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

Pasteurella multocida (P. multocida) is well recognized as "normal flora" in the upper respiratory tract of cats, dogs and other animals. Recently, various infections due to P. multocida in human have been noted as pulmonary infections in the patients with chronic pulmonary diseases as well as skin abscesses or septicemia after an animal bite or scratch. We report here three cases of respiratory tract infections caused by P. multocida. The first two patients had acute exacerbation of bronchiectasis caused by P. multocida and the other patients with pulmonary emphysema developed pneumonia. These three patients improved by antibiotic therapy. In Japan, P. multocida respiratory tract infection is rare, but it may become more common in the future. Therefore, it seems to be important to take this pathogen into consideration in the management of chronic lung disease.
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PMID:[Three cases of Pasteurella multocida infection in the respiratory tract]. 815 Nov 51

1. We investigated the relationship between circulating tumour necrosis factor-alpha concentrations, resting energy expenditure, cachexia and altered intermediary metabolism in patients with cystic fibrosis and chronic pulmonary infection. 2. Twenty adult patients with cystic fibrosis and chronic bronchial sepsis covering a spectrum of severity of lung disease (forced expiratory volume in 1 s 30-100% of predicted) were compared with 10 age matched, healthy, non-cystic fibrosis subjects. 3. Circulating tumour necrosis factor-alpha, C-reactive protein and neutrophil elastase-alpha 1-antiproteinase complex concentrations were determined simultaneously with glycerol, non-esterified fatty acids, catecholamines, anthropometric indices and resting energy expenditure (ventilated hood method). 4. Weight, body mass index and arm muscle mass were reduced in patients with cystic fibrosis compared with healthy control subjects (P < 0.01), whereas mean resting energy expenditure was increased [121 versus 101% predicted, mean difference 19.2% (95% confidence interval 11.0-27.4%), P < 0.001]. Circulating concentrations of glycerol (P < 0.01), non-esterified fatty acids (P < 0.01), adrenaline (P < 0.05), tumour necrosis factor-alpha, C-reactive protein and neutrophil elastase-alpha 1-antiproteinase complex (P < 0.01) were increased in patients compared with control subjects [tumour necrosis factor-alpha 96.9 versus 24.7 pg/ml, mean difference 72.2 pg/ml [95% confidence interval 27.7-116.7 pg/ml), P < 0.001]. Resting energy expenditure was significantly related to tumour necrosis factor-alpha levels and forced expiratory volume in 1 s. 5. In patients with cystic fibrosis and chronic pulmonary sepsis changes in resting energy expenditure, body composition and intermediary metabolism are consistent with the systemic effects of the host inflammatory response, which may be responsible for cachexia in adult patients. In particular these changes are consistent with the action of tumour necrosis factor-alpha, which was detected in the circulation during a period of apparent clinical stability.
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PMID:Tumour necrosis factor-alpha, resting energy expenditure and cachexia in cystic fibrosis. 828 44

The role of genital mycoplasmas in the pathogenesis of neonatal infection is incompletely understood. We performed nasopharyngeal, blood and cerebrospinal fluid (CSF) cultures for Mycoplasma hominis and Ureaplasma urealyticum in 69 neonates who underwent a diagnostic workup for suspected sepsis. The mean gestational age was 35.9 weeks (range, 25 to 42 weeks) with a mean birth weight of 2386 g (range, 652 to 4420 g). Twenty-seven infants (39.1%) had positive nasopharyngeal cultures; 6 were positive for M. hominis, 10 for U. urealyticum and 11 for both organisms. Seven (26%) of these 27 patients developed chronic lung disease compared with 2 (4.7%) infants in the non-colonized group. Nine infants had positive CSF cultures for M. hominis and one infant had a positive CSF culture for U. urealyticum. All blood cultures were sterile. One of the infants with a positive CSF culture for M. hominis had clinical evidence of systemic infection. All of the infants were treated with antibiotic agents that were not active against mycoplasmas. These data indicate that genital mycoplasmas can be found commonly in the CSF and nasopharynx of infants with suspected sepsis. Their etiologic role in the causation of infection and chronic lung disease, however, remains unclear.
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PMID:Mycoplasma hominis and Ureaplasma urealyticum in neonates with suspected infection. 834 98

Early success in clinical lung transplantation was believed due in part to the technique of bronchial anastomosis, routine bronchial omentopexy, and avoidance of early postoperative corticosteroid therapy. A recent 16-month consecutive experience at the University of Toronto and Washington University with single or bilateral lung transplantation was compared to study the current short-term effect of these perioperative strategies. At the University of Toronto, of 37 patients undergoing lung transplantation, 30 (group I) had telescoped bronchial anastomoses, coverage of the bronchus with local tissue only (no omentopexy), and routine perioperative corticosteroid administration. At Washington University, of 50 patients having lung transplantation, 44 (group II) had end-to-end bronchial anastomoses wrapped in omentum and received no routine perioperative corticosteroid. In group I, septic lung disease was the most frequent indication (14 of 29 patients), whereas in group II obstructive lung disease was the most frequently encountered condition (24 of 44 patients). Sepsis accounted for three of five early deaths in group I (all due to resistant Pseudomonas cepacia infection in recipients who had cystic fibrosis) and for two of four perioperative deaths in group II (one Pseudomonas, and Candida). In group I, cytomegalovirus prophylaxis was administered to all patients except recipients negative for cytomegalovirus receiving grafts from donors also negative for cytomegalovirus. Cytomegalovirus infection requiring treatment was encountered in 5 of 30 patients in group I in comparison with 23 of 44 recipients in group II where only D+ and R- mismatches received prophylaxis. Routine omentopexy is not essential for successful lung transplantation. Early postoperative corticosteroids do not impair airway healing, but neither do these agents appear to protect against acute rejection episodes. While routine corticosteroids do not predispose the recipient to cytomegalovirus infection, their use may increase the likelihood of postoperative bacterial sepsis.
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PMID:An evaluation of the role of omentopexy and of early perioperative corticosteroid administration in clinical lung transplantation. The University of Toronto and Washington University Lung Transplant Programs. 838 97

This report describes the Vermont-Oxford Trials Network, a voluntary collaborative research network, and summarizes the outcomes and medical interventions for very low birth weight infants at participating centers in 1990. The Vermont-Oxford Trials Network included 36 centers in 1990 (11% university hospitals, 44% university affiliates, 44% nonaffiliated) with a total of 2961 infants weighing 501 to 1500 g (median 73 infants, range 5 to 172). Eighty percent of the infants were inborn and 65% were white. The overall network frequencies for selected interventions and outcomes were as follows: prenatal care, 90%; a complete course of antenatal corticosteroids, 12%; cesarean section, 56%; surfactant therapy, 49%; postnatal steroids for chronic lung disease, 16%; high-frequency ventilation, 4%; patent ductus arteriosus, 31%; necrotizing enterocolitis, 6%; bacterial sepsis, 16%; and intraventricular hemorrhage, 26%. By 28 days, 15% of the infants had died and 8% had been transferred, whereas by discharge 18% had died and 18% had been transferred. There were marked variations among the centers in the frequencies of different medical interventions and in the frequencies of various clinical outcomes. The Vermont-Oxford Trials Network is a unique collaborative research group composed of a broad range of neonatal intensive care units. During 1990 there were considerable differences among the centers in the interventions used and patient outcomes observed. The investigators plan to devote the resources of the Network to a research program of randomized trials and outcome studies so that effective interventions can be identified and the quality of neonatal intensive care can be continuously improved.
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PMID:The Vermont-Oxford Trials Network: very low birth weight outcomes for 1990. Investigators of the Vermont-Oxford Trials Network Database Project. 844 56

It is common to assign an upper age limit for potential lung transplant recipients. The influence of age on LTX outcome is, however not, documented. A review of our first 103 LTXs, 51 single LTXs and 52 double LTXs, includes 31 recipients aged 50-63 years (mean 55.3 +/- 3.9); 19 received single LTX, and 12 received double LTX. Indications for LTX in those aged greater than 50 included proportionately more patients with emphysema and interstitial lung disease. Actuarial survivals in those aged less than 50 at 12, 36, and 60 months were 68%, 60%, and 55%, and in those aged greater than 50 was 70%, 61%, and 61%, respectively. The causes of death reflect a tendency of younger patients to die from graft rejection and older patients to die from sepsis. Acute rejection more than 6 weeks posttransplant and chronic rejection were less frequent in older patients (P < 0.05). The 6-minute walk and modified Bruce protocol tests, the incidence of CMV pneumonitis, and the late post-LTX renal function were not related to age. In conclusion, in carefully selected candidates in their sixth and seventh decades, LTX is an acceptable operation for end-stage lung disease. The tendency of older patients to a lower incidence of late allograft rejection (acute or chronic) may reflect decreased immunological responsiveness with age.
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PMID:Lung transplantation in patients over the age of 50. 845 77

Ureaplasma urealyticum, a common commensal of the urogenital tract of sexually mature humans, is gaining recognition as an important opportunistic pathogen during pregnancy. While its etiologic significance in many aspects of adverse pregnancy remains controversial, recent evidence indicates that U. urealyticum in the absence of other organisms is a cause of chorioamnionitis. Furthermore, ureaplasmal infection of the chorioamnion is significantly associated with premature spontaneous labor and delivery. In at least some cases, it appears to be causal. Present evidence indicates that U. urealyticum is a cause of septicemia, meningitis, and pneumonia in newborn infants, particularly those born prematurely. There is strong but not definitive evidence that ureaplasmal infection of the lower respiratory tract can lead to development of chronic lung disease in very low-birth-weight infants. Although risk factors for colonization of the lower genitourinary tract have been identified, little information is available concerning risk factors for intrauterine infection and host immune responses to invasive infection. Recent establishment of animal models of respiratory and central nervous system diseases should provide an opportunity to evaluate risk factors, pathogenic mechanisms, and operative immune mechanisms. However, the most critical need is additional information concerning indications for diagnosis and treatment as well as efficacy of treatment.
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PMID:Ureaplasma urealyticum intrauterine infection: role in prematurity and disease in newborns. 845 81

A 12-year review identified 21 patients with nontyphoidal, nonparatyphoidal salmonella septicemia. Eight of the patients had no predisposing factors. Factors identified included malignancy in five, recent surgery in four, alcoholism with aspiration pneumonia in two, chronic lung disease in two, diabetes in two, systemic lupus erythematosus in one and burns in one. Ten patients presented with gastroenteritis, two with localized abscesses, two with aspiration pneumonia and the remainder with nonspecific septicemia. Three patients died of underlying diseases and three died shortly after the septicemia of related causes. Six cases were nosocomial infection and were not related to hospital outbreaks. Salmonella septicemia with these serotypes is uncommon (1 per 14,000 admissions, 1 per 4000 blood cultures) and can occur in patients without diminished host resistance.
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PMID:Nontyphoidal, nonparatyphoidal salmonella septicemia in adults. 850 19

The first clinically successful lung transplantation was performed in 1983. Since that time, more than 2700 transplants have been recorded by the International Lung Transplant Registry [1]. Lung transplantation is currently limited to patients with endstage lung disease and a life expectancy of less than 18 months [1]. Unilateral lung transplantation is the most commonly performed procedure. Bilateral transplantation generally is reserved for patients with pulmonary sepsis. One-year survival after transplantation is currently 80-90%, and 5-year survival is estimated at 50% [1]. Early detection and treatment of the complications of lung transplantation are critical to decrease patient morbidity and mortality [2-4]. This article reviews the radiologic findings of the most common complications of lung transplantation, using our experience with 85 patients.
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PMID:Complications of lung transplantation: radiologic findings. 863 54

A survey was conducted among 259 New Zealand specialist anaesthetists to assess attitudes and practices with regard to epidural or subarachnoid anaesthesia (ESA). Ninety-four per cent replied and virtually all of the respondents indicated that they performed ESA at some time. ESA was used by most anaesthetists for most patients undergoing major hip or knee surgery, abdomino-perineal resection, cystectomy, caesarean section or transurethral resection of the prostate, ESA was used is about half of patients undergoing abdominal aortic aneurysm repair, femoro-popliteal bypass or thoracotomy and there was marked variation between anaesthetists in the frequency of using ESA for these procedures. There was broad consensus about the importance of a number of factors that might influence the decision to employ ESA; in particular that systemic sepsis and prolonged bleeding time were important contraindications and that patient preference and chronic lung disease were important indications. However respondents were equally divided as to whether they felt that recent myocardial infarction or congestive heart failure constituted indications or contraindications to ESA.
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PMID:Attitudes and practices of New Zealand anaesthetists with regard to epidural and subarachnoid anaesthesia. 866 60


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