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

Fifteen patients with non-immune fetal or neonatal ascites and absence of generalized edema are described. Nine patients were diagnosed prenatally. Nine patients were preterm. Artificial ventilation was necessary in twelve infants immediately after birth. In five cases, including two cases of transitory ascites, the etiology could not be established. In accordance with previous reports, we found the following underlying disorders in our patients: urinary tract obstruction, polycystic disease of the kidneys, chylous ascites, sepsis, intrahepatic atresia of the biliary ducts, hepatic and renal failure following severe asphyxia. 8 out of 15 patients died. A survey of the literature shows a variety of underlying disorders. Therefore, several diagnostic tests are necessary, in order to identify the etiology. Causative treatment is possible in some cases of urogenital , gastrointestinal, infectious and chylous ascites. Sophisticated perinatal management is essential for the outcome of patients with fetal or neonatal ascites; nevertheless the mortality rate is still about 50%.
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PMID:[Fetal and neonatal ascites: a report of 15 cases and a review of the literature]. 356 Jul 69

Determining the cause of acutely deteriorating renal function is a common problem in clinical nephrology. The fractional excretion of filtered sodium (FENa) has been demonstrated to be a reliably discriminating test between prerenal azotemia and acute tubular necrosis. However, with increasing clinical use of the FENa, numerous reports of low FENa (less than 1%) have appeared. The clinical settings of these reports include oliguric and nonoliguric acute tubular necrosis, urinary tract obstruction, acute glomerulonephritis, hepatorenal syndrome, renal allograft rejection, sepsis, and drug-related alterations in renal hemodynamics. One particular urinary index cannot be expected to reliably discriminate between prerenal azotemia and acute renal failure in all cases. The utility of the FENa test in the differential diagnosis of acute renal failure must be interpreted in conjunction with the patient's clinical course and the use of additional urinary and serum tests.
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PMID:Fractional excretion of sodium. Exceptions to its diagnostic value. 397 Jun 21

31 percutaneous nephrostomies (P.C.N.) were realised under a combination of real time ultrasound and fluoroscopic guidance. No failure in placement of the nephrostomy tube was noted. 13 complications were noted in 9 patients: 3 were major, consisted in 1 severe hemorrhage and 2 septicemia and 10 were minor, mainly caused by secondary displacement of the tube. Three indications of P.C.N. are related to upper urinary tract obstruction: 1) Overdistension and fever or pain associated with poor patient's condition. 2) Short-term obstructions. 3) Diagnosis of the nature or location of the obstruction when other techniques don't provide the solution, and/or evaluation of renal function. The drainage of some ureteral fistules represent the fourth indication. P.C.N. allows ureteral antegrad catheterization and its applications. Results are discussed and present or future applications of interventional uro-radiology are related.
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PMID:[Percutaneous nephrostomy under echographic guidance. Apropos of 31 cases]. 665 80

We have studied 45 patients who underwent nephrectomy owing to unilateral renal sepsis for anaerobic and aerobic bacterial growth in the urine and kidney. Anaerobic organisms were recovered from 11 patients: 10 had positive kidney cultures, and only 1 had positive kidney and urine cultures. There was a distinct relationship between anaerobic infection of the kidney and urinary tract obstruction; 44 per cent of the obstructed kidneys yielded anaerobic organisms versus only 11 per cent of the unobstructed kidneys. Bacteroides fragilis was the anaerobic organism most often cultured. It is suggested that cultures for anaerobic organisms be performed together with aerobic cultures in patients with symptomatic upper urinary tract infections associated with urinary obstruction. In patients in whom anaerobic infection is suspected, in spite of negative anaerobic cultures, antibiotic treatment for anaerobes should be added to the existing therapeutic measures.
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PMID:Isolation of anaerobic organisms from kidney in serious renal infections. 675 57

An analysis of treatment response in 215 patients treated by percutaneous nephrostomy identified obstruction of the urinary tract, complicated by infection and sometimes gram-negative septicemia, as the single most important indication for this intervention. Percutaneous nephrostomy reduced the mortality from gram-negative septicemia from 40% to 8%. Similarly, the length of hospitalization for patients with severe infection complicating urinary tract obstruction was reduced by half in the group undergoing percutaneous nephrostomy. In 43 patients with longstanding obstruction, percutaneous nephrostomy was used to predict recoverable renal function based on the response of renal plasma flow rate to decompression. In 13 patients, percutaneous nephrostomies were used either for the introduction of solvents to dissolve calculi or to serve as pathways for their extraction. Percutaneous nephrostomies in 21 patients were expanded to serve as points of entry for the placement of stent catheters to treat fistulas or bougie catheters to dilate and subsequently catheterize ureteral strictures. While six serious complications were encountered, five of these might have been prevented by meticulous adherence to proper technique.
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PMID:Redefinitions of indications for percutaneous nephrostomy. 683 20

Among a spectrum of renal disorders encountered in patients infected with the human immunodeficiency virus (HIV), the lesion studied most often has been the glomerular disease known as HIV-associated nephropathy. Of the other coincidental renal perturbations reported, the most significant are a heterogenous group encompassing potentially reversible acute renal failure (ARF), primarily acute tubular necrosis. While HIV-associated nephropathy may frequently be seen in asymptomatic HIV-seropositive individuals, acute tubular necrosis almost always is encountered in patients with clinical acquired immunodeficiency syndrome (AIDS). We analyzed our decade's experience in the management of 146 HIV disease patients with ARF (132 AIDS patients and 14 HIV-seropositive patients) and compared it with a contemporaneous group of 306 non-HIV subjects with ARF. All patients evaluated for ARF between January 1984 and December 1993 by the Renal Division at Kings County Hospital Center, Brooklyn, NY, were reviewed. Only those patients with ARF who reached a serum creatinine concentration of 530 mumol/L or higher were included in the analysis. Ninety-one percent of 146 HIV disease patients with ARF were less than 50 years old compared with only 33% of the 306 non-HIV subjects (P < 0.001). Septicemia was directly or indirectly responsible for 75% of patients with ARF in the AIDS group and for 39% in the non-HIV subjects (P < 0.006). Urinary tract obstruction was the cause of ARF in 54 of 306 (17%) non-HIV patients compared with none in the HIV group (P < 0.00001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. 787 16

Between August 1982 and May 1988, 503 patients underwent construction of a continent ileal reservoir (Kock pouch) for cutaneous urinary diversion at our university. Stenosis of the afferent antireflux valve resulted in upper urinary tract obstruction in 11 patients (2%). In addition, 2 patients underwent Kock pouch diversion elsewhere and upon referral to our institution they had afferent valve stenosis. To date 13 patients have been identified with this problem. Hydronephrosis was present in 100% of the functional kidneys in these patients. Radiographs of the Kock pouch were uniformly normal without evidence of reflux or other pathological condition. The most common presenting symptom was flank pain in 7 patients (54%) and the most common presenting sign was creatinine elevation above baseline in 7 (54%). Infections recurred with or without sepsis in 5 patients (38%). Ureteroileal anastomotic strictures were not present in any patient. The interval from creation of the Kock pouch to the diagnosis of stenosis ranged from 2 to 75 months (mean 39). All patients underwent endoscopic evaluation of the Kock pouch confirming stenosis of the afferent antireflux valve, and subsequent mechanical dilation of the stenotic valve. Dilation procedures were repeated in 6 patients (46%), 4 of whom subsequently required open surgical revision of the afferent valve. Of these patients 3 are clinically stable and 1 died of the primary malignancy. The remaining 2 patients are clinically and radiographically stable after multiple dilations. Of the 7 patients (54%) requiring only a single dilation 6 are clinically stable and 1 died of the primary malignancy. Stenosis of the afferent antireflux valve of the Kock pouch, previously unreported to our knowledge, is a rare late complication leading to flank pain, hydronephrosis, recurrent infection and elevation of serum creatinine levels. Approximately 50% of the patients respond to a single dilation of the nipple valve. However, most patients who require repeat dilation will need open surgical revision.
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PMID:Stenosis of the afferent antireflux valve in the Kock pouch continent urinary diversion: diagnosis and management. 828 19

From January 1988 to February 1992, a total of 26 patients with calculi in the middle third of the ureter underwent primary in situ ESWL in the prone position. All treatments were performed in sedoanalgesia using the Dornier HM 3 lithotriptor. During and after ESWL in the prone position, severe complications did not occur. Of the 26 patients, 10 (38%) were treated by a single application of ESWL. No auxiliary measures were necessary, and they became stone-free within 3 months following treatment. In another 9 patients (35%) auxiliary measures were required for visualization of radiolucent calculi or to relieve a urinary tract obstruction with incipient septicemia. All these auxiliary measures could be performed in sedoanalgesia. In the remaining 7 patients (27%), in whom stone disintegration following ESWL was incomplete, ureteroscopic lithotripsy techniques had to be applied. One of these 7 patients had to undergo an additional open operative procedure. The results of the present study demonstrate that a majority of patients with calculi in the middle portion of the ureter can become stone-free without invasive lithotripsy techniques following ESWL in the prone position, if necessary plus auxiliary measures, in sedoanalgesia. From these results it can be concluded that primary ESWL in the prone position should be considered for patients with calculi in the middle third of the ureter before invasive lithotripsy techniques are applied.
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PMID:[Treatment of ureteral calculi in bone coverage using in situ ESWL in prone position]. 828 60

Infection of the obstructed upper urinary tract is a severe complication of stone disease. Early detection and therapy is crucial to prevent septicemia. The authors investigated prospectively whether C-reactive protein (CRP) might act as a marker for the early detection of infected upper urinary tract obstruction. The serum concentration of CRP was compared with the classic markers of inflammation--white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and temperature--in the follow-up of 85 patients undergoing 173 extracorporeal shockwave lithotripsy (SWL) treatments. Post-SWL, 69% of the patients showed dilation of the upper tract on ultrasonography and 16.5% became symptomatic and required intervention. In this group, the mean CRP value was increased 18-fold, whereas the WBC count, ESR, and temperature were not markedly raised. In contrast, patients with no need for additional treatment showed no more than a 2-fold increase in CRP. C-Reactive protein seems to be a useful indicator for the early detection of infected upper urinary tract obstruction.
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PMID:Early detection of infected ureteral obstruction after SWL employing C-reactive protein. 897 85

A total of 638 patients with acute renal failure (ARF) of diverse etiology were studied over a period of 9 years (July 1985-Dec, 1994) of which 96 (15%) patients were classified as elderly ARF with mean age of 72.5 years. Medical causes accounted for 80% of geriatric ARF while 20% patients, had ARF of surgical origin. Decreased renal perfusion resulting from gastroenteritis was the predominant (52.8%) cause of ARF in the medical group. Nephrotoxic ARF and ARF due to F. malaria were seen in 10 and 7 patients respectively. Obstructive uropathy was observed in 12 patients in surgical group and in remaining 8 patients ARF developed following various surgical procedures. ARF in association with multiorgan failure was not observed in our study. Mortality was seen in 24 patients (25%). The causes of mortality were GI bleed (6), peripheral circulatory failure (5), hyperkalemia (4) and sepsis (4). Thus medical ARF remains the major cause of acute renal failure in elderly patients in our study in contrast to ARF associated with multiorgan failure and surgery in developed countries.
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PMID:Acute renal failure in the elderly: a demographic and clinical study of patients in eastern India. 942 1


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