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

A patient with radiation-induced fibrosarcoma following mastectomy and postoperative radiation for bilateral breast carcinoma is described. Only six such cases have been reported in the literature. In this patient erosion of the axillary artery produced massive hemorrhage, and emergency transthoracic ligation of the subclavian artery caused gangrene of the extremity and empyema and sepsis. Interscapulothoracic amputation not only was life-saving but offered the patient a reasonable chance for long-term survival. Only aggressive surgical management can salvage a patient with radiation-induced sarcoma.
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PMID:Radiation-induced fibrosarcoma following treatment for breast cancer. 19 47

Two patients developed local gangrene after subcutaneous infiltration of vasopressin (Pitressin, Parke, Davis & Company, Detroit, Mich.) utilized for the control of bleeding from esophageal varices. In the 1st patient, ischemic gangrene resulted in transmetatarsal amputation and also necessitated skin grafts on the forearm. The 2nd patient developed gangrene and clostridial sepsis and expired. The effects of systemically administered Pitressin are reviewed and suggestion to prevent local necrosis are presented.
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PMID:Local gangrene: a complication of peripheral Pitressin therapy for bleeding esophageal varices. 30 80

Necrotizing enterocolitis has become the most common condition requiring emergency surgical treatment in the newborn infant, far surpassing all major congenital anomalies in number of presentations and in deaths after surgical treatment. No single cause for the disease is known. Necrotizing enterocolitis is characterized by ischemic necrosis of the intestine, with minimal inflammation. In 25 of 50 per cent of patients, surgical resection of gangrenous bowel is necessary. Operation is reserved for infants with intestinal perforation or grangrene. Recent refinements of indications for operation often permit surgical intervention to coincide with the advent of intestinal gangrene. At operation, expeditious resection of frankly necrotic bowel and exteriorization of the marginally viable ends is all that should be attempted. Special problems postoperatively consist of management of sepsis, maintenance of nutrition and vigilant observation for early and late complications, particularly the development of ischemic intestinal stricture.
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PMID:Necrotizing enterocolitis in the neonate. 36 4

The case studies of four patients with post-transplantation calcinosis are presented. Three of the four patients died of inanition and sepsis secondary to infection of extensive soft tissue ulcers and diffuse cutaneous vascular calcification with gangrene. The fourth patient survived following removal of all four parathyroid glands and autografting of approximately one-half of one gland. Common to the patients was secondary hyperparathyroidism, elevated mean serum calcium levels after transplantation, and radiographic evidence of small and medium vessel calcification. No other differences could be found between these patients and other patients with post-transplantation hyperparathyroidism without calcinosis. In the face of apparently minor complaints of lower extremity discomfort, elevated parathyroid hormone levels (PTH) and positive xerography may indicate subtotal parathyroidectomy regardless of the serum calcium level.
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PMID:Lethal post-transplantation calcinosis. 37 90

Neonatal necrotizing enterocolitis, a highly lethal disorder of premature infants, is a common occurrence in newborn care units. This report details operative experience with 33 infants over the past seven years. During this time many more infants with NNE have recovered with supportive therapy. All patients are treated on a standard protocol of therapy and monitoring designed to select those with signs of continuing clinical deterioration. Therefore, those coming to operation had additional complications, such as perforation, intestinal gangrene or stenosis. This protocol is described. The 33 infants, averaging less than 4 lbs., developed NNE within five days of birth. Perforation and signs of continued clinical deterioration were the indications for operation; severe sepsis and clotting abnormalities were the rule. The overall mortality was 40% but included six infants with total bowel necrosis who had laparotomy alone. Five patients had intestinal or colonic resection with primary anastomosis, with two leaks leading to death. Twenty-one patients had staged resection with delayed anastomosis and only four deaths. Thus 27 determinative cases had a 26% mortality, and the recent group with staged resection had a 19% mortality. The essentials of pre-, intra- and postoperative management are detailed, as well as pathology and bacteriologic data. Most infants had temporary malabsorption requiring parenteral nutrition and special diets. Long-term results are gratifying.
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PMID:Surgical experience with neonatal necrotizing enterocolitis (NNE). 44 13

During the forty-month period ending July, 1976, intraaortic balloon counterpulsation was used as an adjunct to medical or surgical therapy in 273 patients. Thirty-seven developed complications. Limb ischemia occurred in 16; it resolved in 12, resulted in gangrene of the toes in 1 and leg gangrene in 2, and was the casue of death in 1 patient. Aortic dissection was confirmed in 7 patients and strongly suspected in another 4. Eight of the 11 patients with dissection underwent cardiac procedures with heparinization at two days to three months after balloon insertion with no untoward effects. Septicemia developed in 2 patients, 1 of whom died of cardiogenic shock. Localized groin sepsis occurred in 8 patients, 2 of whom required removal of infected Dacron graft material. Awareness of the complications of balloon insertion, proper attention to details of balloon management at the time of insertion and removal, and continuous monitoring through a central-lumen balloon should decrease the incidence of complications.
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PMID:Results and complications of intraaortic balloon counterpulsation. 59 68

Twenty-five patients were treated with ticarcillin disodium, 18 of whom had anaerobic infections that included pleuropulmonary infections (seven), mandibular osteomyelitis (four), perirectal abscess (two), sepsis, primary site unknown (one), liver abscess (one), pelvic abscess (one), decubitus ulcer (one), and synergistic gangrene (one). Seven had no anaerobic infections. Three had anaerobic septicemia. Culture results included anaerobes: peptococci (ten), peptostreptococci (ten), Bacteroides fragilis (six), Bacteroides not fragilis (ten), eubacteria (three), fusobacteria (two), Clostridium (one), Veillonella (one), and acidaminococcus (one); aerobes: Proteus (three), Klebsiella (two), Escherichia coli (two), and streptococci (two). Six patients with mixed aerobic infections initially received gentamicin sulfate in addition. The serum levels were 110 +/- 20 microgram/ml one hour after intravenous infusion of 5 g of ticarcillin disodium. All anaerobic isolates were susceptible at less than or equal to 100 microgram/ml and 85% by less than or equal to 25 microgram/ml of ticarcillin. Sixteen patients responded well to ticarcillin and two failed to respond. Our study suggests that ticarcillin is useful in the treatment of anaerobic infections.
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PMID:Ticarcillin disodium in anaerobic infections. 71 11

We have reviewed the records of 48 patients who had colonic volvulus. Volvulus occurred in the sigmoid colon in 27 (56%) and in the right colon in 19 (40%). Volvulus elsewhere in the colon is rare, requiring unusual anatomic circumstances of a long mesentery and a mobile colon. The clinical history is characterized by a long history of bowel dysfunction followed by an episode of acute intestinal obstruction. The patient is often aged and is plagued by mental disorders and a number of degenerative diseases. Distention of the abdomen is the most significant finding, and tenderness may indicate peritonitis due to ischemic changes in the bowel. Three-positional films of the abdomen are most valuable, showing great distention of the colon and air-fluid levels in the bowel with regularity. Barium-enema studies will more accurately reveal the site and nature of obstruction. The barium-enema examination must be done carefully. It is omitted when peritonitis is present. Operative treatment is necessary for volvulus of the right colon. Non-operative reduction is effective for nonstrangulating volvulus of the sigmoid colon as an emergency procedure. Sigmoidoscopic examination and insertion of a long rubber tube will give dramatic relief to a substantial number of patients. Operative intervention is necessary when conservative measures fail. When gangrene is found at operation, exteriorization resection of the colon may be life-saving. Elective resections are recommended for patients who are in otherwise good health in order to prevent recurrences. The mortality rate in this series of 48 cases was 12.5 per cent. Cecal volvulus was present in each of the six patients who died. Sepsis and cardiopulmonary diseases were common in patients who died.
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PMID:Volvulus of the colon. 86 92

Necrotic colitis in the absence of organic obstruction of the mesenteric vessels is an extreme and fulminant form of ischemic colitis. This calamity with its high mortality rate usually occurs in patients with pre-existent cardiopathy. It is rare for necrotic colitis to occur as a complication of hypotension, hypovolemia or sepsis. A report is presented of a case of total gangrene of the colon in a patient with hemorrhagic shock. Certain concepts are presented concerning the etiology of non-occlusive intestinal infarction. It is postulated that the fulminant gangrene of the colon is co-induced by Gram-positive rods which are demonstrable even in the deep layers of the colonic wall.
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PMID:Necrotic colitis in the presence of normal vascularization of the colon. 93 61

A conservative regime for distal digit amputations allowing healing under vaseline gauze has much to recommend it, being simple and allowing rapid healing with few complications. Secondary distal amputations for gangrene and sepsis also heal rapidly if left open. A consecutive series of 55 amputations treated in this way is described.
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PMID:Conservative treatment of digit amputations. 106 17


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