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

Apple peel deformity of the small bowel is a variant of jejunal atresia with a high mortality. Forty five percent of these patients can be expected to die, most from anastomotic leaks with sepsis, or anastomotic failure with prolonged ileus and malnutrition. This report documents survival of three consecutive patients treated by an adaptation of the Santulli "chimney" anastomosis. This method accomplishes the goals of relief of intestinal obstruction, minimal resection, and preservation of tenuous intestinal blood vessels. All three patients had a benign postoperative course and made an uneventful recovery. Intestinal function is normal in each patient at 1 1/2 years. Based on this experience, it appears that a Santulli jejunojejunostomy combined with total parenteral nutrition offers the most promising operative strategy in the treatment of patients with apple peel bowel.
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PMID:Apple peel jejunal atresia. 310 85

Recent advances in technology have not substantially changed the relatively low survival rate associated with acute renal failure (ARF). Several clinical prognostic variables and multivariate models have been reported to predict survival in individual patients, but these are either cumbersome to use or restrictive in their application. A straightforward clinical index has been developed to predict survival in ARF based on data obtained for all patients receiving dialysis for ARF at the University of Kansas Medical Center from November 1979 through October 1985. During this period, 126 patients received dialysis for ARF, with an overall survival of 25% (32/126). There were no significant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. Eleven variables were statistically related to survival, and were reduced to five when clinically similar variables were combined or eliminated. A clinical survival index was based on these five easily determined variables that were significantly related to survival: systolic blood pressure less than or equal to 110 mm Hg, assisted ventilation, congestive heart failure, proven or suspected sepsis, and gastrointestinal (GI) dysfunction (bleeding, ileus, obstruction, or recent abdominal surgery). Survival was directly related to the number of factors present: zero, 62% (8/13); one, 44% (8/18); two, 30% (10/33); three, 19% (5/26); four, 0% (0/20); and five, 6% (1/16). This straightforward index, derived from easily obtained clinical data, is useful for judging survival prognosis in patients with ARF severe enough to warrant treatment with dialysis.
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PMID:A clinical index to predict survival in acute renal failure patients requiring dialysis. 334 47

The medical records of 20 neonatal foals in which exploratory celiotomies were performed for gastrointestinal disease were reviewed. In all 20 foals, persistent pain and/or progressive abdominal distension were the primary clinical findings influencing the decision to operate. However, ancilliary laboratory data were important to the proper medical management of these foals during anaesthesia and following surgery. Surgical diagnoses of the 20 foals included ileus (nine foals; 45 per cent), small colon obstruction (five foals; 25 per cent), large colon displacement (three foals; 15 per cent), small intestinal displacement (two foals; 10 per cent), and perforated gastric ulcer (one foal; 5 per cent). Seventeen foals were recovered from anaesthesia, 13 of these were discharged from the hospital, seven were alive six months or more following discharge. Sepsis was the cause of death in six of the 10 foals that died following recovery.
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PMID:Exploratory celiotomy for gastrointestinal disease in neonatal foals: a review of 20 cases. 336 15

A 15-year review of children's hospital patients with cystic fibrosis (CF) who underwent surgery yielded 578 cases in 210 patients (mean 2.7 per patient). The median age was 16 years (range newborn to 43 years). Four hundred procedures were done under general anesthesia and 176 under local. There was one anesthetic complication, respiratory depression in a patient whose MediPort (Cormed, Inc, Medina, NY) was inserted using local anesthesia and sedation. The most frequent procedure was nasal polypectomy, with 165 procedures in 50 patients. The second most common procedures were vascular access procedures: 75 central lines and 29 MediPorts were implanted in 57 patients, complicated by two pneumothoraces. Thoracic procedures included 32 bronchoscopies, 8 lobectomies, 2 pneumonectomies, and 30 pleural strippings. There were three reoperations for bleeding in the pulmonary resection patients. Thirteen newborns underwent a total of 26 procedures for meconium ileus and its complications, with two deaths secondary to respiratory failure and sepsis. These, and one death postlobectomy were the only operative deaths in the entire series of 578 cases (0.5% mortality rate). There were four slings for rectal prolapse; two required removal secondary to infection. Eight patients underwent central splenorenal shunts for portal hypertension, 15 underwent cholecystectomy, 5 underwent Nissen fundoplication, 16 underwent inguinal herniorrhaphy, 2 underwent umbilical herniorrhaphy, 3 underwent orchidopexies, and 4 underwent miscellaneous pediatric surgical procedures. Eleven patients underwent appendectomy for appendicitis; four were ruptured at the time of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgery in patients with cystic fibrosis. 361 55

From 1969 to 1984, 42 neonates were managed for meconium ileus caused by cystic fibrosis. Simple, uncomplicated meconium ileus occurred in 24 infants (57%) and complicated meconium ileus occurred in 18 (43%). Meglumine diatrizoate (Gastrografin) enema completely relieved the obstruction in 13 patients with simple meconium ileus (54%) and caused colonic and rectal perforations in three (13%). Six operative procedures were used in 29 patients: double enterostomy (seven), resection with primary anastomosis (seven), Bishop-Koop enterostomy (seven), intraluminal lavage (four), colostomy (three), and Mikulicz enterostomy (one). Postoperative complications included malabsorptive diarrhea (nine), pneumonia (three), intestinal obstruction (two), total parenteral nutrition-catheter sepsis (two), and anastomotic leak (one). Infants managed nonoperatively by Gastrografin enema had a significantly shorter hospitalization (average, 15 days) than those undergoing operation for simple meconium ileus (54 days) and complicated meconium ileus (111 days). Postoperative survival rate was 100% with a late survival rate of 86%.
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PMID:Meconium ileus: a fifteen-year experience with forty-two neonates. 366 Feb 42

Preventive intestinal intubation for ileus prophylaxis in cases of diffuse peritonitis and extended adhesion ileus had often been discredited for the technically demanding and thus time-consuming technique involved. Yet, tube-related complications in the context of tube insertion or removal can be minimised by the experienced surgeon who stringently observes a number of precautions and provided that the indication had been accurate. Fifty-three intestinal intubations on 49 patients were accompanied by three iatrogenic perforations intraoperatively and by four instances of postoperative fistulation of the small intestine which, however, were all properly controlled by suturing or conservative action. Ileus recurred in three patients because of too early tube removal and due to progressive peritonitis against the background of inadequately cured primary disease and due to peritoneal mesothelioma in one case. Periods of intestinal intubation ranged from six to 14 days. Postoperative lethality was relatively high (30.6 per cent) and had been exclusively caused by progressive sepsis or cardiopulmonary insufficiency. It amounted to 50 per cent of all cases of diffuse peritonitis and only to 4.7 per cent of patients with recurrent adhesion ileus.
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PMID:[Internal intubation of the small intestine for preventing ileus in peritonitis and recurrent adhesions]. 368 70

The results of this prospective clinical study have demonstrated a low rate of false-positive abdominal sonographic findings in patients undergoing routine studies the seventh day after abdominal surgical procedures. It is concluded that any intraperitoneal fluid collection detected by ultrasound examination in a patient postoperatively demonstrating signs and symptoms of abdominal sepsis (fever, leukocytosis, pain, tenderness, persistent ileus, excessive drainage, wound changes and so on), should be considered as the source, as abdominal fluid collections do not persist as a "normal" part of the healing process one week after extensive biliary tract or colonic operations. Sonography is a highly specific procedure for the detection of abdominal abscesses after the seventh postoperative day. The type of procedure, type of incision, type of closure, presence of drains, history of prior intraperitoneal surgical procedures and operative blood loss did not affect the accuracy of the test. Postoperative ultrasonography is a specific, sensitive and accurate test and is widely applicable to almost all groups of patients.
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PMID:The reliability of the results of ultrasound detection of fluid collections in the early postceliotomy period. 392 80

A case of asymmetrical thoraco-omphalo-ischiopagus tripus will be reported. Anal atresia, ruptured omphalocele with lesion of the small intestine made an artificial anus necessary. Recurrent adhesion ileus made three further operations necessary. After precise preliminary examinations we separated these twins at the age of 21/2 years. After 7 and 9 months both children had to be reoperated because of fistula of the small intestine. Twin R. died at the age of 3 years and 8 months in consequence of a candida sepsis. Twin P. now lives with his parents.
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PMID:[Separation of an asymmetric xipho-omphalo-ischiopagus tripus]. 399 Apr 73

The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P less than .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P less than .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P less than .01). The fatality rate in shigella bacteremia (21%) was higher (P less than .005) than in nonbacteremic shigellosis (10%) but lower (P less than .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P less than .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.
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PMID:Shigella septicemia: prevalence, presentation, risk factors, and outcome. 404 31

A new device for assessment of delayed cutaneous hypersensitivity using seven standardized antigens (Multitest CMI) was compared to conventional intradermal testing with two recall antigens in 83 patients referred for nutritional support. Sixteen patients (19.3%) were anergic to Multitest CMI while four (4.8%) were anergic to conventional testing. Patients anergic to Multitest CMI had a higher complication (intraabdominal abscess, prolonged ileus, sepsis, pneumonia) than those who were immunocompetent by this test suggesting a group at greater risk. This interpretation is consistent with an increased specificity of Multitest CMI over conventional testing in the identification of clinically important anergy.
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PMID:A new device for delayed hypersensitivity skin testing. 405 35


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