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

Endoscopic stapling diverticulostomy (ESD) using an endostapler is a modification of the standard endoscopic treatment of Zenker's diverticulum (ZD). It is characterized by complete myotomy of the upper esophageal sphincter, with division of the common wall between diverticulum and esophagus, followed by immediate simultaneous closure of the divided edges with the staples. ESD was performed on 21 patients with ZD between January 1996 and October 1997. The results were then evaluated. Operation time averaged 22 min. Wide opening of the diverticulum and excellent hemostasis were achieved. All of the patients but one, who died postoperatively of myocardial infarction, resumed oral intake without any evidence of cervical sepsis or mediastinitis. Complete relief of dysphagia was achieved in all 20 patients. Hospital stay averaged 4.7 days (range, 2-7 days). The patients were followed up after ESD for a median time period of 12 months. No relapses were recorded. ESD is an effective endoscopic treatment for ZD that entails a low risk of complications and requires only a short period of hospitalization.
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PMID:Endoscopic stapling diverticulostomy for Zenker's diverticulum. 1022 61

There are three clinical presentations of anthrax in humans: cutaneous (>95% of cases), orogastric and inhalational. The infectious form, the spore, enters the body and is thought to germinate within macrophages either at the site of inoculation (cutaneous or orogastric) or in the regional lymph node (inhalational). The bacillus then synthesizes its antiphagocytic capsule and the lethal and oedema toxins which interfere with the non-specific host defences leading to the characteristic locally destructive lesion and spread by lymphatics to the systemic circulation and other organs. The cutaneous form begins as a papule which progresses over several days to a vesicle and then ulcerates. There is often oedema, sometimes massive, probably due to the oedema toxin that surrounds the lesions which then develop a characteristic black eschar. The patient may be febrile with mild to severe systemic symptoms of malaise, headache and toxicity. Oropharyngeal anthrax presents with severe sore throat or an ulcer in the oropharyngeal cavity associated with neck swelling, fever, toxicity and dysphagia. Gastrointestinal anthrax begins with anorexia, nausea, vomiting and abdominal pain which may be similar to an acute abdomen. There may be diarrhoea and ascites, both of which may be haemorrhagic. Inhalational anthrax begins with non-specific symptoms of malaise, fever, myalgia and non-productive cough. After a period of 2-3 days, this is followed by a sudden onset of severe respiratory distress associated with diaphoresis, cyanosis and increased chest pain. There may be a widened mediastinum and pleural effusions on chest X-ray. Death follows in 24-36 h from respiratory failure, sepsis and shock. The diagnosis of anthrax is easy if it is considered. The organism is readily observed by Gram or Wright stain in local lesions or blood smear and can be easily cultured from the blood and other body fluids. However, because of its rarity, it is not often included in the differential diagnosis and in inhalational disease the diagnosis is rarely made until the patient is moribund. More rapid diagnostic tests are under development. Penicillin, combined with supportive care, remains the mainstay of treatment, although the organism is susceptible in vitro to many antibiotics. In recent years, there have been significant advances in our knowledge of the organism and its toxins and it is anticipated that similar progress will be made in the future in developing more rapid diagnostic tests and new modalities of treatment.
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PMID:Clinical aspects, diagnosis and treatment of anthrax 1047 74

Patients with advanced esophageal cancer may require intubation with a stent to relieve debilitating dysphagia. However, if these patients also undergo radiation therapy, they may incur esophageal injury, thus increasing the risk of perforation after placement of the stent. Herein we report the case of a 71-year-old man who received such combination therapy and died of severe sepsis 65 days after the stent was inserted. An autopsy revealed that the stent had perforated into the mediastinal pleura and that an abscess had developed around the perforation. We conclude that caution should be taken before combining radiation therapy with the use of a stent.
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PMID:Esophageal perforation and mediastinal abscess following placement of a covered self-expanding metallic stent and radiation therapy in a cancer patient. 1052 46

A retropharyngeal abscess is a potentially fatal deep neck infection. Classical symptoms include fever, neck swelling, sore throat, dysphagia, and cervical rigidity. Sometimes small children present with nonspecific symptoms. We report a rare case whereby the Ga-67 citrate scan was the first investigation to reveal an inflammatory process in the retropharyngeal or submastoid region of a 3-year-old child with sepsis. This directed the line of investigation to a more precise anatomic imaging modality, CT scanning, to localize the abscess. With prompt administration of intravenous antibiotics, the child recovered quickly and did not require surgery. The Ga-67 scan is thus a useful screening test to detect inflammatory foci because of its high sensitivity. It is also valuable in the follow-up of the patient's response to therapy.
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PMID:Retropharyngeal abscess on a Ga-67 scan: a case report. 1059 73

Between January 1988 and December 1997 a total of 22 patients (age: 8 days-46 years) were operated for vascular airway compression syndromes with respiratory insufficiency. Vascular anomalies in tracheal compression were double aortic arch in 7 patients, (2 previously operated elsewhere), right aortic arch + left ligamentum arteriosum in 1, and pulmonary artery sling in 3. Three of these patients had secondary long-segment tracheomalacia. Compression of trachea and a main bronchus existed in 2 patients with right aortic arch + left ligamentum. Isolated main bronchus obstruction was present in 9 patients (abnormal insertion of ligamentum arteriosum in 1, status post (s.p.) previous operation for PDA in 4, s. p. surgery for coarctation in 1, right aortic arch + left ligamentum arteriosum in 2, and right lung aplasia + left ligamentum in 1). 3 of these cases had secondary long-segment bronchomalacia. All patients had a complex respiratory anamnesis [long-term intubation in 7, s.p. tracheostomy in 2 (over 3 months - 3 years), and progressive respiratory insufficiency in 13). In tracheal compression, surgical correction included transsection of the underlying ring or sling components (with additional anterior aortic arch translocation in 5 patients resection-reimplantation of left pulmonary artery in 3, segmental tracheal resection in 1, and external tracheal suspension in 2). In the 2 cases with compression of the trachea and a main bronchus, aortic "extension" by a prosthetic tube was necessary. In isolated main bronchus obstruction, surgical decompression basically consisted of transsection of the ligamentum arteriosum or resection of its scarry remnant forming the "corner point" of a compression between aorta and pulmonary artery. In 3 patients with secondary long-segment malacia, additional external bronchus suspension was performed. Effective decompression and re-expansion of the airway segment concerned was achieved, and was demonstrated by intraoperative endoscopy in all patients. There were 3 postoperative deaths (sepsis 2; massive, irreversible edema of the tracheal mucosa 1). Of the 19 surviving patients 16 could be extubated between the 1st and 17th (mean = 7.5) postoperative day. In 1 case the preoperative long-term tracheostomy had to be left in place for inoperable additional laryngeal stricture. 2 patients had to be reoperated (segmental cervical tracheal resection after 5 months for primary long-term intubation-related subglottic stenosis in 1, esophageal decompression for residual dysphagia after 57 months related to a traction phenomenon at the right descending aorta in the other), both with gratifying results. In all other patients clinical, endoscopic, and radiographic examinations (follow-up = 2 months - 6 years) demonstrate good results.
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PMID:Vascular tracheobronchial compression syndromes-- experience in surgical treatment and literature review. 1090 65

The management of patients with iatrogenic perforation of esophageal cancers is controversial. We reviewed the management of perforated esophageal malignancies at a single institution with a large volume of patients with esophageal cancer. Cases of iatrogenic perforation of the esophagus occurring during a 3-year period were identified from the hospital endoscopy database. Inpatient and outpatient records were reviewed, and subjects were visited to obtain follow-up information. Perforation was suspected after 10 of 492 endoscopic dilatation procedures done in patients with obstructing esophageal malignancies. All patients were diagnosed immediately. One patient with pneumomediastinum and pneumoperitoneum died 7 days after laparotomy. Nine patients with pneumomediastinum were managed endoscopically with delayed (n=1) or immediate (n=8) placement of a self-expanding metal stent. Patients were treated in the hospital for an average of 5.4 days. No patients developed clinical signs of sepsis, and all were discharged tolerating a soft diet. Follow-up data were obtained for seven of nine discharged patients (range 152 to 263 days). None developed signs or symptoms of infection or recurrent dysphagia. Immediate placement of a coated self-expanding metal stent is an effective treatment for iatrogenic perforation of an obstructing esophageal malignancy.
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PMID:Expandable stents for iatrogenic perforation of esophageal malignancies. 1312 45

We report 1 case of esophageal complications after anterior plate fixation of the cervical spine. A 62-year-old man underwent anterior cervical fusion in August 1996, and he did well after the operation. In January 1998, he was hospitalized for cardiac failure and was incubated twice for 10 days to cure. In March 1998, he suffered from dysphagia and continuous fever. Gastric fiberscopy showed the internal defect of esophagus and the plate to fix the cervical spine. He underwent immediate neck exploration via the cervical fusion incision, however he died of sepsis and respiratory failure. An esophageal perforation after an anterior cervical operation is an uncommon but well-recognized complication of the approach.
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PMID:[Esophageal perforation after an anterior cervical fixation; report of a case]. 1367 31

Five cases are presented of patients who were diagnosed with necrotizing fasciitis secondary to (1) hip disarticulation (in a paraplegic patient); (2) tooth abscess with extensive neck dissection, complicated by sepsis and hypotension with resultant dysphagia and ischemic encephalopathy; (3) below-knee amputation, anoxia, and severe debility; (4) emergent above-knee amputation; and (5) percutaneous endoscopic gastrostomy placement. The latter patient developed abdominal and chest wall necrotizing fasciitis that required skin grafting. Four patients were treated in an acute rehabilitation setting and returned home, and the fifth was rehabilitated in a subacute facility. This report emphasizes the importance of carefully monitoring rehabilitation patients, especially those with impaired sensation.
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PMID:Streptococcal infection and necrotizing fasciitis--implications for rehabilitation: a report of 5 cases and review of the literature. 1524 75

We report a case of esophageal perforation by impacted portions of a wild boar. The 77-year-old patient was admitted 5 days after an opulent dinner. He complained of dysphagia and retrosternal pain and showed signs of severe sepsis. Endoscopy revealed meat and bone portions impacted in the esophagus. Surprisingly, impactation had not happened near any of the anatomical narrowings, but in the middle third. A CT scan showed penetration of the foreign body into the mediastinum and purulent mediastinitis. The patient underwent transthoracic esophagectomy and drainage of the severe, purulent mediastinal infection. Postoperative multi organ failure required a prolonged treatment in the intensive care unit. After recovery the gastrointestinal continuity was restored with gastric pull-up in the anterior mediastinum. The further course was uneventful.
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PMID:[Esophageal perforation by portions of a wild boar]. 1535 55

The case of a 34-year-old otherwise healthy woman with retropharyngeal abscess due to a fishbone injury and presenting with neck stiffness and aphagia without visualization of a pharyngeal mucosal lesion is reported. The case illustrates that sore throat with symptoms out of proportion to oropharyngeal findings should prompt a search for pathologies other than simple pharyngotonsillitis. Other typical symptoms of a retropharyngeal abscess are high fever, dysphagia, hot potato voice and, less commonly, dyspnea and sepsis. Retropharyngeal abscess in adults occurs most often as a complication of a spread of infection from a pharyngeal focus, a foreign body injury, an iatrogenic trauma due to tracheal intubation or endoscopy, and blunt or perforating neck trauma. Contrary to children, a retropharyngeal abscess in adults without loco-regional infection or preceding trauma is very rare. This case illustrates how important imaging investigations (CT-scan) are in order to locate foreign bodies and to decide on surgical management. Aetiology, presenting signs, symptoms, methods of diagnosis, treatment and complications of a retropharyngeal abscess are briefly discussed.
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PMID:[Uncommon position of a retropharyngeal impacted fishbone]. 1561 6


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