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

Chronic haemodialysis and renal transplantation are mutually supplementing methods for the treatment of patients with terminal renal lesion. The two methods have proved their worth in clinical practice. The expectance of life of patients with chronic renal insufficiency could essentially be improved during the last years. In last consequence the successes of the transplantation of kidneys depend on the solution of immunobiological problems, which are not yet cleared up nowadays. 1. In the determination of genotypical determinants possibly not all are known or recognizable. 2. The at present clinically usable examination methods do not yet allow to recognize rejections so early that by an aimed immunosuppressive treatment irreversible damages on the graft may be prevented. After a transplantation of kidneys of relatives a long survival time of transplanted patients is better than after a transplantation of kidneys taken from dead bodies. The rejection is still the main factor of the failure of the graft, the sepsis is the most frequent cause of death. It is neccessary, to develop less toxical remedies for the adaptation of the graft. Nevertheless, thousands of optimally transplanted patients prove the usefulness of the allogenic transplantation of the kidney.
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PMID:[Possibilities and limits of kidney transplantation]. 35 41

Since the development of recombinant DNA technology, there has been a rapid expansion of research concerning the use of recombinant DNA synthesized human growth hormone (rhGH) for the treatment of clinical disorders. rhGH has been used to treat patients with acute catabolic stress caused by surgery, trauma and sepsis, children with chronic renal insufficiency and impaired growth, patients undergoing maintenance hemodialysis who are malnourished, and individuals on weight reduction diets. These studies indicate that rhGH enhances protein balance in acutely stressed patients and in malnourished maintenance hemodialysis patients, promotes catch-up growth in children with chronic renal failure, and may reduce protein wasting and enhance lipolysis in obese individuals on weight reduction diets. Experimental studies suggest that in addition to enhancing anabolism, rhGH may increase both immune function and the rate of wound healing. Many, but not all, of the effects of rhGH are mediated through insulin-like growth factor I (IGF-I). For example, the hyperglycemic and lipolytic effects of rhGH do not seem to be caused by IGF-I. Animal or human studies suggest that with severe malnutrition or severe sepsis, rhGH treatment may neither increase serum IGF-I levels nor promote anabolism. These observations provide a rationale for administering IGF-I as an anabolic hormone for severely malnourished or septic patients with renal failure. Further studies will be necessary to examine both the short-term and long-term potential benefits and adverse effects of rhGH or rhIGF-I treatment in these conditions.
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PMID:The rationale for the use of growth hormone or insulin-like growth factor I in adult patients with renal failure. 146 73

Forty-eight patients with acute renal failure (ARF) who were referred to the Department of Renal Medicine, Singapore General Hospital for acute dialysis between August 1985 and August 1989 were studied retrospectively to identify risk factors associated with ARF that serve as prognostic indicators. There was no difference in the mean age of survivors and non-survivors (49.5 +/- 17.5 years vs 53.5 +/- 18 years, p greater than 0.05). The overall mortality rate was 52%. ARF as a result of surgical complication had a higher mortality rate in comparison to ARF from medical complications (66% vs 50%, p greater than 0.05). Septicaemia was the most common cause of ARF requiring dialysis. Hepatobiliary sepsis was the most frequent cause of septicaemia. Pre-dialysis serum urea and creatinine levels, and the number of dialysis treatments did not affect the outcome. Poor prognostic indicators included oliguria or anuria, fluid overload and coma. Patients tended to have a worse outcome if they had more than three risk factors taken from the following list:-decreased renal perfusion, assisted ventilation, coma, gastrointestinal dysfunction, recent surgery, sepsis, congestive heart failure, hepatobiliary dysfunction, malignancy, diabetes mellitus, chronic renal insufficiency and poor nutritional status. Early referral of patients with septicaemia due in particular to hepatobiliary infection may improve the prognosis.
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PMID:Acute renal failure prognostic indices in hospital inpatients referred for haemodialysis. 192 73

A rare case of aplastic anemia which was considered to be induced by allopurinol was reported. A 48-year-old female had suffered from urolithiasis and chronic renal insufficiency. She was administered allopurinol for hyperuricemia for 4 months, and subsequently developed severe pancytopenia and bone marrow suppression. After stopping of allopurinol administration, she was administered prednisolone but died of gastro-intestinal tract bleeding and sepsis on the 21th hospital day, without hematological recovery.
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PMID:[Aplastic anemia probably induced by allopurinol in a patient with renal insufficiency]. 231 10

During ten years 59616 haemodialyses were performed with 18139 capillary dialysers on 226 patients being in the final stage of chronic renal insufficiency. With the semi-automatic technique applied blood can be eliminated from the dialyser in 15-20 minutes. Formalin used for desinfection is washed out of the apparatus such a way, that formalin content of the last washing solution ranges between 0-0.1 microgram/ml. Anti-N antibody indicating the presence of formalin could be detected in the serum of 2 patients out of the 120 cases tested. The same dialyser is used repeatedly on one patient, 3.29-times on the average. The regenerated dialyser eliminates compounds of small-and middle molecular weight with the same efficiency up to the 4th repeated use. Ratio of pyrogenic reactions is low, 0.08%. Neither infection or sepsis associated with the regeneration occurred. Rehabilitation degree as well as the survival time of patient corresponded with the average European standard. Because of the "first use syndrome" (allergic symptoms, hypotension, nausea, vomiting, headache, cramps etc.) with 5 patients haemodialysis could be performed only with regenerated dialysers dialyses. From the considerable sums saved by regeneration process 7 satellite dialysing units were established and equipped.
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PMID:[Experience with the regeneration and repeated use of dialyzers (1977-1987)]. 261 56

Forty-two patients with chronic renal insufficiency were subjected to Brulamycin therapy to combat complications such as sepsis, infection of the lower respiratory tract (bronchopneumonia) or of the urinary tract, Cimino fistula inflammation or peritonitis when the pathogenic agent was sensitive to nothing but aminoglycosides. The proper Brulamycin dose was selected under close clinical and laboratory control so as to fit the dialysed patient and his state of impaired renal function. The various forms of dialysis have been studied to determine their Brulamycin blood level diminishing effects. Familiarity with these effects is as important as with the patient's age, sex, body weight and actual state of renal function. The results confirm the experience gained by other authors that Brulamycin treatment--in curative non-toxic doses as indicated by the blood level index--is useful against severe infectious complications in anuric patients.
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PMID:Experience with brulamycin therapy in dialysed patients. 323 5

To identify risk factors for Vibrio vulnificus infections, we performed a regional case-control study of 19 patients identified by isolates received at a state reference laboratory. Interviews with patients or surviving relatives and with three controls for each patient were compared in a matched analysis. Patients with V vulnificus wound infection were more likely than controls to have sustained a puncture wound while handling fresh seafood or to have been exposed to salt water. More patients with primary septicemia than controls had eaten raw oysters before the onset of illness. Other risk factors for septicemia included underlying liver disease, hematopoietic disorders, chronic renal insufficiency, use of immunosuppressive agents, and heavy alcohol consumption. Although V vulnificus infection is unusual, with a regional incidence of 0.8 per 100,000 population in this study, septicemia in the immunosuppressed patient is a devastating illness that can be prevented by not eating raw seafood.
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PMID:Vibrio vulnificus. Man and the sea. 398 59

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insights into the underlying mechanisms the lysosomal factors of polymorphonuclear (PMN) leukocytes and the plasma elastase-alpha 1-proteinase inhibitor complex were investigated in patients with acute and chronic renal failure. Lysosomal activity was evaluated in peripheral blood smears by the lysis of erythrocytes and plasma (halo formation) around each neutrophil induced by 0.25 M NaC1 borate buffer. In about half of the patients with chronic renal insufficiency on dietary treatment lysosomal activity of PMN leukocytes was reduced. The plasma concentration of elastase-alpha 1-proteinase inhibitor complex was normal in most subjects, but increased in three patients with the highest serum creatinine levels (greater than 13 mg/d1). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis, or dye-induced) halo formation was either reduced or absent. The plasma elastase-alpha 1-proteinase inhibitor complex was increased in 5/6 of the patients by a factor of two to four. Also in the patients on regular hemodialysis treatment halo formation of PMN leukocytes was substantially reduced, whereas the plasma levels of elastase-alpha 1-proteinase inhibitor complex was slightly increased. The finding of reduced lysosomal activity of PMN neutrophils in uremia may be partly due to an enhanced release of neutral proteinases into the circulation as indicated by the elevated plasma levels of elastase-alpha 1-proteinase inhibitor complex in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Granulocyte lysosomal factors and plasma elastase in uremia: a potential factor of catabolism. 620 47

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insight into the underlying mechanisms the neutral proteinases of polymorphonuclear (PMN) leukocytes were investigated in patients with acute and chronic renal failure. The following studies were performed: 1. Neutral proteolytic activity of PMN neutrophils in blood smears (according to Klessen, 1978). 2. Serum levels of elastase alpha 1 proteinase inhibitor complex (Neumann et al., 1981). In about half of the patients with chronic renal insufficiency on dietary treatment the proteolytic activity of PMN leukocytes (halo formation are due to digestion of erythrocytes and plasma) was reduced. The serum concentration of elastase alpha 1 proteinase inhibitor complex was normal in most subjects, but increased in 3 patients with the highest serum creatinine levels (greater than 13 mg/dl). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis or dye induced) halo formation was either reduced or absent. Serum elastase alpha 1 proteinase inhibitor was increased in 5/6 patients by a factor of two to four. Also in the 15 patients on regular hemodialysis treatment halo formation was substantially reduced, while the serum levels of elastase alpha 1 proteinase inhibitor complex was slightly increased. The finding of reduced proteolytic activity of PMN neutrophils in uremia is probably due to an enhanced release of proteinases into the circulation as indicated by the elevated serum levels of elastase alpha 1 proteinase inhibitor complex in some patients. The release of proteinases might be in part due to the effect of "uremic toxins". In the RDT patients the contact of the blood with the dialyzer (cuprophane) membrane might be an additional factor. In the patients with ARF the underlying disease (infection, shock, trauma) contributes to the release of proteinases. These disturbances may be harmful for the patient, if the blood concentration or function of the most important proteinase inhibitors (alpha 1 proteinase inhibitor, alpha 2 macroglobulin) is reduced.
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PMID:Release of granulocyte neutral proteinases in patients with acute and chronic renal failure. 636 15

Hypoglycemia has rarely been described as a clinical sign of severe bacterial sepsis. We recently encountered nine patients in whom hypoglycemia (mean serum glucose of 22 mg/dl) was associated with overwhelming sepsis. Clinical disease in these patients included pneumonia and cellulitis; in three patients, no focus of infection was apparent. Altered mental status, metabolic acidosis, leukopenia, abnormal clotting studies and bacteremia were common features in these cases. In four patients, no cause for hypoglycemia other than sepsis was present. In five patients, another possible metabolic cause for hypoglycemia was present (alcoholism in four and chronic renal insufficiency in one) although none had been observed to be hypoglycemic on previous hospitalizations. Streptococcus pneumoniae (three cases) and Hemophilus influenzae, type b, (two cases) were the most common pathogens, and the over-all mortality was 67 per cent. The mechanism(s) for hypoglycemia with sepsis is not well defined. Depleted glycogen stores, impaired gluconeogenesis and increased peripheral glucose utilization may all be contributing factors. Incubation of bacteria in fresh blood at room temperature does not increase the normal rate of breakdown of glucose suggesting that the hypoglycemia occurs in vivo. Hypoglycemia is an important sign of overwhelming sepsis that may be more common than has previously been recognized.
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PMID:Hypoglycemia as a manifestation of sepsis. 699 Jul 58


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