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

Peritoneal dialysis was required in 20 (12.8%) of 156 neonates and infants for acute renal failure following open heart surgery using cardiopulmonary bypass. Cardiac diagnosis was TAPVD (7 cases), PA with IVS (2), ECD (2), coarctation of the aorta with VSD (2) and other cardiac malformations (7). The indication for dialysis was oliguria of less than 1.0 ml/kg over 4 hours resistant to volume repletion, inotropic agent and diuretics. Peritoneal dialysis was performed using dialysis catheter and glucose containing dialysis solutions. The mean predialysis BUN and serum creatinine were 30.4 mg/dl and 2.7 mg/dl respectively. The highest serum creatinine during dialysis was 4.5 mg/dl, and all but one patient had BUN level of under 100 mg/dl. Dialysis with glucose containing solution could allow sufficient fluid removal as a result, fluid overload was restored. Plasma protein and electrolytes balance were corrected within 48 hours. Two neonates and 4 infants survived. Thirteen patients died on dialysis: nine of those deaths were related to low cardiac output, 2 death were attributable to respiratory insufficiency, and 2 cases died due to sepsis. One infant died of an unexplained cardiac arrhythmia after renal failure had been improved. It is concluded that peritoneal dialysis is beneficial in neonates and infants who become oliguria following open heart surgery.
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PMID:[Peritoneal dialysis in neonates and infants after open heart surgery]. 224 28

This study records our experience with 40 infants who developed acute renal failure in a tropical environment over a period of 2 years. All the patients required intermittent peritoneal dialysis. Septicaemia (88%) and acute gastroenteritis (55%) constituted the leading causes of acute renal failure. Haemolytic uraemic syndrome was present in six (18%) patients. An elevated serum creatinine (85%), metabolic encephalopathy (75%), uncompensated metabolic acidosis (75%) and hyperkalaemia (48%) were the major indications for dialysis, while fluid overload was present in only 18% of the infants. Intermittent peritoneal dialysis was used in all the patients and was found to be effective. Procedural complications were minor and infrequently encountered. The clinical course and laboratory data consistent with haemolytic uraemic syndrome was observed in six patients, and acute tubular necrosis was the predominant renal lesion in the remainder. Mortality was 75%. The aetiology of acute renal failure in infants in the tropics differs significantly from that in the West, and even within a given country marked regional variations exist.
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PMID:Acute renal failure in infants in the tropics. 250 74

One hundred nineteen patients were entered onto a randomized trial of the role of intravenous hyperalimentation (IVH) in patients with small-cell lung cancer. IVH was given during the first 30 days of induction chemotherapy to 54 patients. IVH did not effect any improvement in response or survival from therapy. In view of the lack of benefits from IVH, an analysis was made of the toxicities suffered by the 54 patients receiving IVH as well as any effects IVH might have made on chemotherapy-induced toxicity. Toxicities observed included mechanical difficulties with the catheter leading to temporary or permanent discontinuation of the IVH (11 patients), subclavian vein thrombosis (one patient), sepsis in nine patients v none of the 62 control patients, fluid overload (27 patients), hyponatremia (25 patients), and hyperglycemia requiring insulin (13 patients). Patients receiving IVH had higher granulocyte counts on days 14 and 21 of the first cycle of chemotherapy. Analysis shows that this difference is likely caused by fever and infection associated with IVH rather than any nutritional effect on granulopoiesis. In this population of patients, IVH had significant complications but did not ameliorate chemotherapy-induced toxicity and it did not effect any clinical benefit. Future studies of adjunctive nutritional therapy must consider the significant risk in this older population and must limit IVH volume or exclude patients with even mild compromise in cardiovascular functions. Further, any new trial must have a significant rationale for adjunctive use to justify the potential risks.
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PMID:Effects of intravenous hyperalimentation during treatment in patients with small-cell lung cancer. 299 75

The ability to provide successful rehabilitation in 57 uremic children from a low socioeconomic background was prospectively evaluated by means of assessment of growth and development, incidence of complications, compliance, mortality rate and final outcome. Forty-three patients were on intermittent peritoneal dialysis (PD) and 14 on continuous ambulatory peritoneal dialysis (CAPD). The overall incidence of peritonitis was 5.6 episodes per patient-year; 41 patients are alive; 12 continue on intermittent dialysis; 16 received a renal allograft and 13 shifted to hemodialysis. Hypervolemia, sepsis due to peritonitis and abandonment of treatment were the main causes of death in 16 children. Malnutrition and non-compliance were the main factors leading to unsatisfactory rehabilitation.
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PMID:Adequacy of chronic peritoneal dialysis in low socioeconomic class uremic children. 372 29

Thoracic trauma in multiple trauma increases mortality threefold, usually due to sepsis. Disturbances of the pulmonary vasculature are seen soon after trauma, as is increased EVLW. This can be due to 3 different mechanisms: 1. High pressure edema due to high intrathoracic pressure. Protein-poor edema. No hypervolemia, therefore no diuresis called for. 2. Hematoma: blood and dead tissue should be removed. Bronchial drainage is important. 3. Capillary permeability damage: areas of direct trauma with protein-rich interstitial edema. Can lead to ARDS. Modern ventilation techniques are helpful. No drug therapy (i.e. steroids) is proven.
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PMID:[Thoracic trauma]. 405 83

Respiratory tract injury is a leading cause of mortality, morbidity, and prolonged hospitalization in fire casualties. Direct insults include inhalation of superheated gas, steam, smoke, or toxic fumes. Indirect injury may result from interference with the mechanics of respiration. Pulmonary injuries result from sepsis, fluid overload, endogenous reactive substances, and "shock lung," and also occur secondary to metabolic disturbances resulting from hypoxia.
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PMID:Postburn respiratory injuries in children. 699 14

The use of granulocyte transfusions in profoundly neutropenic patients has increased markedly in recent years. Whenever a pulmonary infiltrate develops during the course of these transfusions, the question arises as to what role the transfusions are playing and whether the transfusions should be discontinued to prevent pulmonary deterioration. We have analyzed our recent experience of 593 granulocyte transfusions in 93 patients. 18 patients (19%) developed respiratory compromise or pulmonary infiltrates at some time during the course of granulocyte transfusion. 6 of the 18 cases were reactions to the granulocytes while the remainder were due to fluid overload or other causes. The risk of pulmonary complications did not correlate with the development of cytotoxic leukocyte antibodies, length of transfusion, or concomitant use of Amphotericin. They appeared to be more common in patients with active sepsis. Acute life-threatening pulmonary reactions were rare. Patients receiving granulocyte transfusions should be monitored carefully for pulmonary infiltrates, but other cases should be sought before the transfusions are discontinued.
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PMID:Pulmonary complications during granulocyte transfusions: incidence and clinical features. 706 30

Of 167 patients with major burns, fatal respiratory distress developed in ten. Fluid overload caused fatal respiratory failure within 48 hours of admission in five patients with anuria, whereas late deaths were due to fluid overload and pulmonary sepsis. Three of the four patients who had a tracheostomy died of pulmonary sepsis, whereas all ten patients who had endotracheal intubation survived, p less than 0.05. Preventable causes of fatal respiratory distress were found in all ten patients. The use of colloid infusions during burn shock resuscitation and serial monitoring of pulmonary extravascular water was suggested for prophylaxis of fluid overload and respiratory distress syndrome. Aspiration pneumonia prophylaxis and avoidance of an early tracheostomy were suggested for prophylaxis of pulmonary sepsis. It is suggested that the concept of idiopathic burn lung syndrome be abandoned, and instead, a vigorous etiologic search to be instituted in order to prevent, to identify and to treat correctable causes of respiratory failure.
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PMID:Fatal respiratory distress in burned patients. 724 47

Twenty-four patients with advanced malignancy received 30 courses of VP-16-213 delivered by a protracted infusion for a minimum of 5 days or 120 hours in a phase I study to determine the maximum tolerated dose. Toxic effects included fluid overload (due to the necessary use of normal saline as the drug delivery vehicle), stomatitis, and marrow suppression with leukopenia and thrombocytopenia. Except for the stomatitis, gastrointestinal effects were virtually absent. The dose-limiting toxic effect was marrow suppression observed at a dose of 60 mg/m2/day X 5 days (300 mg/m2/course). Six of seven patients treated at this dose developed marrow suppression: 50% (three of six patients) had life-threatening leukopenia associated with fever only (one patient), sepsis (one), and septic death (one).
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PMID:Phase I study of VP-16-213 (Etoposide) administered as a continuous 5-day infusion. 727 24

Intractable decubitus ulcers and femoropelvic osteomyelitis are rare sequelae of paraplegia. Therapy for these conditions ranges from the simple to the complex, including wound debridement and care, alimentary and urinary tract diversion, hip disarticulation, and myofasciocutaneous rotational flaps. Should the condition be recalcitrant to these modalities the only curative therapy is hemicorporectomy. A 28-year-old rendered paraplegic 3 years ago presented manifesting sepsis; marasmus; hip and knee flexion contractures; suppurative sacral and femoropelvic decubitus ulcers, exposed bone, and osteomyelitis; and fecal and urinary incontinence. Pre-operative nutritional supplementation, wound debridement and care, and psychological counselling were provided. Hemicorporectomy was performed, including colostomy, ureteroileal conduit, gastrostomy, and translumbar amputation. Several anatomical, physiological, and operative-technical perspectives are emphasized: a two-staged approach may be preferable--at the first setting an intra-peritoneal exploratory celiotomy with alimentary and urinary tract diversion; and at the second setting an extra-peritoneal hemicorporectomy; preservation of abdominal wall musculature and fasciae to facilitate wound closure; sequential and bilateral ligation of the arteriae et venae iliaca communis; translumbar amputation between the fourth and fifth lumbar vertebrae; extirpation of the fourth lumbar processus spinosus vertebrarum; closure of the dura mater and translation of musculi sacrospinalis into the vertebral canal; avoidance of hypervolemia and hyperthermia; avoidance of wound pressure; testosterone replacement therapy for eunuchism; and physical and occupational rehabilitation including adaptation to a customized bucket prosthesis.
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PMID:Hemicorporectomy. 771 21


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