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

In Ohio, a 33-year old woman who had never had an ectopic pregnancy presented at an emergency facility not physically attached to a hospital with abdominal pain over 24 hours which had become more intense during the preceding 4 hours. She did not have vaginal bleeding, diarrhea, vomiting, or pain while urinating. 2 weeks earlier she had a voluntary intrauterine abortion at 8 weeks' gestation. She had intercourse 1 week before coming to the emergency facility. She had widespread tenderness in her abdomen, especially in the lower areas. Blood cell studies suggested an infection. The attending physician presumed her to have pelvic inflammatory disease (PID) as a result of either sexual intercourse or the elective abortion. The physician called for a urinary beta human chorionic gonadotropin test to determine whether placental tissue remained in the uterus. It was positive. 60 minutes after admission, the supine patient's pain increased and her blood pressure dropped to 80/50 mm Hg from 100/60 mm Hg at admission. After administering Ringer's solution, the health team sat her up and she fainted. A repeat cell count indicated sepsis. Her blood pressure decreased to 60 by Doppler and the physician continued to give her fluids and began dopamine. After the team stabilized her, they transferred her to a hospital. Her private physician examined her and then began surgery. The physician found a tubal pregnancy and removed the affected tube and ovary. She recuperated completely. Combined intrauterine and extrauterine pregnancy occurs once in every 30,000 cases. Previous PID, use of ovulation inducing medication, and in vitro fertilization with embryo transfer increases the likelihood of this type of pregnancy occurring. Physicians should consider this possibility if a woman has any of these histories and a combination of abdominal pain, adnexal mass with pain and tenderness, peritoneal irritation, and an enlarged uterus.
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PMID:Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion. 157 Sep 21

Ovariectomized female rats were treated with oestradiol and the progesterone-antagonist mifepristone. They allowed males to copulate to a similar extent as ovariectomized rats treated with oestradiol alone. The additional treatment with mifepristone, however, resulted in uterine infections following copulation, together with the prolonged presence of copulatory plugs in the uterine lumen. On several occasions rats became severely ill during the days after copulatory tests, occasionally with lethal consequences. Microscopic examination of the cervix and uterus 1 day after a copulation test in rats treated with oestradiol plus mifepristone, showed that copulatory plugs passed through the cervical canals directly into the uterine lumen. Bacterial infections and local destruction of the uterine epithelium were found in all rats examined. These features were not found in rats treated with oestradiol alone. Actions of mifepristone on the cervix of oestradiol treated rats are likely to play a key role in the passage of copulatory plugs and, thereafter, the development of uterine sepsis.
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PMID:Treatment with mifepristone (RU486) and oestradiol facilitates the development of genital septic disease after copulation in female rats. 163 75

Seven pregnant women with symptomatic hydronephrosis had sonographically guided percutaneous nephrostomy for pyosepsis (five patients) or for pain with azotemia (two patients with renal transplants). Antibiotics had been ineffective in controlling pyosepsis in each patient; retrograde ureteral catheterization via cystoscopy was unsuccessful in one patient. After percutaneous nephrostomy, prompt clinical improvement was observed in all patients (i.e., sepsis was relieved and pain abated). Labor was not induced in any of the patients, and no adverse effects occurred to any fetus or mother. Eleven (eight percutaneous nephrostomy, three catheter exchanges) of the 12 procedures were done without conventional radiography and with sonographic guidance alone. After percutaneous nephrostomy, maneuvers to obtain a diagnosis and to treat the obstruction (if necessary) were delayed until after delivery. The causes of ureteral obstruction were calculi (four patients) and a gravid uterus (three patients). After delivery, stones were removed either percutaneously (one patient) or cystoscopically (two patients) or passed spontaneously (one patient); resolution of obstruction by the gravid uterus was proved by Whitaker test after delivery. Sonographically guided percutaneous nephrostomy is an effective and safe method to treat pregnant women who have symptomatic obstructive hydronephrosis associated with either pyosepsis or azotemia. The procedure is rapid, requires minimal anesthesia, has no radiation, and is safe for the fetus. The technique is a useful and perhaps preferable alternative to more invasive surgical therapy or retrograde stenting.
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PMID:Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy. 172 66

Physicians admitted a 38-year-old woman to the Stanford University Hospital in Palo Alto, California who had experienced pelvic pressure, suprapubic pain, urinary urgency, and terminal blood in the urine. Microscopic examination showed 15-25 leukocytes and 20-25 red blood cells per high power field in the urine. The culture grew no microorganisms. 16 years prior to admission, the patient had had a Dalkon shield IUD inserted. Yet 13 years prior to admission, she had a pelvic abscess and sepsis after the IUD perforated the uterus. Physicians then performed an emergency hysterectomy and removed both ovaries and Fallopian tubes. She experienced no more symptoms and physicians did not intervene further. Additional tests in the Stanford University hospital revealed a freely moving bladder stone with no mucosal erythema or edema. The physicians removed the 5.2 x 4.5 x 1.5 cm rough calcified mass. When they broke the stone, they found the intact Dalkon Shield IUD which had been completely surrounded by the calcified mass. The physicians were able to discharge the patient 5 days later. This hospital has had a total of 19 cases of uterine perforation by an IUD. The Lippes Loop caused most perforations (6 cases) which took place before 1977. After 1978, however, most cases involved the Dalkon shield (5 cases). Usually the patient had no symptoms when the IUD migrated, but erosion into the bladder often resulted in urinary symptoms, such as repeated urinary tract infections and/or blood in the urine. The duration of symptoms among the 19 cases, which developed many years after IUD insertion, before diagnosis varied from 3 months to 5 years. In the 8 cases where the IUD migrated to the bladder, the erosion took at least 10 years. The case reported here had the longest reported duration period. Once the IUD entered the bladder in 12 cases, calcium at least partially surrounded it.
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PMID:Intravesical migration of intrauterine device. 172 5

Maternal mortality is examined from June 1980 to December 1986 at Mulago, Nsambyo, Old Kampala, Rubaga, and Mengo Hospitals in Kampala, Uganda. Clinical or immediate causes, direct and indirect, were recorded from case summary forms based on ICD9 definitions of obstetric complications. The nonabortion maternal mortality rate (NAMMR) was 2.65/1000 deliveries (580 deaths); the abortion-related maternal mortality rate (ARMMR) was 3.58/1000 abortions. The hospital maternal mortality rate was 2.0/1000 deliveries. 75% of maternal deaths of women of 28 weeks' gestation or more had delivered outside the hospital. NAMMR doubled between 1980-86, a statistically significant increase. ARMMR increases were almost significant. 75% were direct obstetric and 21% were indirect obstetric causes. 38% had clinical anemia, 29% had some sepsis, 18% had substantial bleeding, and 14% had obstructed labor. Other contributing conditions were pneumonia, ruptured uterus, laparotomy, evacuations and curettage, malaria, preeclampsia, sickle cell anemia, pulmonary embolism, malnutrition, tetanus, meningitis, prolonged labor, and hepatitis. At admission, 48% were in poor condition, 30% in good condition, and 22% in fair condition. 27% had sickle cell anemia, high blood pressure, multiple pregnancy, or malaria at admission. 64% were admitted within 24 hours after delivery, 67% 1-7 days after delivery, and 92% 7-42 days after delivery. Those in good condition were all admitted 7 days postdelivery. 41% of deaths were due to lack of drugs, 7% lack of fluids, 20% with theater problems, 14% with doctor-related factors, and 3% with midwife-related factors. Better information is needed on mortality before delivery, mortality in hospitals vs. outside, and mortality from abortion, and ectopic and hydatidiform molar pregnancies. An explanation given for the increase in maternal mortality is the decline in economic conditions. Abortion complications may be due to the concealment practiced. Causes are consistent with trends from the 1950s, 1960s, and 1970s in Uganda and developing countries in general. Availability and accessibility of gynecological and obstetric services needs great improvement. Training traditional birth attendants and obtaining rural ambulance services are also needed. Health workers lack creativity and imagination for developing country conditions; scarce resources are not the only problem.
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PMID:Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986. 176 15

The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the feasibility of a national blood transfusion service network; 8) to improve transportation; 9) to educate young girls on health and sex; 10) to informally educate the masses on MCH; 11) to focus obstetrics and gynecology training primarily on practical skills in management of labor and delivery; 12) to research reproductive behavior; and 13) to assure every women the right to safe motherhood.
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PMID:Maternal mortality in India: current status and strategies for reduction. 181 58

Pelvic congestion syndrome is common to three pathologies: premenstrual syndrome, intermenstrual syndrome and chronic pelvic fibrous congestion syndrome. The two first syndromes are well-known. They are periodical and hormonal treatment is relevant in premenstrual syndrome (all forms of progesterone and provascular treatment). Chronic pelvic congestion syndrome or fibrous congestion is linked with fibrous changes of the subperitoneal cellular tissue after more or less lasting chronic congestion. It is sometimes secondary to low noised and unknown sepsis (Bret and De Brux fibro-sclerous pelviperitonis). It is usually linked with the traumatical rupture of cellular pelvic tissue from obstetrical etiology (Masters and Allen syndrome). In varicocele, uterine plexus and ilio-lumbar ligament, hormonal action has been suggested. Three signs overnite polymorphic clinical study: deep dyspareunia, moving cervix, uterus retroversion. But primitive or secondary congestion is only in fact evoked by coelioscopy even with its limits. When coelioscopy is negative, hysterophlebography will be achieved and will visualize sometimes extremely pelvic plexus vasodilatation. As function of findings lesions, treatment lays down 3 principles: first principle not to abuse with surgery except in case of testing patent ligamentary lesions. Second principle to prescribe a polyvalent general treatment with triade antibiotic, antiinflammatory and phlebotonic drugs. Third principle to be preventive by improving obstetrical exercise as usually this syndrome succeeds to a more or less traumatic delivery.
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PMID:[Clinical aspects and complementary tests in pelvic congestive states]. 183 82

This study was undertaken to determine the incidence of morbidity and mortality of emergency obstetric hysterectomy at the University of Nigeria Teaching Hospital, Enugu, and also the modalities for reducing these complications. Of the 84 cases of emergency obstetric hysterectomy carried out at the Teaching Hospital between January 1979 and December 1988, 43 had antenatal care at the Teaching Hospital while the remaining 41 were referred cases. Sixty patients were operated upon for ruptured uterus while the remaining 24 were as a result of post partum causes such as uterine atony, adherent placenta, lacerated cervix and sepsis. The leading post-operative complications were fever, haemorrhagic shock and sepsis. A maternal mortality rate of 29.8% was recorded, with the referred patients contributing 68% of the mortality. Better supervision of antenatal care in the community studied, improved blood transfusion facilities in the Teaching Hospital and adequate prophylaxis with antibiotics are recommended to reduce morbidity and mortality in operated cases.
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PMID:Emergency obstetric hysterectomy in eastern Nigeria. 186 83

During the period 1986-87, there were a total of 7523 deliveries at the Songea Regional Hospital, southern Tanzania. There were 39 maternal deaths, establishing a maternal mortality rate of 5.2/1000 deliveries. The major causes of death were sepsis after cesarean section for obstructed labor, ruptured uterus, and hemorrhage. 43.6% of the deaths were from women referred from long distances with a diagnosis of prolonged labor. It is emphasized that early and facilitated referral, together with the use of the partogram in labor and use of family planning services, will reduce the high maternal morality rate in this region.
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PMID:Maternal deaths at Songea Regional Hospital, southern Tanzania. 204 Feb 40

A family with autosomal dominant inheritance of sacral agenesis is described. Ten members were affected; four had associated presacral teratomas and anterior sacral meningoceles, giving rise to serious complications in three, including bacterial meningitis, local recurrence of teratoma and perianal sepsis. Three of those with presacral masses presented initially with anorectal anomalies. Other associated abnormalities included tethering of the cord, hydrocephalus, duplex ureter, hydronephrosis, vesicoureteric reflux, neurogenic bladder, bicornuate uterus, rectovaginal fistula and hereditary spherocytosis. Early diagnosis and surgical excision of a presacral mass is advised to prevent future morbidity and mortality.
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PMID:Hereditary sacral agenesis with presacral mass and anorectal stenosis: the Currarino triad. 205 99


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