Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritoneovenous shunts (PVSs) have provided salutary effects on medically recalcitrant ascites, functional renal impairment, nutritional derangements, ventilatory embarrassment, and locomotion potential in patients with cirrhosis. While the LeVeen (LPVS) and Denver (DPVS) PVSs are most frequently implanted in such patients, postoperative complications of bleeding gastroesophageal varices, sepsis, and shunt occlusion occur with notable frequency. Addressing primarily the complication of PVS occlusion, a randomized prospective trial of LPVSs and DPVSs was conducted in cirrhotic patients with refractory ascites. From July 1, 1982 to July 1, 1984, 26 initial PVSs were implanted for hepatic-related intractable ascites. Twenty-two patients were eligible for randomization (cirrhosis, sterile ascites, initial PVS, total bilirubin level less than or equal to 6.0 mg/dL, prothrombin time less than or equal to 5-s prolongation, serum creatinine level less than or equal to 2.0 mg/dL [creatinine clearance rate greater than or equal to 20 mL/min], absence of recent [less than 30 days] bleeding gastroesophageal varices, or absent spontaneous encephalopathy). Twelve LPVSs and ten DPVSs were implanted; however, one patient with a DPVS was found to have hepatic polycystic disease and was excluded from analysis. All patients were followed up until death or Jan 1, 1985. The PVS patency determinations included contrast shuntography, technetium Tc 99m albumin scintigraphy, sequential manual compression (DPVS), and operative or autopsy observation. Using the Kaplan-Meier actuarial analysis, the LPVS patency proved to be highly superior to that of the DPVS, while survival was not significantly different. As LPVS and DPVS complications other than patency are comparable, the LPVS is preferred for its superior patency in cirrhotic patients with intractable ascites.
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PMID:LeVeen vs Denver peritoneovenous shunts for intractable ascites of cirrhosis. A randomized, prospective trial. 394 33

We studied the functional effects of intraperitoneal sepsis on systemic hemodynamics in general, and on renal function in particular, in sheep in whom bacterial peritonitis was induced by cecal perforation. In the first group of seven sheep (group 1) fluid was administered throughout the period of sepsis to maintain pulmonary capillary wedge pressure as close to presepsis values as possible. These sheep exhibited hemodynamic changes known to be associated with sepsis in man: increased cardiac output and decreased systemic vascular resistance. In a second group of seven sheep (group 2) fluid intake was restricted; compared with group 1, these sheep demonstrated a smaller increase in cardiac output that did not persist and that was associated with an increase in the systemic vascular resistance during the septic period. Plasma renin levels increased fivefold in group 2 but were unchanged in group 1. Serial renal biopsies during the septic period revealed that all sheep had evidence of tubular cell damage on electron microscopy: cell swelling, loss of the microvillous brush border, and cell necrosis. Both groups of sheep also demonstrated marked tubular proteinuria similar to that found in humans with generalized sepsis. Despite this, sheep in group 1 exhibited no functional renal changes: creatinine clearance levels rose slightly from control values, urine concentrating ability was unimpaired, and fractional excretion of sodium increased appropriately in response to a sodium load. In contrast, group 2 sheep exhibited a fall in creatinine clearance levels but fractional sodium excretion did not fall as would have been expected were renal function entirely normal. The results suggest that generalized "hyperdynamic" sepsis induces tubular cell damage and tubular proteinuria by an unknown mechanism. However, this does not necessarily produce renal impairment since the glomerular filtration rate does not fall unless volume contraction is also allowed to occur.
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PMID:Renal and cardiovascular response to nonhypotensive sepsis in a large animal model with peritonitis. 396 24

The indications, pharmacology, adverse reactions, clinical studies, dosage, and cost of hetastarch are reviewed. Hetastarch is a plasma volume expander used in adults for the treatment of shock caused by hemorrhage, burns, surgery, sepsis, or other trauma. It is a heterogenous macromolecular agent derived from starch and is composed primarily of amylopectin. The usual dose of 6% hetastarch is 500-1000 ml; total dosage should not exceed 1500 ml/day (20 ml/kg). The dose of hetastarch should be adjusted for patients with severe renal impairment because its major route of elimination is the urine. Adverse reactions associated with its use are minor defects in coagulation produced with recommended doses and dose-related hematologic abnormalities with infusions greater than 1500 ml. Elevations in serum alpha-amylase and indirect bilirubin levels have also been reported. Hetastarch appears to be comparable with albumin as a plasma volume expander and is substantially cheaper. Few controlled studies with hetastarch have been published, and more data are needed to evaluate its effectiveness compared with other plasma volume expanders.
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PMID:Evaluation of hetastarch. 619 62

We report the use of cefoperazone in 62 cases of serious infection, most of which occurred in patients with renal impairment. 43 severe or complicated urinary tract infections, 11 cases of pneumonia and 8 with other severe sepsis were treated with cefoperazone 1 to 2 g twice daily usually for 5 to 10 days. Of the patients with urinary tract infection, all who were symptomatic showed a rapid clinical response; 26 (61%) were cured including 11 of 16 with chronic renal failure; 12 relapsed and 5 were reinfected with a different pathogen. All of these patients were infected by organisms sensitive to cefoperazone by disc testing but in 5 of those who relapsed the cefoperazone MIC was in fact greater than or equal to 50 microgram/ml. Ten of 11 cases with radiologically confirmed pneumonia were cured with cefoperazone. 7 episodes of pneumonia were in patients with end-stage chronic renal failure (6 were on dialysis) and 1 was in a patient with acute renal failure. Seven of 8 cases with severe sepsis were cured with cefoperazone. 1 patient was withdrawn from the study when acute bronchospasm followed a 2 g intravenous dose. 2 of the successfully treated patients had functioning renal transplants, 2 of 3 with severe chronic renal failure were on dialysis and 1 had acute renal failure. Side effects included minor disturbances of liver function in 6 patients (11%), diarrhoea in 7 (13%) and marked alcohol intolerance in one, 4 patients with chronic renal failure developed a coagulation disorder which was corrected with vitamin K. None of the patients showed deterioration in renal function while receiving cefoperazone. Cefoperazone promises to be an effective drug for the treatment of a wide spectrum of severe infections in hospitalised patients including those with impaired renal function.
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PMID:Cefoperazone in the treatment of severe or complicated infections. 645 95

Lipid A, the toxic part of the bacterial endotoxin, is a common antigen for many gram-negative bacteria. Antibodies to lipid A occur naturally in humans; they have been found in 10%-34%, and even up to 73%, of individuals tested, as detected by indirect hemolysis and enzyme-linked immunosorbent assay (ELISA), respectively. Inflammatory bowel diseases (Crohn's disease or ulcerative colitis) cause changes in the level of antibodies to lipid A, as compared with that found in healthy control subjects. Increased levels of antibodies to lipid A are seen in both children and adults with infections due to gram-negative bacteria, such as urinary tract infections (UTI). The highest titers of IgG in serum, as detected by ELISA, have been recorded in patients with development or progression of renal scarring associated with UTI. Since lipid A may play a role in the pathogenesis of renal impairment, the determination of the level of antibodies to lipid A may help in the diagnosis of certain forms of UTI. Possible beneficial roles of antibodies to lipid A during septicemia caused by gram-negative bacteria in humans are still unclear.
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PMID:Antibodies to lipid A: occurrence in humans. 647 15

A 58-year-old Chinese woman was admitted to hospital with a presumed hypersensitivity reaction to allopurinol. Her illness was characterised by high fever, eosinophilia, exfoliative dermatitis and jaundice. She developed fulminant hepatic failure and septicemia with a fatal outcome. Clinical details are presented and the possible relationship of allopurinol hypersensitivity to renal impairment is discussed.
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PMID:Fulminant hepatic failure due to allopurinol. 659 11

Haemopoietic growth factors (HGFs) are being administered to patients with neutropenic fever; however, little is known about the endogenous HGF response in these patients. Specific assays were used to study four HGFs, granulocyte (G-) CSF, granulocyte-macrophage (GM-) CSF, macrophage (M-) CSF and interleukin (IL-) 6 levels in the blood of patients with neutropenic fever (46 episodes). For comparison, levels were also measured in three control populations: normals (20), afebrile neutropenic (14), and bacteraemic but not neutropenic patients (20). In febrile patients, levels of G-CSF (median, range) (0.46, < 0.10-142 ng/ml). IL-6 (0.054, 0.005-24.3 ng/ml) and M-CSF (18.5, 9.9-79.1 ng/ml) were elevated compared with afebrile subjects (< 0.10, < 0.10-1.62 ng/ml). (0.008, 0.002-0.024 ng/ml) and (6.45, < 5.0-31.3 ng/ml) respectively. GM-CSF was not elevated (< 0.02, < 0.02-8.0 ng/ml) compared with afebrile subjects (0.021, < 0.02-0.20 ng/ml). Variables significantly associated (P < 0.05) with elevated cytokine levels were determined by multiple regression analyses. Factors associated with G-CSF elevation were fever, neutropenia, pathogen type and raised bilirubin and creatinine. In contrast, neutropenia was not associated with IL-6 elevation although there was an association between IL-6 elevation and fever, Gram-negative and fungal infections and raised creatinine and bilirubin. M-CSF elevation was associated with fever, renal impairment and known pathogen. Elevated G-CSF and IL-6 levels normalized rapidly (hours-days) with the resolution of infection, whereas M-CSF concentrations remained elevated for up to 10 d. Cytokine levels remained elevated in septic neutropenic patients who did not recover. In summary, G-CSF, IL-6 and M-CSF levels were significantly elevated in sepsis. In contrast, GM-CSF levels were not elevated. These studies should assist the development of therapeutic strategies using HGFs in the treatment of sepsis.
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PMID:Endogenous haemopoietic growth factors in neutropenia and infection. 751 65

Renal dysfunction often complicates the course of liver transplant recipients. Preoperative renal dysfunction, including hepatorenal syndrome (HRS) may be present. Assessment of renal function in the pretransplant patient with end-stage liver disease is fraught with pitfalls. Direct measurement of GFR by a method other than creatinine clearance is recommended wherever possible. Preoperative renal biopsy should also be considered in those patients with renal dysfunction in whom the diagnosis of HRS is not definite. With the routine use of veno venous bypass, renal perfusion is maintained and intraoperative events generally do not play a significant role in the development of postoperative dysfunction. Postoperatively immunosuppressive medications such as CsA or FK506 account for most of the renal dysfunction that is observed. Other factors such as graft dysfunction, sepsis, and nephrotoxic drugs may also participate in renal impairment. The exact mechanism of cyclosporine or FK506 nephrotoxicity remains unknown. In liver transplant recipients, no convincing therapeutic strategies exist to combat nephrotoxicity other than dose reduction of immunosuppressive therapy. Patients with HRS can be successfully treated by liver transplantation with recovery of renal function and with patient survival rates comparable to recipients without HRS, despite increased morbidity.
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PMID:The kidney in liver transplantation. 769 Dec 5

Two sisters, 2 and 5 years of age, suffered from acute haemolytic anaemia occurring after gastroenteritis with Escherichia coli O157. One patient developed clinical signs of severe and acute intravascular haemolysis and sepsis. She received transfusion and antibiotic therapy. The second patient presented with mild to moderate haemolytic symptoms only. None of them developed renal impairment. In serum of both children, elevated titres of short-lived agglutinins were demonstrated in the indirect haemagglutination assay consisting of sheep erythrocytes coated with lipopolysaccharide from E. coli O157. By immunoblot analysis IgM antibodies against the O157 lipopolysaccharide were demonstrated in the acute phase sera but not in follow up sera taken 2 months after disease. On erythrocyte membranes, adsorption of microbial antigens was detected by use of a pool-immunoglobulin fluorescence test. The immunological status of both patients was normal. Complete recovery from haemolytic disease was observed without further therapy. Microbial antigens attached to the cell surface were assumed to be the pathophysiological cause of E. coli O157 associated haemolytic anaemia in two siblings.
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PMID:Haemolytic anaemia in association with Escherichia coli O157 infection in two sisters. 795 24

Thirteen orthotopic liver transplantations were performed in 12 patients for hepatic complications of Wilson's disease between May 1988 and July 1992. Ten patients had fulminant hepatic failure and two chronic liver disease. One patient underwent retransplantation for liver abscess secondary to hepatic artery thrombosis. Nine patients survive at a median follow-up of 18 (range 6-31) months. Three patients have died: two from multiple organ failure and sepsis, one from B cell lymphoma. Postoperative complications included bleeding requiring laparotomy in two patients, renal impairment in five, bacterial septicaemia in three, fungal sepsis in two and acute cellular rejection in six. The nine surviving patients are well with normal liver function test results.
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PMID:Orthotopic liver transplantation for hepatic complications of Wilson's disease. 836 35


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