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

We have treated several patients who required major, proximal extremity amputations despite a patent infrainguinal in situ saphenous vein bypass graft. To determine those factors predisposing to such paradoxical limb loss, we studied a group of 45 patients who underwent 48 in situ, femorodistal bypass grafts for tissue necrosis and who maintained a patent graft throughout the perioperative period. Within this cohort, we compared two distinct subgroups: Group I, whose limbs (n = 8) ultimately required a major proximal amputation; Group II, whose limbs (n = 40) emerged with a viable foot and did not require a major amputation. There was no significant difference in the incidence of diabetes, renal failure, smoking, or postoperative ankle/brachial index between the two groups. The presence of gangrene (88% vs 45%), invasive sepsis (63% vs 23%), and combined gangrene and sepsis (63% vs 18%) was significantly (p less than 0.05) more prevalent in Group I versus Group II. Forty-three percent of patients with both gangrene and foot sepsis required a major proximal amputation despite a patent graft. Such patients are at high risk for limb loss even if they undergo successful revascularization.
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PMID:Functional failure of patent femorodistal in situ grafts. 277 32

A 68-year-old Japanese woman with sepsis developed a gangrene on her left cheek from a small wound in contact with a gastric tube. Klebsiella pneumoniae was cultured from the sputum, wound, and the blood and was assumed to be responsible for this condition, possibly through thrombosis of an artery.
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PMID:Bacterial gangrene on the cheek of a comatose patient--necrotizing fasciitis or noma. 279 26

Dysgonic fermenter type 2, a gram-negative bacillus that is part of the normal oral flora of dogs and cats, is responsible for increasing numbers of cases of fulminant septicemia in humans. Patients usually have preexisting medical illnesses, but infection also occurs in otherwise healthy individuals. Most infections are acquired through animal contact. Dermatologic eruptions occur in half of the patients with dysgonic fermenter type 2 infection, and include petechiae, purpura, cellulitis, and gangrene.
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PMID:Dysgonic fermenter type 2 septicemia with purpura fulminans. Dermatologic features of a zoonosis acquired from household pets. 280 46

Sixty-five lower-extremity amputations were performed as a result of sepsis in diabetic patients during a 3-year period. Chronic plantar ulcer was the most frequent cause of infection. Other causes of infection included ischemic gangrene, trauma, and web space fissures. Advanced ischemia was infrequent; only 21 (32.3%) had ankle-brachial indices (ABI) less than 0.5. Eight (23.5%) deaths and 12 (35.3%) stump failures followed 34 amputations where the stump was closed, compared with no deaths and 4 (12.9%) stump failures when open amputations were done (p less than 0.02). Partial foot amputations with aggressive local debridement resulted in healing in 10 (71.4%) of 14 cases with revision or grafting. Guillotine transmalleolar amputation is advised when foot salvage is not possible, because only 1 (5.9%) of 17 such procedures could not be revised to the below-knee (B-K) level, whereas 8 (33.3%) of 24 definitive, closed B-K amputations were unsuccessful (p less than 0.02). Infections were polymicrobial, with 5.8 bacterial isolates and 2.3 anaerobes recovered per patient. Anaerobic antibiotic coverage, however, failed to alter outcome. Sepsis, often without advanced ischemia, is an important cause of limb loss in patients with diabetes. Open amputations are recommended, with foot salvage possible in many cases.
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PMID:The septic foot in patients with diabetes. 290 97

Axillofemoral bypass (AXB) was performed on 100 patients who had claudication (19), pain at rest (42), gangrene or ulcer (22), aortic sepsis (14), or unresectable abdominal aneurysm (3). Unilateral (27 grafts), double unilateral (1), or axillobifemoral (72) grafts with Dacron (58), polytetrafluoroethylene (PTFE) (28), ring-supported Dacron or PTFE (12), or other material (2) were performed by 13 surgeons. Eight patients died within 30 days and three major amputations were necessary. Fifty-two (57%) of the 92 survivors had a total of 92 graft complications during a mean follow-up period of 21.5 months. Thirty-two patients underwent 57 reoperations of various types, incurring an additional three deaths and three amputations. Sixty (65%) of the original 92 survivors of AXB avoided reoperation. The 89 patients who survived the original and repeat procedures were followed up through the end of 1984 (62 patients), to late death (23), or to late graft removal (4), whichever occurred first. At these end points, 83 of the 89 (93%) patients had patent grafts. The graft patency rate of the original 100 AXBs by life table was 54% at 36 months; but with reoperation, it was 72%. Among those patients who left the hospital after AXB, the survival rate at 36 months was 69%. Statistically insignificant trends toward improved early patency were noted with bilateral femoral anastomoses, total iliac occlusion, and less severe ischemia. AXB provided safe palliation of severe arterial disease, with overall graft patency exceeding postoperative patient survival according to life-table analysis. However, the safety of AXB was tempered by frequent complications and the necessity for many reoperations to provide maximum efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Axillofemoral bypass: a tool with a limited role. 293 65

Gangrenous dermatitis caused by Corynebacterium ulcerans developed in 63 of 350 wild Richardson ground squirrels (Spermophilus richardsonii). Six squirrels died of toxemia and/or septicemia, but 57 responded to topical and parenteral administration of antibiotics. The epizo-otic was believed to be associated with fighting; infected and carrier ground squirrels most likely transmitted the C ulcerans through bite wounds. Individuals handling ground squirrels should be cautioned that C ulcerans may produce a diphtheria-like disease in human beings.
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PMID:Gangrenous dermatitis caused by Corynebacterium ulcerans in Richardson ground squirrels. 318 92

A 72-year-old widowed woman known to have an organic brain syndrome was hospitalised owing to gangrene of her lower limbs. The gangrene had been caused by an adduction contracture of her hip resulting in pressure on the medial surface of her left leg. In addition she had pressure sores over both trochanters and the sacrum. The smell of putrefication could be sensed from a distance and on examination large white worms could be seen slithering in the decomposing tissue. The patient was pyrexial, oblivious of her surroundings, and without pain. Surgery--limb amputations--would not restore the patient to a cognitive state nor improve here quality of life, but abstinence posed an inherent threat of sepsis, and revulsion to the attendants. The sacral pressure sore was so large that surgical closure was impossible. The question of surgical intervention is discussed.
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PMID:For whom the bells knell. 318 34

Critical conditions had been established in 21 (23.1%) of 91 patients with systemic connective tissue diseases for a 12 year period: renal failure (most often), sepsis, pericarditis with cardiac tamponade, hemorrhagic diathesis, terminal arteritis with gangrene, gastrointestinal perforations with peritonitis, etc. The corticosteroids applied in high doses and predominantly parenterally and the immunosuppressors are the main drugs used in the treatment of these conditions. Plasmapheresis when possible is a useful supplement. The prognosis of the acute critical conditions depends mainly on the affected organ (more favorable in pericarditis with tamponade and unfavorable in renal failure and gastrointestinal perforations with peritonitis (and on the basic disease) more optimistic in systemic lupus erythematodes and very pessimistic in nodal periarteritis and other allergic vasculitis).
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PMID:[The problems of treating acute critical states in diffuse connective tissue diseases]. 321 40

This report is concerned with a short review of 3 reported cases in which rare successive complications occurred in various lapses of time after vascular reconstructive operations. In one, 38 year old man, in a 12 year period after primary endarterectomy of aortic bifurcation and common iliac arteries the following complications occurred consecutively: an aneurysmal formation in the iliac artery with urethero-aneurysmal fistula and severe bleeding from the urinary tract, entero-prosthetic fistula with severe gastro-intestinal bleeding, occlusion of the left iliac artery with severe left leg ischaemia. They were surgically corrected each time with a satisfactory result. In another, a 25 year old man, a traumatic lesion of the iliac artery with false aneurysmal formation took place. After an emergency excision of the aneurysm with graft replacement, early bleeding occurred from the operative wound. It was treated conservatively, which resulted in infection of the graft and crawling sepsis which lasted 6 months. Urethero-prosthetic fistula and occlusion of the femoral artery occurred. It was corrected surgically with a satisfactory result. The last case concerned a 53 year old man with atherosclerotic occlusion of the abdominal aorta, external iliac and femoral arteries. An aorto-bilateral femoral bypass graft was instituted in him. In 10 days, complete gangrene of the sigmoid colon with perforation occurred. Sigmoidectomy with colostomy were performed. After that, further complications developed: (1) massive venous thrombosis of the left leg and (2) progressive left buttock necrosis. The last complication resulted in septicemia and death of this patient after 3 months of treatment.
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PMID:Multifarious complications after vascular reconstructive surgery. Diagnostic and therapeutic errors. 324 87

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two-staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.
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PMID:Giant inguinal hernia. 325 Apr 19


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