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

This is a study of 234 children and young adult patients entered in the Intergroup Hodgkin's Disease in Childhood (stage I-II) Study from November 1975 to June 1981 and followed for a mean of 3.8 years after laparotomy. All patients had a staging laparotomy with total splenectomy, liver biopsy, and sampling of abdominal lymph node groups. Four patients (1.7%) have had documented sepsis, and three have had possible sepsis. There has been no sepsis-related death. Intestinal obstruction requiring operation was noted in four patients (no intestinal resection required). Urgent operation was necessary in two patients, one with ureteral obstruction and one with ovarian torsion, following a repositioning procedure, neither of these patients died. Organisms in the four patients with positive blood cultures were Streptococcus pneumoniae (two) and Haemophilus influenzae (two). Of the 234 patients in the study, 194 (83%) had received polyvalent pneumococcal vaccine, and 174 (74%) were taking prophylactic antibiotics. One of the two patients with pneumococcal sepsis had not been vaccinated, and the second was vaccinated only during radiotherapy. Only one of the four patients with positive blood cultures was on a prophylactic antibiotic treatment regimen at the time of the septic episode. The liabilities in employing laparotomy-splenectomy for the evaluation of pediatric patients with Hodgkin's disease include both general surgical complications and an increase in the risk of hyperacute infection, specifically related to encapsulated species. The latter appears to be modified to a major degree by current prophylactic measures or therapy.
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PMID:Complications related to 234 staging laparotomies performed in the Intergroup Hodgkin's Disease in Childhood study. 647 52

Here 145 reported post-splenectomy infections in 115 patients with Hodgkin's disease are reviewed. Such infections can occur at any age (median age 19.8 years) and the interval from splenectomy to the infection is quite variable (median 21.9 months). Most infections are present clinically as pneumonia, septicemia, meningitis, or a combination thereof, with the most common offending organism being pneumococcus. The infection can be fulminant and even fatal. It is recommended that the spleen should only be removed when essential. A staging laparotomy and splenectomy seem justifiable only in cases of Hodgkin's disease where a change of staging would lead to a change of planned therapy. Prophylactic penicillin should be administered at least for 3 years and possibly indefinitely since post-splenectomy infections can occur many years later. Pneumococcal vaccine should also be given before any chemotherapy or radiotherapy is initiated. Prompt and aggressive treatment should be given when post-splenectomy infection is diagnosed.
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PMID:Late infections following splenectomy in Hodgkin's disease. 666

In 1975-1982, autopsies of 201 patients dying with leukemias and other tumors of hemopoietic system revealed infectious complications in 68.6%, among them pneumonias in 46.8%, sepsis in 10.9%, and inflammatory-necrotic processes of the digestive tract in 19.4%. More frequent occurrence of infectious complications in acute leukemias (68-75%) as compared with chronic (61-70%), in lympholeukemias (70-75%) as compared with myeloleukemias (61-68%), and virus infections including generalized forms of herpes in lymphogranulomatosis (30.8%) was noted. The importance of immunodeficiency conditions and granulocytopenia in the development of infectious complications which were the immediate cause of death of 56.7% of those dying with leukemias and other tumors of the hemopoietic system is discussed. The increased role in the etiology of these complications of the opportunistic intestinal microflora frequently present in various associations and in combinations with other microbes and fungi is noted.
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PMID:[Infectious complications of leukemias and other tumors of the hematopoietic system]. 668 27

Between 1956 and 1981, 306 splenectomies for hematologic diseases were performed at the UCLA Medical Center. Of these operations, more than 75% were performed for therapeutic reasons to control anemia, thrombocytopenia, neutropenia, or painful symptoms of splenomegaly. Of the 65 patients who had idiopathic thrombocytopenic purpura, 77% showed an excellent response, and of the 39 patients who had hereditary spherocytosis, 90% responded. Other diseases with predictably good response rates were autoimmune hemolytic anemias, Felty's syndrome, and hairy cell leukemia. Forty patients with Hodgkin's disease had splenectomies for diagnostic purposes the last 10 years. The overall morbidity and mortality were 24% and 6%, respectively, the most common complications being pneumonia, wound infections, and local postoperative bleeding, and the most common cause of death being sepsis. The review supports the thesis that in carefully selected patients, therapeutic splenectomy can have desirable palliative effects and that diagnostic splenectomy has a sufficiently low risk to warrant its consideration in patients with Hodgkin's disease.
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PMID:Splenectomy for hematologic disease. The UCLA experience with 306 patients. 673 25

Between 1972 and 1974, 50 previously untreated patients with Stage III Hodgkin's disease received medical attention. 24 of them were classified in Stage III A and 26 in Stage III B. In 46 patients the treatment included an initial laparotomy with splenectomy, a 6-month polychemotherapy on the MOPP plan, 4 month's treatment with vinblastine and upper and lower section irradiation. The full remission quota was 84%. After 66 months 78% of all patients were still alive. 62% of the patients are in full remission without relapse, 32% had one recurrence. 10 patients died, 3 of them from Hodgkin's disease and 5 in full remission from infections, septicemia or bone marrow insuffiency.
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PMID:[Clinical aspects and therapy of stage III Hodgkin's disease (author's transl)]. 677 41

After staging splenectomy, the risk of overwhelming sepsis in patients with Hodgkin's disease reaches 21% in certain subgroups. Youth, recent splenectomy and vigorous chemoradiotherapy predispose patients to this complication. Because of its explosive course and its known microbiology, post-splenectomy sepsis is better suited to prevention than to treatment. Since immunisation prior to treatment produces good antibody responses, all patients with Hodgkin's disease should probably be vaccinated against encapsulated bacteria at least 10 days prior to the onset of therapy.
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PMID:Overwhelming post-splenectomy infection in Hodgkin's disease: pathogenesis and prevention. 682 44

A fatal case of Streptococcus equisimilis pneumonia and septicemia is described in a young man with Hodgkin's disease. The disease course consisted of exudative pharyngitis, macular rash, septic shock, disseminated intravascular coagulation, deep vein thrombosis, and pulmonary embolization. S. equisimilis was isolated from blood, throat, and sputum cultures antemortem and from lung cultures at autopsy.
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PMID:Streptococcus equisimilis Pneumonia in a compromised host. 683 89

Three hundred ninety-three splenectomies were performed within the Charity Hospital system during the decade from 1969 through 1979. This number included 56 operations in children under 16 years of age, which formed the basis of this report of the risk of infection in young splenectomized patients and provided guidelines for the role of splenectomy under emergency and elective conditions. Eight episodes of serious infection were documented in four patients. There was only one case of overwhelming postsplenectomy infection which resulted in death, for a mortality rate of 1.8 percent (1 of 56 children) for death due to overwhelming postsplenectomy sepsis. It is emphasized, however, that the development of serious postsplenectomy sepsis in our series resulted in a 25 percent mortality rate. The risk of postsplenectomy sepsis is much greater in those individuals who are immunologically compromised, such as those who undergo staging splenectomy for Hodgkin's disease. If splenectomy is indicated for a hematologic disorder, it is wise to defer operation for as long as possible, especially if the acute episodes are self-limiting or mild. Rather than the promiscuous use of polyvalent serum and antibiotic therapy after splenectomy in children, it is recommended that parents be advised to bring the child to the hospital anytime an illness or fever develops that might require an immediate loading dose of an appropriate antibiotic. The role of subtotal splenectomy or hemisplenectomy merits consideration in staging Hodgkin's disease. Preoperative study of certain immunologic parameters may provide guidelines as to the proportion of individuals who may be vulnerable to overwhelming sepsis after splenectomy.
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PMID:Overwhelming postsplenectomy sepsis in childhood. 683 52

To determine the incidence and types of infections in Hodgkin's disease, particularly those related to the overwhelming pneumococcal sepsis syndrome, 210 consecutive patients with previously untreated Hodgkin's disease who underwent staging laparotomy with splenectomy from March 1968 to October 1979 were reviewed. For 178 patients (85 percent) alive at the end of the study, the mean follow-up time was 68.1 months. Eighty-two serious infections occurred among 59 (28 percent) of the patients; 47 (57 percent) serious infections were microbiologically documented and 35 (43 percent) were clinically documented. Forty-seven microbiologically documented serious infections occurred in 34 patients and consisted of 23 episodes of pneumonia, 10 cases of bacteremia, seven wound infections, two cases of disseminated herpes zoster, one subphrenic abscess, and four miscellaneous infections. Microbiologically documented serious infections occurring during initial treatment or remission had lower incidences of leukopenia (29 versus 58 percent) (p = 0.09) and death (11 versus 53 percent) (p = 0.005) than those occurring after relapse of Hodgkin's disease. Of the microbiologically documented serious infections, 76 percent were associated with a predisposing factor(s) (leukopenia, postoperative state, steroids, peripheral neuropathy, leukemia), of which 34 percent were fatal. Microbiologically documented serious infections unassociated with a predisposing factor were never fatal, including the only episode of pneumococcal sepsis in the series. In contrast to microbiologically documented serious infections, only 14 percent of clinically documented serious infections (versus 38 percent) were fatal. The overwhelming pneumococcal sepsis syndrome and other infections thought to be associated with the asplenic state are uncommon problems in patients with Hodgkin's disease after splenectomy.
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PMID:Infection among 210 patients with surgically staged Hodgkin's disease. 685 90

Thirty-six patients with advanced Hodgkin's disease who were treated primarily with MOPP were evaluated to determine the reasons for MOPP failure. Complete remission was achieved in 22 (61%) of the patients, and the predicted 5-year survival rate for all patients is 60%. Reasons for the failure of MOPP to cure patients in this series included: 1) Idiosyncratic drug reactions in 2 patients (6%). MOPP was discontinued after one cycle because of drug-related hepatitis or skin rash; 2) Resistant disease in 8 patients (22%). Primary treatment failure was significantly associated with the presence of B symptoms (p = .005) and age greater than 40 years (p = .02); 3) Death from complicating infection in 5 patients (14%). Four patients died without evidence of Hodgkin's disease while responding to MOPP from pneumocystis pneumonia, viral pneumonia, bacterial pneumonia, or bacterial septicemia. One patient died in complete remission from sudden, overwhelming sepsis; 4) Relapse from complete remission in 4 patients (11%). All patients who relapsed had deviations from the planned dose or timing of MOPP. Remission duration was shorter (p = .06) in patients with documented deviations in MOPP administration than in patients without such changes. It appears that new treatment approaches are needed for patients with B symptoms, and that failure to deliver MOPP on schedule in the planned dose increases the risk of relapse.
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PMID:Reasons for failure of MOPP to cure Hodgkin's disease: The importance of dose and schedule. 689 61


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