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

Ultrasonography (US) has recently been considered in nephrology as the imaging method of choice in the differential diagnosis of acute renal failure (ARF). A dilated renal collecting system is the hallmark of obstructive nephropathy (ON). We report 4 cases of ARF due to ON in which US detected no dilatation of collecting system. Similar data were obtained by computer tomography (TC). The normal size and structure of the kidneys and the clinical suspicion prompted us to perform retrograde pyelography which revealed ON. Ureteral catheterization determined a marked improvement of renal function in all the patients (pts). 2 pts were one kidney, 3 pts had renal stones, in 2 pts dehydration and sepsis were present. We conclude that ON has not ever been excluded on the criterion of absence of dilated urinary tract from US and TC.
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PMID:[Ultrasonography in the diagnosis of acute obstructive renal insufficiency: a cautionary note]. 183 48

A 22 year old female developed preeclampsia with fetal death in utero. After cesarean section she developed uterine inertia and acute hemorrhagic anemia complicated by sepsis, disseminated intravascular coagulation and total anuria for 4 weeks. She was treated with hemodialysis. The second patient, a 49 year old man developed sepsis and intravascular coagulation after a dog bite. Acute renal failure with a 3 week total anuria followed. He was initially treated with peritoneo dialysis. Renal biopsy showed evidence of renal cortical necrosis in both patients.
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PMID:[Acute kidney failure due to kidney cortex necrosis. 2 clinical cases of surviving patients]. 184 56

The examination of 45 patients with acute renal failure (ARF) caused by obstetric problems identified 3 types of its clinical course: 1) "pure" ARF; 2) ARF in the presence of sepsis, and 3) ARF in the presence of exogenous intoxication. Types 2 and 3 were more severe and showed higher mortality rates. The average number of hemodialysis sessions per patient was 2.4, 3.6, and 9.8 with types 1, 2, and 3, respectively. The treatment was of multimodality, including suppurative focus debridement, therapeutic measures, hemodialysis, and hyperbaric oxygenation; with types 2 and 3 efforts were made to combat sepsis, hemodynamic and coagulative abnormalities, multiorgan failure. The operative risk during evolved ARF is extremely high; uterine curettage, rational bacterial therapy, refusal of nephrotoxic agents are preferred. Better treatment outcomes were due to a session of 5-10 hyperbaric oxygenation procedures which were performed in anaerobic sepsis, pulmonary edema, arterial hypoxemia. The patients who had received hyperbaric oxygenation had less severe ARF, lower incidence of complications and lower mortality rates, they tolerated hemodialysis better.
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PMID:[The characteristics of the clinical picture and treatment of patients with acute kidney failure in obstetrical pathology]. 186 53

Over a five-year period 64 Quinton Permcaths were inserted into 51 dialysis patients (age range 17-72 years, mean 52.1 SD 12.83). The duration of catheter use ranged from 5 to 1479 days, mean 315.7 SD 337. The actuarial catheter survival rate at 1 year was 74%, at 2 years 43%, at 3 years 25% and at 4 years 12%. The indications for use were: exhausted peripheral access; CAPD contraindicated; abrupt failure or lack of an arteriovenous fistula; acute renal failure; limited life expectancy; patient insistence; conventional access contraindicated. Only minor complications occurred during insertion: haemorrhage requiring exploration in three patients and a temporary left recurrent laryngeal nerve palsy in one patient. The exit site infection and septicaemia rates were 4.95 and 3.36 per 1000 catheter days respectively. Eighteen catheters failed due to infection (range of use 72-1479 days, mean 559 SD 388). Inadequate initial blood flow (less than 150 ml/min) occurred in 10% of dialyses but only six catheters failed due to intractable flow difficulties (range of use 5-49 days, mean 22 SD 17.5). Catheter sepsis was implicated in the death of two patients. One subclavan/innominate vein thrombosis occurred. The Quinton Permcath represents a significant advance providing immediate, durable, and relatively safe access in a variety of difficult circumstances.
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PMID:Five years experience with the Quinton Permcath for vascular access. 188 81

Obstructive jaundice has been known to cause severe hemodynamic disturbance. The present study was therefore designed to assess the cardiac involvement in jaundiced patients. The multiple-gated blood pool cardioscintigraphic studies were done in 9 jaundiced patients who had either cholestatic or obstructive jaundice (mean total bilirubin 29.30 +/- 3.30 mg/dL), and in 8 normal volunteers (total bilirubin less than 1 mg%). None of the patients had evidences of obvious cirrhosis, intrinisic heart disease, or septicemia. Following intravenous dobutamine there was comparable change of blood pressure and heart rate in both groups. However the response of left ventricular ejection fraction (LVEF) to dobutamine (10 micrograms/kg/min x 5 min) was strikingly blunted in the jaundiced patients as compared to that seen in the normal controls (3.56 +/- 0.9 vs. 12.7 +/- 2.2%, p less than 0.005). Our present data thus show that there is blunted myocardial contractile response to the inotropic stimulation in jaundiced patients. Such myocardial refractoriness to beta-1 stimulation may contribute to the susceptibility of jaundiced patients to postoperative shock and acute renal failure.
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PMID:The jaundiced heart: evidence of blunted response to positive inotropic stimulation. 192 12

Eight patients with acute renal failure (ARF) following electrical injury were studied. The mean area of cutaneous burns was 23 +/- 16% (range 6-60%) and extensive tissue necrosis with gangrene was uniformly present. Oliguria developed 9.3 +/- 7 h (range 3-24 h) after the injury in 7 patients (88%). Urinalysis revealed presence of myoglobin in 75% of the patients. The mean duration of oliguria among those who recovered was 16 +/- 6 days (range 11-23 days) and the mean interval between the onset of oliguria and recovery of renal function was 25 +/- 6 days (range 21-34 days). Four patients died. The cause of death was Klebsiella septicemia in 1, hyperkalemia associated with extensive myonecrosis in 2 patients, and uncertain in 1 patient. Our observations showed that myoglobinuric acute renal failure associated with electrical injury carries a high mortality. Early detection and aggressive management of hyperkalemia and sepsis are necessary to reduce mortality among these patients.
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PMID:Myoglobinuric acute renal failure following electrical injury. 192 13

Forty-eight patients with acute renal failure (ARF) who were referred to the Department of Renal Medicine, Singapore General Hospital for acute dialysis between August 1985 and August 1989 were studied retrospectively to identify risk factors associated with ARF that serve as prognostic indicators. There was no difference in the mean age of survivors and non-survivors (49.5 +/- 17.5 years vs 53.5 +/- 18 years, p greater than 0.05). The overall mortality rate was 52%. ARF as a result of surgical complication had a higher mortality rate in comparison to ARF from medical complications (66% vs 50%, p greater than 0.05). Septicaemia was the most common cause of ARF requiring dialysis. Hepatobiliary sepsis was the most frequent cause of septicaemia. Pre-dialysis serum urea and creatinine levels, and the number of dialysis treatments did not affect the outcome. Poor prognostic indicators included oliguria or anuria, fluid overload and coma. Patients tended to have a worse outcome if they had more than three risk factors taken from the following list:-decreased renal perfusion, assisted ventilation, coma, gastrointestinal dysfunction, recent surgery, sepsis, congestive heart failure, hepatobiliary dysfunction, malignancy, diabetes mellitus, chronic renal insufficiency and poor nutritional status. Early referral of patients with septicaemia due in particular to hepatobiliary infection may improve the prognosis.
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PMID:Acute renal failure prognostic indices in hospital inpatients referred for haemodialysis. 192 73

Twenty-six cases of hemorrhagic fever with renal syndrome from 1981 to 1986 were retrospectively reviewed to determine the scope of clinical presentation and the unique complications of the illness. The diagnosis was confirmed by detection of Hantaan virus antibody in 25 cases and by characteristic autopsy findings in 1 case. The illness could be classified into three distinct clinical subgroups. Fever was universally present. Two patients presented with intractable shock and diffuse hemorrhage and died within 6 days from multi-organ system failure, mimicking the clinical picture of overwhelming sepsis. Eighteen patients presented with acute renal failure with an illness lasting a mean of 21 days (range, 10 to 36 days). Resolution of thrombocytopenia heralded recovery of renal function. At discharge, the serum creatinine level was normal in 13 patients; 5 patients had evidence of minimal renal dysfunction. Acute pulmonary edema requiring hemodialysis and retroperitoneal hemorrhage were the major complications in this subgroup. Six patients had an undifferentiated febrile illness with normal renal function. Fever, thrombocytopenia, abnormal urinalysis, hypertransaminasemia, and a benign clinical course characterized the third clinical pattern. The recent availability of serodiagnostic methods to detect Hantavirus group antibody facilitates the diagnosis of hemorrhagic fever with renal syndrome. Application of this test in the described clinical settings will identify unsuspected cases, broaden the knowledge of the geographic distribution of Hantavirus infection, and increase physician awareness of its protean manifestations.
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PMID:The protean manifestations of hemorrhagic fever with renal syndrome. A retrospective review of 26 cases from Korea. 197 4

Hemolysis following repair of a ventricular septal defect (VSD) is an unusual complication. Three cases of patients who had simple VSD are described here. After repair of the VSD, the postoperative course was complicated by the intravascular hemolysis induced by the interaction between the red blood cells and the double velour Dacron patch. Thus the patients' hemodynamic status deteriorated. The first 2 patients had a course of hemoglobinuria, hyperamylasemia, hyperglycemia, malignant hypertension, hepatospenomegaly, acute renal failure and hypertensive encephalopathy. One patient, who did not undergo reoperation, died due to multiple organ failure; the other one, who underwent operation revision in order to arrest the hemolysis, died of sepsis. Early reoperation was performed in the remaining patient to replace the double velour Dacron patch with a pericardium-covered knitted Dacron patch, and he survived. Hemolysis ceased in both patients who had the double velour Dacron patch replaced with a pericardium-covered patch. A review of the literature failed to show previous reports concerned with hemolysis associated with repair of a simple VSD. We now report what we believe to be the first cases in the literature with this unique clinical course following hemolysis.
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PMID:Hemolysis following correction of ventricular septal defect. 198 19

Even though the isolation rate of Candida species in the vagina stands at 30% during pregnancy, only 8 cases of candida sepsis connected with pregnancy were documented as of early 1991. Effective antifungal treatment began in 1956 and the 1st reported case was in 1954. She and the next 2 cases (1962 and 1971) did not recover. Possible predisposing factors in the 8 cases included antibiotic treatment, especially those in the beta lactam group; and IUD in situ; and intravenous (IV) line; or a urinary catheter. (Presumably antibiotics encourage C. albicans growth and pathogenicity. Foreign objects provide a portal of entry or a foothold for Candida.) In fact, a combination of these factors probably fostered candida sepsis in 4 cases. The 4 mildest cases experienced fever and impaired liver functions or reduced vision. 1 case had a hysterectomy. 2 had generalized convulsions. The 4 more severe cases experienced pneumonia, acute renal failure, osteomyelitis, or shock. In Haifa, Israel, physicians admitted a 24 year old woman with a fever to the Bnai Zion Medical Center for a presumed septic abortion at 15 weeks gestation. They performed a dilation and curettage (D&C) which included removal of an IUD. Laboratory personnel cultured the contents and later blood since her temperature rose .7 degrees. They started IV antibiotic treatment to no avail. Later her temperature hit 40 degrees Celsius and on day 5 she had convulsions. 1 blood sample and D&C materials grew C. albicans. They also observed multiple chorioretinal cotton wool lesions typical of Candida. They changed her medication to the antifungal medication, amphotericin B. Before discharge, they also prescribed 5-fluorocytosine. She had decreased hearing in the right ear, many hot spots over the iliac crests and thoracic vertebrae, and almost complete destruction of the body of D7 in the spine. She completely recovered.
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PMID:Candida sepsis in pregnancy and the postpartum period. 201 14


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