Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The hearts of eight patients aged 22 to 67 years (mean, 41 years) who died during or within 4 days of interleukin-2 (IL-2) based immunotherapy for treatment of renal cell carcinoma or melanoma were studied at necropsy. Death resulted from combined cardiorespiratory failure in two patients, sepsis in four patients, acute myocardial infarction in one patient, and myocarditis in one patient. Transmural left ventricular necrosis was present in one of the two patients with significant atherosclerotic coronary artery narrowing. Noninfectious myocarditis was present in five patients: the inflammatory infiltrate was lymphocytic in four and composed of a mixture of eosinophils and lymphocytes in one. Although treatment-related deaths associated with high-dose IL-2 therapy are uncommon (1.5% in 652 consecutive patients), the potential for significant myocardial ischemia or myocarditis exists, and careful monitoring for arrhythmias or myocardial failure is warranted.
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PMID:Myocarditis or acute myocardial infarction associated with interleukin-2 therapy for cancer. 220 2

The use of interleukin-2 (IL-2), either alone or in combination with lymphokine-activated killer cells, tumor infiltrating lymphocytes, or other immunotherapeutic agents has added a new list of alternatives to conventional antineoplastic regimens. Little information is available about the pathologic changes occurring in patients treated with these agents. In this study, we reviewed the necropsy materials from 19 patients, 12 men and 7 women, with a variety of malignancies including melanoma, renal cell carcinoma, gastrointestinal and pulmonary adenocarcinoma, and metastatic gastrinoma, who died after receiving IL-2-based immunotherapy. Death occurred at intervals ranging from less than 1 hour to 143 days following the last dose of therapy. All patients dying at or less than 43 days following cessation of therapy had lymphoid infiltrates of varying intensity in residual tumor. At necropsy, the major cause of death unrelated to the presence of metastatic tumor was bacterial sepsis. In addition, we found evidence of significant cardiac and pulmonary toxicity: two patients with acute myocardial infarction, one with and one without significant coronary artery disease, two cases of unexplained lymphocytic myocarditis, and one case of fatal pulmonary capillary plugging following an infusion of lymphokine-activated killer cells. Thus, not unlike other forms of therapy for cancer, IL-2-based immunotherapy does not appear to be without significant toxicity.
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PMID:Pathologic findings associated with interleukin-2-based immunotherapy for cancer: a postmortem study of 19 patients. 233 30

We compared three current methods (immunoinhibition, "Isomune-CK" immunoprecipitation, and the Tandem-E CKMB II immunoenzymometric assay) for determination of creatine kinase (CK; EC 2.7.3.2) isoenzyme MB in serum. Although results inter-correlated well, the immunoinhibition assay gave higher activity values. Atypical CK forms did not interfere with the immunoprecipitation and immunoenzymometric methods. In acute myocardial infarction the catalytic properties of CK decreased with the enzyme's age, as reflected by a steady increase in activation energy of the catalyzed reaction. In septicemia patients with very low CK and CK-MB catalytic activity, mean CK-MB mass concentration exceeded the upper reference limit, suggesting an increased rate of loss of activity concentration in these patients' sera. Because of the assay's lesser susceptibility to conformational changes at the active site of the enzyme, we suggest that measurement of CK-MB mass concentration is better suited for infarct sizing than measurement of catalytic activity.
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PMID:Mass concentration and activity concentration of creatine kinase isoenzyme MB compared in serum after acute myocardial infarction. 240 40

Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB. One patient requiring a very difficult proposed angioplasty received percutaneous CPB support while triple-vessel angioplasty was performed. Percutaneous CPB appears to be beneficial in resuscitating patients with refractory cardiac arrest or other forms of circulatory collapse except trauma. Limited use for brief periods in high-risk patients having elective angioplasty might be applicable.
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PMID:Percutaneous cardiopulmonary bypass: application and indication for use. 252 42

Levels of T lymphocytes were measured in 20 consecutive patients, 18 men and two women, supported with ventricular assist devices or an artificial heart. Indications for support were bridge to transplantation (n = 10), postcardiotomy cardiogenic shock (n = 8), and acute myocardial infarction shock (n = 2). Control levels were from healthy volunteers not undergoing cardiac operation. Preoperatively, numbers of total lymphocytes and subclasses CD3, CD4, and CD8, as well as the interleukin-2 receptors (IL2R), were the same as controls (cells/microliters): lymphocytes, 1,940; CD3, 1,413 +/- 410; CD4, 894 +/- 318; CD8, 490 +/- 185; IL2R, 96. From implant to postoperative day 5, levels were below control values (p less than 0.001), reaching a nadir on postoperative day 2 (lymphocytes, 896 +/- 599; CD3, 489 +/- 267; CD4, 309 +/- 207; CD8, 183 +/- 107; IL2R, 43 +/- 47). Data from 10 patients (group 1) who survived (four weaned from cardiopulmonary bypass, six transplanted) were compared with those from 10 patients (group 2) who died of multiorgan failure, sepsis, or both. From preimplant through postoperative day 6, levels did not differ between groups. However, from postoperative day 7 to the last day of ventricular support (group 1, 24-90 days; group 2, 7-29 days), group 1 levels (lymphocytes, 2,364 +/- 618; CD3, 1,825 +/- 553; CD4, 1,013 +/- 187; CD8, 796 +/- 402) were significantly above (p less than 0.01) group 2 levels (lymphocytes, 1,290 +/- 463; CD3, 746 +/- 295; CD4, 534 +/- 253; CD8, 221 +/- 106). These data indicate that lymphocytes and particularly T cells 1) decrease after ventricular assist device insertion, reaching a nadir at postoperative day 2, 2) return to control values after patients whose clinical status improves, and 3) remain low in severely ill patients. T-cell depression in ventricular assist device patients is related to the severity of the patient's condition rather than the presence of the device.
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PMID:T cells in ventricular assist device patients. 280 99

In healthy subjects normal plasmalactoferrin (PLf) concentrations were found to be 0.206 +/- 0.06 mg/l in 49 men and 0.148 +/- 0.06 mg/l in 62 women. A highly significant correlation of PLf with the number of circulating neutrophils (PMN) and a PLf/PMN relationship suggesting proportionality was demonstrated. Among 73 patients absolute PLf concentrations were significantly increased in septicemia, cirrhosis of the liver and tumors with liver metastases, decreased in localized infection, tumors without liver involvement, iron deficiency and acute hepatitis B, and normal in acute myocardial infarction. The PLf/PMN ratio, on the other hand, was normal in liver cirrhosis, hepatitis B and in a part of the patients with septicemia and tumor disease with liver involvement. The ratio was increased in a part of the septicemic patients, and decreased in the remaining disease types. Positive PLf/PMN correlations were found in myocardial infarction, septicemia and liver cirrhosis, whereas a very close, negative correlation existed in acute hepatitis B. These findings are discussed on the basis of existing knowledge on lactoferrin physiology, the intravascular fate of PMN and the RES function.
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PMID:Plasmalactoferrin and the plasmalactoferrin/neutrophil ratio. A reassessment of normal values and of the clinical relevance. 313 91

Critical decreases in oxygen delivery (DO2) and mixed venous oxygen saturation (SvO2) are associated with anaerobic metabolism and, therefore, lactic acidosis. We studied 50 consecutive patients with sepsis and 50 consecutive patients with acute myocardial infarction (AMI) in whom the arterial blood lactate was greater than 1 mmol/L in order to determine critical thresholds of DO2 and SvO2. In both groups, critical values of DO2 or SvO2 associated with lactic acidosis could not be identified. The DO2 ranged from 136 to 811 ml/min.m2 and SvO2 ranged from 28% to 73% in the patients with sepsis. The DO2 ranged from 115 to 434 ml/min.m2 and SvO2 from 17% to 72% in patients with AMI. The absence of threshold values for DO2 and SvO2 probably reflects the influence of distributive flow abnormalities as well as differences in metabolic requirements in these critically ill patients.
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PMID:Relationship of oxygen delivery and mixed venous oxygenation to lactic acidosis in patients with sepsis and acute myocardial infarction. 275 85

Autologous pericardium was used to reconstruct different parts of the left ventricle in 25 desperately ill patients. Fourteen patients had intractable sepsis resulting from infective endocarditis and myocardial abscess and 10 patients had noninfectious disorders. Of the patients with infections, 12 had valvular endocarditis with periannular abscess and three had interventricular septal abscess. The noninfected patients had acute rupture of the ventricular wall after mitral valve replacement (one patient) heavily calcified or surgically absent mitral anulus (three patients), or rupture of the interventricular septum after acute myocardial infarction (six patients). The interventricular septum, the posterior wall of the left ventricle, and the periannular areas were reconstructed by suturing appropriately tailored pericardial patches directly to the endocardium. In patients who also required valve replacement, the prosthetic valve was partially or completely secured to the pericardial patch. There were three operative deaths. All three patients were in either septic or cardiogenic shock before operation and in none of them was the death related to the pericardial patch. All 22 survivors have been observed from 3 to 34 months, an average of 14 months. There has been no case of patch dehiscence, patch aneurysm, prosthetic valve dehiscence, or recurrent endocarditis. Autologous pericardium appears to be safe for reconstruction of the left ventricle. It is easy to handle and problems with suture line bleeding are practically nonexistent.
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PMID:Reconstruction of the left ventricle with autologous pericardium. 366 99

The clinical records of 339 consecutive patients who had received temporary transvenous pacemakers were analyzed for indications, complications and malfunctions. Of the 156 patients who had had an acute myocardial infarction (AMI), 50% had had anterior wall and 43.6% inferior wall involvement. The route of electrode insertion was the antecubital vein in 71%, subclavian vein in 24%, internal jugular vein in 4%, and a femoral vein in the remainder. The indication for pacing in the AMI group was atrioventricular (A-V) block in 55%, fascicular block in 32% and other arrhythmias in 13% of the cases. In the non-AMI group, the indication for pacing was A-V block in 46.4%, sick sinus syndrome in 25%, preparation for noncardiac surgery in 12%, and diagnostic purposes in the remainder. Ventricular fibrillation (VF) occurred only in the AMI group and appeared in 9 (5.66%) of these cases. The site of infarction did not significantly affect the incidence of VF. Ventricular premature beats (VPBs) and ventricular tachycardia (VT) appeared in 28.8 and 12.8% of the AMI group and 4.4 and 3.3% of the non-AMI group, respectively. No difference in the incidence of myocardial perforation, sepsis, and phlebitis was encountered between the AMI and non-AMI groups. Total malfunction rate was significantly higher in the AMI group (15%) vs. the non-AMI group (4%). A higher rate of pacing malfunction was found when a semifloating electrode was used through the subclavian vein (14.3%) vs. a 6 or 7 French electrode through the antecubital vein (7%). Thus, temporary pacing is safe and associated with lower incidence of complications and malfunctions in non-AMI than in AMI subjects. Moreover, a lower incidence of malfunction was encountered when a 6 or 7 French electrode was inserted through the antecubital vein.
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PMID:Temporary transvenous pacing: analysis of indications, complications and malfunctions in acute myocardial infarction versus noninfarction settings. 367 90

This is the first reported case of an acute myocardial infarction probably secondary to DF-2 bacterial septicemia and presumed endocarditis. Selective coronary arteriography revealed a long filling defect causing 95% stenosis of the second diagonal branch of the left anterior descending coronary artery. Multiple blood cultures revealed Decarboxylase Fermentor-2 (DF-2) septicemia that responded to penicillin therapy. Two months status after myocardial infarction recatheterization revealed complete recanalization with slight irregularity of the vessel lumen at the site of previous obstruction.
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PMID:Acute myocardial infarction associated with DF-2 bacteremia after a dog bite. 370 97


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