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

Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.
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PMID:Freezing an extremity in preparation for amputation. 68 74

In 214 patients with healed myocardial infarction an assessment was made of the prognostic value of risk factors relating to early postoperative cardiac decompensation which occurred in 50 cases. A significant influence was shown by age (greater than or equal to 75 years), pre-existing heart failure and load insufficiency, hypertension (greater than or equal to 180/95 mm Hg), advanced arteriosclerosis with cerebrovascular and renovascular symptoms, infections with fever or septicemia, emergency operations, lang-lasting surgery, decrease in blood pressure during operations (greater than or equal to 70 mm Hg systolic) and postoperative anemia (less than or equal to 3.5 millions erythrocytes/cmm). The postoperative cardiac failure took a lethal course in 60%. Pathogenetically, the discrepancy between O2-requirement and O2-supply in the previously damaged myocardium is of essential importance during the postoperative stress period.
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PMID:[Risk factors and pathogenesis of postoperative cardiac decompensation (author's transl)]. 81 21

Nineteen patients aged 1 month to 18 years underwent implantation of a cardiac pacemaker and were followed up for up to 9 years (average duration of pacing 54 months). Complete heart block was present in 16 patients and sinus nodal dysfunction in 3. Heart block was presumably of congenital orgin in eight, secendary to cardiac surgery in seven and subsequent to cardiac catheterization in one. Sinus nodal dysfunction was of presumed congenital origin in one and occurred after cardiac surgery in two. Pacing was required because of syncopal attacks in eight patients, three of whom had congestive heart failure or low cardiac output on physiologic studies. It was required in four because of congestive heart failure, in two because of low cardiac output (one with a wide QRS complex), and in five for postoperative rhythm control. With return of sinus rhythm after 2 and 3 months, respectively, pacing was discontinued in two patients. One child was partially corrected disease died within 3 months, one died of wound breakdown and sepsis after 10 months of pacing and one died suddenly 4 years after implantation. All others have returned to normal activity; only one requires cardiac medication. The degree of emotional stability has been striking. Asynchronous and atrial synchronous pacing are of equal therapeutic value. The very small radiofrequency implanted receiver has been useful in younger children. The major problems have been caused by the large size and short longevity of the generators and the child's growth stressing the lead system. Transvenously implanted pacemakers have presented no greater management problems than those placed during thoracotomy.
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PMID:Cardiac pacing in children and adolescents. 84 40

This report describes the development of fatal pneumococcal pneumonia and septicemia following fiberoptic bronchoscopic examination and endobronchial biopsy of a patient with severe chronic congestive heart failure. Although a causal relationship has not been proven, the temporal sequence seems to favor this over a coincidental nosocomial infection. This case emphasizes that significant and occasionally fatal infectious complications may occur following fiberoptic bronchoscopic examination.
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PMID:Fatal pneumonitis and septicemia after fiberoptic bronchoscopy. 87 39

A unique case of congenital heart disease and complete heart block diagnosed by fetal electrocardiogram (ECG) and phonocardiogram recorded initially at 32 weeks gestation is presented. The slow, regular fetal heart rate of approximately 50 beats/min with bizarre QRS and a diamond-shaped murmur beginning with the fetal QRS complex made a diagnosis of complete heart block (CHB) and associated congenital heart disease highly probable. Direct fetal electrocardiograms (FECG) recorded during labor and vaginal delivery at term confirmed the diagnosis of completel atrioventricular block. Cardiac catheterization at 1 day of age showed multiple congenital heart anomalies. The infant developed signs of congestive heart failure and transvenous pacemaker was successfully placed; however, he died at 9 days of age of sepsis and renal failure.
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PMID:A new prenatal cardiac diagnostic device for congenital heart disease. 90 15

Two cases of nonocclusive mesenteric vascular disease associated with stenosis of the superior mesenteric artery are described. In one patient with congestive heart failure and atrial fibrillation treated with digitalis, the first episode after a bout of sepsis was treated supportively, but a stricture of ileum secondary to full thickness intestinal infarction resulted. His second episode required emergency ileal resection for perforation. The superior mesenteric artery was subsequently reconstructed with an aortomesenteric bypass. The second patient had segmental intestinal necrosis occurring in association with superior mesenteric artery narrowing without total occlusion. These cases emphasize the importance of awareness of nonocclusive mesenteric vascular disease occurring in individuals with narrowing of the mesenteric arteries. A variety of modes of presentation are suggested. Arteriography is essential for diagnosis and, in selected cases, for therapy.
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PMID:Surgical treatment of nonocclusive mesenteric infarction. 92 Aug 97

Complete and unselected data concerning the postoperative pathology of congenital heart disease are presented for the first time. This study was based on 2,365 autopsies performed at the Children's Hospital Medical Center, Boston, in the 9 years from 1966 through 1974. Of these, 586 autopsies (25 percent) revealed congenital heart disease--238 performed in medically treated patients (41 percent) and 348 in surgically treated patients (59 percent). Tetralogy of Fallot, including cases with pulmonary outflow tract atresia and other associated malformations, was the congenital heart disease most often encountered in the postoperative autopsy series (88 cases, 25 percent of that series). D-transposition of the great arteries, including cases with other associated anomalies, was second (54 cases, 15.5 percent). Early death (hospital mortality) accounted for 320 (92 percent) of the 348 surgical cases; late death occurred in 28 patients (8 percent). Causes of late postoperative death included arrhythmias, excessively small ventricular septal defect with tricuspid atresia, massive hemoptysis, rupture of the pulmonary artery, cyanotic spell, congestive heart failure and infection. Prophylactic penicillin is recommended for patients with the asplenia syndrome because of their probably enhanced vulnerability to fulmfulminating septicemia by encapsulated bacteria such as the pneumococcus. Completeness and lack of selection in reporting data are essential in the interests of perspective and comparability of findings.
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PMID:Postoperative pathology of congenital heart disease. 95 66

Combination chemotherapy with adriamycin and DTIC was used in 102 evaluable patients under 15 years of age who had previously treated metastatic solid tumors. Responses, defined as 50% or more reduction in all tumor masses, occurred in 10 out of 27 patients with neuroblastoma, 3 out of 8 patients with Wilms tumor, 7 out 15 patients with Ewing sarcoma, 2 out of 6 patients with osteosarcoma, 5 out of 13 patients with rhabdomyosarcoma, and 15 out of 33 patients with miscellaneous tumors which included a patient who had a complete regression of an extensive juvenile angiofibroma. Response rate to combination chemotherapy with adriamycin and DTIC in patients with Ewing sarcoma was significantly superior to the response rate obtained with adriamycin alone in another Southwest Oncology Group Study. Major toxicity included nausea, vomiting, myelosuppression, high incidence of pneumocystis carinii pneumonia (5 patients) and congestive heart failure (4 patients). There was 7 drug-associated deaths due to sepsis (1), pneumocystis carinii pneumonia (4), and congestive heart failure (2).
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PMID:Combination chemotherapy with adramycin (NSC-123127) and dimethyl triazeno imidazole carboxamide (DTIC) (NSC-45388) in children with metastatic solid tumors. 95 60

Cardiac pathologic findings were analyzed in 22 necropsy cases from a series of 29 patients with leukemia, aplastic anemia, or metastatic cancer who had been treated with ablative therapy followed by bone marrow transplantation. Some cardiac alterations were similar to those that occur in patients with hematologic and neoplastic diseases not treated with bone marrow transplantation, and consisted of cardiomegaly, cardiac atrophy, hemorrhage, foci of necrosis due to shock associated with sepsis or hepatic failure, myocardial abscesses secondary to systemic candidiasis or staphylococcal infection, fibrinous pericarditis, and hemosiderosis. Other cardiac alterations were more specifically related to factors associated with transplantation procedure. Six patients exhibited a distinctive interstitial reactive change characterized by the presence of (1) moderate to large numbers of Anitschkow cells, occurring alone or in small cellular aggregates and histiocytes, histiocytic cells with nuclei of the Anitschkow type, lymphoid cells, and plasma cells, and (2) nuclei of the Anitschkow type in cardiac vascular and endocardial smooth muscle, endothelial and Schwann cells, and occasional cardiac muscle cells. This alteration may have been induced by abnormal immune mechanisms, as suggested by the observation that five of the six patients with interstitial change had clinical evidence of graft-versus-host disease. Two patients developed fatal congestive cardiac failure in the early post-transplant period and exhibited myocardial damage with histologic and post-transplant period features indicative of severe acute injury. Findings in these two patients consisted of necrotic muscle cells, which exhibited multiple contraction bands, diastase-resistant PAS staining, and intracellular fibrin deposits; microthrombi, which were composed of fibrin and occasionally of fibrin and platelets; and extravasated erythrocytes and fibrin strands in the interstitium. One of the two patients also exhibited unusual nuclear alterations, which were characterized by replacement of normal chromatin by palely stained fibrous and filamentous material. Clinicopathologic analysis strongly suggested that the fatal cardiotoxicity in both patients resulted primarily from effects of high doses of cyclophosphamide, which were administered as part of a four drug regimen that provided tumor ablation and immunosuppression for bone marrow transplantation. Our findings emphasize the need for less toxic antineoplastic and immunosuppressive therapy for use in bone marrow transplantation procedures.
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PMID:Cardiac pathologic findings in patients treated with bone marrow transplantation. 110 69

The clinical profile of 28 consecutive patients admitted with infective endocarditis (IE) between 1987 and 1988 was studied. There were 21 males and seven females with a mean age of 24 +/- 11 years. Rheumatic heart disease (RHD) was the commonest underlying disease (68%) followed by congenital heart disease (CHD). Mitral regurgitation with aortic regurgitation were the commonest valvular lesions (47%) in those with RHD while ventricular septal defect was the commonest (43%) in those with CHD. A younger age of onset, complicated course and high mortality were seen in these six patients with acute IE. Persistently positive blood cultures during life or at autopsy were obtained in 21%. Strep viridans was the commonest isolate and was often resistant to streptomycin. 2D echocardicgram revealed vegetations in 96% of patients, the aortic valve (39%) being more commonly affected than the mitral valve (11%). ESR of more than 20 mm drop 1st hour (Wintrobe) was seen in 96%. Thrombophlebitis was a common complication of therapy and cloxacillin the commonest drug implicated. A mortality of 21% as a result of refractory congestive heart failure (CHF) (50%), uncontrolled sepsis (33%) and embolic events (17%) was seen. A rising incidence of culture negative IE, combined aortic and mitral valve disease and CHF is noted.
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PMID:Changing spectrum of clinical and laboratory profile of infective endocarditis. 130 28


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