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

Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality. We reviewed 39 cases from two university-based hospitals over a five-year period. Each patient had biliary tract surgery and biopsy-proven cirrhosis. Eight patients died (21%), and major complications were found in 12 surviving patients (35%). Local and systemic sepsis was the major contributor, accounting for all of the deaths and 17 of the 22 (77%) complications among survivors. Choledochotomy was done in ten patients; three of them died (30%) and nine major complications occurred in the remaining five. Preoperative risk factors found to be predictive of this high morbidity and mortality were ascites (50% mortality, 50% morbidity), prolonged prothrombin time (29% mortality, 38% morbidity), and a serum albumin level of less than 3.5 mg/dl (33% mortality, 40% morbidity). The presence of other major systemic disease was not significantly different between survivors and nonsurvivors. In 12 patients with no ascites and normal preoperative serum chemistry values, no deaths and only one minor complication occurred. We conclude that although biliary surgery in cirrhotic patients carries a high mortality, this risk can be assessed preoperatively. There appears to be a small subgroup of patients with cirrhosis and cholelithiasis who can have a favorable outcome. Operative therapy in these patients should be reserved for the complications of the biliary tract.
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PMID:Liver cirrhosis and biliary surgery: assessment of risk. 391 47

Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Catheterization time ranged from 1 to 79 days with an average of 14.0 +/- 1.0 days per catheter and 18.9 +/- 1.0 days per patient. Twenty nine catheters were infected, 17 of which were the source of bacteremias due to Staphylococcus epidermidis in 13 cases and to Staphylococcus aureus in 4 cases. The incidence of sepsis was not significantly greater in diabetic patients, in patients with corticotherapy or in patients presenting an underlying systemic disease. On the contrary, the incidence was greater in hospitalized patients (15 bacteremias during 1,948 catheter days) than in ambulatory patients (2 bacteremias during 850 catheters-days) as well as during a period corresponding to a greater number of untrained nurses enrolled in the dialysis team. During this period, 6 sepsies occurred in 19 catheters (other periods: 7 sepsies/116 catheters, p less than 0.01). 6 of 28 nurses had less than 3 months of professional experience (other periods: 1 of 25, p less than 0.01). These data underline the key role of nurse training in the prevention of catheter-related infections.
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PMID:Infections associated with subclavian dialysis catheters: the key role of nurse training. 394 49

A 58-year-old man with dizziness and unsteady gait had a 10-year history of behavioral change, impotence, and a progressive peripheral neuropathy. CT revealed low-density, contrast-enhancing lesions in the right pontine tegmentum and the right medial temporal lobe. Temporal lobe biopsy contained a collection of mature histiocytes, with PAS-positive rod-shaped inclusions. These inclusions, when studied by electronmicroscopy, were seen to be membrane-bound bacilliform bodies. Peroral jejunal biopsy contained no such inclusions. Despite treatment with antibiotics, the patient's neurologic illness progressed, and he succumbed to intercurrent sepsis. We believe this to be the first instance in which a lesion of Whipple disease has been identified within the CNS by CT scan, and the diagnosis made antemortem, in the absence of demonstrable systemic disease.
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PMID:Whipple disease of the nervous system. 617 57

Unusual manifestations of meningococcal infection as pneumonia, pericarditis, endocarditis, arthritis, urogenital infections and acute abdominal disease are seen combined with meningitis or septicemia, but can also appear alone without systemic disease. Incidence, diagnosis, clinical symptoms and therapy are briefly discussed with documentation from literature.
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PMID:Unusual manifestations of meningococcal infection. A review. 641 5

Characteristics of 67 strains of Neisseria meningitidis causing systemic disease in Norway during the winter 1981-82 are reported and related to clinical manifestations. Included in the study were also pharyngeal isolates of meningococci collected in the same period from 35 healthy military recruits. The strains were examined for serogroup, serotype as determined with monoclonal antisera (against antigens 2a, 2b, 12, 15 and 16), and sulfonamide susceptibility. Predominating in the systemic disease material were serogroup B, serotype 15, 16 (or 15), and sulfonamide-resistant strains. This complex of characteristics also appeared to be associated with the severity of manifestations (septicemia and death). The material of meningococci from healthy carriers unassociated with cases of disease was clearly different; these strains were typically non-groupable, non-typable and sulfonamide-sensitive. The full combination of traits usually seen in strains causing systemic disease was rare in carrier isolates. The results are discussed in relation to the epidemiological development of meningococcal disease in Norway.
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PMID:Some agent characteristics and their coexistence related to occurrence and severity of systemic meningococcal disease in Norway, Winter 1981-1982. 641 7

Adherence of bacteria to mucosal surfaces is an early step in colonization and infection. Streptococcus pneumoniae colonizes the nasopharynx and causes localized and systemic disease. The higher adhesion capacity of strains isolated from patients with otitis as compared to strains from sepsis or meningitis patients indicates that binding to the nasopharyngeal mucosa is important in localized but not in invasive infections. The biochemical basis of the pneumococcal binding to epithelial cells has been investigated. Human nasopharyngeal epithelial cells were mixed with pneumococci, and adherence was determined microscopically. Inhibition of adherence with analogues of epithelial cell receptors was tested by preincubation of pneumococci before the addition of the epithelial cells. Competitive inhibition with glycoconjugates, representing receptor structures on the epithelial cell surface, showed receptor function of saccharides containing the disaccharide GlcNAcbeta1 leads to 3Galbeta-.
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PMID:Molecular mechanisms of adhesion of Streptococcus pneumoniae to human oropharyngeal epithelial cells. 658 Jul 32

Acute peptic ulcers occurred in 39 infants and children, 22 girls and 17 boys. Eleven patients were less than one year of age. Peptic ulcers were secondary to systemic disease or ulcerogenic medications in 34 cases. Hemorrhage occurred in 27 patients, perforation in 12. Endoscopy was the most useful diagnostic procedure for hemorrhage. Free air was seen on abdominal roentgenogram in all perforated patients. Ligation of the ulcer bed, vagotomy, and pyloroplasty were performed in 25 patients with bleeding. One patient required total gastrectomy. Simple plication was performed in nine patients with perforation. Plication was combined with pyloroplasty and tube duodenostomy in one patient each, and vagotomy and antrectomy were required in one patient. Operative mortality was 5.2%. There were two late deaths (Reye's syndrome and burn sepsis). No ulcer has recurred.
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PMID:Acute peptic ulcer in childhood. Emergency surgical therapy in 39 cases. 683 71

Pasteurella multocida most commonly infects patients with animal contacts. Life-threatening systemic disease is distinctly uncommon in otherwise healthy persons and usually occurs in patients with chronic predisposing disease. Two cases of sepsis occurred in a cancer hospital, and we surmise that specific predisposing factors existed in our patients as in prior reported cases of sepsis in patients without cancer. These factors include animal contact, open wounds, and, most important, advanced hepatic disease.
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PMID:Pasteurella multocida septicemia. Experience at a cancer hospital. 684 52

An unusual form of intrahepatic cholestasis manifested by inspissated bile within dilated and proliferated portal and periportal bile ductules was seen in liver biopsy and autopsy specimens from three patients. Features of sepsis and sever systemic illness with jaundice dominated their clinical presentations, and no autopsy evidence of large bile duct obstruction could be found. This lesion may be related to the old entity, "cholangitis lenta," a form of chronic sepsis associated with biliary tract inflammation in the absence of demonstrable extrinsic obstruction. Identification of this pattern of cholestasis in liver biopsy specimens is useful in certain patients who may be a great risk of mortality and who require serous clinical attention directed toward elucidating a source for sepsis as well as aggressive management of other systemic disease. Laparotomy in such cases will be unrewarding and may hasten the patient's demise.
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PMID:Bile ductular cholestasis: an ominous histopathologic sign related to sepsis and "cholangitis lenta". 707 91

Approximately 1.3% of patients with lymphoma develop obstructive jaundice secondary to lymphomatous involvement of the extrahepatic biliary system. This may occur either as an initial or as a late manifestation of disease. Clinically and radiographically the condition may mimic a variety of more common causes of obstructive jaundice. Surgical exploration may be necessary to confirm the diagnosis, but local radiotherapy would appear to be the preferred mode of treatment. Rapid progression to systemic disease occurs in the majority of patients, necessitating multidrug chemotherapy. Control of jaundice by radiotherapy is good, but long-term prognosis is poor. Supervening sepsis and gastrointestinal bleeding caused the majority of deaths, suggesting that adjunctive nutritional support, immunologic enhancement, and stress ulcer prophylaxis may be necessary if survival is to be improved.
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PMID:The diagnosis and treatment of obstructive jaundice secondary to malignant lymphoma: a problem in multidisciplinary management. 739 35


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