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

Orthotopic hepatic transplantation has become a well-established treatment modality for end-stage liver disease, and research in this field is constantly evolving. Of the 34 canine liver transplants performed in this study, 17 (50%) survived more than 3 days (mean survival time 15 days). Causes of perioperative death included hemorrhage (4), anesthetic complications (3), systemic anaphylaxis (3), portal vein thrombosis (3), hepatic venous outflow block (2), and hepatic artery thrombosis (2). Gentle handling with minimal dissection of the donor liver in situ resulted in a decreased incidence of hepatic venous outflow block. The incidence of biliary leak was similar irrespective of the method of biliary reconstruction, although the incidence of acute cholangitis was 56% in the cholecystoduodenostomy group compared with 0% in the choledochocholedochostomy cohort. Using celiac to common hepatic end-to-side arterial anastomosis with preservation of the gastroduodenal artery, thrombosis of the hepatic artery was encountered in four instances, an incidence similar to previously reported studies where end-to-end hepaticohepatic arterial anastomosis or donor aortic conduit was utilized. The incidence of postoperative intestinal intussusception was reduced from 40 to 0% in those who underwent transmesenteric intestinal plication following implantation of the liver. Among short-term survivors, sepsis was the most frequent noted complication (10), followed by intestinal intussusception (6), rejection (6), and gastrointestinal bleeding (1). Among recipient dogs that survived more than 3 days, rejection was the most common cause of graft loss (5), followed by biliary leak (4) and hepatic artery thrombosis (2).
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PMID:Orthotopic hepatic transplantation in the dog. 157 6

Adverse effects are common in patients with acquired immunodeficiency syndrome (AIDS) who receive trimethoprim-sulfamethoxazole (TMP-SMX). Two patients experienced a rare anaphylactoid syndrome. Within hours of receiving a double-strength TMP-SMX tablet, a 28-year-old human immunodeficiency virus (HIV)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. Broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and specimens for Pneumocystis carinii were negative. A 38-year-old man developed rash, fever, hypotension, hyperbilirubinemia, renal dysfunction, and bilateral pulmonary infiltrates after taking two doses of oral TMP-SMX. Several antimicrobial agents, including parenteral pentamidine, were administered despite lack of evidence for P. carinii or other infection. four case reports of similar reactions in patients with AIDS have been published. Notable differences exist between the syndrome described and anaphylaxis. The TMP-SMX anaphylactoid reactions in patients with AIDS mimic sepsis or opportunistic infection, thus making diagnosis difficult.
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PMID:Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review. 228 64

Because of a nationally apparent increased interest in emergency medical services for children and the need for a greater understanding of the relationship between office pediatric and emergency department care of children, a questionnaire was mailed to practitioners to (1) describe office physician involvement with emergent conditions, and (2) evaluate physician office preparedness for pediatric emergencies. Responses were received from 280 pediatricians and family practitioners, including information regarding the availability of equipment and medication, physician training, and practice characteristics. Of the responding physicians, 62% reported that they assessed in their offices more than one child each week who required hospitalization or urgent treatment. A preparedness score was developed and multiple regression analysis was used to investigate the relationship between this score and physician and practice characteristics. The mean overall preparedness score was 53.7 of a possible 156 (range 5 to 136, SD = 31.3). Characteristics related to this score were type of practice and advanced cardiac life support certification. Large multispecialty practices and practices with physicians trained in advanced cardiac life support tended to have better preparedness scores. Family practitioners tended to have more complete stock of medications than pediatricians. The data presented suggested that critically ill children who enter the medical system via the office setting may have a better than even chance of finding the office unprepared to treat the emergency: in fewer than one third of the offices in which it was reported that at least one patient was seen weekly with asthma, anaphylaxis, sickle cell vasoocclusive crisis, status epilepticus, and sepsis were they fully equipped to treat emergencies related to these conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pediatric emergencies in office practices: prevalence and office preparedness. 272 48

The aim of this chapter was to highlight the major components of PAF actions which lead to a state of shock, i.e. inadequate perfusion of essential organs which if sustained over a critical period of time, leads to irreversible damage in essential organs and eventually death. The heart, the pulmonary vessels and the microcirculation seem to be the primary target organs to PAF-induced hypotension. The effects of PAF on the pulmonary airways in some species (bronchoconstriction) might lead to hypoxemia and further exacerbate organ function. Thrombocytopenia, leukopenia and activation of the complement system are also important in PAF-induced shock by promoting thrombi formation and generation of multiple secondary mediators (e.g. histamine kinins, TXA2, leukotrienes, oxygen radicals). Identification of PAF production during specific or generalized pathophysiological processes is a critical step to implicate this vasoactive lipid in disease processes. So far, only limited information has been derived from studies involving immune responses (anaphylaxis) or bacterial endotoxins. Yet, the growing number of selective and potent PAF antagonists provide important information on the potential role of PAF in shock states. Such evidence, summarized in table I, is of great importance in designing new therapeutic strategies to a highly complex and lethal disease such as septicemia. However, the data summarized in table I clearly show that little is known on the mechanism of action of the various PAF antagonists. It is also important to note that PAF-induced shock and death can be prevented by drugs which are not necessarily PAF antagonists. For example, dexamethasone is extremely efficient in preventing PAF-induced shock and death in the mouse [24, 39] and thyrotropin releasing hormone in the guinea pig [15]. Therefore, it is conceivable that pathological conditions in which PAF might play a fundamental role might be reversed by pharmacological interventions which activate physiological mechanisms which can overcome and reverse the pathological processes activated by PAF. In conclusion, PAF is a powerful vasoactive lipid which can produce severe derangements in essential biological functions which can lead to death. The role of PAF in pathological processes in vivo is well supported in conditions such as anaphylaxis and endotoxemia. Yet, direct proof for PAF production in other shock states, such as multiple trauma, ischemia, inflammation and hemorrhage, is still missing. Furthermore, it is important to keep in mind that in shock, trauma or inflammation, multiple mediators in addition to PAF are formed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Platelet-activating factor and shock. 304 32

Better methods are needed to assess mast-cell activation in vivo and to distinguish the activation of mast cells from that of basophils. Tryptase, a neutral protease selectively concentrated in the secretory granules of human mast cells (but not basophils), is released by mast cells together with histamine and serves as a marker of mast-cell activation. In 17 patients with systemic mastocytosis, concentrations of tryptase in plasma were linearly related to those of histamine (P less than 0.01). Eleven of the 17 patients had tryptase levels of 4 to 88 ng per milliliter, indicating ongoing mast-cell activation. In each of six patients who experienced corresponding anaphylactic reactions after penicillin, aspirin, or melon ingestion, a wasp sting, exercise, or antilymphocyte globulin injection, tryptase levels in serum ranged from 9 to 75 ng per milliliter, indicating mast-cell activation during each of these events. In contrast, serum tryptase levels were less than 5 ng per milliliter in all patients presenting with myocardial disease (n = 8, 6 with hypotension) or sepsis (n = 6, 3 with hypotension) and in the controls (n = 20). One patient had a myocardial infarction after anaphylaxis in response to a wasp sting and an elevated tryptase level of 25 ng per milliliter. Thus, the plasma or serum tryptase level is a diagnostic correlate of mast-cell-related events.
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PMID:Tryptase levels as an indicator of mast-cell activation in systemic anaphylaxis and mastocytosis. 329 49

A 1,700-g, 31 weeks' gestational age infant developed early onset Group B streptococcal septicemia associated with shock and respiratory distress. The infant was treated with antibiotics, exchange transfusion, and white cell transfusion. The infant improved, and then acutely deteriorated following the third white cell transfusion. Cause of death was presumed to be pulmonary sequestration of white cells or anaphylaxis.
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PMID:Sudden death following white cell transfusion in a premature infant. 350 17

Our series of 195 patients, plus 134 reported on in the literature and 949 reviewed by various physicians provide 1,278 patients for review of bacillus Calmette-Guerin therapy complications. Cystitis occurred in 91 per cent of the patients. Complications identified included fever more than 103F in 50 patients (3.9 per cent), granulomatous prostatitis in 17 (1.3 per cent), bacillus Calmette-Guerin pneumonitis or hepatitis in 12 (0.9 per cent), arthritis or arthralgia in 6 (0.5 per cent), hematuria requiring catheterization or transfusion in 6 (0.5 per cent), skin rash in 5 (0.4 per cent), skin abscess in 5 (0.4 per cent), ureteral obstruction in 4 (0.3 per cent), epididymo-orchitis in 2 (0.2 per cent), bladder contracture in 2 (0.2 per cent), hypotension in 1 (0.1 per cent) and cytopenia in 1 (0.1 per cent). Most of the severe irritative side effects and subsequent systemic complications can be prevented with prophylactic isoniazid given for 3 days, beginning the morning of treatment. Patients with life-threatening systemic bacillus Calmette-Guerin infection or anaphylaxis should receive 500 mg. cycloserine twice daily for 3 days in addition to combination antituberculous therapy because the rapid action of this drug may be life-saving. Direct intralesional bacillus Calmette-Guerin immunotherapy can produce sepsis and death, and should be avoided but intravesical bacillus Calmette-Guerin generally is well tolerated and has produced no complication in more than 95 per cent of the patients treated.
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PMID:Complications of bacillus Calmette-Guerin immunotherapy in 1,278 patients with bladder cancer. 351 Dec 86

Endogenous opioid peptides are released in response to stressful situations, such as circulatory shock, both as hormones and as central and peripheral neurotransmitters. Naloxone, an opiate antagonist, improves cardiovascular function in a variety of animal models of shock caused by endotoxemia, hemorrhage, anaphylaxis, or spinal trauma. Administration of thyrotropin-releasing hormone (TRH) in supraphysiologic doses also has pressor effects in these shock models. Given acutely after injury, TRH improves recovery in models of spinal trauma; however, the experimental effects of TRH do not involve action at the opiate receptor. Clinical evaluation of the use of naloxone in patients with shock has been largely limited to treatment of sepsis. The paucity of prospective, randomized trials makes these clinical data difficult to evaluate, but in septic patients the use of naloxone does not seem to improve survival. The use of naloxone in shock of other etiologies has not been clinically investigated, and may hold greater promise. Acute-phase treatment of spinal trauma victims with TRH is currently undergoing clinical trials.
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PMID:Naloxone and TRH in the treatment of shock and trauma: what future roles? 392 93

When patients allergic to penicillin develop life-endangering infections that require treatment with beta-lactam antibiotics, they face a fatal infection or the possibility of a fatal allergic reaction. We have approached this situation by using an oral desensitization procedure before full-dose antibiotic therapy. Thirty consecutive patients with histories of allergic reactions to penicillin, positive immediate wheal and flare skin-test reactions to penicillin determinants, and life-threatening infections were studied. Bacterial endocarditis requiring penicillin G therapy led to desensitization of 19 patients, Pseudomonas sepsis of pneumonia requiring treatment led to desensitization of nine subjects, and staphylococcal infections requiring therapy with a penicillinase-resistant penicillin led to desensitization of two patients. Penicillin G or carbenicillin were administered orally, beginning with 100 U or 60 microgram, respectively. At 15-min intervals, progressively doubled doses were given during continuous monitoring for the appearance of allergic reactions. Within 5 hr, full therapeutic doses were administered intravenously. Skin-test reactions disappeared or diminished in all 23 subjects who were retested after desensitization. Full courses of antibiotic therapy and cure of the infections were accomplished in 30 of 30 patients. No deaths, anaphylaxis, or severe acute allergic reactions occurred. Pruritic cutaneous eruptions appeared in nine patients (30%) 6 to 48 hr after the onset of therapy. One patient developed reversible nephritis 3 wk into therapy with penicillin G. The results of this study suggest that oral desensitization is an effective, relatively safe approach to administering beta-lactam antibiotics to penicillin-allergic patients with life-threatening infections.
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PMID:Desensitization of patients allergic to penicillin using orally administered beta-lactam antibiotics. 706 69

Four strategies for prevention of early onset neonatal group B streptococcal (GBS) sepsis were considered: A: routine antenatal screening for GBS vaginal carriage at 26-28 weeks' gestation and intrapartum antibiotic prophylaxis for all carriers; B: screening as above and prophylaxis only for carriers with risk factors for sepsis; C: prophylaxis for all women with risk factors; D: as for C plus screening at 37 weeks' gestation and prophylaxis for carriers. The outcomes considered for each option were: the proportion of women given prophylaxis; the risk of anaphylaxis; cases of neonatal GBS sepsis and deaths prevented; costs of screening, prophylaxis and of acute care of remaining cases. Published local and overseas studies of neonatal GBS sepsis, effectiveness of antenatal screening and prophylaxis and estimated costs were evaluated. Any of the proposed strategies can prevent a significant proportion of cases of neonatal GBS sepsis and a strategy for prevention of neonatal group B streptococcal sepsis should be part of routine obstetric practice. Strategy C is simple, effective, inexpensive and avoids unnecessary antibiotic use; it is recommended particularly when antenatal care is provided mainly in community or private practice. Strategy A (using vaginal and rectal swabs for screening) could prevent more cases, but at greater cost which could be justified only if protocols can be properly implemented and monitored.
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PMID:Prevention of neonatal group B streptococcal sepsis: is routine antenatal screening appropriate. 767 73


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