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

The consequences of pelvic sepsis after Ivalon rectopexy are described in four patients. Despite clear evidence of pelvic infection, reoperation was delayed by ineffective conservative measures and morbidity thereby prolonged. In three, the causative organism was Staphylococcus aureus and it is suggested that prophylactic antimicrobial regimens for intestinal organisms alone may be inadequate.
Dis Colon Rectum 1984 Sep
PMID:Management of pelvic sepsis after Ivalon rectopexy. 646 97

We report the results of a prospective audit of the rates of postoperative infection in patients having operations for inflammatory bowel disease. Apart from a single prospective controlled trial, all other groups have been studied sequentially using the original placebo control group for comparison. The rate of abdominal wound sepsis when no antibiotic was used was 37 per cent. This was reduced to 23.3 per cent with 24-hour cover using metronidazole and gentamicin. However, only after prolonged use of metronidazole and gentamicin for five days was there a significant reduction in abdominal wound infections to 13.3 per cent. Prophylaxis, using 24-hour cover with metronidazole combined with five-day therapy with mezlocillin, achieved an abdominal wound infection rate of 15.6 per cent. The most recent group of patients studied have received 24-hour cover with metronidazole and five-day exposure to latamoxef. In the last group the rate of abdominal wound infections was only 13.5 per cent and serious postoperative bleeding was recorded in eight patients (15 per cent) compared with serious bleeding is only three of the remaining 129 patients (2.3 per cent). The only patients in whom streptococcal isolates were eliminated were those receiving metronidazole and mezlocillin. The majority of infections was due to antibiotic-sensitive strains of Escherichia coli, Proteus, and Staphylococcus species.
Dis Colon Rectum 1984 Sep
PMID:Audit of sepsis in operations for inflammatory bowel disease. 646 1

Concentrations of ampicillin after intraincisional instillation in laparotomy wounds were measured in ten patients undergoing appendectomy. Ampicillin, 1 gm, was instilled under the fascia and 1 gm in the subcutaneous space during wound closure. Wound secretion was collected every two hours during the first 24 postoperative hours by cannulation of a fine perforated drain placed in the subcutaneous space. Ampicillin was determined by a disk diffusion method. During the first eight hours the median concentration of ampicillin in wound secretion exceeded 1000 microgram/ml; 14 hours and 20 hours after wound closure the median concentrations were 73 and 14 microgram/ml, respectively. The effect of ampicillin in high concentrations on "resistant" strains of Bacteroides fragilis was demonstrated in an in vitro experiment. It is concluded that in colorectal surgery the effect on wound sepsis of intraincisional antibiotics as an addition to systemic antibiotic prophylaxis should be evaluated in a clinical trial.
Dis Colon Rectum 1984 Mar
PMID:Intraincisional antibiotics in laparotomy wounds. 655 66

Nontraumatic Clostridium septicum infections may present as either septicemia or as metastatic myonecrosis. Most of these infections occur in debilitated patients with diabetes who are receiving cancer chemotherapy. The majority have a hematologic abnormality or a carcinoma of the colon. Usually there is an ulcerative lesion of the gastrointestinal tract that serves as the portal of entry. While most of these patients die from overwhelming sepsis, our patient was debrided early and treated promptly with high-dose penicillin therapy as well as hyperbaric oxygen therapy. He fully recovered from C. septicum gas gangrene and underwent resection of a recurrent colonic cancer.
Dis Colon Rectum 1983 Nov
PMID:Nontraumatic Clostridium septicum gangrenous myonecrosis. 662 41

Over a three-year period, 1980-82, 79 per cent of our patients with rectal cancer were treated with the intention of cure, and sphincter-saving procedures were performed in 62 per cent of these cases. This report concerns 21 patients with mid-rectum cancer operated on with low anterior resection and extraperitoneal EEA-stapled anastomosis. Nine patients had Dukes' stage A tumors, seven had stage B, and five had stage C tumors. An 86-year-old woman died in the sixth postoperative week, and a 74-year-old man died after 20 months with a probable recurrence. Nineteen patients are currently alive 4 to 40 months post-operatively, with no overt signs of recurrence. We cannot confirm recent alarming reports on a significant incidence of early local recurrence. Routine Gastrografin enemas were performed and offered very little in terms of clinical guidance. Significant anastomotic leakage occurred in four patients, although without clinical symptoms or the need for fecal diversion. Despite initially intact anastomoses in 13 patients, pelvic sepsis with late dehiscence developed in three, all of whom required fecal diversion. The clinical leak rate was thus 3 of 21, 14 per cent, and the total incidence of leakage 7 of 21, 33 per cent. We performed routine colostomy on the first three patients but, in retrospect, believe this was unneccessary. Only one of the 19 survivors still has a colostomy, due to a benign anastomotic stricture. We consider anterior resection of mid-rectum carcinoma with EEA-stapled anastomosis a highly feasible procedure, the curative potential of which, however, can be established only by long-term follow-up studies.
Dis Colon Rectum 1983 Dec
PMID:EEA stapler for mid-rectum carcinoma. Review of recent literature and own initial experience. 664 59

Colonic resections, particularly those that require mobilization of the splenic flexure, occasionally will lead to injury of the spleen. Under these circumstances, the abdominal surgeon has traditionally considered incidental splenectomy to be the only safe alternative. Currently, a better understanding of splenic physiology and its role in sepsis prevention has reversed this trend. These efforts to preserve splenic function have resulted in various options available to the surgeon, herein reviewed. The results obtained in 36 general surgical patients with splenic injuries suggest that the salvage of the spleen is a safe alternative. In situations where salvage is impossible, the surgeon can resort to omental autotransplantation of the removed spleen, a recently described technique of appealing simplicity. The results obtained with this procedure in 23 other patients are presented.
Dis Colon Rectum 1984 Jan
PMID:Colonic surgery. The splenic connection. 669 Feb 63

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.
Dis Colon Rectum 1984 Feb
PMID:Surgical aspects of radiation enteritis of the small bowel. 669 36

During the last ten years, 14 patients with proven aortoenteric fistulas were admitted to the Greenville Hospital System, a community system of 1200 beds in four units serving a county of 250,000 residents. The experience obtained is tabulated, and illustrative case reports are used to emphasize the diagnostic and treatment problems inherent in this group of patients. It is obvious that two major manifestations result when intra-abdomial vascular prostheses communicate with some portion of the gastrointestinal tract. The most common manifestation of aortenenteric fistual is massive GI hemorrhage, usually preceded by an earlier, less consequential bleeding episode called a "herald bleed." If the small bowel, other than the duodenum or colon, is involved, then chronic bleeding and sepsis are most characteristic. The problems of diagnosis and management are discussed.
Dis Colon Rectum 1984 Mar
PMID:Aortoenteric fistula: diagnosis and management. 669 40

A randomized controlled trial aimed at comparing the individual efficacy of cephalothin, cefoxitin, and metronidazole in the prevention of postoperative wound infection was performed among 74 colorectal surgical patients. Of 28 patients on cephalothin, seven (25 per cent) developed a postoperative infection, but among 23 patients in each of the other two groups, only one (4 per cent) in each group became infected. These results confirm the primary importance of anaerobes in the causation of postoperative sepsis after colorectal surgery.
Dis Colon Rectum
PMID:Cephalothin, cefoxitin, or metronidazole in elective colonic surgery? A single-blind randomized trial. 675 28

A safe and practical procedure for total colectomy and mucosal proctectomy with ileoanal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a low-lying, loop-type ileal reservoir provided the best functional results.
Dis Colon Rectum 1980 Oct
PMID:Total colectomy, mucosal proctectomy, and ileoanal anastomosis. 677 28


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