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

Severe sepsis is characterized by increased oxygen demand, alteration of oxygen extraction, and a diminution of myocardial contractility. The importance of each of these three factors is directly related to the severity of the sepsis. The combination of these factors may lead to tissue hypoxia, which is the shortest route to development of multiple organ failure (MOF). The presence of tissue hypoxia should be suspected in the presence of lactic acidosis. The phenomenon of dependence on oxygen consumption (VO2) in relation to oxygen transport (DO2) is detectable where there is a rise in DO2 induced by perfusion of liquids or administration of vasoactive agents. Study of the relationship between cardiac flow and oxygen extraction is a simple means of studying the relations between VO2 and DO2 at the patient's bedside.
 ...
PMID:[Septic syndrome: cardiocirculatory assessment]. 160 82

Severe sepsis leads to depression of the reticuloendothelial (RE) system with delayed bloodstream clearance of particulate matter and bacteria. Fibronectin may be an important opsonin of the RE system and low fibronectin levels often accompany severe sepsis in man. We have investigated the effect of prolonged intra-abdominal sepsis on plasma fibronectin concentrations and RE function. Serial plasma fibronectin concentrations were determined in rabbits for 2 weeks after either the induction of sepsis (appendix abscess) (n = 6) or laparotomy only (n = 6). RE function was measured at 2 weeks by determining the clearance kinetics and organ distribution of low dose technetium tin colloid (TTC). There was an early transient depression in plasma fibronectin values followed by elevated concentrations at 48-72 h which were more marked in the sepsis group. There was a delay in the blood clearance with reduced hepatic and increased bone uptake of TTC. We conclude that depletion of opsonic fibronectin is unlikely to be an important factor contributing to the impairment of RE function associated with intra-abdominal sepsis and that RE depression in septic animals is due to intrinsic Kupffer cell dysfunction.
 ...
PMID:Reticuloendothelial failure in chronic intra-abdominal sepsis: the role of opsonic fibronectin. 270 51

In Norway a hyperendemic situation has persisted since 1974 as regards meningococcal disease, with an adjusted annual incidence of almost 10 per 100,000 inhabitants. 80% of the cases are caused by group B meningococci, and the lethality has been about 10%. This article summarises the new Norwegian guidelines for the diagnosis and management of systemic meningococcal disease. Clinical signs and symptoms are described, together with criteria for the classification of cases into four main categories: I Distinct meningitis; II Severe sepsis; III Simultaneous distinct meningitis and severe sepsis; IV Milder septicaemia and/or meningitis. This type of classification is useful when choosing treatment, and for prediction and evaluation of the outcome. Hospital departments should establish appropriate routines for the management of such life-threatening infections. In cases of suspected meningococcal disease, antibiotic treatment should be started within 15 minutes of admission. Initially, benzylpenicillin and chloramphenicol are recommended, to cover haemophilus infection as well. When the diagnosis has been confirmed chloramphenicol may be discontinued. Laboratory specimens are highly desirable, but sampling procedures should not delay start of treatment. As a main rule patients with meningitis should have a spinal puncture. In severe septicaemia, antibiotic treatment and management of shock are given priority. All patients should be closely monitored. The condition of the patient may deteriorate rapidly. Detailed advice is given on laboratory tests and patient monitoring, and also on the management of septic shock, adult respiratory distress syndrome (ARDS), brain edema, renal failure and coagulation disturbances (DIC).
 ...
PMID:[Guidelines for the diagnosis and treatment of meningococcal disease at hospitals]. 274 27

Severe sepsis leads to depression of the reticulo-endothelial system (RES) with delayed bloodstream clearance of particulate matter and bacteria. Splenectomy results in increased susceptibility to infection with encapsulated organisms but its effect on the resistance to postoperative Gram-negative infection has been little studied. We have investigated the effect of splenectomy on RES function by measurement of plasma fibronectin concentrations and bacterial clearance in the presence and absence of sepsis. In experiment 1, rabbits underwent splenectomy (n = 8) or laparotomy only (n = 8) 4 weeks before a second laparotomy. In experiment 2, animals had either splenectomy (n = 8) or laparotomy only (n = 8) followed 4 weeks later by devascularization of the appendix (sepsis). Plasma fibronectin concentrations and the blood clearance and organ distribution of an intravenous injection of 75Se-labelled viable Escherichia coli (2-3 X 10(8) colony forming units (c.f.u.] were measured 24 h after the second operation. Splenectomy resulted in: (1) a persistent reduction in plasma fibronectin concentration in the presence and absence of sepsis, and (2) a delay in the bloodstream clearance with reduced hepatic (Kupffer cell) uptake of E. coli which was exaggerated in the septic splenectomized animal. It is concluded that the spleen may be important for Gram-negative bacterial clearance, possibly related to its influence on plasma fibronectin concentration and Kupffer cell function.
 ...
PMID:Effect of splenectomy on gram-negative bacterial clearance in the presence and absence of sepsis. 328 88

Prostacyclin and thromboxane A2 have been implicated as mediators of septic shock. Correlations between the human prostanoid response to sepsis and experimental paradigms are poorly understood. The purpose of this study was to compare changes in plasma levels of prostaglandin 6-keto-F1 alpha (PGI) and thromboxane B2 (TxB) during septic shock in Sprague-Dawley rats, domestic pigs, mongrel dogs, and man. Severe sepsis followed by septic shock (systolic BP less than 90 mmHg) was induced in rats by inoculation of 1.0 X 10(9) Aeromonas hydrophila, in pigs by graded IV infusion of 1.0 X 10(9)/ml A. hydrophila; and in dogs by an IV bolus injection of 5.0 X 10(9)/ml Escherichia coli. Plasma PGI and TxB (pg/ml) were measured by radioimmunoassay in control, septic, and septic shock experimental blood samples, and in normal controls, severly septic, and septic shock (systolic BP less than 90 mmHg) S.I.C.U. patients. Control, septic, and septic shock TxB levels in the dog and the pig were significantly greater than in the rat and man. PGI levels in the dog were significantly greater than in other species. TxB increased significantly in murine sepsis and PGI increased significantly in sepsis and septic shock. TxB increased during porcine sepsis and septic shock. In man, both PGI and TxB were significantly increased in severe sepsis, compared to normal controls, but only PGI was significantly higher in septic shock versus normotensive sepsis. Patterns of change in TxB/PGI ratios were similar for all species studied. Changes in PGI in the porcine septic experiments most closely paralleled those observed clinically.
 ...
PMID:Prostacyclin and thromboxane A2 in septic shock: species differences. 353 88

Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Prophylactic use of cefotaxime in colonic and rectal surgery. 609 48

Fluid therapy in the critically ill patient must be adjusted to accommodate continuing changes in the plasma volume, interstitial space, and intracellular space. During and after hemorrhagic shock, replacement of crystalloid is needed to replenish the plasma and interstitial spaces during operation and then interstitial and intracellular spaces after operation. Severe sepsis leads to a more pronounced expansion of the interstitial space than that of hemorrhagic shock. Continuing therapy after both hemorrhage and sepsis should be directed toward maintaining effective plasma volume and levels of hemoglobin while the interstitial and intracellular spaces return to normal. Concomitantly, effective circulatory volume must be guided by continuing changes in cardiac, pulmonary, and renal function.
 ...
PMID:The fluid problem in the critically ill. 634 78

It is widely assumed that infections are the principal cause and primary outcome determinant of the syndrome of Multiple Organ Failure (MOF) in critically ill patients. Infections are frequent in these patients, but the prevention and treatment of infections may not influence the course of MOF. This study tested the hypothesis that infections play a decisive role in the outcome of MOF. Data were gathered concurrently on all adult patients admitted over an 18-month period to a non-cardiac surgical ICU at a university hospital and recorded in a computer database. Sepsis was defined as a state characterized by at least three of the following: fever, tachycardia, leukocytosis or leukopenia, increased cardiac index, reduced systemic vascular resistance, and hypercatabolism manifested by nitrogen-wasting. The presence of an infection was not required for the diagnosis of sepsis. Mild sepsis was defined as the presence of three or four parameters. Severe sepsis was defined as the presence of five or six parameters. MOF was defined as the development of dysfunction of at least two of the following major organ systems: cardiac, gut, pulmonary, renal, cerebral, and hepatic. Of 749 admissions, 73 patients developed MOF. Thirty four (47%) had a documented source of infection, 37 (51%) had positive blood cultures, and all had sepsis. Hospital mortality was 66 percent (48 of 73 patients). Death could not be predicted by bacteremia (P > 0.25), nor by the presence of an infectious source (P = 1.0), but was strongly associated with severe sepsis (P < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:The role of infection in outcome of Multiple Organ Failure. 823 94

In severe infections two factors play a part: the infectious agent and the response of the host. The response of the host involves production of a large number of endogenous mediators including a number of cytokines that are currently the focus of many studies: tumor necrosis factor (TNF alpha), interleukins (IL-1 and IL-6), and interferon gamma (IGN gamma). These cytokines are part of the body's normal defense mechanisms but can have toxic effects when produced in excessive amounts. Although levels of these cytokines are often high in the blood of patients with sepsis, persistence of these elevations is the main indicator of severe infection. Experimentally, injections of TNF alpha and IL-1 reproduce the manifestations of severe sepsis. Mice that are genetically unable to produce TNF alpha are resistant to the injection of endotoxin. Severe sepsis can be prevented by pretreatment of animals with anticytokine agents (polyclonal and monoclonal antibodies and anti-receptor agents ...). Many issues remain unresolved: for instance, the experimental results obtained with an intravenous bolus of endotoxin or bacteria have not been confirmed in some animal models of subacute infection. These models may more closely resemble human infections. The interrelations between these cytokines are extremely complex. Synergistic effects do occur, but the effects of combinations of cytokines can be different from those of each cytokine given alone... It follows that therapeutic use in humans of anti-cytokine molecules is still an approach of uncertain outcome that will perhaps be clarified by ongoing multicenter clinical trials.
 ...
PMID:[Cytokines and severe infections]. 830 25

Sepsis is the systemic response to severe infection in critically ill patients. Sepsis, sepsis syndrome, and septic shock represent the increasingly severe stages of the same disease. Severe sepsis and septic shock occur in persons with preexisting illness or trauma. If sepsis is not diagnosed and treated early, it can become self-perpetuating, and elderly persons, in particular, are at a greater risk of death from sepsis.
 ...
PMID:The sepsis syndrome. Definition and general approach to management. 879 59


1 2 3 4 5 6 7 8 9 10 Next >>