Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred five patients with obstructive jaundice and cholangitis (49 patients), referred for diagnostic endoscopy, were found to have inextractable bile duct stones. Median age was 76 years and three quarters were more than 72 years of age. Insertion of an endoprosthesis with or without a sphincterotomy relieved jaundice in 94% and settled cholangitis in 90%. Antibiotic cover during the procedure seems essential inasmuch as pyrexia and septicemia occurred in 6 of 57 cases where it was not given. One case was lethal. Another patient died of acute pancreatitis. The patients were old. One quarter died before the follow-up, 1 to 5 years after the initial intervention. The results indicate that the combination of endoscopic sphincterotomy, insertion of an endoprosthesis, and, if feasible, stone extraction on a later occasion when the acute phase of the illness had subsided brought the disease sufficiently under control among three quarters of the patients with large common duct stones or stenoses in the biliary tract. One quarter of the patients were treated surgically. This was accomplished without mortality, but morbidity was not negligible. A policy with a surgical approach restricted to selected cases with persistent symptoms in spite of sufficient endoscopic drainage is recommended.
 ...
PMID:Large bile duct stones treated by endoscopic biliary drainage. 291 4

Sepsis is a major factor in the high mortality and morbidity after surgery for obstructive jaundice. Several studies have suggested that reticuloendothelial function is depressed, but changes in lymphocyte function are poorly understood. A model of obstructive jaundice has been produced by chronic common bile duct ligation in eight dogs. In vitro lymphocyte studies were performed both at 2 and 3 weeks duration of jaundice and compared with simultaneous healthy control subjects. Icteric animals showed no abnormality of natural killer cell function. Relative numbers of T and B lymphocytes and their subsets were unchanged. T lymphocyte responses to three mitogens were not significantly reduced in jaundiced animals. Serum immunoglobulin levels were unchanged compared to those before surgery apart from a significant rise in immunoglobulin A. No evidence of circulating immunosuppressive factors was found by mitogen testing on normal lymphocytes in the presence of pooled serum from jaundiced animals, normal serum, or normal serum with added bilirubin. Our study does not suggest that impairment of lymphocyte function contributes significantly to the dangers of sepsis in obstructive jaundice.
 ...
PMID:Lymphocyte function in obstructive jaundice. 292 63

In order to understand the pathophysiology of jaundice in severely ill patients, we have examined several possible promoting factors in a retrospective study of 86 patients with multiple organ failure admitted to an intensive care unit (ICU). Patients with bile duct obstruction were excluded from this study. Cholestatic jaundice had developed in 19 of 54 patients after trauma and in 20 of 32 patients after septic intra-abdominal complications. No differences were found between the icteric and non-icteric groups of patients with regard to median age, sex distribution, duration of stay in the ICU, number of operations, utilization of gaseous and/or intravenously administered anaesthetics and lipid, and administration of potential hepatotoxic drugs. Twenty-six of 39 icteric patients had a normal renal function. However, a significantly higher number of blood transfusions was found in the icteric as compared to the non-icteric patients. The higher number of blood transfusions and the incidence of initial shock in the icteric trauma patients were probably related to the higher injury severity score. Furthermore, sepsis was found significantly more frequently in the icteric trauma patients, while the number of organ failures when the presence of jaundice was not accounted for was the same in both groups. Nevertheless, the severity of jaundice correlated well with the increasing number of failing organs and the increasing mortality. From these findings we can therefore conclude that jaundice occurring in patients with multiple organ failure is usually not due to the administration of potential hepatotoxic drugs. However, the number of blood transfusions may be an important associated factor.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Etiologic factors of jaundice in severely ill patients. A retrospective study in patients admitted to an intensive care unit with severe trauma or with septic intra-abdominal complications following surgery and without evidence of bile duct obstruction. 318 48

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but there was no significant association with other established preoperative risk factors. Patients with preoperative endotoxemia had a decreased immunoglobulin M anti-J5 endotoxin titer (p less than 0.05) and a decreased serum bile acid concentration (p less than 0.05). Preoperative endotoxemia was associated with reduced creatinine clearance before and after operation (p less than 0.05). There was no association between endotoxemia and clinical sepsis, gram-negative infection, or small-bowel colonization. Patients who died had increased preoperative serum fibrin degradation products (p less than 0.05).
 ...
PMID:Endotoxemia in obstructive jaundice. Observations on cause and clinical significance. 334 55

Sepsis is a common and occasionally lethal complication of obstructive jaundice. The reasons for this increased susceptibility to infection are unknown. This study examines lymphocyte and reticuloendothelial (RES) function in animals with obstructive jaundice. Twelve New Zealand white rabbits (3-4 kg) were studied. Lymphocyte function was evaluated in six rabbits by phytohemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM) stimulation. In six animals, hepatic RES function was assessed by calculating the phagocytic index (PI) using the disappearance of 99Tc sulfacolloid (5 mg/kg) iv. After baseline studies, the common bile duct was divided and ligated. The above studies and serum bilirubin were repeated at 3 weeks. Obstruction was then relieved by cholecystojejunostomy (CJ) and RES studies repeated monthly x 6. Preobstructive lymphocyte function showed a stimulation index ratio (log) of 0.85 +/- 0.25 for PHA, 0.75 +/- 0.3 for Con A, and 0.71 +/- 0.25 for PWM. With biliary obstruction, the values fell to -0.23 +/- 15 (P less than 0.006), -0.31 +/- 0.12 (P less than 0.006), and -0.29 (P less than 0.006), demonstrating impaired lymphocyte function. When tested lymphocytes were mixed with control pooled rabbit serum, however, no lymphocyte impairment was noted. Baseline hepatic PI was 6.02 +/- 0.18 and fell to 3.79 +/- 0.33 with obstruction (P less than .01) and remained low at (3.20 +/- 0.14) 1 month (P less than 0.01) and (3.33 +/- 0.23) at 3 months (P less than .01), after CJ but returned to normal (8.04 +/- 0.97) at 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Impaired immune function in obstructive jaundice. 341 52

Ascariasis lumbricoides is one of the most common helminthic infections in developing countries. Biliary ascariasis presents with recurrent cholangitis and sometimes with liver abscesses. We report the case of a young Philippino worker in Saudi Arabia who presented with obstructive jaundice, cholangitis and liver abscesses secondary to biliary tract ascariasis. The diagnosis was made at endoscopic retrograde cholangio-pancreatography (ERCP) and the obstructing worms were removed with a Dormia basket after endoscopic sphincterotomy at this procedure. Full resolution of the biliary and hepatic sepsis followed. Urgent ERCP and endoscopic decompression of the biliary system in biliary ascariasis is recommended.
 ...
PMID:Endoscopic treatment of ascariasis causing acute obstructive cholangitis. 354 73

Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution of renal failure to mortality. Thirty-eight patients (11 per cent) developed postoperative renal impairment (a two-fold increase in serum creatinine postoperatively or a rise of greater than 100 mumol/l). Ninety-three factors were examined in these and 196 control patients. Stepwise logistic regression analysis identified only three factors which were significantly associated with renal impairment: postoperative sepsis (P less than 0.0005), pre-operative serum bilirubin (P less than 0.0005), and pre-operative urea (P less than 0.05). Renal impairment developed at a median 4 days after surgery and was associated with a median of two additional major postoperative complications, particularly sepsis and haemorrhage, for which 17 patients underwent reoperation. Twenty-eight (74 per cent) of the patients with renal impairment died in hospital, but in only one case was the cause of death directly related to renal failure. Twenty patients received specific therapy for renal failure, but only one of these survived. Pre-operative obstructive jaundice and postoperative infection are the major factors associated with renal impairment after biliary tract surgery. Renal impairment appears to be related to postoperative complications rather than directly to the surgical procedure itself. The development of postoperative renal impairment predicts a low chance of survival but appears to be an indicator, rather than a direct cause of a poor prognosis.
 ...
PMID:Renal impairment following biliary tract surgery. 366 54

Severe coagulopathy in a male patient with septicemia, renal failure, and obstructive jaundice secondary to cholelithiasis precluded safe endoscopic sphincterotomy. A temporary nasobiliary drain, inserted at endoscopic retrograde cholangiopancreatography, decompressed the biliary tree, allowing eventual safe sphincterotomy and bile duct clearance after correction of coagulopathy and improvement in his clinical condition.
 ...
PMID:The benefit of emergency nasobiliary drain in cholelithiasis with ascending cholangitis, coagulopathy, and thrombocytopenia. 372 51

In almost all cases of acute renal failure associated with cholestatic jaundice, the occurrence of renal failure is preceded by episodes of shock, hypotension, sepsis, or surgical intervention. The pathologic finding is usually that of acute tubular necrosis. A patient with obstructive jaundice developed renal failure; the clinical and pathologic features were consistent with those found in the hepatorenal syndrome. No episodes of shock or sepsis preceded the onset of that renal failure. At autopsy, the findings were normal.
 ...
PMID:Hepatorenal syndrome associated with obstructive jaundice. 406 31

Percutaneous catheter biliary decompression was performed in 42 patients with obstructive jaundice. Internal drainage was accomplished in 27 patients (64.3%), and external drainage in 15 patients (35.7%). Serum bilirubin levels decreased at a mean rate of 1.4 mg/dl/day. Tissue diagnosis was obtained by percutaneous aspiration biopsy in nine patients (21.4%). Complications occurred in 10 patients (23.8%): septic shock, two; bilious pleural effusion, one; hepatic subcapsular hematoma, one; sepsis, six. There was one death related to the procedure. The catheter management problems encountered included pain, catheter dislodgement or migration, lumen occlusion, and external bile leakage.
 ...
PMID:Percutaneous catheter biliary decompression. 616 67


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>