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

During the five-year interval from January 1, 1971 to January 1, 1976 118 seriously ill adults received 2916 patient days of TPN therapy with an average infection rate of 7.6%. All patients received the benefit of a well-defined TPN catheter care protocol which emphasized regular (every 48 hours) catheter dressing changes. The lowest risk of infection, 2.7%, was seen in 73 patients who received an amino acid-glucose solution through a silicone elastomer catheter protected by an iodophor dressing. When catheter-related sepsis occurred, Staphlylococcus aureus and Candida albicans were the most common organisms cultured.
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PMID:Catheter infection factors affecting total parenteral nutrition. 9 66

Sepsis is a major catabolic insult resulting in modifications in carbohydrate and fat energy metabolism, and leading to increased muscle breakdown and nitrogen loss. Insulin resistance, which develops in sepsis, decreases glucose utilization, but plasma insulin levels are sufficiently elevated to prevent lipolysis, resulting in a further energy deficit. The availability of fuels in sepsis is therefore limited, and the body resorts to muscle breakdown, gluconeogenesis, and amino acid oxidation for energy supply. Previous work has not defined, however, the exact alterations in amino acid metabolism. Therefore, the following studies were undertaken. Blood samples were drawn from fifteen patients in whom the diagnosis of sepsis was clinically established; the samples were analyzed for amino acid, beta-hydroxyphenylethanolamines, glucose, insulin and glucagon concentrations. The plasma amino acid pattern observed was characterized by an increase in total amino acid content, due mainly to high levels of the aromatic amino acids (phenylalanine and tyrosine) and the sulfur-containing amino acids (taurine, cystine and methionine). Alanine, aspartic acid, glutamic acid and proline were also elevated, but to a lesser degree. The branched chain amino acids (valine, leucine and isoleucine) were within normal limits, as were glycine, serine, threonine, lysine, histidine and tryptophan. Those patients who did not survive sepsis had higher levels of aromatic and sulfur-containing amino acids as compared to those patients surviving sepsis. On the other hand, those patients surviving sepsis had higher levels of alanine and the branched chain amino acids. In a second group of five patients with overwhelming sepsis accompanied by a state of metabolic encephalopathy, a parenteral nutrition solution consisting of 23% dextrose, and an amino acid formulation enriched with branched chain amino acids was administered. In these five patients, normalization of the plasma amino acid pattern and reversal of encephalopathy was observed. The following sequence of events may be postulated: The septic patient develops insulin resistance in the peripheral tissues, primarily muscle, while the adipose tissue is much less affected. The insulin resistance and the inability to utilize fat leads to increased muscle proteolysis. Muscle breakdown results in release into the blood of enormous amounts of various amino acids; the muscle itself is able to oxidize the branched chain amino acids, supplying the muscles' own energy requirements and alanine for gluconeogenesis. The extensive muscle proteolysis coupled with relative hepatic insufficiency occurring early in sepsis results in the appearance in the plasma of high levels of most of the amino acids present in muscle, particularly the aromatic and the sulfur-containing amino acids. The outcome of patients with sepsis might be positively affected by combined therapy with glucose, insulin and branched chain amino acids.
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PMID:Amino acid derangements in patients with sepsis: treatment with branched chain amino acid rich infusions. 9 98

Daily prophylactic application of either 1.0% silver sulfadiazine cream or 0.1% gentamicin cream was compared for effectiveness in preventing bacterial colonization of burn wounds and sepsis. Pseudomonas aeruginosa colonized the wounds of 37% of the 38 patients treated with silver sulfadiazine and 30% of the 33 patients treated with gentamicin; gentamicin-resistant P. aeruginosa colonized the wounds of 21% of the patients treated with gentamicin. Staphylococcus aureus colonization occurred in 55% of the patients treated with silver sulfadiazine, whereas colonization with Candida species occurred in 58% of the patients treated with gentamicin. Although gentamicin-resistant organisms caused no deaths their repeated appearance resulted in discontinuation of prophylaxiz with gentamicin cream. The next year P. aeruginosa strains resistant to gentamicin were isolated from burn wounds of only two patients who had not previously received parenteral therapy with gentamicin or tobramycin. Gentamicin cream should be reserved for treating patients with wounds infected by gentamicin-sensitive P. aeruginosa and those allergic to sulfa drugs. For most patients with burn wounds silver sulfadiazine is safe and effective as an antibacterial agent for topical prophylaxis.
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PMID:Comparison of silver sulfadiazine and gentamicin for topical prophylaxis against burn wound sepsis. 9 23

Recent modifications and refinements in the management of patients with renal allografts have diminished the mortality rate at our hospital to 2 per cent and 5 per cent at one year for patients receiving kidneys from related and cadaveric sources, respectively. Of 186 receiving transplants since 1974, seven (4 per cent) have died within one year of operation. The incidence of wound infections has been reduced from approximately 25 per cent in 1972 to 2 per cent since 1976 by the use of a single high dose of broad-spectrum antibiotics administered at the time of induction of anesthesia for any surgical procedure. Risk and limitations of immunosuppression have been better appreciated, ultrasound is used more often in the diagnosis of partial obstruction or perinephric fluid collections, and needle biopsy of the transplanted kidney has reduced the morbidity inherent in open biopsy. The contribution of sepsis as a cause of death has declined. The diminishing hazard of renal transplantation has made it an increasingly attractive treatment for end-stage kidney disease.
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PMID:Factors contributing to the declining mortality rate in renal transplantation. 10 45

A consecutive series of 25 patients who developed external small bowel fistula within 2 weeks of abdominal surgery is described. Half the patients had a primary diagnosis of inflammatory bowel disease and the fistula arose usually as a result of direct trauma to the bowel or the breakdown of an anastomosis. All the patients were treated conservatively with total bowel rest and intravenous hyperalimentation. In 15 (60 per cent) spontaneous fistula closure occurred, in an average period of 32 days. In 8 patients the fistula failed to close and surgery was performed, but was effective in only 3 cases. Thus the fistula eventually closed in 18 patients. Five patients died, all from intra-abdominal sepsis. Of the 8 patients with a primary diagnosis of Crohn's disease, 3 died, 2 have a persistent fistula, 1 has a permanent ileostomy and spontaneous closure occurred in only 2.
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PMID:Postoperative external small bowel fistulas: a study of a consecutive series of patients treated with intravenous hyperalimentation. 10 92

A 72-year-old male is described with a history of 4 episodes of Pseudomonas aeruginosa sepsis and chronic otitis media caused by pseudomonas species. In vitro testing of the patient's polymorphonuclear leukocytes (PMNs) revealed profoundly abnormal chemotactic responses and defective intracellular killing of Ps. aeruginosa, Staphylococcus aureus and Escherichia coli. Chemiluminescence production by the patient's PMNs in response to opsonized zymosan as well as endotoxin stimulated nitroblue tetrazolium dye reduction were markedly depressed. These data indicate the presence of a profound, apparently acquired, defect in PMN function in an elderly male. Detailed evaluation of adult patients with recurrent infections may reveal similar, apparently acquired defects in PMN function.
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PMID:Recurrent Pseudomonas infection associated with neutrophil dysfunction. 10 88

The authors studied a possibility of obtaining experimental meningococcus sepsis model on mice. The use of cyclophosphane, iron compounds, yolk medium produced no significant organism. When 4--5% mucine was injected intraperitoneally together with meningococcus culture mice died with sepsis phenomena. Differences were revealed in the sensitivity of linear and mongrel mice to meningococcus infection--AKR mice proved to be more sensitive. At the same time it was found that mongrel mice weighing from 10 to 12 g could be used to induce meningococcus sepsis.
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PMID:[Model of meningococcal sepsis in mice]. 10 42

A 4 7/12-year-old Caucasian female with a history of "croup-like symptoms" and persistent airway obstruction, was found to have a primary lymphosarcoma by biopsy at the time of laryngoscopy and bronchoscopy. No metastatic disease was found. After an induction course of vincristine, prednisone and local irradiation, she received CNS prophylaxis with intrathecal methotrexate and cranial irradiation. Maintenance therapy, administered over a 2 3/4 year period, consisted of cyclophosphamide, methotrexate, and 6-mercaptopurine. Excluding the diagnostic evaluation, she was hospitalized only once for the management of suspected sepsis, gastrointestinal ulceration and severe bone marrow depression. Since discontinuing treatment 27 months ago, she has remained free of disease.
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PMID:Primary lymphosarcoma of the larynx in a child. 10 77

The first 100 cases of the 135 THARIES surface replacement procedures with 4--32 months follow-up, are evaluated in terms of clinical results, radiographic information and complications. The short but detailed follow-up suggests that this procedure was an excellent alternative for the younger and more active population. The overall hip ratings (pain, walking and function) and range of motion are comparable to that of stem-type total hip replacements. When the THARIES and conventional hip results are further compared in 34 patients matched by sex and age for 3 major etiological groups (osteoarthritis, osteonecrosis and congenital hip dysplasia), the interim results are essentially comparable for both types. Three cases in the first 100 have required revision. One patient (no. 1) with osteoporosis, chondrolysis and arthrofibrosis following slipped capital femoral epiphysis had loose femoral and acetabular components 24 months postoperatively. He was revised to a T-28 hip replacement. The polyethylene socket in another patient (no. 4), the first dysplastic hip in this series, was 20 nm uncovered superiorly, became loose and was revised 9 months postoperatively. Now 15 months postoperative with a more medial THARIES acetabulum, the patient continues to have a good result. Another patient (no. 12) with bilateral dysplastic hips became progressively more disabled due to heterotopic bone, which was then excised 18 months postoperatively. Radiographic studies of the THARIES sockets demonstrate radiolucent zones at the cement-bone interfaces of the acetabulum in 88 cases, partial in 51 and complete in 37. Three hips were currently considered to have evidence of progressive socket loosening but are active and asymptomatic. There have been no femoral neck fractures in this series which we attribute to the custom fitting ability inherent in the range of components, the reaming protocol and the various remodelling guides. There have been no prosthetic breakages, subluxations, dislocations or sepsis. The complications observed in this series are minor and comparable to that of many other total hip arthroplasty operations. Nerve palsy and trochanteric separation have not been major problems although one existing peroneal nerve dysfunction and one trochanteric migration emphasize the need to minimize these complications by careful handling of the operative leg, and an accurate trochanteric reattachment technique.
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PMID:THARIES surface replacements: a review of the first 100 cases. 10 70

K-1 Escherichia coli are far more frequent in neonatal sepsis (36% of E. coli sepsis) and meningitis (80% of E. coli meningitis) than would be expected by the frequency of K-1 E. coli colonization in neonates (11 to 25%). There is no apparent parallel in cases of sepsis in adults. To study further this apparent age-related difference in virulence, E. coli K-1 clinical isolates were tested for their sensitivity to sera. Strains isolated from cases of neonatal meningitis were more sensitive to serum bactericidal activity than those from cases of neonatal or adult sepsis or adult meningitis (P < 0.01). Serum sensitivity did not appear to be determined by K or O antigens. Four isolates sensitive to serum bactericidal activity obtained from neonatal cerebrospinal fluid were killed by adult serum chelated with 0.05 M Mg(2+) ethyleneglycol-bis (beta-aminoethyl ether)-N,N-tetraacetic acid (EGTA), suggesting that the alternative pathway was activated. Although untreated neonatal sera killed these strains as well as adult sera did, EGTA-treated neonatal sera were less effective than EGTA-treated adult sera. This suggests that the alternative pathway function was not activated in neonatal sera. The bactericidal defect of neonatal EGTA-treated serum was partially corrected by addition of either A or B hyperimmune equine meningococcal antiserum.
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PMID:K-1 antigen of Escherichia coli: epidemiology and serum sensitivity of pathogenic strains. 10 25


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