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

The incidence of bacteremia following proctoscopy and hemorrhoidal injection sclerotherapy was studied in 50 outpatients undergoing both procedures. Bacteremia was found in 2 per cent of the subjects after proctoscopy and in 8 per cent after sclerotherapy. None of the subjects developed symptoms of septicemia following the procedure. It is concluded that antibiotic prophylaxis should be used before sclerotherapy in patients with valvular heart disease or compromised host defense.
Dis Colon Rectum
PMID:Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy. 726 21

The incidence and pathogenesis of sepsis following 107 elective operations in 87 patients with inflammatory bowel disease has been studied. Eighteen per cent developed wound sepsis and 13 per cent developed intra-abdominal abscess postoperatively. The prophylactic antimicrobial regimens used did not reduce the overall postoperative sepsis rates. The risk of developing postoperative sepsis was increased in patients with preoperative enterocutaneous or entero-enteric fistulas, pre-existing abscess and those with evidence of active disease (serum albumin less than 3.0 g/dl and serum seromucoids greater than 400 mg/gl). The incidence of postoperative sepsis was not affected by corticosteroid therapy at the time of surgery.
Dis Colon Rectum 1980 Mar
PMID:Sepsis following operation for inflammatory intestinal disease. 737 54

The influence of a single peroperative five-liter saline peritoneal lavage has been assessed in 21 consecutive patients undergoing elective operation for colorectal cancer. The aim of the study was to investigate whether reduction in bacterial counts by saline lavage would reduce the incidence of infection and thereby avoid the need for prophylactic antimicrobials. Saline lavage was shown to reduce significantly counts in peritoneal fluid of aerobic bacteria from 2 x 10(4) to 5 x 10(1) (P less than 0.001) and to reduce the counts of anaerobes in peritoneal fluid from 8 x 10(4) to 1 x 10(2) (P less than 0.001). Despite the profound reduction in peritoneal bacterial counts the rate of postoperative sepsis was extremely high; wound infection 47 per cent, intraabdominal abscess 26 per cent and septicemia 13 per cent. These results indicate that saline peritoneal lavage alone is no substitute for short-term antimicrobial prophylaxis.
Dis Colon Rectum 1980 Sep
PMID:Prophylactic saline peritoneal lavage in elective colorectal operations. 741 76

Twenty-one patients had a concurrent splenectomy with resection of colorectal cancer between 1970 and 1988. These were matched individually with disease control patients based on age, sex, site of tumor, Dukes stage, tumor differentiation, and date of the operation. Significantly more patients in the splenectomy group (n = 11) developed postoperative infective complications than in the control group (n = 4) (McNemar test: P = 0.03). Five-year overall actuarial survival was 45 percent in the former group and 59 percent in the latter (log rank test: chi-squared = 1.07; P = 0.24). Similarly, five-year disease-free survival in 17 patients with Dukes B and C cancers who had curative resections did not differ between the groups (log rank test: chi-squared = 0.08; P > 0.25). These results suggest that splenectomy with resection of colorectal cancer increases the risk of postoperative sepsis and does not influence long-term survival. The infrequency of concurrent splenectomy at resection of colorectal cancer may not overcome Type II error.
Dis Colon Rectum 1993 Jun
PMID:Does concurrent splenectomy at colorectal cancer resection influence survival? 768 67

We report on eight children with severe diarrhea beginning in the first 6 months of life (< 1 month in six cases), who had a number of features in common. All were small for gestational age and had an abnormal phenotype, including facial dysmorphism, hypertelorism, and woolly, easily removable hair with trichorhexis nodosa. Two were products of consanguineous marriages. Severe secretory diarrhea persisted despite bowel rest (n = 7). Jejunal biopsy specimens showed total or subtotal villous atrophy with crypt necrosis, and inconstant T-cell activation in some cases (n = 3). Colon biopsy specimens showed moderate nonspecific colitis. All the patients had defective antibody responses despite normal serum immunoglobulin levels, and defective antigen-specific skin tests despite positive proliferative responses in vitro. Three had monoclonal hyper-immunoglobulinemia A. The course was marked by diffuse erythroderma in two cases and mental retardation in three. Treatment included bowel rest, intravenous administration of immune globulins, administration of corticosteroids (n = 6) and cyclosporine (n = 2), and bone marrow transplantation (n = 1). Five patients died between the ages of 2 and 5 years (of sepsis or cirrhosis), two are being fed enterally, and one continues to receive total parenteral nutrition. The cause of the combined low birth weight, dysmorphism, severe diarrhea, trichorrhexis, and immunodeficiency is unclear. These features may constitute a specific syndrome within the group of intractable diarrheas of infancy.
 ...
PMID:Intractable infant diarrhea associated with phenotypic abnormalities and immunodeficiency. 802 82

A controlled, randomized trial with blind assessment of end points is described comparing ceftriaxone (1 g) given at induction of anesthesia with gentamicin (2 mg/kg) and metronidazole (500 mg) (GM), three times, every eight hours starting at induction, in preventing wound, chest, and urinary tract infections following bowel operations. Patients with inflammatory bowel disease received prophylaxis for five days. Two hundred sixty patients were randomized, and 196 were studied after exclusions. Ninety-four were given ceftriaxone, and 102 were given GM. Chest infection was defined as pyrexia plus clinical or radiologic signs of consolidation or the production of purulent sputum. Wound infection was diagnosed on the basis of purulent wound discharge or pyrexia plus swelling, redness, and pain around the wound, and urinary tract infection was diagnosed from microbiologic results. There was a significant reduction in wound infection (17 percent to 6 percent; P < 0.05) and in urinary tract infection (8 percent to 1 percent; P < 0.05) in the ceftriaxone group compared with the GM group. Chest infection occurred in 16 percent of the ceftriaxone group compared with 25 percent of the GM group, but this difference was not statistically significant. Infected patients were in the hospital more than four days longer than uninfected patients, a statistically significant difference (P < 0.01). It is concluded that ceftriaxone is superior to GM in reducing postoperative sepsis and that this effect is likely to be due to the sustained bactericidal blood levels achieved by ceftriaxone.
Dis Colon Rectum 1993 Sep
PMID:Ceftriaxone is more effective than gentamicin/metronidazole prophylaxis in reducing wound and urinary tract infections after bowel operations. Results of a controlled, randomized, blind clinical trial. 837 23

We present four cases of perianal synergistic gangrene in severely immunocompromised patients. In all patients, gangrene was controlled by radical surgery, including defunctioning colostomy in three patients, backed up by appropriate antibiotic therapy. Three of the patients survived and left the hospital; the fourth died in the intensive care unit of overwhelming sepsis from an unidentified source other than the anus. We review the literature and conclude that such infections in these patients are not inevitably fatal and that radical surgery can result in a cure.
Dis Colon Rectum 1993 Sep
PMID:Management of synergistic bacterial gangrene in severely immunocompromised patients. Report of four cases. 837 29

In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.
Dis Colon Rectum 1993 Mar
PMID:Complications of rubber band ligation of symptomatic internal hemorrhoids. 844 35

The aim of this work was to study the effects of previous subtotal colectomy (STC) with ileostomy and sigmoidostomy on the outcome of ileal J-pouch-anal anastomosis (IPAA) in patients with acute ulcerative colitis. Between 1983 and 1991, we conducted a prospective, nonrandomized study of 156 patients who underwent IPAA in our center. Fifty-five patients (34.3 percent) had undergone STC with ileostomy and sigmoidostomy for either severe acute colitis (36.5 percent of cases) or nonresolving acute colitis (63.5 percent) up to six months before IPAA with covering ileostomy. There were no perioperative deaths; six patients (11 percent) developed complications requiring reoperation (three cases of pelvic sepsis, two occlusions, and one stenosis of the ileostomy). IPAA was successfully carried out at a later stage in all cases. The results of IPAA in these patients were compared with those in 78 patients who underwent the classical two-stage IPAA procedure. The rates of pelvic sepsis and postoperative occlusion were lower in the subgroup of patients who underwent the three-step procedure. Three months after closure of the ileostomy, the mean number of daily stools was significantly lower in the patients who had undergone prior STC (5.09 vs. 5.9), but there was no significant difference between the two groups with regard to diurnal and nocturnal continence, the need to wear a pad, discrimination between gas and stools, or the use of antidiarrheal medication. In addition, there was no significant difference at one year in terms of functional parameters. We conclude that STC is a simple and safe procedure for the treatment of a severe attack of colitis and that it does not compromise the results of later IPAA. Because it does not increase the morbidity of subsequent IPAA and is associated with more rapid functional recovery, STC appears to be suitable for the treatment of patients with nonresolving acute colitis before the onset of malnutrition or steroid dependency.
Dis Colon Rectum 1993 Apr
PMID:Previous subtotal colectomy with ileostomy and sigmoidostomy improves the morbidity and early functional results after ileal pouch-anal anastomosis in ulcerative colitis. 845 59

Because Crohn's disease of the small bowel is often diffuse, strictureplasty has been advocated as an alternative or adjunct to resection(s) of strictured segments. We reviewed 116 patients with obstructive Crohn's disease undergoing 452 primary strictureplasties (Heineke-Mikulicz, 405; Finney, 47). The median age was 34 years (range, 13-72 years); the male-to-female ratio 1.4:1; and the median follow-up was three years (range, six months to seven years). Seventy-six patients (66 percent) had at least one previous small bowel resection. Perforative disease was present in 18 patients (15 percent), and synchronous resections were performed in 71 patients (61 percent). The median number of strictureplasties was three (range, 1-15). There was no mortality. Septic complications (intra-abdominal abscess/fistula) occurred in seven patients (6 percent), and reoperation for sepsis was needed in two patients. Relief of obstructive symptoms was achieved in 99 percent of the patients. After surgery, the median weight gain was 4 kg, and two-thirds of the patients were weaned off steroids. Symptomatic recurrence occurred in 28 patients (24 percent), and 17 patients (15 percent) needed reoperation. Rates of restricture and new stricture/perforative disease were 2.8 percent and 24 percent, respectively.
Dis Colon Rectum 1993 Apr
PMID:Long-term follow-up of strictureplasty in Crohn's disease. 845 61


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