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

Univariate and multivariate analyses have been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were nine failures requiring intubation, ileostomy or pouch excision. There was a significant association between failure and pelvic sepsis (P less than 0.05, n = 8), endoanal mucosectomy (P less than 0.05, n = 7), preservation of a long rectal cuff (P less than 0.05, n = 5) and lack of experience with the operation (P less than 0.05, n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, three are now known to have Crohn's disease. Functional outcome was significantly impaired in patients who developed pelvic sepsis (P less than 0.01) or a postoperative fistula (P less than 0.05), and who had an endoanal mucosectomy (P less than 0.05). Success with ileoanal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.
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PMID:Multivariate analysis of factors influencing the results of restorative proctocolectomy. 276 17

The physical inconvenience and adverse psychological impact of ileostomy on patients led surgeons to seek a more normal and acceptable alternative. This is a report of the Mayo Clinic experience with, and modifications of, the ileoanal reservoir procedure. The hospital charts of 188 patients who had a J-pouch construction were reviewed. The operative technique is described. There were no hospital deaths. In 10 patients the operation was a failure. Complications included pelvis sepsis (21 patients), anastomotic sinus (15), anastomotic stricture (22), small-bowel obstruction (43), peritonitis after ileostomy closure (10) and pouchitis (15). Careful patient selection for the procedure is important. Crohn's disease is a contraindication. Of the patients studied, 95% found life more acceptable with an ileoanal anastomosis than with a loop ileostomy.
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PMID:J pouch with ileoanal anastomosis. 282 16

Between January, 1977, and March, 1986, 200 patients were registered as receiving home parenteral nutrition (HPN) in the UK and the Republic of Ireland. Although 28 centres contributed case-reports, 75% of the cases were registered by 7 centres. Most patients started treatment between the ages of 10 and 40 years, a reflection of the high incidence of Crohn's disease during these decades. The three main indications for HPN were Crohn's disease (90 patients), mesenteric vascular disease (27), and extensive small-bowel resection for volvulus or other benign enteric disease (14). 85 patients required treatment for less than 1 year and 17 have been on treatment for more than 2 years. Patients whose indication for HPN was a primary intestinal disease had a better quality of life than did those in whom the intestinal failure was secondary to a systemic disorder. Of the 108 patients who have completed treatment 56 have been able to resume enteral nutrition through adaptation of the remaining bowel, or closure of a fistula. 34 have died, 19 as a consequence of the underlying disease and 10 of complications of treatment. The incidence of catheter-related sepsis varied between 0.2 and 0.9 episodes per year of treatment (overall 0.35) depending on the length of experience of the supervising centre.
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PMID:Home parenteral nutrition in the United Kingdom and Ireland. 287 79

We reviewed our experience with 73 patients who had Crohn's disease and underwent local anorectal surgical procedures for perianal suppurative disease during a ten year period. All but one of these patients had intestinal granulomatous disease. The average length of follow-up study was 4.6 years. By using conservative, local anorectal surgical procedures and intensive medical treatment, we were able to establish adequate drainage of abscesses, reduce the inflammatory process and relieve symptoms. Extensive drainage procedures were avoided to preserve the anal sphincter. A sliding endorectal flap repair provided satisfactory results for rectovaginal fistulas and anterior anal fistulas. Proctectomy was eventually necessary in nine patients, the primary indication being severe perianal disease in five. By performing complete excision of the perineal disease at the time of proctectomy, we were able to achieve primary healing of the perineal wound in eight of these patients. Patients were classified according to five categories of results: healed after initial local treatment, eight patients; healed after more than one local treatment, 30 patients; incomplete healing with acceptable condition, 17 patients; healed after fecal diversion, nine patients, and required proctectomy, nine patients. The majority of patients with Crohn's disease and anal and perianal suppurative disease can be managed by meticulous drainage of sepsis and preservation of the anal sphincter.
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PMID:Techniques and results in the management of anal and perianal Crohn's disease. 290 31

A patient with Crohn's disease who required placement of a right external jugular vein central catheter for total hyperalimentation is presented. Catheter-induced thrombosis and catheter-associated bacteremia and sepsis subsequently developed. Following the description of the case is a brief discussion of the complications inherent in central line placement, the mechanisms by which thrombosis and sepsis occur, and the measures that can be taken to decrease the incidence of thrombosis and sepsis in central line placement. The management of central venous thrombosis and sepsis is medical and not surgical in nature, and consists of catheter removal, antibiotics, and anticoagulation.
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PMID:Unusual case of central vein thrombosis and sepsis. 309 Aug 81

The United Kingdom and Ireland Register of Home Parenteral Nutrition (HPN) contains details on 237 cases treated between 1977 and 1987. One hundred courses of HPN were given to 89 patients for complications of Crohn's disease. Six registering centers provided 87 percent of the courses of treatment. The short-bowel syndrome was a factor in 60 patients, fistulas in 29 patients, and exacerbation of the disease in 41 patients. Thirty patients had more than one complication. The age distribution of patients with Crohn's disease was the same as for all HPN patients. Nine patients have died and eight have ceased HPN because of complications from the treatment. Fifty two percent of the patients had no complications. Patients with Crohn's disease on HPN had a significantly better lifestyle than the group as a whole (P less than .05) and had lower sepsis and complication rates (P less than .01 and 0.001, respectively). The 60 Crohn's patients with short-bowel syndrome spent a significantly longer time on HPN than Crohn's patients overall (P less than .05). Only 15 of these have been able to cease treatment and resume enteral feeding, compared with 23 of the other 40 patients who were able to resume enteral nutrition after a median of three months. Analysis of the authors' group of 35 patients included in the 100 showed that the only nutritional parameters of use in monitoring the patients' well-being were weight and serum albumin. Eighty percent of the patients with Crohn's disease who were treated by HPN have either successfully resumed enteral feeding or are successfully managing their own HPN. HPN is a safe and effective treatment for patients with acute or chronic intestinal failure from Crohn's disease.
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PMID:How do patients with Crohn's disease fare on home parenteral nutrition? 313 56

We report what we believe to be the first case of Crohn's disease involving the cervical oesophagus with an oesophago-pulmonary fistula to the apex of the lung. The proximal location of the disease prevented radical therapy and the patient eventually died from chronic sepsis.
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PMID:Cervical Crohn's disease with oesophago-pulmonary fistula. 325 Dec 28

Treatment, by local depot methylprednisolone injection, of severe anal pain in Crohn's disease not associated with overt sepsis is reported. It has given dramatic relief in 5 patients, but has not been successful in 2 patients where anal disease was in continuity with severe rectal involvement. Treatment has been effective for greater than 1 yr, and no complication of the technique has been found on regular follow-up. When compared with previous attempts at treatment, the beneficial results attained with methylprednisolone injection suggest that the effect is more than a placebo response. Careful patient selection to exclude overt sepsis or severe rectal disease is recommended before proceeding to steroid injection.
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PMID:Local depot methylprednisolone injection for painful anal Crohn's disease. 333 39

In 100 consecutive patients with fistulous Crohn's disease who were managed surgically during a 12 year period, a 96 per cent closure rate was obtained with only a 1 per cent 30 day mortality rate. En bloc resection of the diseased intestine and fistula with primary anastomosis was the preferred treatment, but temporary exteriorization of the intestinal ends was undertaken in patients compromised by extensive sepsis or profound hypoalbuminemia. In 43 patients, there were 70 secondary intestinal defects caused by the fistula eroding into otherwise healthy intestine. The majority of these defects were successfully closed by primary suture; however, three secondary duodenal defects, treated by primary suture alone, failed to heal and fistulas recurred. As a result, two of these patients died of overwhelming sepsis. Since adopting closure or protection of duodenal defects by a jejunal serosal patch, this problem has not arisen again. One defect in the sigmoid colon treated by primary suture also had recurrence of fistula, probably because the repair lay adjacent to an abscess cavity. Temporary loop colostomy is now used to protect repairs of defects in the sigmoid colon undertaken in the presence of local sepsis.
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PMID:The operative management of fistulous Crohn's disease. 341 52

All patients referred to the University Department of Surgery in Wellington with anorectal abscess were managed by simple de Pezzer drainage. The catheter used was between 3-5 mm in diameter and was inserted when possible under local anaesthetic. Ninety-seven patients have presented with anorectal abscess. After exclusion of those patients with intersphincteric abscess, 91 have been managed in this way with a male : female ratio of 2.8 : 1. a perianal abscess was present in 76 patients. General anaesthesia was necessary in 18 patients and 16 of these patients were admitted to hospital. Twelve patients were admitted for underlying medical problems. One patient had Crohn's disease. Over half of the patients had symptoms which had lasted for 4 days or less and 22 patients had antibiotics prescribed by their local practitioners. There was no past history of anorectal sepsis in 75 patients. Sixty-two of the catheters were removed in less than 15 days. Of the patients who were drained under local anaesthetic only eight said that the pain was so intolerable that they would opt for a general anaesthetic in the future. Thirty-five patients returned to their normal activities or work within 5 days and 68 were back at work 14 days after drainage. One abscess was inadequately drained. Twenty-two patients developed fistulae within the follow-up period. It is suggested that this simple technique is safe and reliable, is well tolerated by patients, results in minimal hospitalization and an early return to work.
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PMID:A simple method for the management of anorectal abscess. 342 51


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