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

Percutaneous subhepatic cholecystostomy is preferable to the transhepatic technique because it spares the liver from unnecessary trauma and possible sepsis. In order to prevent gallbladder wall invagination and intraperitoneal bile leakage, the fundus is first secured to the abdominal wall with a removable anchoring device that is introduced through a 17-gauge needle system under sonographic and fluoroscopic control. With this technique, the gallbladder was drained in seven patients with possible empyema, and stones were extracted from the gallbladder in three patients who were poor risks for cholecystectomy. None of the patients had hypotension, bile leakage, peritonitis, or bleeding. Subhepatic cholecystostomy was done safely in 10 patients after temporarily anchoring the fundus to the abdominal wall.
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PMID:Percutaneous subhepatic cholecystostomy with removable anchor. 326 66

Unusual infections associated with colorectal tumors may, in some instances, be the sole clue to the presence of a malignancy. The infections are either related to invasion of tissues or organs in close proximity to the tumor or secondary to distant seeding by transient bacteremia arising from necrotic tumors. Seven patients seen at one hospital over a 5-year period illustrate the clinical presentations of such infections. The infections identified in these seven patients include endocarditis, meningitis, nontraumatic gas gangrene, empyema, hepatic abscesses, retroperitoneal abscess, clostridial sepsis, and colovesical fistulae with urosepsis. A computer-assisted search of the English-language literature and cross-checks from other review articles identified other infections associated with colon cancer, which include nontraumatic crepitant cellulitis, suppurative thyroiditis, pericarditis, appendicitis, pulmonary microabscesses, septic arthritis, and fever of unknown origin. The clinical importance of these infections and their correlation with colorectal malignancies are reviewed.
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PMID:Unusual infections associated with colorectal cancer. 328 64

An infant with pyrexia of unknown origin presented to the Paediatric Unit. The initial infection screen was unhelpful and he was, therefore, referred for abdominal ultrasound to look for occult sepsis. During epigastric scanning, a large loculated fluid collection was demonstrated in the pericardium. A pericardial empyema should not be forgotten as a possible source of infection in the infant with undetermined pyrexia.
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PMID:Ultrasound demonstration of pericardial empyema in an infant with pyrexia of undetermined origin. 329 Aug 23

The clinical manifestations of patients with group A beta-hemolytic streptococcal (GAS) bacteremia presenting to an urban children's hospital were reviewed. Group A beta-hemolytic streptococci were isolated from blood cultures from 17 children over a three-year period. Systemic illnesses that may have predisposed these children to GAS bacteremia were identified in seven patients: preceding varicella infection (four patients) or malignant neoplasm/immunosuppressive therapy (three patients). Possible sources of GAS included compromised integument (seven patients), the oropharynx (six patients), or the lower respiratory tract (two patients). The clinical manifestations of GAS sepsis included the following: fever (15 patients); arthritis or arthralgias (four patients); cellulitis (three patients); maculopapular eruption (one patient); petechial or pustular exanthems (three patients); osteomyelitis (two patients); cervical adenitis (one patient); empyema (one patient); and meningitis with multiple brain abscesses (one patient). Two patients died of apparent overwhelming GAS sepsis while at home. Group A beta-hemolytic streptococcal bacteremia can present with a wide range of clinical manifestations and cause mild to fulminant disease in children.
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PMID:Group A beta-hemolytic streptococci as a cause of bacteremia in children. 329 24

The presence of acute pulmonary infarction is not uncommon in severely ill patients and is considered by some to be a contraindication to heart transplantation. It has been our policy to accept these patients for operation. The purpose of this investigation is to examine the results of this policy in patients receiving immunosuppression with cyclosporine A and azathioprine. Between September 1982 and April 1985, eight patients undergoing heart transplantation demonstrated clinical and radiographic evidence of acute preoperative pulmonary infarction. These patients represented 5.5% of our heart transplantation population during this period (total = 145). The age range in these eight patients was from 22 to 55 years. Congestive cardiomyopathy was present in four patients, and four patients had ischemic cardiomyopathy. All patients were New York Heart Association functional status class IV. Five of the eight patients were on inotropic support, and one patient had associated renal failure. Pulmonary infarcts were located in the right, middle, or lower lung field in seven patients and in the left lower lung field in one patient. All patients were treated perioperatively by intensive physiotherapy and specific antibiotics. In four patients the lesions resolved on medical treatment alone. Three patients developed extensive empyema and required chest drainage with or without decortication. Two of these patients survived with complete resolution of the lung lesions, and one patient died from prolonged renal failure and sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The influence of acute preoperative pulmonary infarction on the results of heart transplantation. 330 55

Bacterial hepatic abscesses are a rare but serious disease. They develop either secondary to injuries or ischemia of the liver, infections in the drainage area of the portal vein, systemic sepsis or biliary infections. An abscess secondary to injuries or ischemia of the liver or infections in the drainage area of the portal vein, is usually caused by a mixed flora consisting of gramnegative aerobes and anaerobic bacteria. Hepatic abscesses secondary to systemic sepsis contain Staphylococci or Streptococci, while in abscesses on the basis of biliary infections gramnegative organisms are found. Clinically, one can find signs of systemic sepsis, pain in the right upper quadrant and a tender enlarged liver. Jaundice is absent unless a biliary obstruction is present simultaneously. The diagnosis is confirmed by ultrasonography or computerized tomography. An uncertain diagnosis can be confirmed by aspiration under ultrasonographic or computertomographic guidance. The therapy consists of administration of antibiotics and surgical or percutaneous drainage. Surgical drainage via laparotomy is always mandatory if one suspects a primary infectious focus within the abdomen. The mortality of multiple liver abscesses is 20 per cent, that of single abscesses 10 per cent. Amebic abscesses have been observed in nonendemic regions sporadically after travel or spontaneously. Clinical and radiological manifestations are the same as for bacterial abscesses. They are differentiated from bacterial abscesses by positive serology for amebiasis or aspiration which yields the typical anchovy paste. Most important complications are hepato-bronchial fistulae, empyema and amebic pericarditis. The therapy consists of a nitroimidazole and a luminal amebicide. Except for diagnostic reasons aspiration is only indicated for large abscesses of the left lobe of the liver. Mortality of an uncomplicated amebic liver abscess should be under one per cent.
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PMID:[Pathology, diagnosis and therapy of liver abscess]. 330 50

Group B streptococci (GBS) have gained much attention in recent years as a cause of serious infection in the newborn. Traditionally two clinical syndromes have been defined as "early onset", with fulminant septicemia, pneumonia and meningitis, and "late onset", with a mild meningitis. More recently some previously unrecognized clinical presentations of GBS disease have been documented. These include asymptomatic bacteremia, septic arthritis, osteomyelitis, ethmoiditis with orbital cellulitis, pneumoniae with empyema, conjunctivitis. The literature to date reports 30 instances of osteomyelitis due to GBS. This report describes a forty days infant with a group B streptococcal osteomyelitis of the proximal humerus. Has been also emphasized the increased frequency and the benign clinical course of streptococcal osteomyelitis in the neonate.
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PMID:[Osteomyelitis and arthritis caused by Streptococcus group B in a 40-day-old boy]. 332 62

One hundred and four children who were hospitalized for documented or suspected non-CNS bacterial infections (56 males/48 females, 22 days to 15 years old) were treated with intravenous imipenem/cilastatin for 9.4 days (range 3 to 28 days). Children up to three years of age received 100 mg/kg/day and older children 60 mg/kg/day, administered in four divided doses. Bacterial pathogens were isolated before therapy in 85%. Diagnoses in the 74 evaluable patients included bronchopneumonia with or without empyema (20%), peritonitis complicating appendicitis (16%), skin/soft tissue abscesses (14%), septicemia (11%) and miscellaneous other infections (39%). Among evaluable patients, 95% were clinically cured or improved. One patients, a marasmic child with pneumonitis due to pseudomonas, died during therapy. One evaluable patient each with shigellosis, Klebsiella pneumoniae empyema and streptococcal pneumonia had bacteriologic eradication or suppression but, due partly to noninfectious complications, had no overall clinical improvement. Most bacterial isolates (101/108) were eradicated, including many gram-negative and gram-positive aerobes and anaerobes; three pathogens persisted (one Proteus mirabilis and one Salmonella typhi, one Staphylococcus aureus); and one Escherichia coli pyelonephritis recurred after therapy ended too early. Imipenem/cilastatin was well tolerated by 91% of children. Clinical adverse experiences (AEs), none serious except for the one death, occurred in 19%; 12% were judged possibly related to imipenem/cilastatin, but none probably or definitely related. No serious laboratory AEs occurred; the most common AEs were eosinophilia (11%), urine discoloration, and infusion site pain. Imipenem/cilastatin is well tolerated and has excellent clinical efficacy in a wide variety of pediatric infections.
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PMID:Imipenem/cilastatin for pediatric infections in hospitalized patients. 333 Oct 43

This article describes the infectious complications that occurred among four of the longest-term recipients of the Jarvik-7 artificial heart. Infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. Periprosthetic infections were due to coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and other Pseudomonas species. Other infectious complications incurred by some of the patients included pneumonia, empyema, urinary tract infection, and intravascular line sepsis with Candida. Intensive antimicrobial therapy for prolonged periods seemed to suppress but not to eradicate infection and was accompanied by the appearance of multiresistant bacterial strains. Complications of antimicrobial therapy included diarrhea secondary to overgrowth with Clostridium difficile in two patients. Use of the current device for more than 30 days should be considered extraordinary and should be reserved for patients for whom no other form of life support is available.
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PMID:Infectious complications in four long-term recipients of the Jarvik-7 artificial heart. 333 99

The clinical profiles and management of 236 consecutive chest injury patients treated and followed up at All India Institute of Medical Sciences between January 1983 and July 1985 were analyzed prospectively. There were 149 blunt and 87 penetrating injuries; 21 patients (9%) required thoracotomy. Single- or multiple-tube thoracostomy was performed in 141 patients (60%). The remaining 74 patients (31%) required only observation for a period of 24-48 hours. Fifteen patients (6.3%) died, the mortality being related to head injury in four, irreversible hypovolemic shock in four, pulmonary embolism in three, septicemia in two, and respiratory failure in two. Nonfatal complications included residual hemothorax in 18 cases, persistent air leak in 13, pulmonary infection in eight, pulmonary embolism in one, and empyema in one. The average hospital stay was 6.9 days. Evidence of chest injury of various magnitudes was found in 756 of 2,286 autopsies conducted for trauma-deaths during the same study period analyzed retrospectively; however, it was the major cause of death in only 147 (19%). Cardiac injuries accounted for 41% of the deaths resulting primarily from chest trauma. Only 10% of the patients who sustained cardiac injury reached hospital alive.
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PMID:Chest injuries: a clinical and autopsy profile. 338 31


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