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

Thirty patients underwent a defunctioning loop ileostomy. Elective ileostomy was performed in 23 patients to protect a potentially vulnerable colorectal anastomosis and in one patient as a permanent faecal diversion for colonic atony. Six emergency loop ileostomies were performed; in four patients after colonic perforations and in two patients as a primary treatment secondary to colonic anastomotic leakage. Peri-operatively, none of the patients with an elective operation died. Four patients with an emergency operation, however, all died of irreversible peritoneal sepsis. Complications were a diversion colitis and an abdominal sepsis after anastomotic leakage in a second patient who required a re-operation. During follow-up (up to four years) one patient suffered from an episode of severe dehydration six months after operation. The ileal continuity was, without mortality, restored in 23 patients. Two patients had a wound infection with, in one of them, a late cicatricial hernia. In our experience, a defunctioning loop ileostomy is a relatively safe procedure and is, in our opinion, preferable to loop colostomy for temporary faecal diversion. The high mortality following emergency loop ileostomy reflects the bad prognosis of these patients and indicates the need for resection of the primary disease.
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PMID:A future role for loop ileostomy in colorectal surgery? 178 8

In order to evaluate the prescription practices on gentamicin, we screened retrospectively the case records of 600 patients admitted to this hospital. Of these, 100 received gentamicin, in combination with other antibiotics, as the initial treatment. Therapy with gentamicin was considered to be indicated in 71 cases; 62% were below 1 year. Patients with neonatal septicemia, meningitis, serious staphylococcal infections and those who were immunocompromised received appropriate treatment with the drug. All the bacteria cultured were sensitive to the antibiotic. Gentamicin was unnecessarily prescribed to 29 cases including bronchial asthma (n = 7), bronchiolitis (n = 6) and acute gastroenteritis with dehydration (n = 8). In most of the latter cases, the use of gentamicin indicated the psychologic dependence, of the physician, on the drug. Nine patients showed gentamicin-related nephrotoxicity. Formulation of standard treatment guidelines and regular medical audits are necessary to improve quality of prescribing and avoid misuse of drugs.
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PMID:Gentamicin therapy: medical audit. 145 13

Ultrasonography (US) has recently been considered in nephrology as the imaging method of choice in the differential diagnosis of acute renal failure (ARF). A dilated renal collecting system is the hallmark of obstructive nephropathy (ON). We report 4 cases of ARF due to ON in which US detected no dilatation of collecting system. Similar data were obtained by computer tomography (TC). The normal size and structure of the kidneys and the clinical suspicion prompted us to perform retrograde pyelography which revealed ON. Ureteral catheterization determined a marked improvement of renal function in all the patients (pts). 2 pts were one kidney, 3 pts had renal stones, in 2 pts dehydration and sepsis were present. We conclude that ON has not ever been excluded on the criterion of absence of dilated urinary tract from US and TC.
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PMID:[Ultrasonography in the diagnosis of acute obstructive renal insufficiency: a cautionary note]. 183 48

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Recognition and prevention of barium enema complications. 188 35

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

Clinical and experimental studies on the development of myoglobinuria-associated acute renal failure (ARF) were reviewed. ARF developed in 30% of the cases of rhabdomyolysis. Rhabdomyolysis-associated ARF accounted for 5-10% of all ARF. The presence of dehydration or hypotension at the presentation of rhabdomyolysis seems to be a risk factor in the development of rhabdomyolysis-associated ARF. ARF occurred more frequently in the rhabdomyolysis caused by sepsis or burns. Glycerol-induced ARF in rats or rabbits has been studied to investigate the pathogenesis of myoglobinuria-associated ARF. The early decrease in inulin clearance (Cin) in glycerol-induced ARF was dependent upon the decrease in renal blood flow, but the decrease in Cin in the late phase could not be attributed to the decrease in renal blood flow. Diminished glomerular permeability and cast formation might play important roles in the decrease in Cin in the late phase of glycerol-induced ARF.
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PMID:[Myoglobinuria and acute renal failure]. 204 Dec 8

Complications that can lead to death during shigellosis include intestinal as well as systemic manifestations. The former include intestinal perforation, toxic megacolon, and dehydration, and the latter include sepsis, hyponatremia, hypoglycemia, seizures and encephalopathy, hemolyticuremic syndrome, pneumonia, and malnutrition. Data on the frequency of these complications come primarily from hospital-based studies, in which sepsis-either with Shigella or with other Enterobacteriaceae-and hypoglycemia are the most common causes of death. Management of these two complications requires broad-spectrum empiric antibiotic treatment of all severely ill, malnourished patients with shigellosis as well as frequent feedings to prevent hypoglycemia. Unfortunately, in developing countries, access to parenteral broad-spectrum antimicrobial agents is often limited, and frequent feedings are often precluded by the severe anorexia that is characteristic of shigellosis. Realistic approaches to the reduction of mortality from shigellosis must continue to focus on prevention and early antimicrobial therapy rather than on treatment of established complications.
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PMID:Potentially lethal complications of shigellosis. 204 57

Oral complications of cancer therapy often have systemic consequences. Pain and discomfort are common and can lower intake of fluid and nutrients, which in severe cases can lead to dehydration and malnutrition, requiring hospitalization. Oral infections are frequent accompaniments of cancer treatment. Herpes simplex virus is the most common symptomatic oral viral infection, and, in latently infected patients the virus is frequently reactivated after cytoreductive therapy. Viral (infectious) oral mucositis is often indistinguishable from noninfectious mucositis. Bacterial infections are less commonly observed today, perhaps because of the routine use of empiric broad-spectrum antibiotics; however, many episodes of septicemia in neutropenic patients apparently originate from oral microorganisms. Fungal infections are frequent and are usually due to Candida species. Spread to the esophagus or systemic dissemination can occur. Noninfectious oral mucositis can be used as a marker of toxic effects in other organs, especially hepatic veno-occlusive disease. In bone marrow transplant patients with mucositis, hepatic veno-occlusive disease is six times more frequent than in such patients without mucositis.
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PMID:Oral complications of cancer therapies. Infectious and noninfectious systemic consequences. 218 56

This article has provided an overview of the effects of HIV on renal function. Most transmission of the virus occurs by sexual, blood, and perinatal contact. CD-4 positive cells, especially those that are integral components of the immune system, serve as the reservoir for the reproduction of the virus. The resulting effect is destruction of the immune system with eventual multisystem failure and death. Renal complications arise from several factors, notably the compounding effects of chronic dehydration, malnutrition, infection, and use of nephrotic agents. Acute renal complication can be reversible with prompt assessment, and management directed at maintaining hydration, preventing sepsis, and carefully monitoring drugs. A chronic, irreversible renal disease in HIV is due, in large part, to a syndrome known as AIDS nephropathy, characterized by glomerular sclerosis and nephrotic-type symptoms, which ultimately lead to the need for dialysis. Aids nephropathy is seen most often in intravenous drug users, Haitians, and blacks with HIV. End-stage disease complicates the course of HIV and contributes to early mortality. A small, but significant number of renal patients acquires HIV infection as a result of multiple blood transfusions or through organ donation. Concentrated exposure to blood and body fluid during dialysis necessitates implementation of meticulous infection control procedures to protect both staff and patients. Guidelines by the CDC suggest that universal precautions adequate to prevent the spread of hepatitis B will suffice for HIV as well. HIV infection presents special challenges for those involved with renal management. Prevention and management of renal complication are made possible by thorough understanding of the complex network and interaction of the disease process.
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PMID:Renal system complications in HIV infection. 219 22

We describe six infants, from consanguineous marriages, with a new syndrome comprising the Fanconi syndrome, ichthyosis, musculoskeletal abnormalities, jaundice and diarrhoea. In addition two of the infants were found to have abnormal platelet morphology--the grey platelet syndrome. No evidence of a recognised metabolic disorder was found in any of the six infants, nor did they appear to be typical of any previously described syndromes. Their progress was poor: they required high fluid and bicarbonate intakes and all died by the age of 6 months of dehydration, acidosis and sepsis.
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PMID:Fanconi syndrome, ichthyosis, dysmorphism, jaundice and diarrhoea--a new syndrome. 220 96


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