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

Ischemia of the gastrointestinal mucosa is characterized by acidosis in the submucosal layer during the majority of interventions, which necessitates monitoring of tissue pH (pHi) of the abdominal organs during aortocoronary bypass surgery and the immediate postoperative period. The pHi was measured by gastrotonometry with a nasogastral tube (Trip catheter) and Tonocap-TC200 device (Datex Engstrom, Finland); pHi was measured in 17 patients in department of intensive care on days 1 or 2 after cardiosurgical interventions with at least 120-min artificial circulation and in 23 patients during the operation. Surgical treatment consisted in correction of acquired valvular diseases, myocardial revascularization (shunting operations), and combinations of these operations. The first stage of investigation revealed a relationship between decreased pHi level to the acid values and complicated course of the postoperative period. The second stage showed that postoperative complications occurred in 27.2% cases only in patients subjected to long artificial circulation bypass (more than 120 min). The frequency of complications were 2-fold more in the patients with tissue acidosis (pHi < 7.35) during surgery than in patients with normal and alkaline pHi values. The following complications occurred: acute pancreatitis, acute peptic ulcer, acute renal and polyorgan failure. Comparative analysis of pHi and other metabolic markers of arterial blood showed a correlation between these parameters, but pHi was more specific for the diagnosis of tissue ischemia. Hence, a low invasive highly specific method of gaseous gastrotonometry helps evaluate the blood supply to abdominal organs during and after cardiac surgery with artificial circulation and predict postoperative gastrointestinal and grave systemic complications (sepsis, acute renal failure, and polyorgan failure).
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PMID:[Significance of tissue pH in the prognosis of postoperative complications in heart surgery patients]. 1133 11

The afferent loop syndrome corresponds to an acute or chronic obstruction of the afferent loop following a partial gastrectomy with Billroth II gastro-jejunal anastomosis. We describe the case of a 77-year-old man with history of partial gastrectomy for peptic ulcer disease performed 31 years ago and currently admitted for jaundice and poor general status. MR imaging showed dilatation of biliary and pancreatic ducts and showed a soft tissue mass between the afferent loop and the residual stomach. Endoscopy showed complete obstruction of the afferent loop by a biopsy-proven adenocarcinoma. The patient died of sepsis shortly after endoscopy of septicemia.
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PMID:[MRI of an afferent loop syndrome presenting as obstructive icterus]. 1142 16

During the last decade several new Helicobacter species have been isolated from human gastric mucosa, fecal samples, liver, and gallbladder. Gastric corkscrew-shaped Helicobacter species: H. heilmannii is usually seen in the gastric foveolae in 0.2-0.6% of histological sections from the gastric mucosa of patients with dyspepsia in Western Europe, but it has only been cultured once. It is genetically and morphologically closely related to H. bizzozeronii and H. salmonis which are common in dogs and cats. It causes constantly active chronic gastritis and is regularly associated with peptic ulcer. Intestinal Helicobacter species: H. cinaedi, H. fennelliae, H. pullorum, H. westmeadii, H. canadensis, and 'H. rappini' have been isolated from patients with enteritis and proctitis. H. fennelliae, H. cinaedi, H. westmeadii, and 'H. rappini' have been isolated also from patients with septicemia. Studies indicate that H. cinaedi is transmitted from hamsters and that H. pullorum is common in chickens. 'H. rappini' has been isolated from sheep, dogs, and mice, whereas no animal reservoir has been found for H. fennelliae. Except for the cases of septicemia, none of these Helicobacter species have yet been proven to cause human disease, but they are suspected to play a role in inflammatory bowel diseases. Hepatobiliary Helicobacter species include several Helicobacter species isolated from bile and liver of animals, but only H. bilis has been isolated from the human gallbladder and H. pylori from the human liver. H. bilis has been isolated from dogs, cats, mice, and rats. Nonpylori Helicobacter species are usually difficult to culture and may be more frequently causes of human disease than realized today.
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PMID:New Helicobacter species in humans. 1154 19

Two hundred forty-eight patients were operated for perforated peptic ulcer between 1983 and 1998. Of the patients 112 (45.1%) had chronic, 34 (13.7%) had acute ulcer history and 102 (41.2%) had no ulcer history. Of the patients 228 (92.0%) had duodenal, 9 (3.6%) had juxtapyloric, 6 (2.4%) had marginal, and 5 (2.0%) had antral ulcer. Forty two patients (16.9%) admitted within 12 hours and 206 patients (83.1%) between 12 hours and six days after perforation. Simple closure and omental patch was performed in 32 patients (12.9%) who had severe concomitant illness and 126 (50.8%) intraabdominal sepsis, truncal vagotomy + pyloroplasty in 32 (12.9%), simple closure + omental patch + truncal vagotomy + gastroenterostomy in 34 (13.7%), simple closure + omental patch + parietal cell vagotomy in 21 (8.5%), truncal vagotomy + antrectomy in 3 (1.2%). Patients who didn't have definitive procedure received H2 receptor blockers or proton pomp inhibitors. One hundred ninety-three patients (77.8%) underwent endoscopic control. Two of 53 patients with definitive procedure (3.8%) and 34 of 140 patients (24.3%) with simple closure had recurrence. Two patients in simple closure group underwent parietal cell vagotomy, the others received medical treatment. The recurrence rate was significantly higher in simple closure group (p < 0.01).
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PMID:[Perforated peptic ulcers]. 1181 77

We designed this study to define determinants of gastrointestinal complications after cardiac surgery. From January 1992 through December 2000, 11,058 patients underwent cardiac surgery on cardiopulmonary bypass at our institution. Data were prospectively collected and univariate and multivariate analyses conducted. A total of 147 gastrointestinal complications occurred in 129 patients (129/11,058; 1.2%) including gastroesophagitis (18, 12.2%), upper gastrointestinal hemorrhage (42, 28.6%), perforated peptic ulcer (7, 4.7%), cholecystitis (10, 6.8%), pancreatitis (13, 8.8%), intestinal ischemia (17, 11.5%), colitis (18, 12.2%), diverticulitis (5, 3.4%), intestinal occlusion (2, 1.1%), lower gastrointestinal hemorrhage (1, 0.7%), and mixed gastrointestinal complications (14, 9.5%). Patients with gastrointestinal complications were significantly older and had significantly higher comorbidity (unstable angina, chronic renal failure, and peripheral vascular disease), morbidity (prolonged mechanical ventilation, intraaortic balloon pumping, bleeding, acute renal failure, stroke, and infection), and mortality rates (22.5% vs 4%, P < 0.0001). They also had longer cardiopulmonary bypass times and higher valvular surgery rates. Multivariate analysis identified 6 independent predictors for gastrointestinal complications: prolonged mechanical ventilation (odds ratio [OR], 5.5), postoperative renal failure (OR, 4.2), sepsis (OR, 3.6), valve surgery (OR, 3.2), preoperative chronic renal failure (OR, 2.7), and sternal infection (OR, 2.4). Factors such as mechanical ventilation, renal failure, and sepsis are the stronger predictors for GI complications, causing splanchnic hypoperfusion, hypomotility, and hypoxia. Furthermore, excessive anticoagulation after valve replacement may lead to GI hemorrhage. Valve surgery, often requiring anticoagulation, increases bleeding. Monitoring mechanical ventilation and hemodynamic parameters, adopting early extubation and mobilization measures, preventing infections, and strictly monitoring renal function and anticoagulation may prevent catastrophic abdominal complications.
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PMID:Determinants of gastrointestinal complications in cardiac surgery. 1506 41

Surgery plays a key role in the management of both acute and, less frequently, chronic intestinal failure. Acute intestinal failure frequently requires surgical treatment when it arises as a consequence of intestinal fistulation or obstruction. In specialised clinical practice approximately 50% of acute intestinal failure is associated with intestinal fistulas and in approximately 50% of patients, this condition arises as part of the natural history or complicating treatment for Crohn's disease. A considerable proportion of such patients have abdominal infection and present complex nutritional and metabolic problems. The most important aspect of the surgical management of patients with acute intestinal failure associated with intra-abdominal infection is management of sepsis, since recovery is unlikely in the presence of active infection. Moreover, effective nutritional support and restoration of body composition is not possible if sepsis remains unresolved. Surgical strategies to deal with intra-abdominal infection may involve percutaneous drainage, laparotomy and resection of fistulating segments of intestine and, when infection is persistent and contamination extensive, laparostomy (a technique in which the abdomen is left open and allowed to heal by secondary intention). Surgical treatment should not only be timely and effective, but also aimed at preventing secondary damage to the small intestine, in order to minimise the risk of short bowel syndrome. In some cases a proximal defunctioning stoma may be required, with prolonged nutritional support, using either home total parenteral nutrition or feeding via the defunctioned distal gut (fistuloclysis), pending restoration of intestinal continuity. The role of surgical treatment for patients with short bowel syndrome is less clear. While surgery is frequently required for the management of complications of short bowel syndrome (including gallstones and possibly peptic ulcer disease), the role of intestinal lengthening and tapering procedures (to increase functional intestinal length), and artificial valves, reversed segments and colonic interposition (to reduce intestinal transit) remains controversial. For some patients with short bowel syndrome and, in particular, those with combined intestinal and hepatic failure, intestinal transplantation may become the treatment of choice as long-term results continue to improve.
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PMID:Surgical management of intestinal failure. 1469 6

Duodenal fistula after closure of peptic ulcer perforation, though rare, is difficult to manage and carries a high mortality. The high mortality is associated with the poor nutritional status of the patient, high output from the fistula, and late development of peritonitis and septicemia. The various techniques described in the literature for the closure of the postsurgical external duodenal fistulas range from conservative management with total parenteral nutrition (TPN), serosal patch repair, and Roux-en- Y procedures to radical surgery like Billroth II gastrectomy. Total parenteral nutrition achieves spontaneous closure in 70% to 80% of cases, but it is very expensive and requires prolonged hospitalization. In addition, some surgical procedures have yielded poor results in our setting, so we sought a new modality of treatment. We describe a novel technique for repair of postsurgical external fistula of the duodenum with a rectus abdominis muscle flap. The rectus abdominis muscle is detached from its superior attachment and mobilized from the rectus sheath. The flap, based on the deep inferior epigastric artery, is raised and sutured to the duodenal fistula with thick silk sutures. We treated six patients with post-surgical duodenal fistulas with this technique between 1995 and 2002. The leak was completely sealed in all patients. One patient died of septicemia. We recommend this technique for the management of postsurgical external duodenal fistula as an alternative to other surgical techniques.
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PMID:Rectus abdominis muscle flap for high-output duodenal fistula: novel technique. 1472 65

Laparoscopic surgery has become the treatment of choice for the management of perforated peptic ulcer. The advantages of laparoscopic repair for perforated peptic ulcer include less pain, a short hospital stay, and an early return to normal activity. Although the operation time of laparoscopic surgery is significantly longer than that of open surgery, laparoscopic technique is safe, feasible, and with morbidity and mortality comparable to that of the conventional open technique. To benefit from the advantages offered by minimally invasive laparoscopic technique, further study will need to determine whether laparoscopic surgery is safe in patients with generalized peritonitis or sepsis.
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PMID:[Laparoscopic surgery for perforated peptic ulcer]. 1503 97

Recent accumulating evidence suggests that the vagus nerve modulates the response to peripheral immunologic stimuli and that intact vagal mediation decreases the systemic inflammatory response. We hypothesized that patients who had vagotomy for complicated peptic ulcer disease would be at increased risk of an enhanced systemic inflammatory response compared to patients that did not have a vagotomy as part of their operative treatment. Ninety-six patients were identified from 1985 to 2000 and their medical records were reviewed. Patients were assigned to three groups based on the performance of a truncal vagotomy: truncal vagotomy (TV; N = 62 patients), nontruncal vagotomy (NTV; N = 34 patients), or a subgroup of the TV group, acute truncal vagotomy (ATV; N = 40 patients). Operative indications in the NTV and ATV groups were perforation (94% vs 47%) and bleeding (6% vs 53%). Systemic or organ-specific complications did not differ between groups (NTV vs ATV), and the sepsis (24% vs 23%) and mortality rates (29% vs 20%) were similar. The ICU and hospital length of stay did not differ substantially among the groups. This clinical study demonstrated that acute truncal vagotomy does not increase the risk of the systemic inflammatory response in surgical patients with complicated peptic ulcer disease.
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PMID:Acute vagotomy does not augment the systemic inflammatory response in patients with peptic ulcer disease. 1509 89

To determine the pattern of antibiotic therapy and clinical outcome a prospective survey of all patients operated on for acute generalized peritonitis was undertaken. The male to female ratio was 1.7:1, and the mean age was 27.6 +/- 18.3 years. Operative findings were typhoid ilea perforation in 75 (38.1%), complicated acute intestinal obstruction in 44 (22.3%), complicated and uncomplicated acute appendicitis in 34 (17.3%), peptic ulcer perforation in 18 (9%) and traumatic intestinal injury in 11 (5.6%), representing the majority of the patients. A combination of chloramphenicol, gentamicin and metronidazole was given to 80 (40.6%), ampiclox, gentamicin and metronidazole to 72 (36.5%), ampiclox and gentamicin to 21 (10.6%) and other combinations to 5. A single antibiotic was administered in 13 (6.6%), that is clavulanate-amoxicillin, ampiclox, and cefuroxime. Antibiotics were changed in 37 patients (18.8%): to amoxicillin-clavulanate in 13, cefuroxime in 11, ceftriazone in 7, cefuroxime and metronidazole in 4 and amoxicillin-clavulanate and metronidazole in 2 patients. Postoperative complications were mainly wound infection in 105 (42.6%), wound dehiscence in 33 (16.7%), residual intra-abdominal sepsis in 19 (9.6%), residual intra-abdominal abscess in 17 (8.6%), postoperative chest infection in 14 (7%), incisional hernia in 11 (5.6%), anaemia in 6, faecal fistula in 5 and there was a mortality of 15.7%.
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PMID:Pattern of antibiotic therapy and clinical outcome in acute generalized peritonitis in semi-urban and rural Nigerians. 1656 39


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