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

Since Shumway carried out the first successful heart-lung transplant (HLT) in Stanford in 1981, HLT has become a new therapeutic means for patients with end-stage pulmonary disease or arterial hypertension. However, it is still rarely carried out because of a lack of donors and the complexity of the surgery and postoperative course. This review described the criteria for proper donor and recipient selection, as well as the anaesthetic and postoperative management of HLT patients at Marie Lannelongue Hospital. The lack of suitable organ grafts results, at least in part, from improper donor management. Pulmonary oedema by fluid overloading and excessive haemodilution should be carefully prevented. Low doses of catecholamines and vasopressin maintain circulatory stability and convenient organ function. The indications for HLT (primary pulmonary hypertension, Eisenmenger's complex, and end-stage bronchopulmonary disease) are all characterized by severe pulmonary hypertension, hypoxaemia and cardiac failure. Careful anaesthetic induction is required to avoid circulatory collapse. Cardiopulmonary bypass (CPB) should be started early, so that mediastinal dissection may be carried out in satisfactory haemodynamic conditions. After unclamping the aorta, circulatory support with fluid and catecholamine infusion is often required. High inspired oxygen fraction and end-expiratory positive pressure may be required because of reperfusion pulmonary oedema. Blood transfusion is often needed as there are major blood losses due to dissection of the posterior mediastinum during CPB. Postoperative catecholamine administration is prolonged over several days. Negative fluid balance is often necessary to reduce pulmonary oedema. Improvement in surgical technique, early extubation, and late prescription of steroids have reduced the incidence of tracheal complications. Acute renal failure often occurs as a result of prolonged CPB, hypovolaemia, drug nephrotoxicity and sepsis. Bacterial complications (pneumonia, mediastinitis) are the main causes of early death. After the 15th postoperative day, opportunistic infections and allograft rejection are the main complications. Since 1981, major advances in HLT recipient management resulted in improved survival rates (70-80% at 1 year, and 60-70% at 2 years for the best teams). Despite the complexity of management, and the longterm threat of obliterative bronchiolitis, HLT is, at present time, the only possibility for these young patients to recover a normal quality of life.
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PMID:[Anesthesia and intensive care for heart-lung transplantation]. 205 32

A case of life-threatening peripharyngeal sepsis with mediastinitis is described. The pathology, relevant anatomy and treatment are discussed and the literature is reviewed.
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PMID:Life-threatening peripharyngeal sepsis with mediastinitis. 210 68

The purpose of the present study was to review the results obtained in patients with a ventricular assist devices (VAD) in our hospital, and to discuss various problems concerning a VAD use, such as indications, right ventricular failure, and evaluation of cardiac function. Fourteen VADs were applied to 11 patients for left ventricular assist, including two for right ventricular assist and for one as biventricular assist with a VAD in the left and a biopump in the right. The clinical diagnoses of the patients were as follows: 10 ischemic heart disease, two valvular disease, one acute aortic dissection, and one corrected transposition of the great arteries. VADs were indicated in 11 patients because of difficulty in weaning from cardiopulmonary bypass (CPB), and in three patients because of cardiogenic shock after discontinuing CPB. Among the 14 patients, 11 had an effective VAD, six were successfully weaned from a VAD, and two survived. The VAD was ineffective due to uncontrollable bleeding and improper indications for the device, as in applying a one-sided heart assist when a biventricular assist was necessary. In spite of an effective VAD, five patients could not be weaned from VAD because of brain damage, sepsis, and hypoxia. After removing a VAD, four patients died; one due to mediastinitis, two due to respiratory failure, and one due to low output syndrome. All the four patients had renal failure followed by multi-organ failure finally, because of prolonged CPB time. The CPB time was shorter among the long survivors than in others. Cardiac function during assist and the weaning probability from a VAD were evaluated not only by the so-called on-off test, but also by transesophageal Doppler echocardiography. Ventricular wall motion and pulmonary venous flow pattern were analyzed by transesophageal Doppler echocardiography. The pattern of monophasic forward flow in the pulmonary vein was associated with reduced wall motion during deteriorated cardiac function, while the flow pattern became biphasic as cardiac function recovered. From these results, we concluded as follows: 1. Early decisions as to whether VAD is indicated are important. 2. A right VAD should be considered in cases with biventricular failure, during left ventricular assist, if right atrial pressures elevated more than 18 mmHg constantly. 3. The evaluation of cardiac function by transesophageal Doppler echocardiography is useful for making decisions as to wean patients from a VAD.
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PMID:[Problems in patients with use of a ventricular assist device]. 210 21

Between 1987 and 1990 twenty report cases who suffered carcinoma of the esophagus underwent transmediastinal esophagectomy without thoracotomy at the Surgery Service of the Edgardo Rehabilitation Hospital. Of the report cases 90% were at stage III, 5% of stage II and 5% at stage I of the TNM Classification. Post operative complications were cervical leaks, transitory dysphonia and respiratory illness, and were solved by conservative management. Only one case died with sepsis and mediastinitis, this represents an inpatient mortality of 5%. There were no hemorrhagic complications, nor chylothorax neither visceral necrosis during surgical time. Transmediastinal esophagectomy offers a good choice for the management of surgical cases, it has low mortality, morbidity and similar survival time than other procedures.
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PMID:[Transmediastinal esophagectomy without thoracotomy in cancer of the esophagus]. 212 89

A 51-year-old man developed a Staphylococcal mediastinitis and septicemia 23 days after coronary artery bypass grafting. He was initially treated with surgical debridement and closed irrigation with 0.5% povidone iodine solution. However, since the infection could not be eradicated by this method, an open packing method was subsequently required. Nineteen days after the diagnosis of mediastinitis, massive bleeding occurred due to rupture of an infected vein graft to the LAD. Although he went into profound hemorrhagic shock, suture ligation of the vein graft was successfully performed. The sternum was reapproximated 34 days after the initial debridement. Postoperative coronary angiograms revealed the patent vein grafts to the RCA and LCX, and PTCA was performed to the native stenosis of the LAD. The patient was discharged 5 months after the bypass operation and is now doing well 3 years postoperatively. Rupture of the heart or vessels in the course of postoperative mediastinitis is a very rare but highly lethal complication. We think that it is important to eradicate the infection as soon as possible to prevent the bleeding complication and that the decision as to which method, closed or open, should be employed, is crucial.
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PMID:[Rupture of an infected vein graft in the course of mediastinitis following coronary artery bypass grafting: report of a case]. 224 50

One of the most lethal forms of mediastinitis is descending necrotizing mediastinitis, in which infection arising from the oropharynx spreads to the mediastinum. Two recently treated patients are reported, and the English-language literature on this disease is reviewed from 1960 to the present. Despite the development of computed tomographic scanning to aid in the early diagnosis of mediastinitis, the mortality for descending necrotizing mediastinitis has not changed over the past 30 years, in large part because of continued dependence on transcervical mediastinal drainage. Although transcervical drainage is usually effective in the treatment of acute mediastinitis due to a cervical esophageal perforation, this approach in the patient with descending necrotizing mediastinitis fails to provide adequate drainage and predisposes to sepsis and a poor outcome. In addition to cervical drainage, aggressive, early mediastinal exploration--debridement and drainage through a subxiphoid incision or thoracotomy--is advocated to salvage the patient with descending necrotizing mediastinitis.
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PMID:Descending necrotizing mediastinitis: transcervical drainage is not enough. 224 66

Thirteen patients with successful or unsuccessful delayed sternal closure (DSC) after open heart surgery were reviewed. The indications of DSC were cardiac dilatation in 12 patients and intractable bleeding in one. Patients were divided into two groups as follows: Group A of 7 patients with mediastinum being sealed by prosthetic material, and Group B of 6 patients with primary skin closure by mobilized skin-flap. Postoperative complications and prognosis were compared between these two groups. There were 6 long term survivors. In group A, there were 4 deaths, 2 from low output syndrome (LOS) and 2 from sepsis due to mediastinitis. In group B, 2 died of LOS and 1 died of multiple organ failure, while no patients developed mediastinitis. In patients with unsuccessful DSC, mainly due to poor hemodynamics, there found no tendencies of decrease in CVP and LAP levels and no reduction in the amount of catecholamine dosage prior to attempted DSC. In conclusion, 1) mediastinal isolation with primary skin closure seemed more effective for preventing mediastinitis than coverage with prosthetic materials, 2) DSC was possible when there were hemodynamic improvements with decrease in CVP and LAP levels, and reduction in catecholamine dosage, and 3) plastic surgical technique was useful for primary skin closure.
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PMID:[Clinical analysis of the patients with delayed sternal closure following open heart surgery]. 232 11

We analyzed the treatment of a recent group of patients with life-threatening acute posterior mediastinitis due to esophageal perforation to elucidate common factors in successful treatment. Life-threatening acute posterior mediastinitis due to esophageal perforation was diagnosed in 16 patients over the past 12 years. Esophageal perforation resulted from endoscopy in 11 patients, retching in 4, and blunt trauma in 1 patient. Preoperative serum albumin levels were higher in patients who survived. Fourteen of 16 patients (88%) underwent exploration: mediastinal drainage in 14 (10 survived), esophageal repair in 9 (7 survived) with diversion in 3 (3 survived), and stent placement in 2 (1 survived). Six of 16 patients (38%) died, always of polymicrobial sepsis. Female patients and those with cancer, endoscopic perforations, delayed diagnosis, persistent mediastinal contamination, mediastinal suppuration or necrotizing cellulitis, and postoperative complications did poorly. Antibiotics must be effective against both gram-positive and gram-negative bacteria, and against both anaerobic and aerobic bacteria. Early surgical intervention is key, particularly elimination of ongoing mediastinal soilage. Thorough mediastinal debridement and wide mediastinal drainage appear to be important in improving survival of patients with life-threatening acute posterior mediastinitis due to esophageal perforation.
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PMID:Life-threatening acute posterior mediastinitis due to esophageal perforation. 236

The essential objective of this work is the care provided at Santa Clara Heart Center to a total of 170 patients who underwent Cardiovascular surgery from October 1986 to December 1987. Data were collected from the record book of the Surgical Intensive Care Unit of the Heart Center, taking into account the following variables: sex, age, place of residence, frequency of extracorporeal and closed surgery applied, as well as the causes of the repeated surgery performed. It was found that extracorporeal surgery was performed in 82.2% of patients, who underwent mostly elective cardiovascular surgery. There was a prevalence of acquired diseases. The most frequent causes for repeated surgery were mediastinitis (wound sepsis) and postoperative bleeding. Surgical mortality was 5.8% (112 patients).
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PMID:[Comments on the care provided at the Santa Clara Heart Center]. 237 86

The examination of 41 patients with phlegmons of the face and neck has revealed a considerable activation of kininogenesis. The application of the RUVIB method in 29 patients who had the most severe course of the disease allowed protease inhibitors to be rejected even in cases with sepsis and mediastinitis, effects of RUVIB exerted the regulation of processes of kininogenesis with the help of endogenous mechanisms.
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PMID:[Effect of reinfusion of UV-irradiated blood on the activity of the kallikrein-kinin system in patients with diffuse phlegmons of the face and neck]. 245 52


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