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

Pulmonary alterations after shock and sepsis, described clinically as shock lung or adult respiratory distress syndrome, are of great importance in intensive care. Pathogenetically an alteration of the surfactant system of the lung is often discussed. Since phospholipids are constituents of lung surfactants, phospholipid metabolism is investigated in experimental peritonitis in rats in our laboratory. 15 hours after inducing a peritonitis, the lung incorporates more oleic acid than that in animals of the reference group. 33 hours after inducing peritonitis, the capacity of the lung to incorporate choline and fatty acids is markedly reduced, histologically the lungs represent morphological equivalents of the so-called shock lung at this time. Therefore we conclude, that an alteration of phospholipid metabolism with a diminished and/or altered synthesis of lung surfactant plays, at least in part, an important role in the pathogenesis of respiratory distress in sepsis and peritonitis.
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PMID:Altered metabolism of phospholipids in the lung of rats with peritonitis. 58 Aug 12

During 1974 and 1975, five newborn infants weighing between 760 and 1600 g developed severe intraabdominal complications of NEC due to necrotic bowel with perforation and peritonitis. Because these tiny neonates were very ill with sepsis and other severe medical problems, no attempt at laparotomy under general anesthesia was carried out. Instead, using local anesthesia, the contaminated peritoneal cavity was drained via a small incision, usually in the right lower quadrant. This permitted evacuation of air, pus, and stool. In all babies there was improvement evident in the abdomen within one wk, although two of the five newborns died from other causes. The three survivors are well and have normally functioning intestinal tracts 1-2 yr following surgery. One of these surviving babies developed a bowel stricture which subsequently required resection. We feel this method is preferable in the handling of the tiny sick neonate with a bowel perforation from NEC.
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PMID:Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis. 59 76

Peritoneal lavage resulted in a significant reduction in the duration of hospital stay in a retrospective series of 189 children with peritonitis secondary to perforation of the appendix. Antibiotic peritoneal lavage also resulted in a significant reduction in the number of children with septic and adhesive complications compared with antiseptic lavage and no lavage, mainly as a result of fewer wound infections. The overall incidence of residual intraperitoneal infection was low, and although differences in this respect were not significant, none of the children treated with antibiotic peritoneal lavage required reoperation for intraperitoneal sepsis.
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PMID:Peritoneal lavage in appendicular peritonitis. 62 69

The problem of necrotizing enterocolitis is discussed based on the experience with 24 patients. It has been found that the time factor plays an important role in the decision whether to operate. The indications for operation are intestinal perforation, threatening perforation, and penetration of a covered perforation. Operation is carried out in order to treat the peritonitis caused by perforation. The various operative methods are described and evaluated. Intestinal resection, exclusion enterostomies, and suture of the perforation may all be justified, depending on the findings at operation. The difficulties in the differential diagnosis are discussed. The importance of late complications are stressed, and it is pointed out that every case will require routine controls long after discharge from the hospital. The high mortality is directly related not to the surgical complications, but rather to the septicemia which so often develops.
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PMID:Surgical problems in necrotizing enterocolitis in childhood. 62 65

Two experiments were performed to determine the effect of heparin on experimental fibrinopurulent peritonitis in dogs. Peritonitis was induced by the creation of a 10 cm long isolated loop of terminal ileum. In a first experiment comprising 24 dogs the necrotic loop was removed 24 hours later without cleaning or irrigating the peritoneal cavity. All dogs showed fibrino-purulent peritonitis at that time. No antibiotics were given. All dogs received 500 ml of Ringer's lactate during surgery and were allowed p.o. fluids on the first postoperative day. At the time of excision the dogs were blindly randomized into a control group and two treatment groups receiving heparin 100 u/kg i.p. or s.c. respectively. Of the eight animals in the control group, five died of peritonitis and two showed residual intraperitoneal sepsis at the time of sacrifice 14 days after the initial surgery. Thus, only one dog cleared his peritoneal infection spontaneously. Of the heparin treated dogs six out of eight in the i.p. treated and seven out of eight in the s.c. treated group cleared their peritonitis spontaneously within 14 days (p </= 0.05 and 0.02 respectively). In a second experiment peritonitis was induced in 24 dogs as described above, but the necrotic loop was not removed. The dogs were blindly randomized to daily low dose heparin (50 u/kg s.c. b.i.d.) or no therapy. Only two out of 12 dogs of the control group survived the observation period of 14 days compared with eight out of 12 of the heparin treated group (p </= 0.05). However, in all dogs in this experiment residual i.p. sepsis was found. We conclude that heparin has a therapeutic effect in experimental canine peritonitis by preventing the additional apposition of fibrin and, thus, rendering the bacteria more susceptible to cellular and noncellular clearing mechanisms.
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PMID:Heparin in the treatment of experimental peritonitis. 63 86

The plasma concentrations of substrates, together with transhepatic and transgut balances, have been studied in six control and eight septic awake fasted dogs. Four severely ill septic dogs (typically fluid in chest and/or abdomen, extensive peritonitis, respiratory difficulties) had high concentrations of threonine, glycine, tyrosine, lysine, histidine, tryptophan, and triglycerides (p less than or equal to 0.05). The other septic dogs (less severely ill) showed fewer and less pronounced alterations in the plasma substrates (aspartate and tryptophan were elevated, p less than or equal to 0.05). The infusion of glucose increased the concentration of glucose, lactate, and pyruvate and depressed the concentrations of most amino acids in both normal and septic dogs. Threonine, asparagine, glutamine, leucine, isoleucine, alpha-aminobutyrate, and tyrosine were significantly depressed in the severely ill septic dogs (p less than or equal to 0.05). In the normal dogs most amino acids were removed by the liver, with alanine accounting for approximately 40% of the total. Glutamine removal was negligible. In the septic dogs hepatic removal of amino acids was variable; livers of two severely ill septic dogs did not remove amino acids. In the control dogs glucose infusion (0.015--0.017 g/kg/min) tended to lower hepatic removal of amino acids. Hepatic dye removal in the septic dogs was always very poor. In the gut glutamine was removed and alanine, glutamate, glycine, and ammonia produced, but the overall sum of amino acid uptake was negligible in both the control and septic dogs. The ratio of tryptophan to the sum of valine, isoleucine, leucine, tyrosine, and phenylalanine concentrations was greatly elevated in all septic dogs in which it was measured. The free concentrations of amino acids in the liver, heart, and muscle tissues were grossly elevated in the low intravenous alimented septic state relative to the fasted normal state, whereas the tissue concentrative ability as measured by nonmetabolizable amino acids, alpha-aminoisobutyrate and cycloleucine, was not similarly increased. Sepsis clearly alters plasma and tissue concentrations, and in some instances hepatic uptake of amino acids.
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PMID:Plasma concentrations and tissue uptake of free amino acids in dogs in sepsis and starvation: effects of glucose infusion--some effects of low alimentation. 65 52

The application in purulent peritonitis of a novel surgical lavaging agent with unique properties is reported. Taurolin is a non-toxic formaldehyde-transmitter with a Thiadiazine structure exhibiting a twofold action in gram-negative sepsis owing to its bactericidal potency and its ability to denature endotoxins in vivo. The present study reports the surgical treatment of 62 patients with appendicitis and peritonitis of varying genesis, using 0.5% Taurolin as lavaging and 2% Taurolin as instillation agents. After 5 days 22 out of 25 patients with purulent peritonitis were void of intraperitoneal bacteria. To date no significant adverse drug reactions were observed.
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PMID:[A new surgical lavage]. 65 32

A five year experience with 782 patients requiring laparotomy for trauma is reviewed. Specifically, the 70 patients requiring unplanned reexploration have been studied to delineate the indications for and implications of such repeat laparotomies. The major indications for such reoperation were intraabdominal abscess (45.7 per cent), bleeding (15.5 per cent), peritonitis (12.1 per cent), and small bowel obstruction (8.6 per cent). There were 16 negative reexplorations (13.8 per cent). Overall mortality in the reexplored patients was 21.4 per cent, all victims of gunshot or blunt trauma. Mortality correlated with the number of required reexplorations, being 67 per cent in those requiring four operations. Of the 31 laparotomies performed initially for diffuse or localized intraabdominal sepsis, only 15 were highly suspected, and 13 of these by simple chest x-ray findings. If after laparotomy for repair of intraabdominal trauma a patient fails to meet the anticipated norm of convalescence, a high index of suspicion for early postoperative hemorrhage, or later sepsis, should be maintained. Such patients have far more to gain than lose by reexploration.
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PMID:Reoperation after abdominal trauma. 66 94

The authors isolated in common surgical practice 83 anaerobic bacteria mainly bacteroides and clostridia. They analyse their pathogenic role in relation to the site of sampling. Comparing the bacteriological results with a clinical study of 96 cases of generalised peritonitis, there appeared to be no significant differente between the prognosis in peritonitis and anaerobic bacteria and those without anaerobic bacteria. The mortality was identical in septicemia due to anaerobic and aerobic bacteria; jaundice was just as frequent in both series. However, the prognosis of peritonitis due to anaerobic bacteria seems better when antibiotic treatment is adapted to the bacteria, e.g. lincomycin, metronidazole. With regard to anaerobic bacteria, which represent only part of the fecal flora, it may be dangerous by selection of resistant strains to use prophylactic antibiotics as a routine; local treatment of the septic focus seems the most important. The pathogenic role of anaerobic bacteria in digestive pathology is far from clearly defined; one should not follow the fashion of using even specific antibiotics without justification.
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PMID:[Anaerobic bacteria in digestive surgery. Pathogenic role and prognostic incidence (author's transl)]. 68 59

A mortality of almost 50 per cent from generalized infective peritonitis was obtained. Diagnosis was made chiefly on clinical grounds. Delay was common. Investigations were primarily useful in determining the degree of metabolic derangement. A worsened prognosis could be predicted by several factors assessed preoperatively. The usual cause of death was continuing intraperitoneal sepsis. This was manifest as multisystem failure in an intensive care environment. Abdominal signs of this infection were infrequent.
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PMID:Generalized infective peritonitis. 68 76


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