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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 find out the predisposing factors of local complications after appendectomy in two general hospitals, 268 charts of patients with acute appendicitis confirmed by surgery were reviewed. There were 142 males and 126 females. All wounds were closed and prophylactic antibiotics were not used. Sixty patients (22 per cent) developed local complications; 49 (81.7 per cent) surgical wound infection and 11 (18.3 per cent) with intra-abdominal abscess. In the wound infection group 25 per cent had complicated acute appendicitis and only one per cent non-complicated acute appendicitis. The correlation between the preoperative period and wound sepsis showed, the longer period the higher incidence of wound infection, 1.7 per cent with less than 24 hr. 11 per cent with less than 72 hr. and 78.9 per cent with more than 96 hr.
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PMID:[The local complications of appendicitis]. 771 63

During a 10-year period we operated on 816 children with a diagnosis of acute appendicitis. Of these, 36 (4.5%) were under 5 years of age. A retrospective analysis was made of these 36 cases to assess the natural history, management and outcome in these children. Abdominal pain was the commonest symptom but was not invariable, being present in only 32 of the 36 children while vomiting was present in 28 children. Localized tenderness in the right iliac fossa was present in 21 children and generalized in 10. In 5 children there was a delay in diagnosis in excess of 18 h. The overall perforation rate was 50% as assessed macroscopically and was inversely proportional to the child's age. There was no mortality and the wound sepsis rate was 16.6%. The low incidence of acute appendicitis in very young children means that it is often overlooked. A high index of suspicion may contribute to earlier diagnosis and thereby reduce morbidity.
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PMID:Acute appendicitis in the under-5 year old. 793 37

The diagnosis of abdominal infections and inflammations often presents considerable difficulty, and various imaging techniques may be required to localize them accurately. At present, radiolabelled leucocytes offer the most widely accepted radionuclide method for imaging inflammation. Because of the many advantages of technetium-99m (99mTc) over indium-111 (111In), 99mTc-HMPAO-leucocyte scintigraphy is preferred for the investigation of acute abdominal sepsis and inflammatory bowel disease, and 111In-leucocyte scintigraphy for more chronic infections and renal sepsis. The 99mTc-HMPAO-labelled leucocytes technique is highly accurate within the first few hours postinjection, and is therefore useful also in acutely ill patients. It is sensitive in detecting abdominal abscesses in all locations except the liver and spleen. By whole body imaging, unsuspected sites and types of infection can be found. 99mTc-HMPAO-leucocyte scan is valuable also in the investigation of acute cholecystitis in problematic situations in which ultrasound is known to give misleading results, especially in acute acalculous cholecystitis. In inflammatory bowel disease it can reliably assess disease activity, but a normal scintigraphy does not exclude mild inflammation. Leucocyte scan is useful also in suspected acute appendicitis, acute diverticulitis, pelvic inflammatory disease, aortic graft infection, etc. But infection and inflammation cannot reliably be differentiated, which may cause misinterpretations in the early postoperative period. Radionuclide techniques have an important role to play in the investigation of abdominal sepsis if the nuclear medicine department can offer instant investigations when the clinical problem is acute.
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PMID:Investigation of suspected intra-abdominal sepsis: the contribution of nuclear medicine. 797 41

Twenty-four patients with homozygous beta-thalassaemia who had been splenectomised and currently on treatment were studied retrospectively. They were divided into two groups. Group A: who had splenectomy prior to commencement of any regular blood transfusion. The mean haemoglobin for this group rose from 5.5 gm/dl pre-splenectomy to 7.7 gm/dl post splenectomy (p < 0.001). Group B: who were on regular blood transfusion when they had their splenectomy and the mean blood transfusion requirement dropped from 317 ml/kg/yr to 230 ml/kg/yr of packed red cells following splenectomy (p < 0.001). Three patients who were on regular blood transfusion and desferrioxamine developed Yersinia enterocolitica infection. They presented with fever and signs of an acute abdomen. At laparotomy, 2 of the patients had acute appendicitis. All 3 appendices grew Yersinia enterocolitica and one patient also had a Yersinia enterocolitica septicaemia. If a patient develops fever and enteritis, desferrioxamine should be stopped temporarily and cotrimoxazole started as prophylaxis against systemic Yersiniosis. No cases of pneumoccocal sepsis was reported.
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PMID:Homozygous beta-thalassaemia: a review of patients who had splenectomy at the Royal Alexandra Hospital for Children, Sydney. 800 82

Antimicrobial resistance of operative site flora was correlated with postoperative infection in 175 patients undergoing operation for intra-abdominal sepsis: Diagnoses for study patients were acute or gangrenous appendicitis in 48 (27%), complicated appendicitis in 98 (56%), perforated viscus other than appendix in 21 (12%), and eight (5%) had other intra-abdominal infections. One hundred thirty-six (78%) patients were males. The average age was 33 +/- 14 years, average number of hospital days was 11.6 +/- 13.5, and average number of days on antibiotics was 6.9 +/- 2.5. Overall recovery without infection was 75 per cent (131/175). Analysis of susceptibility of 939 intraoperative isolates indicated a significant relationship (P = 0.0002) between resistance to the empiric antimicrobials received and postoperative infection. Of 131 patients with resolution of the intra-abdominal infection, 57 (44%) had resistant isolates while 36 (82%) of 44 patients with postoperative infectious complications had resistant isolates. Streptococcus Group D, Escherichia coli, and Bacteroides fragilis were the most prevalent resistant organisms isolated from both intra- and postoperative cultures. Other variables that were significantly different between those without complications and those who had complications were, respectively: average age 31 versus 38; admission WBC 14.5 versus 16.7; and diagnosis, acute appendicitis 28 per cent versus 2 per cent. A stepwise logistic regression analysis confirmed the predictive value of intraoperative isolate resistance, age, and admission WBC, in that order, on outcome.
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PMID:Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection. 825 30

During April to August 1992, laparoscopies were performed in this department in 35 of 100 cases of appendicitis. The average patient age was 29 years; 18 of the 35 (51%) were women; 3 patients were operated on electively, and the rest as emergencies. Appendectomy was performed in 33 (94%), but not in 2 women with sepsis due to tubo-ovarian abscess; In 1 of these 2 we had to convert to laparotomy. Acute appendicitis was found in 20 (57%). In 7 women (20%) gynecologic disease was diagnosed. In 1 case (3%) a carcinoid tumor of the tip of the appendix was found and in another primary peritonitis. In the remaining 6 (17%) no lesions were found. In 33 (94%) a regular diet was resumed 25 hours postoperatively and 25 (71%) were discharged the day after operation. The only complication was an abdominal wall hematoma in a single case, which resolved spontaneously. It is our impression that laparoscopy is a useful diagnostic tool in acute appendicitis, that it is a safe route for appendectomy, and that recovery is quick with minimal complications.
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PMID:[Experience with laparoscopic appendectomy]. 834 23

Augmentin as single agent was compared to the combination of metronidazole/gentamicin in the prevention of sepsis after appendicectomy. Two hundred patients admitted to Riyadh Central Hospital with a clinical diagnosis of acute appendicitis were enrolled in a prospective randomized study. All patients had a preoperative chest X ray, CBC, urinalysis and any other necessary investigations. Patients received either drug regime intravenously, 30 min prior to surgery. The overall incidence of wound infections in the Augmentin group was 8% as compared to 14% in the metronidazole/gentamicin group. There were no intra-abdominal abscesses in either group. Patients with perforated or gangrenous appendices received a 3- to 5-day course of treatment. All the early wound infection (2-4 days after operation) occurred in patients with gangrenous or perforated appendices. The results were studied statistically using chi 2 and there was no statistically significant difference between the infection rates in the two treatment groups whatever the state of the appendix at operation. Augmentin is as effective and well-tolerated as metronidazole/gentamicin in the prevention of wound infection following appendicectomy. The ease of administration of one drug with added anti-anaerobic property makes Augmentin superior to the tested combination.
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PMID:Comparative study of augmentin versus metronidazole/gentamicin in the prevention of infections after appendicectomy. 848 7

This study reports major gastrointestinal complications in a group of 416 patients following kidney transplantation. Three hundred and ninety-nine patients received a cadaveric kidney while the other 17 received a living related organ. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, and cyclosporin. Perforations occurred in the colon (n = 6), small bowel (n = 4), duodenum (n = 2), stomach (n = 1), and esophagus (n = 1). There were five cases of acute pancreatitis, four of upper gastrointestinal and two of lower intestinal hemorrhage, two of acute appendicitis, one of acute cholecystitis, one postoperative mesenteric infarction, and two small bowel obstructions. Fifty percent of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or episodes of acute rejection. Ten percent of the complications had an iatrogenic cause. Of the 31 patients affected, 10 (30%) died as a direct result of their gastrointestinal complication. This high mortality appears to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications can be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.
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PMID:Gastrointestinal surgical emergencies following kidney transplantation. 849 65

The body of literature concerning studies of the applications of CRP measurement in the pediatric population continues to grow. Based on current data serial CRP measurements appear to be most useful for monitoring patient response to therapy after the primary diagnosis of invasive infectious or inflammatory diseases, for monitoring patients after major surgical procedures and those with serious burns. Monitoring CRP over time may be used to assess for recrudescent disease, a secondary process or ineffective therapy. In addition CRP appears to be suited to most applications for which the ESR is used but offers many advantages. At present there are no objective outcome-based clinical trial data to justify using CRP values alone, whether elevated or normal, as a basis for management decisions regarding instituting or withholding antimicrobial therapy, or its early discontinuance for patients suspected of having neonatal sepsis, meningitis, bacteremia or pneumonia, regardless of immune status. In addition, because of significant inconsistencies among studies for which CRP has been applied to differential diagnosis of bacterial vs. viral diseases, including meningitis, acute otitis media and lower respiratory tract infection, we cannot recommend it for this purpose. Data do not support a role for CRP in differential diagnosis of acute appendicitis or for localizing urinary tract infections.
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PMID:Clinical applications of C-reactive protein in pediatrics. 927 Oct 34

A three year prospective randomised study was undertaken to study the efficacy of three regimens of antimicrobial drug combinations in reducing postoperative wound sepsis in acute appendicitis. Group A--Metronidazole and gentamicin; Group B--Metronidazole and ciprofloxacin; Group C--Metronidazole and cefotaxime. Randomization was done by drawing from a set of sealed envelopes. Antibiotics were started preoperatively once a presumptive diagnosis of appendicitis was made, provided there was no history of prior antibiotic usage. For simple appendicitis (normal or inflamed) two more doses were given postoperatively. For complicated appendicitis, duration of antibiotic treatment was four days postoperatively. All antibiotics were given intravenously to avoid variations in bioavailability. Wound was inspected daily till discharge and at 30 days post operatively or earlier if the patient had symptoms of wound infection. A total of 128 patients completed the study. Eighty nine were simple appendicitis while the rest were complicated. Twenty one developed wound infection. Out of 21, 13 occurred in group A, 5 in group B and 3 in group C. Individually, the difference in infection rates between group A and group C patients with simple appendicitis was statistically significant. Infection rates in all other groups were not statistically different. Cefotaxime and metronidazole combination had the lowest wound infection rate. Hence it is recommended for antibiotic prophylaxis.
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PMID:A trial of various regimens of antibiotics in acute appendicitis. 961 3


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