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

Stapled hemorrhoidopexy (SH) presents a number of complications which differ from those of traditional haemorrhoidectomy (Milligan-Morgan, diathermy haemorrhoidectomy). The follow-up shows better symptom control than other surgical techniques. Four hundred and forty-nine patients with haemorrhoids of all degrees and mucosal rectal prolapse were treated at our institution over a five-year period (1999-2004). Patients were assessed by structural interview to assess their symptoms before and after surgery, and surgical and functional outcome was assessed at 1, 3, 6, 12 and 24 months. A visual analog scale was used for postoperative pain scoring. Patient's satisfaction is the best response to all criticism. Bleeding in the early postoperative period occurred in 3.9% of all patients and in 7 cases (1.5%) reoperation was necessary. Urge to defecate, although present in 14% of patients, disappears in a few weeks. Severe pain, when present, may depend on technical failure or learning curve. Complete or incomplete recurrence occurred in 10 cases (2.2%). We had one case of rectovaginal fistula in a young woman. In 3 cases we underestimated the extent of the mucosal prolapse and the patients were reoperated on by stapled transanal rectal resection after one (2 patients) and two years. Stapled hemorrhoidopexy is a significantly less painful operation and offers significant advantages in terms of hospital stay and symptom control in the long term, making for a significantly earlier return to work. The complications are similar to those of other techniques and are easily resolved. The unusual complications described (rectal perforation, pelvic sepsis, rectovaginal fistulas) might suggest that the operation should be performed by experienced colorectal surgeons who are familiar with the technique and aware of the possible complications.
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PMID:Stapled hemorrhoidopexy. Complications and 2-year follow-up. 1719 Feb 80

Stapled mucosectomy (SM) was first proposed for the management of patients with rectal internal mucosal prolapse and obstructed defecation, but gained popularity worldwide for the treatment of hemorrhoids. The present review highlights the advantages and disadvantages of the operation. SM tends to decrease postoperative pain and shortens convalescence after hemorrhoid surgery, but may be followed by severe complications, e.g. rectal obliteration and pelvic sepsis requiring a diverting stoma, more frequently than after standard hemorrhoidectomy. Moreover it carries a higher recurrence rate in the treatment of fourth-degree piles. A recent Cochrane metaanalysis demonstrated that SM is less effective than standard hemorrhoidectomy since it carries a higher recurrence rate (OR=3.6) and reintervention rate (OR=2.3). When used for rectal mucosal prolapse and obstructed defecation, SM is reported to have variable results. A better outcome is likely to be achieved in patients without anismus and psychoneurosis operated on by specialists trained with this technique.
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PMID:Stapled transanal rectal mucosectomy ten years after. 1735 59

Jacobsen syndrome is a MCA/MR contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. To date, over 200 cases have been reported. The prevalence has been estimated at 1/100,000 births, with a female/male ratio 2:1. The most common clinical features include pre- and postnatal physical growth retardation, psychomotor retardation, and characteristic facial dysmorphism (skull deformities, hypertelorism, ptosis, coloboma, downslanting palpebral fissures, epicanthal folds, broad nasal bridge, short nose, v-shaped mouth, small ears, low set posteriorly rotated ears). Abnormal platelet function, thrombocytopenia or pancytopenia are usually present at birth. Patients commonly have malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Ocular, hearing, immunological and hormonal problems may be also present. The deletion size ranges from approximately 7 to 20 Mb, with the proximal breakpoint within or telomeric to subband 11q23.3 and the deletion extending usually to the telomere. The deletion is de novo in 85% of reported cases, and in 15% of cases it results from an unbalanced segregation of a familial balanced translocation or from other chromosome rearrangements. In a minority of cases the breakpoint is at the FRA11B fragile site. Diagnosis is based on clinical findings (intellectual deficit, facial dysmorphic features and thrombocytopenia) and confirmed by cytogenetics analysis. Differential diagnoses include Turner and Noonan syndromes, and acquired thrombocytopenia due to sepsis. Prenatal diagnosis of 11q deletion is possible by amniocentesis or chorionic villus sampling and cytogenetic analysis. Management is multi-disciplinary and requires evaluation by general pediatrician, pediatric cardiologist, neurologist, ophthalmologist. Auditory tests, blood tests, endocrine and immunological assessment and follow-up should be offered to all patients. Cardiac malformations can be very severe and require heart surgery in the neonatal period. Newborns with Jacobsen syndrome may have difficulties in feeding and tube feeding may be necessary. Special attention should be devoted due to hematological problems. About 20% of children die during the first two years of life, most commonly related to complications from congenital heart disease, and less commonly from bleeding. For patients who survive the neonatal period and infancy, the life expectancy remains unknown.
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PMID:Jacobsen syndrome. 1926 33

Colonization with the virulent pathogen methicillin-resistant Staphylococcus aureus (MRSA) is becoming more prevalent and can result in serious consequences for surgical patients. A 75-year-old woman with diabetes mellitus underwent elective uterovaginal prolapse surgery after an unsuccessful pessary trial. She was noted preoperatively to have MRSA colonization of the urine, and received 10 days of oral linezolid prior to surgery. Four weeks following surgery, the patient was hospitalized for MRSA sepsis. Numerous questions remain regarding the optimal approach to the prevention of MRSA infections in surgical patients. With the increased prevalence of community-acquired MRSA infections, further management strategies and identification of colonization status are necessary to circumvent potentially serious outcomes.
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PMID:Methicillin-resistant Staphylococcus aureus sepsis after elective vaginal prolapse surgery. 1951 72

A 14-year-old female pudu (Pudu puda) developed a uterine prolapse after unassisted parturition. The length of time between the prolapse and replacement of the organ was not known but was less than 24 hr. When the prolapse was first noticed, uterine tissue appeared undamaged and was immediately cleaned with antiseptic solution, handled carefully during replacement, and prophylactic antibiotic and anti-inflammatory drugs were given. The pudu appeared clinically normal until 4 days postpartum, when she developed clinical signs of tenesmus, dysuria, and a purulent discharge from the vulva. Despite further treatment, the animal was found dead 10 days postpartum, even though it had not shown any other signs of systemic illness. Gross and histologic lesions supported a diagnosis of septicemia secondary to metritis. Arcanobacterium pyogenes was isolated from lung, liver, and uterine exudate.
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PMID:Arcanobacterium pyogenes septicemia in a southern pudu (Pudu puda) following uterine prolapse. 2072 72

The clinical outcome of anastomotic leakage in colorectal and coloanal anastomoses necessitates a loop stoma for fecal diversion. Controversy remains of the most suitable position of the stoma. In this respect a loop ileostomy or loop colostomy can be performed. The aim of this study was to determine the advantages and disadvantages of both surgical strategies from the literature and to derive possible recommendations. Both methods provide a good operative outcome with low complication rates. Overall there is a trend towards ileostomy because of lower complication rates after stoma creation and the incidence of sepsis and stoma prolapse in particular is significantly reduced after ileostomy. Concerning stoma reversal both methods seem to be equivalent. As long as no large evidenced-based, randomized studies are available loop ileostomy seems to be the most appropriate surgical procedure.
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PMID:[Protective ileostoma versus protective transverse stoma. What evidence is available?]. 2095 49

In multiple gestation, premature rupture of fetal membranes (PROM) is an important risk factor for premature delivery and intrauterine infection. The incidence of PROM in twin gestations is threefold of that in singleton pregnancies. The incidence in triplets occurs even more frequently underlining the role of PROM as a leading cause of infant mortality and morbidity. Besides prematurity the complications of PROM include umbilical cord compression due to oligohydramnios, cord prolapse, placental abruption, and chorioamnionitis. Together with PROM, chorioamnionitis is held responsible for significant maternal and neonatal morbidity including endometritis and sepsis in the mother and early-onset sepsis, respiratory distress syndrome, inborn pneumonia, bronchopulmonary dysplasia, intraventricular hemorrhage, and periventricular white matter injury in the neonate. Furthermore, in twin gestations, PROM remains an independent risk factor for long-term neonatal care. An uncommon situation develops when in multiple gestation PROM affects only one of the fetuses. In such cases, the co-existence in the uterine cavity of the properly developing fetus(es) can be a challenge for the process of medical decision-making. In the present work, limited world literature on the topic was critically reviewed in search of the best possible recommendations for clinical management.
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PMID:[Premature rupture of membranes one fetus from a multiple pregnancy]. 2237 42

Rectocele is defined as the herniation of rectal wall due to a rectovaginal septum defect in direction of the vagina. In most of cases it is a result of vaginal delivery or repeated increases of intra-abdominal pressure due to chronic constipation. Some patients can develop rectocele as a consequence of congenital or inherited weakness of the pelvic support system. The rectopexy procedure by a single mechanical stapler allows to ablate the exceeding tissue. This surgery is performed through transanal access without laparotomy, by means of a circular stapler which simultaneously resects portion of the rectal wall and re-anastomizes it. Also the technique of sequential transfixed stitches (TSTS) represents a minimally invasive procedure for the rectocele treatment, allowing the performance of a complete plasty of rectal wall through transanal access. Hence, starting from a more effective stadiation of rectocele, the authors of this study will show the advantages of an endorectal approach for the treatment of the above-mentioned disease using both methods. A total of 25 female patients attending our colonproctology outpatient department, with an age ranging between 38 and 63 years, have been selected for our study; following a careful assessment of stadiation, they have undergone rectopexy with circular stapler first, thereafter fulfilling the surgery with TSTS. the mean duration of hospital stay was 2.5 days (range 2-3). Twelve patients out of 25 have shown early complications, and 11 patients late ones. Among the early complications, 3 patients reported pain (12 %), 3 patients urinary retention (12 %), and 2 patients bleeding (8 %). Among late complications, 5 cases of urgency defecation disorders (>4 months) (20 %), 1 intestinal flatus incontinence (4 %), 1 stenosis (4 %), 2 prolonged pain and 2 cases of persistent obstructive defecation syndrome were reported. No cases of life-threatening local or pelvic sepsis as well as of rectovaginal fistulae were reported. At the 6 months post-surgery evaluation, neither rectocele recurrence nor prolapse was observed. The association of circular stapler and TSTS in the rectopexy treatment of rectocele showed its short-term efficacy, producing an improvement of patient's clinical conditions, without inducing further alterations of pelvic statics, of the sphincteric tone as well as of rectum emptiness deficit.
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PMID:Efficacy of two different surgical techniques combined in the treatment of rectocele. 2252 8

A 67-year-old lady presented to the surgical outpatient clinic with a 4 month history of recurrent purulent discharge from her left buttock. Four years and 4 months prior to this she underwent a posterior intravaginal slingoplasty for vaginal prolapse and urinary stress incontinence. An MRI demonstrated a long gluteo-vaginal fistula tract from the posterior wall of the vaginal vault through the left ischiorectal fossa to the skin. An examination under anaesthesia revealed that the fistulous tract was surrounding the intact mesh used for the posterior intravaginal slingoplasty. The mesh was removed, the fistula tract excised and the perineal wound marsupialised. The patient was discharged 5 days later. The wound healed within 4 weeks and she remains sepsis free 2 years on.
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PMID:Gluteo-vaginal fistula: a long-term complication of posterior intravaginal slingplasty. 2267 11

Pituitary apoplexy (PA) typically results from infarction or hemorrhage in a pituitary adenoma, while PA in nonadenomatous pituitary gland is uncommon. Prothrombotic states have never been recognized as precipitating factors for PA. The authors report a case of an elderly female who received prophylactic fractionated heparin therapy due to sepsis, consequent rhabdomyolysis, and overt disseminated intravascular coagulation. On the seventh day of heparin therapy, she reported sudden vision loss, ptosis, diplopia, and severe headache. Severe thrombocytopenia and positive antibodies to the complex of platelet factor 4 and heparin confirmed heparin-induced thrombocytopenia type 2 (HIT). Magnetic resonance imaging disclosed a homogenous pituitary tumor mass with pronounced sphenoid sinus mucosa thickening and two hypointense zones within the tumor mass on contrast-enhanced images consistent with focal ischemic necrosis. The tumor was confirmed to be squamous cell carcinoma with no signs of necrosis. Ischemic necrosis was found within marginal pituitary tissue. This is the first reported case of ischemic PA associated with pituitary metastasis and the first case in which HIT triggered PA. Our case demonstrates that prothrombotic states such as HIT can precipitate ischemic PA. Pituitary metastasis can present with ischemic PA, but radiological features differ from those described in pituitary adenomas. Segregated low-signal intensity zones within the tumor mass on postcontrast images indicate partial infarction of the tumor, which could be a special feature of ischemic PA in pituitary metastasis and has never been described in pituitary adenomas. These are all novel findings and might enlighten the pathogenesis of PA.
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PMID:Pituitary metastasis presenting as ischemic pituitary apoplexy following heparin-induced thrombocytopenia. 2312 46


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