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

This report presented a twelve-year experience from 1981 to 1992. Seventy-four cases of congenital biliary tract dilatation were at diagnosed an age of 6 days to 16 years. Twenty-two cases were infants. There were 54 females and 20 males. The ratio of female to male was 2.7:1. The classic triad of abdominal pain, jaundice and a palpable mass was seen in eleven cases (14.9%). Most children suffered from abdominal pain (50/74), vomiting (45/74), anorexia (42/74) and jaundice (34/74). Prolonged jaundice was the main symptom in infancy (15/22). A long common pancreatico-biliary channel was seen in six cases (6/47); the bile amylase level was elevated in five cases (5/20), one patient had a complex union with obstructive jaundice. All these cases were diagnosed by preoperative sonography accurately (100%). According to the Todani's classification, type Ia was the most common (40/74), followed by type IV-A (25/74) and type Ic (8/74). Cholelithiasis (13/74), perforation (9/74), and atresia/stenosis of distal choledochus (8/74) were the most common associated conditions. Cyst excision with biliary tract reconstruction was performed in all cases. Reoperation was needed in ten cases. Two cases died postoperatively due to sepsis and cholangitis induced hepatic failure.
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PMID:Congenital biliary tract dilatation in infancy and childhood--74 cases experience. 785 Jun 45

Nine (1.66%) out of 542 cases of HCC treated surgically in our hospital between 1985 and 1992, had macroscopic bile duct thrombi. Three cases presented preoperatively with obstructive jaundice. Two of these received thrombectomy in the hilar bile duct and died of hepatic insufficiency on postoperative days 10 and 66, the other case underwent extended left lobectomy, but also died of renal failure and sepsis 3 months after the operation. In addition, we also treated 6 cases diagnosed at earlier stages than those presenting with obstructive jaundice with both hepatectomy and thrombectomy. In these patients the outcome was as follows: 2 died of recurrent HCC 3 months and 16 months, respectively, after operation, 1 died of apoplexy with no recurrence after 19 months, 1 had a recurrence 5 months after the operation, but is still alive after 7 months, and 2 are still alive 24 months and 60 months after surgery with no recurrence. The outcome is still poor in our series with obstructive jaundice. But in this report, we propose radical surgical treatment for HCC with bile duct thrombi in accordance with our classification, especially for those cases without obstructive jaundice.
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PMID:Classification and surgical treatment of hepatocellular carcinoma (HCC) with bile duct thrombi. 795 70

Septic complications and renal insufficiency following biliary tract surgery are frequently seen in patients with obstructive jaundice. The precise mechanisms for understanding the susceptibility of the jaundiced patients to sepsis are, however, not clear. The present study aimed at investigating the influence of biliary obstruction on the reticuloendothelial function and bacterial translocation at various time intervals in the rat. Reticuloendothelial system (RES) function, as evaluated by measuring blood clearance of intravenously injected 125I-labeled Escherichia coli, and bacterial translocation were studied 3 days and 1, 2, and 3 weeks following either sham operation or common bile duct ligation (CBDL) and transection in the rat. RES function was significantly impaired and renal uptake of radiolabeled E. coli was significantly higher in jaundiced animals from Day 3 and on after CBDL (P < 0.01) concomitant with elevation of plasma levels of bilirubin and liver enzymes (P < 0.001) compared with their corresponding controls. The incidence of bacterial translocation 3 days and 1 and 2 weeks after biliary obstruction significantly increased (P < 0.05). We conclude that RES phagocytic function is impaired and the incidence of bacterial translocation is increased in jaundiced rats. These findings might contribute to explain the high susceptibility of postoperative septic complications and renal dysfunction in patients with obstructive jaundice.
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PMID:Obstructive jaundice impairs reticuloendothelial function and promotes bacterial translocation in the rat. 802 31

Emphysematous cholecystitis is a rare variant of acute cholecystitis, most frequently seen in elderly, debilitated, or diabetic patients. This report documents the development of fulminant sepsis due to acalculous cholecystitis after endoscopic retrograde cholangiopancreatogram (ERCP) in an otherwise healthy patient with suspected malignant obstructive jaundice. Three other cases of acute cholecystitis have been reported in the literature after ERCP. Although not proven to prevent infectious complications during ERCP, strong consideration should be given to prophylactic antibiotics in patients with suspected malignant obstruction and/or coexistent medical illness, eg, diabetes. When attempts at decompression of the obstructed biliary system by endoscopy fail, decompression by percutaneous or surgical routes should be considered in a timely fashion.
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PMID:Emphysematous cholecystitis after ERCP. 805 Mar 24

Sepsis is a major factor in the high mortality and morbidity following diagnostic and therapeutic procedures in patients with obstructive jaundice. The reasons for this increased susceptibility to infection are not fully understood. We therefore observed prospectively changes in immunological status of patients with obstructive jaundice in the perioperative period and studied immunological effects of perioperative arginine therapy. The results showed that there was a significant reduction in interleukin 2 (IL-2) production, interleukin 2 receptor (IL-2R) expression and lymphocyte response to phytohemagglutinin (PHA) mitogen in patients with obstructive jaundice compared with normal controls. After operation, the immune suppression in patients with obstructive jaundice was more significant. Arginine is a known T lymphocyte stimulator. Perioperative supplement with arginine significantly enhanced the immune function of patients with obstructive jaundice, the mechanism being related to increased IL-2 production and IL-2R expression.
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PMID:Immunological status of patients with obstructive jaundice and immunostimulatory effect of arginine. 823 Mar 55

Total parenteral nutrition (TPN) for the nonoperative treatment of acute pancreatic pseudocyst has been of hypothetical benefit. We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who had serial imaging studies. The mean cyst size was 7.4 cm on presentation, decreasing to 5.6 cm after nonoperative treatment with TPN (mean 32.5 days). After a nonoperative period, 68 per cent of cysts regressed, completely in 14 per cent, partially in 54 per cent. Except for a patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complication, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), in the course of hospitalization. The majority of TPN-treated patients had a clinical and radiographic regression of their pseudocyst. However, the increased risk of catheter-related complications in this group suggests that this therapy should be limited to patients who are unable to sustain enteral nutrition.
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PMID:The limited role of total parenteral nutrition in the management of pancreatic pseudocyst. 823 96

Cholestatic jaundice is the major complication of total parenteral nutrition (TPN) in infants and children. The pathogenesis of this syndrome is poorly understood. The aims of this study were: (1) to define the histologic liver injury in relation to the clinical course of infants on TPN and (2) to determine whether enteral feeding will reverse or halt these changes. We identified 31 infants treated for severe gastrointestinal disease for whom liver histology was available from 1987 to 1991. Clinical records and liver biopsy (23) or autopsy specimens (13) were reviewed. Five patients had biopsies at two subsequent operations. The clinical diagnosis was necrotizing enterocolitis (24), atresia or stenosis (3), midgut volvulus (2), Hirschsprung's disease (1), and sepsis (1). Twenty-one of 31 infants were premature and had a mean birth weight of 1,868 g. Twenty-five of 31 were on TPN and 28 of 31 had received some enteral feeding by the time of the biopsy. Enteral feeding was begun as early as possible in all infants even if continued TPN was necessary for full support. Cholestasis occurred in 71% of premature infants versus 22% of full-term babies. Infants with cholestasis had been on TPN for a longer time (37 days v 18) with a correspondingly shorter period of enteral feeding (17 days v 27). Mean total bilirubin level was 14 in patients with cholestasis and 5 in those without, but the bilirubin level did not correlate with the extent of histological injury and was frequently normal despite marked histological damage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Total parenteral nutrition-associated cholestasis: clinical and histopathologic correlation. 826 85

Twenty-six patients with obstructive jaundice were investigated for RBC immune function. It was found that C3b receptor's E rosette forming rate in jaundiced patients was significantly lower than that of nonjaundiced patients, and the C3b receptor's E rosette forming inhibitory rate was higher than that of nonjaundiced patients. The RBC immune function disturbance may contribute to the postoperative sepsis in jaundiced patients.
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PMID:[Immune function of red blood cell (RBC) in patients with obstructive jaundice]. 856 29

Bacterial translocation from the gastrointestinal tract is central to current concepts of endogenous sepsis. Studies were designed to evaluate the potential relevance of translocation to the high incidence of infection in obstructive jaundice. Sprague-Dawley rats underwent laparotomy and division of the bile duct or sham ligation. In Study 1, rats were sacrificed after 24 hr, 1 week, and 3 weeks and the mesenteric lymph node complex, cecum, and blood were cultured and plasma endotoxin was measured. In Studies 2 and 3, sham-and bile duct-ligated rats were challenged after 1 week with operative trauma and intravenous endotoxin, respectively. Animals were sacrificed after a further 24 hr. No translocation was observed in sham-operated rats. Although colonization of the mesenteric lymph nodes was not seen in bile duct-ligated rats after 24 hr, this was evident in 75% of rats after 1 and 3 weeks. Surgical trauma and endotoxin produced bacterial translocation in 33 and 40%, respectively, of sham-operated animals; this was enhanced in bile duct-ligated rats to 75% (P < 0.01 vs shams) and 93% (P < 0.001 vs shams), respectively. Endotoxin resulted in positive blood cultures in 71% of jaundiced rats compared with none of the sham group injected with endotoxin (P < 0.001). Biliary obstruction produces bacterial translocation and this process is enhanced by surgical trauma and endotoxin. The data support the thesis of gut barrier failure in jaundice and suggest that therapies targeted toward decreasing bacterial translocation may merit evaluation in the prophylaxis and treatment of infection in the jaundiced patient.
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PMID:Gut barrier failure in experimental obstructive jaundice. 860 97

Patients with obstructive jaundice have an increased perioperative complication rate. Sepsis, bleeding, wound problems, renal and liver malfunction are all seen in these patients. Assessment of immune function has been an active research area in these patients. This review will examine various aspects of immune functions in obstructive jaundice, discuss the recent research results and controversies and then go on to discuss the relevant mediators of immune function and some possible implications for treatment.
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PMID:Immune dysfunction in patients with obstructive jaundice, mediators and implications for treatments. 917 57


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