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

Between 1949 and 1976, 899 patients underwent treatment for achalasia of the esophagus at the Mayo Clinic, 431 by forceful hydrostatic or pneumatic dilation and 468 by a standardized transthoracic esophagomyotomy. Esophageal leak and mediastinal sepsis was an uncommon but major complication of both types of therapy, occurring four times more often with dilation (4%) than with myotomy (1%), although no deaths resulted from this in either group. The 30-day mortality was 0.2% after myotomy and 0.5% after forceful dilation. Although there was minimal morbidity and mortality with either modality, the late results were significantly superior after myotomy. Excellent to good results were obtained by 85% of the group treated with myotomy but only by 65% of those treated with hydrostatic dilation. Late poor results were encountered three times more frequently after dilation (19%) than after myotomy (6%). Analysis of poor results after myotomy indicates that late serious complications of gastroesophageal reflux developed in only 3% of patients operated on.
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PMID:Esophagomyotomy versus forceful dilation for achalasia of the esophagus: results in 899 patients. 8 37

The triennial Confidential Enquiries into Maternal Deaths in England and Wales report 235 maternal deaths directly due to pregnancy or childbirth in 1973-75. The inquiry covers 94% of maternal deaths, and the figure is 4 times lower than the 1950s report. 37 deaths were attributed to obstetric anesthesia, some of which could have been prevented if the practising house officer had been more knowledgeable. Amniotic fluid deaths numbered 15 and were largely unpreventable. While maternal mortality rates have declined, amniotic fluid embolisms have remained steady since the 1960s. From 1973-75 the causes of death were as follows: hypertensive disease of pregnancy, 47; pulmonary embolism, 61; abortion, 81; sepsis, 70; ectopic pregnancy, 34; uterine hemorrhage, 27.
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PMID:George Stroh. 9 Mar 22

In a prospective double-blind randomised trial 83 patients undergoing elective colorectal surgery were given either preoperative intravenous metronidazole or intravenous normal saline. No other antimicrobials were given. Bowel preparation was the same for both groups. Deep post-operative wound sepsis occurred in 6 of 44 (13-6%) patients on metronidazole but in 20 of 39 (51-2%) control untreated patients. Anaerobes were responsible for all cases of deep sepsis in the metronidazole group (in 5 of the 6 cases aerobes were also isolated), and for 16 of the 20 cases of deep sepsis in the control group (all with aerobes). Superficial infection in the metronidazole group was caused by aerobes. Anastomotic leakage occurred in 5 of the 6 patients who developed deep sepsis on metronidazole and in 10 of 20 patients on placebo. Peroperative intravenous metronidazole dramatically reduced postoperative sepsis but failed to prevent infection in the presence of anastomotic breakdown.
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PMID:Prophylactic peroperative intravenous metronidazole in elective colorectal surgery. 9 Aug 59

Thirty-four patients with advanced squamous cell carcinoma of the head and neck have been treated with sequential combination chemotherapy consisting of Cytoxan, methotrexate, oncovin, bleomycin and adriamycin, followed by Leucovorin (COMBAL). All patients had undergone extensive prior radiation and/or surgery. All the patients had recurrent cancer. Toxicity included two deaths from drug induced pancytophenia and one from sepsis. Treatment was well tolerated and could be given in the outpatient clinic. No bleomycin pulmonary or adriamycin cardiac toxicity was seen. Results include 4 patients who achieved complete remission, objective improvement in measurable lesions in 6 others, stabilization of disease for 1 to 3 mo. in 5, and progression of disease in 13. Survival has ranged from 1 to 19+ months with a median of 10.7 mo. for patients that were evaluated. We conclude that COMBAL produces objective evidence of improvement in approximately 45% of patients with far advanced, previously treated squamous cell carcinoma of the head and neck.
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PMID:Sequential combination chemotherapy for advanced squamous cell carcinoma of the head and neck. 9 40

Thirty-nine patients with advanced epidermoid carcinoma of the head and neck were treated with a combination of cis-dichlorodiammineplatinum(II), methotrexate, bleomycin, and vincristine. Twenty-nine patients were evaluable for response and 39 were evaluable for toxicity. With this regimen toxicity was acceptable and the following rates were observed in a total of 139 treatment courses: 100% (nausea and vomiting), 3% (decreased creatinine clearance), 4% (thrombocytopenia), 5% (leukopenia), and 2% (pulmonary fibrosis). There was one death due to sepsis during a period of chemotherapy-induced leukopenia. Although the patients treated with this regimen had advanced disease and had been treated aggressively previously, an overall response rate of 24% was observed, with three patients (10%) having a complete response. Median duration of response was 7 + months. These results indicate that this intensive combination chemotherapy has a sufficiently favorable risk/benefit ratio to allow its evaluation in randomized clinical trials in patients with head and neck cancer.
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PMID:Cis-dichlorodiammineplatinum(II), methotrexate, bleomycin, and vincristine in head and neck cancer: a pilot study. 9 8

Three patients with malignant histiocytosis treated with combination chemotherapy are reported. Induction treatment included bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP). Complete response was obtained in one patient who is alive and well 32 months after diagnosis. A partial response was obtained in the second patient, who is alive and well 35 months after diagnosis. The third patient died with drug-induced agranulocytosis and sepsis.
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PMID:Combination chemotherapy of malignant histiocytosis. 9 46

The report presents three studies of post-traumatic pulmonary insufficiency (PTPI). In the first no significant pulmonary hemodynamic or ventilatory changes in severely shocked baboons resuscitated with shed fresh blood or stored blood were observed over 48 or 84 hours. Second, a post-mortem study of patients receving more than 5 units of blood within 24 hours of death showed sme microemboli in the lungs in about two thirds. Patients with multiple microthrombi had received an average of 20.6 units of blood; patients with some or no microemboli 15.5 and 6.3, respectively. Third in a review of the respiratory complications of 153 multiple-trauma patients, it was shown that the formerly severe problems with PTPI were now well managed clinically, that persistent respiratory failure was now occurring much later after injury, and occurred almost exclusively in patients with sepsis. Relation of the above data to previous reports in the literature led to the conclusion that the clinical significance of microaggregates in stored blood, if any, is low, and that ultrafiltration to remove microemboli only makes sense if it does not impede the rate of blood infusion and does not increase cost.
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PMID:Blood microaggregates and ultrafilters. 9 93

Nineteen patients (11 women and eight men) aged 20-68 received long-term parenteral nutrition, mostly at home, for six to 63 months (mean 19 months). Indications for LTPN were extensive, active Crohn's disease in three patients, intestinocutaneous fistulas in three, and short-bowel syndrome in the remaining 13 patients. Subclavian or intra-atrial (Broviac) catheters were most commonly used, for which the average life was four and seven months respectively. Complications of long-term parenteral nutrition included pneumothorax in four out of 48 subclavian vein punctures. Catheter-induced thrombosis of central veins was shown by phlebography 17 times in nine patients, and eight episodes of total occlusion occurred. Two of these patients had pulmonary infarction. Nineteen episodes of catheter sepsis occurred in 11 patients, but only one was fatal. Complications related to intestinal disease included intra-abdominal abscesses and intestinal fistulas, and disturbances of liver function. Five patients died, though in only two was death related to long-term parenteral nutrition. One of these patients died from catheter sepsis, the other had subdural haematoma possibly caused by anticoagulant treatment. Eight of the 14 surviving patients still needed parenteral nutrition. All received a disability pension, but six had an acceptable quality of life with almost normal social activities.Despite problems such as difficulties in maintaining standardised infusion programmes, it was concluded that long-term parenteral nutrition at home is practicable and consistent with an acceptable quality of life.
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PMID:Long-term parenteral nutrition. 9 99

DIC is a hemorrhagic syndrome frequently encountered as a complication in severe gram-negative bacterial sepsis. An animal model for sepsis-associated DIC was developed in order to permit study of the appearance and development of this syndrome in relation to the entire disease process. Rhesus monkeys (4 to 6 kg) were infected by intravenous injection of 10(9) Salmonella typhimurium organisms and studied for a period of 7 to 10 days following infection. Ten of 23 infected monkeys developed petechial rash characteristic of DIC, which appeared on days 1 to 2 infection and lasted 4 to 5 days. In the group of monkeys developing rash, activation of coagulation was suggested by an 80% decrease in platelet count and 20% to 30% increases in PT and APTT. Fibrinolytic system activation was indicated by the appearance of FDP. Kinin system activation was evidenced by decreases in both prekallikrein nad kininogen. Changes in laboratory tests suggestive of subclinical DIC were also noted in infected monkeys which did not develop a rash. Pathologic evidence of DIC was obtained through observation of numerous fibrin thrombi in the kidneys of the only monkey which died in the course of infection. Occurrence of DIC in association with this experimental infection in rhesus monkeys was established on the basis of clinical, laboratory, and pathologic criteria. Expression of the syndrome on days 1 to 2 following infection correlated with the period of increasing bacteremia.
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PMID:Model for disseminated intravascular coagulation: bacterial sepsis in rhesus monkeys. 9 3

Sepsis continues to be one of the most feared complications of total parenteral nutrition. Many techniques have been advocated for dressing changes, solution preparation, and evaluation of patients with fever spikes. Our technique in evaluating such a patient with suspected sepsis is to remove the tubing and solution from the pumping mechanism and place the bottle below the patient, permitting approximately 10 cc of blood to flow into the tubing. The entire set-up of solution and tubing is then quickly replaced and the infusion resumed. The removed blood is transferred to a series of three standard blood culture bottles. The first bottle will be culturing blood; the second, a mixture of blood and infusate; the third, solution alone. When performed carefully, negative culture results appear to exclude TPN as a source of spesis. Positive results are obviously helpful, but must be interpreted with caution in that the blood, catheter, tubing, filter, or solution may be suspect.
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PMID:A technique for evaluating sepsis in TPN patients. 9 53


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