Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eight infants were treated for massive symptomatic hemangioma over a 6-year period. The hemangiomas were located in the liver in five infants and in the upper arm, lower leg, and face in one newborn each. Symptoms included congestive heart failure in six infants and platelet trapping in three newborns. Prednisone and surgical excision were curative in six of the eight patients, while two of the eight died of sepsis, congestive heart failure, and continued platelet trapping. Radiation therapy and arteriographic embolization were of limited value.
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PMID:Massive hemangioma in infants: therapeutic considerations. 648 92

The sudden development of diffuse pulmonary infiltration in a patient with SLE presents difficult diagnostic and therapeutic problems to the clinician. In the past ten years, we have seen eight patients with this problem. Neither roentgenograms nor clinical findings were specific. In six patients, pulmonary hemorrhage was found, but in only two of them did it exist alone. In the other four, heart failure, uremia, and coagulopathy complicated the findings. In one patient, P carinii was the cause; in one congestive heart failure, which was not obvious clinically or radiologically, was the cause. Three patients died: one of uncomplicated pulmonary hemorrhage, one with pulmonary hemorrhage occurring during the treatment of pneumonia due to L bozemanii, and one with pulmonary hemorrhage and multiple complications including sepsis due to Candida. On the basis of this experience, we have recommended a plan of action for physicians facing this problem.
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PMID:Severe, acute pulmonary disease in patients with systemic lupus erythematosus: ten years of experience at the National Institutes of Health. 648 76

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

Echocardiography may detect the presence of vegetative lesions in between 55 and 80% of patients with the clinical syndrome of bacterial endocarditis. While the mere presence of vegetations does not alone warrant surgical intervention in patients with this disorder those patients with echocardiographically documented large left sided lesions are more prone to embolic events and patients with multiple valve involvement do have a tendency for progressive valvular deterioration. Serial echocardiography is of help in identifying patients with certain complications such as leaflet disruption, abscess or fistula formation and ventricular compromise. Vegetative lesions do not regress in size with antibiotic treatment and may remain for years. Major criteria for surgical intervention continued to be clinical presence of refractory congestive heart failure, repeated embolic events or persistent septicemia. When surgical intervention is decided on clinical grounds, cardiac catheterization is rarely required in patients with adequate echocardiographic studies.
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PMID:Echocardiography in infective endocarditis. 664 99

Since the introduction of effective antimicrobial therapy, the leading cause of death in patients with infective endocarditis is no longer sepsis but, rather, congestive heart failure. The mortality is higher in patients with severe heart failure due to infective endocarditis who are treated with medical therapy only than in those who additionally undergo cardiac valve replacement. The mortality is also higher in patients with severe heart failure due to aortic infective endocarditis (40 to 93%) than in those with heart failure due to mitral infective endocarditis (17 to 66%). In patients with and in those without infective endocarditis, surgical intervention can be carried out with comparable mortality not only for aortic valve replacement (9 vs 8.4%) but also overall for valve replacement (10 vs 12%). In patients with class IV heart failure, overall mortality of valve replacement was higher (17%) than in patients with class II (8%) or class III heart failure (7%) and, similarly, comparable with that of matched groups of patients without infective endocarditis. In patients with class IV disability, the mortality of valve replacement was higher in those with active infective endocarditis (19%) than in those with inactive infective endocarditis, possibly due to a higher incidence of sudden onset of severe aortic regurgitation and myocardial abscess. No patient with valve replacement for inactive infective endocarditis developed prosthetic valve endocarditis; a single case of prosthetic valve endocarditis occurred in a patient with active infective endocarditis. In general, early surgical intervention is preferable to procrastination in the management of patients with progressive or severe heart failure due to infective endocarditis. Although, in at least 70% of patients, blood cultures may be rendered sterile within one week of initiation of appropriate antimicrobial therapy, patients with infective endocarditis due to staphylococci, multiply-resistant gram-negative bacilli, fungi, Q-fever or those with myocardial abscess or multiple relapses may require surgical intervention. While the overall incidence of clinically apparent emboli has been reported to be as high as 30%, in a ten-year observation period at the Mayo Clinic, the rate was 5.6%. Patients with echocardiographic evidence of large or mobile vegetations and those with infective endocarditis cause by microorganisms associated with a high risk of embolization such as slow-growing fastidious gram-negative bacilli, fungi (especially Aspergillus) and nutritionally-variant viridans streptococci should be considered candidates for surgery irrespective of a history of emboli.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cardiac valve replacement in patients with active infective endocarditis. 666 78

We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.
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PMID:Clinical use of the total artificial heart. 1476 80

The clinical features of endocarditis of the aortic valve in 24 dogs were reviewed. This condition was found most commonly in large-breed, middle-aged male dogs. Evidence of antecedent infection or immunosuppression was usually not historically verified or found at necropsy. However, an association with congenital heart disease, especially discrete subaortic stenosis, was demonstrated. The most frequent clinical findings were systolic and diastolic murmurs and bounding arterial pulses, with or without signs of congestive heart failure. The most commonly isolated organisms were Corynebacterium sp, Erysipelothrix rhusiopathiae, and Streptococcus sp. In addition to antibiotic therapy, treatment for congestive heart failure often was required. Despite aggressive therapy, most affected dogs died as a result of congestive heart failure, arrhythmias, infarction, sepsis, or renal failure.
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PMID:Endocarditis of the aortic valve in the dog. 670 2

A patient with acute myelogenous leukemia developed severe hypophosphatemia manifesting by extreme weakness, confusion, loss of sphincter control, nuchal rigidity, hyperesthesia, hemolysis, congestive heart failure and liver dysfunction. The possible causes for this condition were starvation, parenteral glucose and saline administration, sepsis, hypokalemia and treatment with acetazolamide. A dramatic improvement was noted following phosphate administration.
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PMID:Life-threatening hypophosphatemia in a patient with acute myelogenous leukemia. 677 68

In the past 14 years, 42 patients with active infective endocarditis underwent early valve replacement for severe congestive heart failure, major prosthetic dehiscence, intramyocardial abscesses, sepsis, or major embolization. Blood cultures were positive in 40 patients and the valve tissues were positive in two others. All patients received antimicrobials for from 1 to 4 weeks. Drug addiction was noted in 24%, urinary tract manipulation in 7%, dental work in 5%, contaminated prosthesis in 2%, and unknown cause in 62%. Organisms were predominantly staphylococcal (43%) and streptococcal (41%); the remainder were gram-negative (9%) or fungal (7%). The aortic valve was involved in 72%, mitral in 14%, tricuspid in 7%, and both aortic and mitral in 7%. By the New York Heart Association (NYHA) functional classification, 90% (38/42) were in Class III or IV. Operative mortality was 10% (4/42) and all four patients had preexisting renal failure necessitating dialysis. No predominant organism correlated with early deaths. In aortic valve replacement (30 patients), operative mortality was 7%. Postoperatively, 95% (35/37) were Class I or II with one lost to follow-up. Subsequent reoperation was required in five patients (13%) for recurrent endocarditis, with an operative mortality of 20% (1/5). Late death occurred in 45% (17/38). Overall probability of survival was 0.53 at 5 years. For isolated aortic valve involvement, the 5 year survival was 0.58. Survival for native valve involvement was 0.58 and for prosthetic endocarditis, 0.55. This study shows that after at least 1 week of antibiotics, early operation in patients with active endocarditis has an acceptable operative mortality. Clinical improvement is excellent in 95% and more than half survived 5 years or longer.
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PMID:Early valve replacement in active infective endocarditis. Results and late survival. 682 35

Data collected from a prospective multicenter study of endocarditis caused by S. aureus were analyzed to contrast the clinical presentation of the disease between a group of 46 intravenous drug addicts and a group of 35 nonaddicts. Two-thirds of the patients in each group were men. The duration of illness before diagnosis was similar (mean, 9.3 days). Intravenous-drug addicts were younger and had less underlying disease (30% versus 80%) than the non-addicts. When first seen, the drug addicts had signs and symptoms of sepsis and pulmonary embolism, but only 40% had pathologic murmurs. Seventy-six percent had evidence of tricuspid valve infection only. Congestive heart failure and neurologic manifestations were uncommon in addicts. Nonaddicts had infection involving predominantly the left side of the heart (14 mitral valves, 8 aortic valves, 4 both aortic and mitral valves) and 80% had underlying medical diseases. Only half of these patients had pathologic murmurs when first examined, but another 30% developed them later. Congestive heart failure, involvement of the central nervous system, and peripheral embolic or septic complications each occurred in over half of the nonaddicts. Eighty percent of these patients had peripheral stigmas of endocarditis. One intravenous drug addict (2%) and seven nonaddicts (20%) died. Six patients required cardiac valve replacement either during or after a course of antibiotics. Outcome was not related to the titer of peak serum bactericidal tests. Endocarditis caused by S. aureus presents as two distinct clinical syndromes depending on the patient population (intravenous drug user or nonaddict) and the location of infection (right-sided or left-sided). The disease is distinguished from endocarditis due to other causes by its acute onset and its fulminant course manifested by a multitude of septic and embolic complications and its ability to cause heart failure. Medical management alone is often successful but in certain subsets of patients, notably those with infection of aortic or multiple valves, early operation may be necessary.
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PMID:Staphylococcus aureus endocarditis: clinical manifestations in addicts and nonaddicts. 684 56


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