Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Experience with 37 patients surviving 10 years of hemodialysis therapy was reviewed. These patients were compared with 103 patients who began hemodialysis between 1967 and 1971 and who subsequently died. Males had an excess risk of death. Patients with polycystic kidneys survived longer. There was more uncontrolled hypertension among a control group than in 10-year survivors. In survivors, the hematocrit level increased over time and averaged 30.4 percent at 10 years. Over 10 years, many complications arose including parathyroidectomy (24), pericarditis (13), gastrointestinal bleeding (11), myocardial infarction (10), septicemia (eight), and active tuberculosis (six). Despite complications, most patients are now stable. Between their eighth and 10th years they required an average of only one hospitalization with a mean stay of 9.7 days. Eighteen patients were not hospitalized. Excluding housewives, 67 percent of patients between ages 20 and 59 years are employed full-time and 10 percent part-time. Patients surviving 10 years are not progressively deteriorating and may look to the future with cautious optimism.
 ...
PMID:Patients surviving 10 years of hemodialysis. 685 68

Shock is a clinical syndrome caused by a variety of primary insults, such as myocardial infarction, sepsis, and hypovolemia, which terminate in a failure of cellular perfusion. Management requires identification of the initial insult and the patient's hemodynamic pattern. The therapeutic approach in a patient may include resuscitation, fluid replacement, pH adjustment, and drug therapy. The specific treatment, however, must be tailored to fit the patient's individual problems and hemodynamic responses.
 ...
PMID:Managing shock. 687 35

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
 ...
PMID:Infective endocarditis update experience from a heart hospital. 697 38

During a five-year period, 280 patients underwent myocardial revascularization within 60 days of having suffered an acute myocardial infarction. Eighty-six percent of them had angina. Twelve patients had calculated ejection fractions of less than 20%; 79, 21% to 40%; and 105, from 41% to 60%. Ten patients had one graft; 33, two; 74, three; and 163, four or more. Twenty-four patients had concomitant ventricular aneurysm repair. The intra-aortic balloon pump was used in only seven patients. There was one postoperative death secondary to respiratory insufficiency and sepsis, resulting in a hospital mortality of 0.4%. Myocardial revascularization is a safe procedure following recent myocardial infarction, with results comparable to elective revascularization. Our long-term results suggest that revascularization may decrease the incidence of recurrent myocardial infarction.
 ...
PMID:Coronary artery bypass after recent myocardial infarction. 698 98

In summary, it is clear that duration of surgery is positively correlated with postoperative morbidity in both major and relatively minor procedures. It should be kept in mind that the reason for this in many cases may be that the preoperative condition of the patient or the nature of the surgical procedure can affect both operative time and postoperative outcome. However, there can be little doubt of the independent influence of operative time on the incidence of wound infection and sepsis. It is also highly probably that prolonged anesthesia tends to make postoperative atelectasis and other pulmonary complications more likely to occur, especially if tidal volumes are inadequate. It can be said, too, that the anesthetist will be more likely to see arrhythmias the longer the surgeon operates. The association of myocardial infarction, renal failure, thromboembolic disease, and delirium with prolonged operation time is also a possibility.
 ...
PMID:Length of operation and morbidity: is there a relationships? 707 94

Twenty-eight cases of necrotizing fasciitis (NF) were treated in 27 patients. Most commonly these infections were caused by perineal disease, operative procedures, and cutaneous ulcers. Associated chronic diseases were present in 21 patients. Postoperative fasciitis occurred when prophylactic antibiotics were omitted or used inappropriately during clean-contaminated or contaminated procedures and when primary skin closure was done in the presence of intra-abdominal contamination. All but four infections were polymicrobial. The overall mortality rate was 73% (20 of 27). Death was due to persistent would sepsis in nine, systemic septic complications despite apparent local control of the infection in nine, and myocardial infarction in two patients. Five of seven survivors had NF limited to one region (leg, perineum, or abdomen). Only 2 of 15 patients survived when more than one debridement was necessary to control ongoing wound necrosis. Eleven of 12 patients who had a delay in treatment for more than 12 hours died. These results suggest that prompt recognition and treatment of NF are essential for survival. The presence of chronic debilitating diseases may contribute to the uncontrollable nature of both local and systemic infection, further emphasizing the need for early diagnosis. Postoperative fasciitis is potentially preventable by strict adherence to the principles for management of contaminated procedures.
 ...
PMID:Necrotizing fasciitis: a preventable disaster. 712 97

Multiple extremity gangrene developed in five patients as a complication of dopamine therapy. The clinical conditions were (1) penetrating chest trauma requiring pneumonectomy with postoperative sepsis, (2) cardiac arrest with aspiration pneumonia, (3) lymphoma with sepsis, (4) Klebsiella pneumonia, and (5) myocardial infarction. The development of acrocyanosis leading to gangrene occurred at dopamine dosages of 5.1 to 10.2 micrograms/kg/min. The alpha-adrenergic vasoconstriction effects of dopamine would not be expected from the doses employed in these patients. Thus, other factors beside pure alpha vasoconstriction are responsible for tissue necrosis after the use of dopamine. We believe that the embolic complications of disseminated intravascular coagulation and hypovolemia are serious risk factors in the development of dopamine gangrene. Peripheral vasoconstriction from dopamine, even at low doses, may set the stage for thrombotic complications of disseminated intravascular coagulation and lead to tissue damage. In laboratory models of disseminated intravascular coagulation, an alpha-adrenergic drug is required to produce peripheral ischemic tissue damage. Treatment of tissue ischemia related to dopamine depends on early recognition of acrocyanosis. Phentolamine, an alpha blocker, has been recommended for treating dopamine ischemia, either through local instillation into ischemic tissues or intravenous infusion. We recommend a high index of suspicion for, and early treatment of, underlying consumptive coagulopathy in all patients requiring dopamine.
 ...
PMID:Dopamine gangrene. Association with disseminated intravascular coagulation. 730 16

Patients with cardiovascular disease commonly present with problems requiring surgical treatment. They are more vulnerable than patients without cardiovascular disease to the cardiovascular stresses associated with general anesthesia and surgery--hypotension, hypoxemia, sepsis, and thromboembolism. Their risk of morbidity and mortality is higher. Certain clinical factors have a profound impact on the patient's likelihood of serious cardiac complications or death: Overt heart failure, recent myocardial infarction, and cardiac arrhythmias are the most worrisome. A careful clinical evaluation and formal assessment of the patient's risk dictate better perioperative monitoring and treatment. Early hospital admission provides time for control of other health problems. Prophylaxis with heparin and antimicrobial agents minimizes problems of thromboembolism and sepsis, respectively. Overaggressive treatment of hypertension is avoided, and withdrawal of propranolol or clonidine is carefully supervised. The use of digoxin is restricted to patients with atrial tachyarrhythmias or heart failure. Hemodynamic monitoring via a Swan-Ganz catheter or temporary transvenous pacing may be necessary for selected high-risk patients. Such careful evaluation, monitoring, and treatment are the clinician's methods for improving the chance for patients with heart disease to benefit from surgery.
 ...
PMID:Perioperative care of patients with cardiac disease. 735 25

In 1096 cases of death (autopsy rate 63.8%) the accuracy of clinical diagnoses was investigated by comparing clinical diagnoses with recorded autopsy findings. -- In 81.3% of the cases the primary disease had been determined correctly. In more than half of these cases the immediate cause of death or an additional disease contributing to death had not been correctly identified. In 16% of the cases the diagnosis proved to be inadequate. -- In 2.6% of all cases the primary disease, cause of death and accompanying illnesses were misdiagnosed. Most of these patients had stayed in the hospital for a much shorter time than the rest of the patients. -- Among conditions clinically diagnosed as cirrhosis of the liver, pulmonary embolism, myocardial infarction, cerebral hemorrhage, and malignant tumors -- pulmonary embolism was by far the most frequent condition to go unrecognized, i.e. in 50% of th cases in which it was present. Primary liver cell carcinoma proved to be the malignant tumor most frequently not identified by clinical studies. -- Four clinical diagnoses (shock, septicemia, diabetes mellitus and uremia) were often unsupported by morphological findings. Yet there were 13 clinically undiagnosed cases of septicemia in which findings at post mortem examination revealed this condition. These cases also underline the importance of autopsies.
 ...
PMID:Autopsy and clinical diagnosis. 1879 61

Type A aortic dissection still presents an emergency situation in cardiac surgery that is associated with high morbidity and mortality rates. There has been a significant improvement in the surgical outcome since the introduction of deep hypothermia and circulatory arrest. In this study, we discuss our results after operative repair of ascending aortic dissections, using deep hypothermia and circulatory arrest. This study presents the results of 67 patients (43 men, 24 women) from 18 through 81 years of age (mean, 54 years) who underwent surgery for type A dissecting aneurysm over a period of 4 years. Type A dissection (52 acute and 15 chronic cases) was due to Marfan syndrome in 12 patients, to atherosclerotic disease of the aorta in 27 patients, and to traumatic injury in 1 patient. Hypertension as the only pathologic finding was observed in 27 patients. Deep hypothermia (confirmed by isoelectric electroencephalogram) and circulatory arrest were induced in all patients. Two patients died intraoperatively due to massive bleeding (intraoperative mortality, 3%). The 30-day mortality rate was 30% (n = 20). Causes of perioperative deaths in order of frequency were multi-organ failure (n = 11), myocardial infarction (n = 2), postoperative bleeding (n = 2), cerebrovascular insult (n = 2), and sepsis (n = 1). The mean intensive care unit stay of the surviving 47 patients (72%) was 8 days, followed by a mean of 21 additional days in the hospital. Our experience with profound hypothermia and circulatory arrest, used in combination with coated grafts, supports our conviction that this is the method of choice for the treatment of type A dissecting aneurysm.
 ...
PMID:Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest. 868 Feb 82


<< Previous 1 2 3 4 5 6 7 8 9 10