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

An unusual case of twin unilateral interstitial pregnancy with premature rupture of membranes and leiomyomata uteri is described. A review of the literature reveals only two previous cases of this type. On admission, the patient was diagnosed as having an intrauterine pregnancy of 27 weeks' gestation, with documented premature rupture of the membranes having occurred. An ultrasound was performed revealing a fibroid uterus, an anterior placenta and an gestation. Septicemia ensued, and antibiotics plus pitocin was begun; however, no uterine response occurred. A culdocentesis revealed free intraabdominal blood. Laparotomy followed, revealing a ruptured twin interstitial pregnancy with placenta accreta and leiomyomata of the uterus.
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PMID:Unilateral twin interstitial ectopic pregnancy. A case report. 741 29

The Safe Motherhood Initiative was launched in 1988 as a global effort to halve maternal mortality and morbidity by the year 2000. The program uses a combination of health and nonhealth strategies to emphasize the need for maternal health services, extend family planning services, and improve the status of women. The maternal mortality rate (per 100,000 live births) is 390 for the world, 20-30 for developed countries, 450 for developing countries, and 420 for Asia. This translates into 308,000 maternal deaths in Asia, of which 100,000 occur in India. The direct causes of maternal mortality include sepsis, hemorrhage, eclampsia, and ruptured uterus. Indirect causes occur when associated medical conditions, such as anemia and jaundice, are exacerbated by pregnancy. Underlying causes are ineffective health services, inadequate obstetric care, unregulated fertility, infections, illiteracy, early marriage, poverty, malnutrition, and ignorance. India's Child Survival and Safe Motherhood Program seeks to achieve immediate improvements by improving health care. Longterm improvements will occur as nutrition, income, education, and the status of women improve. Improvements in health care will occur in through the provision of 1) essential obstetric care for all women (which will be essentially designed for low-risk women), 2) early detection of complications during pregnancy and labor, and 3) emergency services. Services will be provided to pregnant women at their door by field staff, at a first referral hospital, perhaps at maternity villages where high risk cases can be housed in the latter part of their pregnancies, and through the continual accessibility of government vehicles. In addition, family planning services will be improved so that fertility regulation can have its expected beneficial effect on the maternal mortality rate. The professional health organizations in India will also play a vital role in the success of this effort to reduce maternal mortality.
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PMID:Strategies for safe motherhood. 765 34

Extra-amniotic injection of prostaglandin F2a has proved to be an effective method of termination of pregnancy, although its use has been associated with serious complications including rupture of the uterus and maternal death. In this retrospective study of 45 patients who required termination of pregnancy in Eshowe Hospital for intra-uterine death or missed abortion two patients developed minor complications of this method. Forty four patients aborted between four hours 30 minutes and 18 hours 15 minutes after the injection. There was one patient who had a failed induction and who developed serious sepsis. It is not clear whether the sepsis was a result of the method used to induce labour or whether it was the primary pathology causing the intra-uterine death and failed induction.
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PMID:Termination of pregnancy using extra-amniotic prostaglandin F2a--experience in a peripheral hospital. 781 97

A 78-year-old woman was admitted to our hospital because of disturbance of consciousness. She had been diagnosed as uterus carcinoma and had undergone radiotherapy one year before admission. On admission, her body temperature was 35.5 degrees C and systolic blood pressure was 50 mmHg. Ascites and semicomatose consciousness were detected. Laboratory evaluation demonstrated the following values: leukocyte count 38800/microliters, blood sugar 3 mg/l and arterial blood pH 6.9. Therapy with catecholamine and antibiotics was started, but she expired 10 hours after admission. Bacteroides ovatus was detected from her blood. Autopsy findings disclosed abscess and perforation of the uterus, and liver cirrhosis. Hypoglycemia has rarely been described as a clinical manifestation of sepsis and this case is, to our knowledge, is the first report of sepsis complicated with hypoglycemia in Japan.
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PMID:[A case report: sepsis associated with hypoglycemia]. 793 Jul 92

Although lactobacillus species are among the most common commensal organisms of the mouth, digestive tract, and female genital tract, they rarely cause serious infection. A case of lactobacillus septicemia and pelvic abscess formation in a posthysterectomy patient with mixed Mullerian tumor of the uterus is presented.
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PMID:Lactobacillus sepsis with pelvic abscess. 802 Aug 48

The results of laparoscopic appendectomy under outpatient conditions are reported here from a retrospective analysis of the data for 78 women (aged 17-55) selected as having clinically acute or subacute appendicitis. Patients with severe disease presenting with sepsis or peritonitis were excluded, since they were referred to hospital. The duration of the procedure in the 78 women was 30-120 minutes (mean: 45), and only one minor intraoperative complication (a slight lesion to the uterus from the working trocar) was encountered. Follow-up was carried out by daily telephone interviews and a physical examination on the third or fourth postoperative day. Five postoperative complications (four cases of peritonitis and one stump insufficiency) were found two to seven days after the laparoscopic appendectomy, and these had to be treated by laparotomy. No severe sequelae or mortality were encountered. The calculated costs of the laparoscopic approach (DM 1,000.00 in total for anesthesia and operation) compared favorably with a conventional inpatient regimen covering seven days (DM 3,000.00-5000.00). We conclude that laparoscopic appendectomy under outpatient conditions is a safe and cost-effective modality for treating acute and subacute appendicitis in selected patients.
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PMID:Results of outpatient laparoscopic appendectomy in women. 807 48

Intraamniotic instillation of urea is a common mode of legal second-trimester pregnancy termination. Associated mortality rarely occurs and is most commonly due to amniotic fluid embolism, pulmonary thromboembolism, infection, hemorrhage, and disseminated intravascular coagulation (DIC). We present the case of an 18-year-old gravida 2, para 1 white woman at 18 weeks' gestation who underwent intraamniotic instillation of hyperosmolar urea and intracervical insertion of laminaria tents; 19 h later, she became unresponsive, academic, and went into shock. Coagulation studies were diagnostic of DIC. Bacilli were seen on peripheral blood smear. Autopsy showed marked subcutaneous emphysema of the anterior abdominal wall, necrosis and emphysema of the uterus, diffuse pulmonary alveolar damage, and renal cortical necrosis. Antemortem blood cultures grew Clostridium perfringens and Escherichia coli. Postmortem culture of the uterus grew E. coli. The source of infection was most likely the introduction of vaginal organisms via laminaria insertion. This is apparently the first reported case of death caused by Clostridium perfringens and E. coli sepsis following urea instillation.
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PMID:Fatal Clostridium perfringens and Escherichia coli sepsis following urea-instillation abortion. 832 37

Pregnancy used to be considered a contraindication for endoscopic surgery of the digestive tract. We report a case of cholecystectomy carried out laparoscopically for complicated gall stones in a woman who was 14 weeks pregnant. There was no post-operative maternal or fetal morbidity. The mother carried on the pregnancy to term normally and gave birth to a normal infant. The same results have been reported in the literature for three other cases of cholecystectomy and six of appendicectomy. The sole technical precautions that had to be undertaken were in introducing and placing the trocars, taking into account the size of the uterus. There has been no scientific proof that CO2 is toxic for the fetus. Clinical practice shows that endoscopic surgery is possible without any obstetrical risk including thrombo-emboli, nor specific sepsis occurring in any of the three trimesters of pregnancy. The advantages of the endoscopic approach are that there is less post-operative pain and therefore less need to take analgesics. There are no complications because of an abdominal wound and the patient can both feed and walk about immediately after the operation with a reduction of the time spent in hospital. There is probably less risk of aborting when compared with classical laparotomy. The endoscopic route can be chosen when surgery is needed in the digestive tract during pregnancy.
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PMID:[Endoscopic surgery during pregnancy. A case report of cholecystectomy]. 834 56

This randomised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation of the uterus. The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss (P < 0.0001) and a significantly higher mean haemoglobin level at follow-up compared with the 178 patients who had conventional curettage. Suction curettage was a faster procedure and less painful. No difference was found between the two groups with regard to the incidence of post-abortal sepsis, or the re-evacuation rate. No problems were encountered with the use of suction curettage in the presence of uterine sepsis. In an era where blood transfusions should be kept to an absolute minimum, suction curettage will help to save blood in several ways.
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PMID:Suction v. conventional curettage in incomplete abortion. A randomised controlled trial. 828 Feb 70

We report a rare case of non-menstrual toxic shock syndrome (TSS) in the course of Staphylococcus aureus sepsis in a 31-year-old primigravida who developed high fever and severe pulmonary and cardiovascular failure within a few hours at the end of the 29th week of a twin pregnancy. Mechanical ventilation was necessary due to signs of adult respiratory distress syndrome (ARDS) and catecholamines were needed to maintain a somewhat adequate blood pressure. A forceps delivery was performed immediately. Postoperatively, the patient was brought to the intensive care unit (ICU) due to the suspicion of severe septic shock. In addition to the extreme cardiovascular instability and massive disturbance of pulmonary gas exchange, the clinical picture was characterised by a disseminated intravascular coagulopathy (DIC) with marked petechial bleeding and ecchymoses on all extremities. Moreover, a confluent, spotty exanthem of the trunk and extremities could be seen. Despite all therapeutic efforts, the patient died within a few hours after admission to the ICU with signs of multiorgan failure. Post-mortem, multiple staphylococcal abscesses were found in the kidneys, liver, and uterus. Moreover, acute ulcerous endocarditis of the mitral valve and septic myocardial foci with myocarditis were seen. The Staph. aureus strain isolated from the blood cultures was shown to produce TSS toxin 1 (TSST-1) and enterotoxin B. In summary, the clinical picture can be interpreted as severe staphylococcal sepsis complicated by TSS. TSS is a specific type of infectious disease, occurring mainly in young women during the menstrual period (80%-90%), but it has also been reported in non-menstrual cases (10%-20%). It is characterised by sudden-onset high fever, hypotension, rash, mucosal hyperaemia, and various additional symptoms such as myalgia, vomiting, and diarrhoea. The clinical course depends on the extent of the organ failure due to decreased tissue perfusion during hypotension. Severe cases are accompanied by multiple organ-system failure including impaired renal function, which is reversible in nearly all cases. Respiratory failure ranges from interstitial and alveolar aedema to ARDS in 10% of cases; severe DIC is seen in 10%-15%. Another severe clinical complication is cardiac insufficiency. The etiology of TSS is based on a localized or, rarely, systemic infection with certain Staph. aureus strains that are capable of producing toxins, the most important one being TSST-1. Staph. aureus strains can also produce various other enterotoxins that may be involved in the pathogenesis of TSS. The pathogenetic importance of the toxins is supported by the antibody titers in TSS patients: more than 80% of healthy adults show high levels of antibody titers, whereas 90% of TSS patients exhibit low levels in the acute phase followed by a significant increase during convalescence. It is not clear whether the toxins cause TSS by a direct effect or by release of mediators due to their function as superantigens. The clinical characteristics of non-menstrual TSS are identical to those of menstrual TSS, but it can occur in many clinical settings in both sexes at any age. Severe clinical courses are more frequent in non-menstrual TSS: the mortality is about 8%-11% in non-menstrual TSS compared to 2%-5% in menstrual TSS. The diagnosis is based mainly on clinical signs and the isolation of toxin-producing Staph. aureus strains. Besides antibiotic therapy, treatment is primarily directed to the correction of hypotension and additional organ-system failure. Other therapeutic measures such as the elimination of toxins by plasma separation or the administration of antibodies or gamma-globulins are subjects of investigation with no general recommendations at this time.
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PMID:[Lethal, non-menstrual toxic shock syndrome associated with Staphylococcus aureus sepsis]. 859 62


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