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

A simple occluding device of the urethra has been described and the rationale for its configuration given. Twenty-three patients have been operated on and 18 have been cured. The main complications are device failure and sepsis. The results so far justify a limited optimism that the device has a significant role to play in the management of male urinary incontinence.
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PMID:The Rosen inflatable incontinence prosthesis. 68 71

Fifty-one patients under the age of 18 with histologic-proven malignant urinary tract tumors were encountered at the Department of Pediatrics of National Taiwan University Hospital from 1979 to 1989. There were 47 tumors arising from the kidney, 2 from the bladder, and 2 from the urethra. For upper urinary tract tumors, abdominal mass (92%) and abdominal distension (86%) were the most common symptoms and signs. For lower urinary tract tumors, painless hematuria, bladder distension and urinary difficulty were most frequently encountered. Associated anomalies were found in one-fifth of our patients, including kyphosis, undescended testes, hypospadias, inguinal hernia, intersex and congenital heart disease. Diagnosis was aided by plain X ray, abdominal ultrasonography, intravenous pyelography, computed tomography, or angiography in upper urinary tract tumors, and cystoscopy, cystography and computed tomography in lower urinary tract tumors. Multimodal treatment including total excision, multiagent chemotherapy, and radiotherapy were performed. Postoperative complications included infection (22%), ascites (19%), ileus, pleural effusion, scoliosis, neuropathies, and growth retardation. The local recurrence rate was 32%, and the metastatic rate was 34%. The overall mortality rate was 53% for an average follow-up period of 38 months. The causes of death included sepsis, respiratory failure and hepatic failure. The two-year survival rate was 47.6%. The important prognostic factors included histology, staging and vascular invasion, in addition to combined chemotherapy and radiotherapy.
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PMID:Malignant urinary tract tumor in childhood. 168 60

Urinary retention following total hip and knee arthroplasty is a common problem frequently necessitating either prolonged urethral catheter drainage or intermittent catheterization. The direct relationship of urinary tract instrumentations, procedures, and infections to deep sepsis in total hip replacements is well documented. Pharmacologic therapy to stimulate voiding or augment bladder emptying is thus theoretically preferable to the use of catheterization. Prasozin hydrochloride, an alpha blocker, relaxes the smooth musculature of the posterior urethra and prostrate and has been used to treat urinary obstruction secondary to benign prostatic hypertrophy. A prospective study in 60 male patients showed a statistically significant decrease in postoperative urinary retention with the perioperative administration of prazosin (p less than 0.01). A higher incidence of urinary tract infection was seen in patients who developed urinary retention (3% versus 20%) (p less than 0.01). Uroflowmetry parameters were not predictive of the patient at risk for retention and were unaltered with the administration of prazosin. Prazosin can be an effective adjunct in the prophylaxis of postoperative urinary tract infections and may decrease the potential risk for total joint sepsis.
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PMID:Postoperative urinary retention associated with total hip and total knee arthroplasties. 186 26

Delayed spontaneous rupture of the urinary bladder following augmentation enterocystoplasty is a serious life-threatening complication of uncertain etiology. Multiple factors are believed to contribute to the mechanism of bladder perforation. Ruptured augmented bladders share a common urodynamic pattern of high leak point pressure of the urethra, with sensory and mechanical tolerance of high filling pressure. This combination seems to be the main predisposing factor for spontaneous perforation. Other risk factors, including catheter trauma during intermittent self-catheterization, urinary retention due to mucus retention or noncompliance with the catheterization protocol, chronic infection, and decreased sensation of bladder filling, may play roles in the mechanism of rupture. Clinically, patients present with sepsis, abdominal pain and distension, ileus, fever, oliguria and peritoneal irritation. The diagnosis is made on low pressure cystography, although failure of cystography to demonstrate extravasation is not unusual. Aggressive surgical treatment consists of immediate exploration, primary repair of the perforation, drainage of the perivesical space, suprapubic cystostomy and broad-spectrum antibiotics. Longterm management includes a strict intermittent catheterization schedule, anticholinergic therapy and urodynamic evaluation. Failure to achieve a low pressure storage reservoir by conservative means entails an increased risk of recurrent perforation. In such cases further surgical intervention should be considered. We present a 21-year-old paraplegic man 5 months after augmentation enterocystoplasty who required operation because of spontaneous rupture of the augmented bladder. Spontaneous delayed rupture of the bladder should be considered in the differential diagnosis of acute abdomen in patients after augmentation enterocystoplasty. Early surgical treatment and subsequent monitoring of the low pressure reservoir are recommended.
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PMID:[Delayed spontaneous rupture of the bladder following augmentation enterocystoplasty]. 222 70

Certain diseases cause an increase in the amount of fluid present in the pleural and/or peritoneal cavity (an effusion). Uroperitoneum subsequent to kidney, ureter, bladder, or urethra rupture also can cause an increased amount of fluid in the abdomen. Evaluation of fluid samples often is helpful in identifying the mechanism causing the effusion and, occasionally, results in a specific diagnosis. The TP, TNCC, and general cytologic examination can be performed easily, quickly, and inexpensively in-house. The TP and TNCC are used to classify effusions as transudates, modified transudates, or exudates. Transudates usually are caused by hypoalbuminemia, but also can be caused by leakage of fluid from efferent intestinal lymphatics. Cytology and culture usually are not rewarding in the evaluation of transudates. Modified transudates usually are caused by increased vascular permeability or increased intrahepatic hydrostatic pressure. Cytologic and radiographic examinations often are helpful in evaluating patients with modified transudates, while cultures usually are unrewarding. The exudate class encompasses the inflammatory exudates (septic or nonseptic), neoplastic exudates, and chylous effusions. Inflammatory exudates have a high TP and predominantly contain inflammatory cells. They may be septic or nonseptic. When septic, degeneration neutrophils often, but not always, are found. Cultures often are needed to determine whether sepsis is present, to identify the specific organism, and to determine the best therapy. Neoplastic exudates may contain numerous neoplastic cells. If there is concern that the cells are dysplastic instead of neoplastic, the cytology preparation should be referred to a consultant. Chylous effusions usually contain many small lymphocytes with a variable number of neutrophils and macrophages. In chronic chylous effusions, however, neutrophils and/or macrophages may predominate. Chylous effusions usually are differentiated easily from pseudochylous effusions by cytology. Comparison of fluid and serum triglyceride and cholesterol concentrations can be used to differentiate chylous and pseudochylous effusions when differentiation cannot be accomplished by cytology.
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PMID:Evaluation of pleural and peritoneal effusions. 267 38

The priority for treatment of a urologic injury in multiple injured patients from external trauma should be determined by the frequency of death from the urologic injury. The medical records of 2,058 patients with urologic injury from external trauma including 214 deaths were reviewed. Four deaths were attributed mainly to the urologic injury; one early in the postinjury period from continued severe hemorrhage from a ruptured kidney managed conservatively and three 6 to 8 weeks after injury from sepsis with a pelvic abscess from a ruptured urethra or bladder. The remaining 210 deaths were attributed to the associated injuries and occurred in the more severely injured older patients compared to the survivors. Death in multiple injured patients was rarely due to the urologic injury.
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PMID:Deaths from urologic injury due to external trauma. 356 Feb 76

The authors report a retrospective study of 320 primary resections for benign prostatic hypertrophy yielding a mean weight of 30 grams, only 5% exceeding 50 grams. Routine internal urethrotomy of the penible urethra carried out in 62 patients did not prevent urethral stenosis in 2 of them. There were no cases of fluid absorption syndrome, but the relatively frequent nature of the immediate (5 cases) or early (10 cases) abundant bleeding should be noted. Only one third of the patients required a transfusion. Seventeen developed a septicaemia and six epididymitis. Septicaemia (2 cases), pulmonary embolism (1 case) and cardiac insufficiency (1 case), were the causes of the 4 deaths (1.25%). There were 14 cases of urethral stenosis, 19 of incomplete resection, 1 fibrosis of the prostatic bed and 6 fibrosis of the bladder neck. There were 3 cases of complete incontinence (0.9%). In this retrospective series, spread over 7 years and involving 16 different surgeons, 80% of the patients undergoing resection had a perfect result, to which could be added 7%, following minor endoscopic re-operation for urethral stenosis or incomplete prostatic resection. The experience of the surgeon and the improvements in equipment appeared to be the two essential factors in the improvement of results of endoscopic resection for benign prostatic hypertrophy.
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PMID:[Transurethral resection of the prostate (author's transl)]. 617 82

Thirty-eight infants admitted to a neonatal intensive care unit because of pneumonia (14 patients) and pulmonary maladaption syndrome (PMA) (24 patients) were included in the study. Samples of potentially pathogenic, facultatively anaerobic bacteria were taken from the external ear, blood, throat, nasopharynx, umbilicus and gastric aspirates of the children, and from urethra and cervix of the mothers. Group B streptococci (GBS) and Escherichia coli were the only potentially pathogenic bacteria isolated from the infants. Out of 14 infants with pneumonia 11 (79%) harboured one of these bacteria, in contrast to 3 out of 24 (13%) with PMA (P less than 0.001). GBS was found in 8/14 infants with pneumonia and in 1/24 infants with PMA (P less than 0.001). The respective frequencies for Escherichia coli were 3/14 and 2/24 (not significant). The infant and/or the mother in 10/14 pneumonia cases harboured GBS, in contrast to 4/24 pairs in the PMA group (P less than 0.001). The levels of antibodies against GBS in sera of mothers to infants with pneumonia did not differ from the antibody levels in control sera (parturient GBS-carriers giving birth to healthy infants). The results gave evidence for an important manifestation of neonatal GBS-infection: pneumonia without septicemia. The incidence of the disease is estimated to be 1:25 parturient GBS-carriers. Finally, maternal fever, gestational age above 42 weeks, more severe respiratory difficulties and the occurrence of severe changes in fetal heart rate during the first stage of labour were found to be typical characteristics of pneumonia, as compared to PMA.
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PMID:The significance of group B streptococci in neonatal pneumonia. 635 5

The cecoureterocele differs from the usual ectopic ureterocele because it extends outside the bladder and may obstruct the urethra. The differentiation requires careful examination of the urethra by a voiding cystourethrogram and cystoscopy. We describe the management of a girl with bilateral cecoureteroceles who presented as a newborn with urinary retention and sepsis. Surgical correction of the cecoureterocele may differ from that required for the usual ectopic ureterocele.
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PMID:Bilateral cecoureteroceles causing urinary retention in the newborn. 635 34

The indwelling urinary catheter is an essential part of modern medical care. It is widely used to relieve temporarily anatomic or physiologic urinary obstruction, to facilitate surgical repair of the urethra and surrounding structures, to provide a dry environment for comatose or incontinent patients, and to permit accurate measurement of urinary output in severely ill patients. Unfortunately, when poorly managed, the indwelling catheter may present a hazard to the very patients it is designed to protect. It is the leading cause of nosocomial induced urinary tract infections and the most common prediposing factor in fatal gram-negative sepsis in hospitals. Catheters drain the bladder, but they obstruct the urethra, producing other major problems such as urethral strictures and epididymitis. Advances in catheter care since the introduction of closed drainage are reviewed. The best means of prevention is the avoidance of use when unnecessary and prompt removal when the need no longer exists. This practice is of particular importance in long-term care institutions. Alternate methods include intermittent catheterization in the paraplegic patient, condom drainage in the nonobstructed patient, and direct drainage of the bladder through the skin. Most recent studies have attempted to improve care of the indwelling catheter by either prevention of periurethral infection (the most common route of acquisition) or sterilization of the drainage bag to prevent ascending infection and cross infection. Thus far, these methods have been unsatisfactory. A new approach to designing drainage systems is clearly needed. Finally, all studies failed to demonstrate the ability of systemic antimicrobial therapy to eradicate catheter-associated infections other than temporarily. Instead, excessive use of antibiotics has led to the emergence of resistant strains that may be spread to other patients through contaminated urine.
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PMID:Genitourinary infections in the patient at risk: extrinsic risk factors. 637 62


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