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

Our patient, with cirrhosis and chronic renal failure, represents an example of the susceptibility of a compromised host to Aeromonas infections. This patient, however, differs from previously reported cases in at least two important aspects. First, it is possible that her portal of entry was a fresh A-V fistula puncture site rather than an intestinal site. The temporal relationship of exposure to flood water prior to the onset of sepsis lends support to this possibility. Epidemiologic investigation of the dialysis center failed to reveal Aeromonas isolates from cultures of the water supply, machinery, or other patients. Second, this case is unique in that our patient developed a destructive aortic valve endocarditis resulting in valvular perforations and acute aortic insufficiency. Furthermore, this infection was initiated on what appears to have been a previously normal valve. Based on a review of the literature and the virulence demonstrated by A. hydrophila in our patient, we conclude that organisms of the genus Aeromonas are capable of inducing serious human infection. Such infections are more likely to occur in compromised hosts. A. hydrophila has accounted for the majority of reported infections.
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PMID:Human aeromonas infections: a review of the literature and a case report of endocarditis. 34 23

This communication describes a new surgical procedure of enlarging the narrow aortic valve ring by extending the aortic incision through the fibrous origin of the aortic leaflet of the mitral valve into this leaflet. A fusiform patch is sutured to the V-shaped defect in the aortic leaflet of the mitral valve and in the aortic anulus. This procedure permits the replacement of the aortic valve by a suitable prosthesis. Between June of 1976 and February of 1978, eight patients underwent this surgical procedure. At the time of operation the patients were between 8 and 50 years old. The estimated enlargement of the aortic root ranged from 10 to 25 mm. The operative technique is described, peculiarities of this method are discussed, and the results are reported. Six to 27 months following operation, the clinical condition of six patients is good. Four patients show no impairment of mitral valve function. In one case, preoperatively diagnosed mitral incompetence persists. In another patient the pericardial patch broke from the aortic leaflet of the mitral valve, so that the valve had to be replaced on the fourth postoperative day. One patient died of myocardial necrosis because of insufficient myocardial protection during operation. One child with acute aortic insufficiency caused by staphylococcal endocarditis and congestive heart failure died of septicemia 3 months postoperatively. Mitral incompetence was not detectable in this child.
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PMID:Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. 47 Apr 20

The clinical profile of 28 consecutive patients admitted with infective endocarditis (IE) between 1987 and 1988 was studied. There were 21 males and seven females with a mean age of 24 +/- 11 years. Rheumatic heart disease (RHD) was the commonest underlying disease (68%) followed by congenital heart disease (CHD). Mitral regurgitation with aortic regurgitation were the commonest valvular lesions (47%) in those with RHD while ventricular septal defect was the commonest (43%) in those with CHD. A younger age of onset, complicated course and high mortality were seen in these six patients with acute IE. Persistently positive blood cultures during life or at autopsy were obtained in 21%. Strep viridans was the commonest isolate and was often resistant to streptomycin. 2D echocardicgram revealed vegetations in 96% of patients, the aortic valve (39%) being more commonly affected than the mitral valve (11%). ESR of more than 20 mm drop 1st hour (Wintrobe) was seen in 96%. Thrombophlebitis was a common complication of therapy and cloxacillin the commonest drug implicated. A mortality of 21% as a result of refractory congestive heart failure (CHF) (50%), uncontrolled sepsis (33%) and embolic events (17%) was seen. A rising incidence of culture negative IE, combined aortic and mitral valve disease and CHF is noted.
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PMID:Changing spectrum of clinical and laboratory profile of infective endocarditis. 130 28

A female patient, 21 years old, was submitted to surgical treatment of severe aortic insufficiency. She was doing well until the 9th postoperative day, when she presented sepsis and an embolic cerebrovascular attack. The transesophageal echo-Doppler-cardiogram showed paraprosthetic abscess and vegetations, that were not seen on the transthoracic echo-Doppler-cardiogram performed one day before. We are convinced that the findings on the echocardiogram were very important for the good results obtained by the prompt surgical procedure.
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PMID:[The importance of the early diagnosis of infectious endocarditis in an aortic prosthesis by transesophageal two-dimensional Doppler echocardiography]. 134 Nov 58

Between 15th June 1991 and 15th August 1992, 40 patients underwent aortic valve replacement with the newly designed Edwards stentless aortic bioprosthesis 2500. The patients' ages ranged from 24 years to 80 years (mean 60.3 years). Preoperatively, 17 patients presented with pure aortic stenosis, three with aortic regurgitation and 20 with mixed lesion. The operations were performed with normothermic extracorporeal cardiopulmonary bypass and cold cardioplegic arrest. The implanted valves ranged in diameter from 21 mm to 27 mm. Ten patients received a subcoronary implantation, with the lower row of sutures being interrupted and the upper being continuous. The so-called miniroot technique was used in the other 30, also involving lower interrupted and running upper sutures after adaptation of the coronary ostia to the preformed openings in the graft. The aortic cross-clamp time ranged from 51 minutes to 94 minutes (mean 71 minutes). There was no operative mortality but three patients died early after the operation due to cardiac tamponade, sepsis and pneumonia. There was no late mortality or morbidity in the surviving patients up to 16 months postoperatively. Echocardiography, performed at discharge and twice a year thereafter showed no signs of significant valve incompetence in any patient, and continuous wave Doppler measurements indicated that resting pressure gradients across the aortic valve were low or absent. Our preliminary experience with the stentless aortic xenograft shows improved hemodynamic function as compared to stent mounted xenografts or mechanical prostheses. Further studies are needed, however, to establish the long-term performance of this device.
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PMID:Aortic valve replacement with stentless xenografts. 134 37

Clinical data from 186 patients (133 males and 53 females) with 190 episodes of infective endocarditis (IE) occurring between January 1981 and July 1991 were studied retrospectively at a large referral hospital in Northern India with the intention of highlighting certain essential differences from those reported in the West. The mean age was much lower (25 +/- SD 12 years, range 2 to 75 years). Rheumatic heart disease was the most frequent underlying heart lesion accounting for 79 patients (42%). This was followed by congenital heart disease in 62 (33%) and normal valve endocarditis in 17 (9%). Twenty-four patients had either aortic regurgitation (n = 15) or mitral regurgitation (n = 9) of uncertain etiology. Prosthetic valve infection and mitral valve prolapse were present in only 2 patients each. A definite predisposing factor could be identified in only 28 patients (15%). Postabortal sepsis and sepsis related to childbirth accounted for 6 and 5 cases, respectively. Only 1 patient had history of intravenous drug abuse. Two-dimensional echocardiography showed vegetations in 121 patients (64%). Blood cultures were positive in only 87 (47%), with a total of 90 microbial isolates. Commonest infecting organisms were staphylococci (37 cases) and streptococci (34 cases). Except for a significantly higher number of patients with neurologic complications in the culture-negative group, there were no differences between patients with culture-positive and culture-negative IE. Of the 190 episodes of IE, the patients had received antibiotics before admission in 110 (58%) instances. A significantly greater number of culture-negative patients had received antibiotics than did culture-positive patients (87 vs 23, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Active infective endocarditis observed in an Indian hospital 1981-1991. 144 18

Since February 1985 the arterial switch operation (ASO) has become the surgical treatment of choice for newborns with simple TGA, appropriate forms of complex TGA and double outlet right ventricle (DORV) as well at our institution. Between 1985 and 1990 a total of 87 patients underwent surgery. In 60 patients with simple TGA and 8 patients with complex TGA or DORV, respectively, an arterial switch-operation was performed. Because of coronary artery anomalies (n = 13), dysplastic pulmonary valves (n = 3) or pressure drop in the left ventricle (n = 1), the initially planned arterial switch operation was discarded and a Mustard type procedure was in 17 patient. Finally there were two primarily performed Mustard operations. The hospital mortality after arterial switch for simple TGA was 15% (9/60), 0/8 in patients with complex TGA. Late mortality was calculated to be 12% (1/8) in patients with complex TGA and 3/60 in patients with simple TGA. Within the Mustard group there were 2/19 hospital deaths and one late death. Causes of early death after arterial switch were: intraoperative myocardial infarct (n = 3) low cardiac output syndrome (n = 2), intractable bleeding (n = 2), metabolic acidosis (n = 1), and septicemia (n = 1). Late after surgery there was one death due to chylothorax after thrombotic obstruction of the SVC, and 3 more deaths secondary to intraoperative infarct, progressive LV dysfunction and meningitis, respectively. Among the long-term survivors 2 patients developed a severe supravalvulary pulmonary stenosis. There were no significant arrhythmias, supravalvulary pulmonary aortic stenoses, aortic insufficiency or myocardial perfusion disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The arterial switch-operation: early and midterm (6 years) results with particular reference to technical problems. 178 51

Thirty-four patients of ascending aortic aneurysm associated with aortic regurgitation were treated with simultaneous aortic valve and ascending aorta replacement utilizing composite graft, until December 1990. Twenty-four patients of the group were diagnosed as Marfan's syndrome and 17 had aortic dissection. For the operative procedure, Bentall's technique were employed in 25 patients and other modifications in nine. Operative death was observed in three cases (8.8%) due to low output syndrome, caused by coronary ostium abnormality, all in Marfan's syndrome. Late death was observed in six including 2 hospital deaths of cerebro-vascular disturbance and sepsis. Other causes of death were rupture of residual aneurysm (in 3) and LOS at reoperation (in 1). Hospital survivors remarkably improved in NYHA class and in cardiac size. Actuarial survival in 3, 5, 7, and 10 years were 78%, 72%, 72%, and 62% respectively. Therefore, surgical result of composite graft technique in our institution proved to be reasonable as others. However, long term result of the procedure should be carefully evaluated, because of the anatomical and histopathological peculiarity of the disease.
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PMID:[Early and late operative results of simultaneous aortic valve and ascending aorta replacement]. 189

Since July 1985, cryopreserved homograft prostheses have been used for aortic valve replacement in 10 patients, aged 2 to 77 years, with active endocarditis. Five patients had positive bacterial cultures from excised valves, and all had clinical findings of uncontrolled infection while receiving appropriate antibiotics. Homograft valves (four) or valved conduits (six) were implanted for treatment of sepsis (6 patients), congestive heart failure (3) or recurrent emboli (1 patient), and complicating native (5 patients) or prosthetic valve (5) endocarditis. Staphylococci (6 patients), streptococci (3), and Candida (1) were infecting organisms. Preoperatively, Doppler echocardiography showed aortic regurgitation in all patients. At operation, 9 patients had gross vegetations, 9 had single or multiple abscess cavities, and 5 had pericarditis. Complex reconstruction of the aortic valve and annulus with homograft conduits was necessary in 6 patients (3 with previous aortoventriculoplasty). Two early deaths (ventricular failure, perioperative stroke) occurred. Mean follow-up of all operative survivors was 2.1 years (range, 0.6 to 3.6 years), and one late death resulted from arrhythmia. Homograft valve regurgitation increased in 1 patient, and 7 late survivors are asymptomatic. No patient has had recurrence of endocarditis. We conclude that cryopreserved homograft aortic valve/root replacement is an effective method for management of active endocarditis complicated by annular destruction.
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PMID:Results of homograft aortic valve replacement for active endocarditis. 232 58

Twenty-four patients with aneurysm of Valsalva sinus were surgically repaired over a 23 year period (1965-1988). These patients were ranged 2 to 54 years of age and eleven of them were male. Rupture of aneurysm of Valsalva sinus was combined with aneurysm in 20 cases, ventricular septal defect in 12 cases and aortic regurgitation in 6 cases. At present, our routine operative procedure for ruptured aneurysm is direct closure of the defect with patch closure of aneurysm after resection of the aneurysm, but when the diameter of aneurysm is smaller than 7 mm, direct closure of the defect of the aneurysm was used. Only one patient after patch closure of ruptured sinus of Valsalva (Konno type I) required reoperation for penetration into left ventricle. This case might be avoided if patch was sutured to annulus of aortic valve. There were two operative death and one late death. The former died of cerebral infarction and low output syndrome, the latter died of sepsis. The mean follow-up period (+/- standard deviation) was 8.2 +/- 6.0 years. All patients that were followed were thirteen and found to be in New York Heart Association class I.
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PMID:[Surgical treatment and long-term results of aneurysms of Valsalva sinus in 24 cases]. 237 15


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