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

Skin tests (ST) in 1332 patients are associated with increased morbidity from sepsis. Patients with normal skin tests had a 7% major sepsis rate and 2% mortality rate. Thirty-six per cent of anergic (A) patients and 21% of relatively anergic (RA) patients died; 52% of A patients and 34% of RA patients had sepsis. These data include all patients studied and represent their worst skin test. Two studies were done. The first was a retrospective evaluation of effect of surgery upon 49 anergic patients with biliary tract disease, colon cancer, bowel obstruction, hypovolemia and visceral abscesses. The patients did not receive total parenteral nutrition (TPN). The data show that surgery without TPN can reverse the anergic state and did so in 84% of patients reported. The second study was a prospective, double-blind, randomized trial of the effect of levamisole on skin tests, neutrophil chemotaxis (CTX), sepsis and mortality iin 39 preoperative anergic patients. Major sepsis was significantly increased in placebo group (p less than 0.05). Mortality, minor sepsis, restoration of skin tests and chemotaxis were somewhat better in levamisole patients but not statistically so. These studies show that in addition to TPN, surgery and immunorestorative drugs are viable approaches to the management of selected anergic patients.
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PMID:Therapeutic approaches to anergy in surgical patients. Surgery and levamisole. 11 27

Twenty patients with suppurative cholangitis were seen at the Massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. Patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.
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PMID:The urgency of diagnosis and surgical treatment of acute suppurative cholangitis. 127 37

A total of 4056 consecutive patients operated for benign biliary tract disease between January 1983 and June 1990 were reviewed retrospectively. There were 71 in-hospital deaths, representing 1.75% of morality rate. Cholecystectomy was performed in 2275 patients; common bile duct exploration was carried out in 1494, with operative mortality rates of 0.4% and 3.1% respectively. Sepsis was the leading cause of mortality. The second common cause of death was hepatic failure, and respiratory failure the third. Cardiovascular problems accounted for 11.3% of death, which was much lower than reports from western series. Other causes of mortality included hypovolemic shock, anaphylactic shock, epilepsy and hypoglycemia. Of the total 4056 patients, 28.5% underwent emergency surgery. The mortality rate for emergency surgery was 3.6 times higher than for those who underwent elective operations (p less than 0.005) Significantly higher mortality rates were also seen for those aged over 70 years and of male gender. Because the mortality rate of patients who underwent emergency operation due to acute inflammatory or obstructive complications were much higher than that of elective operation group, we suggested early surgical intervention for the symptomatic patients before complications occurred.
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PMID:[The incidence and cause of death following surgery for benign biliary tract disease]. 132 87

Since 1984 three patients have been treated for a ruptured abdominal aortic aneurysm and acute biliary sepsis. The biliary tract disease included two cases of gangrene of the gallbladder, one with perforation. Two patients had cholangitis. All patients underwent repair of the ruptured aneurysm and cholecystectomy under the same anesthetic. Two individuals required common duct exploration: one at the time of the initial operation and the other 6 days later. Despite a high incidence of postoperative complications in these elderly men, all survived surgery and are alive and well after periods of 1 to 7 years. There have been no graft infections.
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PMID:Management of ruptured abdominal aortic aneurysm and concomitant biliary sepsis. 159 74

Sixty-three patients with severe acute pancreatitis have been studied. Pancreatitis was associated with biliary tract disease in 23 patients (36.5%) and with alcoholism in 21 (33.3%). It occurred post-operatively in 9, and was associated with other conditions in 10. We evaluated the Ranson prognostic signs (RPS) with the appearance of complications. 36 patients (57.2%) had 3-4 RPS, 9 (30.2%) had 5-6 RPS and 8 (12.6%) had 7 or more RPS. Diagnostic laparotomy was performed in 11 patients (17.5%). 55 patients were operated one or more times due to failure of medical treatment and/or local and septic complications. The most frequent complications were pancreatic abscess (60.3%), sepsis (58.7%) and pulmonary insufficiency (52.4%). Renal failure occurred in 26 patients and 9 required dialysis. Of the patients with renal failure, 84.6% (22/26) had 4 or more RPS; 78.4% (29/37) of those with sepsis and 71.6% (27/38) of those with pancreatic abscess also had 4 or more RPS. The mean duration of hospitalization of survivors was 58 +/- 30 days. Overall mortality was 28.6%. We conclude that RPS are helpful to predict complications in patients with severe pancreatitis.
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PMID:[Acute severe pancreatitis. Analysis of mortality and morbidity]. 184 70

Seventy-eight cardiac transplantations were performed between July 1982 and March 1989. The perioperative death rate was 10%. Overall survival was 86%. Among the long-term survivors, 14 patients underwent 16 noncardiac surgical procedures. Seven of them required emergency laparotomy, four for biliary tract disease, one for ruptured abdominal aortic aneurysm, one for suspected abdominal sepsis and one for enterocolitis. Elective surgical interventions included repair of symptomatic abdominal wall hernia, treatment of hemorrhoids or perianal condylomas, total hip arthroplasty, maxillary sinus drainage and resection of a duodenal villous adenoma. Preoperatively, all patients received cyclosporine orally. Ten of the 14 patients were on triple-drug immunosuppression (cyclosporine, azathioprine and low-dose prednisone [less than 0.20 mg/kg daily]). The remaining four patients took cyclosporine with either azathioprine or prednisone. There were no deaths. Complications were limited to residual choledocholithiasis treated by percutaneous removal, two cases of wound infection and an incisional hernia. The authors' experience indicates that noncardiac surgical procedures may be safely performed in patients who have received a heart transplant.
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PMID:General surgical procedures after heart transplantation. 235 Jul 41

Patients with mild hereditary spherocytosis (HS) often undergo splenectomy for the sole purpose of preventing gallstone formation. Splenectomy carries a surgical risk as well as the risk of postsplenectomy sepsis. Gallstones develop in less than half of mild HS patients and do not always cause symptomatic biliary tract disease. Using decision analysis, a quantitative approach to problem solving under conditions of uncertainty, we have compared the likelihood of surviving the complications of gallstones with the likelihood of surviving routine splenectomy. Probability figures for critical events were obtained from the medical literature; final outcome is recovery (utility = 1.0) or death (utility = 0.0). Our analysis shows that expectant management of gallstones is the preferred choice, being associated with a higher utility than is routine splenectomy (0.9980 vs 0.9755, respectively). The utility values for the two choices become equivalent only when the risk of postsplenectomy sepsis is lowered from 0.022 to 0.0001.
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PMID:Splenectomy in mild hereditary spherocytosis: is it worth the risk? 278 57

Acute pancreatitis is most often secondary to prolonged excessive alcohol intake or biliary tract disease. The diagnosis is based on a combination of physical, laboratory, and radiologic findings. Differentiation from intra-abdominal processes that require surgical intervention is important. Treatment involves restoration of intravascular volume, correction of hypoxemia and metabolic derangements, and resting the gastrointestinal tract. Prognostic indicators are useful in identifying severe cases that may benefit from more aggressive monitoring, peritoneal lavage, antibiotic therapy, and surgical intervention. The recovery period may be complicated by sequellae of pancreatic necrosis and by sepsis.
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PMID:Acute pancreatitis. 304 97

We report a case of Pseudomonas aeruginosa liver abscesses following endoscopic retrograde cholangiopancreatography (ERCP) in a patient without evidence of biliary tract disease and of any known cause of hepatic infection. Computer tomography (CT) scan was the best method of diagnosis, allowing, through guided percutaneous puncture of the abscesses, isolation of the organism, which was sensitive to carbenicillin. One month of antibiotherapy with repeated aspirations of the largest abscesses was successful. This report suggests that ERCP may induce cholangitic sepsis by inoculating pathogens in the biliary tree even in the absence of extrahepatic obstruction.
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PMID:Pseudomonas aeruginosa liver abscesses following endoscopic retrograde cholangiography. Report of a case without biliary tract disease. 330 90

A two-year retrospective review of 137 patients over 70 years of age undergoing cholecystectomy, from January 1, 1983 to January 1, 1985, was done at Mount Sinai Medical Center of Miami Beach. This study focused on the clinical presentations, surgical management, and overall morbidity and mortality of this operative procedure in the elderly. There were 81 women and 56 men in the study ranging in age from 70 to 96. Elective procedures were performed in (78/137) 57 per cent of the patients while (59/137) 43 per cent underwent emergency surgery. Elective procedures were performed in (55/81) 68 per cent of the women and (23/56) 41 per cent of the men. Emergency surgery was required in (26/81) 32 per cent of the women and (33/56) 60 per cent of the men. Complications developed in (16/78) 20 per cent of the elective cases and (19/59) 32 per cent of the emergency cases. In the elective group, the most common complication involved the cardiovascular system. Sepsis with multiple organ failure accounted for all the deaths in the emergency group. Among the 137 patients in this series, there was a (3/78) 3.8 per cent mortality in the elective group and a (7/59) 12 per cent mortality in the emergency group with an overall mortality of (10/137) 7.3 per cent. The purpose of this study was to highlight the necessity for aggressive surgical management of biliary tract disease in the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cholecystectomy in the elderly. 333 81


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