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

Nine patients with implanted pacemakers had the diagnosis of septicaemia to endocarditis. The diagnosis was established on the basis of a repeatedly positive haemoculture. The interval since the first pacemaker implantation to the onset of sepsis to endocarditis was about 5 years. All nine patients had previous reoperation either of the pacemaker or its lead due to decubitus. While, in four patients, the route of infection was a pacemaker lead in its extravascular couse, in 5 patients the source of infection was a lead placed right in the venous system. All patients were treated with ATB according to the antibioticogram. 4 patients had the pacemaker lead extracted. In the remaining five, the pacemaker lead was removed by catheterization. All patients recovered. There is only one way of eliminating infection that caused the sepsis, that is, to remove the foreign body present in the patient - the pacemaker leas in this particular case.
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PMID:Septic complications in patients with permanent pacemakers. 306 27

A 72-year-old widowed woman known to have an organic brain syndrome was hospitalised owing to gangrene of her lower limbs. The gangrene had been caused by an adduction contracture of her hip resulting in pressure on the medial surface of her left leg. In addition she had pressure sores over both trochanters and the sacrum. The smell of putrefication could be sensed from a distance and on examination large white worms could be seen slithering in the decomposing tissue. The patient was pyrexial, oblivious of her surroundings, and without pain. Surgery--limb amputations--would not restore the patient to a cognitive state nor improve here quality of life, but abstinence posed an inherent threat of sepsis, and revulsion to the attendants. The sacral pressure sore was so large that surgical closure was impossible. The question of surgical intervention is discussed.
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PMID:For whom the bells knell. 318 34

The etiology, pathophysiology, clinical presentation, prevention, management, and complications of pressure sores are reviewed. Three specific patient populations are at high risk of developing pressure sores: spinal-cord-injury, geriatric long-term-care, and orthopedic patients. Pressure sores usually develop at bony prominences on the body as a result of four etiologic elements: pressure, shearing forces, friction, and moisture. Excessive pressure causes poor tissue perfusion, which is normally compensated for by shifts in body position. However, in these patient populations, various abnormalities prevent patients from recognizing or compensating for this pressure. Once a lesion forms, it may progress through four stages marked by worsening necrosis, infection, and tissue loss. The best treatment of pressure sores is prevention. Various mechanical devices may assist the patient in decreasing or distributing pressure, but quality nursing care is essential for debilitated or disabled patients. If a pressure sore develops, treatment should focus on (1) eliminating local pressure, (2) cleaning and removing necrotic tissue, (3) creating a tissue-growth environment, and (4) treating factors that retard wound healing. Drug therapy includes agents for chemical cleansing and debridement of pressure sores and systemic antibiotics for complications such as septicemia or osteomyelitis. Despite efforts to improve treatment of pressure sores, prevention remains the best treatment.
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PMID:Current concepts in clinical therapeutics: pressure sores. 352 29

We report our experience with 5 cases of renal transplantation into ileal conduits and review the literature. In 2 cases a modified surgical procedure was used, which combines a groin extraperitoneal approach for the vascular portion of the operation and a peritoneal window for the anastomosis between the urinary collecting system and the ileal loop. Of our 5 patients 3 are alive with functioning grafts, 1 has undergone retransplantation and 1 with a functioning kidney died of sepsis originating in a decubitus ulcer. Two patients had conduit-related complications. In our literature review of 16 reports 52 per cent of 68 patients were alive with functioning grafts and 32 per cent had conduit-related complications, usually involving urosepsis, calculous disease or stenosis. With a high index of suspicion, and an aggressive diagnostic and therapeutic approach to these problems, a good prognosis can be expected when transplantation is performed in these patients.
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PMID:Renal transplantation using ileal conduits in 5 cases. 388 46

Reproductive care of women with spinal cord damage demands knowledge of such women's reproductive potential and the specific complications to which these women are prone during pregnancy and childbirth, especially autonomic hyperreflexia. Fertility in cord-damaged women of reproductive age is generally undiminished as are libido, ability to have intercourse, and ability to bear children. Frequent complications of cord-damaged pregnant women include urinary tract infection, anemia, pressure sores, sepsis, unattended birth, and autonomic hyperreflexia. Autonomic hyperreflexia or autonomic dysreflexia occurs during labor in up to two thirds of women with cord lesions above T-6. Autonomic hyperreflexia results from noxious stimuli including distention of the bladder, cervix, or rectum, which evokes mass triggering of sympathetic and parasympathetic afferents that are uninhibited by supraspinal centers below the cord lesion. Autonomic hyperreflexia manifests itself with sudden onset of marked hypertension and headache during uterine contractions, as well as bradycardia or tachycardia, various cardiac dysrhythmias, and marked diaphoresis with piloerection and flushing above the level of the cord lesion. We describe the second reported occurrence of intraventricular hemorrhage due to autonomic hyperreflexia during labor and detail recommendations for anticipating and mitigating this potentially lethal complication of parturition in cord-damaged women. Pregnancy and parturition are best carried out with informed cooperation of the patient and of obstetric, cord rehabilitation, anesthetic, and nursing personnel.
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PMID:Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor. 397 Jan 1

In the present study we report the renal pathological findings from autopsy material along with relevant clinical data on 21 spinal cord injury patients with end-stage renal disease (SCI-ESRD) treated with maintenance haemodialysis. These data are compared with the relevant clinical and post-mortem findings on 43 ambulatory dialysis patients who expired during the same time period. The SCI-ESRD patients exhibited markedly different clinical and renal histopathological data when compared to the ambulatory--ESRD group. Chronic pyelonephritis and amyloidosis dominated the findings and were the major causes of renal insufficiency. Acute pyelonephritis, papillary necrosis, calculous disease, pyonephrosis and perinephric abscess formation were also more frequently present in the SCI-ESRD patients. Hypertension and nephrosclerosis, which were common findings in the ambulatory--ESRD patients were comparatively rare in the SCI-ESRD patients. In addition, the incidence of acquired cystic disease (ACD) was considerably less in the SCI-ESRD group. Although the reasons for these findings are not entirely clear several possible explanations are given. Infection with gram negative sepsis was the predominant cause of death in the SCI-ESRD patients, while death secondary to cardiovascular disease predominated in the ambulatory-ESRD group. Furthermore, the urinary tract and infected decubitus ulcers were determined to be the major source for sepsis in the SCI patients. From these findings it would follow that more effective prevention and control of these infections would result in not only a lower incidence of renal failure but also a substantially reduced morbidity and mortality in chronic SCI.
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PMID:Renal pathology in end-stage renal disease associated with paraplegia. 671 46

The approach to management of decubitus ulcers is challenging and complex. Management should be targeted to prevention. Many factors will influence the development of ulcers and their healing. These factors include physiologic as well as sociologic elements. The physician's approach must be to consider all potential contributing factors and to translate these into an appropriate program of prevention and education and treatment where necessary. The treatment program should be based on physiologic principles, but should also take into account the full patient and his psycho-social emotional needs. Patient cooperation is very important. With good medical care and full cooperation of the patient, management can achieve a healed wound and a restored patient. If either of these elements are not present, the complications may include chronic local infection with abscess formation, osteomyelitis, sepsis, amyloidosis, and death.
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PMID:Decubitus ulcers and rehabilitation medicine. 675 59

The available data were examined from 43 patients with spinal cord injuries and end-stage renal disease undergoing dialysis. All but one patient had a chronic urinary tract infection, which was characterized by persistence of the same organisms for prolonged periods, high prevalence of mixed infections, scarcity of symptoms, lack of fever of leukocytosis, and a considerable prevalence of cross-infection with the decubitus ulcers. Staphylococcus aureus and various Gram-negative organisms were responsible for most of the vascular access infections in our patients. Decubitus ulcers were common and were frequently infected. Cross-contamination between infected decubitus ulcers, the urinary tract, and vascular access seemed to have occurred on several occasions. The recorded respiratory infections were preponderantly caused by Gram-negative organisms. Urinary tract, vascular access, and decubitus infections seemed to be the source of septicemia in most of the recorded instances. Septicemia was the immediate cause of death in half of the patients.
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PMID:Bacterial infections in patients with chronic renal failure: occurrence with spinal cord injury. 709 42

Bacteraemia is a common disorder in the elderly, and its prevalence and incidence increase with age. It carries a mortality rate of 20 to 40%. The signs and symptoms of bacteraemia are often blunted or nonspecific in the elderly, and the index of suspicion should therefore be high. Comparing underlying disorders of bacteraemia between older and younger patients, the percentage of past cerebrovascular accidents, dementia and decubitus ulcer increases sharply with age, while the percentage of neutropenia is lower. Elderly patients have a predilection for anaerobic bloodstream infections, and for multiresistant bacteria, although age is not an independent risk factor for resistance. Bacterial endocarditis in the old is caused mainly by gut bacteria. Appropriate empirical antibiotic treatment reduces mortality, regardless of age. To target antibiotic treatment, the physician should consider the patient's salient features, and the overall susceptibility of the micro-organisms in the local ecosystem. The most important supportive measure for treatment of sepsis or septic shock is fluid repletion. No non-antibiotic drug has been shown to be effective in sepsis.
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PMID:Bacteraemia in the very old. Features and treatment. 766 65

Intractable decubitus ulcers and femoropelvic osteomyelitis are rare sequelae of paraplegia. Therapy for these conditions ranges from the simple to the complex, including wound debridement and care, alimentary and urinary tract diversion, hip disarticulation, and myofasciocutaneous rotational flaps. Should the condition be recalcitrant to these modalities the only curative therapy is hemicorporectomy. A 28-year-old rendered paraplegic 3 years ago presented manifesting sepsis; marasmus; hip and knee flexion contractures; suppurative sacral and femoropelvic decubitus ulcers, exposed bone, and osteomyelitis; and fecal and urinary incontinence. Pre-operative nutritional supplementation, wound debridement and care, and psychological counselling were provided. Hemicorporectomy was performed, including colostomy, ureteroileal conduit, gastrostomy, and translumbar amputation. Several anatomical, physiological, and operative-technical perspectives are emphasized: a two-staged approach may be preferable--at the first setting an intra-peritoneal exploratory celiotomy with alimentary and urinary tract diversion; and at the second setting an extra-peritoneal hemicorporectomy; preservation of abdominal wall musculature and fasciae to facilitate wound closure; sequential and bilateral ligation of the arteriae et venae iliaca communis; translumbar amputation between the fourth and fifth lumbar vertebrae; extirpation of the fourth lumbar processus spinosus vertebrarum; closure of the dura mater and translation of musculi sacrospinalis into the vertebral canal; avoidance of hypervolemia and hyperthermia; avoidance of wound pressure; testosterone replacement therapy for eunuchism; and physical and occupational rehabilitation including adaptation to a customized bucket prosthesis.
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PMID:Hemicorporectomy. 771 21


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