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)

Of 26 patients who underwent distal splenorenal shunting 4 or more years ago (1969 to 1978), 10 died 3 to 87 months postoperatively (mean 38.5 months). Six deaths were due to liver failure, two to hemorrhagic peptic ulcer disease (the shunt remained patent in each patient), one to brain hemorrhage, and one to sepsis. Eight of the surviving patients resumed professional activity, one showed transient signs of encephalopathy, one had a single episode of recurrent variceal bleeding that could be managed conservatively, and no patient had ascites. Eight patients were investigated angiographically and endoscopically. Preoperative and postoperative measurements of the portal vein showed a decreased diameter in five patients and no opacification in the other three 29 to 97 months after surgery. At endoscopy four patients had small residual esophageal varices, one patient had none, and the other three had large varicosities with variceal pressures between 30 and 40 cm H2O in two and above 40 cm H2O in one. Although the incidence of postoperative encephalopathy and variceal bleeding was low after distal splenorenal shunting, the operation did not prevent a decrease in hepatopetal portal flow and did not always abolish the esophageal varices.
 ...
PMID:Long-term follow-up after a distal splenorenal shunt procedure. A clinical and hemodynamic study. 660 May 87

The septic complications of peptic ulcer perforation have not been adequately described in the literature because the sparse microflora usually present in the upper gastrointestinal tract is generally believed to represent a minimal risk. One hundred and eighty-two peptic ulcer perforations (150 duodenal, 32 gastric), seen over 15 years, are reviewed. The septic complications relating to intestinal perforation included intra-abdominal abscess (22 cases), wound infection (26 cases) and generalized bacterial peritonitis (18 cases). The incidence of postoperative abscesses was significantly (p less than 0.05) greater in patients with gastric than with duodenal perforation. In both groups, abscesses were much more frequent when perforation occurred more than 24 hours before operation. The risk of intra-abdominal sepsis following acute peptic perforation is substantial. In such cases, routine anaerobic and aerobic cultures should be done of fluid taken from the peritoneal cavity at operation.
 ...
PMID:Septic complications of perforated peptic ulcer. 686 Oct 36

The prostaglandins are potent vasoactive fatty acids that are ubiquitously distributed throughout the body. It is now well established that the prostaglandins participate in a variety of pathophysiological processes such as inflammation, burns, renal aspects of hypertension, peptic ulcer disease, diarrhea, skin conditions, vasomotor dysfunctions, platelet abnormalities, dysmenorrhea, fever, and shock. We have previously shown that the prostaglandins appeared to be elevated and were related to the circulatory dysfunction in canine and baboon endotoxin shock. In addition, our studies demonstrated that indomethacin, a prostaglandin synthetase inhibitor, not only inhibited the prostaglandin release and improved the hemodynamic derangements, but also significantly improved the survival. Indomethacin clearly improved the survival in baboon endotoxin shock even when administered after shock had occurred. Since the previous studies were in endotoxin models, the next logical step was to determine the effects of indomethacin in a clinically-relevant rat sepsis model. Two hundred sixty-six male rats (250-500 g) were randomly allocated to saline treated controls or to indomethacin treatment. A pure suspension of live E. Coli organisms (225 X 10(10)/rat) were injected i.p. to each rat. Treatment was introduced at three hours when all blood cultures were positive. Groups were divided into gentamicin (4 mg/kg/rat) alone, gentamicin and indomethacin (3 mg/kg), or indomethacin alone in addition to the saline treated controls. Results showed that indomethacin in combination with gentamicin significantly (p = 0.05) improved the survival at 24 (90%) and 48 hours (90%), when compared with saline treated controls (65%, 45%) and with gentamicin (40%, 40%). Indomethacin alone significantly (p = 0.01) improved the survival. Conclusions are that (i) therapeutic doses of indomethacin or gentamycin clearly improved the survival in a clinically relevant rat sepsis model; (ii) the exact mechanism of protection with indomethacin is unknown; and (iii) indomethacin should be considered for use in human clinical sepsis.
 ...
PMID:The role of prostaglandins in sepsis. 704 14

Eleven cases of chronic duodenal ulcer in children were subjected to surgical treatment in a period of 7 years. The diagnosis was based on typical peptic ulcer symptoms, hyperchlorhydria, and barium meal x-ray studies delineating a duodenal bulb deformity with an ulcer crater in 8 patients. Three cases of duodenal ulcer perforation in infants were diagnosed at aparotomy for peritonitis with pneumoperitoneum. All the patients hailed from the rgion of Assam, India, where peptic ulcer is prevalent. A positive family history of peptic ulcer in 5 patients, blood group O in 7 patients, and the regional diet were considered to be predisposing factors. Medical treatment consisting of a bland diet, sedatives, antispasmodics, and a brief hospital stay failed to provide permanent relief of symptoms. Truncal vagotomy with a drainage procedure was done in 8 patients with no deaths. However, simple closure of the perforation in the 3 infants resulted in fatalities due to fulminant septicemia. The patients were followed up for 1-8 years. Six patients had permanent relief of symptoms. Two patients occasionally complained of epigastric fullness and eructation. They showed normal growth, gain in weight and hemoglobin levels, and had no recurrence. We believe that operative treatment is preferable to medical management of chronic duodenal ulcer in children.
 ...
PMID:Duodenal ulcer disease in chidren. 740 63

A peptic ulcer is a lesion in which acid and pepsin are essential components of pathogenesis. Regardless of the type of patient or the setting in which the ulcer presents, the basic pathogenetic scheme is the same. The primary event is disruption of mucosal integrity. In the presence of acid and pepsin, such disruption of integrity leads to an ulcer. While rarely sufficient by itself to cause ulceration, the presence of acid is a necessary cofactor. The causes of disruption of mucosal integrity include nonsteroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori and critical illness. With the latter, tissue ischaemia may be the primary event, leading to back-diffusion of H+ ions through increased membrane permeability. Impaired mucosal buffering then leads to intramural acidosis and cell death. Risk factors for bleeding peptic ulcer in the intensive care unit (ICU) include severe trauma, sepsis, respiratory failure, and coagulopathy. Potential roles for decreasing gastric acidity in the treatment of bleeding peptic ulcer include cessation of active bleeding, prevention of rebleeding in hospital and primary prevention of bleeding. Most published studies dealing with the first two situations suggest no benefit with antisecretory therapy. However, the optimal pH for clot and platelet function may be > or = 7.0. Can such pH levels be maintained with antisecretory agents such as the proton pump inhibitors? Are the published trials adequate to demonstrate any benefit from antisecretory agents? Primary prevention of bleeding ulcer in the outpatient setting includes avoidance of NSAIDs, use of antisecretory agents and eradication of H. pylori.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:The role of acid in upper gastrointestinal haemorrhage due to ulcer and stress-related mucosal damage. 749 42

A prospective study of 352 patients in an Asian National Burn Centre has been used to develop statistical predictive models for mortality and hospitalization time. The patients are largely of Asian origin. Total burn surface area (% TBSA) and presence of respiratory burns are significant independent predictors of mortality in the multiple logistic regression analysis with an accuracy of 98.3 per cent. Age is not a significant predictor of mortality in our patients. Age, % TBSA, full thickness % TBSA and respiratory burns are significant independent predictors of length of stay in hospital with a R2 value of 0.57 in the multiple linear regression analysis. There were 16 deaths, many of whom had developed multiple complications, common causes of which were sepsis, bronchopneumonia, DIVC and multiorgan failure. The final causes of death were septicaemic shock in 10 patients, extensive burns in four patients, ARDS in one patient and bleeding peptic ulcer in one patient. The development of these two mortality and morbidity predictive models is the first step in the evaluation of our results. These models have to be tested against a future set of patients. After confirmation they will aid in patient management, clinical audit, patient and family counselling. They will also serve as baseline standards for evaluation of new therapies, assist us in the allocation of resources and identifying the at-risk population for improvements in therapy.
 ...
PMID:Burns mortality and hospitalization time--a prospective statistical study of 352 patients in an Asian National Burn Centre. 771 18

Obstetrician-gynecologists reviewed patient records of women delivering during January 1986-December 1992 to determine the maternal mortality rate and trends and the causes of maternal deaths in the maternity ward at the National University of Singapore. There were 26,173 deliveries and 9 maternal deaths (a maternal mortality rate of 22.9/100,000). The causes of maternal deaths were pulmonary embolism (underlying condition, systemic lupus erythematosus [SLE]), hemorrhage from multiple sites (thrombotic thrombocytopenia), acute exacerbation of SLE with interstitial pneumonitis, pulmonary fibrosis (systemic sclerosis), fulminant hepatitis (prior hepatitis and liver disease), and cerebral embolism (rheumatic heart disease with mitral valve replacement). There were also three incidental maternal deaths bringing the maternal mortality rate up to 34.4/1000. The incidental causes of death included septicemia from perforated peptic ulcer (uncontrolled thyrotoxicosis), multiple metastases from lung cancer, and suicide (family dispute over adoption of newborn). A cesarean section preceded 4 (44%) of the 9 maternal deaths. Two of these deaths were incidental maternal deaths. Cesarean section was related to two of the remaining six (33%) deaths. These findings show that traditional direct causes of maternal death (hemorrhage, sepsis, embolism, or hypertension) were not responsible for the maternal deaths at this tertiary facility. Instead, the women tended to have medical conditions that placed them at high risk of death regardless of pregnancy status.
 ...
PMID:Maternal mortality: evolving trends. 781 Nov 98

Vibrio vulnificus infection, which is a rare and fatal disease, can be categorized clinically as either primary septicemia or wound infection. The clinical presentation of patients with primary septicemia can vary from fever alone to a more severe illness including high-grade bullous lesions, hypotension, and shock. Wound infection typically results from either injury to the skin in a marine environment or contact of a preexisting wound with sea water. We reported eight cases with Vibrio vulnificus infection in Chang gung Memorial Hospital and reviewed ten other cases previously reported with details in Taiwan. Fourteen patients presented with primary septicemia, and four with wound infection. Thirteen patients had alcoholism or chronic liver disease, two had peptic ulcer disease, one was steroids abuser, and one patient had thalassemia and chronic liver disease. Overall mortality was 55.6% (ten patients). Patients with hypotension within 48 hours of admission had higher mortality than normotensive patients (77% vs. 0%, P = 0.007). Patients with chronic liver disease or liver cirrhosis also had tendency to a higher mortality than not (64% vs. 25%, P = 0.274). Chronic liver diseases and liver cirrhosis are common disease in Taiwan. They take a high risk for Vibrio vulnificus infection. Clinician should keep in mind of this potentially fatal infection in these patients reporting a history of recent raw oyster consumption and presented with sepsis and characterized skin lesions. Prompt empirical antibiotics treatment and aggressive surgical treatment may be lifesaving for this acute and fatal disease.
 ...
PMID:Vibrio vulnificus infection--report of 8 cases and review of cases in Taiwan. 785 Jun 49

We report a series of 37 patients with upper gastrointestinal fistulas, from a total of 90 postoperative fistulas, treated in our Department over a period of five years (1987-1991). 46% of these originated after peptic ulcer surgery. Most patients (54%) required surgical intervention mainly due to the presence of major intraabdominal sepsis, and only 12 (32.4%) had spontaneous fistula closure. Morbidity (59.4%) and mortality rates (32.4%) were high.
 ...
PMID:[Postoperative digestive upper fistula. Study of 37 cases]. 803 14

In about 95% of patients with acute cholecystitis the cystic duct is obstructed by a gall stone. The imprisoned bile salts have a toxic action on the gall bladder wall. Acute cholecystitis is liable to be confused with other causes of sudden pain and tenderness in the right hypochondrium. Below the diaphragm, acute retrocecal appendicitis, intestinal obstruction, a perforated peptic ulcer or acute pancreatitis may be confusing factors; however, the gall bladder remains shrunken, fibrotic, full of stones and nonfunctioning. Recurrent acute cholecystitis may follow, but there may be surprisingly long clinically silent periods. The treatment of choice is elective cholecystectomy. General measures include bed rest, intravenous fluids, a light diet and relief of pain with pethidine and buscopan. Antibiotics are given to treat septicemia and prevent peritonitis and empyema. During the first 24 h., 30% of the gall bladder cultures are positive. This rises to 80% after 72 h. Common infecting organisms are Escherichia coli, Streptococcus faecalis and Klebsiella, often in combination. Anaerobes are present, if sought, and are usually found with aerobes. They include Bacteroides and Clostridia. Antibiotic(s) should have a spectrum to cover the colonic type micro-organisms which are usually found with infection of the biliary tree. The choice depends upon the clinical picture. A broad-spectrum penicillin or a cephalosporin is usually adequate for the stable patient with pain and mild fever. The severely septicemic patient is better treated with a combination of ureidopenicillin (mezlocillin or piperacillin) and metronidazole.
 ...
PMID:[Acute cholecystitis--conservative therapy]. 809 Oct 58


<< Previous 1 2 3 4 5 6 Next >>