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

During the past five years 75 patients aged 90 years or more had 85 major surgical procedures at the Metropolitan Nashville General and Vanderbilt University hospitals. The most common operation was exploratory laparotomy. The second was lower extremity amputation for peripheral vascular disease and/or gangrene. Fifty-seven percent had general endotracheal anesthesia. Associated medical problems were common, and included congestive heart failure (24%), hypertension (21%), diabetes mellitus (13%), chronic arrhythmias (9%), history of myocardial infarction (8%), and history of cerebrovascular accident (5%). Eleven patients (13.4%), six of whom had general anesthesia, died after operation. Of these, two had postoperative pneumonia, two did not recover from bowel perforation and peritonitis, one had a postoperative myocardial infarction, another had a cerebrovascular accident, and one had sepsis. One patient's sudden death was likely due to myocardial infarction or pulmonary embolus. The other three deaths occurred in patients with extensive carcinomas (gallbladder carcinoma in one and widely metastatic carcinoma of unknown origin in two). These three patients died of the disease for which they were operated upon when the operation failed to alter its course. When surgical procedures are necessary to prolong and/or improve the quality of life in elderly patients, these procedures may be done in most cases with acceptable results.
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PMID:Surgical procedures in patients aged 90 years and older. 649 54

Indications for hemodynamic assessment by right heart catheterization include shock, pulmonary edema, severe trauma and sepsis. The introduction of the catheter and the location of the tip in the pulmonary artery, however, can cause severe complications. In the present study the incidence of complications was observed in 93 consecutive right heart catheterizations in critically ill patients with no evidence of recent myocardial infarction. The low incidence of complications during introduction and with the catheter tip located in the pulmonary artery justifies right heart catheterization in patients with hemodynamic and/or respiratory instability treated in an intensive care unit.
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PMID:Prospective study on the incidence of complications of right heart catheterization. 650 83

To assess the efficacy of surgical revascularization for postinfarction angina within 30 days of acute infarction, the clinical course of 103 patients treated surgically from January 1979 to July 1982 was reviewed. There were 84 men (82%) and 19 women (18%) with a mean age of 58 years (range 34 to 80). Group A (11 patients) underwent surgery within 24 hours of infarction, Group B (21 patients) within 7 days and Group C (71 patients) within 30 days. Eighty-four patients (82%) had subendocardial infarctions and 19 patients (18%) had transmural infarction. Transmural infarction was more common in patients in Group A (36%) than in those in either Group B (19%) or Group C (15%). There were two deaths, both in Group C (1.9%), within 30 days of surgery. The use of intraaortic balloon or inotropic support and the occurrence of major arrhythmias or perioperative infarction was noted in 30 patients (29%) (64% in Group A, 33% in Group B and 18% in Group C). The average time in the intensive care unit was 3.2 days, with an average total hospital stay after surgery of 8.3 days. Late follow-up (mean 15.4 months, range 1 to 39) is complete for 97 patients (97%). There were no late myocardial infarctions and 93 patients (96%) were essentially free of angina. The only late death (1.0%) was caused by septicemia from delayed sternal wound infection. This study suggests that myocardial revascularization within the first 30 days after myocardial infarction can be accomplished with an acceptable operative mortality in selected patients with postinfarction angina refractory to medical management.
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PMID:Postinfarction angina: results of early revascularization. 663 Jul 65

We retrospectively examined the outcome of anesthesia and surgery in 59 hypothyroid patients and in 59 paired euthyroid matched controls. Hypothyroid patients had more preoperative risk factors but did not differ as a group from controls with regard to duration of surgery or anesthesia, lowest temperature and BP recorded during surgery, need for vasopressors, time to extubation, fluid and electrolyte imbalances, incidence of arrhythmias, pulmonary and myocardial infarction, sepsis, need for postoperative respiratory assistance, bleeding complications, or time to hospital dismissal. Analysis of subsets of hypothyroidism (thyroxine level, less than 1.0, less than 3.0, and greater than or equal to 3.0 micrograms/dL) also failed to disclose any significant differences compared with matched controls. Among patients with mild or moderate hypothyroidism, we found no evidence to justify deferring needed surgery until the hypothyroidism has been corrected.
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PMID:Outcome of anesthesia and surgery in hypothyroid patients. 667 33

Twenty synthetic vascular graft infections are reviewed. Diagnosis of aortic shaft infections has been improved by combined CAT and Gallium scanning, with a 100 per cent sensitivity and specificity. An increasing incidence (70%) of gram-negative or resistant infections is noted, with a correspondingly high mortality. Delay in diagnosis resulted in an 100 per cent mortality versus 20 per cent when diagnosis was made rapidly. Mortality was usually from sepsis, but nearly half of the deaths occurred due to stroke or myocardial infarction.
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PMID:Synthetic vascular graft infection. The continuing headache. 669 35

There is increasing emphasis on carrying femoro-popliteal bypass grafts below the knee and most vascular surgeons agree that reversed saphenous vein makes the best graft. However, some other considerations have become important and deserve consideration. P.T.F.E. grafts in this location have almost as good a long term patency rate as autologous vein grafts. Some very experienced vascular surgeons have indicated their preference for this type of graft, citing some of these pertinent reasons: Peripheral vascular disease usually is associated with lesions in other vessels. Since coronary artery bypass has become so commonly used to stave off myocardial infarction some thought should be given to preservation of suitable saphenous veins for this purpose. Harvesting the saphenous vein adds additional surgical trauma, time, exposure to sepsis, lymphatic interruption and extra incisions. Once we opt for preferential P.T.F.E. grafts, then we start to search for a simpler technique.
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PMID:Femoro-popliteal bypass simplified. 670 2

In four of our initial five cases of percutaneous cholecystostomy, performed under ultrasound guidance for septicemia due to suspected cystic duct obstruction and hydrops of the gallbladder, patients suffered profound vagal reactions with severe hypotension and bradycardia. One patient had cardiac arrest. The patients had experienced recent myocardial infarction, ventricular ectopy, or septicemia, and each had a greatly distended gallbladder. The reactions occurred immediately, though in the first patient recognition was delayed. One patient had infected bile, three had obstructing cystic duct stones with inflammatory response, and one had a sterile and nonobstructed gallbladder. All patients survived the acute insult. Treatment consisted of minimizing intravisceral manipulations, administration of intravenous atropine, fluids, antibiotics, and dopamine. Atropine administered prior to the procedure appeared to blunt the reaction in one patient. Two patients died within a week of other causes. At autopsy neither peritoneal cavity had bile staining. The other patients had follow-up ultrasound examinations; no intraperitoneal fluid collections were seen.
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PMID:Life-threatening vagal reactions associated with percutaneous cholecystostomy. 670 6

Purulent pericarditis is a serious but uncommon disorder which rarely complicates acute myocardial infarction. We have described a patient who had fatal purulent pericarditis subsequent to Swan-Ganz catheterization, which was done to facilitate the management of left ventricular failure complicating acute myocardial infarction. Although rare, purulent pericarditis should be considered in the differential diagnosis of otherwise unexplained sepsis associated with myocardial infarction. The presence of a pericardial effusion may rapidly be confirmed by echocardiography, and diagnostic pericardiocentesis undertaken.
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PMID:Infections of the heart complicating acute myocardial infarction. 674 Mar 67

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.
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PMID:Boerhaave syndrome. Successful conservative management in three patients with late presentation. 678 84

29 tubal sterilization deaths occurring in the US between 1977-1981 were identified. 11 followed complications of general anesthesia, 7 were due to sepsis, 4 to hemorrhage, 3 to myocardial infarction, and 4 to other causes. Sterilization was performed by laparoscopy in 17 cases, laparotomy in 11, of which 8 were pregnancy-related, and colpotomy in 1. The mean age was 31, ranging from 19-43. 10 women had underlying medical conditions that may have contributed to their deaths. 6 of the deaths due to complications of anesthesia were probably due to hyperventilation in women who were not intubated, 4 to intraoperative cardiorespiratory arrests with unknown precipitating events, and 1 to hyperkalemia probably caused by an idiosyncratic reaction to succinylcholine. 3 deaths attributed to sepsis followed apparent bowel injury during unipolar coagulation. 3 deaths from hemorrhage followed major vessel lacerations during laparoscopic sterilization. 2 women dying of myocardial infarction were heavy smokers and 1 was also 35 and used oral contraceptives (OCs) to the day of the operation. The 3rd woman was obese and had a strong family history of cardiac disease. 1 other death may have been associated with use of OCs. The 29 deaths may not include all sterilization-attributable deaths from 1977-81, resulting in possible biases in distribution of causes. Use of endotracheal intubation when general anesthesia is used, particularly for laparoscopic sterilization; safer use of unipolar coagulation or use of alternative techniques; careful insertion of the needle and trocar for laparoscopy; and discontinuation of OC use prior to sterilization may help prevent steriliztaion-attributable deaths.
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PMID:Deaths attributable to tubal sterilization in the United States, 1977 to 1981. 684 28


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