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

Patients who have cystic fibrosis (CF) are frequently hospitalized for long-term intravenous (IV) treatment. We evaluated clinical effectiveness of the Drum-Cartridge Catheter (Abbott Laboratories) for such patients. The catheter is placed peripherally under local anesthesia via an antecubital vein into the superior vena cava or right atrium. Patients who were more than 10 years of age and who were hospitalized for IV antibiotic therapy and/or IV hyperalimentation were studied. All but 2 patients had CF. Using an aseptic technique the catheters were inserted into the basilic or cephalic vein. Chest radiographs were used to confirm the final location of the catheter. Catheters were used to administer IV antibiotics, hyperalimentation, and lipids. There were 38 catheterizations in 23 patients; several patients had repeated insertions at later admissions. The success rate of insertion was 86% with 31 of the 38 insertions initially located either in the superior vena cava or right atrium. Mean duration of catheterization was 15.4 days (range 5-49 days). No major complications such as sepsis, catheter or clot embolism, pneumothorax, vascular perforation, or hemorrhage occurred in the patients who had DF. Complications that required displacement of catheter into the axillary vein (1 patient), and cracked catheter hub (1 patient). This study shows that the Drum-Cartridge Catheter can be used easily for IV therapy of patients who have CF for a long duration, repeatedly, and with no major complications.
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PMID:Peripherally inserted central venous catheters for treatment of cystic fibrosis. 393 8

Of 142 critically ill patients undergoing pulmonary artery catheter (PAC) insertion, 1.4% suffered pneumothorax and 7.7% experienced arterial puncture during central venous access. Catheterization was successful in all cases; however, 8.4% of patients required special maneuvers for pulmonary artery cannulation. The 52.3% incidence of cardiac arrhythmias during PAC insertion was primarily due to ventricular arrhythmia (VA), which was more common among patients with complicated myocardial infarction (p less than .01) and less common in patients with sepsis (p less than .05). The development of VA was significantly related to the duration of PAC insertion. Our study suggests that PAC placement carries certain risks and complications which should be weighed against the advantages of a PAC in each patient.
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PMID:Acute complications of pulmonary artery catheter insertion in critically ill patients. 394 35

Electromechanical dissociation (EMD), defined as electrocardiographically adequate ventricular systolic complexes in the absence of detectable pulse or blood pressure, may occur in the terminal course of patients and is frequently unexplained. The 50 cases in the autopsy files of The Johns Hopkins Hospital in which the patients had died after documented episodes of EMD were reviewed. Four major categories of patients were identified: In 22 of 50 cases (44 per cent) myocardial ischemia appeared to precipitate EMD; in 14 of these 22 cases (64 per cent) myocardial ischemia was global in extent, while in eight (36 per cent) myocardial ischemia was regional, occurring in the distribution of an occluded coronary artery. A subset of ten patients with ischemia had terminal ventricular tachycardia or fibrillation, which was converted to EMD following resuscitation maneuvers. In 12 of 50 cases (24 per cent) systemic shock preceded the development of EMD; in nine of these 12 (75 per cent) hypotension was due to myocardial or arterial rupture, while in three (25 per cent) hypotension was secondary to sepsis. In ten of 50 cases (20 per cent) pulmonary vascular compromise was the apparent cause of EMD. Of these ten cases, eight (80 per cent) were secondary to pulmonary embolization, and two (20 per cent) were due to pneumothorax. In six of 50 cases (12 per cent) the precise cause of EMD could not be determined. The results of this study indicate that in the dying patient with electromechanical dissociation the differential diagnosis should include myocardial ischemia, systemic shock, and pulmonary vascular compromise.
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PMID:Electromechanical dissociation: pathologic explanations in 50 patients. 398 75

The records of 26 patients with external blunt or penetrating esophageal trauma were reviewed to determine clinical features and results of therapy. Twenty-one injuries (four blunt, 17 penetrating) were to the cervical esophagus, and five to the thoracic esophagus. Major physical signs included subcutaneous air, neck hematoma, and blood in the nasogastric tube. Helpful roentgenographic findings were cervical and/or mediastinal air, mediastinal widening, pleural effusion, and pneumothorax (15%). Nine of 12 (75%) contrast studies and five of six (83%) esophagoscopies were positive. Twenty-four patients had associated injuries, the most common of which was tracheal (14 patients) (64%). All patients were managed by prompt surgical exploration, primary closure, and drainage. There were three early deaths. Thirteen patients had postoperative complications, four of which were esophageal leaks. Two of the leaks caused mediastinitis, pleural sepsis, and led to death. They were not treated by early esophageal exclusion or excision. There were no significant strictures or esophageal sequelae in the other patients. It is concluded that early primary closure and drainage results in a relatively high incidence of survival. If a thoracic esophageal leak occurs, aggressive management of prompt esophageal exclusion or excision is necessary to control sepsis and improve survival.
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PMID:Management of blunt and penetrating external esophageal trauma. 402 Sep 13

The frequency of early and late complications of percutaneously inserted central venous catheters (CVC) was prospectively assessed. One hundred and fifty-one periods of catheterization (siliconized and heparinized polyethylene and teflon catheters), inserted mainly infraclavicularly and on the right side, were evaluated. Strict aseptic technique was used during insertion and daily care of the CVC. The only early complications noted were three cases of pneumothorax. No nerve injuries or arterial punctures were observed. Of 124 evaluated cases (96 arm-phlebography, 28 post-mortem) 16% developed thrombosis, and in one patient this probably resulted in fatal pulmonary embolism. Septicaemia was seldom seen: two cases were considered as proved and another two cases as probable. This study and other studies indicate that an aseptic technique is essential and perhaps even more important than using tunnelled versus percutaneously inserted catheters in respect of reducing infectious complications of central venous catheters.
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PMID:Infectious complications of percutaneously inserted central venous catheters. 406 Sep 99

Over a 2 year period ending in April, 1981, 268 premature infants with birth weight below 1,750 gm underwent operation for a "hemodynamically significant" patent ductus arteriosus. Operations were performed in 13 centers participating in a collaborative study, which was primarily designed to evaluate the role of indomethacin in the management of patent ductus arteriosus. No patient died during the operations, which were done at a median age of 10 days. Eight infants (3%) died within 36 hours after operation. In only one was the death directly attributable to the operative procedure. Hospital mortality (23%) and postoperative morbidity, which included bronchopulmonary dysplasia, pneumothorax, and sepsis, were unrelated to birth weight, age at operation, and degree of preexisting pulmonary disease or preoperative treatment of the infant with indomethacin. Results indicate that surgical ligation is a safe and effective procedure for treating patent ductus arteriosus with large left-to-right shunting in small premature infants.
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PMID:Surgical closure of patent ductus arteriosus in 268 preterm infants. 637

Complications of subclavian vein catheterization are common and include pneumothorax, hemothorax, and sepsis. Osteomyelitis is a rare complication. The present report describes a patient with osteomyelitis of both clavicles due to subclavian vein venipuncture, in whom fever and chills were absent and the sole clinical finding was local pain and tenderness in the involved area.
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PMID:Osteomyelitis of both clavicles as a complication of subclavian venipuncture. 640 Dec 39

The aim of this study was to determine the incidence of complications of catheterization for total parenteral nutrition (TPN) in patients of the Parenteral Nutrition Unit of Groote Schuur Hospital. During the 2-year study period, 218 central venous catheters were inserted in 170 patients. The preferred technique of percutaneous infraclavicular subclavian venepuncture with subsequent subcutaneous tunnelling using a silicone elastomere catheter is described. The incidence of major complications of catheter insertion was 4,5% (pneumothorax 4, subclavian artery puncture 6). There was a 2,7% incidence of catheter malpositioning (requiring repositioning) at initial insertion. The mean duration of catheterization was 12,9 days. During this period there was a 6,9% incidence of mechanical complications (occluded lines 13, extravascular infusion 2). Catheter-related sepsis was suspected in 37 cases (16,9%) and all these catheters were removed, but in only 7 cases (3,2%) was the sepsis proved to be catheter-related. There was no correlation between the duration of catheterization and the development of catheter-related sepsis. Furthermore, there was no increase in the incidence of catheter sepsis in patients with sepsis before catheterization.
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PMID:Central venous catheterization for parenteral nutrition. Experience at Groote Schuur Hospital. 641 77

Percutaneous nephrolithotomy - PCNL - was made possible by technological progress, with the introduction of nephroscopes, lithotomy forceps, and mechanical, ultrasonic or electrohydraulic lithotriptors. The procedure includes four stages. First needle puncture of the inferior or middle calyx. Secondly, dilatation of the pathway and creation of a tunnel. Thirdly, investigation of the collecting system. And, finally, extraction of the stone. The results of 302 published cases show a success rate of 87 per cent, a complete failure rate of 13 per cent, and residual stones in 10 per cent of cases. The complication rate is 7 per cent, with hemorrhage and sepsis in roughly equal proportions. A few other complications are occasionally reported, such as colic wounds, perirenal collections, traumas of the ureteropelvic junction, pneumothorax, or a stone left in the lumbar wall. There was one case of death. The hospitalization period is the same as for lombotomy, but the return to work is more rapid. The best indications are pelvic and inferior calyceal stones (with a success rate of over 80 per cent). Despite their enthusiasm for this procedure, the authors feel that is still remains to be seen or whether it will in turn be superseded by ultrasound lithotripsy.
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PMID:[Percutaneous nephrolithotomy in 1984. Technics, results, indications]. 653 11

Ultrasound (US) is a safe and accurate imaging method in the evaluation of the urinary tract. It should be the first procedure used in the neonate to confirm prenatal diagnosis, in patients with a malformation in another organ system that is known to be associated with kidney anomalies, in patients presenting with a spontaneous pneumothorax, in cases of an abdominal mass, and, in renal failure, asphyxiated babies, septicemia or urinary tract infection, or, prolonged jaundice. In association with the other uroradiological methods, it will lead to the correct diagnosis in most cases.
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PMID:Ultrasound of the neonatal urinary tract. 662 58


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