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

A clinical case that occurred in a 42 years old female and which fulfils the diagnostic criteria for the entity described as Heat Stroke is presented. In this case, besides the usual manifestations of hyperpyrexia without sweating along with consciousness disorders, features of consumptive coagulopathy, rhabdomyolysis and well marked laboratory liver dysfunction have also been found. The severity of this situation and its less common occurrence in temperate climates, together with the uncertainty in establishing the diagnosis, namely when infection is suspected--in the present case the initial diagnosis was Sepsis, which led to patient's admission in an infectious diseases intensive care unit--motivate the authors to make this report. Furthermore, they consider this case to be a good example of the varied clinical and laboratory manifestations and possible severe complications that Heat Stroke may display.
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PMID:[Febrile coma and disseminated intravascular coagulation following heat stroke]. 160 73

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

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4 per cent. During the period 1981-87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2-87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7.5 (range 0.7-32.0) months. Five patients are still alive 72, 72, 70, 7 and 2 months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19 per cent. These results support surgical intervention for patients with complaints and/or complications attributable to gastrointestinal metastatic melanoma.
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PMID:Surgery for melanoma metastatic to the gastrointestinal tract. 168 96

The endourological approach for utothelial tumors of the upper urinary tract (UUT) is a controversial issue of which there is little experience to date. However, the data reported in the series of other authors as well as our own series support its utilization. Of a total of 137 patients suspected of having UUT tumor, 66 patients underwent endourological management: 56 by ureteroscopy (URS) and 10 by percutaneous nephroscopy (PN). The presence of tumor was discarded in 26 patients, 10 underwent open surgery to treat the tumor, and the remaining 30 patients were primarily treated by URS (20), PN (9), or combined treatment (1). Overall, 30 of 111 patients (27%) were treated by endoscopy; 28 attempted cure and 2 were palliative procedures. Twenty-six of these 30 patients had a previous history of urothelial tumor, 7 had a single kidney, and in 5 patients the tumor had presented following cystectomy. Except for the T2 tumor submitted to palliative treatment and one case with diffuse carcinoma in situ, all tumors were TA-1, 20 were G1, 8 were G2, and were G3. Seven of the 30 patients had died after a mean follow-up of 28.4 months (range 3-117 months: 2 immediately postoperatively from pathological conditions unrelated to the operation (acute CVA, biliary sepsis), 1 from conditions unrelated to the urinary tract or tumor, 2 from disseminated bladder urothelial tumor, and 1 from disseminated primary adenocarcinoma of unknown origin. Currently, 23 patients (76.6%) are alive; of these, 7 (23.3%) have had tumor recurrence: 2 required treatment by nephroureterectomy but the remaining 5 patients were also treated endourologically with success. The progression index was 7% (2/28). Analysis of prognostic factors revealed a close correlation between the histologic grade of malignancy, malignant urinary cytology, and the frequency of tumor recurrence. Tumor recurrence was observed to be 60% in those with a positive cytology and only 17.6% in those with a negative cytology. G3 tumors recurred 50% of the time, G2 37.5%, and Go-1 22%. The frequency of tumor recurrence was also different in patients who had received adjuvant topical BCG or MMC therapy (20%) in comparison to those who received no adjuvant therapy (40% recurrence). On the other hand, no significant difference was observed relative to the technique utilized to treat the tumor: 3/12 (25%) of those who underwent electroresection or electrocoagulation and 6/16 (37.5%) of those submitted to Nd:YAG laser.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Endo-urologic surgery of urothelial tumors of the upper urinary tract]. 172 82

Sepsis-induced pulmonary artery hypertension (SIPAH) causes an increase in right ventricular (RV) afterload, dilatation of the RV, leftward shift of the interventricular septum (IVS), and therefore decreases left ventricular compliance (LVC). This study was designed to evaluate the role of pericardiotomy during SIPAH as an alternative to vasodilators (which cause a detrimental increase in shunt fraction) to improve LVC. Systemic and pulmonary hemodynamics, pulmonary function, RV, and LVC were acquired at baseline (BL), during SIPAH with closed pericardium (PAHCP) and after opening the pericardium (PAHOP). Systemic hemodynamics and pulmonary function did not change significantly during the experiment. The infusion of live bacteria induced a significant rise in mean pulmonary artery pressure from 16 +/- 5.3 at BL to 36.8 +/- 3.3 and 35.0 +/- 6.4 mm Hg during PAHCP and PAHOP, respectively, (P less than 0.05). Pulmonary vascular resistance index and right ventricular stroke work index (RVSWI) displayed a similar rise in response to SIPAH (P less than 0.05 vs BL). Pericardiotomy did not affect pulmonary hemodynamics or RVSWI. Right ventricular contractility did not increase following pulmonary hypertension while the pericardium was closed (440 +/- 78 vs 410 +/- 125, P less than 0.05); however, it rose, although not significantly, to 615 +/- 326 after pericardiotomy. RV time tension index displayed a rise during SIPAH with the pericardium intact and returned to baseline values after pericardiotomy; however, these changes were not significant. RVC did not change significantly throughout the experiment. In contrast, LVC decreased significantly after SIPAH and significantly improved after pericardiotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pericardiotomy improves left ventricular compliance during sepsis-induced pulmonary artery hypertension. 173 27

The aim of the present study was to determine whether hearts that demonstrate depressed myocardial reserves as a result of sustained hypermetabolic sepsis would show a potentiation of the dysfunction after an infusion of high doses of alcohol. We have previously shown that myocardial depression is present in hearts removed from hypermetabolic septic rats. Acute alcohol administration has also been shown to have a negative inotropic effect on the heart. In this study, myocardial function was assessed under in vitro conditions in which preload could be varied and aortic outflow resistance controlled and thus heart function could be determined under both low and high workloads. The alcohol-infused group increased cardiac performance as a function of increasing preload similarly to the controls. Heart rate, however, was significantly elevated compared with control. Isolated hearts from septic, saline-infused animals showed depressed cardiac performance both in terms of stroke volume and myocardial work over a range of preloads. The septic, alcohol-infused animals did not show this depression. Thus, a loss of myocardial reserve was demonstrable in hearts isolated from septic, saline-infused rats but not in septic, alcohol-infused rats. Alcohol, at least acutely, seemed to reverse or ameliorate the loss of myocardial reserve induced by sepsis possibly by increasing the ability of the heart to fill during diastole and thus perform volume work.
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PMID:Function of isolated hearts from septic, saline-infused, and septic, alcohol-infused rats. 178 83

The varying roles of a widely diverse group of noncardiac disorders on the heart, particularly their ability to induce heart failure, are explored. A general overview of the cardiac effects of volume and pressure overloading is followed by specific discussions of the roles of vascular, endocrine and metabolic, renal, gastrointestinal, central nervous system, hematologic, and other miscellaneous disorders (heat stroke, sepsis, immune-mediated disease, obesity, malnutrition, and pregnancy) in producing cardiac dysfunction and failure in companion animals. Pathogenetic and pathophysiologic mechanisms are emphasized.
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PMID:The role of noncardiac disease in the development and precipitation of heart failure. 183 10

Medical complications may account for 30% or more of the deaths resulting from acute ischemic stroke in the elderly. In descending order of frequency, the most deadly complications are bacterial pneumonia, pulmonary embolism, myocardial infarction, and sepsis without pneumonia (often in the setting of a urinary tract infection or a necrotic decubitus). Normal aging is associated with declining pulmonary and cardiovascular functions as well as declining immunocompetence and physical barriers to infection. The neurological effects of acute ischemic brain injury compound these susceptibilities. Accordingly, a high degree of vigilance is emphasized in the diagnostic and therapeutic guidelines provided for care of the lungs, the heart, the urinary tract, and the skin. Guidelines are also provided for management of blood pressure during the first hours and days following stroke onset. Treatment should be withheld unless specific medical indications are identified. When antihypertensive agents are administered, the appropriate dose may be lower than usually recommended (e.g. labetalol) in order to minimize abrupt drops in blood pressure that may result in further injury to potentially viable ischemic brain tissue.
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PMID:Prevention and management of medical complications of the hospitalized elderly stroke patient. 186 5

Seven Yucatan minipigs with chronic, severe intraperitoneal sepsis were given amrinone i.v. (loading dose of 0.75 mg/kg, followed by continuous infusion of 10, 20, 40, and 80 micrograms/kg/min) during the hyperdynamic phase of sepsis. Hemodynamic variables and oxygen utilization, delivery, and extraction were recorded throughout the study. Pulmonary capillary wedge pressure was kept constant to ensure a fixed ventricular filling pressure. Intravenous amrinone modestly augmented cardiac index without altering heart rate. Mean systemic and pulmonary arterial pressures decreased. Systemic and pulmonary vascular resistance fell significantly (P less than 0.05). Amrinone did not significantly alter oxygen utilization or oxygen extraction, although oxygen delivery increased (P less than .05). During the hyperdynamic phase of sepsis in this animal model, amrinone elicits vasodilatation with a modest improvement in stroke volume index. Consequently, cardiac output and oxygen delivery increased modestly. Because of its vasodilating properties and small salutary effects, amrinone is not an optimal first-line medication for hemodynamic stabilization during hyperdynamic sepsis.
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PMID:Amrinone during porcine intraperitoneal sepsis. 193 25

The study objective was to describe the clinical, biologic, and hemodynamic features of adult overwhelming meningococcal purpura and to examine the prognostic factors by multivariate analysis at the time of admission to the intensive care unit. Thirty-five patients (greater than or equal to 13 years of age) with meningococcal infection, circulatory shock, and generalized purpuric lesions of abrupt onset were recorded in eight intensive care units from 1977 to 1989. The patients were young (mean age, 26.6 years; range, 13 to 68 years) and had been previously healthy. The female-to-male ratio was 3:1. Mortality was 54.3%, with most deaths occurring within the first 48 hours, usually secondary to irreversible shock with multiple organ failure. Ischemic complications (eight cases), prolonged heart failure (seven cases), and secondary septicemia (five cases) were the chief complications among survivors. Initial hemodynamic study after volume loading showed low stroke volume index (mean +/- SD, 29.4 +/- 13 mL/m2) and tachycardia (mean +/- SD, 138 +/- 16 beats per minute), a profile suggesting a greater myocardial depression than usually observed in gram-negative bacillary septic shock. Univariate prognostic analysis showed that four variables at the time of admission were associated with fatal outcome: a plasma fibrinogen level of 1.5 g/L or less, a factor V concentration of 0.20 or less, a platelet count lower than 80 x 10(9)/L, and a cerebrospinal fluid leukocyte count of 20 x 10(6)/L or less. Stepwise regression analysis showed that low fibrinogen level (less than or equal to 1.5 g/L) was the sole adverse prognostic variable (odds ratio = 2, 95% confidence interval, 1.5 to 2.7). Adult overwhelming meningococcal purpura is still associated with high mortality and morbidity. Low fibrinogen level at time of admission may permit early recognition of the most severely ill patients.
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PMID:Adult overwhelming meningococcal purpura. A study of 35 cases, 1977-1989. 199 58


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