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)

The clinical results after knee revision arthroplasty using the Total Condylar III (TC III) prosthesis were reviewed in 36 patients (36 knees). Patients were assessed by physical examination, completion of a 100-point, modified Hospital for Special Surgery knee rating form, and roentgenographic evaluation. There were 27 women and nine men, with a mean age of 68 years. Mean follow-up period was 45 months (range, 24-84 months). Reason for revision was sepsis in 15 patients and loosening or instability in 21 patients. Twenty were Category C patients with multiple joint involvement or significant medical infirmity. Preoperative knee scores ranged from 11-72 points (mean, 36 points). Postoperative scores ranged from 40-99 points (mean, 77 points). Clinical results were graded according to Insall. Eleven patients were graded excellent, 14 patients good, six fair, four poor, and there was one failure. Pain scores improved from a mean preoperative score of 16 points to 43 points postoperatively (50 points possible). However, function scores improved less dramatically. Range of motion based on maximum flexion averaged 98 degrees postoperatively. Varus tibial placement occurred in 50% (range, 1 degree-9 degrees). Slight flexion of the femur was seen in 73%. Lucent lines occurred in 60%, with 16% of the patients showing progressive tibial lucencies. The TC III prosthesis for revision arthroplasty is effective for salvaging unstable knees. Since the natural history of tibial radiolucency is not clear, less-constrained devices should probably be used when possible.
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PMID:Clinical results of total knee revision using the Total Condylar III prosthesis. 195 91

Ten patients with a major femur fracture complicating total hip arthroplasty were seen at the Princess Alice Orthopaedic Hospital between June 1986 and May 1988. Four cases were intra-operative fractures sustained at revision surgery and 6 were late postoperative fractures of the femur associated with minimal trauma. Eight patients have a pain-free and functional hip arthroplasty at a mean follow-up of 19.7 months (range 17-32 months). One patient developed deep sepsis and 1 persistent non-union: both are now well mobilised following excision arthroplasty. Predisposing factors are identified and the importance of timeous intervention to avoid this challenging complication is stressed.
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PMID:'Pathological' fracture of the femur--a complication of failed total hip arthroplasty. 199 39

Seventy-five primary cemented total hip arthroplasties (THAs) were performed in 53 patients with rheumatoid arthritis and juvenile rheumatoid arthritis. All patients were followed for an average of 7.4 years, unless their prosthetic hips failed before that time. Clinical evaluation was based on a 10-point maximum rating scale, and ratings for pain, walking, function, and activity improved from preoperative values to the most recent follow-up examination. Revision THA was performed for aseptic acetabular loosening in four hips, and femoral loosening in one hip. Sepsis occurred in another four hips. Complications of wound healing occurred in 14 hips. Roentgenographic evidence of loosening was seen in six acetabular components, in three femoral components, and in the femoral and acetabular component of one hip; none of these hips have as yet required revision THA. The Kaplan-Meier survivorship analysis revealed a 93% survival probability at seven years, which fell to 77% at 12 years in these patients. A trend was that younger, larger patients had increased failure and component loosening rates. Cemented primary THA has been a satisfactory operation in the rheumatoid patient. The relatively high rate of wound healing problems and sepsis may be due to the systemic immune nature of rheumatoid arthritis; however, 25% of these prosthetic hips either failed or are at risk for future failure. Thus, improved techniques are still necessary to increase the long-term success of THA in the rheumatoid patient.
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PMID:Long-term follow-up of cemented total hip arthroplasty in rheumatoid arthritis. 200 52

The authors report their experience with 56 percutaneous nephrostomies (PCNs) performed on an outpatient basis on 55 patients. Complications included pain that required use of parenteral medication in four patients, bleeding in three that resolved spontaneously, and shaking chills or fever in 12. This last complication, considered to be a sign of sepsis and treated with antibiotics, occurred more frequently than the 1.4%-4.5% infectious complication rate reported in the literature. Antibiotic use during and after PCN significantly decreased the likelihood of sepsis. In the high-risk group, antibiotic administration during and after PCN decreased the risk of developing signs of sepsis from 50% to 9%. On the basis of the authors' results and the findings in the literature about antibiotic prophylaxis, guidelines are recommended to improve the safety of PCN as an outpatient procedure. In the majority of instances PCN should still be considered to be more safely performed as an inpatient procedure at this time.
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PMID:Percutaneous nephrostomy tube placement: an outpatient procedure? 202 3

To improve the past statistics of high mortality and morbidity in patients with TEN, definitive measures are required. Early referral and transfer to a burn center and withholding or withdrawing steroid therapy are two crucial factors. Therapeutic goals must be directed toward promotion of wound healing; correction of fluid and electrolyte abnormalities; provision of pulmonary care; prevention or correction of thermal disturbances; control of pain; prevention of physiologic and psychologic disabilities, which may hamper the return to activities of daily living; and above all, prevention of sepsis through protective isolation and refraining from use of invasive lines and catheters. Wound healing is best supported through gentle cleansing with physiologic saline; application of biologic or synthetic skin dressings or silver nitrate dressings; hourly eye care; nutritional support; and avoidance of infection or further injury of the dermis. Collaboration and teamwork by all health care providers are essential, and the quality of intensive nursing care makes the critical difference.
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PMID:Toxic epidermal necrolysis. 205 30

Between October 1987 and July 1990 a prospective, nonrandomized, preliminary study was carried out to assess the efficacy of Sandostatin in treating complex pancreatic and gastrointestinal disorders. The study group consisted of 18 women and 12 men, ranging in age from 23 to 80 years (mean 50 years), in whom conventional medical or surgical therapy, or both, had failed. Nineteen patients had pancreatic disease (5 had chronic pancreatitis, 8 acute necrotizing pancreatitis and 6 pancreatic fistula). Thirteen patients had disorders of the small intestine (7 had enterocutaneous fistula and 6 diarrhea-associated short-gut syndrome). Sandostatin was found to be effective in the closure of pancreatic (five of six cases) and enterocutaneous fistulas (five of seven cases), of benefit in controlling the pain associated with chronic pancreatitis (three of five cases) and of some use in achieving short-term control of intractable diarrhea in patients with short-gut syndrome (five of six cases). It was of particular benefit in the management of acute necrotizing pancreatitis. The standard principles of surgical management must be adhered to when using Sandostatin to treat patients with these disorders. Sandostatin can not correct underlying problems such as pancreatic-duct obstruction, malignant disease or unresolved sepsis. These preliminary results justify more widespread use of Sandostatin as part of a prospective randomized and controlled multicentre trial.
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PMID:Sandostatin in the management of nonendocrine gastrointestinal and pancreatic disorders: a preliminary study. 205 54

The results of 276 cemented revision total hip arthroplasties performed for aseptic failure between 1977 and 1986 have been reviewed. The mean time between revision and review was 75 months (range 30 to 144). Of 220 cases available for review, 159 were assessed clinically and radiographically, and 32 by postal questionnaire. Eighteen hips required further revision, 12 for loosening, two for sepsis, two for persistent pain, and one each for fracture and recurrent dislocation. A further six hips were radiologically and symptomatically loose. Pain was mild or absent in 83%. Over half were able to walk a mile or more; 70% flexed more than 70 degrees; 15% had a flexion deformity, but in only 7% was this more than 10 degrees. The mean Harris hip score was 74. Survival at five years was 95% and at 10 years, 77%.
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PMID:Revision total hip arthroplasty for aseptic failure. A review of 276 cases. 207 36

After a brief literature review, we analyze the results obtained with a retrospective study of 35 neonatal osteomyelitis diagnosed between 1-January-75 and 31-December-87. The valuated frequency was of 0.40% alive newborns. Between the antecedents, we find previous neonatal sepsis in 68% of the cases. The clinical general findings were less apparent, emphasizing among the local symptoms the pain to passive mobilization and swelling. From acute phase reactants, this study rebounds the high sensitivity of C reactive protein and globular sedimentation rate. The most frequently germ isolated was S. aureus followed by K. pneumoniae. The osteomyelitic injure was unifocal in 71% of the cases and the femur was the most probable bone to be affected. At the initial treatment we associated a beta-lactamic antibiotic with an aminoglycoside one in all cases, with surgical removal in 94%. The mortality was null, but grave arthritic sequels appeared in 14% of the patients. Finally, we propose the employance of seriated quantification of C-reactive protein in the follow-up and control of therapeutic efficiency.
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PMID:[Neonatal osteomyelitis. Study of a series of 35 cases]. 209 56

This study describes a prospective randomized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds. Consecutive patients undergoing abdominal operation--elective and emergency surgery--through a midline abdominal wound were randomized to have the peritoneal layer closed with continuous catgut, or to have this step omitted. The linea alba was closed with interrupted stainless steel sutures, and the skin approximated with staples. Patients were evaluated for wound sepsis, wound dehiscence, and subsequent incisional hernia development. Postoperative pain was assessed by a self-administered visual analogue score, and by measuring narcotic requirements. There was no significant difference in narcotic requirements, pain scores, or wound complications between the 2 groups. Single-layer closure of the abdominal wall is quicker, less costly, and theoretically safer than layered closure, and it is recommended that separate suture of the peritoneum be abandoned.
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PMID:Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? 804 38

Twenty adult patients presented with bacteriologically and histologically proven nontuberculous spinal sepsis. Thirteen patients presented with varying degrees of neurologic impairment. All patients underwent spinal decompression; in 11 this was combined with an anterior fusion using autogenous tricortical iliac grafts. All patients have recovered and are ambulatory, and no patient's disorder was made worse by surgery. Twenty-three separate organisms were cultured, only five of which were Staphylococcus. The antibiotic courses were shorter and pain relief more rapid with anterior fusion. All anterior bone grafts incorporated rapidly, and there was no progression of kyphosis or sequestration of grafts, regardless of organisms or level. The rational treatment of adult spinal sepsis necessitates the securing of tissue from the spine for histologic and bacteriologic examination. Pain relief, stabilization, and neural decompression can best be achieved with anterior decompression and fusion. Autogenous iliac crest grafts incorporate in the presence of sepsis.
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PMID:Pyogenic spinal sepsis in adults. 214 5


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