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

The management of the haemophilias has been improved by the advent of potent consistent clotting factor replacement therapy. The previously lethal major complications such as intracerebral haemorrhage are now rare, and the infective complications of treatment, most notably hepatitis and AIDS, are now potentially preventable with the new synthetic products. There is also the prospect of 'cure' by gene insertion therapy. Advanced arthropathy has been minimized but not prevented by early effective treatment of haemarthroses, and there is a diminishing legacy of severely affected patients many of whom may require joint replacement surgery. The present group of such patients has a high prevalence of HIV-1 infection and an increased risk of joint sepsis. The available avenues of treatment for the subacute stage of the arthropathy have not been particularly effective, emphasizing the need to prevent recurrent bleeding. The development of a multidisciplinary team-management approach in centres of expertise has been a significant factor in the improved longevity, life satisfaction and preserved mobility now available to most haemophiliacs.
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PMID:Musculoskeletal disorders in the haemophilias. 175 80

Septic arthritis can complicate many forms of arthritis. Two cases of apatite associated destructive arthropathy (AADA) complicated by sepsis are described. Diagnosis of this complication in the setting of severe joint damage is difficult as AADA and sepsis share certain characteristics--an initial, rapidly progressive, severely painful course and radiographs which show rapidly destructive changes with marked cartilage loss, bone attrition, and virtual absence of osteophyte or cyst response.
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PMID:Septic arthritis complicating apatite associated destructive arthropathy. 176 75

Co-trimoxazole or norfloxacin were randomly administered to 44 granulocytopenic children with malignancies in order to prevent bacterial infections. Although more patients in the co-trimoxazole group had febrile episodes (p less than 0.01), the mean of febrile days and the mean of days with systemic antibiotics did not differ significantly in the two groups. Five patients in the co-trimoxazole group had a microbiologically documented infection (four with septicemia) due to Escherichia coli (n = 2), Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus sp. There were four septicemic episodes in the norfloxacin group due to P. aeruginosa, Streptococcus pneumoniae, Streptococcus mitis and Streptococcus faecalis. Compliance was good during administration of both drugs. No signs or symptoms of arthropathy were seen in the norfloxacin group. The number of gram-negative bacilli resistant to co-trimoxazole isolated from stools significantly increased during prophylaxis with co-trimoxazole (p less than 0.001). Norfloxacin did not select resistant strains and was very active in eradicating gram-negative bacilli from stools (27.5% of positive cultures).
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PMID:Prophylactic co-trimoxazole versus norfloxacin in neutropenic children--perspective randomized study. 265 19

The technetium phosphate bone scans of 106 children with suspected septic arthritis were reviewed to determine whether the bone scan can accurately differentiate septic from nonseptic arthropathy. Only 13% of children with proved septic arthritis had correct "blind" scan interpretation. The clinically adjusted interpretation did not identify septic arthritis in 30%. Septic arthritis was incorrectly identified in 32% of children with no evidence of septic arthritis. No statistically significant differences were noted between the scan findings in the septic and nonseptic groups and no scan findings correlated specifically with the presence or absence of joint sepsis.
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PMID:Technetium phosphate bone scan in the diagnosis of septic arthritis in childhood. 279 33

Arthrodesis is currently the treatment of choice for symptomatic degenerative arthropathy of the ankle. Thirty-seven patients underwent arthrodesis for post-traumatic disorders using either a Hoffmann external fixator or a Calandruccio frame. There was degenerative joint disease in 19 (51%), septic arthritis in 11 (30%), severe comminution in five (14%), and uncontrollable equinus in two (5%). The patients were divided into two groups. Twenty-six (70%) were considered to have sustained high energy open or comminuted injuries and 11 (30%), low energy injuries. Twenty-nine (78%) achieved a radiologic fusion following one operation. Four eventually united with further surgery for a final arthrodesis rate of 89%. In the high energy group 18 of 26 (69%) achieved primary fusion. Four united with additional surgery for a final arthrodesis rate of 85%. Two of these required subsequent amputations and two others, a triple arthrodesis which also failed to control chronic pain. Thus, a total of 18 of the 26 patients (69%) achieved a successful result. Also included in the high energy group were three patients with uncontrolled sepsis who underwent amputation before union occurred and one with a painful non-union. All 11 of the patients (100%) who originally sustained low energy injuries achieved a successful arthrodesis. The most common complication was in pin tract infection requiring incision, drainage, and oral antibiotics in 16 patients (43%). None of these progressed to chronic osteomyelitis.
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PMID:External fixation arthrodesis of the ankle joint following trauma. 309 61

Peripheral neuropathy plays an important part in the development of foot complications in patients with diabetes. We studied the contribution of impairment of the dual sensory and inflammatory function of unmyelinated nociceptive C fibers in the foot complications of diabetes. The integrity of these fibers was assessed objectively by measuring axon reflex vasodilation in response to stimulation with 10 percent acetylcholine introduced by electrophoresis. This was related to the non-neurogenic capacity of the vessels to dilate in response to a mechanical stroke. These measurements were made on the soles of the subjects' feet. The function of the nociceptive C fibers was abnormal in 1 of 14 patients with longstanding diabetes who had no foot complications, 3 of 9 patients with diabetes and skin sepsis, 8 of 11 patients with typical neuropathic plantar ulcers, and all of 8 patients with neuroarthropathy. In patients with longstanding diabetes but no foot complications, the mean ratio of neurogenic to non-neurogenic vasodilation was not significantly different from that in controls; however, it was significantly lower in the other three groups (P less than 0.01 for those with sepsis; P less than 0.001 for those with ulcer or arthropathy). Impairment of the neurogenic vasodilator response, or flare, correlated with the clinical diminution of pain sensation. This study suggests that the loss of both components of nociceptive C-fiber function--neurogenic inflammation and pain sensation--is an important factor in the development of foot complications in diabetes.
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PMID:Impaired neurogenic vascular response in patients with diabetes and neuropathic foot lesions. 336 88

Twenty-five hematogenously infected knee arthroplasties in 20 patients (17 with rheumatoid arthritis and 3 with arthrosis) were followed for 3 years. Staphylococcus aureus was the major infecting organism. Three patients with four arthroplasties died of sepsis. Two patients had removal of the arthroplasty, one of which resulted in an above-the-knee amputation. Four out of five arthrodeses fused. Two knees healed after early debridement and two healed without surgery. Ten knees had successful revision arthroplasty. Rheumatoid arthritis and constrained prostheses increase the risk of hematogenous infection. Any infection and especially cutaneous lesions in a patient with a knee arthroplasty should be treated vigorously.
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PMID:Hematogenous infection after knee arthroplasty. 342 83

The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Fifteen patients had pre-existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Eight patients had underlying systemic illnesses, and eight patients were receiving systemic corticosteroid therapy prior to the development of septic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2 per cent of patients), enteric gram-negative bacilli were found in seven of 23 patients (30.4 per cent). Five patients died (21.7 per cent mortality), two as a result of their infection and three of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4 per cent) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre-existing joint disease is very common and enteric gram-negative bacilli are often the causative organisms.
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PMID:Septic arthritis in the elderly. 397 35

An acutely swollen joint may be indicative of a number of disease entities. A thorough history and physical examination are the cornerstones of evaluation. Laboratory findings can be useful in diagnosis, as can response to therapy (eg, response to penicillin in gonococcal arthritis is often the only criterion for diagnosis, as the organism is difficult to culture). Patients with malignancy (especially leukemia) or who are immunosuppressed or otherwise debilitated are at particular risk for a septic cause of swelling. Infectious arthritis should be the first potential cause looked for in these patients as well as in patients with such preexisting joint diseases as rheumatoid arthritis. The diagnosis of joint sepsis is confirmed by examination of aspirated joint fluid. In no case should a swollen joint be injected with corticosteroids until all possibility of infection has been eliminated.
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PMID:The acutely swollen joint. First impressions may mislead. 669 33

As the average age of the population increases, more elderly individuals with disabling joint diseases may require total joint replacements to improve their quality of life. The development of a postoperative wound infection could lead to extended and costly hospitalizations and perhaps even result in permanent disability. Perioperative nurses play a significant role in the prevention of sepsis during total joint replacement surgery. Perioperative nurses can effectively contribute to positive outcomes for recipients of total joint arthroplasties by keeping up with advancing technology as well as increasing their understanding of the infectious process, the proper care and handling of prosthetic implants, and the need for strict aseptic technique.
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PMID:Preventing infection in total joint replacement surgery. 776 Nov 27


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