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

Sera from 37 Nigerian men with Kaposi's sarcoma were examined for evidence of infection with human T-cell lymphotropic virus type III (HTLV-III), cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B virus (HBV), hepatitis A virus (HAV), and Candida albicans. For comparison purposes, sera from 30 patients with primary cell liver carcinoma and 150 health young adults were also assessed. The Kaposi's sarcoma patients were in poor general condition, with severe anemia and gross sepsis. In each case, cutaneous disease affected only the limbs-- a finding that is in contrast with the visceral organ involvement seen in most black African victims. The serologic testing provided clear evidence that tropical African Kaposi's sarcoma is not associated with HTLV-III infection; non of the 217 serum samples analyzed from the 3 study groups showed antibodies to this virus. A widespread pattern among the Kaposi's sarcoma and liver carcinoma patients was depression of peripheral blood monocyte chemotaxis and a diminished, delayed-type hypersensitivity reaction to tuberculin. All patients in these 2 groups demonstrated circulating antibodies to CMV, EBV, HBV, AND HAV. Candida albicans was isolated from 30 of the 37 Kaposi's sarcoma patients and all 30 liver carcinoma patients compared with none of the health controls. These findings suggest that endemic tropical African Kaposi's sarcoma is a different disease than the epidemic AIDS-linked Kaposi's sarcoma reported from the US, and it is probable that different etiologic agents are involved in each case.
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PMID:Kaposi's sarcoma and HTLV-III: a study in Nigerian adult males. 302 63

Since sepsis places increased demands on the host for energy and on other substrates for tissue repair and host defense, hepatic gluconeogenesis is critical for the host's adaptation to sepsis. Substrate-stimulated gluconeogenesis (i.e., gluconeogenic capacity) was assessed by the alanine load method in mannoheptulose-pretreated rats made septic by cecal ligation after laparotomy, as well as by cecal ligation and puncture after laparotomy. Fasted rats subjected to laparotomy only (sham-ligated) and fasted, nonoperated rats (controls) were investigated simultaneously. Following an overnight (-18 to 0 hr) fast, nonoperated animals converted 17.9 +/- 1.5% of [14C]alanine to [14C]glucose. Continued fasting in nonoperated animals resulted in enhanced (P less than 0.05) gluconeogenic capacity (6 hr = 27.2 +/- 3.0%; 24 hr = 26.2 +/- 1.9%; and 48 hr = 28.5 +/- 2.6%) relative to Time 0. Laparotomy alone (sham ligation) delayed the fasting-induced increase (P less than 0.05) in gluconeogenesis capacity (6 hr = 21.1 +/- 1.2%; 24 hr = 18.5 +/- 1.3%; 48 hr = 27.8 +/- 1.0%) relative to Time 0. In contrast, postoperative sepsis produced a sustained depression (P less than 0.05) of gluconeogenic capacity relative to nonoperated sham-ligated controls at 48 hr (cecal ligation, 18.4 +/- 1.4%; and cecal ligation and puncture, 18.8 +/- 1.2%). Thus, (1) fasting enhances hepatic gluconeogenic capacity; (2) surgical trauma transiently blunts the gluconeogenic response to fasting; and (3) sepsis undermines the gluconeogenic response to fasting.
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PMID:Effect of bacterial sepsis on gluconeogenic capacity in the rat. 304 7

Little is known of the endorphins' role in sepsis-induced respiratory distress and naloxone's effect as a treatment of it. Thirteen piglets were infused with live Escherichia coli at a rate of 2 to 10 X 10(8) colony-forming units per hour for six hours or until death and were divided into two groups: the septic control group (n = 8), and the naloxone-treated group (n = 5), which received 8 mg/kg/h of naloxone by continuous infusion. Hemodynamic parameters, the intrapulmonary shunt fraction (QS/QT), physiologic dead space (VD/VT), minute ventilation, and blood gas levels were measured. Lung lymph flow was obtained by cannulating the right lymphatic duct. The extravascular lung water weight was also measured. The results showed a significant reduction of QS/QT, VD/VT, and arterial carbon dioxide pressure at one hour and a significant increase of arterial carbon dioxide pressure and minute ventilation at 1, 3, and 4 hours in the naloxone-treated group, compared with the untreated septic group. None of the piglets in the naloxone-treated group developed ventilatory depression, while 75% of those in the untreated septic group did. Among the latter piglets, three died of apnea within one hour. These beneficial effects of naloxone are likely related to its action on the central and peripheral respiratory regulatory mechanisms. A transient protection of the cardiac output and relatively decreased extravascular lung water with naloxone treatment may also, in part, improve the ventilation-perfusion maldistribution and secondarily reduce QS/QT and VD/VT. We conclude that endorphins play a role in septic ventilatory depression and that naloxone is effective in ameliorating it.
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PMID:Prevention of septic ventilatory depression with naloxone. 311 29

A patient with acquired immunodeficiency syndrome (AIDS) who required aggressive nutritional intervention via home parenteral nutrition therapy is described, and nutritional status, etiology and therapeutic management of AIDS-associated malnutrition, role of nutrition support, and factors for consideration in using parenteral nutrition in AIDS patients are discussed. Parenteral nutrition therapy was initiated in a 30-year-old AIDS patient with Kaposi's sarcoma lesions of the gastrointestinal tract because of rapid weight loss, low serum protein levels, and malnutrition. He had previously undergone a small-bowel resection and a jejunojejunostomy, and radiation and antineoplastic-drug therapy was planned. During parenteral nutrition therapy, the patient demonstrated increased physical strength and was able to care for himself during most of the time spent at home or in a long-term-care facility. Aggressive measures, including parenteral nutrition therapy, were discontinued 11 days before the patient's death. Complications of therapy included one episode of sepsis and a tear in the external catheter tubing. Malabsorption and diarrhea mainly caused by gastrointestinal disease, reduced food intake because of oral and esophageal infections, adverse effects from medication, and depression are factors that can contribute to AIDS-associated malnutrition. Also, hypermetabolism resulting from infections and fevers may contribute to malnutrition in AIDS. The extent to which this malnutrition affects the underlying immune dysfunction occurring in the syndrome and the response to other more direct drug therapies in AIDS is not known. Available methods for nutritional intervention are based on clinical experience and anecdotal reports. Because of gastrointestinal disease, an oral diet, supplements, and enteral tube feedings may not meet nutritional goals for an AIDS patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parenteral nutrition in the management of gastrointestinal Kaposi's sarcoma in a patient with AIDS. 313 64

Methotrexate, Cisplatin, and Vinblastine (MCV) was followed by Cisplatin plus radiation therapy in 19 patients with muscle-invading clinical Stage T2-4NXM0 transitional cell carcinoma of the urinary bladder (including cystectomy candidates), to achieve local control and prevent distant metastases. Radical cystectomy was recommended for all patients who failed to reach a complete response (CR = biopsy negative and cytology not positive) following MCV and Cisplatin X 2 plus 4000 cGy. Completely responding patients, and those partially responding patients unsuited for cystectomy, were selected for bladder conservation treated with additional irradiation to the bladder tumor volume (total 6,480 cGy) plus one additional Cisplatin treatment. Dose reductions were required for stomatitis in 26%, mild bone marrow depression in 58%, and renal toxicity in 5% of the patients. During the Cisplatin/4000 cGy, mild dysuria occurred in 68% of patients and 36% had mild bowel hyperactivity. Serious complications have occurred in two patients to date. One patient had recurrent pulmonary emboli, marked reduction in bladder capacity, and diarrhea. A second had bladder perforation during cystoscopic evaluation after MCV and a small bowel obstruction after Cisplatin and 4000 cGy. There was no treatment-related sepsis. Three patients had initial complete transurethral resection of their tumors and therefore 16 patients are evaluable for tumor responsiveness to this protocol. Four patients (25%) were biopsy negative and cytology negative, whereas three additional patients (19%) were biopsy negative but cytology positive following initial MCV. Six patients (38%) were biopsy negative and cytology negative whereas three additional patients (19%) were biopsy negative and cytology positive following MCV and Cisplatin X 2 plus 4000 cGy pelvic radiation. Of the entire group, 9 patients were treated with full-dose radiotherapy. All of these patients are alive without evidence of tumor on rebiopsy of the original tumor site, but one has a persistent positive cytology. Seven patients had a radical cystectomy and 6 are disease free. The treatment of 3 patients deviated from the protocol. Overall, only one patient has developed distant metastases and currently 84% of the patients are disease-free, although follow-up is short. To date, this feasibility study has been clinically practical and well tolerated. The proportion of CR's suggests that this program may prove to be an organ-sparing and curative approach for a significant number of patients, but more experience and follow-up are required.
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PMID:Invasive bladder carcinoma: preliminary report of selective bladder conservation by transurethral surgery, upfront MCV (methotrexate, cisplatin, and vinblastine) chemotherapy and pelvic irradiation plus cisplatin. 318 28

To investigate the immune response of surgical patients to injury and sepsis, we measured total lymphocyte counts and T-cell subsets in five nonseptic and 17 septic subjects. Total lymphocyte and T-cell levels declined to similar degrees following injury or sepsis and did not appear to be of value as prognostic indicators. However, analysis of T-cell subsets in septic patients indicated that survivors exhibited normal T-cell subpopulations as well as helper to suppressor cell ratios. Nonsurvivors generally exhibited a selective depression of helper (OKT4) T-cells and the resultant degree of helper to suppressor ratio decline was directly related to mortality. A helper to suppressor ratio (OKT4/T8) below 0.6 was uniformly associated with a fatal outcome. Finally, a small subgroup of septic nonsurviving patients exhibited a selective depression of suppressor (OKT8) lymphocytes which also appeared to carry an unfavorable prognosis. These data indicate that T-lymphocyte subpopulation analysis is a useful predictor of hospital course.
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PMID:Altered T-lymphocyte subsets in severe sepsis. 326 Apr 58

Severe sepsis leads to depression of the reticulo-endothelial system (RES) with delayed bloodstream clearance of particulate matter and bacteria. Splenectomy results in increased susceptibility to infection with encapsulated organisms but its effect on the resistance to postoperative Gram-negative infection has been little studied. We have investigated the effect of splenectomy on RES function by measurement of plasma fibronectin concentrations and bacterial clearance in the presence and absence of sepsis. In experiment 1, rabbits underwent splenectomy (n = 8) or laparotomy only (n = 8) 4 weeks before a second laparotomy. In experiment 2, animals had either splenectomy (n = 8) or laparotomy only (n = 8) followed 4 weeks later by devascularization of the appendix (sepsis). Plasma fibronectin concentrations and the blood clearance and organ distribution of an intravenous injection of 75Se-labelled viable Escherichia coli (2-3 X 10(8) colony forming units (c.f.u.] were measured 24 h after the second operation. Splenectomy resulted in: (1) a persistent reduction in plasma fibronectin concentration in the presence and absence of sepsis, and (2) a delay in the bloodstream clearance with reduced hepatic (Kupffer cell) uptake of E. coli which was exaggerated in the septic splenectomized animal. It is concluded that the spleen may be important for Gram-negative bacterial clearance, possibly related to its influence on plasma fibronectin concentration and Kupffer cell function.
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PMID:Effect of splenectomy on gram-negative bacterial clearance in the presence and absence of sepsis. 328 88

Burn patients, multiple trauma patients, and patients undergoing major surgical operations often suffer from acquired immunologic deficits that predispose them to life-threatening sepsis. This paper reviews the current research in this area, with emphasis on identifying the components of the immune response affected by injury, elucidating the mediators of immunologic change, and determining new therapeutic approaches for correcting immunologic deficits. Lessons learned from the study of immune deficiency disease are reviewed, as are basic observations of burn- and trauma-induced immune depression.
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PMID:Trauma, sepsis, and the immune response. 332 8

The study of mortality in severe burns shows very clearly that most patients die because of septic problems. Surgery and intensive care in burn patients are actually well established, but the fight against infection and septicemia is still difficult. The risk arises due to poor host defence, leading to an unfair struggle and very often ending in death. Today it has become necessary for every burn surgeon and plastic surgeon to understand why this immune depression occurs and how it can be prevented or treated.
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PMID:Immunity of the burned patient. An overview. 332 61

Many antineoplastic drugs in use now have cytotoxic side effects that also manifest in the oral cavity or influence dental management. Chemotherapeutic agents that have a high potential for precipitating oral mucosal damage and bone marrow depression are methotrexate, cyclophosphamide, daunorubicin, doxorubicin hydrochloride, 5-fluorouracil, bleomycin, nitrogen mustard, cytosine-arabinoside, 6-mercaptopurine, busulfan, and L-phenylalanine mustard. Mucositis may lead to neglected oral hygiene, which in turn may cause a chain reaction of local infections, bleeding, and septicemia in myelosuppressed patients. Preventive oral care before chemotherapy and active oral care during therapy are necessary for compromised patients. A protocol for oral care is described.
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PMID:Oral manifestations of systemic chemotherapy and their management. 333 Feb 77


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