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

We present our experience with performing an exploratory laparotomy for peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Six of 134 patients undergoing CAPD during the study period underwent surgical intervention because of abdominal sepsis. Two patients had bacterial peritonitis without abscess formation or evidence of visceral perforation and they recovered readily and, in retrospect, may not have required an operation. Of the three patients with fungal abscesses, two died of subsequent bacterial sepsis, while one patient survived, albeit after drainage of a recurrent pelvic abscess. One patient died because of extensive intestinal gangrene that was misdiagnosed as CAPD-related peritonitis initially. Our experience with these cases suggests that fungal peritonitis is a life-threatening complication that may result in both formation of an abscess and death. Therefore, it warrants aggressive antifungal chemotherapy and surgical intervention should an abscess be discovered. In contrast, bacterial peritonitis should be treated with appropriate antibiotic regimens until adequate evidence indicating the presence of a surgical condition is obtained.
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PMID:Ambulatory peritoneal dialysis. Exploratory laparotomy for peritonitis. 639 19

Purpura fulminans presents as a catastrophic illness with gangrene of the distal extremities and necrosis of skin. The clinical picture consists of septicemia, shock, and disseminated intravascular coagulation. The Shwartzman and Arthus reactions are thought to be responsible for the pathogenesis of purpura fulminans. The exact mechanisms of these reactions are not completely understood. Immediate resuscitation is the treatment for shock and sepsis. Heparin is recommended to reverse the disseminated intravascular coagulation component of this disease. Surviving patients require treatment of skin necrosis and digital and extremity gangrene. The former are managed in a fashion similar to the management of burns. Amputation should be delayed until maximal collateral circulation has developed. A series of 10 patients is presented and 58 cases from the literature are analyzed.
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PMID:Purpura fulminans. 646 Dec 69

During the past five years 75 patients aged 90 years or more had 85 major surgical procedures at the Metropolitan Nashville General and Vanderbilt University hospitals. The most common operation was exploratory laparotomy. The second was lower extremity amputation for peripheral vascular disease and/or gangrene. Fifty-seven percent had general endotracheal anesthesia. Associated medical problems were common, and included congestive heart failure (24%), hypertension (21%), diabetes mellitus (13%), chronic arrhythmias (9%), history of myocardial infarction (8%), and history of cerebrovascular accident (5%). Eleven patients (13.4%), six of whom had general anesthesia, died after operation. Of these, two had postoperative pneumonia, two did not recover from bowel perforation and peritonitis, one had a postoperative myocardial infarction, another had a cerebrovascular accident, and one had sepsis. One patient's sudden death was likely due to myocardial infarction or pulmonary embolus. The other three deaths occurred in patients with extensive carcinomas (gallbladder carcinoma in one and widely metastatic carcinoma of unknown origin in two). These three patients died of the disease for which they were operated upon when the operation failed to alter its course. When surgical procedures are necessary to prolong and/or improve the quality of life in elderly patients, these procedures may be done in most cases with acceptable results.
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PMID:Surgical procedures in patients aged 90 years and older. 649 54

A group of five diabetic patients had gangrene or failed limited amputations and palpable foot pulses in a total of seven limbs. Because a failure to heal persisted and gangrene progressed, arteriography was performed and disclosed occlusion of all three infrapopliteal arteries. Tibial bypass grafting resulted in complete healing in four of the five patients. The fifth patient refused surgery and died with progressive sepsis. The incidence of this unusual syndrome is unknown, but presumably it is rare. The mechanism of pulse formation in the foot, despite occlusion of the infrapopliteal vessels, is dependent on good flow to the popliteal artery, collateral flow to the rigid distal tibial-peroneal vessels, compliant ankle arteries, and highly resistive distal foot vessels. Although healing of limited amputations is usual in diabetic patients with foot pulses, it is not universal. We recommend that arteriography be performed routinely if gangrene is present and the foot is salvageable, irrespective of pedal pulse status.
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PMID:The need for arteriography in diabetic patients with gangrene and palpable foot pulses. 649 29

Clostridium septicum is a virulent cause of gas gangrene and sepsis. Although thought to be rare, a survey of our affiliated hospitals for a recent five-year period disclosed eight cases. Seven of the eight had an occult malignant neoplasm. The eighth patient was thought to be preleukemic. All seven malignant neoplasms involved the gastrointestinal tract. Four patients were admitted with gangrene of an extremity, three with abdominal pain, and one with both. In four patients, C septicum septicemia appeared in an extremity before the underlying gastrointestinal malignant neoplasm was recognized. Four patients had surgical therapy and two survived; four received medical therapy and one survived. Patients who have C septicum septicemia should be assumed to harbor an underlying malignant neoplasm until proved otherwise.
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PMID:Surgical aspects of Clostridium septicum septicemia. 671 67

Extensive gangrene of both lower extremities necessitating bilateral above-the-knee amputations complicated the adult respiratory distress syndrome (ARDS) caused by Escherichia coli pneumonia and septicemia in a 52-yr-old man. Concurrent with the evolution of tissue necrosis, peripheral blood leukocyte and platelet counts fell, and pulmonary vascular resistance increased. Adequacy of the cardiac output was confirmed by repeated thermodilution cardiac output measurements, and major vascular occlusion was excluded surgically. Fibrin degradation products and thrombocytopenia were present, but the other usual criteria for disseminated intravascular coagulation were absent. Small vessel thrombosis by fibrin and leukocytes was observed histologically in the amputated extremities. These findings suggest that gangrene was due to the "microembolism syndrome"--diffuse small vessel occlusion by fibrin thrombi complicating ARDS. This unusual complication of ARDS may occur without abnormalities suggestive of diffuse intravascular coagulation in routine laboratory tests of blood coagulation. It should be suspected and treated promptly to avoid severe disability in survivors.
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PMID:Ischemic necrosis of both lower extremities as a result of the microembolism syndrome complicating the adult respiratory distress syndrome caused by Escherichia coli pneumonia and septicemia. 675 35

A family history encompassing four generations is presented. Definite cyclic neutropenia has been noted in two generations. In one member, the symptoms abated as she grew older. One 12-year-old member died of clostridial septicemia secondary to gangrene of the terminal ileum. At autopsy he was found to have amyloidosis. A trial of lithium carbonate therapy was carried out in a 7-year-old male but a positive hematologic response was not obtained.
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PMID:Cyclic neutropenia. A tale of two brothers and their family. 679 55

While 32% of the patients in this series who required amputation in the lower limb presented with infected or gangrenous toes, only 9% had pedal pulses. In a prospective study of 26 phalangectomies and 9 ray or transmetatarsal amputations, the definition of a successful procedure was taken as a healed, painless wound at 1 month. By 1 month, 6 wounds were healed, 5 pain-free and granulating and 8 septic or painful; 16 patients had had further surgery. In the end 14 of 35 feet were salvaged, with 2 patients lost to follow-up and 4 with painful or septic feet. The 15 patients who later required below-knee or above-knee amputations were pain-free, but 7 could not be rehabilitated on prostheses. Blood supply and sepsis affected the healing rate, whereas diabetes was unimportant. The final salvage rate was apparent within 1 month of the initial surgery. In the absence of a pedal pulse, the use of clinical judgement for the selection of patients with dry gangrene gave a 50% salvage rate, but only 8 patients were selected for local surgery out of the total of 24 in this category. Sixteen amputations were performed for sepsis in the absence of a pedal pulse; no wound healed and only 2 patients had a clean, pain-free, granulating wound at the end of the 1-month period. Direct arterial surgery played an important role in restoring the pulse prior to amputation.
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PMID:Amputation of gangrenous toes--effect of sepsis, blood supply and debridement on healing rates. 685 28

Four patterns of tissue involvement can be distinguished in sepsis due to gram-negative enteric bacilli. When intense local inflammation predominates, cellulitis or thrombophlebitis results, often with venous or arterial obstruction. Bacteria are present in the affected tissues, but not in sufficient numbers to be seen microscopically. When bacterial proliferation is unchecked by an appropriate leukocyte response, ecthyma gangrenosum, erythema multiforme, or diffuse bullous lesions may occur with minimal clinical or histologic signs of inflammation. In symmetric peripheral gangrene associated with disseminated intravascular coagulation, bland fibrinous deposits are seen in small vessels but neither inflammatory cells nor bacteria are present. The fourth kind of lesion is that seen in bacterial endocarditis. In all four patterns a vascular component is prominent clinically and histologically. The pathogenesis of these lesions is multifactorial; in each individual case the interaction between bacterial and host factors probably determines which clinical picture will result. The appearance of symmetric soft tissue lesions of the extremities in the absence of predisposing local conditions suggests the possibility of sepsis due to gram-negative bacilli, especially if other clinical features indicate that sepsis might be present.
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PMID:Cutaneous and soft-tissue manifestations of sepsis due to gram-negative enteric bacilli. 701 88

Acute acalculous cholecystitis was observed to increase in frequency between 1950 and 1979, an increase that was statistically significant. The greatest part of this increase occurred between 1965 and 1979. Acute acalculous cholecystitis was also found to be associated with a higher mortality rate, more than twice that of acute calculous cholecystitis. Acute acalculous cholecystitis occurred in a variety of clinical settings including bacterial sepsis, severe trauma including surgical trauma and burns, multiple transfusions, and severe debilitation. The lesion in the gallbladder consists of intense injury of blood vessels in the muscularis and serosa similar to those induced experimentally by in vivo activation of factor XII dependent pathways. Possibly because of the intensity of vascular injury, acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Undelayed surgical treatment, which has become more widely accepted over the past 50 years, is essential. It may have also contributed to the increased recognition of this clinical entity.
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PMID:Acute acalculous cholecystitis. An increasing entity. 705 88


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