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

The authors report their experience of 551 arteriovenous fistulae created in 400 patients undergoing haemodialysis for chronic renal failure. The mean follow-up period was 34 months. Eighteen cases of primary thrombosis (7%) and 11 cases of secondary thrombosis (4%) were observed. There were 7 cases of local sepsis, one of these fatal, and 7 cases of systemic infection, also with one death. The authors conclude that the Cimino-Brescia fistula is superior to any other type of vascular approach in patients with chronic renal failure. They reserve vascular grafts to those cases where no other procedure is possible.
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PMID:[Arteriovenous fistulae for chronic haemodialysis. Report on 400 patients]. 711 31

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.
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PMID:Complications of subclavian catheter hemodialysis: a 5 year prospective study in 257 consecutive patients. 717 35

Aeromonas hydrophila is a gram-negative bacillus which has been rarely identified as a human pathogen except in immunologically compromised hosts. We have recently treated three patients for severe A hydrophila pneumonia and sepsis. Two of these patients were healthy young men who aspirated the organism from contaminated water associated with near drowning. One patient survived severe ARDS and gram-negative sepsis. A third patient with chronic renal failure acquired A hydrophila pneumonia at home and quickly died from the infection. A hydrophila is becoming more commonly recognized as a lethal pathogen and should be sought when gram negative infection is suspected.
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PMID:Pneumonia and bacteremia due to Aeromonas hydrophila. 727 76

Vitamin B6 deficiency was evaluated in 37 patients with chronic renal failure and in 71 patients undergoing maintenance hemodialysis (HD) or intermittent peritoneal dialysis (PD). Vitamin B6 deficiency was assessed by the in vitro activity of erythrocyte glutamic pyruvic transaminase (EGPT), without (basal) and with (stimulated) the addition of pyridoxal-5-phosphate to the assay, and the EGPT index (stimulated activity ./. basal activity). Basal and stimulated EGPT activities were below normal in the HD patients, and the EGPT index was increased in each group of patients, indicating vitamin B6 deficiency. Supplemental pyridoxine hydrochloride was given to 30 HD patients who received 1.25 to 50 mg/day (37 studies), 6 PD patients who were given 1.25 or 2.5 mg/day (7 studies), and 8 nondialyzed patients with mild to severe renal failure who received 2.5 mg/ day. In all HD patients, 10 or 50 mg/day of pyridoxine hydrochloride rapidly corrected the abnormal EGPT index and maintained normal values; with supplements of 5.0 mg/day or less, the index was often abnormal, particularly in those who were septic or taking pyridoxine antagonists. In PD patients and nondialyzed patients with renal failure, 2.5 mg/day of pyridoxine hydrochloride was inadequate to correct rapidly the abnormal index in all patients. These findings suggest that HD patients should receive 10 mg/day of supplemental pyridoxine hydrochloride (8.2 mg/day pyridoxine). PD patients and patients with chronic renal failure should receive about 5.0 mg/day of supplemental pyridoxine hydrochloride (4.1 mg/day pyridoxine). When sepsis intervenes or vitamin B6 antagonists are taken, 10 mg/day of pyridoxine hydrochloride may be a safer supplement for all patients.
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PMID:Daily requirement for pyridoxine supplements in chronic renal failure. 728 98

A 68-year-old female on two-year chronic hemodialysis for chronic renal failure due to chronic pyelonephritis, was admitted to hospital for weakness, dulled sensorium and dizziness. On examination the patient was in a state of circulatory collapse, the electrocardiogram showed an accelerated idioventricular rhythm and laboratory analysis revealed extreme hyperkalemia (K+ 10.1 mmol/l). There were no common causes of shock, such as hypovolemia, sepsis, heart failure and presence of vasodilator drugs. The patient was treated with calcium gluconate, sodium bicarbonate and sodium chloride (to oppose the effects of hyperkalemia on the cell membrane to minimize cardiac and neuromuscular toxicity), insulin and dextrose (to increase the transport of K+ from the extracellular to the intracellular compartment), and hemodialysis (to remove K+ from the body). At the end of the hemodialysis session, the patient was in a clinically good condition, blood pressure was 160/90 mm Hg and the serum K+ concentration was normal. The case appeared to suggest that extreme hyperkalemia may have direct effects on vascular resistance, causing hypotension and shock.
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PMID:A life-threatening complication of extreme hyperkalemia in a patient on maintenance hemodialysis. 748 41

Outcome of and complications associated with bilateral adrenalectomy in 8 cats with pituitary-dependent hyperadrenocorticism and bilateral adrenocortical hyperplasia and outcome of and complications associated with unilateral adrenalectomy in 2 cats with adrenocortical tumor (adrenocortical adenoma, 1 cat; adrenocortical carcinoma, 1 cat) and unilateral adrenomegaly were determined. Glucocorticoids were administered to all cats at the time of surgery, and mineralocorticoids were administered to the 8 cats that underwent bilateral adrenalectomy. A ventral midline celiotomy was performed in all cats. Intraoperative complications did not develop in any cat. Postoperative complications developed in all cats and included abnormal serum electrolyte concentrations (n = 8), skin lacerations (n = 5), pancreatitis (n = 3), hypoglycemia (n = 2), pneumonia (n = 1), and venous thrombosis (n = 1). Three cats died within 5 weeks after surgery of complications associated with sepsis (n = 2) or thromboembolism (n = 1). Clinical signs and physical abnormalities caused by hyperadrenocorticism resolved in the remaining 7 cats 2 to 4 months after adrenalectomy. Insulin treatment was discontinued in 4 of 6 cats with diabetes mellitus. Median survival time for these 7 cats was 12 months (range, 3 to > 30 months). Two cats died of acute adrenocortical insufficiency 3 and 6 months after bilateral adrenalectomy, 2 cats were euthanatized because of chronic renal failure 3 and 12 months after bilateral (n = 1) or unilateral (n = 1) adrenalectomy, and 2 cats were alive 9 and 14 months after bilateral adrenalectomy. In the remaining cat, clinical signs recurred 10 months after the cat had undergone unilateral adrenalectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Adrenalectomy for treatment of hyperadrenocorticism in cats: 10 cases (1988-1992). 755 48

To determine the causes of death in autosomal dominant polycystic kidney disease (ADPKD) patients and to examine whether the extrarenal manifestations of ADPKD influence the causes of death, the medical records of 129 patients who died between 1956 and 1993 were reviewed; 58% of the 129 patients had an autopsy performed. Seventy-seven percent died after reaching ESRD. The mean age at death increased from 51 yr for those who died before 1975 to 59 yr for those who died after 1975, reflecting the introduction of renal replacement therapies. The most common cause of death before 1975 was infection (30%), followed by uremia (28%) and cardiac disease (21%); after 1975, these were cardiac disease (36%) and infection (24%). Infection was equally prevalent before and after 1975, presenting as sepsis in 94% and directly relating to ADPKD in 47% of these patients. Underlying factors for cardiac death were cardiac hypertrophy, seen in 89% of all autopsied patients, and coronary artery disease, seen in 81%. A neurologic event was the cause of death in 12% of patients; these were ruptured intracranial aneurysm in 6%, hypertensive intracranial hemorrhage in 5%, and ischemic stroke in 1%. The mean age of those who died of ruptured intracranial aneurysm was 37 yr. No patient died of renal cancer. Liver cysts were the most common extrarenal manifestation, seen in 70% of the autopsied cases; cysts in other organs were very rare. Colonic diverticula were found in 21%. Thus, the renal and extrarenal manifestations of ADPKD are important contributors to morbidity and mortality.
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PMID:Causes of death in autosomal dominant polycystic kidney disease. 757 53

An eight-year retrospective study was performed to determine the incidence of peritonitis in a pediatric continuous ambulatory peritoneal dialysis (CAPD) population of 24 children, half of whom were boys and half, girls. All suffered from end stage renal disease (ESRD). When these children, aged 2 through 17 years (mean: 10.7 +/- 3.8), were examined, the incidence of peritonitis was one episode every 15.2 patient-months. Microbiologic evaluation showed that 76.4% of the 34 episodes were culture positive, with Staphylococci species (coagulase negative staphylococci 32.4%, Staphylococcus aureus 14.7%) causing most cases especially early in dialysis. Half the patients presented with a triad of symptoms (fever, abdominal pain and cloudy dialysate), with cloudy dialysate was the major presentation (88%). Peritonitis was treated with intraperitoneal administration of cefacin and/or netromycin when suspected, and 52.9% of the episodes needed hospitalization. Except for two patients who died of complications (sepsis, acute pancreatitis), all episodes of peritonitis were cured; in four episodes it was necessary to remove a catheter, and two of those cases came from fungal peritonitis. Peritonitis rates differed among disconnect systems. The manual spike had peritonitis rate of one episode per 4.6 patient-months which was higher than the O-set (one episode/22.2 patient-months), UV-XD and Y-set disconnect systems. Therefore, the major causes of peritonitis arose from contamination provoked by the technical aspect of the procedure. Nutrition status was stable in these patients. Serum albumin and total protein were adequate in all patients without relation to episode of peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Peritonitis in children being treated with continuous ambulatory peritoneal dialysis. CAPD Team. 761 67

Piperacillin (Pi) kinetics in patients with acute renal failure treated by continuous arteriovenous hemodialysis (CAVHD) are not known. Therefore, dosing regimens have been based on kinetic data derived from patients with chronic renal failure and principal pharmacokinetic considerations [Reetze-Bonorden et al. 1993]. From these estimations it has been predicted that approximately 30% of the dose of Pi is removed by CAVHD (dialysate/ultrafiltrate (D/UF) flow rate 1.5 liter/hour). To confirm this estimate single dose (4g i.v.) Pi kinetics were studied in 12 intensive care patients with anuric acute renal failure due to septicemia treated by CAVHD. Pi plasma and D/UF levels were measured by HPLC. Sieving/Saturation of Pi in the D/UF was 0.71 +/- 0.21 (+/- SD). With a mean D/UF flow rate of 20.4 +/- 1.5 ml/min, the mean extracorporal clearance (Clextra) was 12.2 +/- 1.0 ml/min and accounted for 29% (range 14-48%) of total body clearance (ClB = 47.1 +/- 22.3 ml/min). In 7 out of 12 patients the fraction of the dose eliminated by CAVHD reached a significant value above 25%. The mean volume of distribution (Vd) and elimination half life (t1/2) were 25.8 +/- 3.8 liter and 7.4 +/- 2.9 hours, respectively. In conclusion the extent of extracorporal elimination of Pi by CAVHD was well in agreement with the estimation previously published. In intensive care patients with acute renal failure on continuous hemodialysis Pi dosing should take into account the possibly significant elimination of Pi. The usual dose for anuric patients may be increased by 50% to avoid underdosing in these critically ill patients.
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PMID:Single dose kinetics of piperacillin during continuous arteriovenous hemodialysis in intensive care patients. 778 Dec

We reviewed our experience with patients suffering from civilian trauma to identify risk factors for the development of acute renal failure (ARF) and ARF outcome. Of the 437 patients consecutively admitted to a surgical intensive care unit (SICU), 206 had a SICU stay of at least 1 day and ARF developed in 30 of these patients. All ARF patients had additional organ system failure (OSF). Pre-existing chronic disease (including chronic renal failure), malnutrition, injury severity score (ISS), number of organs injured, sepsis, and all OSFs before the onset of ARF were factors predisposing to ARF. Mortality was 40%. Chronic disease, malnutrition, ISS, failure of cardiovascular, pulmonary, hepatic, and neurological systems (either before and after ARF) were significantly associated with mortality. When OSFs were considered in their temporal relationships to ARF, only cardiovascular and pulmonary failure before, and gastrointestinal failure after, the onset of ARF were related to mortality. An increasing number of OSFs increased mortality, both before and after the development of ARF. However, the number of OSFs before was significantly greater than after ARF. Sepsis was not associated with increased mortality. Thus, the outcome of ARF patients with critical trauma seems to be dependent on factors predisposing to ARF. Our results suggest that more attention must be paid to prevention of these precipitating conditions.
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PMID:Acute renal failure in patients with severe civilian trauma. 780 Feb 44


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