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)

Ten pyeloureteral systems in 8 patients (mean age 74 years) with cytologically proved ureteral carcinoma in situ (1 combined with ureteral papillary tumors) were perfused with bacillus Calmette-Guerin via a percutaneous nephrostomy tube. In 4 patients cytology results remained negative after 1 treatment course during an observation time of 18 to 28 months. In 1 patient a papillary tumor persisted while cytology results became negative for carcinoma in situ. Two patients with bilateral disease had repeated perfusion of bacillus Calmette-Guerin until cytology results became negative and they remained negative during observation for 18 months in 1. The other patient had a multifocal recurrence of carcinoma in situ, combined with a stage T1, grade 3 urothelial cancer in the bladder after 12 months and a recurrence of carcinoma in situ in 1 ureter after 24 months. In 1 patient treatment was stopped prematurely after severe septicemia. Although our short-term results are promising, percutaneous perfusion of bacillus Calmette-Guerin for carcinoma in situ of the upper urinary tract should be considered as an investigational treatment modality until long-term results are available.
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PMID:Percutaneous bacillus Calmette-Guerin perfusion of the upper urinary tract for carcinoma in situ. 279 55

The therapeutic management of the complications of percutaneous nephrolithotomy (PNL) depends on the early recognition of these complications. A review of 720 cases revealed the incidence of significant complications to be less than 4%. An algorithm was developed as a guideline for the diagnosis and management of complications of PNL. Early complications included transient bleeding (83 cases), extravasation of urine (52 cases), significant infection (11 cases [2 with septicemia and shock]), and migration of stone fragments into the retroperitoneum (7 cases). Nonrenal complications were present in less than 6% of these patients. These included pleural effusions or pneumothorax (24 cases) and lung atelectasis (19 cases). Late complications were seen in less than 2% of the patients. These included stricture of the ureter with obstruction (5 cases), A-V fistula with or without pseudoaneurysm (7 cases), and subcapsular hematoma (1 case). Therapeutic management included improvement of technique to the use of antibiotics to treat infection. The use of proper drainage and the placement of stent or catheter in the treatment and prevention of further complications has become an integral part of the algorithm for the treatment of complications of PNL. This algorithm recommends the proper diagnostic modality for the detection and evaluation of the extent of the complication. Once detected, the complications of PNL can be minimized with limited permanent changes.
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PMID:Diagnosis and management of complications of percutaneous nephrolithotomy. 292 89

24 cases of disruption of the perineum from 8 Centres of Pediatric Surgery in France, were studied. The patients were aged between 4 months and 13 years, with an average age of 6.7 years, and 70% were boys. The cause of the injury was crushing in 13 cases. The associated were complex. Fractures of the pelvis (18) and associated multiple fractures (13), as were as profuse pelvi-peritoneal haemorrhages arising from fractures (3) or lower limb amputations (3) determined the care of associated soft-tissue injuries. Disruptions of the skin were almost constant and displayed a high rate of sepsis. There were noted lesions of the ureter (9), the vagina (5), the anus and rectum (17), the ano rectal sphincter (10) and the penis (1). The care of each of these lesions followed the usual practices of Reparative Surgery specific to each organ, but was also adapted to each case. In effect, disruptions of the perineum take place in a context of serious polytrauma, where the hierarchy of urgency determines the choice of therapeutic attitudes.
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PMID:[Lacerations of the perineum in children]. 304 39

Indications for intervention in patients with renal stone disease include persistent pain or bleeding, obstruction, infection and the presence of stones that are too large to pass spontaneously. Extracorporeal shock wave lithotripsy has revolutionized the surgical treatment of kidney stones. Contraindications include anticoagulation, bleeding diathesis, sepsis and renal malignancy. Stones in the renal pelvis and upper ureter are treated with shock wave lithotripsy; those in the lower ureter are best approached with the ureteroscope.
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PMID:New approaches in the treatment of renal calculi. 331 58

Injuries missed at initial operation have the potential to cause the most disastrous complications in trauma patients. Over the past 5 years, 12 patients have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one patient), two pancreatic, and one each of the heart, ureter, and diaphragm. Five patients (42%) died, three with missed vascular and two with missed visceral injuries. Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in patients with vascular injuries were hypotension in two patients, persistent output from drains in three, and refractory acidosis in one. Re-exploration in visceral injuries was for clinical sepsis in three patients, DIC in one, cardiac tamponade in one, and persistent chest tube drainage in one. Eleven of the 12 patients presented to the E.D. in shock. All patients had multiple injuries with a mean of 3.25 organ systems injured. Hypotension, coagulopathy, and/or hypothermia (T less than 92 degrees) were felt to have contributed to missing the injury in five of the patients with vascular, and three of the patients with visceral injuries. In the four other patients, injuries were missed due to inadequate exploration or a low index of suspicion in the presence of multiple injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injuries missed at operation: nemesis of the trauma surgeon. 339 94

This is a survey of 234 pediatric patients in whom staging laparotomy/splenectomy was carried out (1975 to 1981) in the course of the Intergroup Hodgkin's Disease in Childhood Study (IHDCS). Relapse has occurred in 44 of these patients, and 12 have died, 7 secondary to extension of lymphoma, 2 with herpes or pneumocystis infections, 2 with leukemia, and 1 from an unrelated accident. During the period of surveillance (mean 5.5 yr), five episodes of bacterial sepsis (positive blood cultures) have occurred, including two due to Streptococcus pneumoniae; and three, to Hemophilus influenzae. The former occurred in the small group of patients in this series who had not received the prescribed pneumococcal vaccination. No fatalities were associated with these septic episodes. Intestinal obstruction secondary to adhesions (benign) occurred in eight patients and was managed without intestinal resection or mortality. One patient required operative release of an obstructed ureter following laparotomy, and one, oophorectomy for an infarcted (transposed) ovary.
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PMID:Postsplenectomy sepsis and other complications following staging laparotomy for Hodgkin's disease in childhood. 348 87

A retrospective comparison of pyeloureterostomy and external ureteroneocystostomy as methods of reconstructing the urinary tract in 128 renal transplants is presented. There was one urological complication in 52 pyeloureterostomies (1.9%) compared with 4 in the 76 ureteroneocystostomies (5.3%). 6/0 Polydioxanone (PDS) is preferred to Prolene for the anastomosis because of possible calculus formation on the latter. Wound sepsis is commoner in pyeloureterostomies undergoing concomitant nephrectomy, despite prophylactic antibiotics, though this is not statistically significant and the overall sepsis rate is higher for ureteroneocystostomy. Nephrectomy was avoided in 17 selected cases by simply ligating the recipient ureter where the pre-transplant urine output was low. Two of these patients developed hydronephrosis in the isolated kidney and required later nephrectomy.
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PMID:Pyeloureterostomy or ureteroneocystostomy in renal transplantation? 351 20

A 66-year-old patient developed severe urinary stasis due to a concrement in his right ureter; foudroyant septicemia followed. Lactobacillus gasseri was grown from pyoid urine from the right renal pelvis and in two blood cultures, thus suggesting septic urinary infection caused by lactobacilli. The infection was cured by catheterisation of right ureter and antibiotic treatment with cefotaxime and amoxicillin. The concrement was removed by dissolution. Diabetes and urinary stasis appear to be the main predisposing factors for this exceptional case of septic urinary infection caused by L. gasseri.
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PMID:Lactobacillus gasseri as the cause of septic urinary infection. 632 18

During the last 4 years we treated 11 patients with obstructed kidneys and intrapelvic strictures, which were owing to tuberculosis in 9 and renal stone surgery in 2. Pan-caliceal ileoneocystostomy was performed in all 11 cases. The entire caliceal system was anastomosed to an ileal ureter and, thus, relieved the obstruction. The result of this operation was most gratifying. Although 1 patient died of anastomotic leakage and sepsis the morbidity was low.
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PMID:Pan-caliceal ileoneocystostomy: indications, modifications and further evaluation. 647 Dec 8

We describe 2 patients in whom histologically proved inflammatory strictures of the ureter developed after ureteroileal diversion. The dense impassable strictures were located proximal to the ureteroileal junction. The clinical onset was preceded by acute urosepsis and septicemia. Judicious use of percutaneous nephrostomy and antegrade studies is emphasized in establishing the diagnosis.
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PMID:Inflammatory ureteral strictures after ureteroileal diversion. 684 11


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