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

From 1978 through 1987, thirteen pediatric patients aged 14/12 years to 16/12 years were hospitalized for infective endocarditis (IE). Ten cases presented as acute septicemia with modification or development of a murmur and/or heart failure. Three patients had subacute endocarditis. Prior to the endocarditis, ten patients had recognized heart disease, whereas three had no known cardiac abnormality. The organism was recovered in seven cases, from blood cultures in six cases (3 Staphylococcus aureus, 1 group D streptococcus, 1 Staphylococcus albus, and 1 Salmonella typhi) and from a prosthesis in one case (Corynebacterium). Echocardiography confirmed the diagnosis in every patient except the one that had a prosthesis. Although all the patients received parenteral antimicrobial therapy, selected according to bacteriologic data when available, complications developed in every case, including heart failure in nine patients. Three children died, eight underwent valve replacement or repair once the infection was under control, and two have residual valvular disease. This study confirms that, in pediatric patients, the prognosis of IE remains severe despite advances in antimicrobial therapy and the contribution of echocardiography.
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PMID:[Infective endocarditis in children. Apropos of 13 cases]. 264 36

This study reviews our experience in 83 cases of brain abscesses in children diagnosed at seven teaching hospitals during the 10-year period from June 1978 to July 1987. The average age of the patients was 7 years, with 12% of them less than 1 year old. The male-to-female ratio was 1.7:1. Of the brain abscesses, 90.4% were detected by CT brain scan. A total of 50.6% patients had congenital heart disease, and 20.4% patients had sepsis and/or meningitis. Only 6% cases had ear, nose, and throat infection. Sixty-eight (81.9%) patients received a combination of antibiotics and surgical treatment. The cerebral abscesses were totally excised in 26 cases, aspirated and partially excised in 6, and aspirated in 32. Sixty patients had pus cultures from the cerebral abscesses. Organisms were isolated in 29 (49.2%) of them. Streptococcus was by far the most common organism. The overall outcome was: 49 (59%) alive; 16 (19.3%) dead; 18 (21.7%) lost to follow-up. Among the 16 mortalities, the causes of death were due to failure to treat the diseases causing the brain abscesses. We had a better outcome in patients whose cerebral abscesses were totally excised or whose abscesses were aspirated, and in patients who were older than 1 year of age.
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PMID:Brain abscesses in children--a cooperative study of 83 cases. 270 72

The single breath test for carbon dioxide (SBT-CO2) is the plot of expired FCO2 or CO2% against expired volume. It can be monitored during anaesthesia and in the intensive care unit with modest additions to generally available equipment. This paper describes some aspects of a computer program for presenting SBT-CO2 during controlled ventilation, in particular, the corrections to the primary data necessary for scientific accuracy. Examples are given of how the use of SBT-CO2 has increased our understanding of factors which influence the arterial-end-tidal PCO2 difference (PaCO2-PE,CO2). PaCO2-PE, CO2 is, in a given individual, usually dependent on tidal volume and frequency. Changes in lung volume and manoeuvres such as opening the pleura also affect gas exchange. Monitoring CO2 elimination gives a measure of metabolic rate if ventilation and pulmonary perfusion are maintained. This facilitates ventilatory therapy in situations where CO2 production is greatly increased, e.g. sepsis and tetanus. On the other hand, if metabolism and ventilation are unchanged, a reduction in CO2 elimination implies reduced pulmonary perfusion. This can be seen during increased right-left shunting, such as in surgery in patients with congenital heart disease.
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PMID:On-line expiratory CO2 monitoring. 309 79

We studied the effects of prostaglandin D2 (PGD2) in six newborn infants, 1 to 2 days of age, who had persistent pulmonary hypertension syndrome and a PaO2 less than 75 torr during mechanical hyperventilation with an inspired oxygen concentration of 100%. Tolazoline and dopamine were used to treat some of the patients. No patients had congenital heart disease or sepsis. Catheters were placed to measure pulmonary and systemic arterial blood pressures. PGD2 was infused intravenously at doses of 1 to 25 micrograms/kg/min. Pulmonary and systemic arterial blood pressures, heart rate, and descending aortic blood gas values were measured before each dose change. Only two of six patients had a transient increase in PaO2. All had an increase in heart rate. Two of six patients had an increase in pulmonary arterial blood pressure. No deleterious effects occurred during the infusion. Four of six patients subsequently died. Although PGD2 is a specific pulmonary vasodilator in fetal and newborn animals, it did not lower pulmonary arterial blood pressure nor improve oxygenation in newborn infants with persistent pulmonary hypertension syndrome.
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PMID:Effects of prostaglandin D2 on pulmonary arterial pressure and oxygenation in newborn infants with persistent pulmonary hypertension. 316 78

Results with mechanical circulatory assistance for the treatment of profound cardiopulmonary failure after conventional heart surgery have been encouraging. Its usefulness after heart transplantation is not known. Since August 1982, eight patients (of 59 transplant patients) have required support 0 to 48 hours (mean, 19.5 hours) after transplantation. The ages of the patients ranged from 7 days to 52 years (mean, 28.4 years). Underlying recipient heart disease was ischemic in three patients, congenital in two, cardiomyopathic in two, and rheumatic in one patient. Preoperative North American Transplant Coordinators Organization (NATCO) classification was status 9 in one patient (on extracorporeal membrane oxygenation [ECMO]), status 1 in five patients, and status 3 in two patients. Reasons for graft failure, although usually multifactorial, were primarily pulmonary hypertension with right ventricular failure in five patients and pneumonia, hyperacute rejection, and fat embolus in one patient each. In three patients, there was a mismatch in graft size (too small in two adults and too large in one neonate). Graft ischemic times ranged from 75 to 229 minutes (mean, 171 minutes). Two patients received mechanical support with an intra-aortic balloon (IAB), three with ECMO, and three with a right ventricular assist device (RVAD). One of the patients on ECMO and two of the patients with an RVAD also had IABs. Duration of support ranged from 4 hours to 8 days (mean, 3.2 days). Initial hemodynamic stability was achieved in all patients. Complications were common, including sepsis in seven patients and kidney failure in five patients. Only three patients were weaned. One patient with pulmonary hypertension, who was treated with ECMO, died 36 hours after being weaned.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mechanical circulatory assistance after heart transplantation. 330 17

An aggressive surgical approach is warranted in all patients with a salvageable weight-bearing pedal surface. Although patients with pedal sepsis (69 limbs) had a lower 30 day limb salvage rate and higher morbidity and mortality rates than those without sepsis (34 limbs), the long-term salvage rates of both groups by life table analysis were not statistically different and remained at the 70 percent level 3 years postoperatively. Peribypass amputation, debridement of the septic foot, or both should be carried out when deemed necessary to decrease the risk of septic complications after revascularization. Other risk factors such as diabetes or heart disease had no bearing on the short-term results of bypass in either the septic or nonseptic group. Autogenous saphenous vein is preferable to synthetic bypass material, especially in patients with ongoing infection. Lastly, even though the medical climate in 1988 must reflect the stark reality of economic restrictions imposed by third-party payors, optimal patient care remains our primary responsibility. We believe that long-term pedal salvage, as achieved by arterial reconstruction, aggressive wound management, and rehabilitation, attains this goal.
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PMID:Do operative results justify tibial artery reconstruction in the presence of pedal sepsis? 340 Aug 15

Infectious endocarditis is occasionally a complication of Staphylococcus aureus sepsis in previously well individuals with no heart disease or history of intravenous drug use. We report a case of a 16 year old who developed Staphylococcal sepsis and endocarditis probably as the result of neglected paronychia of her toes. Despite adequate antibiotic therapy, the infectious process destroyed her aortic valve, thereby producing aortic regurgitation complicated by cerebral embolism. Aortic valve replacement surgery was required. Endocarditis should always be sought with S. aureus bacteremia. Intravenous high-dose antibiotic therapy for at least 4 weeks is the recommended therapy.
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PMID:Staphylococcus aureus endocarditis in a previously healthy adolescent. 341 9

A 4-month-old infant with congenital heart disease and sepsis and arthritis, and subsequently meningitis, caused by an antibiotic-resistant strain of Haemophilus influenzae type b, failed to respond to sequential therapy with ampicillin and trimethoprim/sulfamethoxazole. Following treatment with ceftizoxime, the infant was well for 42 days, until he returned to the hospital and died. A total of 10 Haemophilus influenzae type b isolates, all outer membrane protein subtype 51, was isolated from the pretreatment blood and synovium, cerebrospinal fluid and subdural fluids, and the petrous pyramids at autopsy. Pretreatment isolates had no detectable plasmid DNA, chloramphenicol acetyltransferase or beta-lactamase; the minimal inhibitory concentration for ampicillin (AM) and chloramphenicol (CM) was 0.2 and 0.8 microgram/ml, respectively. However, all cerebrospinal fluid isolates had a 42-44 mD plasmid and produced chloramphenicol acetyltransferase and beta-lactamase; the minimal inhibitory concentration of these isolates to AM and CM were 12.5 and 25 micrograms/ml, respectively, and were also resistant to tetracycline and sulfonamide. Resistance to AM and CM was cotransferred by filter-mating conjugation at a frequency of one to two transconjugants per 10(5) to an Rd haemophilus recipient. Posttreatment isolates from the petrous pyramids also were resistant to AM and CM and produced chloramphenicol acetyltransferase and beta-lactamase activity, but had no plasmid DNA. These findings and data from genetic studies suggested that plasmid-bearing antibiotic-resistant Haemophilus influenzae type b was selected from a heterogenous population, and that the AM/CM resistance transposons were incorporated into the bacterial chromosome.
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PMID:Ampicillin-chloramphenicol-resistant Haemophilus influenzae: plasmid-mediated resistance in bacterial meningitis. 350 Apr 49

The authors report a case of necrotizing enterocolitis which appeared in the first hours of life of a full-term neonate without signs of sepsis. This neonate presented with a severe hypoplasia of the horizontal aorta and very tight coarctation responsible for hepatic, renal and mesenteric ischemia. Reports of enterocolitis as a complication of congenital heart disease are rare and related most often to hypoplastic left heart than to coarctation of the aorta.
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PMID:[A rare cause of neonatal ulcero-necrotizing enterocolitis: aortic coarctation syndrome]. 361 70

A randomized trial was conducted of dexamethasone therapy in infants with bronchopulmonary dysplasia who were dependent on respirators and were not progressing clinically despite conventional treatment. Babies were admitted to the study if they had a roentgenogram and clinical diagnosis of bronchopulmonary dysplasia, were 2 to 6 weeks in age, weighed less than 1,500 g, had made no progress in weaning for the preceding five days, and were free of sepsis, patent ductus arteriosus, and congenital heart disease, and had had no intravenous fat for at least 24 hours. After parental consent was obtained, infants were randomly assigned to control or treatment groups. The study hypothesis was that with steroid treatment, babies could be weaned from the respirator within 72 hours and would show a significant improvement in lung compliance within that time. Sequential analysis exceeded criterion (P less than .05) when seven consecutive untied pairs showed weaning with dexamethasone and failure to wean in control infants. Pulmonary compliance improved by 64% in the treated group and 5% in the control group (P less than .01). No significant intergroup differences were noted in mortality, length of hospital stay, sepsis, hypertension, hyperglycemia, or electrolyte abnormalities. Study design permits the conclusion that dexamethasone can produce substantial short-term improvement in lung function, often permitting rapid weaning from the respirator, but long-term efficacy and safety must be demonstrated by further investigations.
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PMID:Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia. 388 Aug 79


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