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)

Between January 1982 and December 1986, among the 750 patients with the acquired immunodeficiency syndrome (AIDS) who were treated at two adjacent hospitals in New York City, 78 (10.4 percent) needed evaluation for renal disorders. Reversible acute renal failure due to nephrotoxic injury, ischemic injury, or both was present in 23 patients (30 percent) (Group I). The remaining 55 (70 percent) had massive proteinuria, azotemia, or both (AIDS-associated nephropathy; Group II), and irreversible uremia developed in 43. In an additional 18 patients, all of whom had a history of intravenous narcotic drug use, AIDS was diagnosed after the initiation of maintenance hemodialysis for chronic renal failure (Group III). Survival for more than six months after the onset of chronic uremia occurred in only two subjects in Group II; all patients in Group III died within three months of the diagnosis of AIDS. Death in the patients in Groups II and III followed a syndrome of "failure to thrive" characterized by inanition unresponsive to intensive nutritional support and hemodialysis. In contrast, 8 of 17 patients with acute renal failure (Group I) and a serum creatinine concentration above 6 mg per deciliter regained renal function (serum creatinine level, less than 2.0 mg per deciliter). Four of the seven lived for 10 to 24 months, whereas the other four died of sepsis within a month. Our observations suggest that maintenance hemodialysis is not effective in prolonging life either in patients with AIDS-associated nephropathy and uremia or in patients with end-stage renal failure in whom AIDS develops during the course of maintenance dialysis. Hemodialysis may be useful in the management of potentially reversible acute renal failure in patients with AIDS.
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PMID:The types of renal disease in the acquired immunodeficiency syndrome. 356 58

This report describes a 30-year-old man with a 45 per cent mixed deep partial and full thickness flame burn, who--following sepsis and multisystem failure--developed a severe polyneuropathy affecting the left median and both ulnar nerves, and both peroneal and posterior tibial nerves. The neurological alterations were significantly reversible, early reinnervation in all limbs was demonstrated by electromyography at 8 months, with subsequent progressive reinnervation at 1 year. The most likely cause of this polyneuropathy was the acute development of uraemia, at day 33 post-burn.
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PMID:Severe peripheral burn polyneuropathy: a case report. 360 67

Perforation of the colon in the immunocompromised patient is a catastrophic and usually fatal event. The immunocompromised patient, like all patients, may suffer from the more common causes of colonic perforation, including diverticulitis, chronic inflammatory bowel disease, presence of a foreign body, and trauma. There also appears to be in these patients the unusual occurrence of spontaneous perforation, particularly in patients with renal allografts or on dialysis. In a retrospective multi-hospital review, 10 cases of apparent spontaneous perforation were found. The pathogenesis is unclear, but predisposing factors include immunosuppressive medications, uremia, discrete colon ulcerations, and fecal impaction. The reported mortality rate approaches 100 percent due to delayed recognition and impaired host defense mechanisms. In our patients, mortality was 40 percent. We attribute this improved survival to prompt surgical intervention and aggressive postoperative management, including daily dialysis, parenteral hyperalimentation, broad-spectrum antibiotics, and a high index of suspicion for ongoing sepsis with early repeat exploration.
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PMID:Perforation of the colon in the immunocompromised patient. 370 31

In resection of abdominal aortic aneurysm, ligation and division of the left renal vein may be necessary in order to expose the perirenal aorta. This manoeuvre is possible, with conservation of the left kidney function, because of the extensive venous collateral circulation of the left kidney. It is of crucial importance however, that ligation of the vein is performed close to the inferior vena cava. A case is presented where ligation of the left renal vein was performed in relation to an operation for a ruptured abdominal aortic aneurysm. After the operation there was initially dysfunction of the left kidney, and later on sepsis-induced uraemia. The renal function stabilized at a moderately reduced level. No permanent kidney damage related to the venous ligation could be demonstrated. In the literature serious renal damage has been reported in 10 cases out of 89 reported ligations of the left renal vein. Ligation of the left renal vein is thus a reasonably safe and acceptable procedure for surgical exposure in difficult aortic procedures.
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PMID:Ligation of the renal vein during resection of abdominal aortic aneurysm. 372 50

Normal red cells are flexible and can thus negotiate small capillaries with ease. Impaired red cell deformability (RCD) has been found in patients with uremia, peripheral vascular disease, and diabetes. This study was performed in order to determine if impaired RCD is present during sepsis. The RCD of citrated whole blood (WB) and citrated buffy coat-poor whole blood (BCP) from ten septic patients was compared to ten age-, sex-, and race-matched control patients. The samples were passed through polycarbonate 5 micron pore filters at -10 cm H2O pressure according to the technique of Reid. A red cell deformability index was calculated for each patient by multiplying the volume of blood flowing through the apparatus in a 1-minute period by the hematocrit. The results show very highly significant decreases of flow in both the WB and BCP blood in the septic group. Alterations in flow in the WB can be explained on the basis of changes in the buffy coat fraction and/or the red cell deformability. A decrease in flow in the BCP blood can be explained in terms of a diminished deformability of the red cells themselves. This increased rigidity of the red cells could, in part, explain the AV shunting and decreased microcirculatory flow seen in the septic state.
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PMID:Alterations of capillary flow during sepsis. 397 63

With the development of nonsurgical methods of urinary diversion and the availability of new and more effective methods for treating cancer, an increasing number of patients will be candidates for palliative urinary diversion. Urinary diversion is clearly indicated to provide the time necessary to establish the correct diagnosis, to treat pain or sepsis, and to provide time for other treatments to control the underlying disease. When diversion is being considered solely for the purpose of treating uremia and the tumor has proved to be refractory to all known effective forms of treatment, the decision about whether to perform a diversion must be based on the individual circumstances of the patient including the age, type of tumor, and social and economic considerations. Methods of internal diversion such as ureteral stents are preferred when feasible. Percutaneous nephrectomy may be useful when internal diversion cannot be accomplished or when it can be anticipated that the diversion will be only temporary. When permanent diversion is required, loop cutaneous ureterostomy using the better kidney or bilateral cutaneous ureterostomy is effective only when the ureters are dilated. Diversion into an ileal segment is necessary when the ureters are of normal caliber.
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PMID:Palliative urinary diversion. 618 86

There is scanty reference in the literature from the tropics, especially from Africa, to posterior urethral valves (PUV). The condition is not uncommon in Africans. Forty-five patients seen during a period of 10 years at the Ahmadu Bello University Hospital, Zaria, Nigeria have been analysed in order to discover any problems this abnormality may pose that are peculiar to the developing countries of the tropics. Two-thirds of the patients were under one year of age when first seen, one-third of them being under one month. About a quarter had no urological symptoms at presentation. Most of these were neonates and infants often critically ill due to sepsis and uraemia. These non-urological presentations caused delay in diagnosis and referral with detrimental effects on prognosis. However, the diagnosis could be made on clinical examination by demonstrating a palpable bladder and/or renal masses. Voiding cystourethrogram confirmed the diagnosis when carried out carefully, and required no specialized equipment. Most children were treated satisfactorily by perineal valve ablation, using simple inexpensive instruments. The death rate was high mainly due to delay in diagnosis and in starting appropriate treatment. It is suggested that amongst all who have care of children in the tropics, increased awareness of the varied clinical manifestations of PUV would improve prognosis.
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PMID:Congenital posterior urethral valves: problems of management in countries with limited facilities. 620 66

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insights into the underlying mechanisms the lysosomal factors of polymorphonuclear (PMN) leukocytes and the plasma elastase-alpha 1-proteinase inhibitor complex were investigated in patients with acute and chronic renal failure. Lysosomal activity was evaluated in peripheral blood smears by the lysis of erythrocytes and plasma (halo formation) around each neutrophil induced by 0.25 M NaC1 borate buffer. In about half of the patients with chronic renal insufficiency on dietary treatment lysosomal activity of PMN leukocytes was reduced. The plasma concentration of elastase-alpha 1-proteinase inhibitor complex was normal in most subjects, but increased in three patients with the highest serum creatinine levels (greater than 13 mg/d1). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis, or dye-induced) halo formation was either reduced or absent. The plasma elastase-alpha 1-proteinase inhibitor complex was increased in 5/6 of the patients by a factor of two to four. Also in the patients on regular hemodialysis treatment halo formation of PMN leukocytes was substantially reduced, whereas the plasma levels of elastase-alpha 1-proteinase inhibitor complex was slightly increased. The finding of reduced lysosomal activity of PMN neutrophils in uremia may be partly due to an enhanced release of neutral proteinases into the circulation as indicated by the elevated plasma levels of elastase-alpha 1-proteinase inhibitor complex in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Granulocyte lysosomal factors and plasma elastase in uremia: a potential factor of catabolism. 620 47

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insight into the underlying mechanisms the neutral proteinases of polymorphonuclear (PMN) leukocytes were investigated in patients with acute and chronic renal failure. The following studies were performed: 1. Neutral proteolytic activity of PMN neutrophils in blood smears (according to Klessen, 1978). 2. Serum levels of elastase alpha 1 proteinase inhibitor complex (Neumann et al., 1981). In about half of the patients with chronic renal insufficiency on dietary treatment the proteolytic activity of PMN leukocytes (halo formation are due to digestion of erythrocytes and plasma) was reduced. The serum concentration of elastase alpha 1 proteinase inhibitor complex was normal in most subjects, but increased in 3 patients with the highest serum creatinine levels (greater than 13 mg/dl). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis or dye induced) halo formation was either reduced or absent. Serum elastase alpha 1 proteinase inhibitor was increased in 5/6 patients by a factor of two to four. Also in the 15 patients on regular hemodialysis treatment halo formation was substantially reduced, while the serum levels of elastase alpha 1 proteinase inhibitor complex was slightly increased. The finding of reduced proteolytic activity of PMN neutrophils in uremia is probably due to an enhanced release of proteinases into the circulation as indicated by the elevated serum levels of elastase alpha 1 proteinase inhibitor complex in some patients. The release of proteinases might be in part due to the effect of "uremic toxins". In the RDT patients the contact of the blood with the dialyzer (cuprophane) membrane might be an additional factor. In the patients with ARF the underlying disease (infection, shock, trauma) contributes to the release of proteinases. These disturbances may be harmful for the patient, if the blood concentration or function of the most important proteinase inhibitors (alpha 1 proteinase inhibitor, alpha 2 macroglobulin) is reduced.
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PMID:Release of granulocyte neutral proteinases in patients with acute and chronic renal failure. 636 15

Current concepts in the nutritional support of patients with renal disease are reviewed. In chronic renal failure, alterations in fat, carbohydrate, and glycogen metabolism usually occur and may be worsened by acute illness. Total parenteral nutrient (TPN) therapy is rarely required unless complications occur. In contrast, acute renal failure is generally associated with hypovolemia, sepsis, soft tissue injury, and coagulation defects, all of which influence metabolism and extracellular fluid volume; the gluconeogenesis that often occurs in these patients masks the metabolic effects of uremia. Nutritional support of patients with renal disease aims at providing adequate nutrients while limiting accumulation of nitrogenous waste. Current concepts concerning essential amino acids (EAAs), nonessential amino acids (NEAAs), and urea recycling are reviewed. The caloric needs of patients with renal failure are assumed to be similar to those of other hospitalized patients. There is no clinically important advantage of using an EAA formulation rather than mixed (EAA and NEAA) amino acids. Since fluid restriction is recommended and protein use is improved with diets with a high calorie-to-nitrogen ratio, the use of TPN solutions with dextrose 350 g is recommended. If glucose intolerance is severe, fat should be considered as a calorie source. Recommendations for monitoring the metabolic status of patients with renal failure receiving nutritional support are reviewed. Monitoring the metabolic status of patients with renal disease is crucial to providing safe and effective nutritional therapy. There appears to be no clinically important advantage to amino acid products specially formulated for use in renal disease.
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PMID:Nutritional support of patients with renal disease. 642 98


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