Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The question of general toxemia as an important problem in acute surgery has first been raised. In addition to the infection component attention is called to the presence of a pathologic focus (diseased internal organ) which is the main cause of diffuse peritonitis. Attention is given to sepsis and basedowian goiter with the IV degree thyrotoxicosis followed by pronounced toxemia. In addition to antibacterial therapy the authors recommend transfusion of fresh blood with heparin, forced diuresis, peritoneal dialysis hemosorption, ganglionic blockade with venous antiseptics and other methods to struggle against toxemia. The active tactics of the surgeon is necessary aimed at elimination of the main cause of general toxemia--liquidation of the pathological focus.
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PMID:[Endotoxicosis in surgery]. 342 42

Carbon-mineral sorbents successfully combine a high mechanical resistance of the mineral matrix and a high activity of carbons. It is possible to prepare a mineral matrix of the wanted structure and use it as the basis for producing carbon-mineral sorbents. SUMS-1 and SUMS-2 are the sorbents of mild action. In other words, they cause no thrombosis, they do not absorb oxygen and protein from blood, and they have almost no destructive effect on the blood cells. The sorbents are highly effective in adsorbing microorganisms and their toxins. Treatment of patients with different diseases (sepsis, meningitis, bronchial asthma, tuberculosis, pneumonia, thyrotoxicosis, pancreatitis, liver coma, different types of poisoning) with the SUMS-1 and SUMS-2 has given satisfactory results.
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PMID:Physicochemical properties and applications of carbon-mineral sorbents. 345 27

Obstetrician-gynecologists reviewed patient records of women delivering during January 1986-December 1992 to determine the maternal mortality rate and trends and the causes of maternal deaths in the maternity ward at the National University of Singapore. There were 26,173 deliveries and 9 maternal deaths (a maternal mortality rate of 22.9/100,000). The causes of maternal deaths were pulmonary embolism (underlying condition, systemic lupus erythematosus [SLE]), hemorrhage from multiple sites (thrombotic thrombocytopenia), acute exacerbation of SLE with interstitial pneumonitis, pulmonary fibrosis (systemic sclerosis), fulminant hepatitis (prior hepatitis and liver disease), and cerebral embolism (rheumatic heart disease with mitral valve replacement). There were also three incidental maternal deaths bringing the maternal mortality rate up to 34.4/1000. The incidental causes of death included septicemia from perforated peptic ulcer (uncontrolled thyrotoxicosis), multiple metastases from lung cancer, and suicide (family dispute over adoption of newborn). A cesarean section preceded 4 (44%) of the 9 maternal deaths. Two of these deaths were incidental maternal deaths. Cesarean section was related to two of the remaining six (33%) deaths. These findings show that traditional direct causes of maternal death (hemorrhage, sepsis, embolism, or hypertension) were not responsible for the maternal deaths at this tertiary facility. Instead, the women tended to have medical conditions that placed them at high risk of death regardless of pregnancy status.
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PMID:Maternal mortality: evolving trends. 781 Nov 98

Considerable uncertainty exists regarding the appropriate use and dose limitations for ergotamine tartrate (ET) and dihydroergotamine (DHE) for the treatment of migraine despite more than 50 years of clinical experience. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) appointed an advisory committee from experts in the Headache and Facial Pain Section. As their initial project, the committee elected to review the clinical literature on the appropriate use of these compounds in the treatment of migraine. Subsequently, clinical practice guidelines were formulated and recently published in Neurology. The Headache and Facial Plan Section and the QSS of the AAN were able to reach consensus on the basis of a thorough literature review and formulated practice parameters that describe and define the limits of ergot use, provide information on the oral and parenteral dosing of ET and DHE, and provide physicians with guidance to avoid ET overuse by patients. Because this project was completed prior to the availability of the intranasal (IN) formulation of DHE, intranasal DHE is not included in the practice parameter. Ergotamine tartrate and DHE were found to be safe and effective for the treatment of migraine as long as recommended dosages are not exceeded and high-risk patients such as those with uncontrolled hypertension, coronary or peripheral artery disease, thyrotoxicosis, or sepsis do not receive these compounds. In addition, the committee recommended restricting the use of ET in some instances because the overuse of ET has been associated with physical and psychological dependence resulting in predictable recurrent and/or rebound headaches, and subsequent severe withdrawal symptoms, including nausea, upon discontinuance of ET. None of these symptoms have been reported for DHE. These guidelines should help physicians provide optimal antimigraine therapy with these drugs.
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PMID:Appropriate use of ergotamine tartrate and dihydroergotamine in the treatment of migraine: current perspectives. 900 73

Plasmapheresis is the process by which plasma containing components causing or thought to cause disease is removed from the circulation, and the remaining blood components are returned with plasma or a harmless plasma substitute to the donor. It primarily removes protein-bound solutes or high-molecular-weight solutes such as circulating protein-bound toxins, autoantibodies, immune complexes, or other abnormally occurring molecules. Plasmapheresis has been used in the treatment of more than 100 diseases in human medicine, including immune-mediated diseases, neoplasia, infectious diseases, sepsis, hyperlipidemia, thyrotoxicosis, and removal of toxins. In immune-mediated disease, it is most useful to rapidly decrease plasma concentrations of antibodies or immune complexes, whereas other immunosuppressive measures are used to prolong the effect.
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PMID:Therapeutic plasmapheresis. 928 42

Acute heart failure in adults is the unfolding of heart failure in minutes, hours or a few days. Low output heart failure describes a form of heart failure in which the heart pumps blood at a rate at rest or with exertion that is below the physiological range and the metabolizing tissues extract their required oxygen from blood at a lower rate, causing a proportionately smaller oxygen amount remaining in the blood. Therefore, a widened arterial-venous oxygen difference occurs. High output heart failure is characterized by pumping blood with a rate above the physiological range at rest or during exertion, resulting in an arterial-venous oxygen difference, which is normal or low. This may be caused by peripheral vasodilatation during sepsis or thyrotoxicosis, blood shunting, or reduced blood oxygen content/viscosity (Fig. 1). The differentiation between low output heart failure versus high output heart failure is of highest importance for the choice of therapy and therefore the information and the monitoring of the systemic vascular resistance. Patients who present with acute heart failure suffer from a severe complication of different cardiac disorders. Most often they have an acute injury that affects their myocardial performance (eg, myocardial infarction) or valvular/chamber integrity (mitral regurgitation, ventricular septal rupture), which leads to an acute rise in left-ventricular filling pressures resulting in pulmonary edema.
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PMID:New strategies for the management of acute decompensated heart failure. 1135 11

Certain features of a group of 1309 diabetics were studied. The group was considered representative of Scottish diabetics since the sex distribution of cases corresponded to the sex distribution of deaths from diabetes recorded in the official mortality statistics for Scotland. Evidence is presented which justifies the use of Scottish mortality statistics for this purpose. A study of the incidence of diabetes in 413,110 Scottish recruits (male and female) suggested that in the general population the sex distribution of persons with undiagnosed diabetes might not be the same as that of persons known to have the disease. In both sexes, the disease began most frequently after age 40; sex incidence was equal up to age 40 and thereafter, female diabetics were more common than male diabetics. The high frequency of diabetes in women of middle age was confined to married women and appeared to be related, at least in part, to previous childbearing. The age at onset and the severity of the disease in this group of women were apparently uninfluenced by marriage and childbearing. Adult diabetics were no taller than the controls (hospital visitors). In the case of women diabetics, the maximum weight was significantly greater than that of the control from age 20 onwards, and in the case of male diabetics, from age 40 onwards. In both groups, married women were heavier than single women. The mean blood pressure was significantly higher in female diabetics after age 30 than in the corresponding control group. This hypertension could not be adequately explained on the grounds of obesity; it was not related to previous childbearing. Of 923 diabetics questioned, 23.2% had a family history of diabetes. As age at onset of the disease increased, positive family histories decreased. There was no relationship between presence of a positive family history and severity of the disease. The frequency of a positive family history in obese and hypertensive patients did not differ from that of a group of diabetics as a whole. In the group of middle aged married women, those with the largest families gave the fewest positive family histories. It was considered that there was no proof of parital sex linkage of the hereditary factor, and no convincing evidence that age at onset is determined by heredity. Thyrotoxicosis was present in 1% of the cases. Age at onset in these cases was similar to that of diabetics in general. Sepsis was associated with onset of diabetes in 6% of the cases, but average age at onset was that of diabetics in general and a family history of diabetes was obtained in 18% of the cases. After examining these data, it was concluded that etiologic factors in human diabetes could be divided into hereditary factor(s) fundamental to almost all cases or factors increasing the susceptibility of those persons predisposed to diabetes by a hereditary factor such as abesity, factor(s) associated with childbearing, and minor factors such as sepsis, thyrotoxicosis, or acromegaly.
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PMID:Survey of a Scottish diabetic clinic: a study of the etiology of diabetes mellitus. 1233 41

We present the management of agranulocytosis and neutropenic sepsis secondary to carbimazole with recombinant human granulocyte colony stimulating factor (G-CSF). A 72-year-old woman with a history of thyrotoxicosis presented with sore throat and fever two weeks after starting carbimazole. Investigations confirmed a leucopenia and neutropenia. G-CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad-spectrum antibiotic regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.
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PMID:Treatment of carbimazole-induced agranulocytosis and sepsis with granulocyte colony stimulating factor. 1266 1

Amiodarone-associated thyrotoxicosis (AAT) is often poorly tolerated owing to underlying cardiac disease, and it is frequently refractory to conventional medical treatment. The goal of this study was to describe the patient characteristics, management, and outcomes of all the patients treated surgically for AAT at a single institution. We conducted a retrospective chart review of all patients managed surgically for AAT (April 1985 through November 2002) at the Mayo Clinic in Rochester, Minnesota. Altogether, 29 men and 5 women, ages 39 to 85 years (median 60 years), treated with amiodarone for 3 to 108 months underwent near-total or total thyroidectomy. Frequent symptoms were worsening heart failure, fatigue, weight loss, and tremor. Altogether, 12 patients failed medical management of their AAT, and 21 received no preoperative medical therapy. One patient had been successfully managed medically but required definitive treatment. Common indications for operation were the need to remain on amiodarone, cardiac decompensation, medically refractory disease, and severe symptoms, both hyperthyroid and cardiac, necessitating prompt resolution. The median+/-SD American Society of Anesthesiologists (ASA) classification (1 = healthy through 5 = moribund) was 3.00+/-0.58. A total of 27 specimens had histology consistent with AAT. Complications included death (n = 3), rehospitalization (n = 3), symptomatic hypocalcemia (n = 2), pneumonia (n = 2), cervical hematoma (n = 1), prolonged ventilatorywean (n = 1), and stroke (n = 1); one patient developed hypotension, adult respiratory distress syndrome, and sepsis. Of the 31 surviving patients, 25 (80%) remained on amiodarone postoperatively. The median follow-up was 29 months, at which time all surviving patients were free of hyperthyroid symptoms. Thyroidectomy is an effective treatment for AAT but has a high incidence of perioperative morbidity and mortality. The cardiovascular co-morbidities and high operative risk in this group of patients may account for the increased complication rate.
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PMID:Surgical management of amiodarone-associated thyrotoxicosis: Mayo Clinic experience. 1549 61

We report a case of neonatal Graves' disease involving an infant with severe persistent pulmonary hypertension (PPHN) associated with neonatal thyrotoxicosis that necessitated extracorporeal membrane oxygenation. Hyperthyroidism, although uncommon in the newborn period, has been associated with pulmonary hypertension among adults. The exact mechanisms responsible for this effect on pulmonary vascular pressure are not well understood. Recent studies have provided evidence that thyrotoxicosis has direct and indirect effects on pulmonary vascular maturation, metabolism of endogenous pulmonary vasodilators, oxygen economy, vascular smooth muscle reactivity, and surfactant production, all of which may contribute to the pathophysiologic development of PPHN. Therefore, because PPHN is a significant clinical entity among term newborns and the symptoms of hyperthyroidism may be confused initially with those of other underlying disorders associated with PPHN (eg, sepsis), it would be prudent to perform screening for hyperthyroidism among affected newborns.
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PMID:Neonatal thyrotoxicosis and persistent pulmonary hypertension necessitating extracorporeal life support. 1562 61


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