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

The morphologic and clinical findings in seven fatal cases of meningococcal septicemia are described and interpreted in light of recent experimental and clinical studies. We include evidence that suggests the disease has two distinct pathogenetic mechanisms. First, a shock-like terminal phase is associated with the development of widespread pulmonary microvascular thrombosis. These thrombi, composed largely of platelets and leukocytes, produce severe cor pulmonale that cannot be prevented with heparin sodium treatment. Meningococcal endotoxin also produces disseminated intravascular coagulation, which includes the rapid consumption of fibrinogen and the formation of fibrin thrombi in adrenal and renal glomerular capillaries, causing hemorrhagic infarction of the adrenal glands and renal cortical necrosis. This secondary phase of the disease can be modified with heparin therapy, but its control does not improve survival because the parenchymal lesions produced are not immediately life threatening.
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PMID:Fatal meningococcal septicemia. 57 4

Although systemic lupus erythematosus (SLE) no longer has the very poor prognosis that it had 50 years ago, there remains a significant mortality. We were able to determine the causes of death in 27 of the 29 patients with SLE who died over the period 1985 to 1989. This represents one and five year mortality of six and 24% respectively. In common with other studies, sepsis was a major factor, being implicated in the deaths of 37% of our patients. However, sepsis (i) occurred almost exclusively in patients with active SLE; (ii) often occurred after prolonged hospitalisation; and (iii) was a terminal event in otherwise fatal SLE in several patients. Overall, active disease was determined to be a cause of death in 67% of the patients. An unexpected observation was the finding that active cardiopulmonary disease accounted for 37% of deaths. Although late mortality from degenerative vascular disease is being increasingly reported with the modern prolonged SLE survivorship, it was identified in only one patient. We conclude that active disease remains the most important factor in mortality in SLE.
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PMID:Mortality in systemic lupus erythematosus: active disease is the most important factor. 158 Aug 64

Clinical and autopsy records of 100 elderly patients were analyzed. The most common cause of death in this series was malignant tumors (39%). The second leading cause of death was diseases of the circulatory system (37%), in which cerebrovascular accident alone accounted for 21%. Cor pulmonale and myocardial infarction were also common causes of death. In addition, infective diseases, especially pneumonia and septicemia were often fatal to elderly patients. The discrepancy between clinical and post-mortem diagnoses in this series was 24.7%. The causes of incorrect and missed diagnoses are discussed. The results suggest that extensive autoptic study still has vital practical significance.
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PMID:[Autopsy study of 100 elderly patients]. 161 44

Seventeen infants less than 1 year of age have undergone heart (12), heart-lung (3), and lung (2) transplantation for end-stage cardiopulmonary disease. The infants undergoing heart transplantation had a mean age of 4.5 months (range, 19 days to 12 months) with the diagnosis of cardiomyopathy in 4 and congenital heart disease in 8. Four of the 8 patients (50%) had hypoplastic left heart syndrome. Actuarial survival at 1 and 2 years was 74% and compared favorably with the survival of older children at 1 and 2 years of 82% and 69%. The linearized rejection rate was less in infants as compared with children more than 1 year of age (0.61 versus 1.48 episodes per 100 patient days). In intermediate follow-up, no graft atherosclerosis has been noted. Immunosuppression has included a three-drug protocol of cyclosporine, azathioprine, and prednisone. A steroid taper to alternate day steroids or off completely by 6 months has been the goal and has been accomplished in 6 of 12 infants. Heart-lung and lung transplantation has been performed in 5 infants. One infant in each group died: 1 infant secondary to airway complications and sepsis and another due to pulmonary sepsis. A pulmonary lobe from a larger and older donor was transplanted into a 4-week-old infant as a single-lung transplant with good outcome. The 3 surviving infants are well 24, 18, and 2 months after transplantation. Obliterative bronchiolitis has not been clinically apparent in this group. These data support the clinical efficacy of heart, heart-lung, and lung transplantation in the first year of life.
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PMID:Heart, heart-lung, and lung transplantation in the first year of life. 173 73

The aim of our study is to analyze the clinical features and outcome of digestive surgery in the aged. From Jan. 1979 to Dec. 1981, 1,389 operations under general anesthesia were performed on patients 75 years old and more. From this group, 163 patients (111 females and 52 males, mean age: 79 +/- 0.7 years) underwent surgery of the alimentary tract. The procedures were divided in: colorectal (48%), biliary (32%), gastric (10%), small bowel (6%), esophagus (1%) and others (3%). An operation for cancer was performed in 63 patients: palliative (69%), curative (31%). The mean length of hospital stay is 23 days (pre-op 7 days, post-op 16 days). Only 16% of the patients needed intensive care. Postoperative complications occurred in 43 patients (26%); cardiovascular (47%), psychiatric (26%), pulmonary (23%) and others (4%). The overall mortality rate is 10%: 6% for elective cases and 24% for urgent cases (49 patients). The mortality is related to: sepsis and peritonitis (53%), cardiopulmonary disease (23%), hemorrhage (12%), cachexia (12%). At discharge, 62% of the patients returned home directly, 18% to convalescent homes, 10% to unknown places and 10% in nursing homes. Our data supports the benefit of surgery in the aged.
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PMID:[Geriatric digestive surgery. An analysis of 163 cases]. 281 16

Scleromyxedema is a rare fibromucinous connective tissue disorder characterized by papular skin lesions associated with sclerosis and a serum monoclonal gammopathy. Little is known about either the natural history or the systemic manifestations of this disease. We reviewed the medical records of 19 patients with biopsy-proven scleromyxedema seen from 1950 to 1985 for evidence of systemic disease. There were 10 males and 9 females with a median age at diagnosis of 53 years. Monoclonal gammopathy was present in 13 patients. Eight patients complained of dysphagia; 3 had proximal esophageal dysfunction and 1 had total esophageal aperistalsis on barium swallow. Proximal muscle weakness was noted in 5, with an inflammatory myopathy in 3. Six patients complained of dyspnea on exertion. Of these, 5 had reduced diffusing capacity, 3 had reduced volumes, and 2 developed cor pulmonale. Pathologic changes characteristic of "scleroderma kidney" were demonstrated in 1 patient at postmortem. One patient had Raynaud's phenomenon and 2 had arthralgias/arthritis with noninflammatory synovial fluids. Although 8 of 12 patients treated with melphalan noted regression of their skin changes, no consistent improvement in the extracutaneous manifestations was demonstrated. Furthermore, 2 patients died of sepsis related to melphalan-induced myelosuppression, and 4 developed hematological malignancies following melphalan therapy. In conclusion, systemic manifestations in scleromyxedema are more prevalent than previously recognized, and can resemble those of scleroderma. Significant toxicity occurred with the use of alkylating agents in these patients, with treatment-related complications developing in 45% of patients treated with melphalan. The lack of definitive data regarding the natural history of this disease complicates the question of optimal therapy, but the use of alkylating agents should be reserved for those patients with severe debilitating skin disease.
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PMID:Scleromyxedema: a scleroderma-like disorder with systemic manifestations. 333 81

Eleven of 30 patients with MCTD, followed for a mean of 10 years, developed immune complex nephropathy (five membranous, two mesangial, one mixed, and one sclerosing) with NS in nine of 11. Another patient had membranous nephropathy at autopsy. Patients with renal disease tended to have more systemic manifestations than those without. NS was at times of abrupt onset, recurrent, and/or persistent. Anti-RNP and serum complement were not helpful in predicting nephritis. Seventy-two percent of nephropathy and 62% of NS episodes resolved or improved after corticosteroid therapy. Five patients became hypertensive, two developed chronic renal failure and required chronic dialysis, and one needed acute dialysis twice. One patient progressed to focal proliferative crescentic nephritis with necrotizing arteritis. Three patients with nephropathy died, two of pulmonary hypertension with acute cor pulmonale and one of overwhelming sepsis. Nephropathy is relatively common in MCTD, is associated with substantial morbidity, and with the risk of hypertension and chronic renal failure.
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PMID:Renal involvement in mixed connective tissue disease: a longitudinal clinicopathologic study. 356 25

A descending thoracic aortobifemoral artery bypass graft is proposed as an alternative procedure for revascularization of the lower extremities when an intra-abdominal approach is not feasible or is ill-advised. Three patients underwent a thoracobifemoral graft because of severe cardiopulmonary disease combined with multiple prior abdominal surgeries, complications of radiation, and sepsis. Patency of the aortobifemoral grafts was documented by palpable pulses and increased ankle: brachial ratios improving from 0.3 to 0.6, resulting in the relief of rest pain and obviating a limb-threatening situation.
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PMID:Use of thoracic aortobifemoral artery bypass grafting as an alternative procedure for occlusive aortoiliac disease. 405 33

A child with respiratory failure and cor pulmonale secondary to the obesity hypoventilation syndrome (OHS) was found to have abnormal beta-endorphin levels in cerebrospinal fluid (CSF) and serum. A single iv dose of 10 microgram/kg of naloxone early in the course of respiratory failure resulted in dramatic improvement which lasted approximately 3 to 4 h. The patient failed to response to progesterone, and because of deteriorating respiratory status a low-dose continuous infusion of naloxone, 2 microgram/kg.h, was begun and gradually increased to 10 microgram/kg.h, during which time there was a dramatic improvement in respiratory status and clinical condition. After 5 days, naloxone infusion was discontinued and progressive respiratory deterioration recurred. The child died of over-whelming sepsis and disseminated intravascular coagulation.
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PMID:Narcotic antagonist therapy of the obesity hypoventilation syndrome. 628 52

To update the clinical profile of pediatric patients hospitalized with RSV infection, we retrospectively reviewed the records of 246 children (male:female ratio 1.44:1) admitted during one season to a tertiary-care hospital. The most common admitting diagnoses were bronchiolitis (37.4%), pneumonia (32.5%), and possible septicemia (13%). Median age was 3 months; median length of stay, three days. Twice as many minorities were admitted with RSV infection as all other admissions during the same year. Family history of asthma, while common (35%), did not affect length of stay or complications. Of the 38 (15%) patients requiring intensive care, 29 (76%) underwent ventilation. Patients with underlying cardiopulmonary disease had more complications, were more likely to require intensive care (about 50%), and had significantly longer hospital stays than others. All three patients (1.2%) who died had congenital heart disease. Common risk factors included young age, chronic cardiopulmonary disease, male sex, and possibly family history of asthma. Although the most typical clinical diagnoses remain bronchiolitis and pneumonia, a systemic illness resembling the sepsis syndrome has emerged at our institution as a significant clinical presentation.
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PMID:Clinical profile of pediatric patients hospitalized with respiratory syncytial virus infection. 840 43


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