Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reviewed 46 consecutive patients with Crohn's disease predominantly affecting the ileum who specifically underwent right-sided ileocolectomy with primary anastomosis. All had a primary ileocolic anastomosis done by suture in a single-layer closed fashion. Of these 46 patients, 19.6% had overt intra-abdominal sepsis, 30.4% had prior surgery, and 95.7% were taking corticosteroid drugs just before their operation. The mean (+/- SE) age was 31.5 +/- 2.0 years. The serum albumin level was less than 35 g/L in 93.5% of patients; all had a hematocrit value less than 0.36, and 80.4% lost more than 15% of their normal body weight. No patient received parenteral nutrition either preoperatively or postoperatively. No change in the preoperative, intraoperative, or postoperative approach to treating patients with predominantly ileal Crohn's disease occurred during the 10-year period of review. There was a 2.2% incidence of perioperative complications (one superficial wound infection) and a 6.5% incidence of late (>1.49 months) complications (two suture sinuses and one wound abscess unassociated with a fistula). Our findings suggest that preoperative parenteral nutrition is unnecessary in the majority of patients with predominantly ileal Crohn's disease specifically undergoing right-sided ileocolectomy and primary ileocolic anastomosis.
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PMID:Is preoperative parenteral nutrition necessary for patients with predominantly ileal Crohn's disease? 141 87

184 patients diagnosed with Crohn's disease were observed for an average of 5 years and evaluated for clinical pattern and course of disease. The male/female ratio was almost equal (90 m. vs. 94 f.). The peak of disease manifestation was between years 18-32. Familial clustering of inflammatory bowel disease was observed in 2.2%. The pattern of anatomic involvement was ileocolic in 53%, colon in 24%, small bowel in 20% and other locations in 3%. 34% of patients were afflicted with at least one extraintestinal manifestation, 34% developed fistulae. Fistula formation was seen more often in colon involvement than small bowel involvement (69% vs. 32%). 48% of the patients were operated at least once. 3 patients died during the observation period, 2 of them with sepsis. Evolution of carcinoma was not observed. Some of our results are in accordance with the literature, some distinct observations (e.g. low familial clustering) underline the theory of a multifactorial pathogenesis in Crohn's disease.
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PMID:[Long-term follow-up of Crohn disease]. 150 84

During the period from 1980 through 1990, our institution constructed 253 ileoanal reservoirs in 253 patients, of whom 25 (9.9%) experienced pouch failure. A poor functional result was the most common cause of pouch failure (seven [28%] of 25 patients). Unsuspected Crohn's disease became manifest in 13 (5%) of the 253 patients, resulting in pouch loss due to perianal sepsis or pouch fistulas in six patients (24% of 25 failures), and resulted in a significantly increased risk of pouch failure compared with that of the non-Crohn's population. Pouchitis occurred in 78 patients (31%) and accounted for four (16%) of 25 failures, but patients with pouchitis were not at higher risk for pouch failure than were patients who did not have pouchitis (failure rates of 6.4% vs 10.4%, respectively; not significant). Significant pelvic sepsis in the absence of Crohn's disease developed in 13 patients, five (38%) of whom lost their pouches. Poor functional results, pelvic sepsis, and unsuspected Crohn's disease were the major causes of pouch failure, while pouchitis was not.
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PMID:Ileal pouch-anal anastomosis. Patterns of failure. 152 77

Crohn's disease is a panintestinal disease of unknown aetiology and a tendency to recrudescence throughout the patient's life. It is therefore impossible to cure Crohn's disease by medical therapy or surgical excision. In spite of this, the majority of patients can be managed through their disease and maintained in a good state of health by a combination of medical and surgical treatment. Early attempts at surgical management of Crohn's disease in the 1930's and 1940's involved bypass procedures which were marred with serious complications of sepsis, development of cancer and increased rate of recurrence. By the 1950's resection became the preferred operation but there soon arose a controversy about the amount of bowel that should be removed. There were some who advocated radical excision; removing all diseased bowel with a large margin of apparently normal tissue on each side of the resection. Others found less radical resection safer as it preserved gut and also had no apparent effect on the rate of recurrence of the disease. Although this argument continued, the balance gradually shifted towards less radical surgery. Furthermore, the wave of conservatism led to the evolution of the concept of minimal surgery.
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PMID:The role of strictureplasty in Crohn's disease. 157 74

A 39 year old woman presented with a short history of bloody diarrhoea. She subsequently developed microangiopathic haemolysis, platelet consumption, and renal impairment. Initial investigations suggested underlying Crohn's disease of the terminal ileum complicated by sepsis and disseminated intravascular coagulation. However, after resection of a perforated caecum and terminal ileum, the diagnosis of thrombotic thrombocytopenic purpura was made. There was weak serological evidence of yersinia infection, this may have caused the early localisation of the lesions to the terminal ileum. This is believed to be the first report of thrombotic thrombocytopenic purpura affecting the small bowel alone at presentation.
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PMID:Thrombotic thrombocytopenic purpura mimicking acute small bowel Crohn's disease. 162 73

Sixty-nine patients were operated upon in a three-stage procedure. Early complications occurred in 29 percent after colectomy-ileostomy, in 25 percent after proctomucosectomy with ileoanal anastomosis and loop ileostomy, and in 9 percent after closure of loop ileostomy. Only three of these were considered serious. Seventy-one percent of the patients were readmitted into the hospital between the three operations or after the last one. Total hospital stay was 49 days (median); the range was 20 to 345 days. Reconstruction of the reservoir was performed in four patients owing to defecation problems, with satisfying functional results in two patients, while two emptied by catheter. There was no postoperative mortality or pelvic sepsis, and no pouches were excised. Ileostomy was re-established in two patients. At histopathologic re-evaluation of colectomy specimens, the diagnosis was changed from ulcerative colitis to Crohn's disease in three patients and to indeterminate colitis in five. Median follow-up was 4.3 years. Continent anal defecation without ileostomy was achieved in 67 patients (97 percent), with 4.1 bowel movements per day and 0.6 per night. Perfect continence was achieved in 55 percent in the daytime and in 43 percent at night. The low rate of reservoir-threatening complications is attributed to the three-stage procedure and the technical details in the surgical procedures.
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PMID:Colectomy-proctomucosectomy with S-pouch: operative procedures, complications, and functional outcome in 69 consecutive patients. 173 82

Generalized faecal peritonitis is associated with a mortality of over 50% in most series of cases. Despite great improvements in the standards of intensive care the morbidity and mortality associated with this condition have not improved, in part due to recurrent intra-abdominal sepsis. This preliminary study investigated the role of laparotomy, repeated abdominal lavage and debridement to determine whether such a policy might lead to an improvement in outcome. Of six cases studied three had perforated diverticular disease, two had Crohn's disease. Twenty lavages were performed on these six patients who had a mean ICU stay of 8 days. Five out of the six patients left hospital and remain well, one patient died of septicaemia and pre-existing renal failure. This study found that laparotomy, repeated abdominal lavage and debridement may be effective in reducing the morbidity and mortality of generalized faecal peritonitis and further study of this technique is appropriate.
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PMID:Management of generalized faecal peritonitis--can we do better? 129 27

Sepsis and tricuspid valve regurgitation developed in a 29-year-old man with Crohn's disease after implantation of an intravenous port device for parenteral nutrition. A thrombus, caused by Staphylococcus epidermidis, had grown along the catheter and prolapsed through the valve without affecting it. Complete removal in an open heart procedure led to quick recovery.
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PMID:Infected intravenous port device causing tricuspid valve regurgitation. 190 54

From 1961 to 1989, 67 patients underwent various surgical procedures for psoas abscess. Retrospective analysis was undertaken in an effort to determine optimal surgical therapy. Forty patients were cured with one operation. Twenty-one patients required two operations, four patients required three operations, and two patients required more than three operations. The reason for failure of treatment was failure to resect the diseased bowel or to drain the psoas abscess adequately. A technique to recognize and treat the abscess definitively will be illustrated. The most common etiologies were Crohn's disease in 49 patients, postoperative sepsis in eight patients, and complications of renal disease in four patients. The length of hospital stay ranged from 5 to 392 days (mean, 26 days). There were two deaths. Failure to recognize and treat psoas abscess results in considerable morbidity.
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PMID:Psoas abscess: difficulties encountered. 156 5

During an 11-year period, 41 patients with Crohn's disease were placed on home parenteral nutrition (HPN) for a mean of 1,083 days (range: 33 to 3,258 days). Data were retrospectively analyzed to determine whether HPN had an effect on the course of their disease, i.e., on the number of operative procedures performed and the intensity of required medical therapy. Data represented information obtained during a total of 121 patient-years of HPN for Crohn's disease. The main indications for HPN were short bowel syndrome (66%) and high stoma output. Twenty-four of 41 patients (59%) underwent surgery for Crohn's disease during the course of HPN. There was no significant difference between the number of procedures performed per patient per year of Crohn's disease during pre-HPN and HPN periods (p greater than 0.25). Although there was no significant change in body weight, both serum albumin and transferrin levels increased during HPN (p less than 0.01 and p less than 0.01, respectively). Twenty-nine percent of patients were taking prednisone while on HPN, compared with 54% of patients during the pre-HPN period (p less than 0.01). HPN appeared to result in a significant improvement in the numerically assessed quality of life. During the HPN period, 24 patients had 1 or more HPN-related complications that required 1 to 13 hospital admissions (mean: 1.8). These complications included catheter sepsis in 19 patients, blocked or damaged catheters in 15 patients, and dehydration and/or electrolyte imbalance in 5 patients. Eight patients died, with 7% of deaths secondary to catheter-related sepsis. Although permanent HPN is associated with an identifiable morbidity and mortality and is not associated with a reduction in the frequency of surgery for Crohn's disease, benefits include a decrease in the intensity of medical therapy, an improvement in patients' nutritional state, and a significant perceived improvement in patients' quality of life. Without HPN, we believe all patients would have died secondary to malnutrition and/or dehydration.
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PMID:A century of home parenteral nutrition for Crohn's disease. 197 2


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