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)

A 63-year-old white woman was admitted to the hospital for bilateral total knee arthroplasty. She was given prophylactic subcutaneous heparin therapy postoperatively. Three days later, she had a brief hypotensive episode and an unexplained drop in hemoglobin level. Seven days postoperatively, she became confused and disoriented while complaining of pain in her right side and, later, under her left breast. She also had nausea, vomiting, anorexia, and a vague feeling of "illness." Her condition deteriorated progressively, with blood pressure falling to 65/40 mm Hg and a temperature of 39.7 degrees C. Blood, urine, and cerebrospinal-fluid culture samples showed no evidence of infection. A diagnosis of acute adrenal insufficiency was made. Following corticosteroid therapy, the patient's condition improved markedly. Of interest in our patient was that she had had no antecedent hypotension, sepsis, fever, or surgical complications. Acute adrenal hemorrhage is often overlooked because the symptoms are attributed to other conditions, especially to sepsis. Acute adrenal hemorrhage should be suspected in any stressed patient in whom an abrupt deterioration associated with back or abdominal pain, hypotension, and unexplained fever are noted. Suspicion should be raised regarding those patients who are receiving anticoagulant therapy (including subcutaneous heparin prophylaxis) at the time of deterioration. With increased awareness, more cases of acute bilateral adrenal hemorrhage and subsequent adrenal insufficiency can be recognized ante mortem and treated.
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PMID:Prophylactic subcutaneous heparin therapy as a cause of bilateral adrenal hemorrhage. 155 45

Advances in the imaging of peritoneal pathology are reviewed. Papers published in the past year in the radiologic, surgical, and pediatric literature discussed the detection, quantification, characterization, and management of fluid collections in the trauma patient or the patient with intra-abdominal sepsis; the assessment of various imaging modalities in the evaluation of unexplained fever or pain; and the detection, characterization, and localization of primary, recurrent, or metastatic abdominal neoplasms.
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PMID:Imaging of peritoneal pathology. 158 Nov 27

Upon admission to Box Hill Hospital in Victoria, Australia, a 38-year old woman was pale and febrile (328.6 degrees Celsius) and had a pulse of 88 beats/minute. She had had midabdominal pain for 1 week and severe lower abdominal pain for 2 days. Her menses were heavy. Other than pain during examination, rectal and vaginal examinations were normal. She had considerable neutrophilia (leukocyte count = 21.2 x 1 billion). The X-ray revealed free fluid. Ultrasonography indicated an IUD which she had had for 10 years, a mass with small cystic areas near the right ovary, and fluid in the rectouterine pouch. The physicians suspected peritonitis and administered iv broad spectrum antibiotics (1 mg ampicillin, 80 mg gentamicin, and 500 mg metronidazole) every 8 hours. They did a laparotomy. An abscess containing much green pus, the necrotic right ovary, and the appendix, which appeared normal and later shown not to be infected, occupied the right iliac fossa. The tubes were fine. The surgeons removed the appendix and right ovary. They washed out the abdomen with saline and inserted a drain to the right iliac fossa. The woman improved immediately so the physicians stopped antibiotics 3 days after surgery. Histological tests revealed actinomycosis caused by fast-growing aerobic bacteria which is known to cause necrosis, fibrosis, and suppuration. During recovery, the physicians removed the IUD and performed dilation and curettage. Actinomyces normally just dwell in the mouth and intestines, but, in this case, probably migrated up the IUD tail after spreading from the bowel to the perineum to the vagina. The physicians suspected that the presence of Mycoplasma hominis provided the mucosal breach needed to permit actinomyces' invasion. Physicians should consider actinomycosis in acute abdominal sepsis cases with a longterm use of an IUD. They can treat it with antibiotics since Actinomyces tend to be sensitive to broad spectrum antibiotics.
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PMID:Ovarian actinomycosis presenting as acute peritonitis. 158 8

Two hundred and seventy-six hospitalized patients with severe infection (complicated UTI, pneumonia, skin and soft tissue infection or septicaemia) were randomly allocated to receive either 1g or 2g cefpirome bd. Two hundred and seventy-four patients were evaluable for tolerance, 210 for bacteriological efficacy. The two groups were similar in terms of underlying disease, age, sex, and general condition on admission. The overall clinical and bacteriological response rates were 97/103 (94%) and 68/76 (90%) respectively in the 1g group, compared with 102/107 (95%) and 67/71 (94%) in the 2g group. There was no significant difference between the treatment groups. Eighteen adverse events, possibly or probably drug related, were reported (7 in the 1g group, 11 in the 2g group). This resulted in discontinuation of therapy in four cases (two in each group). Fourteen of the adverse events were local (five receiving 1g, nine receiving 2g), mainly phlebitis or pain at the injection site. Thirteen patients died during the study period (up to 14 days after the last dose) but in no case was death attributed to cefpirome. A review of routine laboratory parameters revealed no abnormalities which could definitely be attributed to cefpirome although in four cases a relationship was considered possible; these included two increases in serum creatinine, one increase in SGPT, and one episode of neutropenia. Cefpirome administered as 1 or 2g twice daily was a well tolerated, effective agent for the treatment of severe sepsis in hospitalized patients.
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PMID:Prospective randomized phase II study of intravenous cefpirome 1g or 2g bd in the treatment of hospitalized patients with different infections. Cefpirome Study Group. 160 64

To improve implant tolerance and muscle function associated with circular external fixation, the authors substituted divergent titanium pins for the tensioned steel wires used to mount the Ilizarov apparatus on a limb. The first ten patients treated with half-pins were compared to the last ten patients managed with tensioned wires. While the conditions were not exactly comparable, the half-pin group showed improvement over the wire group in categories including time in fixation, implant-site sepsis, range of joint motion, pain medication requirements, and ambulatory capacity. Half-pin mountings require special techniques for a successful application.
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PMID:The Rancho mounting technique for the Ilizarov method. A preliminary report. 161 29

We retrospectively reviewed 20 surgically confirmed tubo-ovarian abscesses in postmenopausal women for the period 1973 to 1989. Pain and bleeding were the two most common presenting symptoms. Nine of the 20 patients (45%) had recently had endometrial instrumentation. Fever and the presence of a pelvic mass and elevated white blood cell count, without evidence of peritonitis, were frequent findings on admission. At surgery, seven abscesses were already ruptured or leaking, 12 of 18 patients with both ovaries had unilateral abscesses, and dense adhesions were found in 11 patients. A common intraoperative complication was inadvertent bowel injury. Postoperative complications included fascial dehiscence, enterocutaneous fistula, deep venous thrombosis, and need for prolonged ventilatory support. Eight patients had a coexisting gynecologic malignancy. A high index of suspicion is required for early recognition of postmenopausal tubo-ovarian abscess. Prompt surgical exploration should be done to avoid occult rupture or sepsis.
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PMID:Tubo-ovarian abscess in postmenopausal patients. 163 80

To ascertain the range of neurological problems in patients with systemic cancer, we prospectively evaluated neurological symptoms, neurological diagnoses, and primary tumors in all patients with a history of systemic cancer examined by the Department of Neurology at the Memorial Sloan-Kettering Cancer Center, from Jul 1, 1990, to Dec 31, 1990. Of the 815 patients seen for neurological symptoms, less than half (45.2%) had metastatic involvement of the nervous system. The three most common symptoms were back pain (18.2%), altered mental status (17.1%), and headache (15.4%). The most common neurological diagnosis was brain metastasis (15.9%), followed by metabolic encephalopathy (10.2%), pain associated with bone metastases only (9.9%), and epidural extension or metastasis of tumor (8.4%). Of 133 patients with undiagnosed back or neck pain, 44 (33%) had epidural extension or metastases from tumor and 40 (30%) had pain associated with vertebral metastases only. In 15 (11%) the cause for the back pain was unrelated to metastatic disease. Of 132 patients seen on initial consultation for altered mental status, metabolic encephalopathy was the major neurological diagnosis (80; 61%); 20 (15%) had intracranial metastases. Of 97 patients with undiagnosed headache, 59 (61%) had a nonstructural cause. Fifty-three of these patients had either migraine, tension headache, or headache related to systemic illness (e.g., fever, sepsis). These results indicate that even in patients with systemic cancer, a group particularly prone to developing neurological disease that can be diagnosed radiologically, the role of clinicians remains important in helping distinguish noncancer-related and nonmetastatic neurological problems.
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PMID:The spectrum of neurological disease in patients with systemic cancer. 163 35

A large adrenal pseudocyst was found in a 58-year-old woman presenting with pain in the left hypochondrium and septicemia. Initial blood- and cystic fluid cultures all showed Staphylococcus aureus. After antibiotic therapy the cyst was removed. We have found no previous report of a bacteria-containing infected adrenal cyst in an adult.
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PMID:Infected pseudocyst of adrenal gland. Case report. 167 41

Four homosexual male patients with giant anal carcinomas, ranging from 10 to 17 cm in diameter, are presented. These patients were not candidates for abdominoperineal resection because of fixation to adjacent structures. Common symptoms included pain, sepsis, anemia, incontinence, and weight loss. Diverting colostomy was performed in all patients. Two of the four patients were treated by wide local excision of the tumors for palliation. Two patients were treated with chemotherapy and radiation therapy. Three of the four patients died within 12 months. The authors conclude that diverting colostomy and wide local excision of giant anal cancers offer effective palliation of local wound problems in selected cases.
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PMID:Giant malignant tumors of the anus. A strategy for management. 168 59

Palliative therapy for rectal carcinoma is only indicated in selected patients who do not tolerate radical surgery or with very advanced disease. In a retrospective series the results of transanal electrocoagulation are analyzed. In addition patients or their relatives were questioned about the treatment related increase in quality of life and the wish of recurrent coagulation if needed. The main indication for transanal electrocoagulation was rectal stenosis, blood loss, discharge of mucosa and tumor as well as pain. Anal incontinence only gets better when it is due to discharge. However, transanal exposition bears the risk of worsening the incontinence. The electrocoagulation is favored by all continent patients before colostomy. The main indication for a colostomy was incontinence and fistula. Palliative irradiation was concentrated in patients with pain. In 59 operations upon 40 patients there was one rebleeding and one death due to sepsis resulting in a mortality of 1.7%. We conclude from our results that transanal electrocoagulation is a safe procedure in patients with rectal carcinoma who do not qualify for radical surgery.
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PMID:[Palliative therapy of rectal cancer by electrocoagulation]. 169 Jan 4


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