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

Although a relatively unusual tumor, carcinoma of the proximal biliary tree merits inclusion in the differential diagnosis of all cases of obstructive jaundice. A confident preoperative diagnosis is possible, in the majority of cases, with percutaneous transhepatic cholangiography. The improved accuracy of diagnosis of the tumor has indicated that the incidence is higher than hitherto suspected. Early diagnosis and careful evaluation and selection of cases both preoperatively and intraoperatively should improve overall resectability rates as well as survival. In the past, the overall results of treatment of bile duct cancer were unsatisfactory, with the majority of patients dead within one year of liver failure and sepsis. Now, however, as well as possible cures, extended periods of effective palliation can be provided by current techniques. Transhepatic Silastic biliary stents and U tubes provide lasting palliation. New techniques in radiotherapy allow delivery of massive doses of radiation locally to the tumor site. The results of the transhepatic intubation procedures with or without curative resection, combined with radiotherapy, are encouraging and merit continued evaluation. Chemotherapy treatment using currently available regimens appears to offer very little benefit to these patients.
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PMID:The management of proximal biliary tract tumors. 617 39

One hundred five patients with obstructive jaundice have undergone percutaneous transhepatic internal biliary drainage at the Johns Hopkins Hospital. Many of these patients subsequently underwent corrective or palliative surgery, whereas other died of malignant disease after relatively short periods of catheter decompression, Seven of these patients with percutaneous internal biliary drainage, however, have been followed for over 8 months. Three of these seven patients developed intrahepatic abscesses at a mean of 16 months after catheter placement. Two of the three patients died of sepsis. In two of the patients the abscesses communicated with the biliary tree, in the third it did not. Intrahepatic abscess formation may be a common complication of long-term percutaneous transhepatic internal biliary drainage, and it should be suspected in any patient with fever or signs of sepsis who has been followed with catheter drainage for over 6 months.
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PMID:Intrahepatic abscess as a complication of long-term percutaneous internal biliary drainage. 628 30

To test the ability of cefazolin, given in a single dose preoperatively, to prevent infection in high-risk patients after biliary tract surgery, the authors conducted a double-blind, prospective, randomized, controlled study. Of 92 patients operated on for acute cholecystitis or bile-duct disease, 46 were given 2 g of cefazolin intravenously before operation. Bile was contaminated with bacteria in 36% to 50% of patients with acute cholecystitis, obstructive jaundice, bile-duct disease without jaundice, or over 50 years old compared with only 5% of patients with chronic cholecystitis or under 50 years of age. Postoperative sepsis was eight times more frequent in patients with contaminated bile than in those without. Only 1 patient who received cefazolin had a wound infection, but 9 of the 46 patients in the control group did. The bacteria causing wound sepsis were similar to those in the contaminated bile. The authors conclude that a single dose of cefazolin given intravenously before operation provides effective prophylaxis against infection in high-risk biliary tract surgery.
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PMID:A single preoperative dose of cefazolin prevents postoperative sepsis in high-risk biliary surgery. 638 Jun 93

Hemobilia is a rare complication of percutaneous liver biopsy. We present such a case that demonstrates the usefulness of endoscopic retrograde cholangiopancreatography in establishing the diagnosis, the importance of localization of the bleeding site by angiography, and the therapeutic usefulness of arterial embolization for the control of persistent bleeding. Also, we propose a possible indication for endoscopic sphincterotomy in the rare case where retained intrabiliary blood clot causes progressive obstructive jaundice complicated by severe pain and sepsis.
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PMID:Hemobilia after percutaneous liver biopsy: role of endoscopic retrograde cholangiopancreatography and sphincterotomy. 640 24

A patient with a Billroth II resection and Crohn's disease subsequently developed obstructive jaundice and biliary sepsis. Three hepatic duct stones were demonstrated by ERC. After overcoming the obstruction by means of temporary retrograde internal drainage, perfusion of glyceryl-1-monooctanoate-carnosine and bile-acid-EDTA solution (2) was combined with sucralfate instillation into the blind loop via a duodenal tube. During successful treatment of the cholangiolithiasis, no deterioration of Crohn's disease was seen. Secondary effects such as abdominal pain or diarrhoea, were treated symptomatically.
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PMID:Dissolution of biliary duct stones without papillotomy in a patient with Billroth II resection and Crohn's disease. 642 68

The influence of diabetes on mortality and morbidity following operations for obstructive jaundice has been assessed in 118 consecutive patients, all of whom received antibiotic cover, subcutaneous heparin and intravenous mannitol. 44 patients had diabetes mellitus (37%). There were 12 post operative deaths (10%). Factors which significantly contributed to mortality included; admission values for alkaline phosphatase, creatinine, haematocrit, bilirubin and age of patient over 70 years. Although mortality was not increased in diabetics, wound sepsis was significantly more common (20% and 4% respectively; p less than 0.02). The majority of infections were due to antibiotic sensitive Staphylococcus aureus. Diabetes did not influence survival after operation for malignant disease.
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PMID:Influence of diabetes on mortality and morbidity following operations for obstructive jaundice. 669 98

Wound healing has been investigated in 373 patients undergoing surgery for obstructive jaundice and 760 anicteric patients undergoing cholecystectomy. Reduced wound healing manifested by a higher frequency of wound dehiscence (3.2 per cent vs. 0.5 per cent) and incisional hernia (10.3 per cent vs. 1.8 per cent) was seen in the jaundiced patients. The factors related to this reduced wound healing have been analysed by univariate and multivariate analysis. The independent factors related to wound dehiscence in the 373 jaundiced patients were: an initial low haematocrit (less than 30 per cent), an initial low plasma albumin (less than 30 g/l], a history of pancreatitis, a malignant obstructing lesion, and postoperative wound and/or abdominal sepsis. Haematocrit, albumin and postoperative wound and/or abdominal sepsis were also independent factors for incisional hernia. A raised plasma bilirubin was not of independent significance for either wound dehiscence or incisional hernia. It is concluded that reduced wound healing occurs in jaundiced patients and that this is due to the associated features of poor nutritional status (manifested by low haematocrit and low albumin) and malignancy and not to the raised bilirubin per se.
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PMID:Wound healing in obstructive jaundice. 670 75

Two hundren sixty-seven neonates who received parenteral nutrition were monitored for signs of liver dysfunction. Cholestatic jaundice occurred in we infants, with a higher incidence in the more immature infants. There was an inverse correlation between severity of jaundice and the degree of prematurity. Infants with cholestasis remained without gastrointestinal feedings and received parenteral nutrition for periods of time significantly higher than infants without cholestasis. The incidence of this complication did not seem to correlate with the amount of protein infusate (amino acid solution). A higher incidence of sepsis was noted in infants who were affected by cholestasis. Close monitoring for signs of liver dysfunction in all neonates receiving parenteral nutrition is strongly recommended.
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PMID:Hyperalimentation-induced cholestasis. Increased incidence and severity in premature infants. 679 7

Controlled studies have demonstrated that systemic prophylactic antibiotics significantly reduce the sepsis rate after biliary tract surgery. Other studies have documented the efficacy of topical antibiotic irrigation in decreasing the incidence of wound infection after a wide variety of procedures. Whether systemic antibiotics or the combination of systemic and topical antibiotics provide any advantage over topical antibiotics alone, however, has not been determined. Therefore, a prospective, randomized study was carried out comparing topical intra-abdominal and wound antibiotic irrigation (neomycin and polymyxin) with topical antibiotic irrigation plus parenteral antibiotics (gentamicin and penicillin) in 54 patients undergoing "high-risk" biliary surgery. All patients underwent either an elective common bile duct exploration or a biliary-enteric anastomosis for obstructive jaundice. Twenty-five patients were randomized to the group receiving only topical antibiotics, and 29 received topical plus systemic antibiotics. The two groups were similar with respect to age, sex, presence of common duct stones, incidence of jaundice, positive bile cultures at surgery, and type of surgery performed. There were three wound infections in each group, and no patient developed an intra-abdominal abscess. Other infectious complications occurred with similar frequency in the two study groups. This study suggests that topical antibiotics provide effective prophylaxis in biliary tract surgery and that broad-spectrum systemic antibiotic therapy is of no additional benefit. Topical antibiotics provide an alternative means of prophylaxis for patients discovered intraoperatively to be at "high risk" for infection.
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PMID:The role of topical antibiotics in "high-risk" biliary surgery. 680 77

In the presence of obstructive jaundice, surgical procedures are associated with high rates of mortality and morbidity. In an endeavour to identify risk factors associated with a poor outcome, a detailed prospective study of 28 jaundiced patients has been performed. Factors associated with a fatal outcome of operation were serum bilirubin level > 300 mumol/1, glomerular filtration rate < 50 ml/min, the presence of an abnormal level of fibrin degradation products (FDP) in serum, and the presence of endotoxaemia. Postoperative deep venous thrombosis was associated with low serum albumin, normal liver enzymes and rapid kaolin clotting time. Postoperative haemorrhage occurred in patients with FDP or endotoxaemia. Patients with normal renal function or elevated levels of liver enzymes were protected from sepsis. Based on the identification of these risk factors and of those patients with inoperable disease, a plan for management is proposed.
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PMID:The identification of risk factors and their application to the management of obstructive jaundice. 693 56


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