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

The usefulness of the microscopic examination of the placenta, associated membranes, and umbilical cord was tested in a retrospective clinical review. Fifty-nine patients with inflammation were matched by sex, race, and gestation with 59 patients without inflammation. Blind review of the clinical course of these infants revealed five cases of culture-positive septicemia, 28 cases of probable sepsis, 39 cases of possible sepsis, and 46 normal infants. The clinical categorization was significantly correlated with the microscopic appearance of the placenta, membranes, and cord. Triple vessel vasculitis in the umbilical cord vessels and chorionic microabscesses were significantly related to the incidence of proven, probable, and possible clinical sepsis. The microscopic examination of the umbilical cord and placenta provides a useful, but not infallible, tool in the evaluation of sepsis in the newly born infant.
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PMID:Placental pathology compared with clinical outcome: a retrospective blind review. 56 19

Hypovolemic hyponatremia attributable to severe fluid and electrolyte alterations was diagnosed in a foal with diarrhea. Subsequent consumption of water resulted in rapid reduction of serum sodium concentration and serum osmolar depression. Clinical signs of neurologic disease developed including blindness, loss of menace response, and seizures. Treatment of this condition with IV administered fluids included hypertonic saline solution (7.2%; 2 ml/kg of body weight), and frequent monitoring of serum electrolyte concentrations and osmolality resulted in gradual correction of the fluid and electrolyte imbalance and resolution of the neurologic signs. Hyponatremia has been recognized in foals with renal failure, ruptured urinary bladder, and iatrogenic water overload. The key to diagnosis and management of profound hyponatremia is accurate diagnosis of the status of plasma volume and association of the electrolyte imbalance with clinical signs of neurologic disease. This report describes an unusual complication of a commonly encountered problem in equine practice and documents that the severe metabolic and electrolyte abnormalities associated with diarrhea can result in clinical neurologic disease. The differential diagnosis also should include bacterial sepsis, parasitism, thoracic mass, acute renal failure, congenital neurologic deficit, or seizure syndrome. Serum electrolyte disorders should be considered as a potential cause of signs of neurologic disease in foals with diarrhea.
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PMID:Hypovolemic hyponatremia and signs of neurologic disease associated with diarrhea in a foal. 160 18

Cytomegalovirus (CMV) retinitis is the most common cause of blindness in patients infected with human immunodeficiency virus (HIV). Ganciclovir, a guanosine nucleoside, has been found to be effective in the short-term treatment of CMV retinitis and in the delay of progression to recurrence of the disease. However, ganciclovir has no intrinsic activity against HIV, and patients with the acquired immune deficiency syndrome often require treatment with zidovudine, the only currently approved therapy for HIV infection. Both agents have been associated with dose-limiting granulocytopenia in such patients, and death from sepsis in the setting of profound decreases in absolute granulocyte counts has been reported. However, recent investigation suggests that with careful patient selection and monitoring, relatively safe concomitant therapy may be possible. This article reviews the toxicity issues that influence the decision to employ concomitant therapy with ganciclovir and zidovudine. An approach to dosing ganciclovir, including a schema for modifying or interrupting the zidovudine dosage based on hematologic status, is also presented. A prospective study is presently under way to determine whether combined therapy in selected patients leads to prolonged survival and a decreased incidence of recurrence of active CMV retinitis.
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PMID:Concomitant ganciclovir and zidovudine treatment for cytomegalovirus retinitis in patients with HIV infection: an approach to treatment. 184 17

The purpose of this cohort study was to determine the incidence of and risk factors for major neurodevelopmental impairments among survivors of extreme prematurity. The study cohort comprised 100 infants born between 24 and 28 weeks of gestational age at one tertiary center from 1983 to 1984. Twenty-five infants (25%) died; 75 (75%) survived until follow-up (mean, 60 months). Standardized neurodevelopmental and psychometric assessments were performed in blind fashion on 68 of the 75 surviving children (91% follow-up). Informal assessments (parent, teacher, and physician reports) were obtained instead for seven (9%) children who had relocated outside of the area. Overall, 19 children (25%) had one or more major impairments: mental retardation, 9; cerebral palsy, 4; multiple impairments, 5; and blindness, 1. Despite a high prevalence of impairments, 95% of children (n = 71) were functionally independent [corrected]. Special educational resources were definitely necessary for seven (9%) and possibly needed for 36 (48%) additional children. Univariate analyses revealed four significant risk factors for cerebral palsy: hydrocephalus (relative risk = 12.2), grades III and IV intraventricular hemorrhage (relative risk = 5.8), 5-minute Apgar score lower than 7 (relative risk = 5.7), and bronchopulmonary dysplasia (relative risk = 5.5). Hydrocephalus was the only significant risk factor observed for mental retardation (relative risk = 5.4). Risk factors predicting a need for special education resources included sepsis (relative risk = 24.9), low socioeconomic status (relative risk = 16.3), and nonwhite race (relative risk = 3.0). Thus our data suggest that biomedical factors appear to confer the greatest risk of major impairments; sociodemographic factors appear to have a significant impact on educational risk in extremely premature infants who do not die. Continued follow-up with biomedical and developmental-social interventions appears warranted to decrease the risk of educational underachievement in this population.
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PMID:Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature infants. 191 94

An unusual case of bilateral blindness secondary to a cavernous sinus thrombosis is reported. A woman who had undergone reconstructive surgery after tumor resection of the floor of the mouth, was readmitted 1 month later with bilateral proptosis and signs of sepsis. There were no complaints of blurred vision. A CT-scan of the orbits demonstrated a bilateral cavernous sinus thrombosis (CST) secondary to an infection at the skull base behind the myocutaneous flap. A few days later she became blind, due to bilateral central retinal artery occlusion and anterior ischemic optic neuropathy. The general critical condition improved with intensive AB treatment. The patient recovered well without neurological defects apart from her permanent bilateral blindness. There were no signs of tumor recurrence. To our knowledge, this is the first documented case of bilateral blindness in a patient suffering from CST.
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PMID:Bilateral blindness in cavernous sinus thrombosis. 205 Apr 71

A variety of rheumatologic disorders affect the elderly. Some of these problems are seen almost exclusively in the elderly, such as temporal arteritis and pseudogout. Because of underlying chronic diseases, these patients are also at increased risk for joint infection and resultant sepsis. Evaluation of synovial fluid from the inflamed joint is important. Light microscopy evaluation with a red polarizing compensator can help diagnose crystal-mediated disease, such as gout or pseudogout. Examination of Gram stains can help diagnose infectious arthritis. Thus, appropriate processing of synovial fluid is mandatory for the diagnosis of many rheumatologic disorders that occur in the elderly. A variety of metabolic disorders are associated with pseudogout and should be searched for on laboratory evaluation. Appropriate laboratory evaluation and follow-up following the acute episode are important in the care of these patients. For example, temporal arteritis with resultant blindness is a feared disorder in the elderly. Transient blindness, headaches, jaw claudication, and an elevated Westergren sedimentation rate suggest this diagnosis. Aches and pain in the neck and shoulder area, especially in the morning, are typical of polymyalgia rheumatica. Polymyalgia rheumatica may also be a symptom of temporal arteritis.
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PMID:Acute rheumatologic disorders in the elderly. 218 87

Acute orbital infection is an uncommon condition which is often secondary to acute sinusitis. Although it can present in any age group it is most prevalent in children and may cause impaired vision, blindness, intracranial complications and death. This paper documents the experience at the Royal Liverpool Childrens Hospital, Alder Hey, from 1973 to 1989. Clinical details were recorded retrospectively from the hospital case notes. Sixty-eight children had orbital sepsis of whom 30 had associated acute sinusitis. Of these 30 children, orbital sepsis was always unilateral with a preference for the left side; ten had diplopia of whom four had a sub-periosteal abscess which was subsequently drained. There were no serious complications although two children had diplopia for two to three months.
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PMID:Sinusitis and the acute orbit in children. 218 42

Group B Streptococcus is a common cause of neonatal sepsis and meningitis. The purpose of this study was to evaluate the neurologic, psychologic, and academic status of children who had group B streptococcal meningitis and to compare these children with their siblings. Seventy-four children who acquired group B streptococcal meningitis between one day and 6 months of life formed the study population. Survivors were 3 to 18 years old at the time of their follow-up evaluations. Twenty children (27%) died, two were institutionalized, one severely affected child died at age 2 years, 15 were assessed by phone interview, and two were lost to follow-up. Thirty-four children and 21 siblings were comprehensively evaluated with physical and neurologic examinations, hearing tests, and tests of intellectual, perceptual-motor, and behavioral-adaptive functions. Of the total population, nine children (12%) had major neurologic sequelae (spastic quadraplegia, profound mental retardation, hemiparesis, deafness, or blindness). Six children had acute hydrocephalus; two were doing well after shunt placement. In general, those children surviving group B streptococcal meningitis without major sequelae appeared to be functioning normally or comparably to their sibling in intellectual, social, and academic matters.
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PMID:Long-term outcome of group B streptococcal meningitis. 351 45

Subclavian steal-carotid recovery phenomenon, which accompanies an occlusion of the brachiocephalic trunk, is a rare cause of transient ischemic attacks. In the actual study, including 7 operated patients, preoperative symptoms, results of directional Doppler ultrasound examinations further evaluated by sonography, angiography, peroperative flowmetry and postoperative outcome are presented and discussed. Fits of vertigo, right-sided blindness and left-sided paralysis were the most common symptoms. Retrograde vertebral artery, antegrade common carotid and supraorbital artery blood flow was found by ultrasound. Analysis of the audio-frequency obtained by ultrasound revealed, however, preoperative abnormal flow of the common carotid artery. In 6 patients, angiography revealed retrograde vertebral but antegrade common carotid artery blood flow and in the 7th patient, both vertebral and common carotid artery blood flow was reversed. Peroperative flowmetry revealed increased retrograde blood flow of the vertebral and change from ante- to retrograde flow of the common carotid artery during hyperemia of the right arm. One patient died after 40 days due to sepsis, the focus of which was neither traced clinically nor at autopsy. One patient, who was free of preoperative symptoms, died after 4 years from myocardial infarct. Five patients are alive, 4 are completely free and another improved from the preoperative symptoms after 1-7 years.
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PMID:Subclavian steal-carotid recovery phenomenon. Experience of 7 operated patients. 622 89

In recent years group B streptococci accounted for nearly 40% of all cases of neonatal septicemia in our intensive-care-unit. Nineteen of 38 babies did not survive the acute illness (mortality 50%). Six of 18 surviving children showed abnormalities related to the septicemia/meningitis (morbidity 33%). The severity of chronic complications ranged from minor neurological problems to marked retardation, deafness, blindness, and epilepsy. In our series there seemed to be a relation between the severity of complications during the acute illness (meningitis, convulsions), and later neurological sequelae. Early detection and early treatment were found to be most important for the final outcome.
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PMID:[Long-term sequelae of neonatal group B streptococcal septicemia/meningitis (author's transl)]. 704 33


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