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)

Necrotizing cellulitis and fasciitis may be difficult to recognize. When skin necrosis is not obvious, the diagnosis must be suspected if there are signs of severe sepsis (accelerated heart or respiratory rates, oliguria, mental confusion.) and/or some of the following local symptoms or signs: severe spontaneous pain, indurated edema, bullae, cyanosis, skin pallor, absence of lymphangitis, skin hypoesthesia, crepitation, muscle weakness, foul smell of exudates. Many risk factors are suspected. A recent case-control study demonstrated that using ibuprofen increased the risk of cellulitis complicating chickenpox in children. Evidence is lower for other risk factors that are present with a high prevalence in most series: local lesion of skin or mucous membranes (acute or chronic disease, traumatism, surgery.), diabetes, arteriopathy, alcoholism, obesity, immunosuppression, NSAIDs. The risk of streptococcal necrotizing fasciitis is increased when in contact with patients infected by the same streptococcus.
 ...
PMID:[Necrotizing fasciitis. Clinical criteria and risk factors]. 1131 68

Vertical banded gastroplasty, reported by Mason in 1982, is an effective method to control pathologic obesity (BMI>40 kg/m2). With the widespread of this procedure and the introduction of laparoscopic approach several complications are described in literature: gastroesophageal reflux, esophagitis, gastritis, gastric bleeding and perforations, prolonged vomit, dislocation of gastric ring, cholelithiasis, gastric fistulas, gastric stomal stenosis, dehiscence of vertical stomach staple line. From 2 to 10% of patients are reoperated because of inefficacy of treatment or short and long-term complications. Morbidity and mortality associated to reoperations are still high and it is difficult to identify criteria for an appropriate revision procedure. This can occur through endoscopy, laparotomy or laparoscopy, depending on clinical and radiologic feature. Dehiscence of vertical stomach staple line, observed in 10-20% of cases, even if asymptomatic, can lead to bad complications such as fistulas, peritonitis and sepsis. The case of a young woman, who underwent a vertical banded gastroplasty for pathologic obesity (117 kg, h 167 cm, BMI 42/m2) and subsequent laparotomies in the attempt to correct vertical staple line dehiscence, is reported. The patient came to our observation in a septic shock caused by peritonitis and ARDS and a total gastrectomy with Roux-en-Y esophago-jejunostomy was performed.
 ...
PMID:[Serious complications of vertical banded gastroplasty. Case report]. 1146 78

The level of maternal mortality appears to be higher in France than in other European countries according to the data collected in the 1995 European survey. We performed a retrospective analysis of severe hemorrhage, pregnancy induced hypertension, and maternal sepsis in 1995 in the Lorraine region and reviewed the management scheme used in each case. There was one maternal death and 223 cases of severe maternal morbidity (110 cases of hemorrhage, 105 cases of pregnancy induced hypertension, 8 cases of maternal sepsis). The frequency of these maternal diseases was an estimated 8 per 1000 births. Ninety percent of the children (90.7%) were living 7 days after birth. Pregnancy after the age of 35 years, obesity, and an intermediate level of vocational training were well-documented high risk factors in the Lorraine area. All of the women who developed complications had been followed regularly during their pregnancy. High parity and a scarred uterus were high risk factors for post partum hemorrhage. About 45% (45.5%) of the patients were transferred to an emergency unit for intensive care. Pregnancy-induced hypertension was treated within the normal hospital network, most of the mothers being transferred to a reference center prior to delivery. This retrospective study demonstrates the need for reporting more information on medical records. The data observed improved our knowledge of the prevalence and management of the main causes of direct maternal death in the Lorraine area. It improved our knowledge on the prevalence and management of the main causes of direct maternal death in Lorraine area.
 ...
PMID:[Severe complications of pregnancy and delivery: the situation in Lorraine based on the European investigation]. 1188 10

Certain features of a group of 1309 diabetics were studied. The group was considered representative of Scottish diabetics since the sex distribution of cases corresponded to the sex distribution of deaths from diabetes recorded in the official mortality statistics for Scotland. Evidence is presented which justifies the use of Scottish mortality statistics for this purpose. A study of the incidence of diabetes in 413,110 Scottish recruits (male and female) suggested that in the general population the sex distribution of persons with undiagnosed diabetes might not be the same as that of persons known to have the disease. In both sexes, the disease began most frequently after age 40; sex incidence was equal up to age 40 and thereafter, female diabetics were more common than male diabetics. The high frequency of diabetes in women of middle age was confined to married women and appeared to be related, at least in part, to previous childbearing. The age at onset and the severity of the disease in this group of women were apparently uninfluenced by marriage and childbearing. Adult diabetics were no taller than the controls (hospital visitors). In the case of women diabetics, the maximum weight was significantly greater than that of the control from age 20 onwards, and in the case of male diabetics, from age 40 onwards. In both groups, married women were heavier than single women. The mean blood pressure was significantly higher in female diabetics after age 30 than in the corresponding control group. This hypertension could not be adequately explained on the grounds of obesity; it was not related to previous childbearing. Of 923 diabetics questioned, 23.2% had a family history of diabetes. As age at onset of the disease increased, positive family histories decreased. There was no relationship between presence of a positive family history and severity of the disease. The frequency of a positive family history in obese and hypertensive patients did not differ from that of a group of diabetics as a whole. In the group of middle aged married women, those with the largest families gave the fewest positive family histories. It was considered that there was no proof of parital sex linkage of the hereditary factor, and no convincing evidence that age at onset is determined by heredity. Thyrotoxicosis was present in 1% of the cases. Age at onset in these cases was similar to that of diabetics in general. Sepsis was associated with onset of diabetes in 6% of the cases, but average age at onset was that of diabetics in general and a family history of diabetes was obtained in 18% of the cases. After examining these data, it was concluded that etiologic factors in human diabetes could be divided into hereditary factor(s) fundamental to almost all cases or factors increasing the susceptibility of those persons predisposed to diabetes by a hereditary factor such as abesity, factor(s) associated with childbearing, and minor factors such as sepsis, thyrotoxicosis, or acromegaly.
 ...
PMID:Survey of a Scottish diabetic clinic: a study of the etiology of diabetes mellitus. 1233 41

Plasminogen activator inhibitor-1 (PAI-1) is the major inhibitor of plasminogen activation and likely plays important roles in coronary thrombosis and arteriosclerosis. Tumor necrosis factor-alpha (TNFalpha) is one of many recognized physiological regulators of PAI-1 expression and may contribute to elevated plasma PAI-1 levels in sepsis and obesity. Although TNFalpha is a potent inducer of PAI-1 expression in vitro and in vivo, the precise location of the TNFalpha response site in the PAI-1 promoter has yet to be determined. Transient transfection studies using luciferase reporter constructs containing PAI-1 promoter sequence up to 6.4 kb failed to detect a response to TNFalpha. Moreover, TNFalpha failed to induce expression of enhanced green fluorescent protein under the control of a 2.9-kb human PAI-1 promoter in transgenic mice, although endogenous murine PAI-1 was strongly induced. These data suggested that the TNFalpha response element in the PAI-1 gene is remote from the proximal promoter region. In this study, seven candidate regulatory regions were identified using cross-species sequence homology analysis as well as DNase I-hypersensitive site analysis. We identified a 5' distal TNFalpha-responsive enhancer of the PAI-1 gene located 15 kb upstream of the transcription start site containing a conserved NFkappaB-binding site that mediates the response to TNFalpha. This newly recognized site is fully capable of binding NFkappaB subunits p50 and p65, whereas overexpression of the NFkappaB inhibitor IkappaB prevents TNFalpha-induced activation of this enhancer element.
 ...
PMID:Tumor necrosis factor alpha activates the human plasminogen activator inhibitor-1 gene through a distal nuclear factor kappaB site. 1496 43

It is known that, among human patients with sepsis, acute renal failure (ARF) dramatically increases mortality rates to 50 to 80%. However, the pathogenesis of septic ARF is not fully understood. An increase in endotoxin-induced mortality rates for leptin-deficient ob/ob mice was recently demonstrated. In comparison with ob/ob mice, db/db mice, which are deficient in the long isoforms of leptin receptors (Ob/Rb), demonstrate lower mortality rates after exposure to the endotoxin LPS. In db/db mice, mRNA for the short isoforms of leptin receptors is constitutively expressed in the kidney, lung, liver, and macrophages. It is known that plasma leptin levels increase in rodents after exposure to LPS, and this was demonstrated for db/db mice. Because ob/ob and db/db mice are both obese, factors other than obesity must be involved in the increased mortality rates for ob/ob mice. In this study, the hypothesis that the short forms of leptin receptors might offer protection against endotoxin-induced lethality at least in part by providing protection against ARF was examined. Serum leptin levels were significantly increased with LPS treatment in wild-type and db/db mice but not ob/ob mice. GFR decreased significantly 16 h after the homozygous ob/ob mice received intraperitoneal injections of 0.3 mg/kg LPS (0.37 +/- 0.04 ml/min per g kidney versus 0.83 +/- 0.06 ml/min per g kidney, n = 6, P < 0.01); the mean arterial pressure (MAP) remained unchanged. For ob/ob littermates (+/?ob), there was no significant change in either MAP or GFR when the mice were challenged with the same time interval (16 h) and dose of LPS. In contrast to ob/ob mice, there was no significant change in GFR or MAP when homozygous db/db mice or their littermates received injections of an even higher dose of LPS (0.4 mg/kg). Mouse recombinant leptin had no effect on GFR when ob/ob mice received 0.3 mg/kg LPS injections. However, renal function (serum creatinine levels, 0.4 +/- 0.1 mg/dl versus 0.9 +/- 0.1 mg/dl, P < 0.01) and MAP (68 +/- 4 mmHg versus 51 +/- 2 mmHg, n = 6, P < 0.01) were significantly improved with leptin replacement when the ob/ob mice developed hypotensive ARF with a higher dose of LPS (0.5 mg/kg). In summary, the previously reported increased susceptibility to LPS of ob/ob mice, compared with db/db mice, may be attributable at least in part to increased susceptibility to ARF.
 ...
PMID:Role of leptin deficiency in early acute renal failure during endotoxemia in ob/ob mice. 1497 66

Marginal liver donor criteria included the following: obesity (weight >100 Kg or BMI >27), age >50 years; macrovesicular steatosis >50%; intensive care unit stay >4 days; prolonged hypotensive episodes of >1 hour, and <60 mm Hg with high inotropic drug use (dopamine, [DPM] > 14 microg/kg per minute); cold ischemia time >14 hours, peak serum sodium >155 mEq/L; sepsis, viral infections, and alcoholism; high levels of bilirubin, ALT, and AST, or extrahepatic neoplasia. Between August 1992 and May 2003, we performed 251 liver transplants in 241 patients of whom 155 are presently alive. We used 124 (49.4%) standard donors and 127 (50.6%) marginal donors. Among the group that received a standard donor, 81 (65.3%) are still alive. Among recipients of organs from marginal donors. 81 (63.8%) are still alive. We also assessed the quality of donors according to the severity of recipient disease. For standard donors these outcomes were 61.5% for UNOS 1, 37.5% for UNOS 2A, 73.2% for UNOS 2B, and 80% for UNOS 3 for marginal donors they were 46.1% for UNOS 1, 53.6% for UNOS 2A, 70.7% for UNOS 2B, and 63.6% for UNOS 3. Among the patients who received a liver from a donor >60 years old, there were no survivors in UNOS 1 and 2A, but there were good results in groups 2B and 3. These results suggest there is no difference between marginal and standard donors, even in sick patients, with the exception of donor age.
 ...
PMID:Marginal donors in liver transplantation. 1511 May 80

Calciphylaxis is a confusing disease process that affects people with end-stage renal disease. The prognosis of this increasingly common condition is poor and mortality rates range from 60% to 80% related to wound infection, sepsis, and organ failure. Its presenting sign is skin necrosis related to calcification of the arteriole microvasculature. The disease is painful and debilitating, particularly due to the necrotic wounds. Aggressive wound care to prevent infection is vital when eschar does not protect the wound and drainage is present, but debridement is contraindicated for wounds covered with dry, noninfected eschars. The decision to debride is based on the patient's total clinical picture. Patients with calciphylaxis have poor healing potential due to ischemia and comorbidity factors such as diabetes mellitus, peripheral vascular disease, and obesity. The goal of care is prevention of infection and pain management. Some of the sensitizers and challengers responsible for the chemical imbalance leading to the arteriole calcification, as well as risk factors and clinical manifestations of calciphylaxis, are reviewed. A discussion of treatment focuses on wound care of stable necrotic ulcers and a case report illustrating the progression of calciphylaxis is presented.
 ...
PMID:Mysterious calciphylaxis: wounds with eschar--to debride or not to debride? 1525 2

Mortality of obese patients with severe sepsis is higher than non-obese patients. Thus far, a pathophysiologic mechanism has not been identified that explains this higher mortality. The central nervous system is now becoming increasingly recognized as a target organ in sepsis and the systemic inflammatory response syndrome and may hold clues to the deleterious affects of obesity in patients with sepsis syndrome. In this study, obese and non-obese mice were given LPS IP and the brains were harvested 2 hours after injection. The brains were processed and mRNA isolated and hybridized to a microarray chip and processed. Analysis of gene expression demonstrated distinct expression difference between the lean and obese animals. Ontology data supports clear differences between the lean and obese groups in the coagulation system, neuro-endocrine system, lipid transport and insulin receptors. Approximately eighty genes were identified to show 10-fold differential expression between the obese and lean mice.
 ...
PMID:Brain RNA expression in obese vs lean mice after LPS-induced systemic inflammation. 1535 6

Hyperglycemia, a frequent complication in critically ill patients, has been shown to have a negative influence on morbidity and mortality. Many factors contribute to hyperglycemia, including the stress response, diabetes, obesity, advanced age, corticosteroids, sepsis, pancreatitis, and the use of nutrition support. Application of intensive insulin therapy, when compared with conventional glycemic control measures, seems to improve outcomes in the critically ill patient. Therefore, effective insulin therapy along with appropriate nutrition support prescriptions provide a means for the critical care nurse and other health care team members to lower complications and enhance recovery in the ICU setting.
 ...
PMID:Benefits and methods of achieving strict glycemic control in the ICU. 1557 42


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