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

Thirty-five patients with acute fulminant (hemorrhagic) pancreatitis, verified at laparotomy, were allocated to either pancreatic resection (18 patients) or peritoneal lavation (17 patients) therapy groups. Pancreatic resection was carried out by removing the distal pancreas well cephalad to the portal vein. For peritoneal lavation, two inlet silicone catheters were inserted at laparotomy around the pancreas and an outlet catheter was inserted in the lower abdomen, and the peritoneal cavity was thereafter lavated (1000 ml/hr) with a standard peritoneal dialysis fluid for 7 to 12 days (or until death if met earlier). In other respects, the postoperative care was similar, including intravenous fluids with total parenteral nutrition until oral intake of food was resumed, prophylactic antibiotics (tobramycin and clindamycin) and stress ulcer prophylaxis (cimetidine and antacids). In the resection group, four of the 18 patients (22.2%) died, while in the lavation group eight of the 17 patients (47.1%) died. The most common cause of death was septic complications with multiple organ failure, but one patient in each group died accidentally of airway complications. There was no difference in the incidence of septic complications (sepsis and/or intra-abdominal abscesses), but the incidence and severity of pulmonary and renal complications were greater in the lavation group. However, these complications accumulated to patients who ultimately died. Also, the need for reoperation was greater in the lavation group (20 reoperations/10 patients versus 12 reoperation/eight patients). Yet, the length of overall hospital stay was equal in the two groups. Six of the 14 survivors in the resection group developed diabetes, whereas none of the nine survivors in the lavation group got this complication. The results suggest that pancreatic resection is superior to peritoneal lavation in the management of acute fulminant (hemorrhagic) pancreatitis, decreasing mortality and affording smoother postoperative course. However, these benefits are gained at the expense of higher incidence of postoperative diabetes.
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PMID:Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. A randomized prospective study. 671 18

The operative management of stress ulcer in children is controversial. Between the years 1969 and 1981, ten children were operated on at the Babies Hospital for stress ulcer. Their illnesses included connective tissue disorders (3), sepsis (2), Reye's syndrome (1), hemolytic uremic syndrome (1), leukemia (1), closed head injury (1), and renal failure (1). In those with bleeding (8), aggressive conventional medical management was attempted prior to operation. Four children also received intravenous cimetidine. Four patients underwent embolization of a feeding artery and/or selective vasopressin infusion. In those patients who perforated (2), operation was performed after a brief period of resuscitation. Ten patients underwent 11 operations. In those who bled, multiple ulcerations were the most common finding. Operative procedures consisted of partial gastrectomy and vagotomy (4), partial gastrectomy alone (2), and vagotomy and pyloroplasty (2). One child who underwent vagotomy and pyloroplasty required partial gastrectomy for recurrent bleeding. Of the two children who perforated, one was managed by plication and the other by partial gastrectomy. There were two deaths (20%), both occurring in patients who had undergone gastrectomy. One survivor has mild dumping. This experience suggests that in children (1) stress ulcers are commonly multiple when associated with major medical illnesses; (2) partial gastrectomy with or without vagotomy affords maximum protection against recurrent bleeding; (3) lesser procedures are effective for solitary bleeding duodenal ulcers or perforation; and (4) selective arterial embolization or vasopressin infusion are unreliable methods for controlling bleeding.
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PMID:Operative management of stress ulcers in children. 709 47

Approximately 1.3% of patients with lymphoma develop obstructive jaundice secondary to lymphomatous involvement of the extrahepatic biliary system. This may occur either as an initial or as a late manifestation of disease. Clinically and radiographically the condition may mimic a variety of more common causes of obstructive jaundice. Surgical exploration may be necessary to confirm the diagnosis, but local radiotherapy would appear to be the preferred mode of treatment. Rapid progression to systemic disease occurs in the majority of patients, necessitating multidrug chemotherapy. Control of jaundice by radiotherapy is good, but long-term prognosis is poor. Supervening sepsis and gastrointestinal bleeding caused the majority of deaths, suggesting that adjunctive nutritional support, immunologic enhancement, and stress ulcer prophylaxis may be necessary if survival is to be improved.
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PMID:The diagnosis and treatment of obstructive jaundice secondary to malignant lymphoma: a problem in multidisciplinary management. 739 35

In our intensive care unit we were able to prevent almost all bleedings from stress ulcerations in patients with insufficiency of various organs (1,6%) by administering the H2-receptor blocker cimetidine in doses of 8 X 200 mg per day. However, stress ulcer bleedings occurred in 14% of those patients also suffering from a sepsis. At lower doses of cimetidine, the rate of bleeding was comparable to that encountered in patients treated with antacids, i.e. 12,5% patients with multiple organ insufficiency and 42,7% with sepsis. Cimetidine was able to stop less extensive bleedings, but did not show any therapeutic effect in case of bleeding which led to a significant fall in hemoglobin concentration.
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PMID:[Prevention and therapy of gastroduodenal stress bleeding with cimetidine]. 741 53

Acute gastroduodenal mucosal lesions are observed following shock, sepsis, trauma, bat also after the ingestion of certain substances (alcohol) and in the course of severe, chronic medical illness. The so-called cushing ulcus should probably be separated from the clinical syndrome of stress ulcer. We must also exclude without any discussion reactivated chronic duodenal or ventricular ulcers with their complications, often manifested after serious trauma or illness. Digestive complaints are absent from the history of illness. The earliest manifest sign is in most cases severe gastrointestinal haemorrhage. It appears that the presence of Hydrogen ions in gastric contents and mucosal ischaemia are required for stress ulcer to develop, in which process damage to the "mucosal barrier" is also instrumental. The basic diagnostics is endoscopy. Angiography is only indicated in patients where endoscopy has failed. Conservative therapy brings haemorrhage under control in most cases. Surgery is indicated only if conservative therapy has proved inadequate to control bleeding or in cases of free perforation. Optimal surgical treatment remains a matter of discussion since no surgical method, except total gastrectomy, can protect the patient from recurrent haemorrhage.
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PMID:["Stress" ulcer - acute ulcerous and erosive lesions in the gastroduodenal mucosa]. 745 49

We developed a biliary and pulmonary microbiologic study in 22 Large-White pigs that underwent bile-duct ligation in order to demonstrate that sepsis has a biliary and pulmonary origin which may be involved in the gatroesophageal pathology. All the pigs died at 18.2 +/- 8.9 days of the post-operative period. The cause of death was hemorrhagic ulceration of the gastroesophageal region in 36.3% (n = 8) of the animals that also presented multiple bilateral miliary lung abscesses. High infestation rates with intestinal germs were found in the bile and lung. In conclusion, the experimental model of extrahepatic cholestasis in the Large-White pig could be useful for the study of etiopathogenic mechanisms by which the pulmonary infection produces a hemorrhagic gastroesophageal ulceration considered as stress ulcer.
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PMID:Hemorrhagic gastroesophageal ulceration by pulmonary infection in extrahepatic cholestatic pigs. 799 68

Enteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube-feeding have made early EN possible. Jejunal tube-feeding has advantages over gastric tube-feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO-donating substances and chewing of nitrate-rich food, such as lettuce or spinach, can be useful. Oral and mucosa-protective lipids are recommended. H2 blockers and saliva-inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such as Pseudomonas. Food antioxidants such as glutathione, vitamin E, and beta-carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so-called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa-reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa-adhering Lactobacillus plantarum 299.
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PMID:Nutritional support to prevent and treat multiple organ failure. 866 38

Clinical studies in critically ill patients suggest an increased rate of septicemia during stress ulcer prophylaxis with H2-blockers when compared with sucralfate, a topically active compound. In the present study we examined the effect of stress ulcer prophylaxis with sucralfate as compared with ranitidine versus untreated animals in a rat model on intestinal flora and on the translocation of bacteria from the intestinal tract. The translocation of bacteria was also determined after induction of hemorrhagic shock and, in addition, we examined bacterial translocation in animals infected with a multiple resistant Escherichia coli and following antibiotic therapy with vancomycin and gentamicin during stress ulcer prophylaxis with and without hemorrhagic shock. Male Wistar rats, which received standard meals either without stress ulcer prophylaxis or with ranitidine/sucralfate were investigated. After induction of hemorrhagic shock we analysed qualitatively and quantitatively the bacterial flora in the gastrointestinal tract, blood, mesenteric lymph nodes and visceral organs (liver, spleen). In the absence of shock no changes of the intestinal flora and no translocation of bacteria from the gut were observed in control animals nor during stress ulcer prophylaxis. However, after induction of hemorrhagic shock there was a pronounced bacterial translocation in control animals and during ranitidine, whereas the translocation rate was reduced in animals treated with sucralfate (p < 0.05). During massive E. coli challenge both without and with shock a significantly higher rate of translocation was found in all three experimental groups there were no significant differences between the three groups. We conclude that a) bacterial translocation is low or absent in healthy animals, b) hemorrhagic shock induces a massive increase in bacterial translocation, c) stress ulcer prophylaxis with sucralfate reduces translocation of bacteria during the shock state and c) during massive bacterial overgrowth and/or concomitant shock none of the treatments can reduce the massively elevated rate of bacterial translocation.
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PMID:Influence of stress ulcer prophylaxis on translocation of bacteria from the intestinal tract in rats. 876 82

In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gonadotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p < 0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p < 0.001). In the patients with stress ulcer, significant increases (p < 0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely head-injured patients. In patients with stress ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.
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PMID:Hypothalamic dysfunction in acute head-injured patients with stress ulcer. 979 99

Patients who survive the circulatory and organ deficits in sepsis may still fall victim to complications such as pulmonary embolism and stress ulcer bleeding. Although there is no clearcut evidence to quantitate the impact of such complications on mortality, the anticipated impact is grave when considering the compromised physiological reserve of these patients. For this reason it is important to institute effective prophylaxis to minimize the impact. In addition, catabolism associated with sepsis likely influences the recovery of patients with sepsis and moreover can compromise the response of the immune system against an infectious insult. Early and adequate nutritional support therefore appears important. There is much controversy and lack of prospective research regarding effect of supportive therapies on outcome in patients with severe sepsis. This research is needed.
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PMID:Other supportive therapies in sepsis. 1130 67


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