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

We evaluated the relationship between PPC and various putative risk factors in a prospective longitudinal study of 1,000 patients undergoing abdominal surgery. Transient subclinical events were excluded by defining PPC as positive clinical findings in combination with either positive sputum microbiology, unexplained pyrexia, or positive chest roentgenographic findings. The overall incidence of PPC was 23.2 percent (232/1,000). Multivariate analysis identified seven factors which were associated with PPC: ASA classification greater than 2, upper abdominal surgery, residual intraperitoneal sepsis, age greater than 59 years, BMI greater than 25, preoperative hospital stay greater than 4 days, and colorectal or gastroduodenal surgery (overall F score = 33.5, p less than 0.0001). The ASA classification was the most powerful indicator of risk in both the univariate and the multivariate analyses. The combination of ASA classification greater than 1 and age greater than 59 years identified 88 percent (205 of 232) of the patients who developed PPC. These findings provide clinicians and clinical investigators with a simple means of identifying patients who are at high risk of PPC after abdominal surgery.
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PMID:A multivariate analysis of the risk of pulmonary complications after laparotomy. 200 96

A multi-institutional study to evaluate the efficacy, clinical application, and safety of extracorporeal shock-wave lithotripsy (ESWL) with the Dornier HM-3 or HM-4 lithotripter for bile duct calculi (BDC) was initiated in September, 1987. Symptomatic patients who entered into this prospective trial had BDC in the common bile duct and/or the intrahepatic, cystic or lobar ducts of the liver that were inaccessible or untreatable by papillotomy or percutaneous stone extraction. The study excluded gallbladder stones. Nasobiliary (54.4%) or transhepatic catheters (10.5%) and T-tube or cholecystostomy tubes (17.5%) or combinations (14.0%) permitted access for radiographic contrast to allow fluoroscopic monitoring of stone position and fragmentation. Exclusion criteria included pregnancy, failure to localize the stone, disturbances of coagulation, pacemakers, or vascular aneurysms or large bones that lie in the focal axis of the shock waves. Eleven institutions treated 42 patients (23 male, 19 female) with BDC; age range was 25 to 95 years (mean +/- SD, 73.5 +/- 13.8) and ASA risk category was 1 to 4 (mean, 2.3 +/- 0.8). Fourteen patients (33.3%) had a single BDC; 28 had 2 to 8 stones (mean, 2.7 +/- 1.8) ranging in size from 6 mm to 30 mm (mean, 18.5 +/- 6.4). The majority (66.7%) of patients were postcholecystectomy. The 42 patients received 57 ESWL treatments consisting of 600 to 2400 shocks per treatment (mean, 1924 +/- 289) at 12 to 22 kV (mean, 18.5 +/- 1.9) administered over 20 to 125 minutes (mean, 52.9 +/- 20.8). General anesthesia was used in 32% of the treatments; the majority were treated with epidural or regional block (42.1%), local infiltration (28.1%), or intravenous sedation (38.6%). Fifteen patients (35.7%) required two ESWL treatments. Stone fragmentation occurred in 94.6% of evaluable patients and in 90.4% of ESWL treatments, respectively; however, BDC fragments remained in 59.5% of patients 24 hours after treatment (diameter less than or to 3 mm, 12%; 4 to 9 mm, 16%; greater than or equal to 10 mm, 68%). Some patients (50%) required adjunctive procedures to achieve stone removal that included endoscopic extraction (n = 10; 47.6%), biliary lavage (n = 8; 38.1%), endoscopic bile duct prosthesis (n = 1; 4.8%), and operation (n = 2; 9.5%). ESWL treatment complications during hospitalization were observed in 15 patients (35.7%) and were present in four (9.5%) at discharge. Complications included macrohematuria (5%), biliary pain (15%), biliary sepsis (5%), hemobilia (10%), ileus (2.5%), and adverse pulmonary changes (7.5%). One patient developed pancreatitis before ESWL at ERCP that resolved prior to discharge.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Extracorporeal shock-wave lithotripsy of bile duct calculi. An interim report of the Dornier U.S. Bile Duct Lithotripsy Prospective Study. 265 83

Analysis of 156 records relating to patients at the age of 15 to 85 years with extended purulent peritonitis of the surgical and gynecological genesis (the toxic phase, VI category ASA) showed that combination of programmed sanitation laparotomy and intensive antibacterial therapy performed as short-term courses before, during and after the operation with an account of the information on the nature of the microbial associations and antibioticograms was an efficient procedure in treatment of severe peritonitis. It was indicated in treatment of patients with polyorgan deficiency. When the surgical treatment was adequate early antibiotic therapy allowed to decrease the number and intensity of postoperative complications: the frequency of abscessing in the abdominal cavity and formation of intestinal fistulas lowered 2 and 1.5 times respectively. Such a decrease was also observed in asthenic patients with lowered protective reactions to development of new infectious foci in the abdominal cavity complicating the peritonitis process. It was also possible to prevent with that procedure the infection generalization and development of peritoneal sepsis. With application of the procedure to such patients (20 per cent) lethality lowered 2-fold.
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PMID:[Antibacterial therapy in disseminated purulent peritonitis]. 281 88

Nitric oxide (NO) and prostaglandins (PG) both possess the ability to induce vasodilatation and prevent the aggregation of platelets. The synthesis of these substances is increased following in vivo lipopolysaccharide (LPS) infusion, but their function during sepsis is incompletely understood. We studied the role of NO and PG in a murine model of chronic hepatic inflammation (Corynebacterium parvum injection), which is known to progress to sudden hepatic necrosis after LPS injection. NO synthesis, which is induced in hepatocytes by C. parvum treatment and in nonparenchymal cells by LPS treatment, was inhibited using NG-monomethyl-L-arginine (L-NMMA). High-dose aspirin (ASA) was used to block PG synthesis. Treatment with L-NMMA or ASA alone, in the absence of LPS, resulted in no increase in hepatic injury. C. parvum-treated mice that received both L-NMMA and ASA without LPS developed marked hepatic damage as reflected by increased hepatocellular enzyme release (aspartate aminotransferase and L-ornithine carbamoyl-transferase). Marked hepatic damage was seen after LPS administration, and ASA pretreatment alone had no effect on the LPS-induced hepatic injury, whereas L-NMMA markedly increased the hepatic damage. The combination of L-NMMA and ASA after LPS resulted in the greatest hepatocellular enzyme release, characterized histologically by intravascular thrombosis with diffuse infarction and necrosis. Simultaneous treatment with either PGI2 or L-arginine partially prevented this injury. These data demonstrate that NO and PG function synergistically to maintain hepatocellular integrity; thus increased synthesis of these mediators protects the liver from the pathophysiological effects of LPS in this model.
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PMID:Nitric oxide and prostaglandins interact to prevent hepatic damage during murine endotoxemia. 802 33

Interleukin-6 (IL-6), a cytokine involved in the pathogenesis of sepsis and septic shock, and lymphocyte subpopulations were measured in blood circulation of patients receiving sodium nitroprusside (SNP) for induction of hypotension. The aim of this study was to evaluate whether this procedure influences distribution of lymphocyte subsets and IL-6 response. 30 patients of ASA physical status I and II scheduled for nose-septum correction were randomly assigned to the SNP- or control group (without SNP). Patients were anaesthetized with fentanyl, etomidate and isoflurane in 66% nitrous oxide. SNP was administered continuously during 60 min and mean arterial blood pressure was reduced to 50 mmHg. Before and after induction of anaesthesia, 60 min after the beginning of the operation (end of SNP-infusion) and on the first postoperative day, IL-6 plasma concentrations were determined by ELISA. The percentages of B-, T-lymphocytes, T-helper, T-suppressor cells and HLA-DR positive (activated) T-lymphocytes were examined by direct immunofluorescence using monoclonal antibodies. On the first day after surgery IL-6 plasma concentrations were significantly elevated in the SNP-group compared to preoperative values. In this group the values were higher than in control patients [30.5 (10.9-47.5) pg/ml vs. 17.4 (8.5-21.5) pg/ml]. The percentage of HLA-DR positive T-cells was 25.8 +/- 4.9% in the patients with SNP on the first postoperative day; it was significantly higher than in control patients [16.5 +/- 3.7%]. We conclude that SNP-administration increases percentage of activated T-cells and IL-6 secretion.
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PMID:Increase of interleukin-6 plasma concentrations and HLA-DR positive T-lymphocytes after hypotensive anaesthesia with sodium nitroprusside. 884

In the last years the criteria of operability have been extended to elderly patients with hepato-pancreatic-biliary diseases. We selected 46 patients (in the seventies or older, class 3 or 4 of ASA score, affected by hepato-pancreatic-biliary neoplasms) in order to evaluate the behavior of these patients undergoing to different anaesthesiological techniques. Randomly, we treated 24 patients (group A) in general anaesthesia, and 22 patients (group B) in peridural anaesthesia. We considered mortality rate, morbidity rate, as sepsis, wound infection, pleuritis, and pneumonias. The data were analyzed by chi2-test and Fisher's exact test (p < 0.05). Mortality rate was similar in the two groups (A = 4.1, B = 4.5) (p = ns), and no complications were determined by the different anesthesiologic procedures. Pleuritis was present in 44% of group A vs 45% of group B (p = ns). Atelectasis areas were present in 58% of group A vs 27% of group B (p = ns), pneumonia was present in 33% of group A vs 9% of group B: this value was significant (p = 0.049). There were no differences between the two groups regarding wound infection rate (only one case in group B). We think that pulmonary diseases can be determined by intubation and mechanical ventilation. We show a significant reduction of pneumonia in the patients that underwent peridural anaesthesia. For this reason, peridural technique can be safely extended to elderly patients with hepato-pancreatic-biliary diseases.
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PMID:[Hepatobiliopancreatic surgery in patients over 70 years old: which anesthesia?]. 900 31

Hypocholesterolemia seems to represent a significant predictive factor of morbidity and mortality in critically ill patients. The authors, on the basis of recent literature data, aim to clarify the possible correlation between preoperative hypocholesterolemia and the risk of septic postoperative complications .205 patients undergoing to surgery for gastrointestinal diseases were the object of the study. Patients undergoing "minor" abdominal surgery or video-laparoscopic surgery and classified ASA III-IV were excluded. In all the patients, we considered retrospectively risk factors for postoperative septic complications as follows: preoperative blood concentration of cholesterol, malnutrition, obesity, diabetes, neoplasm, preoperative sepsis, type and duration of operations, antibiotics and regimen of use. Type and incidence of postoperative local or systemic septic complications were recorded. The patients have been stratified according to blood concentration of cholesterol and to the presence or absence of other risk factors. The incidence of postoperative sepsis was 35.1%. The highest incidence of postoperative septic complications (72.7%) was encountered, significantly (X2 = 7.6, p < 0.001), in the patients (11 cases, 5.9%) with cholesterol levels below 105 mg/dl). The results of this study seems to indicate a significant relationship between preoperative hypocholesterolemia and the incidence of septic complications after surgery. Moreover, evaluation of blood cholesterol levels before major surgery might represent a predictive factor of septic risk in the postoperative period.
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PMID:[Blood levels of cholesterol and postoperative septic complications]. 1092 Apr 96

Anaesthesia and surgical procedures lead to a reduction of intestinal motility, and opioids may produce a postoperative ileus, that might delay postoperative feeding. The aim of this prospective randomised study is to test whether or not different kinds of epidural analgesia (Group A: morphine 0.0017 mg/kg/h and bupivacaine 0.125%-0.058 mg/kg/h; Group B: morphine alone 0.035 mg/kg/12h in the postoperative period) allow earlier postoperative enteral feeding, enhance intestinal motility a passage of flatus and help avoid complications, such as nausea, vomiting, ileus, diarrhoea, pneumonia or other infective diseases. We included in the study 60 patients (28 males and 32 females) with a mean age of 61.2 years (range 50-70) and with an ASA score of 2 or 3. All patients had hepato-biliary-pancreatic neoplasm and were candidates for major surgery. We compared two different pharmacological approaches, i.e., morphine plus bupivacaine (30 patients, Group A) versus morphine alone (30 patients, Group B). Each medication was administered by means of a thoracic epidural catheter for the control of postoperative pain. In the postoperative course we recorded every 6 hours peristaltic activity. We also noted morbidity (pneumonia, wound sepsis) and mortality. Effective peristalsis was present in all patients in Group A within the first six postoperative hours; in Group B, after 30 hours. Six patients in Group A had bowel motions in the first postoperative day, 11 in the second day, 10 in the third day and 3 in fourth day, while in Group B none in the first day, two in the second, 7 in the third, 15 in the fourth, and 6 in the fifth: the difference between the two groups was significant (p<0.05 in 1st, 2nd, 4th and 5th days). Pneumonia occurred in 2 patients of Group A, and in 10 of Group B (p < 0.05). We conclude that epidural analgesia with morphine plus bupivacaine allowed a move rapid return to normal gut activity and early enteral nutrition compared with epidural analgesia with morphine alone.
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PMID:Morphine plus bupivacaine vs. morphine peridural analgesia in abdominal surgery: the effects on postoperative course in major hepatobiliary surgery. 1097 18

A 65-year-old man presented with an asymptomatic infrarenal abdominal aortic aneurysm of 6 cm in transverse diameter. Five years before he received a cadaveric renal transplant. The patient also had the following risk factors and associated diseases: arterial hypertension, coronary artery disease, previous myocardial infarction, coronary angioplasty and stent, ileal resection secondary to Chron disease, hepatopathy, hyperlipidemia and hepato-renal cystic disease. The ASA classification was III, IV. Considering previous abdominal operations and risk factors, we decided to repair the aneurysm with a minimal aggression. The aneurysm was successfully approached by an endovascular route implanting a 22x10 bifurcated aorto-iliac endovascular prosthesis. The patient died 13 months later after being diagnosed of enterocolitis by cytomegalovirus complicated with sepsis and lung infection. We consider this less invasive modality of treatment a valid and useful alternative in this high-risk group of patients.
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PMID:Endovascular repair of abdominal aortic aneurysm in a renal transplant patient. 1123 76

We reported anesthesia-related mortality and morbidity in Japanese Society of Anesthesiologists Certified Training Hospitals (JSACTH) in the year 2001, as a part of the second series of annual studies in the identical questionnaires form started in 1999. JSA Committee on Operating Room Safety sent confidential questionnaires to 813 JSACTH and received effective answers from 87.9% of the hospitals. A total number of 1,284,957 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others) during anesthesia and surgery, and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from the list of 52 items. Definition of serious hypotension, serious hypoxemia and others was those events suggesting the possibility of impending cardiac arrest or permanent disability of the central nervous system or myocardium. The respondents were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG). This paper focused on analysis of entire patients, as other later papers will report analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods. Total incidence of cardiac arrest under anesthesia/surgery was 6.12 per 10,000 anesthetics. PC, IP and SG occupied 47.2%, 21.1% and 24.2% of principal causes of total cardiac arrest, respectively. AM occupied only 6.4% of the principal causes and the incidence was 0.39 per 10,000. The most frequent cause of cardiac arrest in 52 more detailed classifications of principal causes was preoperative hemorrhagic shock that occupied 19.2% of all cardiac arrests. The second was massive hemorrhage due to surgical procedures (12.3%), and the third was surgery itself (9.7%). Prognosis of the cardiac arrest was worst in that due to PC, i.e. 86.1% of cardiac arrests died in the operating room or within 7 days after surgery and only 5.3% survived without sequelae. Very low survival rate of preoperative hemorrhagic shock (5.3%) and preoperative multiple organ failure/sepsis (7.1%) aggravated the prognosis. Pulmonary embolism was the worst single cause in prognosis of cardiac arrest due to IP. The best prognosis was found in cardiac arrest due to AM, 82.0% survived without sequelae and 10.0% died. The mortality rate after cardiac arrest was 3.04 per 10,000 anesthetics, of them 0.04 was due to AM, 0.43 due to IP, 1.89 due to PC and 0.67 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.37, and of them 0.06 was due to AM, 0.23 due to IP, 2.25 due to PC and 0.82 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths after cardiac arrest and after other critical incidents was 6.41 per 10,000 anesthetics. The final mortality rate totally attributable to AM was 0.10 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95%C.I.] in 1994-1998. IP, PC and SG showed the final mortality rate of 0.65, 4.14 and 1.49, respectively. Three major causes of all critical incidents in 52 detailed classification of principal causes were preoperative hemorrhagic shock (31.4%), massive hemorrhage due to surgical procedures (16.9%), and preoperative multiple organ failure/sepsis (9.0%). In conclusion, the obtained incidences as to cardiac arrest and death, either in total number during anesthesia/surgery or in that due to anesthetic management, kept decreasing lineally through 8 years study in 1994-2001. We expect that this second series of annual studies for five-years should reveal precise and definite direction for us to reduce anesthesia-related mortality and morbidity by analyzing further detail with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods.
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PMID:[Annual study of anesthesia-related mortality and morbidity in the year 2001 in Japan: the outlines--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety]. 1285 87


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