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

The results of 111 acute below-knee amputations in war wounded were reviewed. The majority of the patients were wounded by exploding mines. The amputation stumps were not closed primarily but secondarily after an average of 6.4 days. Reamputation above the knee was necessary in only one case of wound sepsis. After delayed primary closure 84% of the stumps healed without problems. The best results were obtained when the stump closure was performed within 1 week after the amputation. No cases of gas gangrene or tetanus were encountered.
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PMID:Below knee amputation in war surgery: a review of 111 amputations with delayed primary closure. 843 4

Hepatic artery thrombosis (HAT) after adult orthotopic liver transplantation (OLT) is associated with fulminant sepsis and irretrievable loss of the graft. The purpose of this study was 1) to identify recipients at risk for the development of HAT; 2) to define early signs and methods for diagnosis; 3) to determine surgical treatment strategies following diagnosis of HAT. The charts of 680 adults who underwent primary OLT were reviewed. Eleven patients were symptomatic from HAT. Operative data revealed problematic arterial reconstruction in 9/11, and were related to inadequate recipient inflow, necessitating an interposition allogeneic iliac graft in seven patients, or anastomosis to aberrant right hepatic artery in two recipients. Early HAT in 4/11 occurred within 4 weeks after transplantation, whereas late thrombosis in 7/11 was identified 30 days to 1 year after OLT. The postthrombosis course was manifested by elevated liver transaminases (7/11), sepsis and recurrent cholangitis (9/11), or gas gangrene of the liver (4/11). The treatment modalities included thrombectomy and revision of the arterial anastomosis (1/11), emergency hepatectomy with temporary portocaval shunt (2/11), and urgent retransplantation (5/11). Antibiotic therapy and elective retransplantation was the treatment in 4/11. Overall 1-year patient survival and satisfactory graft function was 45 percent.
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PMID:Etiology and management of symptomatic adult hepatic artery thrombosis after orthotopic liver transplantation (OLT). 860 85

The authors present a case report regarding abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy. Capacitive coupling was considered to be the most probable cause of small intestine perforation and further complications. Despite intensive treatment, the 69-year-old patient died.
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PMID:Small intestine perforation because of capacitive coupling as a cause of abdominal wall gas gangrene and clostridial sepsis after laparoscopic cholecystectomy. 1114 21

Bacteremic episodes caused by anaerobes are unusual and the clinical importance of Clostridium bacteremia remains unclear. This retrospective case study examined the risk factors among a group of patients who developed Clostridium bacteremia. Medical records from 73 episodes of clostridial bacteremia in 73 patients treated in a medical center during an 11-year period were reviewed. Of all episodes, 96% were community-acquired. Twelve percent of patients had polymicrobial bacteremia, with Escherichia coli being the most common accompanying bacterium. Diabetes mellitus (26%) and liver cirrhosis (25%) were the most common underlying diseases. The most common etiological organisms were Clostridium perfringens (77%), Clostridium bifermentans (9%), and Clostridium septicum (4%). Only one patient with C. septicum bacteremia had a histocytotoxic infection, which was a fatal gas gangrene. Univariate analysis of data from patients with monomicrobial Clostridium bacteremia revealed that younger age (age < 65 years), underlying liver cirrhosis, and presence of septic shock at initial presentation were associated with fatality; but only the latter two variables were independently associated with fatality in multivariate logistic regression analysis. Appropriate antimicrobial therapy for monomicrobial Clostridium bacteremia did not significantly affect clinical outcomes, which might suggest that Clostridium species in the bloodstream can be regarded as merely contaminants or transient bacteremia. This suggestion was not supported by the finding that seven of 13 cirrhotic patients with monomicrobial Clostridium bacteremia died of sepsis, of whom six had not receive appropriate antimicrobial therapy. Therefore, the clinical importance of Clostridium bacteremia should be interpreted with caution because of its high risk of mortality in susceptible hosts, particularly cirrhotic patients, who do not receive appropriate therapy timely.
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PMID:Clostridium bacteremia: emphasis on the poor prognosis in cirrhotic patients. 1145 56

We experienced two patients having Aeromonas species infection with severe clinical manifestations. The one patient was a 15-year-old high school girl student, who had been healthy in her school life, was admitted to the hospital with a sudden onset of left thigh muscle pain and swelling. She subsequently went into septic shock and died one day after admission. Pathological examination on autopsy revealed massive gas formation, skin bullas and ulcers, and extensive severe soft tissue damage throughout the body. Also, all the specimens, including brain, liver, spleen, thigh muscle, and blood in cardiac cavity, were positive for A. veronii biovar sobria. The other patient was 35-year-old man, who suffered from multiple bone fractures during the work in the harbor. One day after admission, he became febrile and went into septic shock. With the presumptive diagnosis of sepsis and gas gangrene, amputation of left thigh was performed. The exudate and aspirate of the amputated portion were repeatedly positive for A. hydrophila. Through the surveillance in Okinawa, Kagoshima, Miyazaki, and Kumamoto Prefectures, a total of 426 isolates from blood cultures were collected in the period from August, 1999 to February, 2000. Of these, 14 isolates (3.3%) were the species of Aeromonas. Of 14 isolates of Aeromonas, 13 were reported from Okinawa and the remaining one was from Kumamoto. Most patients had underlying diseases, particularly liver diseases including liver cirrhosis. The mortality rate was extremely high at 62.5%, and the patients died in short terms after blood culture became positive. With these, Aeromonas species infection is unique to Okinawa, and positive blood culture for Aeromonas species potentially indicates a high-risk, particularly among the patients with underlying diseases.
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PMID:[Aeromonas species infection with severe clinical manifestation in okinawa, Japan -association with gas gangrene-]. 2679 Apr 86

This is a retrospective study of limb amputations in Ile-Ife, Nigeria during a thirteen-year period (1987-1999). 82 patients were studied with a mean age of 35 +/- 22 years. 63 of the patients were adults, while 19 patients were children aged 15 years and below. Trauma was indicated as a reason for amputation in 60 patients (73.4%). Road traffic accident with peripheral vascular compromise was the single most common reason for amputation (41.7%). Forty-seven of the 82 patients had lower limb amputations, while the others were in the upper limbs. There was delay in performing amputation in some patients due to refusal to accept the procedure in 10(12.1%), logistics in 5(6.1%) and lack of finance in 3 (3.7%). The average healing time of the amputation stump wounds was 47 +/- 36 days. In 68.3% of cases, there was wound infection and the wound healing time was 63 +/- 45 days, much longer than than the general average. Other complications were flap necrosis, gas gangrene, osteomyelitis of the bony stump, and tetanus. Six patients died from sepsis and one from chronic renal failure, a hospital mortality rate of 8.5%. Prosthesis could not be fitted in any of the patients during the hospital admission and only three of the diabetic patients attended follow up clinic for up to two years; others absconded within 3 months of discharge from hospital. It will be possible to reduce the rate of amputation and improve the quality of life of patients with amputation if more attention is placed on accident prevention and injury control.
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PMID:Indications for amputations in Ile-Ife, Nigeria. 1222 53

An analysis of causes of maternal deaths in the Southern Highlands Zone of Tanzania, concentrating on avoidable factors contributing to these deaths, was conducted in 1983. Deaths were ascertained by forms sent to doctors in hospitals and assistants in health centers, by visiting hospital and centers regularly, and from reports to Regional Medical Officers. The majority of deaths occurred in hospitals, producing a maternal mortality rate of 2.5/1000 in hospitals, compared to 0.8/1000 for the Zone overall. Total numbers and notable cases were discussed in each of the following etiologies: ectopic pregnancy (1), sepsis after abortion (20), placenta previa (3), eclampsia (4), postpartum hemorrhage (21), anemia (3), obstructed labor (6), puerperal infection (10), sepsis after surgery (7), puerperal pulmonary embolism (2), aspiration after anesthesia (1), herbal medicines (2). The greatest number of deaths were in gravida 3 women. The main avoidable factors were lack of blood for transfusion, no partogram being kept in labor, and risk factors noted but not acted upon. Blood was not available for several reasons: blood not kept in maternity ward, equipment not available to transfuse and relatives refused to give blood. Some other avoidable risk factors were: lack of or slow transport to facility, interference abortion, no antenatal care, lack of gas gangrene serum, packing vagina with cloths to stop bleeding, staff errors. It was felt that isolation of rural doctors contributed to errors, which may possibly be avoided by holding periodic seminars and reviews.
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PMID:Preliminary report on maternal deaths in the Southern Highlands of Tanzania in 1983. 1228 47

The abolition of legal abortion in the US would seriously threaten the health, and even the lives, of women and children. Statistics on the relationship between abortion and health attained before and after abortion was legalized were used to project some of the probable consequences of reversing the US Supreme Court's 1973 Roe v. Wade decision. Abortion has been widely practiced throughout US history, but the actual number of procedures performed before some states legalized abortion is unknown. Few legal procedures were performed for medical reasons, yet many illegal abortions took place. In 1955, a panel of experts could only provide a "best estimate" of between 200,000 and 1,200,000 illegally induced abortions occurring annually in the US. The actual number was most likely closer to the higher figure. The complication rates for illegal abortions, most of which were performed by unskilled practitioners in unsafe settings, were much higher than the rates for legal abortion now. Complications were related to ineffective or unsafe methods, Sepsis, particularly with the bacterium "Clostridium prefringens," which causes gas gangrene, was a major problem that has virtually disappeared. Each year prior to the 1970s, more than 100 women in the US died of abortion complications. Due to the fact that vital statistics reflect an incomplete ascertainment of deaths, the actual number of deaths is probably larger, possibly by as much as 50%. In 1983 more than 1.3 million procedures were performed -- a figure close to the estimated number of illegal abortions performed before 1970. In comparison, 672,000 hysterectomies and 424,000 tonsillectomy operations were performed the same year. The number of abortion-related deaths in the US decreased between 1972 and 1980, from 90 to 16. Most of this decrease resulted from the availability and safety of legal abortion. Legal abortion carries an especially low risk of death, particularly when performed in the 1st trimester. For the 1972-80 period, the risk of death was 1.9/100,0000 abortion procedures. Legal abortion also has a lower risk of death than does childbearing. Using even conservative data, the comparison of mortality rates reveals that terminating a pregnancy through legally induced abortion is 7 times safter than carrying the pregnancy to term. Legal abortion also results in low morbidity rates. As legal abortions became widely available, the numbers of women treated for septic abortion complications in emergency rooms and hospitals decreased markedly. If abortions were again made illegal, the number of illegal abortions in the US would probably increase from fewer than 20,000 at present to more than 1,000,000 per year. Because illegal abortion may carry a risk of death as much as 30 times that of legal abortion, deaths to women of reproductive age in the US would be expected to increase.
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PMID:Health benefits of legal abortion: an analysis. 1234 Apr 4

The occurrence of late hepatic artery thrombosis after orthotopic liver transplantation can result in gas gangrene of the graft. This clinical scenario has the potential to be rapidly fatal as a result of fulminant hepatic failure, sepsis and multiple-organ-failure syndrome. Emergency operative intervention is indicated to remove the septic source and replace the failed liver. In this report, both cases demonstrated rapid deterioration within 24 h from the onset of symptoms, in spite of maximum supportive care. Intra-operative handling of the gangrenous graft resulted in hemodynamic instability and a technically unfeasible hepatectomy. The use of extra-corporeal veno-atrial bypass, by isolating the septic source, allowed for graft hepatectomy and successful re-transplantation in the second of these reported cases.
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PMID:Veno-atrial bypass for the operative treatment of septic gas gangrene secondary to delayed hepatic artery thrombosis. 1278 May 69

Clostridial myonecrosis or gas gangrene occurs most frequently in contaminated wounds following trauma or surgery. It is caused by a wide variety of Clostridium species, the most common being Clostridium perfringens. Spontaneous, non-traumatic clostridial myonecrosis is uncommon and is usually associated with gastrointestinal and haematological malignancy, diabetes mellitus and peripheral vascular disease. The case of a previously healthy 16-year-old boy with acute onset of gastrointestinal symptoms, who died of bacterial sepsis without apparent preceding trauma, is presented here. Clostridium fallax was identified as the most probable causative agent. As far as is known, this is the first report of fatal sepsis in humans due to C. fallax, which has been described only rarely as a cause of gas oedema in animals.
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PMID:Clostridium fallax associated with sudden death in a 16-year-old boy. 1515 Mar 41


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