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

Pseudomonas aeruginosa septicemia rarely occurs in non-immunocompromised adults. We present a case of septic shock following Pseudomonas aeruginosa pneumonia in a previously healthy 48-year-old woman. The onset was sudden, with back pain, pyrexia and shock. Chest radiographs revealed pneumonia, and Pseudomonas aeruginosa was identified from blood and sputum cultures. Therapy with dopamine, piperacillin and fluid replacement led to a prompt recovery. Laboratory tests failed to reveal any immunological deficits. Including this case, only five cases of Pseudomonas aeruginosa septicemia in patients though to be non-immunocompromised have been reported. Two remarkable features of this type of Pseudomonas infection are apparent: i) it commonly develops from pneumonia and ii) it has a better prognosis than that in immunocompromised hosts.
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PMID:Septic shock due to Pseudomonas aeruginosa in a previously healthy woman. 779 Jun 8

The fat embolism syndrome is an uncommon clinical disorder that typically occurs as a complication of severe trauma. We report the case of a 60-year-old single-lung transplant recipient who died of massive fat emboli. Before lung transplantation, the patient had been treated with corticosteroids for at least 1 year because of chronic obstructive pulmonary disease caused by centrilobular emphysema and asthmatic bronchitis. After receiving his lung transplant, he was treated with triple-drug immunosuppression, which included 25 mg of prednisone per day. He was discharged from the hospital 2 months after transplantation only to be readmitted 2 weeks later with cytomegalovirus pneumonia, from which he recovered. Concomitantly, he had new lumbar compression fractures with severe back pain and lost approximately 3 cm in height during a 3-week period. On the eleventh day after hospital readmission, he suddenly had a "sepsis-like" illness without a known infectious cause, numerous petechiae and ecchymoses, marked pulmonary edema with worsening diffuse pulmonary infiltrates, profound hypoxemia, decreased mentation, and mild thrombocytopenia. He died 3 days later. With the exception of a positive sputum culture for cytomegalovirus, all cultures were negative. The postmortem examination showed severe osteoporosis, multiple vertebral compression fractures, and widespread massive fat emboli. This is the first reported case of fat emboli as the cause of death in a lung transplant recipient, and the case suggests that the fat embolism syndrome should be considered in the differential diagnosis of a sepsis-like illness in patients who have received steroids during a long period, particularly in the setting of vertebral compression fractures.
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PMID:Fatal fat embolism syndrome after numerous vertebral body compression fractures in a lung transplant recipient. 780 19

Surgical treatment of pyogenic infections of the sacroiliac joint is indicated in cases of ineffective conservative treatment, abscess formation, septicemia, and neurological deficits. Between 1983 and 1990 in nine patients surgical treatment was performed for pyogenic sacroiliitis under this criteria. The surgical procedure included joint debridement, primary arthrodesis of the sacroiliac joint using a autologous bone graft, antibiotic therapy and postoperative immobilisation. Follow-up examination of 8 patients in average 47 months postoperatively revealed excellent functional and roentgenological results in 6 patients. Two patients suffered only from mild low-back pain, none of the eight patients demonstrated signs of a recurrent infection, one patient died due to complications of a long-lasting preoperative septicemia. Regarding these postoperative follow-up results surgical therapy including primary sacroiliac arthrodesis should be early considered, because this treatment has a low complication rate and the surgical technique is easy to perform and results are excellent or good in most of the patients.
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PMID:[Results of surgical therapy of bacterial sacroiliitis with primary arthrodesis]. 828 43

Treatment of mycotic aortic aneurysm by excision and extraanatomic bypass is difficult to apply when the infectious process involves the visceral arteries. On the basis of experimental studies in our laboratory that demonstrated prolonged antistaphylococcal activity of rifampin-bonded, gelatin-impregnated Dacron grafts after implantation in the arterial circulation, this conduit was successfully used for in situ replacement of a native aortic infection in two patients. Both patients had fever, leukocytosis, abdominal or back pain, and a computed tomographic scan that demonstrated contained rupture of a mycotic aneurysm. Preoperative computed tomography-guided aspiration and culture of periaortic fluid from one patient grew Staphylococcus aureus. Treatment consisted of prolonged (6 weeks) culture-specific parenteral antibiotic therapy, excision of involved aorta, oxychlorosene irrigation of the aortic bed, and restoration of aortic continuity by in situ prosthetic replacement. A preliminary right axillobifemoral bypass was performed in the patient who had an infection involving the suprarenal and infrarenal aorta. In both patients intraoperative culture of aorta wall recovered S. aureus. Patients were discharged at 20 and 21 days. Clinical follow-up and computed tomographic imaging of the replacement graft beyond 10 months after surgery demonstrated no signs of residual aortic infection. In the absence of gross pus and frank sepsis, the use of an antibiotic-bonded prosthetic graft with antistaphylococcal activity should be considered in patients who have arterial infections caused by S. aureus when excision and ex situ bypass are not feasible.
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PMID:In situ repair of mycotic abdominal aortic aneurysms with rifampin-bonded gelatin-impregnated Dacron grafts: a preliminary case report. 880 70

Five patients, aged between 64 and 75 years with Salmonella-infected abdominal aortic aneurysms were surgically treated between 1993 and 1995 at the National Cheng Kung University Hospital. Cultures of aneurysmal wall tissue and blood yielded Salmonella enteritidis Group B in three patients and Salmonella choleraesuis in the remaining two. All patients presented with fever and abdominal or back pain. Pulsatile masses were noted in only two patients. Infrarenal abdominal infected aneurysms were demonstrated by computed tomography and aortography in each patient. The five patients underwent aneurysmal resection with in situ graft reconstruction from 1 to 20 days after the diagnosis was made. The graft was wrapped with an omental pedicle. Duodenal repair was performed in one patient due to an aortoduodenal fistula found during surgery. He died 19 days after surgery because of duodenal leakage and uncontrolled sepsis. Four patients survived and remained well 11 to 34 months (mean, 25 mo) after surgery. Postoperatively, only one patient developed adhesion ileus and required enterolysis. Parenteral antimicrobial therapy was continued in all patients after surgery for 2 to 4 weeks; only one patient had an additional 4 months of oral antibiotics. Although the number of patients was small, the survival rate was high, at 80%. Our experience suggests that Salmonella-infected aneurysms of the abdominal aorta can be successfully treated by resection of the aneurysm with extensive debridement followed by in situ graft interposition with omentum wrapping. Once diagnosed, the patients should be scheduled for surgery as soon as possible. Antibiotics should be continued parenterally for at least 2 to 4 weeks postoperatively. While long-term suppressive antibiotic therapy is usually recommended, it might not be essential with our surgical approach.
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PMID:Surgical experience with Salmonella-infected aneurysms of the abdominal aorta. 917 Aug 22

Twelve patients with rupture of the perivisceral abdominal aorta were admitted to the UCLA Medical Center between 1984 and 1996. Six patients had atherosclerotic thoracoabdominal aneurysms (TAA) which ruptured in the visceral segment of the aorta. The remaining 6 patients proved to have ruptured mycotic aneurysm (MA). Clinical presentation was different in the two groups. Whereas all 6 patients with TAA and < 24 hr history of abdominal, chest, or back pain, patients with MA had these symptoms for 2-5 weeks (mean 3.4 weeks). History of sepsis was present in 4/6 MA and in 0/6 TAA patients. No difference in risk factors for atherosclerosis were seen between these two groups. Clinical outcomes were also different. Operation consisted of in situ vascular grafting in all patients. Operative mortality for TAA was 33% (2/6), whereas all patients with MA survived repair with no operative mortality. Two patients had cardiac arrest prior to surgery. One of these had a TAA and died 5 days after surgery, whereas the other survived repair of an MA. Follow-up ranges from 1-84 months (mean 48 months). Four survivors in the TAA group are alive at 6, 8, 14, and 84 months, with the latter having a pseudoaneurysm of the visceral patch-graft anastomosis. All 6 patients with MA are alive at 1-73 months (mean 39 months) without evidence of graft sepsis or recurrent aneurysm. We conclude that rupture of the visceral portion of the aorta is often associated with a mycotic process, with important differences noted in clinical presentation when compared to atherosclerotic TAA. Surgical intervention is effective in both MA and TAA. Operative mortality, however, is significantly higher in patients with ruptured TAA. In situ prosthetic replacement for ruptured MA is associated with low mortality and excellent long-term results.
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PMID:Rupture of the perivisceral aorta: atherosclerotic versus mycotic aneurysm. 923 87

A 59-year-old man, who manifested lower back pain, was admitted with sepsis and disseminated intravascular coagulation (DIC). A computed tomographic scan showed a slight thickening of the abdominal aortic wall. A blood examination revealed pancytopenia. Myelodysplastic syndrome was diagnosed after bone marrow aspiration and a chromosome analysis. Sepsis due to a Staphylococcus aureus infection and DIC subsided after medical treatment; however, an aortobifemoral bypass was performed upon the detection of a localized rupture of a mycotic abdominal aortic aneurysm 1 month later. The patient is still alive 2 years after operation despite the presence of a hematological disorder.
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PMID:Mycotic abdominal aortic aneurysm associated with myelodysplastic syndrome (MDS): report of a case. 959 Jul 13

Altogether 40 patients aged 13-91 y (average 58 y) with vertebral osteomyelitis were treated at the Bergen University Hospital between July 1987 and June 1997. All patients presented with back pain, 33 (83%) had vertebral tenderness, and 26 (65%) patients were febrile. The duration of symptoms before diagnosis was < 3 weeks in 13 patients, and from 3 to 16 weeks in the remaining 27 patients. C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were elevated in 39 and 38 patients, respectively. Staphylococcus aureus was the most frequent cause of osteomyelitis followed by Streptococcus spp., Escherichia coli and Mycobacterium tuberculosis. Magnetic resonance imaging was superior to other radiological methods and demonstrated changes consistent with osteomyelitis in all 23 patients examined with this method. 35 patients survived. 18/35 surviving patients had pareses and 17 underwent surgery with drainage of abscesses or laminectomy. All 35 patients made a good recovery and only 3 patients experienced permanent pareses. The diagnosis of vertebral osteomyelitis is easily missed, and treatment is often delayed, particularly in the elderly in whom signs of sepsis may not manifest. However, persisting localized pain and tenderness over the spine together with elevated CRP and ESR should prompt the physician to consider vertebral osteomyelitis. Fever and leukocytosis may support the diagnosis, but may not always be present.
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PMID:Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome. 973 Mar 1

Factors determining change in ambulatory status were studied over a 12-year observation time in 60 ambulating patients with myelomeningocele. There were 26 female and 34 male subjects with a median age of 22 years (range, 12-54). We used the method of Lindseth to define the neurologic level of the lesion and classified walking ability according to the criteria of Hoffer. The prevalence of spasticity and spine and lower-limb deformities was assessed. Orthopedic and neurosurgical interventions and other medical events were registered, as well as occurrence of pressure sores, musculoskeletal pain, and use of orthoses. There were 19 patients with downward transitions in ambulatory level during the follow-up time. Factors explaining deterioration in these 19 patients included deterioration of the neurologic level of lesion, spasticity, knee and hip flexion contractures, low-back pain, lack of motivation, as well as those of major medical events like stroke, recurrent septicemia, lower limb edema, and invasive surgical interventions.
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PMID:Ambulation in patients with myelomeningocele: a 12-year follow-up. 1008 89

Neutropenia is the dose-limiting toxicity of docetaxel in children. This Phase I trial was designed to determine the maximum tolerated dose, the dose-limiting toxicities, and the incidence and severity of other toxicities of docetaxel with filgrastim (G-CSF) support in children with refractory solid tumors. Docetaxel was administered as an i.v. infusion for 1 h every 21 days with a starting dose of 150 mg/m2 and an escalation to 185 mg/m2 and 235 mg/m2 in subsequent patient cohorts. G-CSF (5 microg/kg/day) was administered s.c., starting 48 h after docetaxel and continuing until the post-nadir neutrophil count reached 10,000/microl. Seventeen patients received 27 courses of docetaxel with G-CSF support. Generalized erythematous desquamating skin rash and myalgias were dose-limiting at 235 mg/m2. Localized and generalized rashes were seen at all of the three dose levels. Neutropenia (median nadir, 95/1microl) occurred at all of the dose levels but was brief in duration and not dose-limiting. Thrombocytopenia was minimal (median platelet count nadir, 139,000/microl), and the severity of neutropenia and thrombocytopenia did not seem to be related to the docetaxel dose. Other docetaxel-related toxicities included hemorrhage (associated with mucositis), sepsis, hypersensitivity reaction, transient elevation of liver enzymes, stomatitis, back pain, asthenia, and neuropathy. One minor response was observed in a patient with colon cancer. The maximum tolerated dose of docetaxel with G-CSF support in children is 185 mg/m2, which is 50% higher than the maximum tolerated dose of docetaxel alone in children and 85 % higher than the recommended adult dose.
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PMID:Phase I trial of docetaxel with filgrastim support in pediatric patients with refractory solid tumors: a collaborative Pediatric Oncology Branch, National Cancer Institute and Children's Cancer Group trial. 1021 6


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