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

This is a Phase II groupwide study of the Gynecologic Oncology Group (GOG) to determine the toxicity and efficacy of a combination of ifosfamide and doxorubicin in patients with advanced or metastatic leiomyosarcomas of the uterus who had not received other chemotherapy. Thirty-five women were entered into this study; 1 patient was ineligible (primary not documented), leaving 34 patients treated with ifosfamide, 5.0 g/m2/24 hr, and mesna, 6.0 g/m2/36 hr, by continuous IV infusion preceded by doxorubicin, 50 mg/m2 iv over 15 min. Each course of therapy was repeated every 3 weeks if counts allowed. One patient was inevaluable for response, leaving 34 evaluable for toxicity and 33 evaluable for response of chemotherapy. GOG grade 3 or 4 granulocytopenia occurred in 17 patients (48.6%), 2 patients developed granulocytopenic fever (5.7%), and 1 died of sepsis. Two patients developed grade 3 thrombocytopenia, and 1 died of cardiotoxicity. There were nine partial and one complete responses for an overall response rate of 30.3%; the response duration averaged 4 months. The combination of ifosfamide and doxorubicin is toxic but has moderate activity in patients with advanced or metastatic leiomyosarcoma of the uterus.
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PMID:Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcomas of the uterus: a Gynecologic Oncology Group study. 875 54

Between the 1st July 1990 and the 30th June 1995, 34 caesarean hysterectomies and 2708 (22%) caesarean sections were performed from 12,227 births on the I. Department of Obstetrics and Gynaecology Semmelweis University Medical School in Budapest. From all 34 cases, hysterectomy were performed in 9 cases (26%) after complicated delivery, in other 9 cases (26%) during elective caesarean section and in 16 cases (47%) during urgent caesarean section. The incidence of caesarean hysterectomy is 2.7/1000 labour in our study. We listed the placenta increta, placenta accreta, placenta adherens, placenta praevia, uteroplacental apoplexia, scar disruption, uterus rupture, atony, sepsis puerperalis, abruptio placentae, haematoma paravaginale as urgent indications and so elective indications were myoma uteri, cervical carcinoma, ovarial tumour and in-situ cervical carcinoma. We collect the elective and urgent indications of caesarean hysterectomy and summarize the possible operative and postoperative complications in our study.
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PMID:[Postpartum hysterectomy]. 875 6

A two and a half year review of 39 peripartum hysterectomies done at Ga-Rankuwa Hospital from 1 January 1993 to 30 June 1995 was conducted. There were a total of 21,108 deliveries, 4,894 (23.19 pc) of which were caesarean deliveries. The ages of the patients ranged from 17 to 46 years and parity from 0 to 9. A large number, 31 (79.5 pc) of the patients were unbooked. The commonest indications were ruptured uterus 14 (35.9 pc) puerperal sepsis 13 (33.3 pc) and post partum haemorrhage four (10.3 pc). The complications included wound dihescence, sepsis, bladder injury, ureteral injury and two deaths occurred.
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PMID:Peripartum hysterectomy at Ga-Rankuwa Hospital: a two and a half year review. 886 82

The management of a pregnancy complicated by uterus myomatosus remains being controversially discussed. Myomectomy early in pregnancy is opposed by exspectative management with myomectomy subsequent to the post partum period. Therapeutic abortion and exstirpation of the gravid uterus represent only hypothetical but not reasonable alternatives. Complications like ureteral obstruction, sepsis, and torsion of the uterus with subperimetrial bleeding as a cause of fever of unknown origin may occur. Rapid growth of a fibromatous uterus in pregnancy may call for a biopsy. Two cases are presented to demonstrate that with intensive pregnancy surveillance exspectative management is justified and may lead to successful confinement of the pregnancy.
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PMID:[Pregnancy and extreme myomatous uterus--conservative management]. 899 21

In the relatively long history of man, surgery has been a comparatively recent development; the abdomen was first deliberately opened to remove an ovarian cyst by Ephraim McDowell in Kentucky in 1809. The first abdominal hysterectomy was performed by Charles Clay in Manchester, England in 1843; unfortunately the diagnosis was wrong and the patient died in the immediate post-operative period. The following year, Charles Clay was almost the first to claim a surviving patient, however she died post-operatively and it was not until 1853 that Ellis Burnham from Lowell, Massachusetts achieved the first successful abdominal hysterectomy although again the diagnosis was wrong. Vaginal hysterectomy dates back to ancient times. The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. The early hysterectomies were fraught with hazard and the patients usually died of haemorrhage, peritonitis, and exhaustion. Early procedures were performed without anaesthesia with a mortality of about 70%, mainly due to sepsis from leaving a long ligature to encourage the drainage of pus. Thomas Keith from Scotland realized the danger of this practice and merely cauterized the cervical stump and allowed it to fall internally, thereby bringing the mortality down to about 8%. Hysterectomy became safer with the introduction of anaesthesia, antibiotics and antisepsis, blood transfusions and intravenous therapy. During the 1930s, Richardson introduced the total abdominal hysterectomy to avoid serosanguineous discharge from the cervical remnant and the risk of cervical carcinoma developing in the stump. Apart from this innovation, and the transverse incision introduced by Johanns Pfannenstiel in the 1920s, there was little advance in hysterectomy techniques until the advent of endoscopic surgery and the performance of the first laparoscopic hysterectomy by Harry Reich in Kingston, Pennsylvania in 1988. The refinement and increasing safety of laparoscopic hysterectomy suggests that it will be used increasingly in the future, although developments in pharmacology and photodynamic therapy and interventional radiology may reduce the traditional indications for the operation.
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PMID:Hysterectomy: a historical perspective. 915 33

Disseminated intravascular coagulation is the result of a severe underlying disorder that initiates massive activation of the coagulation system. It is always a symptom of the underlying disorder. These disorders may be as varied as meningococcemia and abdominal aortic aneurysm. Disseminated intravascular coagulation is a clinical diagnosis. Once the clinical impression has been considered, a small number of readily available tests will substantiate the diagnosis. Further testing is probably not necessary and certainly not cost-effective. Therapy for disseminated intravascular coagulation requires 1) the correction of the underlying problem, either by drainage of an abscess for sepsis, evacuation of the uterus in an obstetric catastrophe, or treatment of septicemia with antibiotics; and 2) the concomitant restoration of the circulatory system, perfusion, blood pressure, and electrolyte balance. Other forms of therapy are available but are quite secondary to these two. Success depends on the ability to recognize and correct the cause.
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PMID:Disseminated intravascular coagulation. 937 26

Beta-hemolytic Streptococcus agalactiae serotype V was identified as the cause of an infection in laboratory mice. Principally, the organism induced fatal septicemia in DBA/2 breeding-age mice. The syndrome appeared to originate as an ascending pyelonephritis, which progressed to septicemia. Microscopic lesions were found in the heart, kidneys, spleen, and liver, and less commonly in the uterus, thoracic cavity, lymph nodes, and lungs. The epizootic was controlled by eradication of the breeding colonies, disinfection of the barrier, and autoclaving of all equipment. The new replacement colonies have remained free of the organism.
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PMID:Epizootic of group B Streptococcus agalactiae serotype V in DBA/2 mice. 951 86

This study assessed the nature and extent of maternal mortality (MM) among a cohort of pregnant women in urban Bamako, Mali. Data were obtained from a sample of 5782 pregnant women identified during March 1989 and September 1992. Interviews were conducted at 6 weeks and 1 year after delivery. Other clinical information was collected from households and medical records in 1993. By 1994, 4717 women had been traced. Over 95% of the sample were married and Muslim. About 16% were primiparous. Over 25% had 4 or more children. Most women had some contact with local health centers during pregnancy. Only 10% delivered at home. 24-55% delivered in maternity units that were different from their source of prenatal care. 4580 had live births; 198 had late abortions or stillbirths. The MM ratio was 327/100,000 (15 deaths). The lifetime risk of maternal death was 2.7%. Inclusion of the 5 late maternal deaths raised the MM ratio to 436/100,000. 13 deaths were due to direct causes. 7 deaths were due to hemorrhage, including 1 abortion and 2 cases of ruptured uterus. 4 were due to hypertensive disorders during pregnancy. 3 died from sepsis after cesarean section, including 2 cases of obstructed labor. 6 women delivered and died at a national teaching hospital. 5 were delivered at a district maternity hospital and died at the referred national teaching hospital. 3 died at home.
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PMID:Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali. 1042 61

We report our experience in a woman with a twin pregnancy. The patient suffered severe Escherichia coli chorioamnionitis and the outcomes were different between the two babies after birth. The first baby had only a mild infection, but the second suffered sepsis and subsequent perinatal death. These differences in outcome appeared to be due to amniotomy performed for the first baby after late labor stage I to augment uterus contractions. Removal of infectious amniotic fluid from the amniotic cavity might thus have prevented the spread of the chorioamnionitis. E. coli sometimes causes severe infection during pregnancy and the perinatal period. In this case, a large number of enteropathogenic E. coli (serotype O-6) was cultured from blood, stool, pharyngeal swab, gastric juice and puncture fluid from the thoracic cavity of the second baby. O-6 is classified an enterotoxigenic strain mainly causing diarrhea because of endotoxin released from bacteria. O-6 has not hitherto been reported as a cause of severe infection in chorioamnionitis and perinatal sepsis.
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PMID:Does amniotomy influence the prognosis of babies in cases with severe chorioamnionitis? Report of a twin pregnancy with varying outcome. 1070 15

The causes of non-haemorrhagic obstetric shock (pulmonary thromboembolism, amniotic fluid embolism, acute uterine inversion and sepsis) are uncommon but responsible for the majority of maternal deaths in the developed world. Clinically suspected pulmonary thromboembolism should be treated initially with heparin and objective testing should be performed. If the diagnosis is confirmed, heparin is usually continued until delivery, following which anticoagulation in the puerperium is achieved with either warfarin or heparin. Amniotic fluid embolism is a rare complication of pregnancy, occurring most commonly during labour. The management of amniotic fluid embolism involves maternal oxygenation, the maintenance of cardiac output and blood pressure, and the management of any associated coagulopathy. Acute uterine inversion arises most commonly following mismanagement of the third stage of labour. The shock in uterine inversion is neurogenic in origin, although there may also be profound haemorrhage. The management of this condition includes maternal resuscitation and replacement of the uterus either manually, surgically or by hydrostatic pressure. Genital tract sepsis remains a significant cause of maternal death, the most common predisposing factor being prolonged rupture of the fetal membranes. The management of septic shock in pregnancy includes resuscitation, identification of the source of infection and alteration of the systemic inflammatory response.
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PMID:Non-haemorrhagic obstetric shock. 1078 58


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