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

Orthotopic hepatic transplantation has become a well-established treatment modality for end-stage liver disease, and research in this field is constantly evolving. Of the 34 canine liver transplants performed in this study, 17 (50%) survived more than 3 days (mean survival time 15 days). Causes of perioperative death included hemorrhage (4), anesthetic complications (3), systemic anaphylaxis (3), portal vein thrombosis (3), hepatic venous outflow block (2), and hepatic artery thrombosis (2). Gentle handling with minimal dissection of the donor liver in situ resulted in a decreased incidence of hepatic venous outflow block. The incidence of biliary leak was similar irrespective of the method of biliary reconstruction, although the incidence of acute cholangitis was 56% in the cholecystoduodenostomy group compared with 0% in the choledochocholedochostomy cohort. Using celiac to common hepatic end-to-side arterial anastomosis with preservation of the gastroduodenal artery, thrombosis of the hepatic artery was encountered in four instances, an incidence similar to previously reported studies where end-to-end hepaticohepatic arterial anastomosis or donor aortic conduit was utilized. The incidence of postoperative intestinal intussusception was reduced from 40 to 0% in those who underwent transmesenteric intestinal plication following implantation of the liver. Among short-term survivors, sepsis was the most frequent noted complication (10), followed by intestinal intussusception (6), rejection (6), and gastrointestinal bleeding (1). Among recipient dogs that survived more than 3 days, rejection was the most common cause of graft loss (5), followed by biliary leak (4) and hepatic artery thrombosis (2).
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PMID:Orthotopic hepatic transplantation in the dog. 157 6

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4 per cent. During the period 1981-87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2-87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7.5 (range 0.7-32.0) months. Five patients are still alive 72, 72, 70, 7 and 2 months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19 per cent. These results support surgical intervention for patients with complaints and/or complications attributable to gastrointestinal metastatic melanoma.
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PMID:Surgery for melanoma metastatic to the gastrointestinal tract. 168 96

The records of 28 children with the pathological diagnosis of American Burkitt's lymphoma were reviewed. Twenty-three of these children (82%) presented with primary abdominal tumors and 5 with disease located in the head and neck. Twelve required an emergency operation for either intestinal obstruction (3), intussusception (5), or appendicitis (4); the others underwent an elective exploration for tissue diagnosis. Ten patients had disease localized to one particular site. Seven of these 10 children underwent complete resection of the tumor including a right colectomy (4), small bowel segmental resection (1), tonsillectomy (1), and appendectomy (1). Eight children had a subtotal resection of the tumor (less than 90% of tumor burden) and the rest underwent incisional biopsies. Following the diagnosis, all patients received chemotherapy; 8 (29%) also were treated concurrently with radiation therapy. Nineteen patients (70%) remain long-term survivors with a mean survival time of 3.6 years. Eight patients died of either recurrent disease (6) or sepsis secondary to their chemotherapy, with a mean survival time of 6 months. Sixteen patients (57%) developed complications during their hospitalization that required surgical consultation or intervention (acute renal failure [9], pleural effusion [2], intestinal obstruction [5], gastric outlet obstruction [1], and wound infection [1]). No subsequent treatment of these complications resulted in mortality or morbidity. The significant positive determinant for survival was the initial absence of either bone marrow or central nervous system involvement (P less than .05). In those children who had complete resection of their tumor, survival time was greater than 3.7 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of surgery in American Burkitt's lymphoma in children. 177 35

This is a retrospective analysis of 82 patients of intussusception in infancy and childhood. Males were more than females in the ratio 2.4 : 1, the ages varied from 2 months to 12 years. Majority (73%) were less than 1 year old. Commonest presentations were pain, vomiting, distension, palpable lump and blood and mucus in stools. The management of these patients varied from barium enema reduction (3 cases), reduction by surgery and manipulation (59 cases) and resection with primary anastomosis (20 cases). We analysed our patients by giving scores based on clinical criteria. We concluded that the patients in our circumstances do not show any correlation of the scoring pattern with morbidity or mortality, chances of reduction by barium enema or manually. Resection, however, did correlate with a high incidence of death (75%). Resections were required slightly more in ileo-ileal intussusceptions than in those having a colonic involvement, morbidity in the form of wound dehiscence, and sepsis was higher in those patients who had undergone resections.
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PMID:Intussusception in infancy and childhood: evaluation of a prognostic scoring pattern. 180 93

Models for the study of prosthetic vascular graft infection have been studied frequently in the dog and rabbit. We have developed a reproducible swine model to study this problem and its treatment. The cardiovascular system, healing characteristics, and the bloodstream clearance of bacteria in swine more closely resembles those of humans than do other animal models. The low cost and availability of the swine is an additional attractive aspect. One hundred fifty-six farm-bred pigs have undergone infrarenal aortic replacement with a 3-cm segment of 6-mm prosthetic graft over the past two years. Graft infection was produced by (1) direct inoculation of 10(6) Staphylococcus aureus at the time of the surgery or (2) intravenous infusion of bacteria (10(2)-10(6) organisms/mL) immediately after surgery. All animals were sacrificed 1 to 4 weeks later, depending on the study design. Cultures, histology, and electron microscopy were performed on each graft. Anesthetic complications were rare (2.5%). Postoperative complications leading to animal death decreased with increasing experience (11.5%), but included graft thrombosis, bleeding, sepsis, intussusception, and colonic ischemia. Wound infection was the most common cause of morbidity. The swine model is an attractive alternative to that of other animals for the study of prosthetic vascular graft infections. Further details of the operative technique and the comparison to the human and other animal models is discussed.
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PMID:Porcine model for vascular graft studies. 186 86

A case of intussusception in a 6 month old with lethargy as the initial and predominant system is presented. Children presented to the Emergency Department with otherwise unexplained lethargy should have intussusception as part of the differential diagnosis. A plain film of the abdomen should be obtained. A rectal exam should be done, and a stool checked for occult blood. Radiologic and surgical consultation should be sought simultaneously. Delay in diagnosis and treatment may be associated with decreased success rates of reduction by barium enema, and increased rates of complications of perforation, peritonitis, sepsis, and death.
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PMID:Intussusception presenting as lethargy in a 6-month-old infant. 195 81

Most techniques described in animal models of pancreatic transplantation use either segmental or autotransplants. We employ a technique of pancreaticoduodenal allotransplantation in the dog that closely resembles the operation used in humans. The arterial supply of the entire pancreatic graft is preserved by procuring a Carrel patch of aorta encompassing the origin of the celiac and the superior mesenteric arteries. Splenic, inferior pancreaticoduodenal, and superior pancreaticoduodenal arteries remain intact with the graft. Venous drainage is through a short segment of portal vein. A 6-cm cuff of duodenum is taken with the head of the pancreas. Engraftment proceeds by placing the allograft within the peritoneal cavity of the recipient. End-to-side vascular anastomoses are constructed to distal aorta and inferior vena cava. The duodenal cuff is anastomosed to the dome of the bladder for drainage and analysis of exocrine secretions and to provide a port of entry for cystoscopically directed needle biopsy. A total pancreatectomy is performed to induce a state of diabetes. The average operating time is 5 h. Twenty-two dogs have undergone allotransplantation using this technique. Six dogs had no complications and were sacrificed after meeting criteria of their study protocol. There were three technical failures, two arterial thromboses and one exsanguination, yielding an 86% rate of successful engraftment. Three other dogs died of intussusception and three dogs died of sepsis, one secondary to wound dehiscence and one due to inadvertent common bile duct ligation during pancreatectomy. Wound problems, four dehiscences and two superficial infections, occurred only in immunosuppressed dogs.
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PMID:Canine pancreaticoduodenal allotransplantation with cystoduodenostomy: an animal model with clinical application. 248 44

The effects of trimetrexate following marrow transplantation were studied in a dog model. Four animals were given 9.2 Gy total body irradiation (TBI), autologous marrow, and either trimetrexate alone (0.4 mg/kg on days 1, 3, 6, and 11) or combined with cyclosporine (CSP) (15 mg/kg per day i.m. on days 1-7, then orally until day 25, then taper). All four animals engrafted normally, demonstrating that trimetrexate at this dose is tolerable. Ten additional animals were given a similar dose of TBI followed by marrow and buffy coat cells from littermate donors differing for one DLA haplotype. Trimetrexate and CSP were given as noted above. Four of the 10 animals died, one with septicemia prior to engraftment (day 14), one with intussusception (day 28), one with graft failure (day 32) and one with a tracheal abscess without graft-versus-host disease (GVHD) (day 67). Six dogs survived in excess of 100 days; one of the six developed chronic GVHD. These results are superior to those previously achieved with either methotrexate or CSP as single agents and are roughly equivalent to results achieved with a combination of methotrexate and CSP in similarly mismatched donor-recipient pairs.
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PMID:Use of trimetrexate for the prevention of graft-versus-host disease. 252 87

A 3-year-old girl is reported on who underwent laparotomy for ileocaecal intussusception elsewhere one week following severe gastroenteritis. Immediately after surgery, she developed haemolytic-uraemic syndrome with haemolytic anaemia, thrombocytopenia, increase of urea and creatinine and anuria as well as subsequent peritonitis, enterocolitis and sepsis. Following relaparotomy with establishment of ileostomy, peritoneal dialysis for several days was carried out for treatment of the haemolytic-uraemic syndrome. This case demonstrates that the haemolytic-uraemic syndrome can be treated effectively by peritoneal dialysis despite fresh bowel anastomoses, and that simultaneously occurring peritonitis can be managed by intraperitoneal administration of antibiotics via dialysis fluid.
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PMID:[Peritoneal dialysis in hemolytic-uremic syndrome following ileocecal resection for invagination in postoperative peritonitis]. 275 Mar 44

Forty-four patients presenting with painful outlet constipation had internal rectal intussusception documented by cinedefecography. Rectal reservoir reduction by multiple elastic ligation or staple excision of redundant mucosa effectively improved bowel function and outlet symptoms in the majority of patients. Rectal reduction procedures were performed under intravenous sedation with antibiotic coverage, no postoperative sepsis, and a single case of significant postoperative bleeding. Associated abnormalities on defecography were unaffected.
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PMID:Rectal reservoir reduction procedures for internal rectal prolapse. 365 90


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