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)

During the past six years, 100 patients with retained biliary tract calculi underwent stone extraction, consisting of manipulation of the ductal system through the sinus tract using a variety of flexible catheters, stone baskets and a specially designed forceps and fiberoptic scope. Thirty-one of the patients were referred from outside the Chicago area and 19 of the total group had previously been operated upon at medical school hospitals. Stone extraction was successful in 96 of the total group. Eighty-five of these extractions were accomplished in one to three sessions, while eight of the patients required four to nine sessions before all of the stones were removed. Forty-five patients had multiple stones; 25, single stones; eight, sludge, fragments, mucus or debris, and no stones could be found in 12. Four patients required reoperation following unsuccessful percutaneous duct manipulation. One of these patients died along with two others who had successful extraction procedures. In two additional patients, duct obstruction recurred requiring reoperation three months and one year after manipulation. A high percentage of patients with retained biliary calculi can be successfully treated without reoperation using these methods. Failures are related to poorly placed T tubes, tortuous sinus tracts or dislodged tubes. Major morbidity and mortality are related to biliary obstruction and sepsis. An aggressive approach to infection with urgent nonoperative or operative measures to decompress completely the biliary tree is mandatory to reduce the incidence of major complications in these patients.
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PMID:Results of nonsurgical treatment of retained biliary calculi. 743 72

Although liver biopsy is a very useful procedure used frequently in the diagnosis and management of liver dysfunction occurring after orthotopic liver transplantation, complications can occur with its use. An unusual complication of arterioportal fistula is reported here. Based upon this small series of an unusual event and the knowledge that the posttransplant liver may be more hypervascular than prior to OLTx and that it is uniquely susceptible to hepatic infarction and abscess formation, any attempt at fistula closure should be considered carefully prior to initiating the therapy (15). Unless a serious complication occurs [such as a transient biliary obstruction due to hemobilia as occurred in case 2, portal hypertension as also occurred in case 2, or systemic sepsis or other symptoms develop related directly to the fistula], simple observation may be the best choice of action. Should therapy be required, hepatic arterial embolization should be reserved for adults with intrahepatic fistulas. Primary surgical closure of intrahepatic fistula should be reserved for cases of extrahepatic fistula.
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PMID:Arterioportal fistula following liver biopsy. Three cases occurring in liver transplant recipients. 772 61

The development of hypotensive complications, renal failure, and cholangitis in patients with jaundice [1-4] has particular implications for radiologists asked to perform diagnostic studies that require IV contrast material and for radiologists, gastroenterologists, and surgeons who do invasive procedures to relieve bile duct obstruction. Although systemic effects of obstruction eventually are eliminated by reestablishment of the free flow of bile, all invasive procedures are painful, require sedation or anesthesia, and can induce fluid shifts, electrolyte abnormalities, hemorrhage, bile peritonitis, and sepsis. A patient with jaundice is less able to respond to and easily decompensates after such stresses [4]. An awareness of the pathophysiologic effects of biliary obstruction is essential because proper preparation of patients with jaundice before invasive diagnostic and therapeutic procedures avoids complications and decreases morbidity and mortality [5-8]. An overview of the systemic effects of bile duct obstruction and their implications for patients who require invasive diagnostic and therapeutic procedures is provided in this article.
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PMID:Adverse effects of biliary obstruction: implications for treatment of patients with obstructive jaundice. 783 57

Bacteriologic studies of bile and blood cultures of 579 patients with ductal stones and infected bile revealed that 121 patients (21%) had associated bacteremia. Analysis of bile and stone cultures showed that Escherichia coli, Klebsiella sp, Enterobacter sp, Enterococcus sp, and Streptococcus sp were the most commonly isolated bacteria. Two-thirds of the patients with bacteremia had similar organisms isolated from blood and bile. Pharmacokinetic studies of the hepatic/biliary excretion profiles of ceftazidime, cefoperazone, imipenem, netilmicin, and ciprofloxacin were performed by ERCP and nasobiliary catheter drainage. The bile samples obtained immediately after cannulation from patients with complete biliary obstruction contained low or undetectable levels of the antibiotics administered--the exception being ciprofloxacin, which was present at a concentration of 20% of the serum level. In vitro determination of minimum inhibitory concentration of the aforementioned antibiotics against 199 isolates of biliary pathogens revealed imipenem and ciprofloxacin to have the highest antimicrobial activity. Based on pharmacokinetic studies and in vitro susceptibility findings, we conclude that ciprofloxacin is superior to the other tested antibiotics in prophylaxis and treatment of biliary sepsis.
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PMID:Antibiotics, biliary sepsis, and bile duct stones. 2814 18

The T lymphocyte function in 59 patients with malignant biliary obstruction undergoing pre-operative endoscopic drainage (group Ia, n = 24) or surgery (group Ib, n = 35) was evaluated by mitogen stimulation test with phytohaemagglutinin. The T lymphocyte function before endoscopic or surgical intervention was found to be impaired as compared with patients with gastric cancer (group II, n = 27) and with normal persons (group III, n = 19). Regression analysis showed a significant negative correlation between T lymphocyte function and the serum bilirubin level (correlation coefficient -0.3, P = 0.01) and a positive correlation with serum albumin level (correlation coefficient 0.34, P = 0.01) and serum transferrin level (correlation coefficient 0.45, P = 0.001). After 18 +/- 3 days of endoscopic biliary drainage, the T lymphocyte function of group Ia patients did not change substantially. At postoperative day 14, there were more patients in both groups Ia and Ib having deterioration of T lymphocyte function than those with improvement. The incidence of postoperative sepsis was found to be significantly higher in patients with deterioration than those with improvement of T lymphocyte function (18/31 vs 7/26, P = 0.036). It is concluded that endoscopic biliary drainage and surgery could not reverse the T lymphocyte dysfunction in patients with malignant biliary obstruction.
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PMID:T lymphocyte function in patients with malignant biliary obstruction. 794 22

Endotoxin sensitivity varies among animal species and appears to correlate with the presence of pulmonary intravascular macrophage (PIM). In rats, which lack PIM, we investigated the hypothesis that chronic cholestatic liver injury leads to induction of PIM and endotoxin sensitivity. Rats were randomized to either common bile duct ligation (BDL) or sham-surgery and studied at 1 wk (acute cholestasis), 2 wk (cholestasis, early cirrhosis), and 4 wk (cholestasis, established cirrhosis) after surgery. Intravascularly injected fluorescent latex microspheres (1 micron diameter) were taken up by large phagocytic cells in lung parenchyma of BDL rats (at 2 and 4 wk), while no uptake was observed in lungs from control rats. Electronmicroscopy revealed accumulation of large, mononuclear, macrophage-like cells containing ingested latex particles within the pulmonary capillaries. Pulmonary intravascular phagocytosis, as reflected in lung uptake of 99mTc microaggregated albumin (Microlite, mean particle diameter = 1 micron), averaged 0.7 +/- 0.1% (mean +/- SEM) of total injected dose in 13 control rats and progressively increased with time after BDL (1 wk, 1.7 +/- 0.2%; 2 wk, 10.0 +/- 3.0%; 4 wk 35.1 +/- 5.9%). Rats with biliary cirrhosis were markedly sensitive to the lethal effects of low dose endotoxin and demonstrated marked lung edema at the time of death. Furthermore, the lung uptake of intravascular 125I-lipopolysaccharide was increased five-fold in cirrhotic rats. We conclude that chronic biliary obstruction leads to the induction of pulmonary intravascular phagocytes and enhances endotoxin sensitivity in rats. Pulmonary intravascular phagocytosis in patients with advanced cirrhosis may account for their increased susceptibility to sepsis-induced adult respiratory distress syndrome.
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PMID:Chronic biliary obstruction induces pulmonary intravascular phagocytosis and endotoxin sensitivity in rats. 796 47

The present study evaluated the effects of prophylactic administration of cefotaxime in patients undergoing therapeutic or complicated diagnostic ERCP. One hundred patients were randomized to two groups of 50 patients each. Patients in group 1 received an intravenous infusion of 2 g cefotaxime 15 minutes before endoscopy; patients in group 2 did not receive an intravenous antibiotic before ERCP (control group). Blood samples were drawn for bacteriologic cultures before endoscopy and 5, 15, 30, and 120 minutes after beginning the procedure. Bacteremia was detected by blood cultures (15- and 30-minute samples) in 4 patients who did not receive prophylactic antibiotics (Escherichia coli in 2 cases, Peptostreptococcus in 1, and Staphylococcus aureus in 1). Cholangitis or sepsis did not occur after the bacteremic episodes in any of these patients. In 4 other patients who did not receive cefotaxime-all of whom had biliary obstruction-clinical cholangitis or sepsis developed during the 3-day follow-up; ERCP had failed to decompress the biliary system completely in these 4 cases. Blood cultures identified bacteria in 3 of these 4 patients (Pseudomonas aeruginosa in 1, E. coli in 2). Thus, bacteremia or clinical sepsis developed in 8/50 patients (16%) in the control group without antibiotic prophylaxis, whereas no such episode was observed in patients who had received prophylactic treatment (chi 2 = 8.7; p < 0.01). The present results indicate that prophylactic administration of an antibiotic such as cefotaxime can reduce the incidence of bacteremia and sepsis in patients who undergo therapeutic or complicated diagnostic ERCP.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: results of a randomized controlled clinical study. 798 37

Septic complications and renal insufficiency following biliary tract surgery are frequently seen in patients with obstructive jaundice. The precise mechanisms for understanding the susceptibility of the jaundiced patients to sepsis are, however, not clear. The present study aimed at investigating the influence of biliary obstruction on the reticuloendothelial function and bacterial translocation at various time intervals in the rat. Reticuloendothelial system (RES) function, as evaluated by measuring blood clearance of intravenously injected 125I-labeled Escherichia coli, and bacterial translocation were studied 3 days and 1, 2, and 3 weeks following either sham operation or common bile duct ligation (CBDL) and transection in the rat. RES function was significantly impaired and renal uptake of radiolabeled E. coli was significantly higher in jaundiced animals from Day 3 and on after CBDL (P < 0.01) concomitant with elevation of plasma levels of bilirubin and liver enzymes (P < 0.001) compared with their corresponding controls. The incidence of bacterial translocation 3 days and 1 and 2 weeks after biliary obstruction significantly increased (P < 0.05). We conclude that RES phagocytic function is impaired and the incidence of bacterial translocation is increased in jaundiced rats. These findings might contribute to explain the high susceptibility of postoperative septic complications and renal dysfunction in patients with obstructive jaundice.
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PMID:Obstructive jaundice impairs reticuloendothelial function and promotes bacterial translocation in the rat. 802 31

Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). We prospectively performed blood cultures and surveyed patients for complications. The aims were first, to determine the incidence of bacteraemia associated with ERCP, second, to assess the incidence of clinical sepsis following the procedure and third, to evaluate the effectiveness of our antibiotic prophylaxis. One hundred and fifty successive patients underwent 179 ERCP. Bacteraemia related to the procedure or the underlying pathology was found in nine procedures (5.2%). Bacteraemias were more likely to complicate therapeutic procedures (P = 0.015), biliary obstruction (P = 0.045) or underlying pathology (P = 0.022). Although 61% of ERCP received antibiotics, 22 septic events occurred. Five bacteraemic patients were septic despite antibiotics. Septic complications were associated with the same factors as bacteraemia. It was concluded that patients with biliary obstruction and undergoing therapeutic endoscopic procedures are at greatest risk of bacteraemia. Single dose prophylactic antibiotics may not prevent sepsis in these patients and longer-acting drugs or repeated dosing may be necessary.
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PMID:A prospective study of septic complications of endoscopic retrograde cholangiopancreatography. 815 67

Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established technique and has considerable diagnostic value and therapeutic potential in patients with hepatobiliary disease. In experienced hands, ERCP is a safe procedure. The most important complications are pancreatitis, infection--ascending cholangitis and septicaemia--instrumental injury and haemorrhage. The reported incidence of bacteraemia complicating ERCP varies considerably (0.16-16%) but this may be due to differences in specimen collection and culture techniques. Clinically significant sepsis is the commonest cause of death due to ERCP with a case fatality rate of 8-20%. As the danger of sepsis was increasingly recognized, antibiotic prophylaxis was considered as routine policy in many centres; supporting evidence was retrospective. Significant differences between antibiotic and control groups are difficult to confirm in clinically controlled trials because of an insufficient number of patients and the low incidence of cholangitis and septicaemia. The optimum regimen is unknown and there is uncertainty regarding the duration of treatment required to provide adequate protection. Local variations in bacterial sensitivity should be taken into account when choosing the antimicrobial agent. In patients without clinical signs of biliary obstruction the risk of infection is low and prophylaxis may be unnecessary.
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PMID:Antimicrobial prophylaxis during biliary endoscopic procedures. 844 39


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