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

Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully.
Dis Esophagus 2002
PMID:Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopy. 1244

The aim of this study was to critically evaluate acute and long-term complications of hand-sewn and semimechanical cervical esophagogastric anastomosis following resection of primary esophageal adenocarcinoma. Between February 1991 and 2001, 91 consecutive patients underwent subtotal esophagectomy (transthoracic, n=49; transhiatal, n=42), transposing a gastric tube based on the right gastroepiploic artery. All esophagogastric anastomoses were performed in the left neck using a hand-sewn technique (n=53) and, from September 1997, a side-to-side semimechanical technique (n=38). Outcomes evaluated were anastomotic leak rates, length of stay, and development of strictures. Postoperative mortality was 4.4% (all cardiopulmonary causes). Fifty-eight patients (63.7%) had an uncomplicated postoperative course, with a median postoperative length of stay of 10 days (vs. 20 days with associated morbidity; P </= 0.001). Anastomotic leaks were the leading cause of postoperative morbidity (16.5%, 15/91), and were classified into four types based on severity. The semimechanical anastomotic technique was associated with a reduced leak rate compared with the hand-sewn technique (7.9%, 3/38 vs. 22.6%, 12/53; P=0.08), although different patterns of anastomotic failure were seen following semimechanical anastomoses, with increased mediastinal and pleural sepsis. Anastomotic strictures developed in nine (17.0%) hand-sewn and three (7.9%) semimechanical anastomoses. Our conclusion was that a semimechanical technique for cervical esophagogastrostomy is associated with reduced anastomotic leak rates compared with hand-sewn anastomoses, resulting in a shorter postoperative stay. Patterns of anastomotic failure varied between each technique, possibly as a consequence of a longer cervical esophageal segment required for construction of a semimechanical anastomosis. The association between anastomotic technique and stricture development was not clear from this study.
Dis Esophagus 2002
PMID:Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. 1247 75

We herein report about a case of perforation of the cervical esophagus by an artificial denture, which had been swallowed by the patient after a horse-related-injury. Impactation of the foreign body at the level of the upper esophageal sphincter was followed by its penetration through the esophageal wall, causing severe infection of the cervical soft tissue, mediastinitis and sepsis. We discuss the well-known phenomena of prosthesis ingestion and frequently delayed diagnosis, as well as our treatment strategy of cervical esophageal perforation with placement of a T-tube into the cervical esophagus and mediastinal drainage.
Dis Esophagus 2002
PMID:Cervical esophageal perforation with severe mediastinitis due to an impacted dental prosthesis. 1247 85

Rupture of the esophagogastric anastomosis is potentially lethal if untreated. We report a case of esophagogastrostomy disconnection after an upper partial gastrectomy for strangulated paraesophageal hernia. The patient, a 50-year-old woman, developed systemic sepsis due to rapid manifestation of suppurative mediastinitis followed by peritonitis and was admitted to the intensive care unit 8 days after the primary operation. The patient underwent a staged surgical treatment and survived after a prolonged hospital stay. Initial reoperation consisted of emergent laparotomy and right thoracotomy for drainage and debridement completed with excision of the anastomosis, gastric stump exclusion and subcutaneous presternal transposition of the esophagus performed through a left cervical incision. Delayed restoration of the continuity of the gastrointestinal tract was re-established using jejunum. The final result achieved was a successful esophagojejunal anastomosis with both organs transposed in a subcutaneous presternal canal. The patient regained normal swallowing function. The 'subcutaneous esophageal transposition' procedure enables the easy performance of an extrathoracic esophagojejunal anastomosis and results in a safe gastrointestinal tract reconstruction in cases with esophagogastric anastomotic leakage.
Dis Esophagus 2005
PMID:Subcutaneous esophagojejunal reconstruction in the management of esophagogastric anastomotic leak: a staged procedure. 1619 38

Oesophageal cysts are rare congenital anomalies. Most commonly, they are located in the posterior mediastinum, approximately at the level of the distal third of the oesophagus. In most cases, they are diagnosed during childhood as an accidental finding of a symptomatic mediastinal lesion. A CT or MRI, oesophagoscopy and endosonography of the oesophagus are the essential diagnostic methods. In the adulthood, most of the cysts cause problems pushing against the surrounding organs and, therefore, surgical removal is recommended. In this report, a case of a potential complication is described: infection of the oesophageal cyst of the distal part of the oesophagus following a transoesophageal punction. The case resulted in sepsis, which was managed laparoscopically. Entering through the diaphragmatic hiatus,a cyst in the posterior mediastinum was revealed. The cyst was partially resected and its content evacuated. No complications followed. The laparoscopic method is feasible and safe even if the oesophageal cysts are infected. A complete resection of the cyst would be complicated due to a possibility of injuring the oesophagus. A significance of the peroperative oesophagoscopy to verify the oesophagus position in an unclear anatomic situation due to inflammatory infiltration, is highlighted. The above decreases the risk of the oesophageal wall lesion.
 ...
PMID:[Laparoscopic management of an infected oesophageal cyst]. 1633 30

High-mobility group box chromosomal protein 1 (HMGB-1) has recently been shown as an important late mediator of endotoxin shock, intra-abdominal sepsis, and acute lung injury. However, its role in the systemic inflammatory response syndrome after major surgical stress, which may lead to multiple organ dysfunction syndrome, has not been thoroughly investigated. We hypothesized that serum HMGB-1 participates in the pathogenesis of postoperative organ system dysfunction after exposure to major surgical stress. A prospective clinical study was performed to consecutive patients (n = 24) with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy with three field lymph node resection between 1998 and 2003 at Keio University Hospital, Japan. Serum HMGB-1 concentrations were measured by enzyme-linked immunosorbent assay. Preoperative serum HMGB-1 levels correlated with postoperative duration of SIRS, mechanical ventilation, and intensive care unit stay. Three of the 24 patients had serious postoperative complications: sepsis in two, and acute lung injury in one. Serum HMGB-1 levels in patients without complications increased within the first 24 h postoperatively, remained high during postoperative days 2-3, and then decreased gradually by postoperative day 7. In patients with serious complications, serum HMGB-1 was significantly higher than that found in patients without postoperative complications at every time point except postoperative day 2. Preoperative serum HMGB-1 concentration seems to be an important predictor of the postoperative clinical course. Transthoracic esophagectomy induces an increase in HMGB-1 in serum even in patients without complications. Postoperative serum HMGB-1 concentrations were higher in patients who developed complications, and may be a predictive marker for complications in this setting.
Dis Esophagus 2006
PMID:Serum concentrations of high-mobility group box chromosomal protein 1 before and after exposure to the surgical stress of thoracic esophagectomy: a predictor of clinical course after surgery? 1636 36

We report a late onset, benign, tracheoesophageal fistula in a 51-year-old man, due to an accidentally swallowed denture. In view of the extensive peri-esophageal sepsis and fibrosis, he was managed by a subtotal esophagectomy and a cervical esophagogastric anastomosis. The tracheal defect was closed with the help of an intercostal muscle flap. This report also highlights the difficulty in identifying swallowed prosthetic dental material radiologically, when no metallic component is present. This fact was also responsible for the delay in diagnosis, eventually leading to the rare complication of a tracheoesophageal fistula.
Dis Esophagus 2006
PMID:A missing denture's misadventure! 1636 46

Dr. Herman Boerhaave (1668-1738) first described esophageal rupture and the subsequent mediastinal sepsis based upon his careful clinical and autopsy findings and hundreds of references have since been written about Boerhaave's syndrome. Several fine historical accounts of this brilliant scientist have been published over the years and he has received appropriate credit for his valuable contributions. But what about that unfortunate propositus that Dr. Boerhaave attended to, performed necropsy upon, and subsequently received acclaim with? Medical history pays inadequate regard to the Baron Jan Gerrit van Wassenaer heer van Rosenberg, Prefect of Rhineland and Grand Admiral of the Dutch Fleet. This figure was a nobleman and war hero at the peak of the Dutch Golden Age who played his role in steering the course of European history. Without this nobleman's heroic contemporaneous account, Boerhaave's celebrated impact on medical science would never have been realized. Therefore, we offer an overdue recitation of Admiral van Wassenaer's biography. Based on found precedent we propose that spontaneous rupture of the esophagus be henceforth referred to as the 'Boerhaave-van Wassenaer's syndrome'.
Dis Esophagus 2006
PMID:Honoring the Admiral: Boerhaave-van Wassenaer's syndrome. 1672 90

Cancer of the esophagus has a poor long-term prognosis and a high peri-operative morbidity in which pulmonary complications play a major role. The combination of the surgical approach, pre-existing pulmonary disorders, poor nutritional status and the release of pro-inflammatory cytokines may be contributing factors. N-acetylcysteine ((NAC) has been shown to have oxygen scavenging abilities. In severe sepsis and acute respiratory distress syndrome, positive effects of NAC on morbidity and mortality were discovered. In this observational study peri-operative high dose NAC was administered in 22 patients. The effects of this treatment on respiratory function, morbidity and survival were studied. These prospectively collected data were compared with data of a matched, retrospective group without NAC treatment. There were no significant differences between the groups in terms of socio-demographic data, preoperative pulmonary function, intra-operative course and oncologic characteristics. The oxygenation indices at the postoperative hours 2 (P = 0.019), 4 (P < 0.001), 8 (P = 0.035), 12 (P = 0.035) and 24 (P = 0.046) were significantly higher in the NAC group. After 36 h, the difference between groups was no longer significant (P = 0.064). NAC-treated patients showed significant lower overall pulmonary morbidity, 45.5% versus 81.8% (P = 0.027). Surgical morbidity, intensive care unit and hospital stay were not significantly different between groups, mortality was zero. Kaplan-Meier curves showed no significant difference in survival 12 months postoperatively. These data indicate that postoperative oxygenation can be improved and rate of overall pulmonary complications is reduced using peri-operative high dose NAC in transthoracic esophagectomy.
Dis Esophagus 2007
PMID:High dose N-acetylcysteine to prevent pulmonary complications in partial or total transthoracic esophagectomy: results of a prospective observational study. 1776 Jun 53

We aim to determine the effect of splenectomy on clinical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction (GEJ) after a curative intended resection. From January 1991 to July 2004, 210 patients underwent a potentially curative gastroesophageal resection with an extended nodal dissection. The study group was divided into: group I with splenectomy, consisting of 66 patients (31.4%), and group II without splenectomy, of 144 patients. Splenectomy was performed for oncological reasons. Medical records were reviewed retrospectively. Postoperative complications occurred in 27 patients (40.9%) in group I and in 68 patients (47.2%) in group II (P = 0.4). The overall mortality was not significantly different between both groups (P = 0.7). There was a higher administration of red blood cells during surgery (P < or = 0.001), increased operating room (OR) time (P < or = 0.001) and longer intensive care unit (ICU) stay (P = 0.01) in group I. Independent prognostic factors for survival were outcome of surgery, nodal metastases, gender, complications and ICU stay. Sepsis was a strong prognostic factor among the complications. The 1 and 2-year survival was significantly higher in group II; 75% and 67% (P = 0.032) compared to 69% and 56% (P = 0.017) in group I, respectively. However, the 5-year survival was not different in both groups (29% in group I and 60% in group II, P = 0.191). Splenectomy had no marked effect on mortality and morbidity after curative resection of esophageal cancer. Splenectomy had a significant increase in blood transfusions with prolonged OR time and ICU stay and decreased short-term survival.
Dis Esophagus 2008
PMID:Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction. 1847 56


<< Previous 1 2 3 4 5 6 Next >>