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

Twenty-one patients older than 60 years of age with septic arthritis were reviewed over a ten-year period. The knee was the joint most commonly involved. Concurrent medical illnesses were noted in the majority of patients, with diabetes mellitus present in 24%. Seventy-one percent of patients had roentgenographic evidence of preexisting joint disease in the affected joint. Most patients were afebrile and had normal white blood cell counts at the time of admission. The erythrocyte sedimentation rate was elevated in all patients tested, with an average value of 79. Despite surgical treatment in the majority of patients, the complication rate was high, with 38% developing osteomyelitis; 14%, secondary osteoarthritis; and 19%, mortality due to sepsis. Septic arthritis in the elderly is difficult to diagnose and carries a poor prognosis despite aggressive management.
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PMID:Septic arthritis in the elderly. 229 80

Diabetes mellitus is associated with several non articular rheumatic conditions and is a cause of Charcot's arthropathy. We report three cases of long-standing insulin-dependent diabetics who developed an inflammatory monoarthritis of the ankle. There was no evidence of a peripheral neuropathy or sepsis. They were all seronegative for rheumatoid factor. In two the synovitis persisted; in the third there was a gradual resolution. This type of inflammatory synovitis has not been previously described in diabetes. It developed after a mean duration of diabetes of 34.3 years (range 18-52 years). We suggest that it may be associated with microvascular changes in diabetes, possibly involving hypoxic reperfusion.
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PMID:Monoarthritis of the ankle in diabetes mellitus without neuropathy: a report of three cases. 239 Aug 52

Some indices of humoral and cellular immunity were studied in 98 patients with diabetes mellitus (DM), complicated with pyoseptic infection (phlegmon, abscess, gangrene of different sites, hematogenic osteomyelitis, furunculosis, sepsis). A course of hyperbaric oxygenation (HBO) was conducted. Multimodality antidiabetic therapy in combination with HBO resulted in the improved general status of almost all DM patients, stimulation of reparative processes and wound defect closure were faster; DM compensation was achieved and ketoacidosis stopped. Normalization of laboratory and clinical indices was accompanied by immunological tests. The use of HBO in multimodality therapy of patients with DM complicated with pyoseptic infection brings about a good therapeutic effect.
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PMID:[Hyperbaric oxygenation in the combined treatment of patients with diabetes mellitus complicated by a suppurative-septic infection]. 239 27

Forty patients with diabetes mellitus and severe mal perforans underwent dorsal excision of the involved metatarsal head with primary closure of the plantar ulcer. Patients were screened before operation with noninvasive studies documenting pulse examination, ankle pressure index, and toe blood pressures. Fifteen of 40 patients (38%) had no palpable pedal pulses. Three patients had vascular reconstruction before metatarsal head resection. Mean toe pressure of the entire group was 135 +/- 35 mm Hg (range, 60 to 190), with six patients having a pressure less than 100 mm Hg. All patients had primary healing of the plantar wound and secondary healing of the dorsal incision with no amputations or readmissions for forefoot sepsis in the mean follow-up of 38.5 months (range, 2 to 54 months). In seven patients with recurrent ulcers, no relationship was found between measured indexes of forefoot perfusion and recurrence. However, all patients with recurrence were noncompliant in returning for follow-up orthotic care. This technique provides a means to ensure rapid healing of severe mal perforans while decreasing hospitalization, wound care, and periods of immobilization and is applicable in diabetic patients with arterial insufficiency and toe pressure of at least 60 mm Hg.
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PMID:Radical treatment of mal perforans in diabetic patients with arterial insufficiency. 239 85

Prophylactic antibiotics are given routinely to patients undergoing surgical treatment of the biliary tract to prevent postoperative infection if risk factors for postoperative sepsis are present. Cefmetazole (CM) is a new broad spectrum parenteral cephamycin antibiotic. This drug possesses a spectrum of activity against a wide range of gram-negative and gram-positive bacteria that is similar to cefoxitin (CX), an antibiotic widely used for prophylaxis with operations upon the abdomen. In this study, there was a random selection of two patients to receive CM to every one patient to receive CX. The dose of CM was 1 gram given intravenously every eight hours for three doses beginning 30 minutes before the operation; three doses of CX were given intravenously, 2 grams every six hours. Fifty-two evaluable patients comprised the CM group and 26, the CX group. The risk factors for postoperative infection were acute cholecystitis (CM, seven patients; CX, one patient), evidence from imaging procedure suggesting need for exploration of the common duct (CM, six; CX, one), hyperbilirubinemia (CM, eight; CX, four), hyperamylasemia (CM, 17; CX, seven); age of 60 years or more (CM, six; CX, one), obesity (CM, 36; CX, 14) and diabetes mellitus (CM, four; CX, five). Operative bactibilia and the organisms were comparable in both groups. Postoperative days of fever greater than or equal to 38 degrees C. (oral) (CM, 0.83 +/- 1.20; CX, 0.58 +/- 0.96) and hospitalization (CM, 6.59 +/- 2.20; CX, 5.04 +/- 1.26) were similar. Postoperative septic complications at the operative site occurred in two patients in the CM group (4 per cent) and in none of the patients in the CX group (p = 0.4; N.S., Fischer exact test). These two antibiotics had similar efficiency in preventing postoperative infections.
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PMID:Controlled comparison of cefmetazole with cefoxitin for prophylaxis in elective cholecystectomy. 240 23

The availability of safe and effective preparations of human immune globulin that can be administered intravenously has revolutionized replacement therapy for patients suffering from hypogammaglobulinaemia. Of equal importance and greater interest, however, has been the recognition that super physiological doses of IgG can manipulate an abnormal immune system. Future prospects for the use of immunoglobulin preparations to supply specific antibodies includes the standardization of procedures, whereby patients with acute sepsis may receive antibiotics and immunoglobulin simultaneously. Already there is in vitro evidence that suggests that opsonized bacteria are more readily affected by aminoglycosides. It seems certain that gamma globulin will be used routinely in the management of patients with a number of immunomalignancies, such as chronic lymphatic leukaemia and multiple myeloma that feature hypogammaglobulinaemia, especially when chemotherapy is being administered. Control trials are underway to determine whether gamma globulin given intravenously to premature babies will satisfactorily correct their immuno-deficient state and improve their chances of survival. The immunomanipulative capacity of immunoglobulin is yet to be fully realized. Success in ideopathic thrombocytopenic purpura had led to a trial of gamma globulin in a number of autoimmune conditions. Success has been reported in myasthenia gravis, rheumatoid arthritis, diabetes, patients with circulating antibodies to factor VIII and Kawasaki's disease. The mechanism of action is unknown but almost certainly multifactorial. Two proven mechanisms that will be added to in the future, include blockade of the Fc receptors on cells of the reticulo-endothelial system and manipulation of immunoregulatory T cells by the presence of anti-idiotypic antibodies in the preparation.
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PMID:The clinical use of intravenous gammaglobulin. 244 Jul 43

Most techniques described in animal models of pancreatic transplantation use either segmental or autotransplants. We employ a technique of pancreaticoduodenal allotransplantation in the dog that closely resembles the operation used in humans. The arterial supply of the entire pancreatic graft is preserved by procuring a Carrel patch of aorta encompassing the origin of the celiac and the superior mesenteric arteries. Splenic, inferior pancreaticoduodenal, and superior pancreaticoduodenal arteries remain intact with the graft. Venous drainage is through a short segment of portal vein. A 6-cm cuff of duodenum is taken with the head of the pancreas. Engraftment proceeds by placing the allograft within the peritoneal cavity of the recipient. End-to-side vascular anastomoses are constructed to distal aorta and inferior vena cava. The duodenal cuff is anastomosed to the dome of the bladder for drainage and analysis of exocrine secretions and to provide a port of entry for cystoscopically directed needle biopsy. A total pancreatectomy is performed to induce a state of diabetes. The average operating time is 5 h. Twenty-two dogs have undergone allotransplantation using this technique. Six dogs had no complications and were sacrificed after meeting criteria of their study protocol. There were three technical failures, two arterial thromboses and one exsanguination, yielding an 86% rate of successful engraftment. Three other dogs died of intussusception and three dogs died of sepsis, one secondary to wound dehiscence and one due to inadvertent common bile duct ligation during pancreatectomy. Wound problems, four dehiscences and two superficial infections, occurred only in immunosuppressed dogs.
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PMID:Canine pancreaticoduodenal allotransplantation with cystoduodenostomy: an animal model with clinical application. 248 44

126 cases of sepsis were retrospectively studied in an Internal Medicine Department, giving special attention to the clinical evolution. 67 males and 59 females with a median age of 65 years old were discovered. 92% had one or more diseases, mainly COLD (30%) and diabetes mellitus (28%). The septic sources were urinary (37%) and respiratory (31%). 84% of the germs were gram (-), mainly E. Coli and Proteus sp. A mortality rate of 36% was found, the primary rates being: eighth decade (52%), patients with neoplastic disease (46%), biliary tract diseases (64%), endocarditis (66%), infection by Serratia (60%), Pseudomonas (50%), shock (55%) and DIC (50%). These last two complications were analysed and found to be the more frequent (35% and 6.3% respectively), also being those with higher mortality rate. Finally, the prognostic factors are established based on the results obtained.
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PMID:[Sepsis: clinical course study of 126 patients in an internal medicine department]. 249 19

A patient who developed extreme fluctuations in serum glucose concentrations while receiving total parenteral nutrition (TPN) is described, and etiologies of hyperglycemia and hypoglycemia, as well as a rational approach to preventing and managing these disorders in patients receiving TPN, are presented. A 40-year-old white man with a 29-year history of insulin-dependent diabetes mellitus was hospitalized after he had an episode of rejection related to a cadaveric kidney transplant. During the hospitalization, his right leg was amputated because of cellulitis, and he developed septicemia with respiratory failure. A renal biopsy revealed cytomegalovirus inclusion disease, the kidney was removed, and intermittent hemodialysis was begun. Control of the patient's serum glucose concentration included four routes of insulin administration: a continuous titratable insulin infusion, subcutaneous sliding-scale insulin, insulin incorporated into the TPN solution, and intravenous bolus insulin. Further, glucose management was being coordinated by three teams: intensive care, nutrition support, and the renal service, with physicians from each service prescribing insulin therapy. The patient also received prednisone daily. The sporadic approach to this patient's glucose control, complicated by the extensive disease profile of the patient, resulted in precipitous fluctuations in his serum glucose concentrations. Patients receiving parenteral nutrition are subject to widely varying serum glucose concentrations related not only to the nutrition support provided but also to various underlying metabolic and physiologic complications commonly present. Common etiologies of, and ways to prevent and manage, hypoglycemia and hyperglycemia are reviewed. Clinicians should be aware of the risk of hyperglycemia and hypoglycemia in patients receiving TPN and monitor patients appropriately for alterations in glucose homeostasis.
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PMID:Management of glucose abnormalities in patients receiving total parenteral nutrition. 249 13

Causes of death were analyzed for 63 diabetic patients treated with hemodialysis. In all cases, autopsy-based death certificates were evaluated. The causes of death were compared during the periods 1969 through 1979 versus 1980 through 1987, and the causes of death in patients who died after less than 18 months versus those who died greater than 18 months after starting hemodialysis treatment. Our population of decreased diabetics had a mean age of 41.8 years, with a mean of 23.4 years of diabetes duration. The mean age at manifestation of diabetes was 18.2 years. Cardiac failure has been shown to be the most prevalent cause of death (55.6%), while sepsis accounted for 20.6% of the deaths. In both the period from 1969 through 1979 and that from 1980 through 1987, cardiac failure was identified as the commonest cause of death, with an equal proportion of septic causes (i.e., 20% versus 21.05%). When comparing causes of death among diabetics on hemodialysis for less than 18 months versus those receiving greater than 18 months of treatment, cardiac failure was responsible for 54% versus 61.5% of deaths. Septic causes were found to be more prevalent after a longer duration of treatment (i.e., 30.8%). Therefore, it is concluded that to prevent cardiac deaths, blood pressure control has to be as tight as possible in patients with diabetic kidney disease. To prevent late-occurring septic deaths, good nutritional status in patients undergoing hemodialysis seems to be of importance. The prevention of macroangiopathy in diabetes represents a major medical problem that needs to be solved.
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PMID:Causes of death in insulin-dependent diabetic patients treated with hemodialysis. 252 60


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