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

The first 100 cases of the 135 THARIES surface replacement procedures with 4--32 months follow-up, are evaluated in terms of clinical results, radiographic information and complications. The short but detailed follow-up suggests that this procedure was an excellent alternative for the younger and more active population. The overall hip ratings (pain, walking and function) and range of motion are comparable to that of stem-type total hip replacements. When the THARIES and conventional hip results are further compared in 34 patients matched by sex and age for 3 major etiological groups (osteoarthritis, osteonecrosis and congenital hip dysplasia), the interim results are essentially comparable for both types. Three cases in the first 100 have required revision. One patient (no. 1) with osteoporosis, chondrolysis and arthrofibrosis following slipped capital femoral epiphysis had loose femoral and acetabular components 24 months postoperatively. He was revised to a T-28 hip replacement. The polyethylene socket in another patient (no. 4), the first dysplastic hip in this series, was 20 nm uncovered superiorly, became loose and was revised 9 months postoperatively. Now 15 months postoperative with a more medial THARIES acetabulum, the patient continues to have a good result. Another patient (no. 12) with bilateral dysplastic hips became progressively more disabled due to heterotopic bone, which was then excised 18 months postoperatively. Radiographic studies of the THARIES sockets demonstrate radiolucent zones at the cement-bone interfaces of the acetabulum in 88 cases, partial in 51 and complete in 37. Three hips were currently considered to have evidence of progressive socket loosening but are active and asymptomatic. There have been no femoral neck fractures in this series which we attribute to the custom fitting ability inherent in the range of components, the reaming protocol and the various remodelling guides. There have been no prosthetic breakages, subluxations, dislocations or sepsis. The complications observed in this series are minor and comparable to that of many other total hip arthroplasty operations. Nerve palsy and trochanteric separation have not been major problems although one existing peroneal nerve dysfunction and one trochanteric migration emphasize the need to minimize these complications by careful handling of the operative leg, and an accurate trochanteric reattachment technique.
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PMID:THARIES surface replacements: a review of the first 100 cases. 10 70

Tarsal bone disintegration is characterised by fragmentation and progressive collapse of one or more tarsal bones. It occurs in 10% of leprosy patients, and is responsible for many severe foot deformities associated with this disease. The main cause is micro-traumata, but sensory impairment, sepsis and osteoporosis are predisposing factors. In this series of 400 consecutive patients the talus and navicular were involved most frequently (2% of 119 tarsal lesions). Treatment, including prolonged immobilisation of the foot, results in dense sclerosis of the affected bone, and leaves a functional limb. Initial radiological features include: (i) Bone fragmentation. (ii) Calcified fragments in adjacent soft tissues. (iii) Linear fractures. (iv) Progressive compression and deformity of the affected bone. (v) Loss of density of the affected bone. (vi) Flattening of the longitudinal plantar arch. Illustrative case histories are presented, and the differential diagnosis discussed.
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PMID:Tarsal bone disintegration in leprosy. 45 6

Clinical and experimental evidence suggests that shock, arthritis, osteoporosis, colitis, leukemia, diabetes, wasting and atherosclerosis are mediated, in part, by interleukin 1 (IL-1). Inhibition of this cytokine has been a strategy for studying disease and for new drug development. A naturally-occurring IL-1 inhibitor (IL-1 receptor antagonist, IL-1ra) that blocks binding of IL-1 to its receptors has been cloned and produced in recombinant organisms. IL-1ra reduces the severity of sepsis, colitis, arthritis and diabetes in animals and is presently being tested in humans with arthritis, shock and myelogenous leukemia.
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PMID:Blocking IL-1: interleukin 1 receptor antagonist in vivo and in vitro. 183 80

Among 149 kidneys transplanted in 141 children and teenagers aged 4 1/2 to 20 years, from November 1972 through December 1979, 70 (47%) were still functioning after ten years (67/145 cadaver donor grafts and 3/4 living related donor grafts). Medical and social status at the last follow-up visit (10 to 16 1/2 years after transplantation; m = 12 years) was analyzed. Patients were divided into five groups on the basis of glomerular filtration rate (GFR; ml/min/1.73 m2) and blood pressure (BP): 1) GFR greater than 80 ml and normal BP: 23 patients (33%); 2) GFR in the 60-80 ml range and/or high BP: 24 patients (34%/3) GFR in the 40-60 range: 6 patients; 4) GFR in the 15-40 range: 7 patients; and 5) hemodialysis restarted 10 1/2 to 13 years after transplantation. Mean adult stature was 155.7 +/- 10.4 cm in males and 149.8 +/- 10 cm in females. Osteoporosis was found in 88% of patients who underwent bone density quantitation. Twenty-four per cent of patients had aseptic osteonecrosis with variable degrees of impairment as a result. Chronic HBsAg carrier status was found in 37% of patients and was accompanied with persistent cytolysis in half the cases. Only one malignancy was seen (carcinoma of the urinary bladder in a child under cyclophosphamide). Six deaths were recorded between 10 and 13 years after transplantation; causes included septicemia (2 cases), cancer (1 case), hepatitis B (1 case), cerebral cystinosis (1 case), and unexplained sudden death (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical evaluation of 70 pediatric renal transplants after 10 to 17 years]. 192 8

Immobilization-related hypercalcaemia is an uncommon but important condition being associated not infrequently with both urolithiasis and osteoporosis. In this study 5 patients who had been immobilized for a mean of 3 months and had a mean adjusted serum calcium of 3.15 mmol/l were treated with doses of intravenous pamidronate ranging between 10 mg and 45 mg. All patients became normocalcaemic by day 3. Patients 1-3 mobilized shortly after treatment and remained normocalcaemic. In those patients who continued to be immobile hypercalcaemia recurred after an interval of several weeks. Retreatment with pamidronate again resulted in normocalcaemia. No side effects were noted with treatment. All of the patients studied had increased rates of bone resorption as shown by elevated urinary hydroxyproline/creatinine ratios (median:range) of 0.101:0.045-0.180 (normal less than 0.033) and elevated calcium/creatinine ratios of 2.50:0.69-3.63 (normal less than 0.50). None of the patients in this study had any of the usual risk factors for developing immobilization-related hypercalcaemia though all 5 patients had problems with significant sepsis which we postulate may have lead to cytokine release which in turn contributed to the development of hypercalcaemia. We conclude that pamidronate (at doses as low as 10 mg) is safe and effective in immobilization-related hypercalcaemia and suggest that sepsis should be added to the list of risk factors for development of this syndrome.
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PMID:Immobilization-related hypercalcaemia--a possible novel mechanism and response to pamidronate. 226 2

We reviewed the data on thirty-six supracondylar fractures of the femur (in thirty-four patients) that occurred after total knee arthroplasties that were done between April 1974 and December 1981. Patients who had osteoporosis, rheumatoid arthritis, one or more previous arthroplasties of the knee, or inadvertent breeching of the anterior aspect of the femoral cortex at operation appeared to be particularly at risk for a supracondylar femoral fracture. Malalignment of the component could not be implicated as a cause. Twenty-six fractures (in twenty-five patients) were treated by non-operative methods. Seventeen of them (65.4 per cent) healed and required no surgical treatment. Fourteen of the seventeen were followed for more than two years; they had no significant difference in the knee score and lost less than 10 degrees of motion. The nine remaining knees required revision of the arthroplasty because of non-union in four knees, malunion in two, loosening of the component in two, and extension lag in one. At an average of forty months after revision, the nine knees were rated as having one excellent, four good, three satisfactory, and one failed result. In contrast, only three of the five fractures that were treated by early open reduction and internal fixation had a satisfactory result, and one of them required a second bone-grafting procedure. One patient died perioperatively and another required an above-the-knee amputation because of sepsis. Of the three fractures that were initially treated by external fixation, one had an excellent and two had a good result at an average of forty-five months after fracture. We have found that supracondylar fractures that occur after total knee arthroplasty can be managed by either traction or application of a cast, or both, which usually results in healing of the fracture and a satisfactory outcome of the arthroplasty. Patients who have a poor arthroplasty result after non-operative treatment of the fracture usually can undergo a revision arthroplasty with the expectation of a satisfactory outcome. Operative treatment of the fracture should be reserved for patients who do not have osteopenia and in whom stable fixation can be achieved, for those who demand a highly functional arthroplasty, and for those in whom adequate closed reduction cannot be maintained.
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PMID:Supracondylar fracture of the femur after total knee arthroplasty. 394 Nov 20

Nitric oxide (.NO) is synthesized by the enzyme nitric oxide synthase (NOS). There are 2 constitutive forms of NOS (cNOS) and 1 inducible form (iNOS). Cells containing cNOS rapidly and transiently produce small amounts of NO in response to agonists that raise cytosolic levels of free Ca2+, whereas cells expressing inducible iNOS produce large amounts of .NO for extended periods after a lag of several hours during which time the enzyme is induced. Until recently, the 2 constitutive isoforms of NOS were thought to be confined to endothelial cells (eNOS) and brain (bNOS or nNOS). However, eNOS and bNOS have been identified in an increasing variety of additional cells. Many, if not most, types of cells are capable of expressing iNOS in response to cytokines, endotoxin, and phagocytosis. Regulation of iNOS occurs at transcriptional, translational, and posttranslational levels. Because .NO is rapidly diffusible and soluble in hydrophobic and aqueous environments, it is well suited to its role as an intercellular messenger with the unique ability to penetrate solid tissue. However, it is rapidly inactivated by hemoglobin. The biochemistry of .NO is dominated by its rapid reaction with oxygen and transitional metals, notably iron. The former reaction may be protective, as when neutralizing superoxide (.O2-), or harmful in forming additional highly damaging radicals such as peroxynitrite. Interaction of .NO with iron-containing proteins has a number of sequelae, including the activation of guanylate cyclase, inhibition of mitochondrial respiration, and inhibition of cell division. Nitric oxide has been implicated in a number of conditions of orthopaedic interest, including inflammation, arthritis, osteoporosis, sepsis, ligament healing, and aseptic loosening of joint prostheses.
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PMID:Nitric oxide and its role in orthopaedic disease. 754 92

The fat embolism syndrome is an uncommon clinical disorder that typically occurs as a complication of severe trauma. We report the case of a 60-year-old single-lung transplant recipient who died of massive fat emboli. Before lung transplantation, the patient had been treated with corticosteroids for at least 1 year because of chronic obstructive pulmonary disease caused by centrilobular emphysema and asthmatic bronchitis. After receiving his lung transplant, he was treated with triple-drug immunosuppression, which included 25 mg of prednisone per day. He was discharged from the hospital 2 months after transplantation only to be readmitted 2 weeks later with cytomegalovirus pneumonia, from which he recovered. Concomitantly, he had new lumbar compression fractures with severe back pain and lost approximately 3 cm in height during a 3-week period. On the eleventh day after hospital readmission, he suddenly had a "sepsis-like" illness without a known infectious cause, numerous petechiae and ecchymoses, marked pulmonary edema with worsening diffuse pulmonary infiltrates, profound hypoxemia, decreased mentation, and mild thrombocytopenia. He died 3 days later. With the exception of a positive sputum culture for cytomegalovirus, all cultures were negative. The postmortem examination showed severe osteoporosis, multiple vertebral compression fractures, and widespread massive fat emboli. This is the first reported case of fat emboli as the cause of death in a lung transplant recipient, and the case suggests that the fat embolism syndrome should be considered in the differential diagnosis of a sepsis-like illness in patients who have received steroids during a long period, particularly in the setting of vertebral compression fractures.
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PMID:Fatal fat embolism syndrome after numerous vertebral body compression fractures in a lung transplant recipient. 780 19

A 52 year old man developed a painful swollen left knee. Clinically there was an effusion and radiographs showed local osteoporosis. Sepsis was suspected but tests proved negative and the symptoms gradually settled. During the course of the following year he developed similar pain migrating from the left foot to the right knee then to the right foot. Investigations showed a right knee effusion and 'punctate' radiographic lucencies in the patellae thought to be erosions. A bone scan demonstrated increased uptake at all four sites and sepsis was once again suspected. Biopsies and culture proved negative and a computed tomographic scan confirmed that the lucencies were due to focal osteoporosis rather than erosions. This case of transient regional osteoporosis illustrates two unusual features of this condition which resulted in diagnostic difficulty with respect to sepsis.
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PMID:Transient regional osteoporosis presenting as a septic arthritis. 829 Apr 35

Intramedullary arthrodesis of the knee is a satisfactory method for treating difficult salvage cases of infected arthroplasty, bone loss, and severe osteoporosis. In eight cases, a medial compression plate was routinely used for complete fixation. Union occurred in all cases, including two proximal tibial segmental allografts. Five previously infected cases were healed at follow-up examination (average, six to 44 months). Complications included proximal rod prominence, partial peroneal nerve palsy, recurrent sepsis in one case, and tibial shaft perforation on nail insertion. Seven of the eight patients used some form of walking aid for extended ambulation. Leg length was generally 1.5-2.5 cm shorter than the opposite limb.
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PMID:Knee arthrodesis using combined intramedullary rod and plate fixation. 835 22


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