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

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

We performed a retrospective review of echocardiographic data files of infants and children hospitalized in the Newborn and Pediatric Intensive Care Units. Echocardiograms were examined to detect the presence and evolution of great vein and right atrial thrombosis in patients with central venous lines. Thirty-seven patients were identified over a five-year period. Echocardiograms were performed, not routinely, but in response to specific indications including catheter malfunction, thrombocytopenia, persistent chylothorax, bacterial or fungal sepsis, and superior vena cava syndrome. Fifteen of 37 patients died, 13 of them during the hospitalization in which the thrombus was discovered. Thrombolytic agents and surgery were used to treat selected patients, with mixed results. Two of the 22 survivors have significant disability related to the thrombus or complications arising from it. We conclude that great vein and/or right atrial thrombosis is a common complication of central venous catheterization in small infants and children; moreover, the morbidity and mortality relating to this complication is substantial.
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PMID:Great vein and right atrial thrombosis in critically ill infants and children with central venous lines. 200 3

Between 1987 and 1990 twenty report cases who suffered carcinoma of the esophagus underwent transmediastinal esophagectomy without thoracotomy at the Surgery Service of the Edgardo Rehabilitation Hospital. Of the report cases 90% were at stage III, 5% of stage II and 5% at stage I of the TNM Classification. Post operative complications were cervical leaks, transitory dysphonia and respiratory illness, and were solved by conservative management. Only one case died with sepsis and mediastinitis, this represents an inpatient mortality of 5%. There were no hemorrhagic complications, nor chylothorax neither visceral necrosis during surgical time. Transmediastinal esophagectomy offers a good choice for the management of surgical cases, it has low mortality, morbidity and similar survival time than other procedures.
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PMID:[Transmediastinal esophagectomy without thoracotomy in cancer of the esophagus]. 212 89

Of the patients who underwent surgical treatment for the respiratory system at our hospital over the past 9 years, 6 were postoperatively complicated with chylothorax, 1 with liquorrhea and the other one with paraplegia. Chylothorax occurred after mediastinal lymph node dissection which was carried out for the treatment of malignant tumors. In five cases, it occurred on the left side, and in the sixth case, it occurred on the right side. In 2 patients who received conservative treatment, there was no reduction in chyle outflow, and they died of cerebral infarction and sepsis. The other 4 cases were surgically treated. In 3 of them, the impaired site of the thoracic duct was confirmed by administration of Sudan III before surgery. We confirmed that early reoperation for the chylothorax after lung resection should be performed. Liquorrhea occurred from the 5th costvertebral joint which had been directly infiltrated by lung carcinoma. Fortunately, the postoperative course was uneventful, though the patient complained of dizziness and headache until 14 postoperative days. The case of paraplegia was caused by oxydized cellulose cotton that entered the epidural space via the intervertebral foramen. It was used for hemostasis in the 5th costvertebral joint. This case indicates that oxydized cellulose cotton, which swells when it absorbs water, should be carefully used for hemostasis around the nerves.
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PMID:[Complication related to operative procedure in lung cancer and mediastinal malignancy--report of 6 cases]. 258 77

A young patient who had traumatic amputation of left arm developed extensive chylothorax on right side of chest. The pathophysiology appears to be left subclavian thrombosis secondary to gross sepsis of the amputation stump which resulted in occlusion of thoracic duct opening and chylothorax. The child was successfully treated by closed chest tube drainage.
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PMID:Chylothorax following traumatic amputation of upper arm. 336 20

Pleural complications occurred in 30 (22%) of 138 patients after 53 single and 91 double lung transplants between September 1986 and February 1993. These were defined for the purpose of this study as pneumothorax persisting beyond the first 14 postoperative days, recurrent pneumothorax, or any other pleural process that necessitated diagnostic or therapeutic intervention. Overall, a higher pleural complication rate was seen in double lung transplantation (25 of 30) than in single lung transplantation (5 of 30) with no differences noted in the frequency among preoperative diagnostic groups (p > 0.05). Pneumothorax was the most frequent complication, affecting 14 of 30 patients, with 6 of 14 cases occurring after transbronchial biopsy. All pneumothoraces in single (n = 4) and double lung transplantation (n = 10) resolved spontaneously or with chest tube thoracostomy. One patient required placement of a Clagett window after open lung biopsy and another required thoracotomy and pleural abrasion after transbronchial biopsy. Parapneumonic effusion was observed in 4 of 30 double lung transplantations with spontaneous resolution in all cases. Empyema affected 7 of 30 patients and occurred exclusively in the double lung transplant group. Sepsis developed in three of the patients with this complication and they subsequently died. The risk of empyema was independent of preoperative diagnosis (p > 0.05). Of interest, all patients with cystic fibrosis (n = 3) with complicating empyema had Pseudomonas cepacia in the pleural fluid. Other miscellaneous complications included subpleural hematoma, chylothorax, and hemothorax. The latter two necessitated thoracic duct and bronchial artery ligation, respectively. In summary, a significant proportion of lung transplant recipients will have pleural space complications. The vast majority of these will resolve spontaneously or with conservative procedures. These complications were not related to preoperative diagnosis nor associated with a significant prolongation of hospital stay (p > 0.05). Empyema is the only pleural space complication associated with increased patient mortality and, as such, is an important clinical marker for those at risk for sepsis and death.
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PMID:Pleural complications in lung transplant recipients. 754 81

Our purpose was to determine the natural history of unresectable lymphangiomas. From 1986-1992, 11 cases of unresectable lymphangiomas were seen in our institution (age 1 month to 14 years). Locations affected included cervical (8), mediastinal (6), and abdominal (3). Presenting symptoms included abdominal pain, respiratory problems, chylothorax, pleural effusions, and pneumococcal sepsis. Attempts at total excision were performed in all but one patient who had biopsy only. The tumor that could not be removed was then observed for the development of complications. Follow-up of these 11 patients ranged from 2 to 6 years. Two have completely regressed, five have stabilized, and four have required repeat operation. Of the five that have stabilized, none have developed complications such as infection or compression secondary to the mass. In an asymptomatic patient, it appears that the portion of the lymphangiomas remaining will regress or at least not progress, and no further resections were required.
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PMID:Follow-up of complex unresectable lymphangiomas. 797 77

Questions persist about the management of postoperative chylothorax in infants and children. Our experience with postoperative chylothorax over the most recent decade (1980 to 1990) has been reviewed. The type and amount of drainage, data from cardiac catheterization and echocardiography, operative decisions and details, and eventual outcomes have been cataloged. All patients were initially treated with total gut rest, with operation reserved for unabated drainage. Chylothorax developed postoperatively in 15 infants and 11 children (18 with a cardiac procedure and 8 with a noncardiac procedure). The average age was 3.1 years. Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Those for whom operation was chosen drained preoperatively for an average of 29.2 days (range, 25 to 40 days). There were no deaths in either group. Complications were lymphopenia (2 patients) and fungal sepsis (1 patient). The amount of drainage per day was not significantly different between patients treated operatively and those treated nonoperatively. Failure of nonoperative management was associated with venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). Presumably this increased pressure is transmitted to the lymphatic system. These patients should be identified early and considered for thoracic duct suture or pleuroperitoneal shunting.
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PMID:Management of pediatric postoperative chylothorax. 837 18

We describe a newborn female with a severe presentation of distichiasis-lymphedema syndrome (McKusick 15340). She was initially evaluated because of a phenotype suggestive of Ullrich-Turner or Noonan syndrome (low posterior hairline, cupped ears, severe pterygium colli, heart murmur, and pectus excavatum). Distichiasis was noted at age 6 weeks. Subsequent to surgery for tetralogy of Fallot, patent ductus arteriosus, and branch pulmonic stenosis, she developed persistent chylothorax and sepsis. She died at 3 months. Family history indicated segregation of distichiasis-lymphedema syndrome. She was the sixth member in her family to have this disorder and was the most severely affected.
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PMID:Distichiasis-lymphedema syndrome: tetralogy of Fallot, chylothorax, and neonatal death. 898 86

Case 1. An 85-year-old woman had a papillary adenocarcinoma of the thyroid gland and a pleural effusion. The pleural effusion appeared to be a chylous exudate and it did not re-accumulate after thoracenthesis. Thoracic imaging indicated that the chylothorax was caused by direct invasion of the thoracic duct by the thyroid carcinoma. Case 2. A 53-year-old woman had a 20-year history of recurrent chylothorax. She died due to sepsis one year after the third admission for dyspnea and chylothorax. The autopsy findings included papillary adenocarcinoma of the thyroid gland with metastasis to the left supraclavicular lymph nodes. The thoracic duct was inflamed, fibrotic, and completely obstructed. Invasion by the carcinoma may have compressed and destroyed the thoracic duct, and caused chylothorax. Recurrent inflammatory granulation caused total obstruction of the thoracic duct. Reports of chylothorax associated with carcinoma of the thyroid gland are rare.
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PMID:[Two cases of papillary adenocarcinoma of the thyroid gland associated with chylothorax]. 926 55


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