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

We reviewed the records of 115 patients treated for upper gastrointestinal (UGI) bleeding on a general surgical and trauma service from January 1981 to June 1984. Clinical variables were analyzed with regard to three outcome criteria: mortality rate, blood transfusion requirements, and need for operation. Endoscopy was performed in all patients, usually within 24 hours of detection of bleeding. Thirty-six patients required greater than or equal to 5 U of blood, 27 patients required an operation for bleeding, and 26 patients (23%) died in the hospital. In 19 patients, death was attributed to the patient's underlying disease; in seven patients, death was due to bleeding or operation. Significant predictors of death were: age greater than or equal to 60 years old (p less than or equal to 0.02), disease in three organ systems (p less than 0.05), 5 U transfusion requirement (p less than 0.001), operation for bleeding necessary (p less than 0.03), lung/liver disease (p less than 0.03), and recent stress of major operation, trauma, or sepsis. Mortality rates were highest for bleeding varices (36%) and lowest for duodenal ulcers (7.7%) and gastric ulcers (15.8%). Endoscopy accurately determined the cause of UGI bleeding in most patients. The data suggest that the unchanging mortality rate for UGI bleeding is largely due to underlying disease or injury for which the success of current treatment is limited.
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PMID:Upper gastrointestinal bleeding: predictors of outcome. 349 3

The authors report the results of endoscopic obliteration of recently bleeding esophagogastric varices with Bucrylate (isobutyl-2-cyanoacrylate) in 49 patients. Forty-five patients had cirrhosis; in all patients, propranolol was contraindicated or had failed, hepatocellular function was poor, or early rebleeding had occurred. In 15 cases, injections were made during active bleeding of esophageal or gastric varices; in 14 cases, the hemorrhage stopped immediately. The cumulative percentages of patients free of variceal rebleeding 1.6 and 12 months after inclusion were 88.63 and 58 p. 100 respectively. The cumulative percentages of patients surviving 1, 12 and 18 months after inclusion were 70, 53 and 46 p. 100 respectively. The cumulative percentages of survival at 6 months after inclusion were 100.63 and 13 p. 100 in grade A, B and C patients respectively. The major causes of death were liver failure and sepsis; autopsy revealed mediastinitis in 3 patients. Long-lasting esophageal strictures developed in two patients. This procedure differs from endoscopic sclerotherapy in that gastric varices can be adequately obliterated and the risk of early rebleeding seems to be decreased.
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PMID:[Endoscopic obturation of esophagogastric varices with bucrylate. I. Clinical study of 49 patients]. 349 Oct 14

Denver type peritoneo-venous (PV) shunting for intractable ascites was performed in 16 patients also treated with endoscopic injection sclerotherapy (ST) for variceal haemorrhage. Indications, timing and results of shunt insertion are detailed and discussed. Serial ST for eradication of varices could be completed in 10 patients a median of 7 months before PV shunting. The postoperative risk of bleeding was increased four times, i.e. the number of GI bleedings per month of follow-up, was 0.05 and 0.21 (p less than 0.05) respectively, before and after shunt operation. Two patients experienced their first variceal bleeding and 6 patients rebled during a median follow-up of 3 months after PV shunting. The Denver shunt succeeded in resolving ascites clinically in 13 patients within 7 days with a median decrease in weight of 10 kg, parallel to increased urinary output and reduced serum-creatinine. Three patients did not benefit from the shunt procedure due to terminal neoplastic disease (one patient), and severe hepatorenal failure, although the shunts were proven patent. Serious complications included clinically important consumptive coagulopathy, DIC-syndrome (two patients), myocardial infarction (one), pulmonary embolism (three), and sepsis following intervention of obstruction (one).
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PMID:Peritoneo-venous shunting and endoscopic sclerotherapy in patients with portal hypertension. 349 19

Since 1974, 25 patients with biliary atresia underwent a modified Sawaguchi hepatoportoenterostomy. Seventeen of 18 patients operated on before the age of 10 weeks became free of jaundice within 2 to 4 months and had biliary intestinal continuity established by 10 months of age. Two of these patients experienced sudden diminution of bile flow with return of jaundice. Both responded to transconduit repeat resection of the portal fibrous tissue with resolution of jaundice, which allowed take-down of the biliostomy. At last follow-up 1 to 13 years postoperatively, all 17 patients were free of jaundice (94 percent of total). One patient in this group never had drainage of bile and eventually died from sepsis. In contrast, five of seven patients operated on after 10 weeks never had drainage of bile. Four of these patients died from hepatic failure and one from bleeding varices. Two patients initially had bile drainage and became anicteric, but thereafter, acute cessation of bile flow and reccurrence of jaundice occurred. Reoperation resulted in a definitive increase in bile flow in both of these patients. The modified Sawaguchi procedure is definitely preferable to liver transplantation as primary treatment in infants with biliary atresia, especially if operation is performed before the age of 10 weeks.
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PMID:Encouraging results with a modified Sawaguchi hepatoportoenterostomy for biliary atresia. 360 12

Thirty-four adult patients with portomesenteric venous occlusion (PVO) were reviewed. In 11 with hepatic cirrhosis, PVO was usually heralded by worsening ascites often with varix hemorrhage; mortality was high. Four with isolated portal block had varix hemorrhage without ascites. All of these patients survived despite recurrent hematemesis when portal decompression was not feasible in two patients. Eight others (5 agnogenic and 3 with hypercoagulability), experienced sudden abdominal pain with a clot typically propagated into mesenteric tributaries with ileojejunal infarction; survival was related to the promptness of operation and the extent of bowel ischemia. Of five patients with intraabdominal sepsis and pylephlebitis, only one survived. In the final six patients, PVO occurred with intraabdominal carcinoma. Five had progressive ascites, cachexia, and an early death. Imaging techniques included plain and contrast roentgenograms, ultrasonography, and for definitive diagnosis direct portography (operative or splenoportogram), indirect portography (splanchnic arteriovenogram), and computed tomography. Thirteen of 34 patients had ascites, and in nine of 11 patients examined, protein concentration of ascitic fluid was extremely low (less than 0.6 g/dl). Clinical presentation of PVO varies, depending on acuteness and extent of visceral venous blockade, severity of portal hypertension, auxiliary venous collateralization, and regional lymph flow. Inciting factors include endothelial damage and blood hypercoagulability from trauma, infection, stagnant circulation, blood dyscrasia, and malignancy. Improved imaging now allows early diagnosis.
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PMID:Protean manifestations of pylethrombosis. A review of thirty-four patients. 387 12

Ascites is the end result when the rate of conversion of plasma to peritoneal fluid exceeds the rate of reabsorption from the peritoneal cavity. Physiologic therapy demands the return of this fluid to the plasma volume from whence it arose. The peritoneovenous shunt was devised to accomplish this. If precautionary measures are followed, complications are avoided. The shunt can be accomplished with a mortality under 1% in uncomplicated cirrhosis without jaundice or hydrothorax. Postoperative coagulopathy and infection are avoidable complications. Shunt failure is partly preventable and can almost always be remedied. Patients must be carefully followed to prevent late sepsis: care must be even more rigorous than that given to implanted artificial heart valves, because of the lower resistance of cirrhotics to infection. The cause of death in ascites untreated by shunts is early renal failure that is averted by the shunt. The shunt does not prevent rupture of esophageal varices, a frequent mode of late mortality. Varices require separate therapy. Because the shunt is effective with minimal morbidity and mortality, the indications for a peritoneovenous shunt should be liberalized.
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PMID:The LeVeen shunt. 388 61

Peritoneovenous shunts (PVSs) have provided salutary effects on medically recalcitrant ascites, functional renal impairment, nutritional derangements, ventilatory embarrassment, and locomotion potential in patients with cirrhosis. While the LeVeen (LPVS) and Denver (DPVS) PVSs are most frequently implanted in such patients, postoperative complications of bleeding gastroesophageal varices, sepsis, and shunt occlusion occur with notable frequency. Addressing primarily the complication of PVS occlusion, a randomized prospective trial of LPVSs and DPVSs was conducted in cirrhotic patients with refractory ascites. From July 1, 1982 to July 1, 1984, 26 initial PVSs were implanted for hepatic-related intractable ascites. Twenty-two patients were eligible for randomization (cirrhosis, sterile ascites, initial PVS, total bilirubin level less than or equal to 6.0 mg/dL, prothrombin time less than or equal to 5-s prolongation, serum creatinine level less than or equal to 2.0 mg/dL [creatinine clearance rate greater than or equal to 20 mL/min], absence of recent [less than 30 days] bleeding gastroesophageal varices, or absent spontaneous encephalopathy). Twelve LPVSs and ten DPVSs were implanted; however, one patient with a DPVS was found to have hepatic polycystic disease and was excluded from analysis. All patients were followed up until death or Jan 1, 1985. The PVS patency determinations included contrast shuntography, technetium Tc 99m albumin scintigraphy, sequential manual compression (DPVS), and operative or autopsy observation. Using the Kaplan-Meier actuarial analysis, the LPVS patency proved to be highly superior to that of the DPVS, while survival was not significantly different. As LPVS and DPVS complications other than patency are comparable, the LPVS is preferred for its superior patency in cirrhotic patients with intractable ascites.
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PMID:LeVeen vs Denver peritoneovenous shunts for intractable ascites of cirrhosis. A randomized, prospective trial. 394 33

Although only about 2-3 percent of annual deaths are attributed to one of the four underlying causes linked to chronic alcohol use, research results suggest that the impact of alcohol is much greater. The recent issue of mortality multiple cause of death tapes from National Center for Health Statistics permit exploration of associations of chronic alcohol abuse with conditions coded as underlying cause of death and provide leads for case-finding. Data analysis is reported from certificates of resident deaths in the United States in 1978. There are 12 groups of underlying causes for which the percentage of pairings with chronic alcohol abuse ranges from 4-16 percent of the number of deaths from the underlying cause. Age, sex, and metropolitan status of residence are associated with a listing of chronic alcohol abuse among decedents of liver cancer, varicose veins, symptomatic heart disease, septicemia, and respiratory system disease. Planners concerned with secondary prevention can use these clues provided by logistic regression modelling as an aid in case-finding.
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PMID:The influence of alcohol abuse as a hidden contributor to mortality. 402 76

Of 26 patients who underwent distal splenorenal shunting 4 or more years ago (1969 to 1978), 10 died 3 to 87 months postoperatively (mean 38.5 months). Six deaths were due to liver failure, two to hemorrhagic peptic ulcer disease (the shunt remained patent in each patient), one to brain hemorrhage, and one to sepsis. Eight of the surviving patients resumed professional activity, one showed transient signs of encephalopathy, one had a single episode of recurrent variceal bleeding that could be managed conservatively, and no patient had ascites. Eight patients were investigated angiographically and endoscopically. Preoperative and postoperative measurements of the portal vein showed a decreased diameter in five patients and no opacification in the other three 29 to 97 months after surgery. At endoscopy four patients had small residual esophageal varices, one patient had none, and the other three had large varicosities with variceal pressures between 30 and 40 cm H2O in two and above 40 cm H2O in one. Although the incidence of postoperative encephalopathy and variceal bleeding was low after distal splenorenal shunting, the operation did not prevent a decrease in hepatopetal portal flow and did not always abolish the esophageal varices.
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PMID:Long-term follow-up after a distal splenorenal shunt procedure. A clinical and hemodynamic study. 660 May 87

Six cirrhotic patients underwent emergency esophageal transection utilizing the EEA Auto Suture stapling instrument for treatment of unrelenting variceal hemorrhage. All were grade C, and the combination of ascites, encephalopathy, and jaundice was present in four. All were critically ill with ancillary medical problems, including recent subtotal gastrectomy with sepsis and dehiscence, coexisting malignant biliary obstruction, and respiratory insufficiency. All were anergic to skin testing. Four died in the postoperative period, primarily of problems related to sepsis and ascites present before operation. Autopsy showed a well-healed anastomosis without stricture and complete interruption of the varices in all. No patient had recurrent bleeding. All received oral or tube feedings after operation. Two survive at 2 and 1.5 years with no recurrence of varices. This is a rapid, simple, and effective technique which can be done with minimal blood loss or training. There is no diversion of portal blood and minimal interruption of collateral circulation. Whereas the long-term benefits in terms of rebleeding are not yet known, results to date suggest a trial earlier and in better risk patients as a definitive treatment procedure.
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PMID:Treatment of bleeding esophageal varices by transabdominal esophageal transection with the EEA stapling instrument. 696 2


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