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

In order to give an overview of recent advances in general surgery, it is necessary to define: (i) what is general surgery; (ii) what is recent; and (iii) what constitutes an advance. General surgery appears to have entered an era of conservatism. This is particularly evident in the surgery of breast cancer, peptic ulceration, varicose veins, liver trauma, portal hypertension, upper gastrointestinal bleeding, and hiatal hernia. Controlled clinical trials in surgery have become popular. The following are considered to be advances: parenteral nutrition, suction drainage, control of Gram-negative sepsis, bypass surgery for pathological obesity, and a discriminatory approach to transplant surgery.
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PMID:Recent advances in general surgery. 41 36

This report describes our experience at wound closure using metallic staples and nylon sutures in 150 patients undergoing elective ligation and stripping for varicose veins. We compared the two methods for speed of closure and wound complications. Closure by Auto Suture is delightfully quick. Fewer patients developed complications from the staples as judged by wound sepsis, separation of the incision and keloid formation.
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PMID:A comparison of staples and nylon closure in varicose vein surgery. 110 30

Hepatolithiasis or intrahepatic stone is associated with a variety of complications of which biliary sepsis is one. Left untreated, infection results in formation of micro-abscesses, portal thrombophlebitis and fistulation into adjacent structures. With repeated infection, biliary strictures and severe destruction of liver parenchyma occur. Biliary cirrhosis, portal hypertension and bleeding varices are the terminal manifestations. Early recognition and proper treatment are essential for the prevention of severe complications and functional deterioration.
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PMID:Complications of hepatolithiasis. 131 24

The results of esophageal varices treatment in two groups of patients are shown. The first group consists of 351 patients who suffered an hemorrhage and were treated with sclerosing varices during the acute period or in the intervals of bleedings. The second group consists of 90 cirrhotic patients to whom a prophylactic treatment was administered. From 67 patients treated during acute hemorrhage 6 (9%) died due to hemorrhage, 6 (9%) due to hepatic failure and 1 (1.5%) due to sepsis. The 90 cirrhotic patients with prophylactic treatment were divided in 3 groups. In the first group of 30, 15 were sclerosized and 15 did not get treatment. From the second group of 32, 16 got propranolol and 16 no treatment. In the third group of 28, 14 got propranolol and were sclerosized and 14 were not treated. In all three groups with treatment hemorrhage ceased in a statistically significative manner. Surviving was the same in the treated and non-treated groups. Most patients died due to an hepatic failure.
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PMID:[Sclerosing treatment of esophageal varices]. 182 Jun 95

Deep venous thrombosis and its complication pulmonary embolism are responsible for more than 50,000 deaths annually in the US, 2/3 of which occur postoperatively. Nearly 75% of such deaths could be avoided by adequate prophylaxis. All forms of surgery entail some risk of deep venous thrombosis, ranging from 10% after endoscopic prostate resection to over 50% for total hip replacement. 1.6 of thromboses will embolize and 1/4 of pulmonary emboli are fatal. The goal of prevention is to decrease the incidence of fatal pulmonary emboli while limiting the risks related to prevention. A secondary goal is to reduce the frequency of postthrombotic syndrome, a late complication of deep venous thrombosis which frequently causes invalidism. A preoperative evaluation of risks of deep venous thrombosis and of the likelihood of bleeding problems should be followed by selection of appropriate preventive measures. The evaluation should be repeated postoperatively, taking into account such factors as the duration of the intervention, the diagnosis, and the predicted duration of bed rest. Evaluation of the risk of deep venous thrombosis requires knowledge of its etiopathogenesis. Deep venous thrombosis results from a multifactorial process involving venous stasis, lesion of the vascular wall, and anomalies of blood composition. All the clinical risk factors for deep venous thrombosis are related to 1 or more of these elements. Risk factors related to stasis include immobilization, postoperative or postpartum status, pregnancy, and Cockett's syndrome. Risk factors related to lesions of the vascular wall include hip surgery, trauma, age, sepsis, varices and obesity, and postthrombotic syndrome. Risk factors related to blood anomaly include postoperative status, pregnancy, oral contraceptive use, cancer, nephrotic syndrome, hypercoagulability, trauma, and heredity. The most common clinical risk factors for deep venous thrombosis are age, surgical intervention, trauma, burns, cancer, pregnancy and delivery, oral contraceptive use, varices, obesity, and postthrombotic syndrome. The relative risk of deep venous thrombosis among OC users is 4.0 overall and higher for those with type A blood. The pathogenic mechanisms are similar to those of pregnancy except that the fibrinolytic capacity is not change. The principal mechanism is perhaps the declining level of antithrombin III, observed with estrogens and some progestins. Among methods of prevention are different forms of compression, use of heparin alone or in combination with other drugs, and oral anticoagulants.
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PMID:[Epidemiology and etiopathogenesis of deep venous thrombosis of the lower limbs]. 224 Apr 6

A 11-year-old white girl presented with a diagnosis of thrombosis of the portal vein after newborn septicemia. Duplex sonography revealed significant narrowing of the portal vein and its right and left branches. A Doppler signal could only be obtained in certain short segments of the portal vein and indicated hepatopetal flow. Color-coded Doppler sonography showed extensive varicose veins in the gallbladder with a bigger draining vessel running to the porta hepatis. Documentation of varices like those in the gallbladder wall confirms the diagnosis of portal hypertension and may increase the sensitivity of Doppler sonography. Color mapping has the potential to detect unexpected flow and to analyze blood flow to better advantage.
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PMID:Color-coded Doppler evaluation of cholecystic varices in portal hypertension. 228 47

In 27 patients who had bled from esophagogastric varices, large-sized and/or actively bleeding gastric varices were endoscopically obturated with the tissue adhesive butyl cyanoacrylate. Active bleeding was stopped in six patients. Rebleeding occurred in 10 patients; in four patients, rebleeding was due to ruptured gastric varices, occurred early and was successfully treated by reinjection of gastric varices; in one patient, rebleeding was attributed to ulceration on an injected gastric varix. Eight patients died: two of rebleeding (from esophageal varices or undetermined source), four of sepsis and/or liver failure and two at home of undetermined cause. No specific complication due to injection of gastric varices was observed. The results obtained in this series of patients with gastric varices obturated by injection of butyl cyanoacrylate are much more satisfactory than those obtained in previously published series of patients with gastric varices treated by injection of sclerosants.
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PMID:Successful endoscopic obturation of gastric varices with butyl cyanoacrylate. 255 Mar 45

Thrombophlebitis is defined as thrombotic inflammation of a previously healthy superficial vein, varicophlebitis as that occurring in varicosities. The latter appears responsible for the majority of thrombotic venous occlusions. In contrast to venous thrombosis, the thrombotic involvement of deep veins, thrombophlebitis usually resolves without sequel and, in general, thrombophlebitis nor varicophlebitis are associated with the risk of pulmonary embolism. The clinical presentation of thrombophlebitis is that of a tender, hardened superficial vein which, in the presence of inflammation, may be very painful. The lower extremities are most frequently involved. Differential diagnostic considerations include bacterial cellulitis and lymphangitis. The cause of thrombophlebitis, which is rare without precipitating factors, may be a mechanical lesion such as kinking of the vein or trauma to the wall of the vein as well as other primary disease such as auto-immune afflictions, endangiitis obliterans or malignancy; in particular, with localization in the area of the rump, with concomitant occurrence in various regions or extending phlebitis, paraneoplastic syndromes and hemoblastoses should be ruled out. Rarely, phlebitis may be associated with tuberculosis and syphilis. Thrombophlebitis may be caused iatrogenically by improper application of chemical substances which cause damage to the venous walls as well as by indwelling catheters or cannulas. This form can progress to sepsis and pulmonary embolism may be incurred. Varicophlebitis, in contrast, accounts for about 90% of all cases of phlebitis and can be regarded as a typical late complication of varicosities in the superficial venous system.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pathogenesis, diagnosis and therapy of thrombophlebitis and varicophlebitis]. 268 Aug 51

Nine patients with bleeding oesophageal varices, who had not responded to aggressive conservative treatment, underwent emergency transabdominal oesophageal transection and reanastomosis using a mechanical stapling instrument. According to the classification of Child, 2 were graded as Class A, 4 as Class B, and 3 as Class C. Successful control of haemorrhage was achieved in all patients. Three patients died 15-33 days postoperatively. Causes were hepatic failure, sepsis and circulatory insufficiency. Recurrent variceal bleeding occurred in one patient after 15 and 23 months. One patient bled from the oesophageal wall were a clips had slipped after 17 months. One patient required postoperative dilatation due to oesophageal stricture. There was no anastomotic leakage and no cases of hepatic encephalopathy. One patient died after 26 months from an intercurrent disease. The remaining 5 patients are alive and free from symptoms related to varices 6, 20, 24, 25 and 32 months postoperatively. When other measures prove ineffective, transection with the EEA instrument can be recommended to control exsanguinating haemorrhage from oesophageal varices. It seems to be a useful additional procedure to those already in use. For definite assessment and conclusion, however, more experience from additional operations must be gained and longer follow-up is required.
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PMID:Emergency oesophageal transection for uncontrolled variceal bleeding. 348 3

A retrospective necropsy survey of 13 patients who had received endoscopic injection sclerotherapy was carried out to study tissue changes induced and to determine the causes of death. These results were compared with autopsy findings in nine patients with portal hypertension, comparable for age, sex, and nature and severity of underlying liver disease, who had not received sclerotherapy. Although all treated patients had variceal thrombosis with an associated vasculitis, residual varices were usually present, probably reflecting the brief duration of treatment (median, 12 days). The major complications of sclerotherapy resulted from necrosis, with resultant mucosal ulceration and abscess formation. These features were not present in the control group. Complications contributing to death were hemorrhage in three patients, and in one sepsis with deep necrosis and periesophageal abscess formation.
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PMID:Endoscopic sclerotherapy: lessons from a necropsy study. 348 38


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