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

After major surgery some patients, especially those with an infectiouss process or sepsis, develop jaundice which has been called reactive hepatitis, toxic hepatitis, septic hepatitis or benign postoperative cholestasis; these terms do not have a very precise connotation. Eighty patients with postoperative sepsis and jaundice where studied, excluding those with liver or biliary tract disease, hepato-toxic drugs or repeated halogenated anesthetics. All of them had complete laboratory tests, cultures and percutaneous liver biopsy when it was feasible. Thirty five patients were submitted to percutaneous liver biopsy and they are the material for this paper. There was no correlation with the type and duration of the operation, postoperative complications, shock or kind of anesthesia. The main laboratory changes were leukocytosis, neutrophilia, elevation of the bilirubins mainly the direct type and increase of the alkaline phosphatase; transaminases were within normal limits. Cultures were positive in 76% of the cases predominating E. coli, Pseudomonas a. and Proteus, anaerobics were present in 22.8% of the cases. The liver biopsy showed lymphoctic infiltration, hyperplasia of the Kupffer cells, hepatic regeneration and turbid tumefaction; pericholangitis, focal necrosis, retention of pigment and steatosis were less frequent. We consider that the best denomination of these complications is benign postoperative cholestasis.
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PMID:[Postoperative reactive hepatitis in the septic patient]. 728 Apr 56

The case records of 17 horses with atrophy of the right hepatic lobe were reviewed. Fifteen horses had signs of colic. Two horses had clinical problems that were unassociated with gastrointestinal tract disease. Ages ranged from 5 to 30 years (mean, 12.6 years) and there was no breed or sex predisposition. In clinically normal horses, the right hepatic lobe constitutes half of the total liver weight. The right hepatic lobe in the 17 horses in this study ranged from 11.0 to 38.3% of the total liver weight (mean, 27.8%). Findings on histologic examination of hepatic tissue from horses in the study were variable. Most had loss of hepatocytes, with condensation of hepatic stroma and thick wrinkled hepatic capsules. Additional findings in the horses included torsion of the large colon (15), ileus without gastric rupture (3), typhlocolitis (2), colon infarction secondary to mesenteric strangulation (1), colon infarction secondary to sepsis (1), strangulation of the small intestine from pendulous lipoma (1), and nephrosplenic entrapment (1). No morphologic evidence of angiopathic disease involving the arterial or venous blood supply to the right hepatic lobe was found. Additionally, there was no evidence of biliary tract disease in this portion of the liver. Right hepatic lobe atrophy is believed to result from long-term, insidious, compression of this portion of the liver from abnormal distention of the right dorsal colon and base of the cecum. The practice of feeding horses high-concentrate, low-fiber diets may contribute to atony of the right dorsal colon, with resultant distention that compresses the right hepatic lobe against the rigid, visceral surface of the diaphragm.
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PMID:Right hepatic lobe atrophy in horses: 17 cases (1983-1993). 804 7

In the last few years, Computed Tomography (CT) has emerged as the most sensitive and reliable imaging technique to diagnose acute pancreatitis (AP). Besides assessing the extent of damage to the pancreas and to periglandular tissue. CT can recognize the major early and late complications of the disease promptly and with extreme accuracy. We investigated the diagnostic capabilities of CT in controlling AP development and tried to assess the role of interventional radiology as a therapeutic support after or instead of surgery in treating the necrotic forms of pancreatitis complicated by sepsis. From 1989 to 1995, acute pancreatitis mostly due to biliary tract disease and alcoholism was diagnosed in 228 patients. Necrotic processes were identified in 105 of them since disease onset; septic complications developed in 57 patients. Surgery was performed in 42 patients, but the result was poor in 11 of them (30%) and CT showed the persistence of some infectious pancreatic exudate which had been drained insufficiently. Since sepsis persisted in these patients, the exudate was aspirated percutaneously after positioning appropriate drainage means guided by abdominal CT. Sepsis resolved completely in 10 patients, while one required subsequent surgery. Percutaneous drainage catheters were positioned in 15 patients as the treatment of choice, under CT and US guidance. Sepsis resolved in 7 cases only (45%), while 3 of the extant patients died and 5 needed surgery. The results of our experience demonstrate the effectiveness of percutaneous drainage under CT guidance. However, this technique should be used after and as a support to surgery, the latter remaining the treatment of choice for infectious necrotic AP. Thus, in our experience, the use of percutaneous aspiration instead of surgery proved to be a less effective tool in curing this condition and its use should therefore be limited to high-risk surgical patients.
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PMID:[Role of computerized tomography in percutaneous drainage of acute infected necrotic-hemorrhagic pancreatitis]. 897 9

Thirty-one patients with biliary enteric fistula who were operated on over a 19-year period (1976-1994) with an incidence of 0.74% in all biliary tract operations were reviewed retrospectively to identify etiologic factors, types of fistulas, signs and symptoms, methods of diagnosis, management and prognosis of the cases. Most common symptoms were abdominal pain, nausea, vomiting and jaundice. Two patients had gallstone ileus. The majority of the patients had severe concomitant medical illnesses. The exact preoperative diagnosis of a biliary enteric fistula was established in only five (16%) patients. In 81% of the cases fistula was secondary to chronic calculous biliary tract disease. Postoperative complications included wound infection in six (19%), biliary fistula in two (6%) and erosive gastritis in one (3%) patient. Two patients died of intra-abdominal sepsis and two of cardiac failure, with an operative mortality of 13%. Early elective cholecystectomy is recommended to avoid complications of chronic calculous cholecystitis such as bilioenteric fistulas and their increased mortality and morbidity.
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PMID:Biliary enteric fistulas. 937 75

The development of acute acalculous cholecystitis (AAC) after cardiovascular surgery is an infrequent but devastating complication, the etiology and management of which remains controversial. To evaluate the etiology, treatment, and outcome of patients with AAC, the cases of six patients encountered within an 8-year period who developed AAC after cardiovascular surgery requiring cardiopulmonary bypass (CPB) were reviewed. Atherosclerotic risk factors including diabetes, hyperlipidemia, and smoking were evident in five patients, three of whom had a history of stroke or arteriosclerosis obliterans, while low cardiac output was recognized in three. Percutaneous transhepatic cholecystostomy was performed in five patients, and another required cholecystectomy for peritonitis due to gangrene of the gallbladder. Two patients died of respiratory failure and sepsis after 15 and 82 days of percutaneous drainage, respectively; however, the four survivors had an excellent outcome without any biliary tract disease during a mean follow-up period of 5.3 years. In conclusion, AAC after cardiovascular surgery may result from hypoperfusion of the gallbladder due to various factors including CPB, visceral atherosclerosis, and low cardiac output. We advocate early percutaneous cholecystostomy for patients without peritonitis, while early cholecystectomy is indicated for those with peritonitis.
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PMID:Acute acalculous cholecystitis after cardiovascular surgery. 1087 May 75

Acute acalculous cholecystitis (AAC) developed in 11 (7.7%) of 143 patients with surgical acute renal failure (ARF) who had no prior biliary tract disease. The cause of this potentially fatal complication is multifactorial and include trauma, previous surgery, sepsis, intermittent positive pressure ventilation, total parenteral nutrition, multiple transfusions, hypotension, and opiate sedation. The diagnosis of AAC was based on clinical suspicion, ultrasound scanning, and laboratory tests (leukocyte count, liver enzymes, bilirubin and C-reactive protein). All our ARF patients with AAC were receiving antibiotics at the time of diagnosis. Five patients were treated conservatively and six underwent cholecystectomy. The mortality rate in our ARF patients with AAC was 45.5%, and was not significantly different from than in ARF patients without AAC. The diagnosis of AAC should be made early, and judicious management (conservative or surgical) decreases its role as a contributory factor to the mortality in ARF patients.
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PMID:Acute acalculous cholecystitis in patients with surgical acute renal failure. 1091 36

Over a 6-year period, 42 patients with different underlying diseases developed Aeromonas bacteremia in our hospital. The male to female ratio was 2:1. The vast majority of these patients had underlying diseases, including various types of neoplasm (n = 14), liver cirrhosis (n = 11), biliary tract disorder (n = 10) and other illnesses (n = 7). Community-acquired bacteremia was predominant (33 cases, 79%). Aeromonas hydrophila was the most common species isolated (88%). Monomicrobial bacteremia was more common than polymicrobial bacteremia (64% vs 36%). Monomicrobial bacteremia was associated with neoplasm or liver cirrhosis in 80% of patients. Polymicrobial bacteremia was more common in patients with biliary tract disorder than in patients from other groups (60% vs 40%). Escherichia coli (60%) was the predominant concomitant organism isolated. The major clinical manifestations were fever (74%), jaundice (57%), and abdominal pain (45%). Recognized infection sites included biliary tract, soft tissue involvement, peritoneal involvement, while 50% of patients had no recognized infection site. Eight patients (80%) received cholecystectomy due to gall stone with acute cholecystitis. However, none of the cirrhotic patients with necrotizing fasciitis received surgical treatment. The mortality attributed to Aeromonas bacteremia was 70%. Patients with liver cirrhosis or malignancy had a higher acute mortality (death within 7 days after admission) than the other patients (89% vs 11%). We conclude that Aeromonas bacteremia can cause a rapidly fatal outcome and should be considered an important pathogen for septicemia in patients with liver cirrhosis or neoplasm.
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PMID:Outcomes of Aeromonas bacteremia in patients with different types of underlying disease. 1126 69

We described the clinical and bacteriological features of 12 cases of liver abscess caused by Streptococcus milleri group (SMG) during a 6-year period from 1993 to 1998. The gender was 11 males and 1 female with their ages ranging from 39 to 76 years old (mean: 53.4). The common symptoms were fever (100%), abdominal pain (67%), and appetite loss (58%). Nine cases had underlying diseases such as carcinomas and diabetes mellitus. Predominant causes of the liver abscess were cryptogenic (42%) and biliary tract disease (33%). Three patients died of an exacerbation of the carcinoma. Eight cases (67%) was single infection of SMG and no mixed infection with anaerobes. No strains isolated in this series showed resistance against penicillin G and ampicillin. SMG was highly isolated from the blood culture in eight of the 11 cases (73%). Liver abscess should be taken into consideration as one of the causes of SMG septicemia.
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PMID:[Clinical and bacteriological features of 12 cases of liver abscess caused by Streptococcus milleri group]. 1149 62

Cholelithiasis, choledocholithiasis and hepatolithiasis are common biliary tract diseases. These diseases may cause severe infection and/or sepsis. In addition to surgical treatments, prompt administration of appropriate antibiotic is important to control the biliary tract infection. The purpose of this study is to illustrate the bacteriology in biliary tract disease and provide information for antibiotic choices. From Jan 1991 to Aug 2000, 1394 patients including gallbladder (GB) stones, common bile duct (CBD) stones, intrahepatic duct (IHD) stones, GB polyps and biliary malignancy were subjects for this retrospective study. The overall positive rate of bile culture is 36% in this study while it was 25%, 66%, 67% and 9% for GB stones, CBD stones, IHD stones and biliary malignancy, respectively. A significantly higher (p = 0.001) positive culture rate was found for GB stones with acute cholecystits (47%) compared with that without inflammation (17%). Similarly, the culture rate for hepatolithiasis with acute cholangitis was higher than that without cholangitis (75% vs 51%, p = 0.011). Long-term external biliary drainage in biliary malignancy increased the risk of bacterial culture rate. For gallstone diseases, the most common organisms cultured were Gram negative bacteria (74%), in which Escherichia coli (36%) and Klebsiella (15%) were most commonly found, followed by Gram positive (15%) bacteria such as Enterococcus (6%), Staphylcoccus (3%), Streptococcus (2%). Bacteroides (5%) and Clostridium (3%) were occasionally found anaerobes (9%). Polymicrobial infection was encountered in 19%, 31% and 29% for patients with GB stones, CBD stones and IHD stones, respectively; frequency of mixed aerobic and anaerobic infection was 7%, 12% and 9%. In the current study, ampicillin in combination with sulbactam and aminoglycoside is still a suggestive empirical therapy. Antibiotic treatment should be adjusted based on later bacteriological cultures and clinical condition.
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PMID:Bacteriology and antimicrobial susceptibility in biliary tract disease: an audit of 10-year's experience. 1219 28


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