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

Sixty cases of choledochal cysts in children are reviewed. The series comprises 55 cases of Alonso-Lej. Type 1 cysts, two cases whose cysts were infraduodenal and retropancreatic in position, and three cases of choledochal cysts with both proximal and distal atresia of bile ducts. The following five types of operative procedures were employed for the 58 cases: (1) Choledochocystoduodenostomy in 12; (2) Partial excision, choledochorraphy and choledocho-duodenostomy in six; (3) Cyst excision, portal dissection and portojejunostomy in three; (4) Choledochocystojejunostomy Roux-en-Y in 20; and (5) Cyst excision with hepaticojejunostomy Roux-en-Y in 17 cases. Two patients did not receive definitive surgical treatment. Early complications included six cases of leakage, of which one died; and four cases of cholangitis and septicemia, resulting in fatality in all. The overall operative mortality was 5/58 (8.6%). This review, though retrospective in nature, further supports the more recent trend that radical cyst excision with hepaticojejunostomy is the treatment of choice. This procedure carried no mortality and low morbidity. All 17 patients treated in this manner are well and free from jaundice and recurrent cholangitis. Cyst excision eliminates the reservoir for bile stasis, biliary obstruction, cholangitis, and biliary cirrhosis. It also removes the possibility of malignant change in the cyst and spontaneous rupture.
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PMID:Surgical management of choledochal cysts: a review of 60 cases. 404 73

Twelve patients with advanced malignant biliary obstruction were managed with a combination of sonography, percutaneous fine-needle aspiration biopsy, transhepatic cholangiography, and percutaneous biliary drainage. Excellent palliation of biliary obstruction was obtained in nine patients, four of whom are still living. Surgery was avoided in all cases, and a single episode of sepsis was the only complication. The literature indicates that surgical bypass procedures for malignant bile duct obstruction incur an average 20% operative mortality and provide only a 6 month mean survival. A combined radiologic approach offers an alternative to standard operative management of malignant biliary obstruction. When the cost-benefit ratios of operative vs. nonoperative management are considered, perhaps more patients should undergo radiologic management.
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PMID:Nonoperative management of malignant biliary obstruction: a radiologic alternative. 615 91

A prospective study of 101 Nigerian infants with conjugated hyperbilirubinaemia seen over 6 years shows that extrahepatic biliary tract obstruction, idiopathic hepatitis, and bacterial infections were the common causes. A firm diagnosis was based on clinical, biochemical and histological features when the patient presented early. However, most of the infants presented late and the superimposed features of prolonged cholestasis made differentiation of the probable causes difficult. Erythrocyte peroxide haemolysis test and laparatomy aided diagnosis in these cases. Seventy five per cent of the patients with sepsis treated with antibiotics, and 70% of those with hepatitis treated symptomatically, recovered. Surgery was successful in only 15% of the patients with biliary tract obstruction. These were those who had either diverticulum of the common bile duct, localized atresia or stenosis or in whom biliary obstruction was due to viscid bile.
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PMID:Conjugated hyperbilirubinaemia in Nigerian infants. 628 57

It has been our impression that clinical deterioration and worsening of liver tests of patients with alcoholic liver disease (ALD) is common immediately following hospitalization and cessation of ethanol intake. In order to determine the frequency of such deterioration and characterize features which may identify those patients who initially deteriorate, we analyzed the standard liver tests and clinical parameters of liver function following hospitalization of 273 cases of ALD, and correlated these with histologic patterns and hospital course. We found that moderate liver test worsening following hospitalization is frequent in patients with ALD, especially alcoholic hepatitis. The presence of alcoholic hyalin in patients with alcoholic hepatitis did not correlate with liver function or frequency of biochemical worsening, but did correlate with mortality. Biochemical deterioration did not correlate with clinical deterioration or mortality, unless complications such as bleeding, sepsis, or pancreatitis occurred. Spontaneous clinical deterioration of our patients in the absence of precipitating factors was rare. We conclude that worsening of liver tests following hospitalization frequently occurs in patients with ALD, does not necessarily imply presence of complications (e.g., biliary obstruction, sepsis, other liver injury), but should suggest the presence of alcoholic hepatitis.
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PMID:Clinical and biochemical course of alcoholic liver disease following sudden discontinuation of alcoholic consumption. 635 82

Sepsis is a major cause of mortality in patients with common bile duct obstruction. To define possible contributing factors to this phenomenon, this study evaluates the effect of biliary obstruction on the intravascular clearance and organ trapping of viable Escherichia coli using a rat model. Adult male Sprague-Dawley rats were placed in three groups: Group I controls had sham operation, Group II had division and ligation of common bile duct (CDL), and Group III underwent splenectomy. At 21 days following operation 10(9) radiolabeled E. coli were injected intravenously. At varying intervals after infusion, blood samples were obtained for clearance study. At 10 minutes, bacterial distribution in the liver, spleen, kidneys, and lungs was determined (expressed as the mean percentage of injected viable E. coli). Intravascular clearance was similar in all groups. There was a significant decrease in the trapping of bacteria by the liver of CDL rats 14.5% +/- 4.95 (vs. control = 70.0% +/- 13.3) (p less than 0.005). A significant increase of bacterial trapping by the lung was observed in the CDL animals: 63.1% +/- 7.06 (vs. controls 1.4% +/- 0.82) (p less than 0.005). There was no significant change in bacterial localization in splenectomized rats. These data suggest that biliary obstruction decreases hepatic phagocytosis and increases pulmonary localization of viable E. coli. As the Kupffer cells of the liver are usually effective in removal of blood borne bacteria, this phagocytic dysfunction may contribute to the increased susceptibility to infection noted in instances of biliary obstruction.
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PMID:Impaired bacterial clearance and trapping in obstructive jaundice. 636 81

Six cirrhotic patients underwent emergency esophageal transection utilizing the EEA Auto Suture stapling instrument for treatment of unrelenting variceal hemorrhage. All were grade C, and the combination of ascites, encephalopathy, and jaundice was present in four. All were critically ill with ancillary medical problems, including recent subtotal gastrectomy with sepsis and dehiscence, coexisting malignant biliary obstruction, and respiratory insufficiency. All were anergic to skin testing. Four died in the postoperative period, primarily of problems related to sepsis and ascites present before operation. Autopsy showed a well-healed anastomosis without stricture and complete interruption of the varices in all. No patient had recurrent bleeding. All received oral or tube feedings after operation. Two survive at 2 and 1.5 years with no recurrence of varices. This is a rapid, simple, and effective technique which can be done with minimal blood loss or training. There is no diversion of portal blood and minimal interruption of collateral circulation. Whereas the long-term benefits in terms of rebleeding are not yet known, results to date suggest a trial earlier and in better risk patients as a definitive treatment procedure.
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PMID:Treatment of bleeding esophageal varices by transabdominal esophageal transection with the EEA stapling instrument. 696 2

Cholecystectomy and common bile duct exploration in cirrhotic patients is associated with an 83 percent mortality if prothrombin time is prolonged 2.5 seconds over control. The causes of death are related to complications of liver disease such as hepatic encephalopathy, ascites, sepsis and hemorrhage. If the prothrombin time is prolonged, major intraoperative blood loss can be anticipated, and blood and plasma transfusion requirements may be massive. Jaundice in the presence of cirrhosis requires careful preoperative evaluation and is most frequently due to hepatocellular disease rather than extrahepatic biliary obstruction. Cholecystectomy and common duct exploration in cirrhotic patients should be performed only for life-threatening complications of biliary tract disease such as empyema, perforation and ascending cholangitis.
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PMID:Cholecystectomy in cirrhotic patients: a formidable operation. 705 56

A retrospective study of 65 patients with biliary sepsis and mechanical biliary obstruction, 19 of them with suppurative cholangitis (SC) and 46 with nonsuppurative cholangitis (NSC), was undertaken to identify distinguishing characteristics of the two forms of the disease. There were no statistically significant differences between SC and NSC based on histologic data, physical findings, or preoperative laboratory values. Mortality was significantly increased in patients with SC and in those with both forms of the disease who were given medical therapy alone. The treatment of choice for cholangitis with mechanical biliary obstruction is early operative drainage of the biliary tree, regardless of the presence or absence of suppuration in the common bile duct.
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PMID:Acute bacterial cholangitis: an analysis of clinical manifestation. 706 90

Fine-needle transhepatic cholangiography is a diagnostic tool often used for evaluating the biliary tree because of its wide availability and relatively low complication rate. Fine-needle cholangiography is primarily used in patients with obstructive jaundice with dilated ducts, but has been useful in patients with those entities that cause obstruction without dilatation (sclerosing cholangitis, ampullary stenosis, nonobstructing stone). We review our experience with over 700 cases of fine-needle cholangiography. The complication rate (due to bleeding, peritonitis, sepsis, and death) is less than 5%. The central role that fine-needle cholangiography plays in defining the site and cause of biliary obstruction is emphasized.
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PMID:Fine-needle transhepatic cholangiography. Indications and usefulness. 712 16

Internal catheter drainage was achieved in 46 of 62 consecutive patients (71.4%) undergoing percutaneous transhepatic biliary drainage (PTHBD). External drainage was achieved in 12 patients (19.3). Thus the overall success rate was 58 of 62 (93.5%). Postprocedural bilirubin levels returned to normal in 14 cases (22.5%), while bilirubin declines greater than 10 mg resulted in half the cases. Complications related to procedures occurred in three patients, although no deaths resulted. Late episodes of cholangitis were common (9/62 or 14.5%). Postprocedural care of the biliary drainage catheter included evaluation and management of acute biliary sepsis, persistent hyperbilirubinemia, electrolyte depletion, as well as catheter occlusion, bleeding, and dislodgement. PTHBD offers an effective new radiological alternative to surgical therapy of biliary obstruction.
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PMID:Percutaneous transhepatic biliary drainage: technique, results, and applications. 736 Sep 43


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