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

Necrotizing lesions of the colon occur in patients with malignancy. We identified 26 patients with cancer (23 with acute leukemia and three with solid tumors) who died from necrotizing colitis. Autopsies revealed three pathologic categories: pseudomembranous colitis in 69 per cent, agranulocytic colitis in 19 per cent and ischemic colitis in 12 per cent. Most died from sepsis. A comparison of characteristics was made with a control population matched for diagnosis, age, cause of death and duration of neoplasia. Nearly all patients in both groups had fever and were granulocytopenic secondary to chemotherapy. Most received antineoplastic and antimicrobial regimens during the month prior to their terminal illness. Abdominal pain and distention, stomatitis and necrotizing pharyngitis were frequently associated with colitis. Hyperbilirubinemia was a frequent late complication in those with colitis and the control group. Single and multiorganism septicemia were found more frequently in patients with colitis. As antemortem diagnosis was unusual, aggressive attempts at diagnosis are necessary to assess the true incidence of this disorder and the best therapy.
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PMID:Necrotizing colitis in patients with cancer. 49 35

Necrotic colitis in the absence of organic obstruction of the mesenteric vessels is an extreme and fulminant form of ischemic colitis. This calamity with its high mortality rate usually occurs in patients with pre-existent cardiopathy. It is rare for necrotic colitis to occur as a complication of hypotension, hypovolemia or sepsis. A report is presented of a case of total gangrene of the colon in a patient with hemorrhagic shock. Certain concepts are presented concerning the etiology of non-occlusive intestinal infarction. It is postulated that the fulminant gangrene of the colon is co-induced by Gram-positive rods which are demonstrable even in the deep layers of the colonic wall.
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PMID:Necrotic colitis in the presence of normal vascularization of the colon. 93 61

The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.
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PMID:[Hartmann's procedure. A retrospective study of 86 cases]. 144 49

Very recently, the concept of artificial intracorporeal oxygenation of blood for patients suffering from respiratory failure has been introduced into clinical practice through development of a totally implantable intravascular oxygenator (IVOX). We report on the use of such a device in a patient who developed severe respiratory insufficiency secondary to prolonged hypovolaemic shock and pneumonia following successful repair of a ruptured abdominal aortic aneurysm in September, 1990. Postoperatively, severe hypoxaemia occurred (AaDO2 548-602 torr) despite extensive mechanical ventilatory support. There was no obvious chance to overcome this situation by conventional therapeutic measures and the decision was made to institute IVOX therapy. Hypoxaemia was resolved immediately and both FiO2 and tidal volume could be reduced within hours. The patient's respiratory condition continued to improve over the next days leading to termination of IVOX therapy after 71 hours. However, the necessity of long-term ventilatory support secondary to recurrent pneumonia and sepsis, multiple abdominal reoperations for ischemic colitis and retroperitoneal abscess prolonged his recovery. He was discharged from the hospital after four months and is alive and well now 14 months after his operation. He is the first long-term survivor after IVOX therapy in Europe. IVOX may be successfully used in selected patients while the indications and it's potential role in the therapy of severe respiratory failure still need to be defined.
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PMID:[Artificial intravascular oxygenation (IVOX). Application to the treatment of postoperative respiratory failure]. 148 73

Between January 1984 and December 1989, 13 patients, aged 39 to 89 (median 63), underwent surgery for histologically proven ischemic colitis. Most suffered from pre-existing cardiovascular conditions (2 shortly after surgery for aortic aneurysm). One patient developed ischemia after the traumatic avulsion of the ileocolic artery and another after the spontaneous reduction of a strangled inguinal hernia. Diagnosis of ischemic colitis was made prior to operation in 4 instances only. The left colon was affected 5 times and the right colon 8 times (with the terminal coil of ileum 3 times). Treatment always consisted in segmental colectomy; laparotomy was used in 3 patients (2 to 7 reoperations). Colon anastomosis was performed directly 5 times, while 4 patients had secondary stomy closures; 2 patients still have their original stomy. Two patients died (15%), one of sepsis and the other following broncho-aspiration. The prognosis of ischemic colitis is rather favorable, even at the stage of transmural necrosis, provided all ischemic zones are resected. This is in contrast with the severe mortality of mesenteric infarcts, when extensive small bowel necrosis is found in association with colonic ischemia.
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PMID:[Results of surgical treatment of ischemic colitis]. 186 48

Abdominal aortic aneurysm is conventionally treated by aneurysmorrhaphy with inlying graft. Alternatively, division of the aorta, with suture closure of the distal aorta and outflow vessels (exclusion of the aneurysm), and end-to-end proximal to distal bypass may be performed. However, the long-term fate of this operation has not been determined. Specifically, concern exists that the excluded blood filled aneurysm may not thrombose or may be the source of late sepsis. During an 8-year period we have treated 280 abdominal aortic aneurysms (urgent and elective) by exclusion of the abdominal aortic aneurysm sac and bypass via the posterolateral retroperitoneal approach. Mean age was 70 years (range, 44 to 88), with 217 men and 63 women. Preoperative CT scanning and aortography were performed to assess arterial anatomy. Seventy tube grafts and 260 bifurcation grafts were used. Thirty-day mortality rate was 4%. Estimated blood loss was 731 +/- 52 ml; mean transfusion requirements were 456 +/- 82 ml. The minor complication rate was 6%, and it is of great interest that there were no cases of ischemic colitis requiring colectomy. Aneurysm sacs thrombosed except in two anticoagulated patients who required further treatment. No late infections occurred. Five-year bypass patency rate was 98%. These data demonstrate that this method of treatment effectively minimized operative dissection and blood loss and therefore is a viable alternative for the management of abdominal aortic aneurysms.
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PMID:Treatment of abdominal aortic aneurysm by exclusion and bypass: an analysis of outcome. 176 16

The paper is a unique pathological description of a bilateral, symmetric, anterior, temporal ischemic optic neuropathy with the morphological characteristics of cavernous optic atrophy initially described by Schnabel in glaucomatous eyes. The 80-year-old woman had suffered from cardiac insufficiency and diabetes mellitus for many years. She died from sepsis and circulatory collapse due to ischemic colitis, intestinal perforation, and peritonitis. There was widespread arteriosclerosis but no evidence of giant-cell arteritis. Cell loss was demonstrated in both retinas, the chiasm, and in the central lateral geniculate body. These represent a retrograde, descending and ascending optic atrophy, with transsynaptic degeneration in the LGB. A small craniopharyngioma was found by chance in the infundibulum. Neither clinically nor morphologically were there any signs of glaucoma.
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PMID:[Histopathology of the retina, optic fascicle and lateral geniculate body in chronic, bilateral symmetric ischemic Schnabel's cavernous optic atrophy]. 224 78

Multiple levels of aortoileofemoral occlusive disease may necessitate profundoplasty or extension of the outflow anastomosis to insure pelvic and distal arterial perfusion. During the period 1978 through 1988, 1637 patients underwent elective aortic reconstruction for aneurysmal or occlusive disease. One hundred forty-five had profundoplasty performed to ensure adequate outflow. Associated disease was common with 88 (60%) patients having arteriosclerotic heart disease and chronic obstructive pulmonary disease (COPD) present in 89 (61%) patients. Hypertension and extracranial occlusive disease was found in 68 (46%) and 56 (38%) patients, respectively. The superficial femoral artery was occluded in 108 (74%) patients, while in 17 (12%) the profunda femoris was the only patent artery in the groin. Death occurred in nine patients (6.2%). Three were due to arrhythmias or myocardial infarction and ischemic colitis was the cause of death in two. Renal failure, sepsis, aspiration and cerebral anoxia, and disseminated intravascular coagulopathy accounted for one each. Five graft limbs failed. Amputation was required in one patient, while thrombectomy or distal bypass restored flow in four patients. Seventeen graft limbs in 136 patients occluded during the follow-up period. Distal bypass was successful in four and amputation was required in the fifth patient. Extension of the profundoplasty restored flow in nine limbs, while thrombectomy alone was successful in one. Bilateral amputation was required in one patient with poor run off and insufficient autogenus venous tissue. One hundred fourteen (78.6%) of the 145 patients survived 10 years with patency in 268 of the original 290 limbs at risk (92.4%). Profundoplasty in these patients with multilevel disease seems to extend the long-term patency of aortofemoral grafts and allows return to a normal life-style.
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PMID:Extended profundoplasty to minimize pelvic and distal tissue loss. 235 32

Between January 1, 1978, and December 31, 1987, a total of 103 patients had operations for ruptured abdominal aortic aneurysms. The average age was 73 years (range, 53 to 91 years). Thirty-two patients died during surgery or in the immediate postoperative period. In 19 of the remaining 71 patients ischemic colitis developed, an incidence of 27 per cent. This report reviews the clinical findings and course of these patients. The average age of patients developing ischemic colitis was 72 years (range, 53 to 90 years), not significantly different from the group as a whole. There was no correlation between the type of vascular reconstruction and the development of ischemic colitis. Eleven patients died and eight survived, for a mortality rate of 58 per cent. The most common clinical finding was diarrhea early in the postoperative period, which was noted in 20 patients. Thirteen of these patients had ischemic colitis confirmed by flexible sigmoidoscopy. Eight (62%) of these 13 patients survived; three were managed nonoperatively and five had colectomy. Six patients presented between postoperative days 9 and 20 with signs of increasing sepsis but with no diarrhea or other significant clinical findings; ischemic colitis was confirmed by sigmoidoscopy in all six patients. All of these patients died of septic complications. Seven patients with early postoperative diarrhea had normal sigmoidoscopic findings. None developed septic complications and five survived; two died of cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ischemic colitis following abdominal aortic reconstruction for ruptured aneurysm. A 10-year experience. 272 75

Thirty-nine hospital-based cases of ischemic colitis were reviewed. There were 18 males and 21 females. Average age was 68.7 years (range, 18 to 92 years). Associated diseases among 13 patients younger than 65 included renal failure in seven patients and hematologic, vasculitic, or collagen vascular diseases in four. In 26 patients 65 or older, congestive heart failure was seen in 13, vascular disease in eight, and previous aortic surgery in four. Nineteen patients were treated nonsurgically and 8 died (42 percent mortality). Twenty patients (51 percent) underwent surgery: 18 had resection with colostomy or ileostomy and two had resection with reanastomosis; one patient underwent laparotomy followed by second-look exploration without resection. Thirteen of the 20 surgical patients died (65 percent mortality). Both patients who underwent reanastomosis died of sepsis. The data show a close association between ischemic colitis and a number of serious systemic diseases including renal failure, arteriosclerotic heart and vascular disease, and hematologic, vasculitic, and connective-tissue disease. A predilection for the right colon and sigmoid colon and splenic flexure was seen. A formidable mortality rate (53 percent) was found among patients treated both surgically and nonsurgically.
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PMID:Mortality from ischemic colitis. 279 81


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