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

Immunocompetence was measured in 320 gastrointestinal surgery patients using the delayed hypersensitivity test. The frequency of complications and death from sepsis was greater (p less than 0,001) in anergic patients (39%) than in patients with normal response (5%). A close correlation was observed between anergy and malnutrition as determined on the basis of biological criteria (triceps skinfold, arm circumference, ratio between actual and deal weights). This double correlation led to study the influence of hyperalimentation on immune response and prognosis. Parenteral hyperalimentation with nitrogen and calories was administered to 26 anergic patients with heavy or complicated intestinal surgery (peritonitis) for from 10 to 37 days (av.: 19, 2 days). One or more test(s) had turned positive by the 10th day in 7 patients; by the 30th day in 16 and by the 69th day in 20. Out of 26 anergic patients, 19 were nutritionally normal; hyperalimentation had no influence on biological criteria and began to modify body measurements only after 17 days; in the 16 anergic malnourished patients,, hypernutrition led to the development of a positive nitrogen balance (3,60 +/- 1,7 days) and to a return within normal range of biological criteria (7,2 +/- 2,3 days), and body measurements (14,3 +/- 9,2 days). Death from sepsis in anergic patients with hyperalimentation was lower (11,2% and 44,4%; p less than 0,01) than in anergic ones without hyperalimentation. Hyperalimentation with nitrogen and calories modified the nutritional status, immunological response and improved prognosis in anergic patients.
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PMID:[Hyperalimentation after digestive surgery: influence on immune state and on prognosis (author's transl)]. 678 Sep 72

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.
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PMID:Boerhaave syndrome. Successful conservative management in three patients with late presentation. 678 84

In 216 patients with end-stage renal disease (ESRD) undergoing 406 major operations, surgery was elective in 143 cases (mortality, 1.4%) and nonelective in 263 (mortality, 11.1%). Of 82 patients who received 105 pretransplant operations to prevent posttransplant complications, eg, gastrointestinal hemorrhage, urinary tract sepsis, and azathioprine intolerance, surgical mortality was 1.9%, with 80 patients becoming active candidates for transplantation. Sepsis requiring surgical care occurred in 54 patients, in 36 of these in the posttransplant period. Parenteral and enteral hyperalimentation was used as a therapeutic adjunct in 40 of these patients. Overall mortality in those with septic complications was 35.2%, 22.5% in the nutritional support group and 71.4% in the group not receiving hyperalimentation. Improved survival rates can be achieved for surgical emergencies in ESRD, particularly in the posttransplant immunosuppressed patient, if both definitive surgical intervention and nutritional support are actively applied.
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PMID:Surgery, nutritional support, and survival in patients with end-stage renal disease. 678 59

Over 1,500 patients at our institution have received intravenous hyperalimentation (IVH) as nutritional support for nutritional rehabilitation prior to and/or during oncologic therapy. Stimulation of tumor growth has not been identified, and septic and metabolic complications of this technique have been minimal. Nutritional repletion resulted in return of immunocompetence and was associated with a reduction in sepsis, proper wound healing, and an apparent increase in tumor response to chemotherapy. If these observations were related as cause and effect, then a method of restoring and maintaining adequate nutrition should be added to the armamentarium of the oncologist. The use of IVh allowed specific oncologic therapy to be administered to a group of malnourished patients who otherwise might not have been acceptable candidates for intensive antineoplastic therapy.
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PMID:Nutrition and cancer. 678 9

Liver blood flow and exchange of oxygen, glucose, lactate, and amino acids were measured in pigs at the same time as the peripheral arteriovenous (A-V) difference of these substances was determined. Four groups of animals were studied; they were normal postabsorptive, septic fasted, and septic infused either with complete parenteral nutrition (4.25% mixed amino acid solution with 25% glucose) or an isocaloric solution of 1.8% leucine with glucose. Sepsis in the pig caused a rise in arterial concentration of all essential amino acids except tryptophan and a decrease of most of the others. The liver uptake of the sum of all amino acids rose from nonsignificant values to 26.03 mumol/min/kg at the same time as the peripheral A-V difference changed from +20.4 to -678.0 mumol/l. Hyperalimentation increased arterial amino acid concentration, whereas peripheral A-V difference decreased to -132.3 mumol/l. The total liver uptake of amino acids was 24.80 mumol/min/kg but with a higher proportion of essential amino acids than in the fasted septic state suggesting increased liver protein synthesis. When leucine and glucose were infused the peripheral A-V difference of the sum of all amino acids was only -45.6 mumol/l indicating an almost complete cessation of muscle proteolysis. The arterial plasma concentration of all amino acids except leucine, glutamine, and glutamate were markedly reduced. Although hepatic clearance rate of amino acids fell only slightly, due to the low plasma concentrations, the liver uptake decreased substantially to 7.37 mumol/min/kg suggesting a decreased liver protein synthesis which could be deleterious in the presence of sepsis.
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PMID:The effects of hyperalimentation and infused leucine on the amino acid metabolism in sepsis: an experimental study in vivo. 678 84

Catheter sepsis remains a persistent, though infrequent, complication of intravenous hyperalimentation (IVH). Those select patients requiring home hyperalimentation delivered through Silastic catheters are subject to this serious problem. Reported in this article is a case of Enterococcus endocarditis of the tricuspid valve in a patient receiving home IVH; the endocarditis was recognized early using two-dimensional echocardiography and was treated successfully with catheter removal and IV antibiotic administration. Ideal conditions exist for the formation of endocarditis in the setting of catheter sepsis with parenteral nutrition. Routine echocardiography is indicated when catheter sepsis is documented, since early diagnosis and treatment may reduce invasive cardiac tissue infection and permanent injury. The right atrial catheter generates reflections during echocardiography that require special attention for accurate interpretation.
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PMID:Endocarditis complicating home hyperalimentation. 678 99

An infant, born with multiple anomalies of the gastrointestinal tract, required intravenous hyperalimentation for virtually his entire life. His course was characterized by multiple episodes of sepsis or phlebitis, culminating in death five and one-half months after birth. The brain and spinal cord at necropsy were normal on gross inspection. However, microscopic study showed inflammation of the dura surrounding the spinal cord with sparing of the spinal and cerebral subarachnoid spaces.
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PMID:Primary epiduritis. 679 49

A retrospective study of standard hyperalimentation catheter dressing compared to the use of Op Site has demonstrated that Op Site is cost and time effective and is efficacious for attaining a low catheter sepsis rate. It is easy for nursing personnel to apply and comfortable for the patients to wear. Op Site may be contraindicated in diaphoretic patients.
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PMID:Use of op site as an occlusive dressing for total parenteral nutrition catheters. 680 75

A double lumen right atrial catheter was placed in 57 allogeneic marrow transplant recipients, and its use was compared to a concurrent series of 63 patients receiving the large-bore single lumen catheter. Ten double lumen catheter recipients developed septicemia, while neutropenic with granulocyte counts less than 100 per cubic centimeter, and three had their catheters removed for persistent septicemia. Seventeen single lumen catheter recipients developed septicemia while granulocytopenic, and one had the catheter removed for persistent septicemia. Hyperalimentation was more effectively delivered with the double lumen catheter which provides a route for infusion of hyperalimentation solutions at a constant rate during infusions of blood products, antibiotics, and other fluids.
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PMID:Experience with double lumen right atrial catheters. 680 80

The increasing awareness among surgeons of overwhelming postsplenectomy sepsis has led to new and innovative procedures to save the spleen. In pancreatic transection injuries (Type II)26 the classical treatment has been distal pancreatectomy and splenectomy. The opportunity to treat several patients with pancreatic transections sustained during blunt abdominal trauma lead to the review of the literature on the subject. Particular attention was paid to treatment of these injuries during distal pancreatectomy with splenic salvage, appropriate drainage, and hyperalimentation. Associated complications were likewise investigated and reviewed.
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PMID:Blunt transection of the pancrease treated by distal pancreatectomy, splenic salvage and hyperalimentation. Four cases and review of the literature. 681 55


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