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

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 +/- 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.
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PMID:Clinical characteristics of nosocomial sinusitis. 368 59

Two cases of pituitary abscesses are reported. The first case was a 22-year-old female who was admitted with 14 months history of intermittent fever and headache followed by amenorrhea and polyuria. Plain craniograms showed no remarkable changes on the sella turcica. Direct coronal CT demonstrated a cystic lesion with a ring-like enhanced capsule in the pituitary complex with the apparent bulging of the pituitary top surface. On dynamic CT, the cystic lesion showed no remarkable increase in density. Transsphenoidal surgery was performed and a purulent materials was drained by cutting the underlying fibrous pituitary tissue. Pathological specimen revealed a marked inflammatory reaction around the degenerative pituitary gland. The second case was a 27-year-old female who underwent transsphenoidal excision of craniopharyngioma on May 12, 1983. Postoperatively she did well with the hormonal replacement therapy until 9 months after surgery when a follow up direct coronal CT revealed a cystic lesion with ring-like enhancement in the pituitary fossa. Purulent material was found at transsphenoidal surgery. Pathological specimen from the hard capsule was a chronic inflammatory fibrous tissue without tumorous component. Over seventy cases of pituitary abscesses have been reported previously, but the majority of them were secondary infections associated with systemic sepsis, chronic sphenoid sinusitis or pituitary tumors. Primary pituitary abscesses were rare and would be difficult to be diagnosed preoperatively without an aid of recent CT technology. Thirty cases in the literature since 1970 are reviewed and its clinical pictures and radiological findings are discussed.
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PMID:[Pituitary abscess: report of two cases and a review]. 380

Paranasal sinusitis secondary to prolonged nasotracheal intubation represents an infrequently reported source of sepsis. Of 27 nasally intubated patients who developed paranasal sinusitis over a 1-yr period, 17 patients underwent emergency blind nasotracheal intubation post-trauma or shock (group 1) and the remaining ten were intubated electively under operating room or ICU conditions (group 2). Group 1 patients were younger (mean age 33 +/- 6 vs. 57 +/- 5 yr) than those in group 2; they also developed sinusitis more quickly after intubation (mean time 8 +/- 1 vs. 15 +/- 2 days). Diagnosis was confirmed via sinus x-rays (14 cases), computed tomography (five cases), indium scan (two cases), or clinical picture. Cultures were obtained in 14 cases. Staphylococci predominated in group 1, while nosocomial Gram-negative organisms predominated in group 2. Seven patients developed pulmonary infections and two developed systemic sepsis with an organism present on sinus culture. In all cases treatment was successful with antibiotics and tracheostomy or movement of the tube to the oral route. These data indicate that patients nasally intubated are at risk for development of paranasal sinusitis; this diagnosis should be suspected in sepsis of undetermined etiology.
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PMID:Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis. 394 15

The ultimate source of sepsis may be difficult to pinpoint in critically ill patients with multiple possible sources of iatrogenic infection. In the last year, we have been consulted with regard to several febrile intensive care unit patients in whom sinusitis was initially identified by computerized axial tomography done for other reasons. The questions are: 1. are the x-ray findings significant; 2. is this the cause of fever and sepsis; 3. how should the patient be treated for this problem; and 4. can this be prevented. In five patients, sepsis was clearly related to sinusitis. Treatment had included nasal tubes in all six patients, and in addition, five patients had received high doses of corticosteroids while intubated. The sixth patient was a diabetic. Etiology, diagnosis, and management are discussed in detail. We believe that prolonged nasal intubation should be avoided, particularly in patients with decreased resistance to infection. Initial treatment consists of removing intranasal tubes and the administration of broad spectrum or culture specific antibiotics. Surgery is indicated in the event of persistent sepsis or secondary complications. Computerized tomography is an excellent tool for diagnosis and following response to therapy.
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PMID:Sinusitis in intensive care unit patients. 402 87

Sinusitis secondary to nasotracheal intubation has not been reported to occur in neurosurgical patients. Over a 1-year period, 11 patients admitted to the Intensive Care/Trauma Unit at St. Paul Ramsey Medical Center developed this entity. The mean age of these patients was 36 +/- 4 years; 7 were trauma victims, 3 had each had a subarachnoid hemorrhage, and 1 had suffered hypertensive hemorrhage. The patients presented with fever of unknown origin (FUO) and evidence of persistent hypermetabolism without an obvious cause. In 8 cases, the diagnosis was not suspected until mucopurulent nasal discharge was noted. Three additional cases were evaluated for suspected sinusitis before the occurrence of discharge. The mean duration of intubation before the diagnosis of sinusitis was 7.8 +/- 1.5 days. The diagnosis was confirmed by sinus films with a Waters view in 7 cases or by computed tomographic scanning in 4 cases and by bacteriological cultures. Two cases involved only the maxillary sinus on the side of intubation; the rest were polysinusites. The organisms involved included gram-positive and gram-negative species; all were polymicrobial with a single organism predominant. Secondary pulmonary involvement was common, and 4 patients revealed a bacteremia consistent with the major sinus organism. One patient developed septic shock. Treatment involved either orotracheal intubation or tracheostomy. This was curative in all cases. It is concluded that neurosurgical patients nasally intubated are at risk for sinusitis, which can have untoward effects such as septicemia or pulmonary infection. A high degree of suspicion will permit early diagnosis and treatment.
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PMID:Paranasal sinusitis: a common complication of nasotracheal intubation in neurosurgical patients. 403 81

Pharmacokinetics and clinical effects of ceftizoxime (CZX), a new cephalosporin antibiotic, were investigated and following results were obtained. 1) Ceftizoxime was given by intravenous injection or drip infusion for 1 hour at a single dose of 30 mg/kg. After intravenous injection, the mean peak serum level of 3 children was 95.9 mcg/ml at 15 minutes and half-life time was 1.18 hours. After 1 hour drip infusion, the mean peak serum level of 3 children was 79.5 mcg/ml at the end of infusion and half-life time was 1.20 hours. The urinary level was high and the mean urinary recovery rate was 69.6% and 63.4% up to 6 hours after intravenous injection and 1 hour drip infusion, respectively. 2) CZX was administered in dose of 39--76 mg/kg to 7 pediatric patients (4 cases of purulent meningitis, 2 of septicemia with purulent meningitis, and 1 of aseptic meningitis) by a single intravenous injection. In patients with purulent meningitis, passage into the cerebrospinal fluid was relatively as good as 30% of serum level at the same time in the presence of remarkable signs of inflammation, but poor in cases of mild inflammation or aseptic meningitis. 3) Cerebral puncture fluid level in 1 patient with cerebral abscess was as good as 65.5% of serum level at the same time. 4) CZX was given to 28 cases of respiratory tract infection, 1 of tonsillitis with otitis media, 6 of scarlet fever, 1 each of maxillary sinusitis and bacterial endocarditis, 6 of purulent meningitis, 2 of septicemia, 5 of septicemia suspected, 2 of septicemia with purulent meningitis, 1 each of osteomyelitis, typhoid fever, peritonitis and biliary tract infection, 16 of urinary tract infection, 14 of skin and soft tissue infection, and 1 of external otitis, totaling 87 cases. The mean daily dose of 101.6 mg/kg was administered for an average of 10 days mainly by intravenous injection 4 times daily. Clinical results obtained were excellent in 34 cases, and good in 46. Bacteriological effectiveness rate was 100%. As for side effects, fever, fever with rash, fever with cough and diarrhea appeared in 1 each case out of 182 cases including 95 drop out cases. As for laboratory findings, eosinophilia, thrombocytopenia, elevation of GOT, that of GOT with GPT, and that of GOT with LDH appeared in 10, 2, 2, 3 and 1 cases, respectively.
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PMID:[Pharmacokinetics and clinical effects of ceftizoxime in pediatric field (author's transl)]. 627 4

The cause of sepsis in the intensive care unit patient can be a perplexing diagnostic problem. We have recently encountered seven patients who had sepsis associated with sinusitis of the paranasal sinuses. They represented 26 percent of all patients who had nasotracheal intubation for 5 days or more. Sinusitis as a complication of nasotracheal intubation has been previously reported, but its frequency has not been appreciated. Three case reports are presented to emphasize the importance of making this diagnosis. Standard x-ray studies will not adequately demonstrate all the paranasal sinuses. We have utilized computerized tomography to study these patients and found it to clearly demonstrate all the paranasal sinuses. We suggest a plan to help prevent sinusitis from nasotracheal intubation. Should this complication occur, however, the nasotracheal tube should be removed and the sinuses surgically drained or treated aggressively with topical agents.
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PMID:Sepsis from sinusitis in nasotracheally intubated patients. A diagnostic dilemma. 672 Oct 35

Neisseriae other than N. meningitidis and N. gonorrhoeae are common upper respiratory commensals, but rarely cause disease. A case of N. sicca bacteremia in an immunocompromised patient is reported, and the literature dealing with infections attributed to these usually nonpathogenic organisms is reviewed. These neisseriae have been shown to cause meningitis, endocarditis, sepsis, and some cases of pneumonia, otitis media, and sinusitis; however, their pathogenicity is doubtful in many of the reported cases of urethritis, cervicitis, and upper respiratory infection. They are not uniformly sensitive to the penicillins, so therapy should be guided by the results of antimicrobial susceptibility testing.
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PMID:Are the "nonpathogenic" Neisseriae pathogenic? 701 24

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient's illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient's illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient's illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.
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PMID:Bacteremia caused by viridans streptococci in 71 children. 733 84

Three cases of hematogenous cranial osteitis are described. The etiology in two cases was a staphylococcus aureus infection from meningeal septicemia. One of these patients died and chronic osteomyelitis developed in the second case. The third case was one of multifocal tuberculous infection, localized in the cranium but asymptomatic. The last case was a Gradenigo-Lannois syndrome, and its etiology, either chronic otitis or sphenoidal sinusitis, is discussed.
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PMID:[Cranial osteitis: a report on four cases, including a Gradenigo-Lannois syndrome (author's transl)]. 745 36


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