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

Dysgonic fermenter 2 (DF-2) is a slow-growing gram-negative bacillus causing a zoonotic infection that is acquired through dog bites or other contact with dogs. Splenectomized patients and those with alcoholic liver disease are most susceptible to DF-2 infection. The clinical picture can be one of fulminant septicemia and disseminated intravascular coagulation in the splenectomized patient; the presentation is milder in the alcoholic patient. The overall mortality from DF-2 septicemia among the 41 cases reported in the literature is 27%. The organism is sensitive to penicillin, resistant to aminoglycosides, and not easily grown on common media. It appears to be serum-sensitive in tests with normal human serum. Penicillin prophylaxis of dog bite wounds is especially important in high-risk patients. DF-2 infection should be considered when any splenectomized patient develops fulminant septicemia, disseminated intravascular coagulation, and peripheral gangrene. Examination of a gram stain of the peripheral blood or buffy coat is of value in such cases.
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PMID:Dysgonic fermenter 2 septicemia. 331 33

The entity of postoperative acute cholecystitis has striking features that demand special attention. The process may follow intra- and extra-abdominal procedures, and the diagnosis may be especially difficult after recent abdominal operations. The course of the disease is frequently obscure and fulminant, progressing rapidly to gangrene and perforation of the gallbladder, with a high mortality rate. Six such patients, aged 69 to 83 years, were managed in our department, with one death. The cause of this complication is probably multifactorial and includes: stasis of bile of high viscosity induced by dehydration, hypovolemia, fever, and shock; obstruction at the sphincter of Oddi following starvation, anesthesia, narcotics or other possible factors such as pigment load following blood transfusion; and impaired circulation to the gallbladder secondary to sympathetic stimulation or blood-borne toxic factors induced by septicemia. The key to successful treatment is awareness, early diagnosis, intensive preoperative treatment with fluids and antibiotics, and percutaneous drainage or immediate cholecystectomy.
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PMID:Postoperative acute cholecystitis complicating unrelated operations. 357 Jul 34

Flexible fiberoptic gastrointestinal endoscopy has greatly simplified the diagnosis and treatment of colonic volvulus. The management of 39 patients with colonic volvulus treated over 9 years was reviewed. Five per cent were treated with rectal tube decompression alone, 23% were treated with either sigmoidoscopic or colonoscopic reduction, and 26% were treated exclusively with operation. Endoscopic reduction was attempted in nearly half of the patients in preparation for operation. Recurrent volvulus occurred in 57% of patients initially treated with endoscopic reduction alone. Sigmoidoscopic examination did not confirm the diagnosis in 24% of instances in which it was used, although colonoscopy was always diagnostic. The overall mortality rate was 8%, but increased to 25% in patients with gangrene of the colon. Three patients who later proved to have gangrene of the colon had a normal initial sigmoidoscopic examination. Two of these patients died of intra-abdominal sepsis from a perforated colon. In five patients an accurate endoscopic diagnosis of gangrene prompted immediate exploration. None of these patients died. Endoscopy is a safe and effective diagnostic tool for the initial evaluation of patients with suspected colon volvulus. In addition, endoscopy may result in therapeutic decompression and may provide visual assessment of the viability of the bowel mucosa, thus assisting in the timing of appropriate operative treatment.
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PMID:Endoscopy in colonic volvulus. 360 28

Diabetic foot lesions are a common medical problem with major socioeconomic impact. Gangrene is usually a late and sometimes fatal complication. A series of 118 diabetic patients who underwent amputation of the lower limb at our institution over a 10 year period has been presented. Forty-two patients underwent amputation of the toes or part of the foot, 48 underwent below-knee amputation, and 18 underwent above-knee amputation. In 24 (20.3 percent), the necrotic process advanced postoperatively and necessitated additional amputation. The average hospital stay was 33.6 days. Twenty-eight patients (23.7 percent) died during the postoperative period, and the main cause of death was sepsis. Patients who presented with extensive gangrene had a higher mortality rate. There was no correlation between mortality and the duration of conservative treatment, number of repeated operations, the treatment of diabetes before hospitalization, onset of symptoms, or status of the peripheral pulses. The solution to the problem is early and vigorous preventive treatment. This could be accomplished through highly specialized clinics within the community.
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PMID:Gangrene of the lower limbs in diabetic patients: a malignant complication. 363 9

When a patient with neuropathic diabetic gangrene of the foot has sepsis, it is not always necessary to do a below-knee guillotine amputation or a Syme's amputation. In more than six years we have done 18 successful open Lisfranc's and Chopart's amputations. Improved ambulation has been achieved in three months using simple shoe prostheses. All flaps are fashioned immediately and never sutured. No equinus deformities have developed.
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PMID:Resurrection of the amputations of Lisfranc and Chopart for diabetic gangrene. 363 41

A 62 yr-old man with a recent history of dog bite and a past history of splenectomy developed septicemia and signs suggestive of a generalized Schwartzman reaction, including fever, hypotension, symmetrical peripheral gangrene and laboratory evidence of consumptive coagulopathy. The causative organism was a Dysgonic Fermenter-2 (DF-2), a designation given to an unnamed group of Gram-negative rod shaped bacteria. This organism has not previously been reported in Australia. A review of documented cases of serious infection suggests that splenectomy and dog bite are predisposing factors to disease caused by this organism.
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PMID:Dysgonic fermenter-2 septicemia. 372 27

From 1977 to 1984, 87 above- and below-knee amputations were done on 77 patients for ischemic ulcerations and gangrene of the lower extremities. The overall three-month mortality was 14% and was mainly related to generalized atherosclerosis. Patients having infections with gas formations were more likely to be diabetic (80% vs 15%, P less than .01), have clinical sepsis and a higher preoperative WBC (19,000 vs 12,600/cu mm, P less than .01), and have a higher mortality (40% vs 12%, P less than .05) than those with infections due to non-gas-forming organisms. Mixed bacterial flora were cultured from most wounds. We conclude that infections with gas formation may be due to either clostridial or nonclostridial organisms, mortality is higher if gas accumulates and if the patient is diabetic, gas is more likely to accumulate in infected extremities of diabetic patients, and the combination of gas formation and diabetes is highly lethal.
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PMID:Infections of the lower extremities due to gas-forming and non-gas-forming organisms. 378 84

Symmetrical peripheral gangrene (SPG) is a rare syndrome associated with a multitude of underlying medical problems. We are adding three cases of SPG to the medical literature, all of which had disseminated intravascular coagulation (DIC). Each had an underlying illness that, to our knowledge, has not been previously associated with SPG: Hodgkin's lymphoma, Escherichia coli urinary tract infection with septicemia, and polymyalgia rheumatica. Review of the medical literature shows a high association between SPG and DIC. Symmetrical peripheral gangrene should therefore be considered a cutaneous marker of DIC. Early recognition and treatment of the underlying medical problem and DIC could be lifesaving.
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PMID:Symmetrical peripheral gangrene and disseminated intravascular coagulation. 389 58

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the early, rapid, and radical debridement of all devitalized tissues and prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.
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PMID:Gangrene of male external genitalia in a patient with colorectal disease. Anatomic pathways of spread. 401 14

Over a 20-year interval, 167 patients sustained acute full-thickness abdominal wall loss due to necrotizing infection (124 patients), destructive trauma (32 patients), or en bloc tumor excision (11 patients). Polymicrobial infection or contamination was present in all but five of the patients. Of 13 patients managed by debridement and primary closure under tension, abdominal wall dehiscence occurred in each. Only two patients survived, the 11 deaths being caused by wound sepsis, evisceration, and/or bowel fistula. Debridement and gauze packing of a small defect was used in 15 patients; the single death resulted from recurrence of infectious gangrene. Pedicled flap closure, with or without a fascial prosthesis beneath, led to survival in nine of the 12 patients so-treated; yet flap necrosis from infection was a significant complication in seven patients who survived. The majority of patients (124) were managed by debridements, insertions of a fascial prostheses (prolene in 101 patients, marlex in 23 patients), and alternate day dressing changes, until the wound could be closed by skin grafts placed directly on granulations over the mesh or the bowel itself after the mesh had been removed. Sepsis and/or intestinal fistulas accounted for 25 of the 27 deaths. Major principles to evolve from this experience were: 1) insertion of a synthetic prosthesis to bridge any sizeable defect in abdominal wall rather than closure under tension or via a primarily mobilized flap; 2) use of end bowel stomas rather than exteriorized loops or primary anastomoses in the face of active infection, significant contamination, and/or massive contusion; and 3) delay in final reconstruction until all intestinal vents and fistulas have been closed by prior operation.
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PMID:Management of acute full-thickness losses of the abdominal wall. 626 97


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