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

The clinical spectrum of neonatal endocarditis, including bacterial and nonbacterial types, is examined in five case reports that were drawn from nursery experiences over a recent 2-year period. In contrast to previous reports of 100% mortality from neonatal endocarditis, one patient survived. Changing heart murmur and hematuria were most frequently associated with bacterial and nonbacterial endocarditis in four of the five cases. Pulmonary hypertension, thrombocytopenia, and coagulopathy were also associated with nonbacterial endocarditis. Echocardiograms were performed on four of the patients; only one was suggestive of endocarditis. Staphylococcus aureus was isolated from both cases of bacterial endocarditis, including the single survivor. Thus, it is suggested that the initial antibiotic coverage of any neonate with the clinical syndrome of sepsis, hematuria, and a heart murmur include antistaphylococcal coverage for the possibility of bacterial endocarditis.
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PMID:Endocarditis in high-risk neonates. 682 46

Intraoperative infusion of autologous shed blood is efficacious in elective vascular, cardiac, and orthopedic surgery. Blood recycling has also been advocated for emergency and trauma surgery. We examined 33 candidates for autotransfusion during emergency surgery. Autologous blood accounted for only 11% of the total blood replaced. Only 25 of the patients survived long enough to permit reinfusion. Because of rapid hemostasis, nine of the remaining patients (36%) received less than the 2 units necessary to be cost-effective. No evidence was found for septicemia or coagulopathy caused by autotransfusion. We concluded that, as currently applied, recycling of shed blood during emergency surgery is of value in a limited group of patients. The collection and storage of heparinized shed blood during the preoperative and early intraoperative periods, with later processing and reinfusion in selected patients, may expand its applicability.
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PMID:Utilization of blood recycling in nonelective surgery. 683 67

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
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PMID:Infective endocarditis update experience from a heart hospital. 697 38

Goats, sheep and calves were inoculated intravenously with strain Y3343 of the large colony type of Mycoplasma mycoides subsp. mycoides isolated from a goat with polyarthritis. The goats and sheep died of septicemia (one was killed in extremis) within eight days. The goats had leukopenia and granulocytopenia. Coagulopathy was indicated in some goats; the fibrinogen titer, prothrombin and partial thromboplastin times increased with the progress of disease and the number of platelets decreased dramatically in one goat. Goats and sheep had cellulitis at the site of inoculation, pleural hemorrhages, pneumonia, myocarditis, renal infarcts, glomerulitis, adrenal cortical necrosis, enteritis, focal splenic necrosis, polyarthritis and lymphadenitis. Vasculitis and thrombi were seen occasionally, suggesting that vascular changes, perhaps together with coagulopathy, had a role in pathogenesis. One of two experimental calves developed a slight fever, arthritis and minor inflammation of adrenal tissue. Calves seen less susceptible to the mycoplasma organism given intravenously than do goats or sheep.
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PMID:Experimental infection of goats, sheep and calves with the large colony type of Mycoplasma mycoides subsp. mycoides. 700 31

In the case of neonatal group B streptococcal disease, two distinct types of illness have been described in the past few years. The early onset type occurs in the first hours of days of life and emerges as septicemia. The late onset type occurs after the first week and emerges as meningitis. Other frequent local manifestations are pneumonia and pleural effusions, but there are few reports on localized inflammation of other organs. This paper gives a brief survey of the local manifestations of the disease. In addition, a case of a 1120 g premature of 29 gestational week is reported. After ten uneventful weeks, the patient developed acute fulminating group B streptococcal septicemia. The initial signs of apnea, respiratory insufficiency and shock were followed by meningitis, cellulitis of the tongue and skin and severe coagulopathy. After seven days the baby died of an intracranial hemorrhage.
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PMID:[Local manifestations of neonatal group B streptococcal disease (author's transl)]. 701 50

Strain Y3343 isolated from a goat with septicemia and polyarthritis was studied. The strain was virulent and induced septicemia, polyarthritis and coagulopathy in two goats. Limulus amebocyte lysate active material was present in plasma, but not in higher titre in inoculated goats. Sonicated mycoplasma material induced a dramatic somatic cell response in the mammary gland of cows and goats and marked clotting of the cows' milk, but it did not clot limulus amebocyte lysate or kill chick embryos. Phenol-water extract clotted limulus amebocyte lysate and induced somatic cell response in cows but not in goats. The phenol-water extract did not kill chick embryos, was not pyrogenic in rabbits or goats, and did not induce generalized Shwartzman reaction or change the leukocyte kinetics in rabbits. It therfore appears that the virulence mechanisms of strain Y3343 can not be explained on the basis of factors with strong endotoxin activity.
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PMID:Biological effects of sonicated suspension and phenol-water extract of Mycoplasma mycoides subspecies mycoides in goats. 704 90

Fifty-five infants participated in a double-blind study of indomethacin therapy for the closure of patent ductus arteriosus. Seventeen infants died. There was no significant difference in autopsy findings between the groups with respect to pneumonia, disseminated intravascular coagulopathy, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, hydrocephalus, kernicterus, brain softening, and renal damage. For those infants who survived and returned for follow-up at approximately 1 year of age, there was no significant difference between the control (n = 17) and indomethacin (n = 13) groups with respect to physical growth, Bayley scores, respiratory infection, abnormal eye ground, neurological defects, and abnormal EEG. Four in the control group (24%) and three in the indomethacin group (23%) had moderate to severe neurological defects and/or scored less than 80 on the Bayley Mental Development Index or Psychomotor Development Index. It appeared that indomethacin therapy did not have a long-term adverse effect on premature infants.
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PMID:Intravenous indomethacin therapy in premature infants with patent ductus arteriosus. Causes of death and one-year follow-up. 711 4

Trauma surgeons must be familiar with the different alternatives that are available in managing hepatic injuries. Although most injuries of the liver can be managed by straightforward operative techniques, the severe injury requires immediate recognition and expedient application of surgical skills for a successful outcome. These guidelines are intended to counter the two major causes of death associated with liver trauma: operative hemorrhage and postoperative sepsis. Operative technique must be impeccable. Operative judgment must be based on the specific entities involved. The correct operative maneuvers must be made before hypovolemic and ischemic insults have irreversibly affected organ function or before a profound coagulopathy has developed. It is imperative that the surgeon and anesthesiologist work as a team when confronted with a patient who has a major liver injury.
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PMID:Surgical management of liver trauma. 712 74

Le Veen's peritoneal-jugular shunt was employed in the treatment of irreducible ascites in 16 patients with cirrhosis of the liver. Intraoperative mortality was 18%. It was due to disseminated intravascular coagulopathy in 2/3 cases. Regression of ascites and renal failure was noted in all survivors. Follow-up over 6-28 months (mean 10 months) showed that 2 patients had died from sepsis and two from liver failure. Recurrence of ascites (3 cases) had been brought about by malposition or thrombosis of the venous catheter; in one subject, thrombosis extending to the vena cava superior necessitated a portal shunt. There were no instances of digestive haemorrhage attributable to rupture of oesophageal varices. Good results free from complications were noted in 7 patients (43%) and easily treatable complications in 9 (56%). There was an evident improvement over the results obtainable with conventional management. The fact that mortality is generally confined to patients in Child's group C with marked hypoprothrombinaemia suggests that such candidates should be carefully selected. This, together with technical improvements designed to reduce the incidence of intravascular coagulopathy and haemodynamic overload following the operation, would seem capable of permitting better results in the future.
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PMID:[Treatment of irreducible ascites of cirrhotic patients with peritoneo-jugular shunt]. 715 96

Reported are 27 autopsies with significant increases in the numbers of megakaryocytes within the renal glomerular capillary network (P less than 0.001). These were selected from 118 cases in which peripheral vascular megakaryocytosis could be expected preterminally. Generally, the histologically observed increases in numbers of renal megakaryocytes corresponded to increases in the pulmonary microcirculation and in the bone marrow. An exception to the latter was noted in patients who had morphologic evidence of coagulopathy without sepsis.
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PMID:Megakaryocytes in renal glomeruli. 719 93


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