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

A severe staphylococcal septicemia originating from an unknown focus occurred in a 17-year-old patient who had undergone a Rastelli-Ross operation 5 years earlier. The clinical course was complicated by extensive bilateral pneumonia, diffuse intravascular coagulation, and glomerulonephritis. After 4 weeks of intensive conservative treatment, including a daily regimen of 16 Gm. of cloxacillin, the patient was operated upon for a rapidly progressive false aneurysm, which had resulted from dehiscence of the anastomosis between the prosthesis and ventricle. The excised prosthesis proved to be sterile. The postoperative course was uneventful. Cloxacillin treatment was continued for 6 months, initially parenterally and later orally. After discontinuation of therapy, no signs of infection have occurred. Right-sided intracardiac or intravascular prosthetic material may be particularly susceptible to infections originating from the body surface.
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PMID:Prosthesis endocarditis: treatment of a case occurring five years after a Rastelli-Ross operation. 13 78

Between January 1974 and March 1977, arm bovine carotid heterograft arteriovenous fistulas were constructed in 75 patients. Twenty-six fistulas were established between the distal radial artery and an antecubital vein, and 49 fistulas used the brachial artery and the axillary vein. Thirty-eight heterografts have functioned without complication over a maximun interval of 29 months, including 15 of 26 radiobasilic fistulas and 23 of 49 brachioaxillary fistulas. Of the 37 heterograft failures, 28 were caused by thrombosis, six by infection, two by false aneurysm formation, and one by distal arm ischemia. Early postoperative thrombosis was associated with a higher subsequent failure rate after thrombectomy than was late thrombosis and it often required insertion of a new heterograft. Infected heterografts must be ligated and eventually replaced with another fistula at a distant site to avoid the potentially lethal complications of systemic sepsis and local hemorrhage.
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PMID:Venous access using the bovine carotid heterograft: techniques, results, and complications in 75 patients. 65 43

The experience with 14 patients with infected aortic bifurcation grafts has been reviewed. Factors which appeared to predispose to infection in 11 patients included "re-do" operations, concomitant cholecystectomy or gastrostomy, and ruptured abdominal aneurysm. A mixture of gastrointestinal organisms was responsible for the infections. The pathogenesis, presentation, and treatment varied according to whether the proximal or distal anastomosis was involved or not. Aortoduodenal communications were present in five patients; they presented with gastrointestinal bleeding or septicemia. One patient survived as a result of early, aggressive surgical therapy. Infection presented at the distal anastomosis in nine patients, either as groin abscess or false aneurysm. Conservative therapy failed in the majority of patients but apparently was successful in three of five patients in whom infection did not involve the intra-abdominal portion of the graft. When infection does involve the intra-abdominal portion of the graft, then the graft must be excised also. Revascularization often can be accomplished with extra-anatomic bypasses of prosthesis or autogenous material, depending on the characteristics of the individual patient. Regardless of the mode of presentation or the site of infection, the early institution of judicious surgical management offers the best chance of success in these patients, and temporization usually leads to failure.
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PMID:Infected aortic bifurcation grafts: experience with fourteen patients. 79 Jun 20

In the last ten years, 22 patients with transection of the descending thoracic aorta were seen at the Ben Taub General Hospital. Five patients with massive left hemothorax died shortly after admission. Among 17 patients in whom proximal and distal control could be achieved, three died in the operating room; three died within 30 days of operation, and one patient died of sepsis more than 1 year postinjury: ten patients are longterm survivors. Partial pump bypass was utilized in six patients, and in one a heparinized shunt was used intraoperatively. Dacron tube grafts were used in 12 cases, and primary repair was accomplished in three. One patient was paraplegic on admission, and two others in whom this was not established before operation were found to have this complication postoperatively. One patient with an infected false aneurysm 1 year after operation underwent resection of the distal aortic arch and Dacron graft with extensive extravascular bypass procedures. Patients with transection of the descending thoracic aorta die if proximal control is not achieved before rupture of the hematoma. Successful repair of this injury requires aggressive diagnostic and surgical management.
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PMID:Transection of the descending thoracic aorta secondary to blunt trauma. 90 15

Over a 10-year period, aortofemoral grafting was employed in the revascularization of 484 limbs in 245 patients with peripheral limb ischaemia. Six patients (2.4%) died in the postoperative period, the most common cause of death being myocardial infarction. Forty-three patients (18%) developed significant non-fatal complications within 30 days of operation, half of whom required further surgery as a consequence. Thirty-seven patients suffered late graft-related complications of which graft thrombosis was the most common. Immediate graft patency was 98.4%, cumulative patency was 95% and 87% at 1 and 5 years respectively. False aneurysm formation was encountered in 3.3% of patients, deep graft sepsis in 1.6% and the phenomenon of 'non-healing' of grafts in 1.2%. Cumulative survival following elective surgery was 97% and 84% at 1 and 5 years respectively, and 89% and 72% for those undergoing limb salvage procedures.
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PMID:Morbidity and mortality after aortofemoral grafting for peripheral limb ischaemia. 281 Jan 85

Eight cases of secondary aorto-enteric fistulae are presented occurring 9 months to 10 years after aortic Dacron grafting. In four patients there was a simple fistula between the anastomosis and the adherent duodenum, three patients had clinically infected grafts and one had a false aneurysm that had ruptured into the bowel. The four patients with a simple fistula had direct suture repair of the defect. One developed a recurrent fistula at 2 months and was successfully repaired again by direct suture. All four patients remain well at a follow-up of 1-5 years. The other four patients had the grafts excised, with local regrafting in two cases, both patients remaining well at follow-up. One patient had an axillo-bifemoral graft, but died at 30 days of overwhelming sepsis. The final patient, a girl with diffuse aneurysmal disease, had the aortic stump oversewn but no reconstruction. She died at 9 months of aortic stump disruption. These results suggest that a more conservative approach to the operative correction of secondary fistulae should be used wherever possible.
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PMID:Secondary aorto-enteric fistulae: towards a more conservative approach. 379 Sep 10

One hundred forty-three patients underwent cardiac transplantation from 1980 to 1985; 122 received a heart, 19 received a heart-lung, and two received a heart-liver transplant. All patients received immunosuppression with prednisone and cyclosporine. General surgical complications have developed since transplantation in 40 patients (28%). Of these, 17 patients have required surgery: exploratory laparotomy (10 patients), inguinal or ventral herniorrhaphy (two patients), repair of false aneurysm of the femoral artery (two patients), repair of lymphocele of the groin (two patients), and incision and drainage of a perirectal abscess (one patient). Of the 10 patients who required laparotomy, three underwent sigmoid resection for a perforated sigmoid diverticulum (all survived), two underwent small bowel resection for perforation (both died), two had free intraperitoneal air with no site of perforation found (one died), one underwent a cholecystostomy and one a cholecystectomy for acute calculous cholecystitis (one died), and one underwent an elective pyloroplasty for gastric outlet obstruction secondary to vagus nerve injury during heart-lung transplantation and survived. All patients who underwent elective surgery survived. Six patients died without operation and at autopsy were found to have unrecognized general surgical complications including pancreatitis (three patients), cecal ulceration with sepsis (two patients), and jejunal perforation secondary to peritoneal dialysis (one patient). Eleven other patients had severe abdominal pain and five had gastrointestinal hemorrhage not requiring operation. Proper management of these patients includes early and aggressive diagnosis of conditions requiring operative intervention, strict attention to surgical technique, and careful titration of dose of immunosuppressive drugs. The 28% incidence of general surgical complications associated with heart and heart-lung transplantation emphasizes the role of the general surgeon in the management of these complex patients.
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PMID:General surgical complications in heart and heart-lung transplantation. 393 Dec 74

To assess the impact of an aggressive approach (early operation, graft removal, and extraanatomic bypass) adopted by us 5 years ago in patients with aortic synthetic grafts and gastrointestinal bleeding, we reviewed our 15 year experience with aortoenteric fistula in 13 patients. The courses of six patients from the recent series (1979 through 1984) were contrasted with those of seven patients from our earlier series (1968 through 1978). Twelve of 13 patients presented with gastrointestinal bleeding (usually low volume), and no patient presented in shock. Six of seven patients in Series I (earlier series) had positive blood cultures, whereas only two of six in Series II (recent series) had this finding. Of the 13 patients, 10 underwent preoperative endoscopy. It was only with consistent visualization of third and fourth portions of the duodenum that a diagnosis of aortoenteric fistula was established (three of four patients 75 percent). Although the upper gastrointestinal series was abnormal more frequently (five of seven patients, 71 percent) than arteriograms (three of nine patients, 33 percent), the latter was more specific for a predisposing lesion. At surgery, nine (70 percent) patients had an anastomotic fistula and four (30 percent), a false aneurysm. Although only one of seven patients in Series I survived (14 percent), four of six patients in Series II were alive at last follow-up in September 1984 (67 percent). Early diagnosis followed by prompt operation with removal of the synthetic graft and extraanatomic bypass is associated with an improved survival for patients with aortoenteric fistula, but the degree of preoperative sepsis as indicated by positive blood cultures appears to be an important prognostic sign.
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PMID:Improvements in the diagnosis and management of aortoenteric fistula. 398 88

A retrospective study was carried out in 30 patients after unilateral iliac endarterectomy, the contralateral limb being asymptomatic, to assess the evolution of the unoperated limb. Findings indicated 4 claudications uncovered by the unilateral operation, 8 secondary thromboses (including one asymptomatic lesion) of the unoperated iliac axis--repeat operation was necessary in only one patient. Findings emphasize the importance of control of risk factors to prevent secondary deterioration of an unoperated limb. The risk of thrombosis in the primarily asymptomatic side appears to lessen with immediate insertion of an aorto-bifemoral prosthesis, but risks inherent in prosthesis application--sepsis, false aneurysm--must be allowed for.
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PMID:[The future of the asymptomatic leg after unilateral iliac artery repair]. 409 21

One 12 day newborn, a 2 year old infant and two children aged 10 and 14, operated for isthmic coarctation of the aorta by three different surgical techniques (resection-anastomosis, angioplasty with an autograft, prosthetic graft) suffered infection of the operative field, resulting in septicemia (3 staphylococcal and 1 yeast infections). The aorta ruptured after 4 days, before any collection of pus in the newborn but a mycotic false aneurysm developed in the three other patients: this was the cause of death by aortic rupture during the 5th postoperative week in one case but was diagnosed and operated successfully in the other two, 13 and 54 days after their first operation. These complications are well known. Therefore, these patients should be closely followed up for at least one month. The occurrence of pyrexia, even slight or late, should be treated with suspicion. Characteristic dilatation of the part of the aorta operated on should be actively looked for by simple radiography, 2D echocardiography and, when in doubt, right heart angiocardiography. The diagnosis is a surgical emergency: the safest technique consists in initially establishing an aorto-aortic deviation by a right sided approach followed by exclusion of the lesion. Surgery is the only means of preventing catastrophic rupture of the aorta.
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PMID:[Infection of an anastomosis: a formidable complication of operations for aortic coarctation]. 641 Oct 34


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