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

A 78-year-old woman was admitted to our hospital because of disturbance of consciousness. She had been diagnosed as uterus carcinoma and had undergone radiotherapy one year before admission. On admission, her body temperature was 35.5 degrees C and systolic blood pressure was 50 mmHg. Ascites and semicomatose consciousness were detected. Laboratory evaluation demonstrated the following values: leukocyte count 38800/microliters, blood sugar 3 mg/l and arterial blood pH 6.9. Therapy with catecholamine and antibiotics was started, but she expired 10 hours after admission. Bacteroides ovatus was detected from her blood. Autopsy findings disclosed abscess and perforation of the uterus, and liver cirrhosis. Hypoglycemia has rarely been described as a clinical manifestation of sepsis and this case is, to our knowledge, is the first report of sepsis complicated with hypoglycemia in Japan.
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PMID:[A case report: sepsis associated with hypoglycemia]. 793 Jul 92

Most liver injuries are minor (class I and II) which can be managed by simple techniques. Class III injuries are primarily treated by deep liver suture and hepatotomy and vessel ligation. Most class IV injuries are amenable to resectional debridement. Direct repair of class V juxtahepatic venous disruption may be facilitated by early caval shunt placement. Hepatic resetion should be avoided because of high morbidity and mortality. Perihepatic packing is an effective and safe adjunct after hepatic repair. Routine closed suction drainage is recommended for complex liver injuries. Postoperative hyperpyrexia is found more in blunt trauma and severe liver injuries but not related to the occurrence of sepsis. Hypoglycemia can be prevented by routinely administered 10 per cent dextrose solutions intraoperatively followed by total parenteral nutrition or enteral nutrition in the immediate postoperative period. The high mortality and morbidity of liver injury will remain a challenge to traumatic surgeons until these figures are acceptably low and this can be achieved by well regulated accident prevention measures.
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PMID:Management of liver trauma: a 5-year experience. 796 39

Acute alcohol ingestion can affect life expectancy and is directly responsible for 3,500 deaths per year. Acute lung diseases are mainly caused by pneumococci, Gram negative bacilli and anaerobic germs, and are often due to multiple microbes. In this case, evolution toward abscess can be feared. Septicaemia and enterobacterial peritonitis are frequently observed in cirrhotic patients. Ethanol, hypokaliemia and hypophosphoraemia also lead to rhabdomyolysis. Rhabdomyolysis can be complicated with acute renal failure and hyperkaliaemia. Alcoholic ketoacidosis and the hypoglycaemia favored by prolonged inadequate nutrition, are corrected by infusion of glucose solutions. Hyponatraemia can be complicated by convulsions and central pontine myelinolysis. Minor forms of alcoholic hepatitis remiss after stopping alcohol intoxication. The major forms can evolve toward fatal encephalopathy; treatment with corticosteroids improves the prognosis in severe hepatitis. The cardiac failure with lactic acidosis in shoshin beriberi rapidly evolves to collapsus; treatment is based on emergency administration of vitamin B1. Management of patients in acute alcohol episodes requires great vigilance. Careful clinical examination and biological tests should eliminate severe somatic complications before concluding to simple alcoholic intoxication.
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PMID:[Severe somatic complications of acute alcoholic intoxication]. 813 83

Gram-negative sepsis/septic shock in the human newborn continues to be a severe medical problem because of significant mortality and morbidity. Since macrophages detoxify endotoxin, a decreased number of macrophages may contribute to the newborn's sensitivity to endotoxin. In this study, peritoneal macrophages were used for the treatment of endotoxic shock in 10-day-old rats, and 24-hr mortality, plasma glucose, and lactate concentrations were monitored. Peritoneal macrophages were harvested from adult or 10-day-old rats. Caseinate-stimulated macrophages from adult and 10-day-old rats significantly decreased the mortality of 10-day-old rat endotoxic shock from 90% to 37.5% and 44.4%, respectively. Resident macrophages from adult and 10-day-old rats also decreased the mortality from 90% to 12.5% and 45.4%, respectively. Peritoneal macrophages from adult rats significantly ameliorated hypoglycemia during endotoxic shock in a dose-dependent manner. Macrophage treatment decreased plasma endotoxin concentration (P < 0.05). Macrophage treatment was important for host defense.
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PMID:Macrophage treatment in suckling rat endotoxic shock. 814 52

One hundred and thirty-three colonic biopsies of proven cases of Shigella colitis were examined and post-mortem examinations were carried out on 29 fatal cases at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) hospital between 1988 and 1992. The distribution of pathological lesions and the spectrum of histopathological changes in the intestinal tract of these patients, and the features of intestinal and extra-intestinal complications of shigellosis are presented. Septicaemia, hyponatraemia, hypokalaemia and hypoglycaemia were present in a high percentage of these cases. All but two patients were malnorished at the time of autopsy. Shigellosis patients rapidly became hypoproteinaemic and were susceptible to other infections including opportunistic infections. Mortality amongst shigellosis patients admitted to our hospital continues to be high in spite of adequate antibiotic and supportive therapy.
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PMID:Pathology of shigellosis and its complications. 814 44

We compared the extrauterine adaptation of preterm with term newborn infants, by sequentially measuring plasma catecholamine (CAT) levels at birth and during the first 24 h of life. Twenty-seven preterm appropriate-for-gestational-age (AGA) infants, less than 35 weeks gestation, were compared with 26 healthy near-term AGA infants. Modes of delivery and umbilical arterial pH (mean 7.28) did not differ. Infants with asphyxia, presumed sepsis or hypoglycemia were excluded. CAT (norepinephrine, epinephrine, dopamine) levels were measured by radioenzymatic assay in blood samples from maternal vein, cord vein, cord artery and blood samples obtained at 1, 2 and 24 h of postnatal age. At birth, the cord arterial CAT levels were significantly higher than maternal venous CAT levels in both groups of neonates. Plasma epinephrine levels (mean +/- SD) at 1 and 2 h of postnatal age were significantly higher in preterm than in near-term newborns (0.98 +/- 0.82 nmol/l vs. 0.30 +/- 0.21 nmol/l at 1 h; 0.98 +/- 0.68 nmol/l vs. 0.28 +/- 0.29 nmol/l at 2 h; p < 0.05). The norepinephrine and dopamine measurements did not differ between the two groups studied at birth, 1, 2 and 24 h of postnatal age. These data indicate that the preterm infants (25-35 weeks gestation) are capable of mounting a catecholamine response at birth similar to near-term newborns. The persistent elevation of epinephrine in preterm infants at 1 and 2 h of life may be attributed to either slower clearance of epinephrine or continued stimulation during clinical care in the NICU.
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PMID:Catecholamine response at birth in preterm newborns. 826 May 50

In a 3-month period (January to March, 1992), patients with rectal temperature below 35 degrees C detected by an electrical rectal thermometer (Diatek, Inc, San Diego, CA) were enrolled. In addition to treatment of the underlying diseases, the patients were rewarmed with either a heating lamp (core temperature > 32 degrees C) or warm fluid intravenous infusion and/or gastric lavage (core temperature < 32 degrees C). Patients' vital signs, serum potassium, pH, initial temperature, mean weather temperature, underlying disease and outcome were recorded and compared between survivors and non-survivors. We collected 23 cases with mean age of 71.6 years and mean core temperature, 33.32 degrees C (29.4-34.9 degrees C). The diagnosis included hypoglycemia in 7 cases, sepsis in 3 cases, active TB in 2 cases, HHNK in 1 case, DKA in 1 case, UGI bleeding in 1 case, parkinsonism in 1 case, intracerebral hemorrhage in 1 case, urinary tract infection in 1 case, brain tumor post operation in 1 case, arrhythmia in 1 case, senile dementia in 1 case, COPD in 1 case and lung CA in 1 case. 12 (52%) cases died during admission. No significant difference in clinical parameters was noted between survivors and non-survivors. In conclusion, although in subtropic area, the hypothermic patients in our country cannot be overlooked. As patients are usually elder and have other diseases, the prognosis is correlated with the severity of the underlying disease. Alert, intensive care, prevention and treatment of the complications that arouse, and careful rewarming are necessary for management of such patients.
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PMID:[Hypothermia in the patients of emergency department]. 828 89

Gram-negative sepsis/septic shock in the newborn continues to be a major medical problem, causing high mortality. Hyperglycemia followed by hypoglycemia is a common symptom in endotoxic shock. However, the mechanism of newborn glucoregulatory response to endotoxin has not been well understood. Paradoxically, monocyte-phagocytes can contribute to shock by overwhelming secretion of cytokines and also host defense by detoxifying endotoxin. Since monocyte-phagocyte function is immature in the newborn, this study was performed to evaluate Kupffer cell's role in liver glycogenolysis during endotoxic shock. Endotoxin (LPS) induced hyperglycemia in 10-day-old rats, and increased net glucose output in the isolated perfused liver. 1) Cytarabine decreased Kupffer cell function (decreased hepatic colloid carbon uptake) and blunted LPS-increased liver net glucose output in the Cytarabine + LPS-treated group (104 +/- 4 vs. 146 +/- 3 micrograms/min/g wet liver in the LPS-treated group: P < .001). 2) Indomethacin (IND) suppressed LPS-induced liver net glucose output in the LPS + IND-treated group (133 +/- 5 vs. 146 +/- 3 micrograms/min/g wet liver, P < .05). Thus, prostaglandins were suggested to contribute to glycogenolysis in the 10-day-old rat liver. 3) Phorbol 12-myristate 13-acetate (PMA) increased liver net glucose output (166 +/- 4 micrograms/min/g wet liver), and H-7, a protein kinase C inhibitor, blunted PMA-induced liver glucose output (140 +/- 2 micrograms/min/g wet liver, P < .05). H-7 enhanced LPS-induced liver net glucose output (196 +/- 9 micrograms/min/g wet liver, P < .01). Therefore, protein kinase C may not be the dominant cell signaling system for LPS stimulation in suckling rat Kupffer cells.
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PMID:Lipopolysaccharide alters suckling rat liver glycogenolysis. 832 90

Hypoglycaemia is a relatively common cause for referral of patients to the accident and emergency departments of hospitals but most of it is iatrogenic. Occasionally, however, hypoglycaemia is due to any one of up to a hundred different disorders. In some, hypoglycaemia is the cause of intermittent neuroglycopenic symptoms that lead to their referral to medical outpatients for investigation. Only the most important are discussed here. Hyperinsulinism due to abnormal beta-cell function is an uncommon but important cause of spontaneous hypoglycaemia. The diagnosis is suspected from the history of episodes of altered consciousness confirmed by demonstrating raised plasma insulin, C-peptide and proinsulin levels in peripheral blood in the presence of hypoglycaemia. Differentiation of the various causes of endogenous hyperinsulinism before surgery is difficult if not impossible and the low predictive value of most of the localizing techniques that are available makes them an additional and unnecessary cost, producing little clinical benefit. Hypoglycaemia caused by non-islet cell tumours (NICTH) is seemingly rarer than hyperinsulinism from insulinoma and tends to occur in older patients. The clinical features are similar to those of hyperinsulinism but laboratory investigation reveals appropriately depressed plasma insulin, C-peptide and proinsulin levels in the presence of hypoglycaemia. The plasma IGF-II:IGF-I ratio is characteristically high and the concentration of the E-domain of proIGF-II is raised. Autoimmune hypoglycaemia is more common in some countries than others and is most often due to autoantibodies to insulin (AIS). It may also be caused by autoantibodies to the insulin receptor and possibly to autoantibodies that are stimulatory to pancreatic beta-cells. Contrary to popular belief, idiopathic reactive hypoglycaemia is rare and only one of the possible causes of the postprandial syndrome. It is characterized by a low blood glucose concentration in blood collected during a spontaneous symptomatic episode but not at other times. Its cause is unknown. Other causes of hypoglycaemia include endocrinopathies of various kinds; sepsis including malaria; congestive cardiac failure; hepatic and renal insufficiencies; diverse inborn errors of metabolism; and exogenous toxins, of which alcohol is probably the commonest.
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PMID:Hypoglycaemia in the adult. 837 12

Patients with end-stage liver disease have significant mortality often associated with intercurrent episodes of bleeding or sepsis. Intact adrenal function is essential in such situations. In order to test the hypothesis that adrenal insufficiency might be present in severe liver disease, hypothalamic-pituitary adrenal function was evaluated in patients with end-stage liver disease awaiting transplantation. The study had a prospective, open comparative design with patients restricted to those having non-alcoholic liver disease in order to avoid the confounding direct effects of alcohol on adrenocortical function. Fifty-one consecutive patients with end-stage, non-alcoholic liver disease undergoing evaluation for liver transplantation and 40 healthy controls were studied. Patients who had used corticosteroids (n = 8) or who were unable to complete the investigations (n = 5) were excluded leaving 38 patients eligible for analysis. Adrenal function was evaluated under basal conditions by single morning measurements of plasma total and free cortisol, corticosteroid-binding globulin, dehydroepiandrosterone sulfate and by adrenal stimulation indirectly using insulin-induced (0.1 U/kg, i.v.) hypoglycaemia and/or directly by adrenocorticotrophic hormone (ACTH); 250 micrograms tetracosactrin, i.v.) stimulation. Compared with healthy controls, patients with liver disease had a 64% reduction in maximal increments of plasma cortisol to indirect adrenal stimulation via insulin-induced hypoglycaemia and a 39% reduction to direct adrenal stimulation by ACTH (all P < 0.001). There was a significant negative correlation between the severity of underlying liver disease as assessed by Child-Pugh scores and peak control responses to ACTH (r = -0.647, P < 0.0001) and insulin-induced hypoglycaemia (r = -0.597, P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hypothalamic-pituitary adrenal function in end-stage non-alcoholic liver disease. 839 Aug 70


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