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)

Endoscopic laser therapy (ELT) for palliation of cancer of the esophagus and the gastroesophageal junction was evaluated in 31 patients with far advanced disease. Initial technical success (94%) and initial improvement of symptoms (81%) were comparable to data reported previously. Complications were bleeding (6%), sepsis (6%), and tracheoesophageal fistula (6%). This analysis, however, addressed the impact of ELT on the remaining life of the patients. In 9 patients (29%) ELT was the only palliative alternative, and in 7 of these patients a fair functional success was achieved. In 13/21 (63%) of the patients with good initial functional result palliation could be preserved by repeated ELT until death from cachexia. Eight patients, however, were intubated in the follow-up period because of failure to keep the esophagus open. The dysphagia-free interval was only 4 weeks, and repeated ELT became progressively more difficult because of increased tumor load and increasing debility of the patient. 32% of the patients experienced ELT as more difficult than repeated dilations. Our data also suggest that duration of palliation after ELT alone lasts longer than palliation after dilation followed by ELT. Results of ELT were best in patients with recurrent cancer at the esophagogastric or esophagojejunal anastomosis.
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PMID:Palliative Nd:YAG laser therapy for cancer of the esophagus and gastroesophageal junction: impact on the quality of remaining life. 245 64

A case of signet cell carcinoma associated with AIDS is presented. A 50-year old Japanese man with hemophilia A was suffering from human immunodeficiency virus (HIV) infection, the result of multiple injections of clotting factor concentrates. A diagnosis of signet cell carcinoma of the stomach was reached upon endoscopic and histological examinations. Opportunistic infections of esophageal candidiasis and candida septicemia occurred. The patient died of repeated gastrointestinal bleeding and cachexia. Although there is a possibility of the patient having a coincidential carcinoma along with AIDS, the HIV infection, perhaps, had a role in causing signet cell cercinoma.
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PMID:Signet cell carcinoma of the stomach in a patient with acquired immunodeficiency syndrome: a case report. 253 9

The studies reviewed here represent but a fraction of those published in the field last year, but they serve to illustrate two important points: (1) the cytokine network possesses enormous diversity of biological function, and (2) it is redundant, such that overlapping and synergistic effects are observed between many different cytokines. The impact of this system on the host is pervasive and readily amplifiable, and integrates the diverse responses to infectious disease which may be either beneficial, protecting against infection, or deleterious, causing tissue injury and death. The example of cachectin/TNF illustrates this type of scenario: during local infection or inflammation, low levels of cachectin/TNF act to enhance immune responsiveness, stimulate blood-vessel growth, increase energy mobilization, induce the release of other cytokines, and promote wound-healing; when overwhelming infection occurs, as in septicemia, large quantities of cachectin/TNF reach the circulation and cause shock, MSOF, and death; if a persisting infection develops and cachectin/TNF is chronically secreted, it mediates a state of cachexia which may be fatal. Future studies will undoubtedly advance our understanding of these effects, and that of the other cytokines. The development of novel therapies for inflammation, septic shock, and cachexia may be based on such advances.
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PMID:Cachectin/tumor necrosis factor and other cytokines in infectious disease. 267 5

Circulating factors produced by the macrophages mediate skeletal muscle proteolysis in sepsis and trauma. This study was done to determine whether cytokines affect skeletal muscle metabolism in cancer. Using a method initially developed to measure proteolytic factors in sepsis and trauma, plasma from cachectic cancer patients, noncachectic cancer patients, and normal controls was tested for effects on normal rat skeletal muscle (soleus, extensor digitorum longus). The experimental design allows concomitant measurement of protein synthesis, by [14C]phenylalanine uptake, and protein degradation, by tyrosine release. Plasma from cancer patients caused no acceleration of protein degradation. Noncachectic cancer plasma acted synergistically with insulin to increase protein synthesis (P less than 0.05). These results indicate that a growth factor is present in the plasma of cancer patients who have not become cachexic. To our knowledge, this is the first documentation of a cancer plasma growth factor acting at the organ level to induce synthesis. Our data refute the theory that cancer cachexia is mediated by circulating proteolytic factors. In a separate experiment, purified human recombinant tumor necrosis factor (rTNF) was incubated with normal rat skeletal muscle. No changes were seen in synthesis or degradation rates. Skeletal muscle proteolysis does not appear to be directly induced by rTNF.
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PMID:Effect of cancer plasma on skeletal muscle metabolism. 268 6

Fifty-four elderly patients with thermoregulatory failure were evaluated retrospectively. The most commonly associated cause was underlying sepsis, which occurred in 78% of cases. Underlying conditions that increased the incidence of hypothermia were hypoproteinemia (50%), cachexia (30%), and neuroleptic medications (21%), most commonly thioridazine. Digoxin toxicity was a common finding (20% of all cases). One third of the patients developed hypothermia in warm months and half of them developed it while in the hospital. Patients who presented with hypothermia from out of the hospital had lower temperatures, were more bradycardic and hemoconcentrated, and died more rapidly than the in-hospital group. This could be explained by lower outside temperature or delay in diagnosis and treatment of the underlying disease. The overall mortality rate was extremely high (74%) in both groups. The mortality rate was not affected by age, sex, or degree of hypothermia. We conclude that thermo-regulatory failure in the elderly can occur in warm as well as cold environments or climates. The development of hypothermia in elderly patients should be promptly treated as sepsis unless proven otherwise, in light of the poor prognosis of this condition.
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PMID:Mortality in elderly patients with thermoregulatory failure. 274 25

The aim of our study is to analyze the clinical features and outcome of digestive surgery in the aged. From Jan. 1979 to Dec. 1981, 1,389 operations under general anesthesia were performed on patients 75 years old and more. From this group, 163 patients (111 females and 52 males, mean age: 79 +/- 0.7 years) underwent surgery of the alimentary tract. The procedures were divided in: colorectal (48%), biliary (32%), gastric (10%), small bowel (6%), esophagus (1%) and others (3%). An operation for cancer was performed in 63 patients: palliative (69%), curative (31%). The mean length of hospital stay is 23 days (pre-op 7 days, post-op 16 days). Only 16% of the patients needed intensive care. Postoperative complications occurred in 43 patients (26%); cardiovascular (47%), psychiatric (26%), pulmonary (23%) and others (4%). The overall mortality rate is 10%: 6% for elective cases and 24% for urgent cases (49 patients). The mortality is related to: sepsis and peritonitis (53%), cardiopulmonary disease (23%), hemorrhage (12%), cachexia (12%). At discharge, 62% of the patients returned home directly, 18% to convalescent homes, 10% to unknown places and 10% in nursing homes. Our data supports the benefit of surgery in the aged.
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PMID:[Geriatric digestive surgery. An analysis of 163 cases]. 281 16

Tumor necrosis factor (TNF; cachectin) has been implicated as a mediator of the toxic manifestations of overwhelming bacterial infection as well as the chronic catabolic state of cancer cachexia. We have examined the acute metabolic and hormonal response after administration of recombinant human TNF in the rat. TNF given by intraperitoneal injection produced dose- and time-related increases in hepatic amino acid uptake, decreases in serum trace metal concentrations, and a pattern of endocrine hormone alterations characteristic of the acute phase response to tissue injury. In vitro zinc transport studies by rat hepatocytes cultured in the presence of TNF alone, or in combination with recombinant human interleukin 1, another mediator of the acute phase response, demonstrated that neither monokine was capable of directly stimulating zinc transport into cells. These findings suggest that TNF may function as an endogenous mediator of the early metabolic response to sepsis and that the trace metal changes induced by TNF in vivo may occur through a secondary mechanism.
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PMID:Hormonal and metabolic response to recombinant human tumor necrosis factor in rat: in vitro and in vivo. 304 39

Thirty-four adult patients with portomesenteric venous occlusion (PVO) were reviewed. In 11 with hepatic cirrhosis, PVO was usually heralded by worsening ascites often with varix hemorrhage; mortality was high. Four with isolated portal block had varix hemorrhage without ascites. All of these patients survived despite recurrent hematemesis when portal decompression was not feasible in two patients. Eight others (5 agnogenic and 3 with hypercoagulability), experienced sudden abdominal pain with a clot typically propagated into mesenteric tributaries with ileojejunal infarction; survival was related to the promptness of operation and the extent of bowel ischemia. Of five patients with intraabdominal sepsis and pylephlebitis, only one survived. In the final six patients, PVO occurred with intraabdominal carcinoma. Five had progressive ascites, cachexia, and an early death. Imaging techniques included plain and contrast roentgenograms, ultrasonography, and for definitive diagnosis direct portography (operative or splenoportogram), indirect portography (splanchnic arteriovenogram), and computed tomography. Thirteen of 34 patients had ascites, and in nine of 11 patients examined, protein concentration of ascitic fluid was extremely low (less than 0.6 g/dl). Clinical presentation of PVO varies, depending on acuteness and extent of visceral venous blockade, severity of portal hypertension, auxiliary venous collateralization, and regional lymph flow. Inciting factors include endothelial damage and blood hypercoagulability from trauma, infection, stagnant circulation, blood dyscrasia, and malignancy. Improved imaging now allows early diagnosis.
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PMID:Protean manifestations of pylethrombosis. A review of thirty-four patients. 387 12

There are many tumors that have paraneoplastic syndromes. Furthermore, location of certain tumors can result in very specific effects on the host, especially tumors in the hypothalamus, the intestinal tract, or the liver. Finally, tumors of the immune system can have significant distant consequences. However, from direct experimental evidence, from model systems, and from the utilization of nutritional manipulation in the treatment of cancer, the data suggest very strongly that there is no unique cancer malnutrition. Early diagnosed cancer does not show malnutrition as a presenting symptom. Furthermore, all metabolic disturbances can be explained on the basis of the metabolic differences of tumor cells and normal cells and are very frequently proportional to the bulk of the tumor. The cachexia that is associated with malignancies is more likely cachexia in cancer patients than it is a specific cancer cachexia, unless the tumor burden is very large. This point was clearly made in a short review of the causes of cachexia in nearly 1500 cancer patients in Russia (145). Brennan also feels that most cases of malnutrition are uncomplicated starvation, and cancer cachexia has many features seen in major injury or sepsis (16). This distinction has great implications in the management of cancer patients.
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PMID:Nutrition and cancer: physiological interrelationships. 392 50

Glutamate decarboxylase (GAD) activity was estimated in various areas of the brain in 21 control and 26 parkinsonian subjects matched for age, postmortem delay and premortem state. Retrospective analysis of clinical data was used to define a premortem severity index (PMSI), scaled from 0 to 6, based upon a semiquantitative estimation of the duration of anoxia (0-3) and hypovolaemia (0-3). A significant correlation was found between GAD activity and PMSI in most regions of the brain. In the prefrontal cortex and caudate nucleus, GAD activity was not correlated with age, postmortem delay, sepsis, being bedridden, or with cachexia. Dosage and duration of drug treatment did not influence striatal or cortical GAD levels. In Parkinson's disease, GAD activity did not differ from controls in many brain areas except in the caudate nucleus, hippocampus and the frontal and occipital cortex. No difference in striatal and cortical GAD activity was observed when 10 control and 9 parkinsonian brains were selected for an optimal premortem state which approximated to sudden death (PMSI less than or equal to 2). GAD activity in the caudate nucleus and prefrontal cortex was not significantly influenced by the duration of L-DOPA treatment or withdrawal, disease duration, or severity of intellectual deterioration. Although the number of samples in certain brain areas was too small to allow a definitive conclusion, these results make it doubtful that GABAergic neurons are damaged in this disease.
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PMID:Brain glutamate decarboxylase in Parkinson's disease with particular reference to a premortem severity index. 400 26


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