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

Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection. Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection. Seven hips had previously been infected with tuberculosis. All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty. One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty. The mean length of follow-up was forty-two months. Fourteen of the eighteen reconstructions were successful. The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms. There was no evidence of recurrence of infection in the other three groups (thirty-nine hips).
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PMID:Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis. 746 76

A 24-year-old woman was admitted to our department with sepsis, polyserositis and suspected abdominal tumor immediately after delivery. Effusion analyses suggested an etiology of tuberculosis. The severe general condition of the patient allowed for no invasive diagnostic procedures. Antituberculosis therapy was administrated too late and was of no benefit. The fatal outcome was due to septic shock and adult respiratory distress syndrome (ARDS). Autopsy findings confirmed tuberculous polyserositis as well as tuberculous infection of the lungs. The same diagnosis was established in her newborn infant, who responded well to antituberculosis treatment.
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PMID:A female patient with tuberculous polyserositis, and congenital tuberculosis in her new-born child. 749 10

Recent advances in the field of molecular biology have revolutionized our understanding of the functioning of living organisms and facilitated the development of robust tools for both diagnosis and treatment of diseases. With particular reference to the field of critical care medicine, development of molecular biology techniques have aided in the following: (1) rapid and highly specific detection of pathogenic infectious agents (eg, Mycobacterium tuberculosis, Pneumocystis carinii, cytomegalovirus, Legionella); (2) development of assays for measurement of circulating cytokines such as tumor necrosis factor (TNF) and interleukin (IL)-1 that has helped our understanding of the pathogenesis of the sepsis syndrome; (3) administration of antibodies or soluble receptors to attempt to prevent untoward effects of cytokines such as TNF or IL-1; and (4) the administration of recombinant deoxyribonucleic acid (DNA) or proteins to patients in an attempt to alter the course of a disease such as antioxidant enzymes (superoxide dismutase). The rapidity of progress in this field has been staggering, which necessitates frequent updating of our knowledge for clinicians to put these molecular tools to their best use. This brief review attempts to explain the basic principles of commonly used techniques in molecular biology including recombinant DNA, polymerase chain reaction, DNA libraries, gene therapy, and protein biochemistry in a manner that is understandable to those without an in-depth knowledge of the field.
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PMID:Current techniques in cell and molecular biology. 749 50

Melioidosis was diagnosed in a diabetic sailor who presented with a history and chest radiograph that suggested tuberculosis. Melioidosis is a tropical disease with protean manifestations: from asymptomatic infection to chronic cavitary lung disease to overwhelming sepsis. The diagnosis is easily made, even in nonendemic areas when duly considered by the clinicians and microbiology laboratory. Ceftazidime has dramatically improved outcomes in hospitalized patients with severe melioidosis.
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PMID:Melioidosis in a diabetic sailor. 752 16

Researchers analyzed data on 52 HIV-positive patients with Kaposi's sarcoma (KS) aged 23-67 (74% Black, 26% White; male/female ratio = 2.8:1) referred to the Johannesburg General Hospital in South Africa during 1980-1990 to examine the hospital's experience with these patients. 23 patients had a fever and/or at least 10% weight loss. 34% had prior or coexistent opportunistic infection, particularly Pneumocystis carinii pneumonia, fungal disease, or tuberculosis. Possible risk factors among 21 patients were homosexual intercourse, history of sexually transmitted disease, and drug abuse. Almost all patients had skin disease, either localized or disseminated. Other KS sites included the oral cavity, regional lymph nodes, and large bowel. 90% of 20 patients treated with radiation responded to treatment. Response rates for radiation treatment among the 20 patients were 80% for symptomatic relief, 45% for complete remission, 45% for partial remission, and 10% for tumor progression. The recurrence-free period among irradiated patients was five months. Five patients developed radiation-induced mucositis of the oropharyngeal region. None of the 32 patients treated with chemotherapy and not radiation experienced complete remission. Chemotherapy induced partial remission in 38% and tumor progression in 62% of patients. 9% of chemotherapy-treated patients experienced symptomatic relief. Deteriorating performance status and/or debilitating side effects (severe mucositis and neutropenic sepsis) necessitated cessation of chemotherapy or dose modification. The clinical course of AIDS-related KS in this population paralleled that in Western countries. Based on these findings, the authors recommend local radiation therapy to treat AIDS-related KS or a watch-and-wait policy for asymptomatic, minimal disease in patients with an intact immune status.
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PMID:Epidemic AIDS-related Kaposi's sarcoma in southern Africa: experience at the Johannesburg General Hospital (1980-1990). 757 Aug 33

Rhinocerebral phycomycosis is an uncommon opportunistic infection with ubiquitous fungi of the class Phycomycetes, starting in the nose and extending to the paranasal sinuses and then intracranially. The condition is often characterized by poor prognosis because of occlusion of the internal carotid artery. This disease is commonly associated with predispositions such as uncontrolled diabetes mellitus, which is the most common, immunosuppressive states and metabolic bankruptcy including leukemia, lymphoma, myeloma, malnutrition, uremic or diarrheal acidosis, severe burns, anemia, carcinoma, radiotherapy, liver cirrhosis, hemochromatosis, tuberculosis, septicemia, long-term medication of steroid, antibiotics and antimetabolite, drug addiction, cytotoxic drug administration and AIDS. Cases with unknown predisposition, however, have been infrequently reported in the literature. The authors report a case of rhinocerebral phycomycosis in which concurrence of Candida species instead of the above-mentioned common predispositions was considered a potential predisposition. To our knowledge, only 1 report in which Candida species are referred to as a potential predisposition for this disease has been previously issued. A 85-year-old man was admitted to our hospital on March 2, 1994 because of generalized convulsion. He had received a total extirpation of an ascending colon cancer in July 1993. On admission, physical inspection showed no abnormalities and neurological examination revealed obtunded consciousness without other abnormalities. He had no diabetes mellitus. Hematological and blood chemistry values were normal except for CA19-9 of 45 U/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of rhinocerebral phycomycosis]. 760 36

A 33 year old woman with recurrent Salmonella enteritidis sepsis is described. Penicillins, ceftriaxone, ciprofloxacin, and chloramphenicol could not eradicate the salmonellas but a combination of high dose ciprofloxacin and ceftriaxone for the eighth episode successfully cured the infection. The combination of ciprofloxacin and ceftriaxone may be a valuable therapeutic regimen in patients with recurrent salmonella sepsis. Prolonged intrahepatic cholestasis resulting from granulomatous hepatitis in this patient improved considerably with empiric ursodeoxycholic acid treatment. A liver biopsy specimen showing non-caseating epitheloid granulomas was positive for mycobacterial DNA by polymerase chain reaction. Repeated bronchoscopy with multiple biopsies eventually revealed caseating granulomas with acid fast bacilli in the lung biopsy specimens. Therefore, tuberculosis was diagnosed as the underlying disease and the cause of granulomatous hepatitis in this patient and tuberculostatic treatment was started. Polymerase chain reaction for mycobacterial DNA may be helpful in the differential diagnosis of hepatic granulomas when routine histological examination and culture of biopsy specimens are not diagnostic. Tuberculosis should be considered as one of the diseases predisposing to recurrent salmonella sepsis.
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PMID:Recurrent Salmonella enteritidis sepsis and hepatic tuberculosis. 767 64

Successful management of chronic postoperative bronchopleural fistula remains a challenge for thoracic surgeons. Forty-two patients (33 referred from other institutions) were treated for major postoperative bronchopleural fistula since 1978. Factors associated with bronchopleural fistula included right pneumonectomy (n = 23), left pneumonectomy (n = 8), long bronchial stump (n = 16), pneumonia (n = 13), radiation therapy (n = 12), stapled bronchial closure (n = 8), prolonged mechanical ventilation (n = 7), recurrent carcinoma (n = 6), and tuberculosis (n = 2). Patients had undergone an average of 3.3 surgical procedures to correct their bronchopleural fistulas during a mean interval of 24 months before our treatment. Bronchopleural fistulas were located in the right main bronchial stump (n = 23), left main bronchial stump (n = 8), right lobar bronchial stumps (n = 10), and tracheobronchial anastomosis (n = 1). Thirty-five patients were treated by suture closure of the bronchial stump, buttressed with vascularized pedicle flaps of omentum (n = 19), muscle (n = 13), or pleura (n = 2). In seven cases, direct suture closure was not possible, and omental (n = 6) or muscle (n = 1) flaps were sutured over the bronchopleural fistula. Suture closure without pedicle coverage was performed successfully in one case. Initial repair of the fistula was successful in 23 of 25 patients treated with omentum, in nine of 14 patients treated with muscle and in neither of two patients treated with pleural flaps. In nine patients with persistent or recurrent bronchopleural fistula after our initial repair, four underwent a second procedure (three successful) and five were managed with drainage only. The fistula was successfully closed in 11 of 12 patients who had received high-dose radiation therapy (nine with omentum). Overall, successful closure of bronchopleural fistula was achieved in 36 of 42 patients (86%). Four in-hospital deaths resulted from pneumonia and sepsis, two in patients with recurrent bronchopleural fistula after pleural flap closure. In 16 patients the empyema cavity was obliterated during definitive repair of the fistula. The cavity resolved with drainage in four others, nine had draining cavities at follow-up, and one was lost to follow-up. Ten patients required a total of 17 Clagett procedures and one had a delayed myoplasty. Direct surgical repair of chronic bronchopleural fistula may be achieved in most patients after adequate pleural drainage by suture closure and aggressive transposition of vascularized pedicle flaps. Omentum is particularly effective in buttressing the closure of bronchopleural fistulas.
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PMID:Treatment strategies for bronchopleural fistula. 773 61

Autopsy or biopsy findings in 10 human immunodeficiency virus (HIV)-positive persons from Bangalore, India, revealed a wide spectrum of pathological changes. Patients' mean age was 33.4 years and the mean duration between symptom onset and death was 27.13 days. Nine patients had evidence of neuro-acquired immunodeficiency syndrome (AIDS) and 8 of them succumbed to various opportunistic infections. Histologic examination showed diffuse cryptococcal meningitis in 5 cases; 2 cases showed disseminated systemic cryptococcosis. Pulmonary tuberculosis was present in 3 patients. Despite no signs of associated neurotuberculosis in any patient, 4 autopsied and 1 biopsied case showed evidence of systemic tuberculosis. Toxoplasma encephalitis was present in 2 cases; observed in this series was the first case, in India, of co-existent toxoplasma and acanthamoeba. Other bacterial infections such as meningococcal meningitis and psudomonas septicemia were found in 3 cases; pneumocystis carinii pneumonia was present in 1 case. Evidence of early HIV leukoencephalopathy was observed in the only asymptomatic HIV-positive individual (who died in a traffic accident). AIDS-associated bacterial infections caused by organisms other than Mycobacterium tuberculosis are often underdiagnosed and should be considered in developing countries. In cases of cryptococcal and tuberculosis meningitis or multiple parasitic infections, patients should be screened for associated HIV infection.
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PMID:Pathological lesions in HIV positive patients. 775 Oct 41

We report 10 women and five men with papulonecrotic tuberculid, an uncommon form of cutaneous tuberculosis (TB). The mean age was 22.6 years (range, 2 1/2-35 years) at presentation. The Mantoux test was strongly positive in 13 patients. Five patients showed presumptive evidence of associated TB; in one case, the presence of TB was proven by culture. Response to anti-TB was dramatic in all cases. Clinical findings were similar to those previously published. We emphasize the simultaneous occurrence of erythema induratum, associated Takayasu's disease, possible associated phlebitic tuberculid, and clinical mimicry of acute bacterial endocarditis. The main histopathological findings obtained from 27 biopsy specimens included dermal necrosis (26 of 27 cases), a poorly formed granulomatous infiltrate (27 of 27 cases), vasculitis (11 of 27 cases), perivascular spongy edema (11 of 27 cases), and follicular necrosis or suppuration (five of 27 cases). A Ziehl-Neelsen stain was negative in all biopsy specimens. Immunohistochemical labeling revealed a preponderance of T-lymphocytes (UCHL-1+), monocytes-macrophages (S-100+), and Langerhans cells (ACT+), indicative of a type IV hypersensitivity reaction. B-lymphocytes (L26+) were sparse. Conditions that may be confused with PNT on clinical or histopathological ground include pityriasis lichenoides et varioliformis acuta, papular urticaria, papulopustular syphilide, miliary TB, septicemia, perforating granuloma annulare, chondrodermatitis nodularis, reactive perforating collagenosis, allergic granulomatosis, suppurative folliculitis, and infectious causes of palisading granulomas. Papulonecrotic tuberculid has distinct clinical, histopathological, and immunohistochemical features. Awareness of this entity is important since an appropriate diagnosis is necessary for the institution of timely curative treatment.
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PMID:Papulonecrotic tuberculid. A clinical, histopathological, and immunohistochemical study of 15 patients. 780 63


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