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

The efficacy and the safety of a combination regimen using cefbuperazone (CBPZ) and amikacin (AMK) were evaluated in severe infections in patients with hematological diseases. Twenty two patients were subjected to this combination therapy; among these, 18 patients were evaluable for the effectiveness. They included 9 cases of leukemia, 5 cases of malignant lymphoma, 2 cases of aplastic anemia, and 2 cases of angio-immunoblastic lymphadenopathy with dysproteinemia. Excellent responses were obtained in 5 patients and good responses in 5 patients, with a total effectiveness of 55.6%. Efficacy rates for individual types of infections were; 2/2 in sepsis, 6/14, or 42.9% in suspected sepsis, 1/1 in urinary tract infection, and and 1/1 in upper respiratory infection. The combination treatment was also effective in 4 of 6 cases in which neutrophil counts were less than 500/mm3 prior to therapy. Side effects were observed in only one patient. Mild proteinuria occurred in a 80-year-old male in 6 days after the regimen was started, but was not serious. These results indicate that a combination of CBPZ and AMK is safe and effective for the treatment of infections even in patients with compromised immunodefenses.
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PMID:[Clinical evaluation of a combination treatment with cefbuperazone and amikacin in infections complicating with hematological disorders]. 261 12

Imipenem/cilastatin sodium (IMP/CS) was administered to patients with severe infections complicated by hematological disorders and solid tumors to assess its efficacy and safety. Primary diseases in this series of 76 cases included 37 cases of hematological disorders (acute leukemia in 25 cases, malignant lymphoma in 7 cases, aplastic anemia in 3 cases and 2 other diseases) and 38 cases of solid tumors (lung cancer in 7 cases, gastric cancer in 11 cases, esophageal cancer in 6 cases, pancreatic cancer in 3 cases, bile duct cancer in 4 cases, hepatocellular cancer in 3 cases, and 4 other diseases). Following results were obtained. 1. Types of infection in hematological diseases were sepsis in 5 cases, suspected sepsis in 24 cases, pneumonia in 5 cases and 3 others. The efficacy rates were 100% in sepsis, 62.5% in suspected sepsis, 80% in pneumonia and 73% in all cases. 2. Types of infection in solid tumors were sepsis in 2 cases, suspected sepsis in 13 cases, pneumonia in 10 cases, cholecystitis in 2 cases, cholangitis in 5 cases, liver abscess in 2 cases, and 4 others. The efficacy rates were 50% in sepsis, 69.2% in suspected sepsis, 80% in pneumonia, and 71.1% in all cases. 3. IPM/CS was administered in single use in 66 cases and in combination with other antibiotics in 9 cases. The efficacy rate in the single use was 72.7% and that in the combination use was 66.7%. 4. The efficacy rate in 35 cases of first use was 71.4% and that in 40 cases of second use was 72.5%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical evaluation of imipenem/cilastatin sodium against severe infections complicated with hematological disorders and solid tumors]. 261 13

From January 1981 to January 1986, 34 children between 2 and 14 years of age were diagnosed as non-Hodgkin's lymphoma by the Rapport's classification at the Department of Pediatrics of Veterans General Hospital, Taipei, R.O.C. These patients were retrospectively analysed. There was male predominance with a male to female ratio of 2.4:1. The most common symptom was the palpable mass (29 cases, 85.3%) involved the neck and abdomen equally. All the cases were diffuse patterns, DUL (diffuse undifferentiated lymphoma) and DPDL (diffuse poorly differentiated lymphoma) both were the common subtypes of histological patterns. Twenty-eight cases (82%) were in the advanced stage (stage III and IV). The incidence of BM and CNS involvement was 56% and 29.4%, respectively. CNS involvement demonstrated a higher mortality of 100%. Surgery, radiation, and chemotherapy were mainly used for stage I-II and chemotherapy for stage III-IV. The 3-year survival rate of the whole series was 26.5%, and stage I, II, III, and IV was 100%, 50%, 33%, 9%, respectively. The causes of death were CNS involvement (10 cases, 40%), extensive involvement (7 cases, 28.0%), and sepsis (3 cases, 12.0%). This study shows that NHL in children are usually diffuse rather than follicular in histological patterns, often present a palpable mass involved the cervical or abdominal area, and commonly are widespread and tend to disseminate early.
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PMID:Non-Hodgkin's lymphoma in childhood--five years survey in VGH-Taipei. 263 60

Twenty-one patients with Philadelphia chromosome-positive chronic myelogenous leukemia (CML) in advanced phases were treated with piperazinedione (PIP), total body irradiation (TBI) and allogeneic bone marrow transplantation. Eleven were in blastic transformation, five were in accelerated phase, and five were in second chronic phase. The median age was 29 years (range, 13-41 years); there were 14 males. All patients but one were rendered aplastic by this regimen. Of these, 17 had hematologic engraftment, recovering granulocytes to 1.0 x 10(9)/l in a median of 28 days (range, 11-52 days). Three patients failed to engraft. Of those who engrafted, five relapsed and died of disease, one relapsed and died of a polymicrobial wound infection, nine patients died of treatment-related complications, including graft-versus-host disease, interstitial pneumonitis and sepsis, and one patient developed large-cell lymphoma 27 months after transplant and died of this 18 months later. One patient relapsed after 31 months died of polymicrobial sepsis at 37 months, and one patient remains disease-free at 54+ months. The 3-year survival rate was 14%. Survival at 1 year was related to having a spleen that did not extend beyond 2 cm below the left costal margin at the time of transplantation, and those with a large spleen at initial presentation relapsed more often. PIP-TBI with allogeneic bone marrow transplantation can induce durable remissions in a small proportion of patients in advanced phases of CML, but it is not superior to cyclophosphamide-TBI in this patient group.
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PMID:Piperazinedione plus total body irradiation: an alternative preparative regimen for allogeneic bone marrow transplantation in advanced phases of chronic myelogenous leukemia. 264 72

Ceftriaxone (CTRX), a new long acting antibiotic in the 3rd generation cephem group, was administered intravenously once or twice a day in daily doses of 1-6 g for at least 3 days to 86 patients with severe infections complicating hematopoietic disorders. Underlying diseases were acute leukemia in 41 cases, chronic leukemia in 3 cases, malignant lymphoma in 19 cases, myeloma in 7 cases and others. Most patients (55 cases) suffered from sepsis or suspected sepsis. As for efficacy rates classified by underlying diseases, the treatment was effective in 61.0% of patients with acute leukemia. As for efficacy rates classified by infections, the treatment was effective in 60.0% of patients with sepsis. No side effects were noted except rash in 2 patients. Abnormal hepatic functions were recognized in 3 patients but were not attributed to the agent in any case. The results indicate that CTRX is a safe and useful antibiotic for the treatment of severe infections accompanied by hematopoietic disorders.
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PMID:[Effects of ceftriaxone on severe infectious complications in hematological disorders. Tohkai Research Group on Infections in Hematological Disorders]. 267 28

In a previous study (Burkitt lymphoma study I, BL I) between 1982 and 1984, we used a multidrug rotating chemotherapy schedule, now known as 'GRAB', to treat 24 Iraqi children with non-localised BL (Murphy stages II, III and IV). At the time of reporting, actuarial survival was 50% (current actual survival 42%) and the major morbidity and mortality was not from resistant or relapsed lymphoma, but from complications of the tumour lysis syndrome, sepsis and early abdominal surgery. The study (BL II) reported here was carried out between 1984 and 1986; we used GRAB to treat 24 newly and consecutively diagnosed children with advanced Burkitt lymphoma but discouraged early 'debulking' surgery and paid special attention to supportive care during the first two weeks of treatment. As in BL I, no radiotherapy was used. Twenty patients (83.8%) attained complete remission: 17 (71%), including three of the seven stage IV patients, survive continuously disease-free at a median of 26 months (range 18-36 months) from diagnosis. We have previously pointed out that GRAB, without radiotherapy, may be especially suited for use in some developing countries. From this study we conclude that, with appropriate supportive care and minimal surgery, survival rates over 50% may be achieved. Our next studies are aimed at defining a 'good risk' group of patients, who may be curable without alkylating agents and a 'poor risk' group, who need more intensive therapy.
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PMID:'Debulking' surgery is unnecessary in advanced abdominal Burkitt lymphoma in Iraq. 271 46

Septicemia in hematologic malignancies and infection of herpes zoster in cancer patients were studied, and trend in organisms in a cancer hospital was investigated. 1) Septicemia in hematologic malignancies. The success rate of antibiotic therapy for septicemia was 76% if the patients were not under antibiotic therapy when septicemia developed. But recovery from septicemia was only 25% if the patients were undergoing antibiotic therapy when septicemia developed. Some 90% of neutropenic patients under 500/microliters, who were not under antibiotic therapy when septicemia developed, recovered from septicemia if the neutrophil count increased in the following 5 days. Change in the neutrophil count was an important factor determining the success or failure of antibiotic therapy for septicemia. The use of granulocyte colony-stimulating factor may prevent chemotherapy-induced neutropenia. Shortening of the period of neutropenia or preventing its occurrence should reduce the incidence and the severity of infection. 2) Infection of herpes zoster in cancer patients. Thirty-four cancer patients were associated with herpes zoster. Eleven of them were patients with malignant lymphoma and ten of them were patients of breast cancer. Most patients were heavily pretreated by chemotherapy and/or radiotherapy before the development of herpes zoster. Marked lymphocytopenia was observed at the onset of herpes zoster. Absolute lymphocyte count was under 1000/microliters in 71% of these patients. Development of herpes zoster in cancer patients was considered to be due to the depression of cell-mediated immunity which was the result of repeated and continued anticancer therapy. Acyclovir was found to be effective to treat herpes zoster in these patients. 3) Trend of organisms detected in cancer hospital. The frequency of organisms isolated from clinical materials in the National Cancer Center Hospital was compared during the period from 1978 to 1982 and the period from 1983 to 1987. The most common organism detected in both periods was P. aeruginosa and no change in frequency was observed. But the frequency of gram-negative bacilli, E. coli, Klebsiella and Serratia, decreased significantly in the latter period while the frequency of gram-positive cocci, Enterococcus and Staphylococcus increased markedly in the latter period. The use of cephems of third generation in the latter period could be one reason for the recent change of organisms detected in the hospital. Appropriate therapy for infection based on the latest and accurate information should be used.
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PMID:[Infection and immunosuppression in cancer patients]. 273 15

Postoperative course is reported in 52 children with malignant tumors (neuroblastoma, Wilms-tumor, non-Hodgkin-lymphoma, osteosarcoma etc.) who were operated on between 1979 and 1987. 26 children received chemotherapy prior to surgery, whereas 26 children were operated on without preceding chemotherapy (control group). Most children were under six years of age. 15 Children (57.7%) with preoperative chemotherapy developed early postoperative complications, such as sepsis, pneumonia, suture dehiscence, woundhealing disturbances and ileus, whereas this was the case in only 5 children (19.2%) without preoperative chemotherapy (P 0.0005). Four of the children with preoperative chemotherapy (15.4%) sustained late complications, such as local recurrence or mechanical bowel obstruction, whereas none of the control children did so. Lethality rate from underlying disease did not differ in both groups during follow-up (5 = 19.2% vs. 5 = 19.2%). This demonstrates that the surgeon must carefully be aware of an increased possibility of early and late complications in children who have to undergo surgery for malignant tumors following preoperative chemotherapy.
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PMID:[Postoperative course in children with malignant tumors following preoperative chemotherapy]. 273 47

Sepsis is one of the important complications on the treatment of severe hematological diseases. In this report, we analyzed sepsis in 309 patients with hematological diseases who were admitted to the First Department of Internal Medicine of Yokohama City University Hospital from 1979 to 1986. Positive blood culture were found in 17.8% (55/309 cases) and total positive cases were 73 including recurrent patients. Positive rate by underlying diseases was 30.3% in acute leukemia, 20.8% in chronic myelocytic leukemia, 17.2% in aplastic anemia, 8.0% in multiple myeloma, 6.0% in malignant lymphoma and 6.5% in others. The organisms causing sepsis were as follows; gram negative bacilli 56.4%, gram positive organisms 34.6%, fungus 6.4% and anaerobic bacteria 2.6%. Pseudomonas aeruginosa was found in 19.2%. The mortality rate of patients with sepsis was 34.2% (25/73 cases). The significant prognostic factors in patients with sepsis were the degree of neutropenia, duration of neutropenia (500 less than microliters), the species of organisms, simultaneous complication with shock and the site of other infections.
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PMID:[Sepsis in patients with hematological diseases]. 274 71

We report here three patients with sepsis and one with acute pancreatitis and possible sepsis who developed granulocytic fragments on blood smears obtained prior to death. In case 1, these fragments were identified cytochemically. In case 3, granulocytic cytoplasmic projections and fragments were identified by electron microscopy of the buffy coat. All patients had leukerythroblastosis. The average corrected white blood count (WBC) was 46 X 10(9)/liter with 34 nucleated red blood cells (nRBC)/100 WBC. Patient 1 had thrombocytosis whereas patients 2, 3, and 4 were thrombocytopenic. Terminal complement levels were decreased in patients 3 and 4 as previously noted in sepsis (Sprung CL, Shultz DR, Marcial E, et al.: Complement activation in septic shock patients. Crit Care Med 14:525, 1986). A general correlation between nRBC and granulocytic fragments/100 hpf (high power field) was observed in patients 3 and 4. Granulocytic fragments were not identified on the blood smears of several patients with leukemoid reactions without erythroblastosis. Although the precise etiology of these fragments is unclear, we believe their recognition is important because all patients died within 32 hours after granulocytic fragments were identified. Furthermore, these fragments can falsely elevate the platelet count. Although myeloid fragments have previously been noted in leukemia and lymphoma, this is the first report of their association with conditions unrelated to hematologic neoplasms. These fragments can easily be recognized by careful examination of the blood smear and represent a newly recognized aspect of the septic shock syndrome.
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PMID:Granulocytic fragments in sepsis. 276 86


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