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

Septicaemia caused by Yersinia pseudotuberculosis in a female patient, aged 22, is reported. She had suffered from a chronic active hepatitis for 14 years and had been treated with corticosteroids and azathioprine. The Y. pseudotuberculosis septicaemia responded well to treatment with doxycycline orally, but the patient died 2 weeks later because of excessive bleeding from varicose veins of the oesophagus.
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PMID:Yersinia pseudotuberculosis as the cause of septicaemia in a patient with liver cirrhosis. A case report. 702 Mar 42

The authors submit the results of the follow-up of the dynamics of 10 acute stage plasma proteins (up to the 7th day) in two surgical model situations: 1. planned operation of colorectal carcinoma by an intraabdominal approach and 2. operation of extensive varicosities of the lower extremities. As reference groups 3. healthy subjects (blood donors) were used and 4. patients with developed postoperative sepsis. Based on the results, the authors provide evidence of the asset of some selected indicators they assessed such as transferrin, prealbumin, alpha-1 acid glycoprotein (orosomucoid) and C reactive protein, for the early diagnosis of postoperative septic complications.
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PMID:[Early diagnosis of septic complications in the postoperative period by determination of acute phase proteins]. 750 38

The TIPS (transjugular intrahepatic portosystemic shunt) procedure is a relatively new therapeutic treatment option for variceal bleeding secondary to portal hypertension. The TIPS procedure evolved in response to the need for a safe, nonoperative shunting procedure, and is becoming a practical alternative to surgically placed shunts. Possible complications of a TIPS include hemorrhage, postprocedure sepsis, shunt encephalopathy or decompensation. Development of shunt stenosis or occlusion is associated with re-bleeding. Three children (ages 10-13) with recurrent, significant variceal bleeding were referred for the TIPS procedure. Two had recurrent GI hemorrhage despite sclerotherapy. To date, all have maintained shunt patency for up to 1 year. None of these children have had significant re-bleeding episodes, and the only recurrence of varices was associated with an obstructed shunt. In this article, the author reviews both conventional treatment and the TIPS procedure for the child with bleeding varices. Nursing implications from a pediatric perspective are emphasized. Pediatric GI nurses must understand TIPS in order to prepare the child and family and to monitor for complications or shunt failure afterward.
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PMID:Transjugular intrahepatic portosystemic shunt (TIPS): a pediatric perspective. 785 7

Wound infection is a frequent complication and is related to various parameters: type of surgery, patient's age, nutritional status, associated diseases, length of surgery and hospital stay, use of prosthesis and drainage and finally surgeon's ability. The frequency of wound infection is reported between 1.5%-5.1% after "clean surgery" and the greatest source of microbial contamination is due to GRAM positive cocci either aerobic or anaerobic. The Authors present their experience of ultra short-term prophylaxis with Teicoplanin in 375 patients undergoing major ambulatory surgery. Median age was 49 years (15-87 ys); patients over 65 years were 22%. Hernias of the abdominal wall and varicose veins represent the diseases most commonly operated on. In 30% of the cases the patients selected for major ambulatory surgery were in II and III classes according to the standards of the American Society of Anaesthesiologists (A.S.A.). The ultra short-term prophylaxis with Teicoplanin was administered as follows: 400 mg, i.v., thirty minutes pre-operatively. The operations were performed under local or loco-regional anaesthesia. The choice of Teicoplanin was based on the strong bactericidal activity on GRAM positive cocci, including the methicillin-resistant Staphylococcus aureus infections, and on the long activity of the drug. The results were considered according to the American College of Surgeons scheme: no wound infection was observed and excellent local and general drug's tolerance were noticed. Ultra short-term prophylaxis in ambulatory surgery was chosen for the following reasons: large use of prosthesis, major risk of sepsis in older patients and at last for a badly accepted infective complications in outpatient surgery.
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PMID:[Teicoplanin in the prevention of wound infections in major ambulatory surgery]. 797 37

Orthotopic liver transplantation (OLT) is a life-saving procedure for end-stage liver failure. We reviewed 39 children (24 girls, 15 boys) who received OLT for biliary atresia from 1987 to 1991. Twenty had unsuccessful portoenterostomy, 6 were referred too late for a drainage operation, and the remaining 13 achieved bile drainage but developed portal hypertension. At transplant 37 had decompensated liver disease with varices (28), ascites (24), encephalopathy (17), and gastrointestinal bleeding (12). The median weight and age at transplant were 8 kg and 12.6 months, respectively. The median waiting time was 65 days. Forty-eight grafts (30 reduced and 18 whole) were performed; graft loss was 33% and 27%, respectively. Of the 30 segmental grafts, 15 were reduced conserving the left lateral segment and hepatic vein (Brisbane technique)--13 were from the left lobe and 2 from the right lobe. The overall subject survival rate is 72%. Eleven deaths occurred: primary nonfunction (3), sepsis (3), perioperative bleed (3), and other causes (2). Early complications included: hepatic artery thrombosis (5), hepatic vein thrombosis (2), bowel perforation (3), biliary leak (3), and acute rejection (8). Later complications were chronic rejection (4) and biliary stricture requiring reconstruction (3). Follow-up at 12 months confirms good quality of life for both child and family with catch up growth and normal development. Technical advances in reduction hepatectomy have allowed us to treat small babies under 1 year with an urgent requirement for OLT, with comparable results to those obtained with whole grafts. In conclusion, in the future size and age need not be a contraindication to OLT in children with biliary atresia.
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PMID:Liver transplantation in babies and children with extrahepatic biliary atresia. 822 94

With continuing improvements in the medical therapy of peptic ulcer disease, the incidence of primary upper gastrointestinal bleeding (UGIB) has markedly declined. Nonetheless, in a subset of surgical patients, secondary UGIB following a major operation may still be a source of substantial morbidity. To further elucidate this problem, we reviewed 103 cases of overt UGIB following all major surgical procedures conducted in two hospitals between July 1982 and June 1994. The prevalence of postoperative UGIB during this period was 0.39%. The mean interval between initial operation and UGIB was 16 days (range 1-55 days) and there was a high incidence of associated sepsis (26%). The source of bleeding was defined endoscopically in all cases and included gastritis (69.9%), solitary ulcers (17.5%), and other causes (12.6%). Postoperative UGIB (nonvariceal) was most commonly seen following portacaval shunting operations but mortality rates were highest in patients who developed UGIB after cardiovascular operations. We conclude that: (1) postoperative UGIB has become a relatively uncommon but still formidable clinical problem; (2) erosive gastritis continues to be the major source of UGIB but acute ulcers, varices, and other causes contribute to the total; and (3) postoperative UGIB is most likely to be fatal in cardiovascular patients and those who develop concurrent sepsis and/or multiorgan failure.
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PMID:Upper gastrointestinal bleeding following major surgical procedures: prevalence, etiology, and outcome. 880 77

Extrahepatic portal vein thrombosis (EHPVT) is the leading cause of variceal hemorrhage in patients with healthy livers; however, in an era of dynamic imaging, the incidental discovery of EHPVT places a special burden on the surgeon to understand the surgical implications of the disease in this setting. During the period 1989 to 1995, 23 patients (12 males and 11 females) were found to have EHPVT. In 20 (87%), this was an unexpected finding on ultrasound (11 of 23), abdominal CT scan (9 of 23), or both (9 of 23). In two patients, the diagnosis was suspected and confirmed with angiography, whereas in the other, the lesion was discovered at surgery. Only seven (30%) had hemorrhage as a presenting complaint. More typically (61%), abdominal pain alone or pain with sepsis was the indication for evaluation. In 20 patients (87%), there was an identifiable etiology for the EHPVT. A total of 15 operations were performed on 12 patients (52%), in 7 (4, variceal hemorrhage, and 3, bowel ischemia) as a direct consequence of the EHPVT and in five, for conditions not directly related to the EHPVT. Three of the 23 patients (13%) died, two (17%) following surgery and one (9%) from advanced malignant disease. No patients with hemorrhage (seven), even those who required a shunt for decompression (three) or devascularization (one), died. We found that the diagnosis of EHPVT is usually not related to variceal hemorrhage, but rather, abdominal symptoms that serve as an indication for the imaging study. Three subsets of patients emerged: (1) those requiring no surgery (11 patients), (2) those requiring surgery related to hemorrhage (4 patients), and (3) those requiring surgery for conditions other than varices (8 patients). In any of these circumstances, mortality (13%) was related to the underlying disease process rather than EHPVT. Given the earlier recognition of EHPVT, the natural history of the disease has been altered, with outcome reflecting the underlying disease rather than the sequelae of portal hypertension.
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PMID:Portal vein thrombosis in the adult: surgical implications in an era of dynamic imaging. 924 33

Portal hypertension hemorrhage (PHH) due to esophageal varices (EV) rupture in nearly 80% of cases, or gastric varices (GV) in the remaining 20%, account for one-fifth of the GI tract bleedings in a general hospital. Its frequency, but more importantly, its magnitude, that causes up to one-third of the cirrhotic casualties, deserves constant update in its management. Diverse inherent patient factors influence the course of any PHH, i.e., a) remaining liver function, which is determinant; b) variceal size; c) sepsis, and d) alcohol intake. Mortality due to PHH is 27% during the first week, 41% within 6 weeks and 75% by one year of follow-up after the index hemorrhage. Time of intervention is then of utmost importance. All these key circumstances determine the ultimate course of the bleeding event, in many cases to a greater degree than the opportunity and quality of the specific treatment itself. This diversity of influential factors also jeopardizes adequate patient randomization in trials designed to compare treatment modalities. During the last decade, EV sclerosis, when compared to conventional medical treatment (non-beta blockers), has proved useful to stop active bleeding in 71 vs. 31% of cases, decreasing early and late recurrence from 70 to 40%, and direct bleeding-related mortality from 24 to 9%, even when global mortality remains around 14% per year. Disappointing as it seems, remaining liver function is the determinant issue, but a biased underestimation factor may also play a role, due to greater surgical rescue of patients in the medical branch compared to EV sclerosis, 6 vs. 28%. Minor morbidity in 14% of sclerosis treatment has given way to endoscopic ligation with similar results and less morbidity. Prophylactic EV sclerosis was prohibited by prospective controlled trials, which demonstrated significant increase in bleeding and mortality, even though there might be a subgroup of patients with large varices or endoscopic prognostic signs of bleeding that decrease by 10% their incidence expected 35%/year bleeding. GV bleeding remains a challenge; where cyanoacrylate may be needed to improve immediate control and prevent recurrence of PHH. These patients, as well as those failures to endoscopic treatment are candidates for intrahepatic portosystemic shunt (TIPS), although long-lasting control is achieved, in most cases, by liver transplant.
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PMID:[Therapeutic endoscopy in portal hypertension. When, how and how far in 1998]. 1006 21

In 151 (17.5%) of 861 patients with liver cirrhosis regularly screened by sonography and determination of alpha-fetoprotein a hepatocellular carcinoma (HCC) was detected. Diagnosis was verified by sonographically guided fine needle puncture and exceptionally by laparoscopy and direct puncture. In 34 patients (22.5%) selection criteria for operation were a tumour diameter under 5 cm, no central localisation in the liver and at least 5 mm distant from the main structures; furthermore multilocular HCC and intra- and extrahepatic metastases were contraindications. Additionally Child-Pugh-classification should be A + B and urea synthesis rate 6 g per day. 27 patients (80%) had esophagogastric varices seen at endoscopy and 20 (59%) had bleeding episodes from varices managed endoscopically or surgically. Types of surgical resections were segmentectomy [17], bisegmentectomy [10] and oncologically defined wedge resections [7] using controlled hypotension and interrupted occlusion of the hepatoduodenal ligament. 4 patients (11.8%) died within 30 days of liver failure [3] and sepsis [1]. All patients could be followed up for eleven years: 18 patients died after 1.5-10 years of liver failure, tumour recurrence or second tumour and a cause not associated with HCC, 12 patients are living. Kaplan-Meier survival curves show that survival at 5 years is 50% and at 10 years 34%. The main indicators for a good prognosis were clinically the HBsAG-activity, the Child-Pugh-classification and the application of autologous blood, pathologic-anatomically the classification and grading and histologically the absence of vascular invasion, absence of satellites and a number of mitoses under 7 in the visual field. For tumour recurrence dysplasia is of positive influence.--Liver resection remains the most widely used therapeutic option for treatment of HCC in cirrhosis. The early and long-term results can be improved by early diagnosis, strict selection of patients for operation and the use of well defined clinical, pathological and histological criteria.
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PMID:[Small unilocular hepatocellular carcinoma (0 < 5 cm) in patients with liver cirrhosis. Early diagnosis, surgical indications, resection and prognosis]. 1096 Sep 74

Peritoneovenous shunt placement has been reported as a treatment of refractory ascites by general surgeons, but without a clearly established role. The authors successfully inserted shunts under ultrasonographic and fluoroscopic guidance in 12 patients who had symptomatic refractory ascites (nine men, three women; mean maintenance duration, 88.5 d). Nine patients had advanced liver cirrhosis (five with superimposed hepatoma). Other patients had stomach cancer, colon cancer, and complicated polycystic kidney disease. The mortality rate was 83%. Causes of death included bleeding from preexisting varices, sepsis, hepatic failure, rupture of hepatoma, and disseminated intravascular coagulation. The authors describe the feasibility, technical details, and short-term results of percutaneous peritoneovenous shunt placement.
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PMID:Percutaneous peritoneovenous shunt creation for the treatment of benign and malignant refractory ascites. 1174 23


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