Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 21-year-old female who had developed ileus underwent abdominal surgery for adhesiolysis. Because of postoperative bleeding she required repeated surgical reexploration. Subsequently, the patient developed abdominal sepsis (Enterobacter cloacae) and, on day 11 of mechanical ventilation, severe adult respiratory distress syndrome (ARDS) (Lung injury score 3.5, paO2/FiO2 55 mmHg). Despite clearing the abdominal situation, chest films showed persisting and new pulmonary infiltrates, leucocytosis, fever and purulent bronchial secretion occurring over a period of five weeks. Despite aggressive antibiotic treatment the patient deteriorated further and disease progressed to multiple organ dysfunction syndrome. At the beginning of week six all bacteriological specimens (blood, bronchoalveolar lavage, urine, catheter tips) were negative for potential pathogens. Possible extrapulmonary infection sites were cleared by computed tomography and Tc 99 labeled antigranulocyte antibody scan. Open lung biopsy was performed on day 33 of ARDS and revealed severe diffuse alveolar damage in the fibroproliferative phase of ARDS. On day 37 after ARDS onset, antibiotic treatment was discontinued and methyl-prednisolone (32 mg every 6 hours, 2.5 mg/kg.day) was started. After five days a significant improvement of pulmonary function (lung injury score decreased from 3.5 to 2.5, paO2/FiO2 increased from 82 to > 200 mmHg) and of cardiovascular performance occurred. Corticosteroid treatment was continued for 29 days and was complicated by an episode of pneumonia (Klebsiella pneumoniae) requiring antibiotic therapy. The patient's trachea was successfully extubated on day 80. She was discharged from intensive care unit on day 93 and left hospital three weeks later. We conclude that late ARDS may cause systemic inflammatory response and persisting organ dysfunction without an identifiable source of infection. Corticosteroid therapy might improve fibroproliferative changes of the lung even if instituted weeks after the onset of ARDS.
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PMID:[Multiple organ failure with several weeks' persistence of ARDS: successful therapy with methylprednisolone]. 949 90

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-oedematous and necrotizing pancreatitis. Surgical decision-making is based on clinical, bacteriological and contrast-enhanced CT-data. Persisting or progressive systemic or local organ complications occurring despite ICU-treatment are indicators for surgical management. Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, surgical acute abdomen and persisting or progressing ileus should be treated surgically. The surgical technique is based on careful necrosectomy or debridement in combination with continuous or repeated surgical evacuation of necrotic tissue, bacteria and biologically active compounds. Necrosectomy and postoperative continuous local lavage resulted in a hospital mortality of 17% in necrotizing pancreatitis, conservative management of necrotizing pancreatitis in a hospital mortality of 6.3%. In 1442 patients treated in a 14-year period the overall hospital mortality was 4.4%.
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PMID:Surgical treatment of acute pancreatitis. 982 61

Analysis of early and late post-surgical complications in 44 cases of Studer's type bladder replacement due to carcinoma of the bladder performed over a 6-year period. Follow-up ranges between 6 months and 6 years. 4 patients died during the post-operative (9.09%): 1 myocardial infarction, 1 pulmonary embolism and 2 intestinal fistula. 28 patients (63.64%) had post-operative complications: 4 GI fistula (9.09%) 5 ileus (11.36%), 2 GI bleeding (4.54%), 1 ureteral fistula (2.27%), 1 ureteral stenosis, 6 urethro-intestinal fistula (13.36%), 1 tubular necrosis, 1 ruptured ureteral catheter, 5 wound infections (11.36%), 12 urine infections (27.27%), 6 sepsis (13.63%), 1 lymphocele, 1 evisceration and 2 eventrations. Repeat surgery was required in 6 cases. Within 6 months from discharge, 7 of 40 patients (17.5%) had some complication: 3 acute pyelonephritis, 4 episodes of acidosis-dehydration and 1 ureter stenosis. After 6 months, 7 of 38 patients (18.4%) had complications: 1 acidosis, 3 vesical lithiasis, 2 ureteral stenosis and 1 urethro-intestinal, plus 2 cases of chronic urinary retention. Daytime continence was 97.2% and nighttime continence 30%; after 6 months evolution, no further changes were seen.
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PMID:[Studer's type ileal neobladder. Study of complications and continence]. 994 71

A total of 42 Japanese centenarians (9 males & 33 females) autopsied in Tokyo Metropolitan Geriatric Hospital during 22 years (1975-1996) were clinico-pathologically examined to determine details of the main cause of death. The main cause of death of the 42 cases were sepsis (16 cases), pneumonia (14 cases), suffocation (4 cases), heart failure (4 cases), cerebrovascular disorder (2 cases) and malnutrition (2 cases). Most pneumonias were caused aspiration of foreign bodies, and the origins of sepsis were pyelonephritis (7 cases), biliary tract infection (3 cases), necrotic lesions of the intestine due to ileus, ischemia and pseudomembranous colitis (3 cases) and indwelling vein catheter (3 cases). Malignant neoplasms were observed in 16 cases (38%), and 5 of them had 2 or 3 lesions. Thus, the total number of lesions of malignant neoplasms were 22, as follows; colonic cancer (36%), urinary bladder cancer (14%), lung adenocarcinoma (9%), gastric cancer (9%), malignant lymphoma (9%) and others. However, none of these malignant neoplasms were directly related with the cause of death. All 42 centenarians died not of simple "senile decay", but due to diseases.
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PMID:[Pathologic evaluation of the main cause of death in Japanese centenarians]. 1036 29

Pathologic conditions affecting the abdomen are a significant cause of morbidity and mortality in the intensive care unit, but their importance is not widely recognized. This article presents several aspects of abdominal pathology that can occur in intensive care unit patients. This pathology may have a considerable impact on the prognosis and survival of the critically ill patient. The diagnostic contribution of laboratory tests and imaging is discussed. Conditions such as the abdominal compartment syndrome, acute mesenteric ischemia, gastrointestinal bleeding, diarrhea, abdominal sepsis, complications of entereal and parenteral nutrition, and ileus in critically ill patients are also reviewed.
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PMID:Gastrointestinal complications in the intensive care unit. 1038 60

Cellular mechanisms of sepsis-induced ileus remain an enigma. The study aim was to determine the role of nitric oxide (NO) in mediating the suppression of rat jejunal circular smooth muscle activity during endotoxemia. Isolated muscularis inducible NO synthase (iNOS) mRNA was measured by RT-PCR, immunohistochemistry was employed to localize iNOS protein, and contractile activity was measured in an organ bath. The low basal expression of muscularis iNOS mRNA expression was increased in a time-dependent fashion after lipopolysaccharide (LPS), resulting in a 20-fold increase over controls 3 h after injection. Immunohistochemistry of muscularis whole mounts and dissociated muscularis cells for iNOS revealed staining only in the muscularis macrophages 12 h after LPS. LPS caused a 68% reduction in spontaneous muscle activity 12 h after injection, which improved by 53% after the in vitro application of the selective iNOS inhibitor L-N(6)-(1-iminoethyl)lysine. Similar results were obtained in C57BL/6 mice but not in iNOS knockout mice. These data demonstrate that macrophage iNOS plays an important role in mediating LPS-induced intestinal circular muscle suppression.
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PMID:LPS-induced muscularis macrophage nitric oxide suppresses rat jejunal circular muscle activity. 1044 63

The diagnosis of obturator hernia is difficult, and delayed treatment is associated with serious complications. Recently, computed tomography (CT) has been used successfully for establishing a correct diagnosis. We encountered nine cases of obturator hernia from 1988 to 1997. All the patients were elderly women. In six of them, a correct diagnosis was established by emergent CT scan. In two of the remaining cases, diagnosis could not be established because of unavailability of CT, and the other patient was diagnosed correctly based on clinical features, including a positive Howship-Romberg sign. Surgical repair was performed successfully. One patient died postoperatively because of septicemia associated with anastomotic leakage. Our cases indicate that emergent CT scan is useful for the diagnosis of obturator hernia, particularly in elderly patients presenting with ileus of unknown origin.
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PMID:Obturator hernia: the usefulness of emergent computed tomography for early diagnosis. 1049 7

Short-bowel syndrome is functionally defined as a state of malabsorption following loss of small bowel. Most cases occur in the neonatal period after extensive resection for necrotizing enterocolitis, or due to congenital anomalies of the gastrointestinal tract. A smaller percentage originate later in life from surgical treatment of Crohn's disease, neoplastic disorders, or vascular events. The physiological, morphological and functional intestinal gradient determines the clinical picture leading to better tolerance of jejunal than ileal resections. The subsequent adaptation process requires enteral feeding with a different impact of specific nutrients, and is also influenced by a number of humoral mediators such as enteroglucagon, gastrin, growth factors, prostaglandins and polyamines. Nutritional management starts parenterally via a central venous line covering basic demands, substituting current losses and restoring pre-existing deficiencies. Continuous enteral tube feeding is added as soon as postoperative ileus resolves, beginning with an elemental diet, which is gradually increased first in concentration, then in quantity, and supplemented by small oral meals. Cycling of parenteral nutrition is the next step. As soon as sufficient stability is reached, the child should be discharged home under continued outpatient care. Main long-term problems comprise bacterial overgrowth, fluid and electrolyte disequilibration, nutritional deficiencies, parenteral nutrition-related liver disease, and central venous line complications such as sepsis and thrombosis.
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PMID:Enteral and parenteral nutrition in patients with short-bowel syndrome. 1053 60

Sixty-eight neonates with functional ileus were reviewed. Twelve required laparotomy; in seven, histological studies revealed decreased ganglia and ganglion cells of the myenteric plexus (MP) (Group A), and in five, MP was normal (Group B). In the remaining 56 cases, obstructive symptoms were relieved following conservative therapy (Group C). All Group A cases except one had normal birth weight, while Group B and C cases showed significantly lower birth weights. A marked caliber change of the small intestine and/or small-caliber distal intestine with meconium stagnation in the proximal intestine was commonly demonstrated at operation in Group A and B, or on contrast enema in Group C. Four Group A cases died of enteritis, and three survivors suffered from prolonged obstructive symptoms. The grade of histological abnormality of MP correlated with the clinical outcome. In Group B, three died of sepsis shortly after surgery, but two survivors have been free from symptoms. Group A can be categorized as Hirschsprung's disease-allied disorders (HAD). Group B and C can be categorized as meconium-related ileus (MRI). The similarity of the macroscopic findings of HAD and MRI, and the occurrence of MRI exclusively in low birth weight neonates, strongly suggest that functional immaturity of MP plays a role in the etiology of MRI.
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PMID:Functional ileus in neonates: Hirschsprung's disease-allied disorders versus meconium-related ileus. 1066 50

We present a rare case of a five-year survivor of small cell lung cancer with severe complications who responded to combined modality treatment. Prior to initial chemotherapy, he experienced severe complications including sepsis, pneumonia, ileus, and a performance status of 4. He was treated with an ileus tube and IVH, and was managed by mechanical ventilation for four days. After his general condition improved, he received combination chemotherapy of carboplatin, with the target area under the plasma concentration versus the time curve (AUC) of 5 mg x min/ml day 1, and etoposide (80 mg/m2) on days 1, 2, 3 for four courses, and complete remission (CR) was obtained. Six months later, systemic relapse occurred, but he achieved complete remission again with nine courses of CODE (cisplatin, vincristine, adriamycin, and etoposide) chemotherapy and sequential chest radiotherapy. Five years after the initial chemotherapy, the patient is alive and disease free.
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PMID:Response to combined modality treatment in a five-year survivor of extensive small cell lung cancer with severe complications. 1085 68


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