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

Renal failure in sepsis often occurs without other organ failure such as cardiovascular or pulmonary dysfunction. An endotoxin-induced renal insufficiency model using rabbits, which does not complicate other organ failure, was developed. To selectively damage kidneys endotoxin (40 micrograms/kg/h, 3 h) was infused through a cannula placed into the abdominal aorta just distally to the take-off of the superior mesenteric artery after ligation of the aorta below the junction of renal arteries. The following manifestations of renal insufficiencies were observed with high reproducibility: oliguria, increase in plasma creatinine (from 1.1 to 1.6 mg/dl) and urine N-acetyl-beta-D-glucosaminidase (from 7.9 to 23.7 U/l), decrease in effective renal plasma flow (33%) and glomerular filtration rate (35%), and an apparent renal ischemic change in the histological examination. On the other hand, blood pressure, heart rate, respiration rate, body temperature and hematocrit were not significantly altered. The present model is useful for studying the effects of drugs on renal insufficiency in sepsis or endotoxemia and its pathogenesis. Most renal insufficiencies in clinical sepsis may be caused by endotoxin-induced renal ischemic change due to neither low blood pressure nor renal microthrombi.
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PMID:Renal insufficiency induced by locally administered endotoxin in rabbits. 208 49

Recently introduced chloroquine resistant malaria has altered the clinical picture and complicated the overall management of malaria. 113 adults with proved malaria admitted at Harare Central Hospital, Zimbabwe, were evaluated to determine the incidence, nature, relationship to morbidity and mortality and response to treatment of the complications due to malaria. 47.7 pc (52 of 109) patients had relatively chloroquine resistant malaria. 87.4 pc (99 of 113) had complications whose percentage frequency of occurrence were: Anaemia 51.2 pc, diarrhoea and/or vomiting 42.2 pc, cerebral malaria +/- fits 39.2 pc, renal insufficiency +/- hyperkalaemia 26.4 pc, hypoglycaemia 15.6 pc, jaundice 15.2 pc, neuro-psychiatric 15.0 pc, shock 10.6 pc, concurrent sepsis 8.9 pc, pulmonary oedema 3.5 pc and hyperpyrexia 1.7 pc. Multiple complications in the same patient were common. The combination of cerebral malaria and renal insufficiency had the worst mortality (p less than 0.001). All patients dialysed, however, survived. Non-iron deficiency anaemia, 91.7 pc (51 of 55) and diarrhoea and/or vomiting, were common, worsened morbidity but not mortality (p = 0.555). A seriously-ill patient with malaria should be suspected of having complications and chloroquine resistance and should be referred promptly to a centre with facilities for dialysis. Anti-malaria drugs should be mixed in a dextrose solution and iron supplements should not be given routinely.
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PMID:Complications of seasonal adult malaria at a central hospital. 209 79

A new lipid emulsion for parenteral nutrition, Elolipid, was evaluated for in vitro stability as a component of an all-in-one nutrition solution and, in an open prospective investigation, for clinical tolerance and utilisation in intensive care patients with a broad spectrum of underlying diseases and organ dysfunctions. In vitro stability was determined by photon correlation spectroscopy (mean particle diameter) and Coulter Counter cell sizing (particle size distribution) after 0, 24, 48, 96 h of storage at temperatures of 4 degrees C and 25 degrees C. Mean particle diameter of 330 nm was not altered at any storage time or temperature. The portion of particles with an diameter of greater than 1,000 nm increased mildly during storage of 96 h at room temperature. 31 critically ill patients (mean age 55 +/- 3 years) entered the clinical study: 23 subjects were on artificial ventilation, 15 acquired septicemia, 9 renal insufficiency, and 7 acute or chronic hepatic failure. Fat was given as a component of an all-in-one solution at a rate of 1 g/kg b.w./day for a mean duration of 10 +/- 2 days. Plasma triglycerice concentrations rose mildly between days 3 and 5 only, but in none of the patients the infusion had to be stopped. Lipid-related disturbances of glucose or electrolyte metabolism, hepatic function, cholestasis, induction of disseminated coagulation, impairment of pulmonary gas exchange or renal function were not seen. 7 of 31 patients (22%) died. Side effects of complications attributable to the fat infusion could not be identified. It is concluded that the new lipid emulsion Elolipid is stable as a component of an all-in-one parenteral nutrition solution, is free of side effects and is well-tolerated and utilized even in critically ill patients with multiple organ dysfunctions.
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PMID:[Administration of a new fat emulsion in intensive care]. 212 1

Insulin resistance is a cause for morning hyperglycemia seen in diabetic patients. Other reasons for morning hyperglycemia should be eliminated by performing an insulin response test. Once insulin resistance has been established as the cause of hyperglycemia, a step-by-step process should be used to establish the cause of the insulin resistance. Common causes of insulin resistance include hyperadrenocorticism, acromegaly, hyperthyroidism, and obesity. Hepatic disease, renal insufficiency, and sepsis are other causes of insulin resistance in practice. Less common causes include insulin antibodies, pregnancy, neoplasia, hyperandrogenism, and pheochromocytoma. If the underlying cause cannot be found or resolved, then increased doses of insulin are required to manage the hyperglycemia.
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PMID:Problems in diabetes mellitus management. Insulin resistance. 213 77

Ninety-one children that were subjected to transabdominal radical nephrectomy are reviewed. The patients' ages ranged from 20 days to 10 years. Forty cases had a right side tumor and 44 a left side tumor; bilateral tumor incidence was 7.70% (7 cases). The tumor weight incidence was 75% for greater than or equal to 500 g and 37.5% for greater than or equal to 1,000 g. Incidence of local extension of the disease was 21.98%. Intraoperative complications were 12 ruptures of the kidney capsule, 1 laceration of the cecum, 1 opening of the pleura, 1 section of the superior mesenteric artery, and 1 section of the right common iliac artery. The mortality rate in unilateral surgery, because of intraoperative massive hemorrhage, was 3/83 (3.61%). One patient with bilateral tumor died because of acute renal insufficiency and sepsis. One patient with caval thrombus which extended up to the right atrium died because of intraoperative massive pulmonary embolism.
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PMID:Transabdominal radical nephrectomy in ninety-one consecutive patients with Wilms' tumor. 216 9

Acute causes and chronic risk factors for the development of acute renal failure were analyzed in prospective acquired data of 261 patients in a medical ICU. The population was divided into a group requiring dialysis treatment for established renal failure (n = 95) and a collective maintaining mild renal insufficiency (n = 166). Bivariate and linear discriminant analyses revealed that, above all, variables related to bacterial infections (sepsis and administration of antibiotic agents) and pancreatitis contributed to the discrimination, followed by bleeding, volume depletion, and chronic liver disease in the discriminant function. Bivariate analysis also yielded significant results for mechanical ventilation, CNS depression, and surgery. The importance of the nephrotoxic properties of aminoglycosides may be outweighed by their role as an indicator of severe infectious disease. The overall correct classification rate of the discriminant function was 78.5%, which reflects the importance of the predictor variables, but does not allow individual predictions.
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PMID:Impairment of renal function in medical intensive care: predictability of acute renal failure. 218 66

Four fatalities related to intramuscular and intra-articular injections are reported. In two of these cases a Staphylococcus aureus sepsis developed, as a consequence of injections into the left hip joint in one and in the lateral upper quadrant of the gluteal region in the other. The intra-articular injection of triamcinolone produced severe pain, but no marked signs of purulent arthritis were seen at autopsy, probably because of the anti-inflammatory effect of the corticosteroid. A cutaneous infection was seen in the gluteal region of the other patient, but no apparent abscess formation. In another case of intra-articular injection, purulent knee joint arthritis developed after an injection of glucosaminoglycan. The patient died of renal insufficiency, which was probably connected with the treatment of the arthritis with tobramycin and cefuroxim. The fourth case was that of a mentally ill patient who suffered sudden cardiac arrest after an intramuscular injection of chlorpromazine, but with no apparent signs of an anaphylactic reaction. It is suggested that vasodilatation and drop in blood pressure caused by the chlorpromazine could have had some effect, while cardiotoxicity of other psychotropic drugs with which he had been treated cannot be ruled out.
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PMID:Fatal complications of intramuscular and intra-articular injections. 222 Jan 34

A prospective clinical trial was done to evaluate the efficacy and toxicity of cisplatin plus etoposide (VP-16) in patients with breast cancer who failed one previous chemotherapy regimen for advanced disease or relapsed within 12 months of adjuvant chemotherapy. Partial responses occurred in 11 of 44 evaluable patients (25%; 95% confidence interval (CI), 13% to 40%). The median time to disease progression in responding patients was 4 months (range, 3 to 6+ months), whereas the median time to disease progression and survival for all patients who were treated were 3 and 7 months, respectively. There was marked toxicity related to this protocol treatment including pancytopenia, gastrointestinal upset, and renal insufficiency. Two treatment-related deaths occurred; one from sepsis and one from renal failure. Thus, this regimen, as second-line chemotherapy for women with metastatic breast cancer, resulted in moderate, short-term, antitumor activity at the expense of marked toxicity.
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PMID:Evaluation of the continuous infusion of etoposide plus cisplatin in metastatic breast cancer. A collaborative North Central Cancer Treatment Group/Mayo Clinic phase II study. 229 32

A 20-year-old man presented to the emergency department (ED) with an injured right hand, fever, and a history of dog exposure. This splenectomized individual developed hypotension less than 90 minutes after arriving in the ED with normal vital signs. He later developed overwhelming sepsis, gangrene, disseminated intravascular coagulation (DIC), respiratory insufficiency, retroperitoneal hematoma, and renal insufficiency. Blood cultures grew Capnocytophaga canimorsus sp nov (formerly Dysgonic Fermenter-2). Sepsis, gangrene, and DIC are more likely to occur in asplenic individuals exposed to this organism. Many physicians use prophylactic outpatient penicillin therapy in asplenic or functionally asplenic victims of dog and cat bites. However, a brief admission or stay in an observation unit may be indicated for these high-risk individuals.
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PMID:Precipitous hypotension in the emergency department caused by Capnocytophaga canimorsus sp nov sepsis. 236 53

The mechanisms responsible for renal insufficiency in septic shock (SS) have not been well characterized. We therefore investigated renal hemodynamics and the renal excretion of prostaglandin E2 (PGE2) in a nonhuman primate model of severe, low systemic vascular resistance (SVR) SS. In 18 cynomolgus monkeys, SS was induced by an infusion of 3 x 10(10) live Escherichia coli per kg; five saline-treated animals served as nonseptic controls. Systemic and renal hemodynamics, and urine PGE2 concentrations were determined over the 3 h after the induction of sepsis. The septic group demonstrated a significant (p less than .001) and sustained depression in both mean arterial pressure and SVR. Septic animals also had significantly lower effective renal plasma flow (ERPF) (p less than .01) and glomerular filtration rate (GFR) (p less than .01) compared to controls. Furthermore, the renal hemodynamic response to SS was biphasic, with significant increases in ERPF and GFR in the second hour postsepsis, followed by a pronounced decrease in the third postseptic hour. The septic group also demonstrated an increase in the renal excretion of PGE2 (p less than .001) that was temporally associated with the transient recovery in renal hemodynamics during the second postseptic hour. These sepsis-induced renal alterations may be important in the pathogenesis of renal insufficiency complicating clinical SS.
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PMID:Renal hemodynamics and prostaglandin E2 excretion in a nonhuman primate model of septic shock. 240 7


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