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

In 285 renal transplantations, performed during the years 1967-1978, 6 ureteral obstructions (2,1%) and 15 urinary fistulas (5,3%) were observed. Ureteral obstructions occurred in the late phase after transplantation and were caused by strictures at the uretero-vesical anastomosis (two patients), compression of the ureter by enlarged kidney during rejection (one patient) resp. lymphocele (one patient) and strictures at the pyelo-ureteral junction (two patients). Satisfactory results were achieved by surgical treatment in all patients. Urinary fistulas occurred in the early postoperative phase. Two vesical, 12 vesico-ureteral and one calyceal fistula were observed. 7 fistulas (1 vesical, 6 vesico-ureteral) closed spontaneously after temporary drainage of the bladder. 8 fistulas were repaired surgically. While satisfactory results were obtained in 13 patients, two patients died due to infection and sepsis after reoccurrence of fistulas.
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PMID:[Treatment of ureteral obstruction and urinary fistulas after kidney transplantation]. 38 61

One of the major therapeutic challenges facing the pediatric urologist is the massively dilated ureter. When conservative measures, such as relief of obstruction or treatment of infection, have failed or are likely to fail, surgical treatment must be directed at the massive dilatation itself. These circumstances were encountered in 366 massively dilated ureters in 244 children during a 10-year period. Loop and/or terminal cutaneous ureterostomy was used to manage 125 of these ureters in 74 children. Indications for temporary non-intubated proximal urinary diversion included uncontrolled infection, sepsis, azotemia, significant ureteral redundancy and tortuosity, and questionable over-all renal function. Advantages of loop ureterostomy included more proximal drainage and less stomal problems but terminal ureterostomy required a significantly lesser number of surgical procedures in reconstructing the urinary tract. Temporary splinting of the ureter in dry ureteral reimplantations has diminished markedly the incidence of ureterovesical complications. No instances of permanent vesical contracture were noted after long periods of defunctionalization. After initial reconstruction of 47 cutaneous ureterostomies good results by all parameters were obtained in 68 per cent. Additional surgical procedures in selected initial failures have resulted in a final success rate of 85 per cent.
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PMID:Surgical treatment of the massively dilated ureter in children. Part I. management by cutaneous ureterostomy. 87 Jul 18

Frequently traumatic injury to the renal pelvis or upper ureter is overshadowed by multiple associated injuries. The diagnosis may be particularly difficult, due to the lack of hematuria and absence of pathognomonic findings. All too frequently the delayed manifestations of urinary wound drainage, retroperitoneal mass, or urinary ascites and sepsis first draw attention to the ureteral injury. A review of the problem and our experience with 16 such injuries is presented. As with other infrequent injuries the single and most important diagnostic factor is the prepared mind of the examiner. We feel all patients who have penetrating abdominal trauma, have fractured lumbar processes, or are involved in accidents where deceleration or extension occur should have infusion pyelography even in the absence of hematuria.
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PMID:Violent injuries to the upper ureter. 94 98

An elderly man had pyelonephritis and sepsis owing to ureteral obstruction. Retrograde pyelography showed entrapment of the right ureter in an inguinal hernia. This condition, which may be congenital or acquired, should be considered before herniorrhapy is performed and as a possible cause of ureteral obstruction.
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PMID:Ureteral obstruction and pyelonephritis caused by an inguinal hernia: report of a case. 125 99

A case of chorioadenoma destruens with uterine rupture is reported. The patient was admitted because a persistent uterine bleeding after abortion about two months before. The titulation of gonadotrophic hormone resulted in 25,000 unities. After curettage she was complicated with hemoperitoneum and went to surgery. During hysterectomy were identified trophoblastic tissue in the broad ligament and partial blocking of the right ureter. After repeated chemotherapy she presented severe immuno depression and sepsis complicated with hemopericardium and died five months after the first admission. The pathology study demonstrated a perforation because a trophoblastic invasion in the right side of the cervix and in the autopsy was demonstrated right ureteral obstruction due to a fibro necrotic an inactive trophoblastic tissue determining significant right hydro-uretero nephrosis.
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PMID:[Invasive mole with uterine rupture]. 134 67

In situ (no instrumentation) extracorporeal shock wave lithotripsy (ESWL*) was used to treat 49 patients with obstructing ureteral stones causing acute renal colic. Ureteral obstruction was diagnosed on the delayed films of an excretory urogram and was classified as severe (dilatation above and no contrast medium seen below the stone) in 17 patients and partial (dilatation above and contrast medium seen below the stone) in 32. Upper third ureteral stones were present in 41 patients (obstruction severe in 15 and partial in 26) and lower third ureteral stones were present in 8 (obstruction severe in 2 and partial in 6). ESWL was performed within 14 days of the onset of the acute renal colic because of persistent pain with an unmodified Dornier HM3 lithotriptor in 17 patients and a Medstone STS device in 32. With single stones the stone-free rate at 3 months, the repeat ESWL rate and the secondary procedure (stone basketing) rate were 92%, 6% and 8%, respectively, with severe obstruction, and 78%, 6% and 6%, respectively, with partial obstruction. No urinary drainage procedures for sepsis were required after ESWL. Obstructing ureteral stones, which presented mainly in the upper third of the ureter, were successfully treated with in situ ESWL without the need for either bypassing the stone with a ureteral stent or for pushing the stone back into the kidney before treatment with ESWL.
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PMID:In situ extracorporeal shock wave lithotripsy for obstructing ureteral stones with acute renal colic. 143 8

Between January 1973 and January 1990 we carried out 1,038 kidney transplantations using a transvesical end-to-side implantation of the ureter in the bladder without an antireflux mechanism. Moreover, 30 transplantations were done in 26 patients with a urinary diversion. We examined the urological complications in these 1,068 consecutive transplants. Urinary leakage and obstruction were the two main urological posttransplant complications. Severe leakage occurred in 21 patients (2.0%), and was treated by open surgery; 2 patients had a urinary diversion. The treatment of choice is a pyeloureterostomy (anastomosis between the transplant renal pelvis and the native ureter). There were 35 patients (3.3%) with severe ureteral obstruction of whom 5 had a urinary diversion. In 30 patients open surgical treatment of the obstruction was necessary and in 7 patients a percutaneous endourologic treatment was done (dilatation of a confined ureteral stricture in 6 patients and percutaneous stone treatment in 1). The postoperative mortality in the patients treated for leakage or obstruction was low: 4 patients (7%) died, 3 of septicemia due to leakage and 1 of pulmonary embolism after repair of the obstruction. The results of surgical treatment were good. The graft survival after 2 years in the group of urologically complicated transplants was 68% for the patients with leakage and 80% for those with obstruction. The 2-year graft survival in the patients without complications was 67% and 71% for the patients with a urinary diversion. We conclude from these results that urological complications after renal transplantation can be treated successfully by surgical (or percutaneous) correction.
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PMID:Diagnosis and treatment of urological complications in kidney transplantation. 144 Oct 19

A case of emphysematous pyelonephritis with disseminated intravascular coagulation (DIC) is presented. A 54-year-old woman was admitted to our hospital because of unclear consciousness and extremely high blood glucose level. The laboratory data suggested uncontrolled diabetes mellitus (DM) and urinary tract infection with sepsis and DIC. The plain abdominal X-P and abdominal CT revealed the existence of gas in the right renal parenchyma, perinephric tissue and the upper part of the right ureter. Right nephrectomy was performed after the improvement of the patient's condition by the echo-guided drainage of the right kidney and the treatment for infection, DM and DIC. We reviewed 71 cases of emphysematous pyelonephritis in the Japanese literature and the choice of treatment was discussed.
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PMID:[A case of emphysematous pyelonephritis with disseminated intravascular coagulation]. 154 72

Renal and ureteral calculi are treated primarily using extracorporeal lithotripsy, with percutaneous nephrostolithotomy retaining an important role for the treatment of large stones and complex situations. Aspects of pretherapy evaluation are reviewed. The vast majority of calculi 5 mm or less in diameter in the mid and lower ureter will pass spontaneously; in patients with acute ureteral obstruction, lower-osmolar nonionic contrast for urography caused as much discomfort as conventional high-osmolar contrast. Treatment planning for extracorporeal lithotripsy has changed in that internal stenting is no longer routinely recommended. Milk-of-calcium and calyceal diverticular stones respond poorly to extracorporeal lithotripsy. The access route used for percutaneous stone removal varies among investigators. Some advocate an intercostal approach for up to one third of patients; substantial complications occur with placement of a track above the 11th rib. Sepsis develops after percutaneous nephrostomy in up to 21% of patients, but the risk of sepsis can be decreased significantly by the administration of antibiotics during and after the procedure. Complications of extracorporeal lithotripsy include renal hematoma (especially if the patient is hypertensive or is taking aspirin), regional organ injury, and bacteremia. Although originally feared to occur frequently, hypertension occurring after or caused by extracorporeal lithotripsy was not confirmed to be a major problem. The incidence in a 2-year postlithotripsy follow-up was no greater than that for control subjects.
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PMID:Radiology and treatment of urinary tract stone disease. 155 85

We report our use of percutaneous antegrade ureteral stenting (PAUS) as an adjunct for the management of dehisced ureteral repairs and delayed-presentation ureteral injuries secondary to penetrating trauma. This procedure was performed in treating six patients with ureteral injuries. Four patients had dehiscence of a lacerated ureter that had been primarily repaired. Two other patients had ureteral contusions that subsequently became full-thickness disruptions postoperatively. One of these patients developed a pancreaticoureteral fistula. The sepsis resolved in all six patients and in five of the six patients the ureteral disruption healed within 2 months after PAUS without operative intervention. In one patient the ureter healed with stricture, necessitating ureteral reanastomosis. All urinomas resolved with percutaneous drainage. The PAUS technique was used to successfully treat four dehisced ureteral repairs and was the primary method used to successfully treat two disrupted ureteral contusions that were associated with multiple collections and fistulas. These techniques can be utilized for complex ureteral injuries associated with pancreatic leaks, colon or duodenal injuries, and multiple abscesses.
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PMID:Percutaneous antegrade ureteral stenting as an adjunct for treatment of complicated ureteral injuries. 156 28


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