Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
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The authors have developed a simplified technique of lumbar subarachnoid peritoneal shunt in which the spinal tube is easily introduced through a puncture needle without doing a laminectomy. Seventeen cases of communicating hydrocephalus of various orgin have been treated by this procedure. In this paper, we reported our shunting system and the technique of precedures, and discussed the clinical results and some advantages of this method. The spinal tube is a custom made Silastic tube with small side holes 2 mm apart from each other at slanting tip located within the first 1.0 cm of the end. French No. 5 tube is available for older children and for adults, and French No. 3.6 tube for infants. Total length of the tube measures 30 cm with 4 black markers at 5 cm intervals from the tip for assisting in positioning. The puncture needle is a modified Touhey needle. Two needles different in size are prepared according to the size of the tube. Outer diameter of these needles is 2.1 mn & 1.8 mn. Our operative procedures are divided into following three steps. 1) Puncture of the lumbar subarachnoid space and insertion of the spinal tube through the needle. 2) Introduction and placement of the peritoneal tube into some point of the peritoneal cavity. Concerning to this point, we have the three candidates, namely into the Douglas pouch, the suprahepatic space, and the bursa omental cavity. 3) Connection of the spinal tube and the peritoneal catheter end. We used a kind of flushing device only in some exceptional cases, and recently, we feel that it is not so necessary for this shunting. We have employed this technique in a total of 17 cases. Eleven cases of them are adults and the other 6 cases are children less than 2 years of age. Postoperative follow up period varied from 13 months to 1 month, and all the cases except two had good result, suggesting the shunt system is working well with no evidence of complications such as low pressure syndrome or radicular irritation. Some troubles occurred in two children. One was a disconnection between the spinal and the peritoneal tube, and the other was an obstruction at the peritoneal tube end. The authors believe that our L-P shunt has several advantages as listed below, 1)Procedure is very simple, in other words, there is no need of laminectomy. 2) The entire system is short. 3) No need to pass the catheter into the brain tissue. 4) Obstruction of the spinal catheter end is very unusual. 5) Alteration of communicating hydrocepalus into non communicating one by secondary obstruction of aqueduct of Sylvius is less likely with this shunting system. 6) Siphon effect might be minimal, if present. 7) As compared to V-A shunt, severe complication like septicemia will not occur in the L-P shunt. With this simple method and good material, we hope that this L-P shunt is employed more widely for the patients with communicating hydrocephalus.
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PMID:[Simplfied technique of lumbar subarachnoid-peritoneal shunt (author's transl)]. 55 43

Although the incidence of 1 year kidney graft survival has been on a plateau for the past 7 or 8 years, the likelihood of recipient survival has increased. These observations reflect the limits of our current nonspecific immunosuppressive techniques and the acquisition of knowledge about when to discontinue their use and allow rejection of the kidney rather than death from sepsis. Yet, there are many leads from the laboratory which, when applied clinically in the next few years, should allow safe kidney transplantation to become a routine clinical event. Among these are safer, more effective antilymphocyte preparations; precise indications for splenectomy; accurate identification of presensitized states in potential recipients; methods of reducing the immunogenicity of grafts by removing donor passenger leukocytes or flushing the kidney with substances that alter surface antigens; and possibly new classes of chemical immunosuppressive drugs. In addition, it is likely that techniques will evolve for selective suppression of the immune response to donor antigens. This will be achieved by using cytotoxic agents coupled to donor antigen to destroy specific antigen recognition lymphocytes. Other forms of noncytotoxic donor antigen and antibody with or without ALS will be used to manipulate the recipient's immune response prior to and after transplantation. These manipulations will leave intact most of the potential for immune response to antigens other than those introduced with the graft. Together, these manipulations and their effect in experimental animals have been called immunologic enhancement. Intentional enhancement in man by means of antigen treatment or passive immunization has just barely begun. Clinical trials will be difficult and, initially at least, they will be confined to only a few transplantation centers. Yet, the "antigen pretreatment" of natural pregnancy, blood transfusion, prior unsuccessful organ transplantation, and bacterial infection have at times inadvertently conditioned a potential host so as to allow enhancement of a subsequent graft. It is likely that much can be done with current clinical assays of cellular and humoral immunity to detect those patients who are already conditioned to enhance a subsequent graft.
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PMID:New approaches to immunosuppression in renal transplantation. 79 Jul 32

An implantable drug delivery system will play an important role for patients who need chemotherapy or prolonged total parenteral nutrition in the future. We implanted 72 injection capsules in 74 patients who were undergoing aggressive chemotherapy or total parenteral nutrition programs. These capsules were implanted in different positions, including central access in 67 cases, peritoneal cavity in 1, hepatic artery in 2, portal vein in 1 and intrathecal space in 1. The actual median functional survival of the injection capsules was 12.3 months (range, 2 months to 4 years). The total cumulative puncture numbers were 1651 (range, 5 to 153; median 23). There was no unsuccessful instance in infusion or injection. To date, 27 patients still survive. The complication rate was about 7% including 1 sepsis, 1 skin infection, 1 catheter thrombosis, 1 dislodgement of reservoir and 1 catheter-reservoir disengagement, which were all corrected by a secondary operation without mortality. Patency of the Port-A-Cath system was maintained using a regular flushing schedule once every 30 days. The results of this study suggest that the implantable drug delivery system can provide a safe and reliable method for venous access or even arterious access in patients requiring intermittent or prolonged intravenous therapy.
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PMID:Seventy-two patients' experience with an implantable drug delivery system for chemotherapy or total parenteral nutrition. 131 6

Intraarterial access is used to provide continuous monitoring of systemic arterial blood pressure and to provide access to sample arterial blood. The use of chronic indwelling arterial catheters became commonplace in the 1970s and was rapidly adapted to the care of infants and children. The placement of intraarterial catheters can be technically challenging for even the most experienced surgeon, especially in small infants. Arterial catheters can directly injure vessels, resulting in thrombosis or occlusion. Distal embolization or ischemia can also occur. Catheter flushing may cause retrograde flow with the potential for embolization at remote sites. Local insertion site complications, such as hematoma, hemorrhage, and infection, can occur. Arterial catheters can also be a source of systemic sepsis. Although the risks and complication rates are low, the potential for devastating injury exists and deserves the greatest respect whenever placement of an arterial catheter is contemplated.
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PMID:Arterial access in infants and children. 134 85

Although catheter-related sepsis (CRS) is an important cause of nosocomial infection and the major complication of intravenous catheter use, there is, as yet, no consensus concerning either a useful definition of CRS or the optimal method of catheter management and prevention of infection. Semiquantitative culture of catheter tips is a useful method of diagnosis of CRS but other techniques such as quantitative catheter blood cultures and Gram staining of the catheter have roles in selected patients. The most significant impact on the prevention of CRS is made by the introduction of an intravenous therapy team. The site and method of catheter insertion, type of dressing and antisepsis, catheter flushing and use of prophylactic antibiotics are also important issues. Techniques such as guide-wire exchange and catheters such as triple lumen and total implantable venous access devices have their own infection problems. Many new and interesting approaches to the prevention of CRS are being formulated. To facilitate further progress, a standardized definition for diagnosis, and revised recommendations for prevention of CRS would be helpful.
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PMID:Vascular catheter-related sepsis: diagnosis and prevention. 135 51

We used a pulsed tunable dye laser (operating at 60 mJ per pulse, 504-nm wavelength) to fragment large (0.8-4.5 cm) stones retained in the hepatic ducts or common bile duct in 12 patients after cholecystectomy. Attempts to extract stones via a T-tube or endoscope had been unsuccessful in all patients. In nine of 12 patients, all stone fragments were successfully eliminated during the initial treatment. In one patient, fragmentation occurred but debris remained, requiring endoscopic stenting. Pseudomonas sepsis developed in this patient 30 days after the procedure and was treated by extraction of the stone fragments. Fragments remaining after lithotripsy were cleared at the same sitting by using saline flushing or endoscopic or percutaneous basket extraction. In two of 12 patients, the treatment was unsuccessful because of laser malfunction. The treatment was performed without complications, except for clinically insignificant hyperamylasemia, which occurred in two patients. Our experience suggests that laser lithotripsy offers a safe alternative for nonsurgical treatment of large retained biliary stones for patients in whom traditional treatments have failed.
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PMID:Treatment of bile duct stones by laser lithotripsy: results in 12 patients. 134 1

Bacteria can invade the biliary tract by ascending from the duodenum and via the hematogenous route from the hepatic portal venous blood. The sphincter of Oddi, situated at the junction of the biliary tract and the upper gastrointestinal tract, forms an effective mechanical barrier to duodenal reflex and ascending bacterial infection. Conversely, Kupffer cells and the tight junctions between hepatocytes help prevent bacteria and toxic metabolites from entering the hepatobiliary system from the portal circulation. The continuous flushing action of bile and the bacteriostatic effects of bile salts keeps the biliary tract sterile under normal conditions. Secretory immunoglobulin A (sIgA), the predominant immunoglobulin in the bile, and mucus excreted by the biliary epithelium probably function as antiadherence factors, preventing microbial colonization. When barrier mechanisms break down, as in surgical or endoscopic sphincterotomy and with insertion of biliary stents, pathogenic bacteria enter the biliary system at high concentrations and take up residence on any foreign bodies. Intrabiliary pressure is a key factor in the development of cholangitis. Chronic biliary obstruction raises the intrabiliary pressure. This adversely influences the defensive mechanisms such as the tight junctions, Kupffer cell functions, bile flow, and sIgA production in the system, resulting in a higher incidence of septicemia and endotoxemia in these patients. Knowledge of biliary defense against infection is still quite primitive. Unclear are the roles of sIgA in the bile, mechanism of bacterial adhesion to the biliary epithelium, Kupffer cell function in biliary obstruction, and the antimicrobial activity of bile salts.
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PMID:Defense system in the biliary tract against bacterial infection. 156 8

Because of the difficulty in maintaining vascular access in patients receiving aggressive parenteral chemotherapy, a growing number of patients have had implantation of either percutaneous or subcutaneous devices allowing permanent intravenous access. In our study, between July 1980 and July 1985, 110 patients had placement of a Broviac catheter, while 100 patients had placement of a subcutaneous device via a subclavian venous approach. Both groups of patients were identical regarding age, primary malignancy, chemotherapy, and nutritional status. Catheter-related sepsis occurred in 15% and thrombotic occlusion in 22% of those patients with Broviac catheters, compared with 3% and 1%, respectively, in patients having subcutaneous reservoirs. Although the initial cost of the subcutaneous reservoir is greater, overall cost of maintenance of the percutaneous catheter far exceeds that of the reservoir because of the need for daily catheter care and heparin flushing of the Broviac device, which is unnecessary for the subcutaneous port. Our experience favors the use of the subcutaneous reservoir in patients receiving prolonged chemotherapy.
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PMID:Comparison of a totally implantable access device for chemotherapy (Port-A-Cath) and long-term percutaneous catheterization (Broviac). 336 8

Reproductive care of women with spinal cord damage demands knowledge of such women's reproductive potential and the specific complications to which these women are prone during pregnancy and childbirth, especially autonomic hyperreflexia. Fertility in cord-damaged women of reproductive age is generally undiminished as are libido, ability to have intercourse, and ability to bear children. Frequent complications of cord-damaged pregnant women include urinary tract infection, anemia, pressure sores, sepsis, unattended birth, and autonomic hyperreflexia. Autonomic hyperreflexia or autonomic dysreflexia occurs during labor in up to two thirds of women with cord lesions above T-6. Autonomic hyperreflexia results from noxious stimuli including distention of the bladder, cervix, or rectum, which evokes mass triggering of sympathetic and parasympathetic afferents that are uninhibited by supraspinal centers below the cord lesion. Autonomic hyperreflexia manifests itself with sudden onset of marked hypertension and headache during uterine contractions, as well as bradycardia or tachycardia, various cardiac dysrhythmias, and marked diaphoresis with piloerection and flushing above the level of the cord lesion. We describe the second reported occurrence of intraventricular hemorrhage due to autonomic hyperreflexia during labor and detail recommendations for anticipating and mitigating this potentially lethal complication of parturition in cord-damaged women. Pregnancy and parturition are best carried out with informed cooperation of the patient and of obstetric, cord rehabilitation, anesthetic, and nursing personnel.
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PMID:Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor. 397 Jan 1

Portal vein thrombosis is often considered a contraindication to orthotopic liver transplantation. We have analyzed the incidence, risk factors, management and outcome of patients with portal vein thrombosis undergoing orthotopic liver transplantation. During the period from October 1988 to October 1992 140 grafts were performed on 132 patients. Fourteen had portal vein thrombosis with either partial (n = 7) or complete (n = 7) occlusion of the portal vein at surgery. Portal vein thrombosis was more common in patients with autoimmune chronic active hepatitis (3/5 vs. 11/127, chi 2 = 13.3, P < 0.001), cryptogenic cirrhosis (4/12 vs. 10/120, chi 2 = 7.2, P < 0.01), or those with tumors (6/22 vs. 10/110, chi 2 = 5.7, P < 0.05). In 13 of the 14 portal inflow was reestablished by flushing, balloon thrombectomy, or passage of a graduated dilator. In one patient complete fibrous obliteration necessitated a portal vein to right gastroepiploic vein anastomosis. On follow-up there have been 6 deaths in this group (6/14 = 43%) from recurrent cancer (n = 1), sepsis (n = 4), and cardiac and renal failure (n = 1). Four of these 6 patients had confirmation of PV patency on imaging. The remaining 8 patients are alive and well (median follow-up 37 months, range 6-53 months). Post-transplant portal vein thrombosis occurred in 3 of the 14 patients (21%) with a portal vein abnormality at surgery and in two of the 118 patients with a normal portal vein (3/14 vs. 2/118, chi 2 = 8.5, P < 0.01). Four of the 5 cases were successfully treated by surgical thrombectomy.
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PMID:Incidence, risk factors, management, and outcome of portal vein abnormalities at orthotopic liver transplantation. 817 42


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