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

From 1983 to 1990, 65 axillobifemoral and 20 axillofemoral bypasses have been performed in 85 patients (77 men and 8 women), with a mean age of 69 +/- 9 years. Indications for surgery were: severe aortoiliac occlusive disease (87%), sepsis of previous aortoiliac prosthesis, abdominal aorta aneurysm. Anatomic bypass was precluded for general (81%) or local (19%) conditions. In the last group, 9 patients have had previous laparotomy. Four patients presented with aortoenteric fistulas. Eighteen patients were operated on in emergency. The operative mortality was 12%, with 50% cardiac related deaths. Early primary patency was 98%. Early secondary patency was 100%. The mean follow-up is 28 +/- 15 months. The 3 years survival is 77%. The cumulative patency rates at 1 and 3 years are 89% and 76% respectively. Although axillobifemoral bypasses achieve poor long-term results when compared with aortoiliac bypasses, they can be considered in high risk patients. In this group of patients, the cumulative patency rate and the survival curves tend to be parallel.
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PMID:Axillounifemoral and axillobifemoral bypasses. Retrospective study of 85 cases. 195 Feb 96

Conventional extraanatomic reconstruction for aortic sepsis is associated with a significant risk of operative death, as well as frequent late complications. We evaluated in situ aortic grafting in the treatment of primary or graft-related aortic infection. Eleven selected patients underwent in situ aortic graft reconstruction in the setting of mycotic aneurysm (n = 5), secondarily infected aortic aneurysm (n = 1), primary aortoenteric fistula (n = 1), and secondary aortoenteric fistula (n = 4). All patients survived: follow-up from 10 to 130 months reveals no evidence for graft thrombosis, pseudoaneurysm, new or recurrent aortoenteric fistula, or subsequent aortic operations in any patient. A literature review produced 110 cases of aortic sepsis managed by in situ aortic reconstruction during the last decade. Thirty-two patients (29%) either died in the operative period or suffered a lethal late complication associated with their aortic reconstruction. This mortality rate declined to 21% if patients undergoing incomplete removal of a contaminated graft were excluded, and to 19% with the addition of our 11 patients. Both our experience and that described in the literature suggest that, in properly-selected patients, in situ aortic graft replacement may be a rational treatment option for localized or circumscribed aortic sepsis.
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PMID:Aortic sepsis: is there a role for in situ graft reconstruction? 202 7

Infection of a prosthetic graft is one of the most feared complications of vascular surgery. The difficulties of accurate, objective diagnosis are well recognised. We have used III Indium labelled white blood cell scans (InWBC) in two groups: 9 control patients who underwent uncomplicated aortic aneurysm surgery, and 23 patients with suspected graft sepsis. In the control group there was one positive scan in a patient with an inflammatory aneurysm. In the suspected sepsis group, 11 patients subsequently has proven graft sepsis. Nine were correctly predicted by Indium scanning. Ten of 12 patients who did not have proven graft sepsis had negative scans. There was a total of 5 inflammatory aneurysms in the control and suspected sepsis groups, of whom two had positive scans. False positive scans were not present in the early postoperative period i patients without inflammatory aneurysms. In our experience Indium labelled WBC scanning for suspected graft sepsis has a accuracy of 83% a negative predictive value of 83% and a positive predictive value of 82%. These results suggest that Indium white cell labelling techniques which do not involve substantial cross-labelling of platelets are the best objective methods of establishing the presence or absence of graft sepsis.
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PMID:Vascular graft infection: the role of indium scanning. 268 Jun 9

We report a patient with septicemia who developed a mycotic thoracoabdominal aortic aneurysm over a six-week period. The value of contrast-enhanced computed tomography in the diagnosis of mycotic aneurysms of the aorta is stressed.
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PMID:Evolution of a mycotic aneurysm of the thoracoabdominal aorta. 292 81

Two cases of mycotic suprarenal aortic aneurysm treated by anatomic reconstruction are presented. Diagnosis was facilitated by 67-Gallium Citrate Scanning, Computer Assisted Tomography (CT), and Angiography. Increasing symptoms with attenuation of the aortic wall identified by CT necessitated urgent resection and reconstruction in both patients. Contained rupture of the aneurysm was found in one patient. Cultures of the resected tissue grew Salmonella dublin and Bacteroides fragilis. The patients were treated with continuous antibiotic therapy. Follow-up demonstrated asymptomatic patients with sterile blood cultured and good anatomic results on CT at one year. No recurrent sepsis nor aneurysmal dilatation is evident to date. Based on our experience and the available literature we conclude that inline reconstruction is the method of choice for treatment on these lesions.
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PMID:Mycotic suprarenal aortic aneurysm. 297 99

Three patients with infected (mycotic) aortic aneurysms were diagnosed primarily by CT. In two patients findings included the presence of a saccular aneurysm with an irregular lumen, perianeurysmal fluid, gas and/or hematoma, osteomyelitis in adjacent vertebral bodies, and disruption of intimal calcification. In one patient with sepsis there was rapid development of an aortic aneurysm. Computed tomography is of substantial benefit in the identification and characterization of infected aortic aneurysms. Certain features may strongly suggest the diagnosis without use of aortography.
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PMID:Infected aortic aneurysms: CT appearance. 333 48

To better understand declining autopsy rates, data have been gathered prospectively on 1080 consecutive deaths over six years among patients admitted to a medical intensive care/coronary care unit. Overall autopsy rate was 36%. Autopsy rates declined sharply with age from 60% for those aged 16 to 34 years to 23% for those 85 and over (P less than .001). The highest rates by diagnosis were aortic aneurysm (70%), hepatic failure (52%), heart rhythm disturbance (48%), pulmonary embolism (45%), and sepsis (41%). Patients receiving major procedures had a significantly higher autopsy rate (38 versus 29%, P less than .05) but rates bore little relation to prognoses given at admission by house officers, suddenness of death, sex, marital status or year of admission. Even among intensively treated patients, autopsy rates decline strikingly with age, demanding honest re-appraisal to restore the place of autopsy in medical education, clinical research, and quality of care assessment for an increasingly elderly population.
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PMID:Age and the declining rate of autopsy. 378

A 21-year-old man presented with fever and septicemia resistant to antibiotic therapy. An unusual post-coarctation mycotic aortic aneurysm that had eroded into the left main stem bronchus was identified and replaced with a Dacron graft. A critical factor in achieving the satisfactory result was preparation of the femoral vessels for autotransfusion and possible cardiopulmonary bypass.
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PMID:Aortopulmonary fistula in a post-coarctation mycotic aneurysm. 383 16

A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected.
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PMID:Aortic aneurysm secondary to umbilical artery catheterization. 388 16

Aneurysm contents were cultured in 275 patients out of a series of 546 cases undergoing infrarenal aortic aneurysm repair between 1961 and 1981. The incidence of positive cultures was 8 per cent. Cultures were more likely to be positive if taken from ruptured (16.7 per cent) and acute (9.1 per cent) aneurysms than from elective (4.2 per cent) cases (X2 = 6.69, P less than 0.01). Gram-positive organisms predominated with Micrococcus being the commonest isolate. Positive cultures were seen at an annual rate of 1-3 cases up to 1976 since which time all have been negative and we believe this may be due to prophylactic antibiotics being given preoperatively rather than postoperatively. The incidence of subsequent graft sepsis was greater in patients with positive aneurysm contents cultures (7 out of 22) than in those with negative cultures (6 out of 253) (X2 = 32.7, P less than 0.001). We recommend the routine culture of aneurysm contents to identify patients who are at high risk of developing graft sepsis and suggest that those cases with positive cultures receive prolonged organism-specific antibiotic therapy. In addition, there is evidence that pre-operative antibiotics may eliminate organisms from aneurysms, thus reducing the subsequent risk of graft sepsis.
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PMID:Significance of positive bacterial cultures from aortic aneurysm contents. 401 10


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