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)

Biliary drainage is a well-accepted procedure for decompression of bile ducts or drainage of infected bile. Percutaneous biliary drainage (PBD) can be performed under fluoroscopic, combined fluoroscopic-US or pure US guidance. The indications of PBD are not well established being closely related to the possibility of an endoscopic stenting. Generally, PBD is indicated in malignant obstructive jaundice especially if accompanied by cholangitis. The main contraindications of percutaneous biliary drainage are bleeding disorders, ascites and rupture of an echinococcus cyst. The rate of successful percutaneous US-guided biliary drainage varies between 85-100% being lower in cases with nondilated bile ducts. Acute complications after US-guided PBD (bleeding, septicemia and bile leakage) are rare (1-5%). Delayed complications include catheter occlusion with cholangitis, intrahepatic abscesses, catheter dislodgment with subsequent bile peritonitis, pericatheter leakage and maldigestion. In percutaneous US-guided biliary drainage there are some pitfalls and critical points. Being aware of them and knowing the implied therapeutic approach is very important in the success of procedure and limitation of incidents and complications.
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PMID:Echoguided percutaneous biliary drainage. Indications, performances, complications. 1522 80

A 57-year-old man was referred to our hospital because of elevated ALP. CT and MRI scans together with abdominal angiography showed multiple masses in his abdomen and portal vein obstruction. A diagnostic laparoscopic examination revealed a tumor of 3 cm x 3 cm near the portal vein and para-aortic lymphadenopathy. Histopathological examination of the tumor showed abnormal follicles with poorly formed germinal centers, scattered large spindle cells with proliferation of small lymphocytes, and hypervascular interfollicular tissue. The spindle cells were positive for follicular dendritic cell markers CD21, CD35, and epithelial membrane antigen. The diagnosis was made of a follicular dendritic cell (FDC) tumor in Castleman's disease (CD) of the hyaline-vascular type. Although the portal vein was obstructed by the FDC tumor, blood flow to the liver was retained by collateral vein. The patient did not show any response to four courses of CHOP therapy and died of obstructive jaundice, biliary tract infection and sepsis. So far, 17 cases of FDC tumor complicating CD have been reported, with a poor prognosis in all cases.
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PMID:[An abdominal follicular dendritic cell tumor in Castleman's disease]. 1551 Aug 31

Liver involvement is common in advanced stages of Hodgkin's disease. However, only a small percentage of patients with Hodgkin's disease develops jaundice due to several causes. Vanishing bile duct syndrome secondary to Hodgkin's disease is a rare cause of cholestasis in these patients. Only 20 cases, to our knowledge, have been reported so far in adults. We report a case of Hodgkin's disease presenting with obstructive jaundice without detectable liver involvement. Liver biopsies revealed intrahepatic cholestasis and ductopenia. Although the patient was given chemotherapy, he died of sepsis and disseminated intravascular coagulation after 24 weeks of admission to hospital.
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PMID:Cholestatic liver disease with ductopenia (vanishing bile duct syndrome) in Hodgkin's disease: report of a case. 1565 42

In 1958 Caroli was the first to define exactly in literature the congenital dilatations of the intrahepatic bile ducts, concerning a segment, a lobe, or both lobes of the Liver. Later Todani involved it in his classification of the bile duct cysts as type V. Caroli's disease (CD) is quite a rare entity (about 150 cases reported in literature). In CD, stenosis and dilatation cause initially biliary stasis, leading to intrahepatic biliary lithiasis and secondary infection. The spontaneous course of CD is dominated by biliary infection: cholangitis (cholangiohepatitis), septicemia and intrahepatic and subphrenic abscesses. That is why the disease must be recognized before serious complications develop. The authors report about 5 cases of Caroli's disease--2 women and 3 men. Diffuse spread in one patient (25-year-old man) and in four--left lobe involved predominantly. Most common signs and symptoms were: fever, cholangitis, upper quadrant abdominal pain, hepatosplenomegaly, obstructive jaundice, Charcot's triad (in two). Importance for the exact diagnosis involves the use of ultrasonography (US), computer tomography (CT) scan, endoscopic cholangiopancreatography (ERCP), intraoperative cholangiography and cholangioscopy, allowing early diagnosis and therefore a better therapeutic and surgical approach.
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PMID:Caroli's disease. Report of 5 cases and review of literature. 1581 87

Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.
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PMID:Retroperitoneal perforation of the duodenum from biliary stent erosion. 1612 9

Obstructive jaundice (OJ) is a severe condition that leads to several complications. One of the important problems in OJ is the increased incidence of endotoxemia, which is the result of bacterial translocation (BT) and defective host immune response. Lipid peroxidation (LP) is an important problem in OJ and sepsis in which nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) activity are increased and antioxidative activity is decreased. Formation of peroxynitrite (ONOO(-)) anion leads to cellular damage and apoptosis. In this experimental study, we explore the effect of specific iNOS inhibitor aminoguanidine (AG) on blood and tissue (liver and renal) LP and iNOS levels in jaundiced rats with endotoxemia induced with lipopolysaccharide (LPS). Rats were randomized into six groups; group A, sham; group B, obstructive jaundice (OJ); group C, OJ + LPS; group D, OJ + AG; group E, OJ + LPS + AG; group F, OJ + AG + LPS. Serum malondialdehyde (MDA) and serum myeloperoxidase (MPO) activity and liver and renal tissue MDA, MPO, and Na(+)/K(+)-ATPase activity levels were detected in biochemical methods. Liver and renal tissue iNOS levels were examined immunohistopathologically. Serum and tissue MDA and MPO levels and tissue iNOS expression were increased significantly in groups B, C, and E, while tissue ATPase levels were decreased significantly in the same groups. In the group treated with AG (group D), serum and tissue MDA and MPO levels and tissue iNOS expression were decreased while tissue ATPase levels were increased significantly. In group F, if AG was administrated before LPS, we observed that serum and tissue MDA and MPO levels and tissue iNOS expression were decreased while tissue ATPase levels were increased significantly. Thus, our study showed that AG had a protective effect when it was administrated before LPS, but it failed to prevent tissue iNOS expression and LP if there was established endotoxemia in OJ.
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PMID:The effect of aminoguanidine on blood and tissue lipid peroxidation in jaundiced rats with endotoxemia induced with LPS. 1654 26

This study reports the gastrointestinal complications of primary upper gastrointestinal lymphoma (PUGIL). of thirty-three patients with PUGIL, twenty-one (64%) had complications. These included upper gastrointestinal bleeding, narrowing of the lumen, malabsorption and obstructive jaundice in 11, 9, 5 and 4 patients, respectively. Perforation and fistula formation were encountered in one patient each. THe patients with complications were treated with chemotherapy alone (13), in combination with surgery (6), or combination with surgery and radiotherapy (2). Only in one of four patients was the mortality due to gastrointestinal complication in the form of severe upper gastrointestinal hemorrhage. The remaining three patients died of refractory septicemia. In conclusion, there was a high rate of gastrointestinal complications in patients with PUGIL in our population. Mortality was commonly unrelated to these gastrointestinal complications.
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PMID:Complications of primary upper gastrointestinal lymphoma. 1758 73

As part of the multifactorial role of liver in protein synthesis, many coagulation factors, natural anticoagulants, and compounds of the fibrinolytic system are produced in the liver. A prolonged liver disease, either biliary obstruction or parenchymal liver disease, is consecutively accompanied by abnormal clotting. In the present paper we review the haemostasis impairment in obstructive jaundice with special reference to the hepatic cirrhosis and failure, to systemic inflammation and sepsis that develops in cholestatic diseases, and finally in some other benign or malignant diseases including pancreatic adenocarcinoma, acute pancreatitis, cholangiocarcinoma, and hepatocellular carcinoma. Finally, a special reference to the possible therapeutic interventions has been made. The aim of the present review is to collect the current concepts concerning the haemostasis impairment in obstructive jaundice and provide practical guidelines for the diagnostic and therapeutic strategies. Understanding the pathophysiology of haemostatic changes in patients with cholestasis, and, more generally, liver disease, is the hallmark of accurate diagnosis and treatment.
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PMID:Haemostasis impairment in patients with obstructive jaundice. 1759 68

Approximately 60 cases of biliary papillomatosis have been reported in the world literature, while only 6 cases have been reported to be treated with liver transplantation. This rare disease, which is characterized by relapsing episodes of obstructive jaundice and cholangitis that lead to secondary cirrhosis and death from sepsis or liver failure, it is also considered premalignant because of its frequent malignant transformation (25-50%). We present a case of a 43-year-old white man with papillomatosis of intra- and extrahepatic biliary tree who sought care for repeated episodes of obstructive jaundice and cholangitis. The diagnosis was suspected after endoscopic retrograde cholangiopancreatography and confirmed by liver and common bile duct biopsies. The patient underwent orthotopic liver transplantation with Roux-en-Y hepatico-jejunostomy to treat end-stage liver cirrhosis. Fifteen months' follow-up revealed a patient with normal graft function and with no clinically or laboratory findings of disease recurrence or cancer development.
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PMID:Papillomatosis of intra- and extrahepatic biliary tree: Successful treatment with liver transplantation. 1760 Mar 52

Patients with CT evidence of more than 50 % necrosis, or an increased CRP or procalcitonin are at risk of developing severe pancreatitis and septic complications and should be monitored in an intensive care unit. ERCP and sphincterotomy are indicated in patients with biliary pancreatitis and impacted gall stones, biliary sepsis, or obstructive jaundice. In septic patients with necrotizing pancreatitis, a FNA should be performed for differentiation of sterile and infected pancreatic necrosis. Adequate volume resuscitation and analgesic treatment are the most important treatment of acute pancreatitis. Antibiotic prophylaxis reduces septic complications in severe necrotizing pancreatitis and should be started early. Surgical therapy is indicated in patients with infected pancreatic necrosis. The surgical technique of choice is open necrosectomy with postoperative closed lavage of the lesser sac.
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PMID:[Infectious complications in necrotizing pancreatitis]. 1790 86


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