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

We consider a proximal loop ileostomy to be an integral part of a pelvic pouch procedure with ileoanal anastomosis. In the absence of controlled studies and considering the reported poor results with high rates of pelvic sepsis when this operation is performed without a proximal defunctionalizing ileostomy, we will continue to routinely use proximal ileostomy in all patients undergoing this procedure. There is a high rate of complications related to loop ileostomy; however, they are not life threatening and do not preclude an excellent long-term result. Dehydration requiring readmission to the hospital occurred in 20 percent of the patients in this series. More sensitive clinical data, such as measurement of urinary electrolyte levels, should be used to identify patients at high risk for this complication. Septic complications were rare after closure of the loop ileostomy, but bowel obstruction was common. Bowel obstruction rarely required operative intervention, but it is possible that changing the method of closure may decrease the rate of obstruction. The use of loop ileostomy to bypass temporarily part of the terminal ileum may have significant metabolic effects that require further study.
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PMID:Complications of loop ileostomy. 379 85

Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.
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PMID:Perinatal and infant mortality in urban slums under I.C.D.S. scheme. 380 6

The therapeutic goals for fluid replacement in 9 patients were studied. Five cases in sepsis, 2 in necrotizing pancreatitis and 2 in fat embolism were treated as dehydration or hypovolemia. Fluid replacement was performed with the view of obtaining the amelioration of circulation and urine output, even if CVP or PCWP had been elevated on admission. The values of CVP and PCWP, renal function and pulmonary function were assessed retrospectively. Out of 9 patients, one died of refractory shock, brain edema due to fat embolism and remaining one after recovery of shock. Out of 6 survivors, 2 showed oliguric renal failure, and 2 nonoliguric renal failure. The volume of administered fluid ranged from 5445 ml/10 hrs to 15820 ml/14 hrs and speeds of fluid administration were 545 ml/hr to 1248 ml/hr. CVP value on admission ranged from 4.0 to 22.0 cmH2O (3.0 to 16.3 mmHg), mean value 14.0 +/- 6.5 cmH2O. Through the course, the highest CVP and PCWP ranged from 12.5 to 26.5 (mean 19.8) mmHg and 14 to 36 (mean 20.9) mmHg, respectively. Out of 9 patients, 8 were suffering from respiratory distress, however, 7 recovered by PEEP except for one refractory shock. High values of CVP or PCWP could be recognized even if in hypovolemic shock and/or septic shock. Maintenance of higher values (18-20 mmHg) in CVP and/or PCWP during fluid resuscitation might be recommended because adequate fluid resuscitation could sustain the renal function, and result in good outcome.
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PMID:[Therapeutic goals for fluid management in profound shock]. 382 15

The recent published literature dealing with urinary tract calculi during pregnancy has been summarized. Our own experience with 17 patients, (0.08% of the deliveries) in a recent 12-year interval has been described. Emphasis must be placed on the safety and limitations of renal ultrasonography. Excretory urography should be performed in patients with urinary infection not responding after 48 hours of antibiotic therapy, with declining renal function, with massive hydronephrosis on renal echography, or with pain and dehydration from vomiting. The timing of postinjection films is critical; a 3-hour film and, if needed, a 6-hour film are recommended. Criteria for intervention (nonoperative or operative) include calculous pyelonephritis, persistent massive hydronephrosis with impairment of renal function, and protracted pain or sepsis.
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PMID:Renal calculi in pregnancy. 389 20

Uterine rupture in the developing world remains a significant problem. 45 cases treated in a rural hospital in Nigeria are discussed in this article. The predisposing factors included cephalopelvic disproportion (62%), grand multiparity (33%), previous cesarean section (24%), placental pathology (15%) and abnormal presentation (20%). The factors associated with maternal death included sepsis (71%), macerated stillborn infant (60%), vulvar edema (50%), prolonged labor (42%), hand presentation (50%) and hysterectomy (37.5%). Hemodynamic resuscitation and prompt surgical intervention remain the mainstays of therapy. Patients ranged from ages 16 to 46, and gravidity ranged from 1 to 11. 38 of the 45 patients had no prenatal care. 8 of the 9 maternal deaths that occurred were among these 38. It is common for patients with uterine rupture to be admitted after uterine contractions have ceased, with profound dehydration and early septic or hemorrhagic shock. In 39 (87%) of the 45 cases, no fetal heart tones were heard on admission. 29 (58%) of the 45 uterine ruptures involved the lower uterine segment exclusively. Surgical procedures performed were hysterectomy in 8 cases and tubal ligations in 4 cases. The distinction between early and obstructed labor, cephalopelvic disproportion in the US, and true obstructed labor, as seen in rural Nigeria, is an important one. There often is a double-hump sign from the ballooning lower uterine segment in cases of long-obstructed labor, for which the patient may have been given an herbal powder. Numerous types of herbal mixtures have shown oxytocic properties and may contribute to the high incidence of uterine rupture. Prenatal care is an important preventive factor. Placental pathology appeared to play an etiologic role in several cases. The decision as to whether surgical repair or hysterectomy is the appropriate treatment is greatly influenced by cultural realities. Among the rural tribes of the Bendel State in Nigeria, fertility and the ability to menstruate are considered essential to a woman's worth within the community and in her family. Repair of a ruptured uterus is associated with lower maternal mortality than is hysterectomy and is therefore the preferred procedure.
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PMID:Uterine rupture in Nigeria. 399 69

The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P less than .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P less than .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P less than .01). The fatality rate in shigella bacteremia (21%) was higher (P less than .005) than in nonbacteremic shigellosis (10%) but lower (P less than .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P less than .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.
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PMID:Shigella septicemia: prevalence, presentation, risk factors, and outcome. 404 31

Two cases of Yersinia enterocolitica septicemia occurred in a breeding group of 22 adult patas monkeys (Erythrocebus patas). Affected animals had acute clinical signs of depression, weakness, dehydration, hypothermia, hepatomegaly and pronounced leukopenia. Both animals died a few hours after treatment was initiated. Gross necropsy findings included jaundice, fluid in body cavities, hepatomegaly, splenomegaly, multiple white foci within the liver and spleen, generalized lymph node enlargement and numerous mucosal ulcerations in the colon. Primary histopathological lesions were multifocal hepatic necrosis, splenic necrosis, chronic ulcerative enteritis and diaphragmatic myositis with necrosis and edema. Yersinia enterocolitica was cultured from the liver, spleen, lung, jejunum and rectum. Wild rodents, particularly mice, may have been a source of infection for these animals, as the monkeys were housed in a rural, indoor-outdoor facility. A preliminary culture survey showed that some clinically normal patas monkeys harbored the organism in their intestinal tracts.
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PMID:Naturally occurring Yersinia enterocolitica septicemia in patas monkeys (Erythrocebus patas). 405 42

Our experience in treating seven patients with severe crush injury of the lower limbs is described. They were brought to hospital 12 h after rescue and had no treatment until then. All seven developed acute renal failure due to myoglobinuria and dehydration. Five were anuric and three non-oliguric. All developed severe sepsis and two had also acute respiratory failure. No bleeding tendency was observed. They were treated along the following lines: early extensive fasciotomy and removal of dead tissues; early fluid challenge; early peritoneal dialysis and/or hemodialysis; high caloric, high protein nutrition; vigorous antibiotic therapy when infection was evident. There were no deaths in our patients. Our management and results are discussed and compared with those in the literature.
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PMID:Management of crush syndrome. 609 Dec 2

A male infant had severe muscular hypotonia from birth. Recurrent vomiting with dehydration and severe metabolic acidosis complicated the course. Elevated lactate (up to 12.3 mmol/l; n less than 2), pyruvate (0.4 mmol/l; n less than 0.05) and alanine levels were found in serum with an abnormal lactate/pyruvate ratio (greater than 30; n less than 15). In urine the concentrations of lactate, pyruvate, alanine and of several intermediates of the citric acid cycle were increased. In muscle, numerous disseminated "ragged red fibres" were found by light microscopy; muscle fibres were found to contain subsarcolemmal aggregates of mitochondria, lipid droplets and glycogen by electromicroscopical methods. Moreover, mitochondria with a typical circular arrangement of cristae were noticed. In liver homogenates normal activities of pyruvate carboxylase and pyruvate dehydrogenase complex were found; in liver mitochondria also succinate-cytochrome-c-oxidoreductase activity was normal. However, in muscle no succinate-cytochrome-c-oxidoreductase activity was detectable. The patient became increasingly lethargic and died because of sepsis at 5 months of age.
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PMID:Mitochondrial myopathy with lactic acidosis and deficient activity of muscle succinate cytochrome-c-oxidoreductase. 609 51

A review of the clinical course of gastroenteritis in 274 hospitalized children revealed a severe form of the disease. Eight-eight per cent were aged 12 months or under and 20% had severe associated malnutrition. The commonest clinical manifestations were diarrhoea (100%), dehydration (98.9%), vomiting (81.4%) and fever (77.7%). Pathogens were isolated from 75.2% of cases (rotavirus 24.5%, Escherichia coli 20.8%, salmonellae 20%, shigellae 6.2%, campylobacter 2.2% and Yersinia enterocolitica in 1.5%). Septicaemia was confirmed in 12 patients (4.4%) and strong clinical evidence of septicaemia was present in 36 more cases (13%). Dehydration was isonatraemic in 68%, hyponatraemic in 21% and hypernatraemic in 11% of cases. There was a clear association between septicaemia and hyponatraemia. The overall mortality rate was 1.8%. Data from our study show that the use of intravenous hyperalimentation, and/or antibiotics in the management of gastroenteritis in selected patients, can significantly reduce morbidity and mortality.
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PMID:Gastroenteritis in a regional hospital in Kuwait: some aspects of the disease. 619 27


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