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

The purpose of this study was to identify patients who were more likely to experience septicemia after endoscopic biliary drainage. In an attempt to determine the relative importance of each risk factor and their possible interdependancy to more precisely identify high-risk patients and to deduce some guidelines for prevention, a discriminant regression analysis of risk factors for septicemia was used. Clinical, biological, and radiological data of 34 consecutive patients who experienced septicemia within 3 days after endoscopic biliary stenting were reviewed retrospectively and compared with data of a group of 71 patients without any septic complication. If only data available before the procedure were used in the discriminant analysis, prior cholangitis and leucocytosis appeared as significant risk factors, but the linear combination of these data could not predict septicemia in 50% of cases. When information concerning the quality of drainage after the procedure was introduced into the analysis, 91% of the septicemic patients were identified, and other expected risk factors such as the nature of the stricture, the type of drainage, or prior cholangitis and leukocytosis had no or marginal predictive values. Patients referred from centers where duodenoscopes might have been poorly disinfected appeared to be at higher risk for Pseudomonas aeruginosa septicemia. These results emphasize the crucial role of the quality of drainage as a risk for septicemia. Regarding the prevention of infection, it is concluded from this study that (a) pure diagnostic endoscopic retrograde cholangiopancreatography should be avoided in obstructed patients if drainage cannot be performed during the same procedure; (b) drainage should be as complete as possible; (c) antibiotics should be administered before ERCP to every patient with suspected obstructive jaundice and should cover P. aeruginosa if local epidemiological data suggest that there is a problem with disinfection of the endoscopes; and (d) the quality of drainage should guide the duration of antibiotic prophylaxis.
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PMID:Risk factors for septicemia following endoscopic biliary stenting. 193 9

It has been known that intrahepatic biliary lithiasis (IHBL) is prevalent in East Asia including Japan, South Korea, Taiwan, Malaysia, Hong Kong, and Singapore. In contrast, the entity has drawn little attention in Europe and the United States where only scattered reports appear. IHBL can be placed in the category of the benign disease. Its distinctive clinical picture is an intractable course necessitating multiple surgical interventions because recurrence is usual, rather than exceptional. This is in distinct contrast to ordinal stones which originate in the gallbladder. Patients with IHBL do not rarely die of progressive hepatic damage resulting from longstanding obstructive jaundice, cholangitis, liver abscess, septicemia, and so forth.
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PMID:Intrahepatic biliary lithiasis. 205 8

Over a 6-month period 5 patients with obstructive jaundice developed Gram-negative septicaemia, all within 48 hours of undergoing endoscopic retrograde cholangiopancreatography. The sepsis proved fatal in 3 patients, despite prompt decompression of the obstructed biliary system. In all cases the organism responsible was Pseudomonas aeruginosa and the source of infection appeared to be a contaminated water-bottle attached to the endoscopic apparatus. This report highlights the importance of disinfection techniques and reviews the present situation in respect of antibiotic prophylaxis.
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PMID:Pseudomonas septicaemia after endoscopic retrograde cholangiopancreatography--an unresolved problem. 218 80

The risk of cholangitis after ERCP has been reported to occur in up to 50% of patients with obstructive jaundice. Prophylactic antibiotics have therefore been advocated to reduce the risk. Here we report on the results of 46 patients with obstructive jaundice who were given 1 g of Ceftriaxone i.v. 30 to 60 min. prior to the procedure. Only one patient developed cholangitis with septicemia, which was treated conservatively. No side effects were observed in this group of patients. It is suggested that Ceftriaxone is an adequate prophylactic method to prevent cholangitis and septicemia in patients with obstructive jaundice.
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PMID:[ERCP under ceftriaxone antibiotic cover in patients with obstructive jaundice]. 232 Aug 12

At the instance of a female patient with obstructive jaundice due to inoperable carcinoma of the head of the pancreas is reported on the percutaneous transhepatic cholangiodrainage. With the help of this non-operative palliative drainage of the system of bile ducts in malignant tumors of the biliopancreatic area an at least transitory relief with regression of the jaundice and the excruciating pruritus is achieved. With regard to the relatively high complication rate of the percutaneous drainages performed without laparotomy (haemorrhage, cholangitis, sepsis) and to the possibly already early loss of function by occlusion or dislocation of the catheter the indication for such an approach is strictly to be made.
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PMID:[Percutaneous transhepatic bile duct drainage (PTCD)]. 241 32

Percutaneous transhepatic biliary drainage is usually used for preoperative decompression and for palliation in obstructive jaundice, but little attention has been focused on catheter complications. We retrospectively reviewed our experience with percutaneous transhepatic biliary drainage in 81 consecutive patients. There was a 10.0% failure rate and an 8.6% mortality rate. Four patients (4.9%) required emergency operations for complications and an additional ten patients (12.3%) required transfusions. The overall sepsis rate was 34.6%; prophylactic antibiotics decreased the sepsis rate. Thirty-eight patients (47.0%) required 68 manipulation procedures for catheter malfunctions. No distinguishing characteristics could be found to identify the subgroups having complications or mortalities. The efficacy of preoperative percutaneous transhepatic biliary drainage has not been proved, and the indications for palliation are not clearly defined. Further trials are needed to define the role of percutaneous transhepatic biliary drainage in patients with obstructive jaundice.
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PMID:Percutaneous transhepatic biliary drainage. Results and complications in 81 patients. 242 4

Percutaneous biliary drainage was performed in 296 patients on 311 occasions using a fine-needle puncture technique. In 59%, the procedure served as postoperative decompression, and in 35% for palliation of obstruction, particularly in malignant disease. Postoperative drainage for the management of postoperative complication accounted for 2.5%. In more than 80% of the patients treated, the underlying disease was malignant obstructive jaundice. In 257 retrospectively evaluated patients the following complications were observed: cholangitis (6.6%), sepsis (3.1%), bile leakage (1.6%) with two deaths (0.7%), and subcapsular hematoma and hematoma in the hepatoduodenal ligament (1.2%). Catheter dislocations accounted for 8.5% and were eliminated by the use of self-retaining catheters. In 51 prospectively studied patients pain was encountered in 55% and cholangitis in 11.8%. The procedure is most valuable for complicated biliary obstruction, palliative drainage, and endobiliary manipulations.
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PMID:Percutaneous transhepatic biliary drainage: experience with 311 procedures. 245 99

High surgical mortality in patients with obstructive jaundice and sepsis have been attributed to reticuloendothelial system (RES) depression. The purpose of this study was to clarify the effects of mechanical biliary obstruction on RES clearance of pathogenic bacteria by comparing the phagocytic index (K) with the directly measured hepatic uptake of indium 111-labeled bacteria injected into the portal vein of normal dogs and dogs with partial (PBO) or complete biliary obstruction (CBO). No significant difference was observed between the K in normal dogs (0.19 +/- 0.08; n = 6) and that in dogs with PBO (0.24 +/- 0.06; n = 5) or CBO (0.21 +/- 0.03; n = 4). There was no significant difference in uptake of radiolabel by the liver among the three groups of dogs. In our model, biliary obstruction had no effect on hepatic RES function and may not represent a significant determinant of mortality in patients with obstructive jaundice.
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PMID:Effects of biliary obstruction on hepatic clearance of bacteria. 250 73

Eleven patients with obstructive jaundice from unresectable cholangiocarcinoma, metastatic porta hepatis adenopathy, or direct compression from a pancreatic malignancy were treated at the Stanford University Medical Center from 1978-1983 with an external drainage procedure followed by high-dose external-beam radiotherapy and by an intracavitary boost to the site of obstruction with Iridium192 (Ir192). A median dose of 5000 cGy was delivered with 4-6 Mv photons to the tumor bed and regional lymphatics in 9 patients, 1 patient received 2100 cGy to the liver in accelerated fractions because of extensive intrahepatic disease, and 1 patient received 7000 "equivalent" cGy to his pancreatic tumor bed and regional lymphatics with neon heavy particles. An Ir192 wire source later delivered a 3100-10,647 cGy boost to the site of biliary obstruction in each patient, for a mean combined dose of 10,202 cGy to a point 5 mm from the line source. Few acute complications were noted, but 3/11 patients (27%) subsequently developed upper gastrointestinal bleeding from duodenitis or frank duodenal ulceration 4 weeks, 4 months, and 7.5 months following treatment. Eight patients died--5 with local recurrence +/- distant metastasis, 2 with sepsis, and 1 with widespread systemic metastasis. Autopsies revealed no evidence of biliary tree obstruction in 3/3 patients. Mean survival time from initial laparotomy and bypass was 16.1 months, and from radiotherapy completion was 8.3 months. Evolution of radiation treatment techniques for biliary obstruction in the literature is reviewed. High-dose external-beam therapy followed by high-dose Ir192 intracavitary boost is well tolerated and provides significant palliation. Survival of these aggressively managed patients approaches that of patients with primarily resectable tumors.
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PMID:Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy. 257 52

The diagnostic accuracy of ultrasonography (US) was evaluated in delineating the site and cause of biliary obstruction in 59 patients of surgical obstructive jaundice (SOJ). A final analysis of the ultrasonographic data was carried out in 42 patients on whom laparotomy or endoscopic papillotomy with removal of common bile duct stones, confirmed the diagnosis. Evaluation of the role of second investigation following ultrasound in 28 patients (side-viewing endoscopy in 13, ERCP in 12 and PTC in 3) was also done to determine whether they provide any additional information over ultrasonography in delineating the exact level and etiology of biliary obstruction. US was done by the clinician who interpreted the findings in conjunction with the clinical profile of the patient. US correctly diagnosed SOJ in all 42 patients. In 26 of the 28 patients with distal CBD block (specificity 87.5%; sensitivity 100%) and in 14 out of 16 patients with proximal CBD block (specificity 100%; sensitivity 87.5%) US provided and accurate diagnosis of the site of obstruction. US was correct in diagnosing a malignant etiology in 26 out of 27 malignant cases whereas it accurately indentified the benign nature of biliary obstruction in 14 of the 15 patients of SOJ due to benign obstruction (specificity and sensitivity range 93.3% to 96.3%). A second investigation could correctly change the etiology and site of biliary obstruction in only 5 patients (17.9%) whereas in the remaining 23 patients (82.1%) it did not add any additional information over the US findings. Six out of fifteen patients (40%) who underwent cholangiography had cholangitis and in one severe septicemia led to death.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Accuracy of abdominal ultrasonography and the role of a second investigation in surgical obstructive jaundice. 268 Jul 44


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