three, malnutrition in two, heroin addiction in one, tuberculosis in one, serious prior valvular heart disease in two. The aortic valve was affected in four patients - mitral in two, mitral and aortic in one, tricuspid in four, unknown in one. The presentation was acute in seven patients. Metastatic infection occurred in seven, heart failure in six, major emboli in four, septic pericarditis in one, myocardial abscess in one. The group B streptococcus should be considered as a pathogen capable of causing acute endocarditis in certain patients with defects of host defense, particularly patients with diabetes mellitus, carcinoma or alcoholism. Cardiac surgery may be necessary in these patients due to the rapid destruction of the valves which occurs, in spite of the fact that the organisms are usually highly susceptible to penicillin.
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PMID:Streptococcus agalactiae (group B) endocarditis--a description of twelve cases and review of the literature. 330 82

Placement of an intracaval device is the treatment of choice for failure of, or contraindication to, anticoagulation therapy. A retrospective study of 111 patients from 1980 to 1986 was undertaken to identify the incidence and degree of related complications or problems regarding placement of the device. Ninety seven of 111 (87.4%) patients had no complications or problems in placement; 14/111 (12.6%) patients did have problems. Of the latter group, mechanical problems included eccentric filter placement, insertional difficulty, problems in filter carrier removal, premature discharge, and misplacement. A total of four patients required a second filter. A single instance of worsening renal insufficiency was noted. Of the total group (ages 24 to 97 [means = 62.4] years), other medical problems including diabetes, smoking, malignancy, sepsis, hypertension, and alcoholism had no influence on the complications or problems. The Greenfield filter remains the method of choice for the listed indications; however, an awareness of potential problems may lessen the technical complications. The operative problems did not adversely impact hospital morbidity or cost.
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PMID:Problems in placement of the Greenfield inferior vena cava filter. 341 96

The possibility of bilateral femoral neuropathy after microsurgical tuboplasty for the reversal of sterilization is possible. There seems to be little awareness of this condition by gynecologists and fertility surgeons. This type of femoral neuropathy has an excellent prognosis and only physiotherapy is necessary to aid muscular function. Some cases have been reported where recovery has been extremely slow, normal functions had taken months, and some disability lasted years. The femoral nerve is not included in the pelvis, therefore injury through operative procedures are unlikely. The self-retaining retractors were used in all reported cases and verified through clinical experience. There are 2 types of injury to the femoral nerve: Direct pressure on the nerve itself by retractor blades, and impingement of the psoas muscle and the nerve against the lateral pelvic muscle. Factors that increase the possibility of this condition include diabetes mellitus, rheumatism, gout, alcoholism, malnutrition, syphilis, tuberculosis, typhoid fever, tetanus, liver abscesses, sepsis of distal parts of the body, polyarteritis nodosa, anticoagulants, and bleeding diseases. Femoral neuropathy has been observed after using self-retaining retractors such as O'Connor, O'Sullivan, Mann, Collin and Balfour. The preventive measures suggested are to use a retractor with appropriate blade depth.
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PMID:Bilateral femoral neuropathy after microsurgical reversal of tubal sterilization: case report and analysis of contributing factors. 362 33

Of approximately 6000 admissions to the Henry Ford Hospital medical ICU between October 1969 and September 1984, 61 (1%) had active tuberculosis (TB). Forty-three (70%) of these 61 had acute respiratory failure (ARF). TB was considered to be the sole cause of ARF in 12 and contributory in 31. Eighteen patients with TB but without ARF were admitted for treatment of other critical illnesses. Alcoholism was present in 31 (51%) of the TB patients. Only one of 12 whose ARF was caused primarily by TB had a history of known TB at the time of admission. Important factors contributing to ARF in TB patients included Gram-negative pneumonia and/or sepsis, chronic obstructive pulmonary disease, prior TB with anti-TB medication noncompliance, and malignancy. Six patients were not suspected of having TB when admitted to the medical ICU; three patients who had not been treated for TB were found to have TB on autopsy. The inhospital mortality rate for all patients with TB requiring intensive care was 67%, but was 81% in those with ARF.
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PMID:Active tuberculosis in the medical intensive care unit: a 15-year retrospective analysis. 367 43

An enhanced frequency and morbidity of urinary tract infections (UTI) have been observed in association with alcoholism and liver disease. The causes of these phenomena may relate, in part, to the defects in humoral and cellular immune mechanisms that occur in alcoholism. Urinary catheterization is the most common cause of UTI in hospitalized alcoholics. The severity of the sequelae of UTI in alcoholism is demonstrated by the unusually frequent occurrence of renal papillary necrosis (RPN) in conjunction with pyelonephritis in these patients. Indeed, in over 90% of the reported cases of RPN occurring with alcoholism or liver disease, pyelonephritis has been a contributing factor. The proclivity to medullary ischemia and RPN in this patient group may be, at least in part, a result of interstitial renal edema secondary both to infection and the effect of ethanol per se and to renal arterial vasoconstriction that occurs in cirrhosis. The frequency with which death due to sepsis or renal failure occurs in association with UTI in alcoholics obliges the physician to exercise caution in the prevention and treatment of UTI in these patients.
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PMID:Urinary tract infections and renal papillary necrosis in alcoholism. 370 22

A randomized, prospective trial was conducted of 93 patients with operatively confirmed intra-abdominal sepsis. The study compared clindamycin-gentamicin and chloramphenicol-gentamicin for treatment of carefully stratified patient groups. Malnutrition, age over 65 years, shock, alcoholism, gastrointestinal tract bleeding, steroid administration, diabetes, obesity, and organ malfunction were present with equal frequencies in each group. The duration of antibiotic treatment averaged 8 1/2 days, and the average length of postoperative hospitalization was 29 days. Study antibiotics were changed for bacteriologic reasons in 11 patients taking clindamycin-gentamicin and 12 patients taking chloramphenicol-gentamicin (25% of the total), and two patients in the clindamycin-gentamicin group had a minor adverse reaction. Initial satisfactory clinical responses were obtained in 59 (63%) patients. Twenty-five patients (27%) subsequently developed unsatisfactory courses, but 48 (52%) patients remained well through the 30-day period. Septic-related mortality occurred in 18 (19%) patients, and two (2%) patients had unrelated deaths. There were no significant differences between the study regimens by the outcome criteria evaluated.
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PMID:Stratified outcome comparison of clindamycin-gentamicin vs chloramphenicol-gentamicin for treatment of intra-abdominal sepsis. 389 87

During a 12-month prospective study there were 125 visits to the Harlem Hospital Emergency Room for symptomatic hypoglycemia. Sixty-five patients had obtundation, stupor, or coma; 38 had confusion or bizarre behavior; 10 were dizzy or tremulous; 9 had had seizures; and 3 had suffered sudden hemiparesis. Diabetes mellitus, alcoholism, and sepsis, alone or in combination, accounted for 90% of predisposing conditions; others included fasting, terminal cancer, gastroenteritis, insulin abuse, and myxedema. Average blood glucose levels were lower among comatose than among obtunded patients, but overlap was considerable, and overall there was little correlation among cause, blood glucose levels, and symptoms. Although mortality was 11%, only one death was attributable to hypoglycemia per se, and only four survivors had focal neurological residua.
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PMID:Hypoglycemia: causes, neurological manifestations, and outcome. 400 66


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