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

Thirty-nine cadaveric renal allografts were performed in 28 children under 6 years of age. Common primary renal diseases were glomerulonephritis, dysplasia/hypoplasia, and reflux/obstructive nephropathy. After a mean follow-up of 40 months of patients with surviving grafts, 19 patients had functioning grafts, 3 had returned to dialysis, and 6 had died. These children required an extraordinary amount of care postoperatively because of anorexia, diarrhea, and ileus. Their psychomotor and physical development was retarded prior to transplant; this reversed dramatically after transplant, but catch-up growth occurred in only 4 patients. Many patients were noticeably more active and distractible for 1 to 2 years post-transplant. Major causes of graft failure were primary nonfunction of 5 donor kidneys (4 from donors under 1 year old) and renal vessel thrombosis in 5 recipients (3 with native kidneys in place who received kidneys from donors over 10 years old). Other causes were recurrence of hemolytic uremic syndrome and Wilms tumor, rejection, and sepsis. Kidneys from donors under 1 year old proved unsatisfactory, and large donor kidneys in small children tended to thrombose, especially when native kidneys with high urine output were left in situ.
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PMID:Cadaveric renal transplants in children under 6 years of age. 636 47

Enteral feeding has many advantages over total parenteral nutrition (TPN) in the early postoperative period. The risk of sepsis is small, the nutrients are cheap and metabolic problems are rare. In the period April 1980 to January 1983, needle catheter jejunostomy (NCJ) was applied in 210 patients after surgery of the oesophagus, stomach, duodenum, liver or pancreas. All but 14 of these patients were fed by NCJ for a certain period postoperatively, NCJ feeding being initiated within 48 hours after the operation in 63% of the cases. In 14 patients, it was decided not to use NCJ feeding because of counter-indications observed postoperatively. The mean duration of the feeding by NCJ was 17 days (range two to 84 days). The complications observed were intraperitoneal leakage in four patients (1.9%), ileus in seven patients (3.3%) and diarrhoea in 54 patients (25.7%). The total number of feeding days was 2,906. This form of feeding resulted in savings of Dfl. 115,00 per patient per day compared with TPN, for a 12,600 Joule intake. NCJ feeding is a relatively safe, economical procedure that can be applied as a matter of routine after abdominal surgery.
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PMID:Needle catheter jejunostomy (NCJ) for early postoperative feeding: experience in 210 patients. 641 77

In the past 10 years, the diagnosis of pseudoobstruction lasting more than two months was confirmed in 10 infants after sepsis, meconium ileus, and Hirschsprung's disease were excluded, and surgery or autopsy failed to demonstrate a site of mechanical intestinal obstruction. Four infants had undergone prior operation for another anomaly: gastroschisis (2) and ileal atresia (2). Five of the remaining infants also had megacystis. The lack of coordinated intestinal motility was best appreciated by radiocontrast small bowel studies, which showed degrees of aperistalsis or segmentation. Rectal manometric studies were not helpful. Histology of the intestine was normal in seven, while a gross deficiency of nerve fibres was noted in one patient and a myopathy of smooth muscle in another. A variety of drugs used to stimulate peristalsis were ineffective. Seven patients had 25 operations, often to exclude mechanical causes of obstruction. The mainstay of treatment was TPN and intestinal decompression. Six children survived; their ages ranged between 8 months and 9 years (median age, 16 months). There has been improvement in intestinal peristalsis in five children, three of whom now tolerate a regular diet and two of whom are on TPN and are currently increasing oral intake. Four infants died, two from sepsis, two from TPN-related hepatic failure. In contrast to previous reports, we conclude that intestinal pseudoobstruction may be self-limited in some neonates, including those with megacystis. Therapy should consist of long-term nutritional support and treatment of other anomalies that may be present.
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PMID:Neonatal intestinal pseudoobstruction. 644 Sep 67

Pseudo-obstruction of the colon is a problem of bowel motility that predominantly involves the large intestine and that can mimic the clinical and radiographic features of mechanical obstruction of the colon. It must not be confused with the much more common and less dangerous complication of post-operative ileus. Although it is most often seen in elderly patients who are confined to bed, it can occur in younger patients. Cecal dilation can develop rapidly to dangerous proportions, and recognition by thorough physical examination and early abdominal radiographs is essential if operative intervention is to be avoided. Nasogastric suction, intravenous fluids, and frequent turning of the patient are often successful if begun early, but are unlikely to be of benefit once cecal dilation approaches fourteen centimeters on plain radiographs. In these advanced cases, tube cecostomy or colostomy may be the only way to avoid necrosis of the bowel wall, perforation, and sepsis.
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PMID:Pseudo-obstruction of the colon. A postoperative complication in orthopaedic patients. 682 84

Sixteen patients underwent a modification of the Sugiura procedure for bleeding esophageal varices, involving (a) esophageal transection, (b) splenectomy, (c) selective vagotomy, and (d) pyloroplasty. Five patients died, and the remaining 11 had barium studies of the esophagus and stomach which were compared with the preoperative appearance. Esophageal varices disappeared in 7 patients and persisted in 1. No recurrent bleeding or encephalopathy was seen: however, there were a large number of complications, including pleural effusion, ascites, ileus, pneumonia, and renal failure. Hepatic failure, respiratory failure, and sepsis secondary to gastrointestinal leakage also occurred and were fatal in all cases. As the Sugiura procedure is increasingly being employed in the United States, radiologists should be familiar with the spectrum of postoperative radiographic findings in the esophagus and stomach.
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PMID:Radiographic findings in the esophagus following the Sugiura procedure. 697 61

1. The most frequent causes of postoperative peritonitis are circumscribed abscesses, the postoperative ileus and the anastomotic leakage or breakdown of the digestive suture. 2. The mortality is 33%; procedures in upper abdominal surgery are accompanied by higher mortality than in colorectal surgery in cases of postoperative peritonitis. 3. The most frequent cause of death after reoperation is the generalized sepsis. 4. A mixed flora of spores are found in most cases; obligate anaerobic spores are found mostly after colorectal procedures, while typical "hospitalized spores" were present equally after all surgical treatment in abdomen. 5. Method of treatment is: early surgical reintervention, systemic application of antibiotics, peritoneal lavage in generalized peritonitis, sufficient drainage in local peritonitis and the open-wound-treatment of the abdominal cavage in severe forms.
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PMID:[Postoperative peritonitis. Patients, causes, therapy, prognosis]. 709 86

To define the most important diagnostic signs, symptoms and laboratory findings related to intra-abdominal sepsis in the early post-operative period, 15 binary variables were prospectively assessed in 100 febrile (greater than 39 degrees C) post-laparotomy patients admitted to an intensive care unit. Intra-abdominal sepsis was found alone in 55 patients and in association with an extra-abdominal focus in 11 patients. Fever was related to an extra-abdominal septic focus in 23 patients and no infectious cause was found in 11. Analysis (chi 2) indicated that 6 of the 15 variables were significantly associated with an intra-abdominal focus of infection. The predictive value of each variable, indicated by relative risk, ranked the six variables in order of diagnostic importances: no bacteraemia (1.67), leucocytosis (1.60), ileus (1.50), mental disturbances (1.41), contaminated first laparotomy (1.38), abdominal tenderness (1.22). The absence of bacteraemia was the most important finding separating intra- and extra-abdominal foci of infection. In a febrile post-laparotomy patient with any evidence of sepsis, the absence of bacteraemia should not lull the physician into a false sense of security but rather alert him to the likelihood of an intra-abdominal septic focus.
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PMID:Diagnostic features of early high post-laparotomy fever: a prospective study of 100 patients. 710 31

The authors describe three patients with similar clinical features and patterns of colonic injury following blunt abdominal trauma. Perforation was discovered 7 to 10 days after injury and was indicated by the clinical signs of systemic sepsis. A prominent sign of occult sepsis was post-traumatic pulmonary insufficiency. Blunt trauma to the colon was initially present but was not very impressive, consequently diagnosis was delayed. The large number of concomitant injuries and the subsequent sepsis led to a higher morbidity and mortality than in cases of penetrating injuries to the colon. The key to successful management of blunt colonic injuries is early diagnosis. Awareness of the type of injury and the magnitude of the deceleration force combined with the presence of persistent ileus may lead to earlier laparotomy.
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PMID:Delayed perforation of the colon in blunt abdominal trauma. 743 60

The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of cases (stroke 51%) and 53% of patients were severely malnourished (body mass index < 17 kg/m2) at the time of referral. In 12 (16%) patients swallowing recovered and the PEG was removed after a median (range) of 55 days (20-150). Three (4%) deaths were related to PEG (one oesophageal perforation, one haemorrhage, and one aspiration pneumonia). One patient developed peritonism and ileus, which resolved with conservative treatment. Minor complications included local sepsis 3%, tube blockage 12%, and tube connector leak 5%. During seven days of observation, demands on nursing time for routine care of the PEG were the same as for nasogastric tube feeding, median (range) 21 (4-42) v 16 (4-40) min/day respectively, but in about half the latter cases the tube had to be replaced at least once. Over 15 months, 29 patients were randomised to receive a 1.9 mm inner, 2.9 mm (9F) outer diameter Fresenius and 27 a 3.0 mm inner, 4.0 mm (12F) outer diameter Bower polyurethane tube and were followed for 2920 and 2388 patient days respectively. There was no difference in the insertion time (median (range) 20 (10-45) v 24 (10-45) min respectively) or number of patients with complications (three v eight patients NS), although there were more minor mechanical problems (three v 12, p < 0.01) with the 12F tube. The internal anchoring device of the 12F tube allowed its non-endoscopic removal, a method applicable too 16% of cases. No tubes were removed because of blockage.
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PMID:Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. 782 71

Ileus is common during sepsis; however, the etiology of this gastrointestinal dysmotility is unclear. The aim of our study was to determine the effects of a single, sublethal dose of endotoxin on canine gastrointestinal motility, gastric emptying, gastric acid secretion, and colonic transit. Six dogs underwent placement of manometric catheters in the stomach and small bowel and insertion of a gastric and a cecal cannula. After the animals recovered, fasting and fed gastrointestinal motility was recorded, and gastric emptying and colonic transit were studied with nonabsorbable liquid and solid markers, respectively. Following completion of baseline studies, each dog was given a single dose of Escherichia coli lipopolysaccharide (200 micrograms/kg intravenously) and the studies were repeated on Postendotoxin Days 1-3. The single bolus of endotoxin abolished the migrating motor complexes, decreased the fasting motility index, decreased hydrogen ion output, slowed liquid gastric emptying, and prolonged colonic transit for 2 days. Gastrointestinal motility and transit returned to baseline on Postendotoxin Day 3. In conclusion, a single, sublethal dose of endotoxin temporarily disrupts fasting and postprandial canine gastrointestinal motility and transit.
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PMID:Effect of endotoxin on canine gastrointestinal motility and transit. 783 Apr 12


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