Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The goal of this study was to investigate the factors that could predict prognosis in 51 premature infants with positive sharp waves on their EEGs (gestational age 23-36 wks) with 114 tracings. Follow-up clinical examinations were conducted, up to 10 yrs later. Death occurred in 18%, from a non-CNS cause, either sepsis or a congenital cardiac or pulmonary defect. A severe outcome was seen in 8% and was related to maternal i.v. drug abuse (IVDA) and the presence of many positive sharp waves. A moderate outcome, noted in 29%, was associated with a Grade III-IV intracerebral hemorrhage (ICH) or periventricular leukomalacia (PVL) and maternal IVDA. A mild outcome seen in 20% was related to infrequent positive sharp waves, vaginal delivery and an improving EEG over time, while a normal outcome (26%) was also related to infrequent discharges, a normalized EEG over time, a normal sonogram and the absence of clinical seizures. The addition of negative sharp waves to the positive ones and the addition of central to temporal positive sharp waves were associated less often with a normal outcome. The general conclusion of this study was that various aspects of positive sharp waves in premature infants, in addition to other factors, can be used to predict outcome in these neonates.
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PMID:The use of the EEG to predict outcome in premature infants with positive sharp waves. 781 91

Intraamniotic infection is a common (2-4%) event in labor. The predictors of IAI include preterm labor or rupture of membranes, abnormal vaginal flora (e.g., GBS, sexually transmitted disease, bacterial vaginosis), obstetric manipulations (e.g., vaginal exams, internal fetal monitoring) in the presence of ruptured membranes, and diminished host response (due to smoking, drug abuse, obesity, immunodeficiency states, etc.). Group B Streptococcus and Enterobacteriaceae are the most important organisms associated with the polymicrobial infection. Anaerobes predict post-cesarean section complications. Neonatal pneumonia (2-5%) and early neonatal sepsis (1-4%) are the outcomes of the greatest concern and are caused by group B streptococcal or aerobic gram-negative rod infections. These outcomes are kept to a minimum if maternal antibiotic chemotherapy is started interpartum with agents that are safe, cross the placenta, and are active against GBS and Escherichia coli (e.g., ampicillin plus gentamicin). Anaerobic coverage should be added (clindamycin) if a cesarean section is performed. Antipyretics such as acetaminophen will reduce the hyperthermic stress on the fetus, and persistent fetal tachycardia after antipyretics may indicate fetal infection. Continuous electronic fetal monitoring is appropriate in cases of IAI, and providers should be prepared for neonatal resuscitation, early neonatal intravenous antibiotics, and respiratory support at delivery.
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PMID:Chorioamnionitis and intraamniotic infection. 829 82

With further improvements of the prehospital rescue systems, an increasing number of patients with extreme injuries such as traumatic hemipelvectomy are admitted to trauma centers alive. The accepted definition of traumatic hemipelvectomy is: unstable ligamentous or osseous hemipelvic injury with rupture of the pelvic neurovascular bundle (open or closed integuments). A review of the literature up to 1995 yielded on 48 surving cases with such an injury. A review of 2002 consecutive patients after pelvic fractures treated from 1972-1994 at the Medical School Hannover, resulted in the identification of 11 traumatic hemipelvectomies with four survivors. The purpose of the study was the analysis of the early clinical course of the patients after traumatic hemipelvectomy and the evaluation of the late outcome of the survivors. All accessible clinical and radiological data were reviewed for the preclinical and primary clinical treatment, concomitant injuries, cause of death and complications. The survivors are under continuous follow-up at our institution and were evaluated on average 5.5 years (range 2-7 years) after trauma. All patients were managed with early and aggressive shock therapy by an emergency physician, hemorrhage control with manual compression of the wound and a short transit time to a trauma center. Immediate surgical hemostasis was attempted in all cases. Despite this, four patients died within the first 4 h secondary to uncontrollable bleeding. Another three died between 2 days and 5 weeks after accident from complications of septic or hemorrhagic shock. In four patients a limb-saving procedure was attempted. Three of these died early, and in the remaining case secondary hemipelvectomy was necessary due to sepsis and paralyses. After primary surgical completion of the hemipelvectomy, three of four patients survived. The late result was good in two children and moderate in one adult (ambulatory and socially reintegrated). A bad result occurred in one male after secondary surgical completion of the hemipelvectomy (social deterioration and drug abuse). A strict protocol has to be set for the primary treatment of a traumatic hemipelvectomy. It includes immediate prehospital hemostasis by local pressure, advanced shock therapy and prompt transfer to a trauma center. In-hospital procedures include immediate surgical hemostasis and debridement. When the criteria or traumatic hemipelvectomy are fulfilled, surgical completion of the hemipelvectomy is mandatory. Limb-saving procedures endanger the patient's life. Early and frequent second-look operations minimize wound healing problems. Early psychological support for the patient and family is advantageous for personal well-being and social reintegration.
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PMID:[Traumatic hemipelvectomy. Experiences with 11 cases]. 865 10

Thirty-one patients (26 males, 5 females) with mean age 35 +/- 19 years (range 8 to 85 years) were diagnosed as non-traumatic rhabdomyolysis by clinical findings and elevation of serum creatine kinase (CK) between January 1989 and December 1993. Causes, laboratory measures, clinical courses, and outcome were reviewed retrospectively. Drug abuse, seizure, and excessive activity are the most common etiologies for non-traumatic rhabdomyolysis. Twelve patients presented with muscular pain and seven patients with muscle weakness. Twenty eight patients had urinalysis and five of them (18%) had negative orthotolidine dipstick test. Only seven patients (25%) were detected positive orthotolidine test without microscopic hematuria. Patients with acute renal failure had higher levels of potassium and uric acid. The patients who developed acute renal failure after admission had significantly higher levels of uric acid. The peak levels of CK did not correlate with development of acute renal failure. There was no episode of hyercalcemia. Seventeen patients (55%) had acute renal failure. Hemodialysis was required in nine cases. All survivors recovered with normal renal function except one who needed maintenance hemodialysis after two months follow-up. Two patients died of multi-organ failure and sepsis.
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PMID:Non-traumatic rhabdomyolysis and acute renal failure. 893 69

Rhabdomyolysis results from skeletal muscle injury and release of muscle cell contents into plasma. A number of etiologic factors have been reported for the condition, including strenuous exercise, weight lifting, trauma, seizure, sepsis, and alcohol and drug abuse. Hundreds of drugs also reportedly cause rhabdomyolysis. A 24-year-old body builder developed the disease after ingesting 1200 microg of chromium picolinate (6-24 times the daily recommended allowance of 50-200 microg) over 48 hours. We believe this to be the first reported case of chromium-induced rhabdomyolysis.
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PMID:Suspected chromium picolinate-induced rhabdomyolysis. 969 62

We studied clinical presentations on admission in Infectious Disease Wards of 1053 patients (308 i.v. drug abusers and 745 non drug abusers) with IE validated according to the Duke Hospitals' criteria, from a total of 1164 patients observed from 1984 to 1999. We divided the patients in three five-year span groups (1984-89, 1990-94 and 1995-99) and we examined signs and symptoms on presentation that led us to suspect I.E. (sepsis, valvulopathy, peripheric vascular damage and predisposing conditions including i.v. drug abuse). Our study confirms that clinical diagnosis of I-E. nowadays is reliable if history and physical examination are carried out correctly.
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PMID:[Signs and symptoms that lead to clinical hypothesis of infective endocarditis]. 1235 84

We present here a case of sepsis due to infectious endocarditis in a methamphetamine abuser. A 32 year-old male presented high fever and abdominal pain last two weeks. He was admitted to the hospital on the diagnosis of infectious endocarditis. In the evening on the day of admission, he suddenly collapsed. Despite of cardiopulmonary resuscitation, his death was confirmed. From the autopsy findings, toxicological analysis and results of the microbiological examination, we concluded that the cause of death was septic shock due to infectious endocarditis, presumably based on the methamphetamine abuse. The result obtained from microbiological examination gave us useful information. We shall have to be on the lookout, not only for acute poisoning, but also for cases of drug abuse related deaths.
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PMID:An autopsy case of infectious endocarditis in a methamphetamine abuser usefulness of microbiological examination. 1596 86

Antimicrobials are among the most important and commonly prescribed drugs in the management of critically ill patients. Selecting the appropriate antimicrobial at the commencement of therapy, both in terms of spectrum of activity and dose and frequency of administration according to concentration or time dependency, is mandatory in this setting. Despite appropriate standard dosage regimens, failure of the antimicrobial treatment may occur because of the inability of the antimicrobial to achieve adequate concentrations at the infection site through alterations in its pharmacokinetics due to underlying pathophysiological conditions. According to the intrinsic chemicophysical properties of antimicrobials, hydrophilic antimicrobials (beta-lactams, aminoglycosides, glycopeptides) have to be considered at much higher risk of inter- and intraindividual pharmacokinetic variations than lipophilic antimicrobials (macrolides, fluoroquinolones, tetracyclines, chloramphenicol, rifampicin [rifampin]) in critically ill patients, with significant frequent fluctuations of plasma concentrations that may require significant dosage adjustments. For example, underexposure may occur because of increased volume of distribution (as a result of oedema in sepsis and trauma, pleural effusion, ascites, mediastinitis, fluid therapy or indwelling post-surgical drainage) and/or enhanced renal clearance (as a result of burns, drug abuse, hyperdynamic conditions during sepsis, acute leukaemia or use of haemodynamically active drugs). On the other hand, overexposure may occur because of a drop in renal clearance caused by renal impairment. Care with all these factors whenever choosing an antimicrobial may substantially improve the outcome of antimicrobial therapy in critically ill patients. However, since these situations may often coexist in the same patient and pharmacokinetic variability may be unpredictable, the antimicrobial policy may further benefit from real-time application of therapeutic drug monitoring, since this practice, by tailoring exposure to the individual patient, may consequently be helpful both in improving the outcome of antimicrobial therapy and in containing the spread of resistance in the hospital setting.
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PMID:Antimicrobial therapy in critically ill patients: a review of pathophysiological conditions responsible for altered disposition and pharmacokinetic variability. 1617 16

Rhabdomyolysis is not an uncommon cause of acute renal failure (ARF). It is usually caused by severe traumatic crush injury, severe exercise, septicemia, drug abuse, alcoholic intoxication, heat stroke and myopathy. In this case, we present a patient who developed rhabdomyolysis after severe hypokalemia (serum potassium 1.9mmol/L). This is an unusual cause of rhabdomyolysis even though hypokalemia is a common medical problem. This patient developed acute oliguric renal failure that required daily hemodialysis for 12 days, before start of recovery. This case demonstrates that hypokalemia is a preventable cause of rhabdomyolysis and ARF.
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PMID:Acute Renal Failure due to Rhabdomyolysis Caused by Hypokalemia. 1820 73

Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.
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PMID:Emergency stent grafting after unsuccessful surgical repair of a mycotic common femoral artery pseudoaneurysm in a drug abuser. 1893 76


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