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

The Chiba technique of percutaneous transhepatic cholangiography (PTC) can be easily learned and does not require much technical equipment; it is thus widely used now in the diagnosis of suspected obstructive jaundice. The procedure is generally regarded as safe; thus standby availability of a surgical outfit is not considered to be necessary. However fever, cholangitis, septicemia, biliary peritonitis and bleeding have been reported in patients who underwent PTC. A case report is given of a patient who had biliary peritonitis following PTC, in order to demonstrate the need for careful selection of patients undergoing this procedure. PTC should not be done in patients with coagulopathy, cholangitis and known allergic reactions against the cntrast medium to be injected. If a dilated duct can be visualized bile should be aspirated and only small amounts of contrast medium be injected. If extrahepatic biliary obstruction has been diagnosed or if the patient complains about pain after the procedure surgery should be done within 24 hours.
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PMID:[Biliary peritonitis after percutaneous transhepatic cholangiography with the Chiba technique (author's transl)]. 48 Oct 59

Before performing vasectomy, the doctor or surgeon should make sure that both husband and wife have been properly counseled as to what vasectomy is all about. Although the operation is normally thought of as minor, both patient and surgeon together should choose the proper anesthesia (general or local) to be used, especially when the patient appears apprehensive about the whole operation. Preoperative preparation should include the patient shaving his scrotum and having a good bath the night before the operation (to get rid of free hairs). Premedication with atropine and a sedative should be considered in the apprehensive patient to prevent vagal stimulation which can lead to cardiac arrest or fainting. 24 hours after the operation, the patient can be advised to return to light work, although it is advisable to take the weekend off. Often, the scrotum feels stiff and uncomfortable. Development of hematoma is the most important and commonest complication of vasectomy. If there is enlargement, the patient should be managed at the hospital; otherwise, a small swelling that is not growing is better left alone. Other possible complications include sepsis, pain and fusiform swelling where the vas was cut, and in some cases, spontaneous recanalization. With respect to reversal of vasectomy, the divided vasa can be reanastamose with or without a splint or assistance of a magnifying loupe. However, although reversal techniques are available and provide some measure of success, couples should be advised that such techniques do not guarantee full restoration of fertility.
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PMID:Vasectomy. 48 35

A cluster of three cases of staphylococcal septic endarteritis originating from percutaneously inserted brachial artery catheters for regional cancer chemotherapy prompted an epidemiologic and clinical study of bacteremic infections associated with this therapeutic modality. Nine cases were identified over a 3 1/2-year period (1.6% of all catheterizations), all caused by Staphylococcus aureus. The cluster followed discontinuation of hexachlorophene for scrub of the extremity prior to cannulation; phage-typing suggested the three cases were caused by the patients' own strains of Staphylococcus. These infections produced a distinctive clinical syndrome which facilitates implicating the catheter in the genesis of fever occurring in a patient receiving intra-arterial chemotherapy: early localized pain (89%) and hemorrhage (78%), and Osler's nodes distally (44%), later followed by local inflammation (78%), purulence (56%) and signs of systemic sepsis (100%) (each factor, p less than or equal to .005). Duration of cannulation did not influence susceptibility to infection. However, difficult cannulations or need for repositioning the catheter (p = .0096), prior radiation therapy (p = .033), leukopenia (p less than .05) and hypoalbuminemia (p less than .05) were all associated with septicemia. In the 25 months since implementation of specific control measures, there have been no further catheter-related septicemia in 310 catheterization (p less than .001). Guide-lines for prevention and management of these infections are provided.
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PMID:Septic endarteritis due to intra-arterial catheters for cancer chemotherapy. I. Evaluation of an outbreak. II. Risk factors, clinical features and management, III. Guidelines for prevention. 49 11

Utilizing a semiquantitative technique for culturing vascular catheters, we prospectively studied the risk and profile of infection caused by arterial catheters used for hemodynamic monitoring in 95 patients with a high risk of nosocomial infection. Of 130 catheters, 23 (18 per cent) produced local infection (larger than or equal to 15 colonies on semi-quantitative culture) and five septicemia (4 per cent). Sixteen of the 23 local infections and all septicemias occurred with catheter placements exceeding four days (p less than 0.001). Other factors associated with an increased risk of infection included insertion by surgical cut-down rather than percutaneously (ninefold increased rate of bacteremia, p = 0.008) and the presence of local inflammation (12-fold increase, p = 0.009). Systemic antimicrobial therapy (given to 80 per cent of the entire group and to four of the five with septicemia) did not protect against catheter-related infection but may account for the predominance of enterococci, Candida and gram-negative bacilli in these infections. Twelve per cent of all nosocomial bacteremias occurring in this critical care unit population originated from an arterial catheter. Indwelling arterial catheters pose a significant risk of bacteremic infection to ctirically ill patients. The percutaneous mode of placement is preferred; when prolonged arterial cannulation is required, the site should be rotated every four days. Local pain or inflammation, or clinical signs of sepsis without an obvious source should prompt removal and culture of the catheter.
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PMID:Infections caused by aterial catheters used for hemodynamic monitoring. 50 85

The charts of 68 patients from 65 to 99 years of age who underwent appendectomy for appendicitis were reviewed between 1964 and 1976. Thirty-three were men and 35 women. All patients underwent appendectomy. Four patients had normal appendices. The remainder had appendicitis; 74% were ruptured. The duration of symptoms varied greatly, and was related to outcome. The mean duration was 58 hours, but both those who died and those who suffered complications had significantly longer mean duration while those who had an uncomplicated course had a shorter mean duration of symptoms. The incidence of rupture rose from 60% in those seen with symptoms less than 48 hours to 90% in those with symptoms longer than 49 hours. Delay was invariably related to delay in seeking medical treatment. In no case was the patient under the care of another physician for an extended period of time. Pain was the chief complaint in 63 patients, and was present in all. Seventy-four per cent had fever and 78% had leukocytosis. Those with normal appendices had normal white blood cell counts. Right lower quadrant tenderness was present in 80%. Thirty-nine per cent had significant additional medical problems. Most (73%) had operation within six hours of their original evaluation, and yet the overall complication rate was 34% including six deaths. Delay during evaluation did not correlate with unsatisfactory outcome as did delay in seeking medical attention. The most common complications were due to infection. In at least three of the deaths wound infection was associated with sepsis and death. Delay in seeking medical care, advanced age, and underlying problems were the most significant factors in those who died.
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PMID:Appendicitis in the elderly. 64 78

Fulminant pneumococcal infections are rare in teen-agers with sickle cell anemia. A 16-year-old black male with sickle cell anemia was treated as an outpatient for cryptogenic pain crisis, which delayed antibiotic therapy for primary pneumococcal septicemia for seven hours. This patient did not appear ill upon initial presentation but rapidly developed disseminated intravascular coagulation and died.
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PMID:Concurrent primary pneumococcemia, disseminated intravascular coagulation, and sickle cell anemia. 66 36

Patients requiring a major amputation for ischemia are frequently gravely ill. Physiologic amputation obtained by freezing the leg, usually with a tourniquet, will permit delay and intensive preoperative therapy. In an efficient, safe, and convenient method which we have developed and used in 46 patients, a pump circulates antifreeze solution through a specially constructed boot. The last 32 patients so treated have been analyzed as to indications and results. Advantages obtained control of sepsis, correction of diabetic coma, dialysis for chronic renal failure, improvement in congestive heart failure, and improvement in pulmonary function. Four patients had successful below-knee amputations after control of infection that had previously seemed to dictate above-knee amputation. The control of pain and odor, the resultant appreciation of the family, and the lessened demand on nursing staff offer worthwhile benefits in many of the patients, even in some in whom advanced systemic disease prevented survival.
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PMID:Freezing an extremity in preparation for amputation. 68 74

In its early stages necrotizing fasciitis may mimic an uncomplicated cellulitis, with erythema and only mild swelling and minimal pain. The combination of physical findings in a patient with a current history of drug addiction should arouse suspicion of an underlying fasciitis. An aggressive diagnostic approach including incisional biopsy, visual inspection of the underlying subcutaneous tissue, fasica and muscle, along with a Gram stain is suggested. Extensive and frequent debridement, appropriate antibiotics and physical therapy remain the essentials of treatment. A patient is discussed in whom a delay in diagnosis lead to near-fatal sepsis.
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PMID:Necrotizing fasciitis in narcotic addicts. 77 30

Skin allografts and xenografts are routinely used as dressings to control infection, pain and fluid loss from the burn wound. The procedure for preparing and storing grafts will be reviewed and suggested indications for use will be considered. A method for preparing porcine xenograft will be discussed in some detail. Skin banking by low temperature preservation including conditions and processing necessary for obtaining viable grafts will be discussed. The use of tissue typing matching procedures for obtaining prolonged survival will be considered. Possible harmful effects of grafts will be reviewed. The use of blood and blood products for resuscitation of burn patients is of primary importance in burn patients. The literature will be reviewed concerning a variety of blood and blood products including a consideration of washed cells, single donoplasma, serum albumin and purified blood components for treatment of burned patients. The use and indications for hyper-immune serum and gammu-globulin will be considered. Coagulopathy syndromes, burn wound sepsis, and support of immunologically deficient patients will be discussed on the basis of current literature.
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PMID:Burn wounds: selection and preservation of skin, natural products, blood, and blood products for burn therapy. 82 97

30 patients with different infections were treated with fosfomycin: 13 had urinary infections, 14 had pneumonial infections, 2 had staphylococcus osteomyelitis and 1 had staphylococcus septicemia. The antibiotic was administered in doses ranging from 100 to 230 mg/kg/day, with periods of treatment that lasted from 5 to 58 days. The doses were administered every 6 h by the oral or intramuscular route. A total of 35 organisms were isolated: 7 E. coli, 7beta-hemolitic Streptococcus, 6 Proteus sp., 6 S. aureus, 6 S. viridans, 2 Klebsiella sp. and 1 negative coagulase S. aureus. All were sensitive to fosfomycin in vitro, as was revealed by the diffusion in discs method. The therapeutic results were good in 29 of the 30 cases (96.7%). There were no important side effects. A patient complained of a local pain in the area of the injection. The transaminases increased temporarily in 2 patients. One patient had a moderate eosinophilia while under treatment.
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PMID:Activity of fosfomycin in the treatment of bacterial infections. 83 37


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