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

Between October 1985 and March 1988, 16 patients received the Jarvik-7 total artificial heart as an interim device before transplantation. Ten patients were afflicted with cardiomyopathy, and 6 had end-stage ischemic disease. All but 1 were men; the mean age was 47 years (range, 27 to 59 years). Thirteen patients developed cardiogenic shock despite the use of intravenous inotropic agents (mean, 23 days; range, two to 83 days) and the intraaortic balloon pump (mean, 13 days; range, two to 65 days). Three other patients became candidates because of failed transplantation. The 100-mL Jarvik-7 device was used in the first 3 patients; all subsequent recipients were treated with the 70-mL Jarvik-7. Postoperative anticoagulation was designed to keep the partial thromboplastin time between 2 and 2.5 times control. The control values were obtained during administration of heparin and dipyridamole. In all cases the function of the total artificial heart was adequate to support the needs of the recipient, and there were no mechanical difficulties with the device or the drive system. The average time of implantation was 9 days (range, one to 35 days). Two patients died before transplantation, 1 with sepsis from fungus and the other with hemorrhage from a torn pulmonary arterial anastomosis. Fourteen patients received cardiac allografts, and 7 continue to survive without restrictions. Infection within the mediastinum caused the death of 4 patients after transplantation; in 3 of these mediastinitis was not recognized before transplantation but occurred within the first 2 weeks after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Interim use of the Jarvik-7 artificial heart: lessons learned at Presbyterian-University Hospital of Pittsburgh. 264 3

The tracheoesophageal (TE) fistula with a speech prosthesis has become the method of choice for vocal rehabilitation in many postlaryngectomy patients. Several modifications of the procedure have been described including primary TE puncture at the time of laryngectomy. Fear of increased risk of complications has kept the primary procedure from widespread usage. Our series of 95 TE fistula procedures from 1980 to 1988 revealed 33 to be primary and 62 secondary. Eighty-five percent (85%) (28 of 33) patients in the primary group achieved long-term satisfactory speech (1 year or more of follow-up). Complications occurred in 36% of this group of patients. The success rate for the secondary group was 69% (43 of 62), while the complication rate was 21%. There were no instances of death, sepsis, or mediastinitis associated with either primary or secondary TE fistula patients. It appears that the primary TE fistula can be performed as safely and effectively as the secondary procedure.
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PMID:Speech restoration and complications of primary versus secondary tracheoesophageal puncture following total laryngectomy. 270 36

Over the last 3 years, 403 patients operated in the Department of Cardiovascular Surgery of Broussais Hospital have been transferred to a Department of Internal Medicine for secondary postoperative care. A total of 245 non-cardiac complications (64%) and 134 cardiac or vascular complications (36%) were observed in 321 of these 403 patients (80%). Infections accounted for 26% of non-cardiac complications (63/245). They included 9 cases of mediastinitis, 2 cases of septicemia, 6 endocarditis, 6 wound infections, and 40 other infections (ENT, gastrointestinal, pulmonary, urogenital). The non-cardiac, non-infectious complications comprised mainly delayed healing (39 cases) and pleuropulmonary (29 cases), ENT (9 cases), gastrointestinal (31 cases), urogenital (12 cases), hematological (17 cases) and neuropsychiatric (9 cases) complications; and, finally, 37 inflammatory syndromes. The cardiac complications were pericarditis with or without tamponade (24 cases), arrhythmias or conduction disturbances (50 cases), haemodynamic (54 cases) and vascular (6 cases complications. These very varied complications sometimes occurred late and could be latent. They resulted in prolongation of the duration of hospitalization, so increasing the overall health costs.
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PMID:[Experience at an Internal Medicine service in the postoperative follow-up of 403 patients operated on at a cardiovascular surgery service]. 274 59

Sixty-six cases of Gram positive infections were treated with teicoplanin in an open multicenter study, comprising 7 centers in Eastern France. There were 38 male patients and 28 females. Teicoplanin was given at a dose of 400 mg daily for a mean duration of 18.4 days. The most common infections were due to Staphylococcus aureus, found in 43 out of 56 documented cases. 69 (89.9%) of the 78 Gram + strains isolated had an MIC for teicoplanin of less than or equal to 2 mg/l. There were 44 serious infections (30 septicemia, 10 endocarditis, 1 joint and bone infection, 2 mediastinitis, 1 toxic shock syndrome) and 22 less serious infections (4 urinary infections, 14 skin and soft tissue infections, 3 lower respiratory infections, 1 hepatic abscess). In 42 cases concurrent medication was given: beta-lactamase in 11 cases, rifampicin in 10 cases, aminoglycosides in 22, phosphomycin in 3, pefloxacin in 5. The clinical cure and improvement rate was 90.10%. Adverse events were reported in 11 patients, and in only 3 cases was the therapy stopped. All were reversible on stopping therapy. Teicoplanin was found to be well tolerated and effective in the treatment of Gram positive infections in this study.
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PMID:[Teicoplanin and Gram-positive coccus infections. Results of a multicenter study on 66 cases]. 295 64

We used single daily intravenous teicoplanin as therapy for 12 severe nosocomial infections caused by gram-positive bacteria. A daily dosage of 3-6 mg/kg was usually adopted; however, in selected cases the dosage was increased to 8-9.5 mg/day on the basis of serum bactericidal monitoring. Most of these infections were life-threatening and included ventriculitis/meningitis (3 cases), sepsis (3 cases), mediastinitis (1 case) and extensive burn wound infection (1 case). Staphylococcus aureus was by far the most frequent pathogen and methicillin-resistant strains were isolated in 7 out of 9 infections caused by this organism. The remaining isolates were Staphylococcus epidermidis, JK Corynebacterium, Streptococcus agalactiae and Propionilbacterium acnes. Additional antibiotics were used in 5 cases for concomitant gram-negative bacillus etiology (2 cases), granulocytopenia (2 cases), superinfection (1 case). Overall a clinical success and microbial eradication were documented in 100% and 91% of 12 cases, respectively. Except one case of fever, no other major adverse effect was observed and no patient required trial therapy discontinuation. In conclusion, our preliminary data seem to suggest a satisfactory activity of teicoplanin against nosocomial gram-positive infections.
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PMID:Efficacy of teicoplanin as antimicrobial treatment of severe nosocomial infections caused by gram-positive bacteria: a preliminary study. 296 2

Nocardial sepsis occurred after aortic valve replacement in two patients. A septic suture aneurysm of the aortotomy was resected and the prosthesis exchanged in one of them. The other received conservative treatment for sternal osteomyelitis and local mediastinitis. Clinical cure was followed by relapse and death from cerebral infarction, and necropsy revealed a septic suture aneurysm of the aortotomy. Radical surgical revision seems to be necessary for lasting cure in such infections.
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PMID:Nocardial endocarditis after aortic valve replacement. Reports of two cases. 322 32

Between October, 1985, and September, 1987, a total of 195 patients received cardiac allografts and 15 candidates required mechanical support with the Jarvik-7 total artificial heart. Seven of the 15 died within 60 days of total artificial heart implant. There have been no late deaths, and survivors are unrestricted. Six of 7 deaths were related to infection (mediastinitis, 5; pneumonia and sepsis, 1), and the remaining 1 was due to failure of the transplanted heart. Respiratory tract infection occurred in each of the recipients who died with infection, and the same organisms appeared to be related to subsequent mediastinitis in 3 patients (Serratia marcescens, 2; Pseudomonas, 1) and caused fatal sepsis in another (Enterobacter aerogenes, Candida albicans). One patient died with pneumonia and sepsis prior to transplantation, and another succumbed with mediastinal infection known to be present before transplantation.
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PMID:The artificial heart: infection-related morbidity and its effect on transplantation. 328 15

Currently subtotal oesophagogastrectomy with reconstruction of the digestive tract by use of a gastric tube appears to be the treatment of choice in patients with a carcinoma of the thoracic oesophagus and gastroesophageal junction. The results of 96 patients with a clinically operable oesophageal-cardiacarcinoma operated upon between 1977 and 1983 are reviewed. Resection intended for cure could be performed in 57 patients (59.4%). Twenty-five patients underwent a 'standard' Ivor Lewis procedure with an intrathoracic anastomosis, whereas in twenty-one patients the Akiyama technique with a retrosternal gastric tube and cervical oesphagogastrostomy was accomplished. There was a great shift in stage-grouping from cTNM to pTNM. The major causes of mortality after oesophageal resection were respiratory and cardiac insufficiency (87% respectively 40% of the deaths) and sepsis from a mediastinitis caused by an intrathoracic anastomotic leak (20%). The postoperative mortality rate was similar in both procedures and amounted to 22.8%, but has decreased to 5% during the period 1983 to 1986. The 5-year survival rate for patients undergoing resections intended for cure was 20% as calculated by the actuarial method. There was no significant difference in long-term survival rates between the two resection groups. The late functional results were better in the cases with the Akiyama method, particularly where gastroesophageal reflux is concerned (P less than 0.05).
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PMID:The Akiyama procedure in the surgical management of oesophageal cardiacarcinoma. 334 53

Between July 1, 1976, and June 30, 1986, at the Henrietta Egleston Hospital for Children, 2,242 infants and children underwent palliation or repair of a congenital heart defect. Twenty-one (0.94%) of these patients developed mediastinitis following a median sternotomy. Nineteen of these twenty-one patients had required cardiopulmonary bypass. All patients had positive mediastinal cultures. The first 8 patients were managed traditionally by debridement and irrigation. Three of these patients suffered serious metabolic complications related to the povidone-iodine irrigant, which resulted in 1 death. Another patient died from persistent sepsis following debridement. Subsequently, 13 patients were managed by early debridement and rotation of the pectoralis major or rectus abdominis muscle flaps, or both. Following muscle flap rotation and early wound closure, 2 patients had subsequent incisional complications. One patient had incisional dehiscence and 1 had a superficial skin separation. Two deaths in this group, 28 and 51 days, respectively, following muscle flap rotation, resulted from nonincisional problems in patients with healed median sternotomies. The group having muscle flap rotation required a significantly shorter duration of postoperative ventilatory support (3.2 versus 24 days, p less than 0.05) and a significantly shorter confinement in the intensive care unit (6.2 versus 33 days, p less than 0.01). Also, the physiological and physical trauma of continued wound care in the awake child was minimized in the group with muscle flap rotation.
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PMID:Management of postoperative mediastinitis in infants and children by muscle flap rotation. 338 86

Non-tuberculous retropharyngeal abscesses in adults are usually secondary to pharyngeal or oesophageal perforation, or sepsis in the throat or sinuses. Mediastinitis may follow, and broad-spectrum antibiotics and surgical drainage are required. The management of neck wounds must include adequate radiology where there is a risk of retained foreign body, and careful exploration, under general anaesthetic in many cases, is necessary. In the case reported here, retention of a foreign body in a neck wound led to the development of an unusual retropharyngeal abscess.
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PMID:Retropharyngeal abscess complicating a neck wound (a case report). 339 64


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