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

The objective of this report was to analyze the current surgical results of operative treatment in patients suffering ruptured AAA (abdominal aortic aneurysms) and to define those independent predictive factors for mortality. During a period of 2 years, from January 1996 to December 1997, 144 patients operated on for ruptured AAA in 10 hospitals were included in a multicenter retrospective study. Among the collected variables concerning each patient, those with potential relation to surgical mortality were studied: gender, age, diabetes, hypertension, cardiopathy, pulmonary obstructive disease, preoperative renal dysfunction, symptomatic cerebrovascular disease, peripheral vascular disease, hematocrit on admission, preoperative hypotension < 80 mmHg, loss of consciousness, cardiac arrest, aortic aneurysm location (infrarenal versus non-infrarenal), iliac involvement, aneurysm size, type of rupture, left renal vein ligature, ligature of a patent inferior mesenteric artery, place of aortic cross-clamping, type of grafting, exclusion of both hypogastric arteries, venous technical complications, associated surgery, use of cell saver, intraoperative blood loss, and postoperative complications (renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation). Those variables with statistical significance in the univariate analysis were introduced into a multivariate logistic regression model to determine the independent predictors of death. From our results we concluded that surgery for ruptured abdominal aortic aneurysms continues to have an excessively high mortality rate. Even though some preoperative variables could be identified as predictors of mortality, an absolute mortality risk has not yet been determined and the decision to negate surgery should be individualized rather than taken on that basis only. Early diagnosis and treatment of symptomatic aneurysms would improve mortality figures and selective screening should be contemplated.
 ...
PMID:Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms. 1176 39

An aortoesophageal fistula is a rare but fatal disease, most commonly associated with thoracic aortic aneurysm. Early diagnosis and emergency surgical intervention are mandatory for survival. We reported a case of mycotic aneurysm of thoracic aorta with aortoesophageal fistula, presenting with intermittent hematemesis, tarry stool and sepsis. Initially, misdiagnosis of esophageal submucosal tumor with bleeding was made clinically and endoscopically. With contrast-enhanced spiral computed tomography (CT) scan the diagnosis was confirmed. The pathogenesis, clinical presentation, endoscopic feature and imaging findings were reviewed.
 ...
PMID:Mycotic aneurysm of thoracic aorta with aortoesophageal fistula mimicking the esophageal tumor with bleeding--a case report. 1219 32

Between December 1972 and January 2002, 201 patients had replacement of the ascending aorta at Vilnius University Heart Surgery Clinic. 171 of them had aortic valve replacement, too, and 30 patients - without aortic valve correction. Septical complications post operation had 24 (11.94%) patients. Their age ranged from 30 to 73 years (mean 49.4 years). Most of the patients were male (87.5%) and IV functional class NYHA (70.8%) preoperatively. Main etiological factor of ascending aorta aneurysm was atherosclerosis, rare - Marfan's syndrome. Sepsis, prosthetic infective endocarditis was detected in 10 (41.7%), mediastinitis - in 9 (37.5%) and sepsis with mediastinitis - in 5 (20.8%) cases. Hospital period (< 1 month) septical complications were diagnosed in 91.7% of all cases. Total sepsis related hospital period mortality was 3.5%, late - 4.0% from all 201 operated. Septical complications were not common in patients after ascending aorta replacement. Reoperations were associated with early mortality and satisfactory long-term results. Conservative treatment was not successful.
 ...
PMID:[Septical complications after ascending aorta replacement]. 1256 Jun 72

The prognosis of the ruptured thoracic aortic aneurysm is poor. Even if the surgical treatment was performed, the clinical outcome does not sufficiently satisfy us. Between January 1978 to July 1999, 171 cases of thoracic aortic surgery were operated in our department, in which 12 patients were with the ruptured thoracic aortic aneurysm without acute dissection. The aneurysm was located in ascending aorta (2), aortic arch (6), descending aorta (3), and thoracoabdominal aorta (1). The aneurysm was ruptured into thorax (4), pericardium (2), mediastinum (3), lung (2), and esophagus (1). The operative procedure was artificial vascular graft replacement (9), patch closure (2), and aneurysmal interposition (1) [bypass with ascending aorta to abdominal aorta)]. The operations were performed during hypothermic circulatory arrest with antegrade selective cerebral perfusion (6), under total (1) or partial complete extracorporeal circulation (5). The hospital death was 33% (4/12). The causes of death were cerebral complication (2), sepsis (1), and multiple organ failure (1). The 12 patients were divided into 2 groups: group A; 8 cases with alive; group D; 4 cases with hospital death. We compared and analyzed the perioperative factors of these 2 groups. On intraoperative factors, operation time (minute) demonstrated a significant difference (498 +/- 129 in group A v.s. 851 +/- 227 in group D, p < 0.05). No significant difference was observed between the groups on extracorporeal circulation time, aortic clumping time, selective cerebral perfusion time, systemic circulatory arrest time, intraoperative blood loss, and blood transfusion. The postoperative major complication was revealed in 6 cases (50%, 6/12), cerebral infarction (3), sepsis (2), and hoarsness (1). In conclusions, to make an effort to shorten an operative time as possible, and to prevent the postoperative neurological dysfunction under selective cerebral perfusion, those efforts should contribute to a good postoperative outcome for the ruptured thoracic aortic aneurysm.
 ...
PMID:[Clinical study on the surgical cases of the ruptured thoracic aortic aneurysm]. 1285 63

The pressure within the abdominal cavity is normally little more than atmospheric pressure. However, even small increases in intra-abdominal pressure can have adverse effects on renal function, cardiac output, hepatic blood flow, respiratory mechanics, splanchnic perfusion and intracranial pressure. Although intra-abdominal pressure can be measured directly, this is invasive and bedside measurement of intra-abdominal pressure is usually achieved via the urinary bladder. This cheap, easy approach has been shown to produce results that correlate closely with directly measured abdominal pressures. Significant increases in intra-abdominal pressure are seen in a wide variety of conditions commonly encountered in the intensive care unit, such as ruptured aortic aneurysm, abdominal trauma and acute pancreatitis. Abdominal compartment syndrome describes the combination of increased intra-abdominal pressure and end-organ dysfunction. This syndrome has a high mortality, most deaths resulting from sepsis and multi-organ failure. Detection of abdominal compartment syndrome requires close surveillance of intra-abdominal pressure in patients thought to be at risk of developing intra-abdominal hypertension. The only available treatment for established abdominal compartment syndrome is decompressive laparotomy. Prevention of abdominal compartment syndrome after laparotomy by adoption of an open abdomen approach may be preferable in the patient at significant risk of developing intra-abdominal hypertension, but this has not been demonstrated in any large trials. Most surgeons prefer to adopt a 'wait and see' policy, only intervening when clinical deterioration is associated with a significant increase in intra-abdominal pressure.
 ...
PMID:Intra-abdominal hypertension and the abdominal compartment syndrome. 1531 Mar 55

Infected abdominal aortic aneurysms are uncommon but not rare (1-3% of all abdominal aortic aneurysms). This life-threatening disease can lead to rapid uncontrolled sepsis and/or aortic rupture. We report one case that underlines two notions. Firstly computed tomography is effective to detect early stages of the pathology providing complete depiction of the anatomical abnormalities. Secondly infected aortic aneurysm can be successfully treated by antibiotherapy and in situ replacement with cryopreserved arterial homograft.
 ...
PMID:Infected abdominal aortic aneurysm treated by in situ replacement with cryopreserved arterial homograft. 1701 7

Rupture of an aortic aneurysm is a major cause of early mortality during the course of disease. A less invasive approach with fewer complications is sought. A case of leaking thoracic aortic aneurysm is presented, where endovascular approach was adapted owing to ongoing sepsis. This report indicates prospects for employment of endovascular stenting as a suitable alternative to surgery in a growing variety of settings.
 ...
PMID:Endovascular stenting of a leaking thoracic aortic pseudoaneurysm. 1705 28

An 82-year-old man with a mycotic aortic aneurysm of the distal arch underwent urgent surgery because of sepsis. The infected aortic arch was excised, replaced with a rifampicin-bonded prosthetic graft, and covered with omentum. Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was intraoperatively carried out in parallel with the cardiopulmonary circuit. Intraoperative PMX-DHP dramatically reduced the level of plasma endotoxin, and ameliorated hemodynamic instability and oxygenation, resulting in smooth weaning from cardiopulmonary bypass. Intraoperative endotoxin adsorption is technically simple and easy, effective in hemodynamic stabilization, and so could be a new therapeutic option for mycotic aortic aneurysm.
 ...
PMID:Intraoperative endotoxin adsorption as a new therapeutic option for mycotic aortic aneurysm. 1815 19

We report a case of iatrogenic perforation of the oesophagus, with subsequent infection of a pre-existing thoracic aortic aneurysm and development of an aorto-oesophageal fistula resulting in life-threatening haemorrhage. This was successfully treated with endovascular aortic stent-graft using a Cook Zenith Tx2 device. Follow-up CT scan 3 months later showed that the aneurysm sac is getting smaller, and patient had no further septic or haemorrhagic complications. However, we emphasise that even if initial endovascular management of aorto-oesophageal fistula is successful, these patients often risk recurrent sepsis and therefore long-term clinical and radiological surveillance is mandatory.
 ...
PMID:Secondary infection of a pre-existing thoracic aortic aneurysm by iatrogenic oesophageal perforation with aorta-oesophageal fistula formation. 1910 27

Prompt diagnosis of aortoenteric fistulas is imperative for patient survival. The clinical signs of aortoenteric fistula include hematemesis, melena, sepsis, and abdominal pain, but the condition also may be clinically occult. Because clinical signs may not be present or may not be sufficiently specific, imaging is most often necessary to achieve an accurate diagnosis. Although no single imaging modality demonstrates the condition with sufficient sensitivity and specificity, computed tomography (CT), owing to its widespread availability and high efficiency, has become the imaging modality of choice for evaluations in the emergency setting. CT has widely variable sensitivity (40%-90%) and specificity (33%-100%) for the diagnosis of aortoenteric fistulas. To use this modality effectively for the initial diagnostic examination, radiologists must be familiar with the spectrum of CT appearances. Mimics of aortoenteric fistulas include retroperitoneal fibrosis, infected aortic aneurysm, infectious aortitis, and perigraft infection without fistulization. Differentiation is aided by the observation of ectopic gas, loss of the normal fat plane, extravasation of aortic contrast material into the enteric lumen, or leakage of enteric contrast material into the paraprosthetic space; these features are highly suggestive of aortoenteric fistula in a patient with bleeding in the gastrointestinal tract.
 ...
PMID:Aortoenteric fistulas: CT features and potential mimics. 1916 45


<< Previous 1 2 3 4 5 6 7 8 Next >>