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

The authors discuss the clinical-diagnostic and surgical problems in the treatment of the pyogenic hepatic abscesses. Eight patients, undergone the operation during the second period after 1971, were out of 18 patients operated (1951--1983) were analyzed in details. An inexplicable predomination of males and affection of all age groups is reported. The abscesses are cryptogenic in 2 of the patients, after operation of the hepaticbiliary system--in 2, after gastric operation--in 3, after abdominal trauma--in 1. The possible way of penetration of the infection is discussed. In was established that it parallel with the characteristic clinical picture and biochemical deviations, typical for the septic process, a definite diagnosis is made via echography and computer tomography, supported by scintigraphy, angiography, punching of the abscess, inspection graphy of the hepatic region. The treatment is difficult and complex: Antibiotic, generally tonizising and surgical. The choice of the operative approach denends on the localization, number of the abscesses and character (pyogenic, amebic, etc). The therapeutic tasks are discussed as well as the operation methods applied, punch-aspiration including. The risk of complications and lethality remain high, three patients were discharged healthy, with improvement--2, deceased--3 (sepsis, stress-ulcer, pulmonary embolism).
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PMID:[Pyogenic liver abscesses--diagnostic and surgical problems]. 293 6

A technique for the exchange of occluded, tunnelled, subclavian venous catheters reusing the existing tunnel is described. It was successfully used 14 times in 5 patients needing permanent parenteral nutrition at home, in whom insertion of a new catheter by another route would have been cumbersome and hazardous. The tunnel was opened below the clavicle, and the catheter clamped. The catheter was then cut close to the tunnel exist, and its distal part removed centrally through the opening at the clavicle. A guide wire was simultaneously pulled through. An introducer cannula was placed over the central part of the catheter into the subclavian vein, and the occluded catheter was withdrawn and a new one inserted. The latter was then guided through the tunnel by the guide wire. The catheter was then fixed, and the wound was closed and dressed. Prophylactic cloxacillin was given i.v. for 3 days. No bleeding, pulmonary embolism, local infection or sepsis were observed.
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PMID:Exchange of occluded, tunnelled, subclavian central venous catheters. A technique reusing the existing tunnel. 310 36

There were 37 maternal deaths among the 109,221 livebirths registered during the period 1977-86 in Bahrain, Arabian Gulf. The maternal mortality rate was 33.9/100,000 for the 10-year study period; however, disaggregation reveals a decline in this rate from 42.3/100,000 in 1977-81 to 26.9/100,000 in 1982-86. This decline presumably reflects streamlining of the Ministry of Health's maternity services, including a central maternity hospital with all modern facilities that serves as a referral center for all of Bahrain, 2 peripheral hospitals with provision for blood transfusion and surgical deliveries, and 3 maternity units managed by fully qualified midwives. About 80% of deliveries are covered by these maternity services; only 2.5% of deliveries occur in the home. Despite this highly developed maternity care system, 18 of the maternal deaths were due to direct obstetric cause: hemorrhage, 7; pre-eclampsia and eclampsia, 5; abortion septicemia, 2; bowel perforation during cesarean section, 1; thromboembolism, 2; and amniotic fluid embolism, 1. The causes of the 19 indirect maternal deaths were: pulmonary embolism, 5; infection, 7; cardiac failure, 2; cerebrovascular accident, 2; pulmonary hypertension, 1; and uncertain, 2. Of interest is the finding that sickle cell disease was the underlying cause of maternal death in 12 of the 37 deaths in this series. Sickle cell disease was implicated in 3 of the deaths from hemorrhage, all 5 deaths from pulmonary embolism, 2 deaths from septicemia, and the 2 cases of cardiac failure. In this series, 50% of the patients with sickle cell disease had thromboembolic crises following treatment of anemia with packed cell transfusion. Blood transfusion, especially of packed cells, should be given with caution to these patients since it may precipitate vaso-occlusive crisis by increasing blood viscosity. Since sickle cell disease represents a high risk during pregnancy in this Arab population, such patients should have frequent prenatal check-ups and deliver in a well-equipped hospital.
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PMID:Maternal mortality in Bahrain with special reference to sickle cell disease. 321 81

Septic complication is one of the major problems associated with central venous catheterization. Thrombi produced around a catheter are regarded to a predisposing factor. However, few reports have focused on thrombus formation in clinical settings. We studied prospectively thrombus formation associated with central venous catheterization in 56 patients. Thrombus formation was identified in 39 cases (70%). In most cases, this thrombi formed around a catheter and were released into stream when the catheter was removed. However, complications attributable to the thrombi, such as pulmonary embolism were not observed. Then we tested four materials of catheters including vinylchloride, vinylchloride coated with heparine, polyurethane, and silicone to compare the incidence of thrombus formation. Thrombi were found regardless the catheter material when they were placed for more than 10 days. Cultures of blood, catheter tips and parts of catheters placed under the skin were performed to clarify the relation between thrombus formation and catheter-related sepsis. Positive culture was obtained only five cases but they were all associated with thrombus formation. These results suggest that central venous catheterization frequently results in thrombus formation, which would lead to catheter-related spesis.
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PMID:[A clinical study of thrombus formation associated with central venous catheterization]. 323 Dec 4

From 1966 through 1985, a total of 640 patients received 739 renal transplants at a single center transplantation program. Of 245 total deaths, a slide and chart review of all 116 autopsied cases (47%) identified the major causes of death as pneumonia (n = 43), sepsis (n = 32), hemorrhage (n = 15), peritonitis (n = 11), meningitis (n = 7), and pulmonary embolism (n = 5). Eighty-five (73.3%) of these patients died of complications directly associated with immunosuppression, almost all (n = 82) as a result of infection. Organisms most frequently identified at death were gram-negative bacilli (n = 72), Candida species (n = 23), cytomegalovirus (n = 17), enterococcus (n = 14), Staphylococcus aureus (n = 11), Aspergillus species (n = 10), Pneumocystis carinii (n = 5), and mycobacteria (n = 5). Significant associations were found between bolus steroid antirejection therapy and infection with Aspergillus cytomegalovirus. Diabetics had a higher incidence of fungal infections and bowel perforation than nondiabetics. During this 20-year period, overall one-year actual patient survival rates for the four respective five-year intervals increased dramatically (69.9%, 68.2%, 83.3%, and 91.8%), but the normalized death rate showed a smaller decrease for infectious vs noninfectious causes.
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PMID:Causes of death in renal transplant recipients. A review of autopsy findings from 1966 through 1985. 330 85

During the last three decades it has become clear that removal of the spleen, for any reason, is not a benign procedure. In both adults and children splenectomy places the patient at significantly higher risk of overwhelming infection, compared to the normal population. The risk of the post-splenectomy septic syndrome is lifelong and is not eliminated by the administration of polyvalent pneumococcal vaccine. Thus far, the reported rate of overwhelming sepsis in asplenic individuals has ranged from 2.5-13.5%. As more long-term follow-up data become available, it is likely that the true incidence will be 5-10%. In addition to this late complication, splenectomy increases the frequency of adverse events, including death, in the immediate postoperative period. Infections, particularly pulmonary and abdominal sepsis, constitute the majority of the complications. The mortality rate from postoperative sepsis is substantial. Atelectasis, pancreatitis/fistula, pulmonary embolism and bleeding at the operative site are also relatively common occurrences following splenic removal. These alarming statistics have spurred surgeons to change their attitudes concerning splenectomy for trauma, both accidental and iatrogenic. Nonoperative management of hemodynamically stable patients with isolated splenic injury and splenorrhaphy in patients requiring laparotomy are now firmly entrenched in the surgical armamentarium. Patients in whom splenectomy is necessary are given polyvalent pneumococcal vaccine and are instructed to seek early medical attention for febrile illnesses. Splenic autotransplantation and lifelong prophylactic antibiotic therapy have been used in some centers, but their clinical value remains to be proven.
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PMID:Complications of splenectomy. 332 38

The clinical profiles and management of 236 consecutive chest injury patients treated and followed up at All India Institute of Medical Sciences between January 1983 and July 1985 were analyzed prospectively. There were 149 blunt and 87 penetrating injuries; 21 patients (9%) required thoracotomy. Single- or multiple-tube thoracostomy was performed in 141 patients (60%). The remaining 74 patients (31%) required only observation for a period of 24-48 hours. Fifteen patients (6.3%) died, the mortality being related to head injury in four, irreversible hypovolemic shock in four, pulmonary embolism in three, septicemia in two, and respiratory failure in two. Nonfatal complications included residual hemothorax in 18 cases, persistent air leak in 13, pulmonary infection in eight, pulmonary embolism in one, and empyema in one. The average hospital stay was 6.9 days. Evidence of chest injury of various magnitudes was found in 756 of 2,286 autopsies conducted for trauma-deaths during the same study period analyzed retrospectively; however, it was the major cause of death in only 147 (19%). Cardiac injuries accounted for 41% of the deaths resulting primarily from chest trauma. Only 10% of the patients who sustained cardiac injury reached hospital alive.
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PMID:Chest injuries: a clinical and autopsy profile. 338 31

The natural history of hypertrophic obstructive cardiomyopathy (HOCM) is usually characterized by development of mitral insufficiency, congestive heart failure (CHF) and sudden death. In patients (pts) belonging to at least clinical class III (NYHA) after failed medical therapy (beta-blocking agents and calcium-antagonists) surgery should be considered (by means of transaortic subvalvular myectomy). The history and development of different surgical techniques and procedures has been described in detail since 1958, when Cleland performed the first transaortic subvalvular myotomy. Our surgical series (1963-May 31, 1986) consists of 212 pts (mean age 40 years, range 6-73 years) with typical and atypical HOCM. The total hospital mortality rate was 6.6% (n = 14), which was reduced to 3.8% (n = 6), if only transaortic subvalvular myectomy (TSM) was performed (n = 160). In the group of 52 pts with additional surgical procedures the mortality rate was 15.4% (n = 8). The main problems occurred in pts with additional mitral valve replacement (MVR) (n = 15, three deaths). The rate of HOCM-related complications (secondary VSD, total AV-block, cerebral embolism, intraoperative re-myectomy) and those related to surgery (bleeding, pulmonary embolism, wound dehiscence, septicemia) was low. Therefore TSM for HOCM is a low-risk surgical procedure with a good long-term prognosis. However, in pts with a need for additional surgical procedures, the risk is considerably increased. Subjective impression of the pts and hemodynamic data indicate a clear clinical improvement postoperatively. Concerning long-term survival and reduction of the sudden death rate, our data do not allow a final judgement at the moment.
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PMID:Techniques and complications of transaortic subvalvular myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). 343 68

Denver type peritoneo-venous (PV) shunting for intractable ascites was performed in 16 patients also treated with endoscopic injection sclerotherapy (ST) for variceal haemorrhage. Indications, timing and results of shunt insertion are detailed and discussed. Serial ST for eradication of varices could be completed in 10 patients a median of 7 months before PV shunting. The postoperative risk of bleeding was increased four times, i.e. the number of GI bleedings per month of follow-up, was 0.05 and 0.21 (p less than 0.05) respectively, before and after shunt operation. Two patients experienced their first variceal bleeding and 6 patients rebled during a median follow-up of 3 months after PV shunting. The Denver shunt succeeded in resolving ascites clinically in 13 patients within 7 days with a median decrease in weight of 10 kg, parallel to increased urinary output and reduced serum-creatinine. Three patients did not benefit from the shunt procedure due to terminal neoplastic disease (one patient), and severe hepatorenal failure, although the shunts were proven patent. Serious complications included clinically important consumptive coagulopathy, DIC-syndrome (two patients), myocardial infarction (one), pulmonary embolism (three), and sepsis following intervention of obstruction (one).
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PMID:Peritoneo-venous shunting and endoscopic sclerotherapy in patients with portal hypertension. 349 19

Ten cardiac transplant patients have had bilateral total hip or knee surgery for treatment of osteonecrosis secondary to corticosteroid immunosuppression. Nine had bilateral total hip arthroplasty and one had bilateral total knee arthroplasty for osteonecrosis of the tibial plateaus. The only immediate postoperative complication was in a single hip patient who had a nonfatal pulmonary embolism. Two patients died from cardiovascular causes; the remaining eight had excellent results from arthroplasty, with an average Harris hip rating of 95 at a mean follow-up period of 34 months. No patient had required revision surgery and radiographic follow-up examination has revealed no evidence of loosening of any of these cemented arthroplasties. One patient developed a late hematogeneous sepsis of one hip seven years after replacement from atypical mycobacterium three months following renal transplantation, which was done 11 years after cardiac transplantation. Total joint arthroplasty has resulted in excellent clinical and radiologic results in this patient population. Despite the increased risks of major surgery in these immunocompromised transplant recipients, total joint arthroplasty appears to be a safe and effective method of treatment of osteonecrosis of the hip.
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PMID:Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients. 354 92


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